Department of Orthopedic Surgery, CHU UCL Namur, Godinne, Avenue Docteur Gaston Therasse 1, 5530, Yvoir, Belgium.
Department of Orthopedic Surgery, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium.
Arch Orthop Trauma Surg. 2024 Mar;144(3):1333-1344. doi: 10.1007/s00402-023-05100-9. Epub 2023 Oct 25.
The aim of this study was to evaluate total knee arthroplasty (TKA) radiographically to detect the occurrence of radiolucent lines (RLL) under the tibial base plate and to determine what type of RLL may have a correlation with aseptic loosening (AL). The study had two hypotheses: (1) RLLs may have different radiological aspects and evolutions in time depending of different factors (2) Signs of micro- and/or macro-mobility of the implant are necessary before diagnosing aseptic loosening of the tibial component.
Retrospective cohort study of 774 patients operated with a Vanguard TKA (Zimmer Biomet, Warsaw, IN, US) from 2007 to 2015. RLLs were recorded in a database and described according to their radiological aspect, localization, time of apparition, progression and eventual evolution to AL. Other collected parameters were pre- and post-operative HKA angles, amount of post-operative HKA correction, surgical, clinical and demographic data.
178/774 TKAs (23%) showed RLLs under the tibial base plate including 9 (1.2%) tibial implants needing revision for AL. Three different types and two aspects of RLLs were observed. Important deformity corrections or undercorrected implants were recognized as a mechanical risk factor for loosening. Elderly women with osteoporosis and young men with important pre-operative deformities were identified as clinical risk factors for RLLs.
RLLs are frequently present at the epiphyseal bone/implant interface after total knee arthroplasty, but do not mean the implant is loose. They can be considered a sign of reduced epiphyseal surface fixation due to micro mobility of the tibial implant. Aseptic loosening can be observed radiologically when signs of macro-mobility of the implant are present at the metaphyseal level.
III.
本研究旨在通过评估全膝关节置换术（TKA）的影像学结果，检测胫骨基板下的透亮线（RLL）的发生情况，并确定哪种类型的 RLL 可能与无菌性松动（AL）有关。该研究有两个假设：（1）RLL 可能因不同的因素而具有不同的影像学表现和随时间的演变；（2）在诊断胫骨组件的无菌性松动之前，植入物的微观和/或宏观运动迹象是必要的。
这是一项回顾性队列研究，纳入了 2007 年至 2015 年期间接受 Vanguard TKA（Zimmer Biomet，Warsaw，IN，美国）治疗的 774 例患者。将 RLL 记录在数据库中，并根据其影像学表现、定位、出现时间、进展和最终向 AL 的演变进行描述。收集的其他参数包括术前和术后 HKA 角、术后 HKA 矫正量、手术、临床和人口统计学数据。
774 例 TKA 中有 178 例（23%）在胫骨基板下出现 RLL，其中 9 例（1.2%）胫骨植入物因 AL 而需要翻修。观察到三种不同类型和两种 RLL 表现。重要的畸形矫正或矫正不足的植入物被认为是松动的机械危险因素。患有骨质疏松症的老年女性和术前存在严重畸形的年轻男性被确定为 RLL 的临床危险因素。
TKA 后，在骨骺骨/植入物界面经常出现 RLL，但这并不意味着植入物松动。它们可被视为由于胫骨植入物的微动导致的骨骺表面固定减少的标志。当在骨干水平出现植入物的宏观运动迹象时，可在影像学上观察到无菌性松动。
III 级。
