Schlechter Matthias, Theil Christoph, Gosheger Georg, Moellenbeck Burkhard, Schwarze Jan, Puetzler Jan, Bockholt Sebastian
Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany.
Department of Orthopedics, St. Elisabeth Hospital Damme, Lindenstraße 3-7, 49401 Damme, Germany.
J Clin Med. 2023 Sep 22;12(19):6113. doi: 10.3390/jcm12196113.
Rotating-hinge knee (RHK) implants are an option for knee arthroplasty in cases of instability or severe bone loss. However, the revision rate can be increased compared to unconstrained implants which mandate improvements in implant design. This study investigates a novel RHK design for total knee arthroplasty (TKA).
Retrospective analysis of a single design RHK TKA (GenuX MK, Implantcast) implanted between 2015 and 2019 including 133 patients (21 primary TKA, 112 revisions). The main indication for revision TKA was second-stage reimplantation following infection. The median follow-up amounted to 30 months (IQR 22-47).
In total, 13% (18/133) of patients underwent revision surgery after a mean time of 1 month (IQR 0-6). The main reason for the revision was (re-) infection in 8% of patients. All revisions were performed following revision TKA and none following primary TKA. There were no revision surgeries for loosening or instability. The revision-free implant survival of 83% was (95% CI 75-91%) after five years. A higher number of previous surgeries was associated with a greater revision risk ( = 0.05).
Revision and complex primary TKA using a single-design RHK implant results in good implant survival at mid-term follow-up although infection remains a major concern.
旋转铰链膝关节（RHK）植入物是膝关节置换术治疗膝关节不稳或严重骨缺损的一种选择。然而，与非限制性植入物相比，其翻修率可能会增加，这就要求改进植入物设计。本研究调查了一种用于全膝关节置换术（TKA）的新型RHK设计。
对2015年至2019年间植入的单一设计RHK TKA（GenuX MK，Implantcast）进行回顾性分析，共纳入133例患者（21例初次TKA，112例翻修）。翻修TKA的主要指征是感染后的二期再植入。中位随访时间为30个月（四分位间距22 - 47个月）。
共有13%（18/133）的患者在平均1个月（四分位间距0 - 6个月）后接受了翻修手术。翻修的主要原因是8%的患者发生（再）感染。所有翻修均在翻修TKA后进行，初次TKA后无翻修情况。没有因松动或不稳而进行的翻修手术。五年后的无翻修植入物生存率为83%（95%置信区间75 - 91%）。既往手术次数越多，翻修风险越高（P = 0.05）。
使用单一设计的RHK植入物进行翻修和复杂的初次TKA，在中期随访时植入物生存率良好，尽管感染仍是一个主要问题。
