全膝关节置换术后，非骨水泥内侧旋转平台设计与非骨水泥保留交叉韧带设计相比，显示出同等或更好的疗效。
Cementless medial pivot design demonstrates equal or better outcomes compared to cementless cruciate-retaining design following total knee arthroplasty.
作者信息
Dubin Jeremy A, Hameed Daniel, Bains Sandeep S, Chen Zhongming, Monárrez Rubén, Gilmor Ruby, Delanois Ronald E, Nace James
机构信息
Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA.
出版信息
J Orthop. 2023 Dec 7;50:65-69. doi: 10.1016/j.jor.2023.11.076. eCollection 2024 Apr.
INTRODUCTION
Traditional total knee arthroplasty (TKA) designs fail to reproduce physiologic knee kinematics, which can contribute to patient dissatisfaction. In an attempt to restore more normal knee kinematics, the medial pivot (MP) design may improve knee function and stability as well as patient satisfaction. A limited number of studies have compared postoperative outcomes of exclusively cementless Cruciate-Retaining (CR) TKAs to cementless MP TKAs. We aimed to compare: (1) 90-day, 1-year, and 2-year complications and revisions, (2) preoperative and postoperative range of motion (ROM), (3) Knee Injury and Osteoarthritis Outcome (KOOS-JR), and (4) visual analog scale (VAS) pain scores at 3-month, 6-month, 1-year, and 2-years.
METHODS
A retrospective analysis was performed to identify all patients who had previously undergone a TKA at our institution and compare a cementless CR system to a cementless MP design. Categorical variables, including demographics, comorbidities, and complications utilized -square tests in bivariable analysis. Continuous variables, such as age, were compared using Student's -tests. Significance was defined as < 0.05.
RESULTS
Cementless CR and cementless MP cohorts showed low profiles of postoperative complications and favorable patient-reported outcome measures (PROMs). The MP cohort had lower VAS pain at 1-year (1.70 vs. 3.76, p < 0.001) and 2-years (1.43 vs. 2.60, p < 0.001) and higher ROM at 3-months (118 vs. 100, p < 0.001), 6-months (113 vs. 103, p < 0.0001), and 1-year (117 vs. 110, p = 0.02), respectively.
CONCLUSION
This study is the first comparison of postoperative outcomes between a cementless CR TKA and cementless MP TKA designs. Implant design and fixation type are vital components influencing patient satisfaction after TKA. Pain scores and range of motion favored the cementless MP cohort in comparison to the cementless CR cohort.
引言
传统全膝关节置换术（TKA）设计无法重现生理性膝关节运动学，这可能导致患者不满意。为了恢复更正常的膝关节运动学，内侧旋转铰链（MP）设计可能会改善膝关节功能和稳定性以及患者满意度。仅有少数研究比较了单纯非骨水泥型保留交叉韧带（CR）TKA与非骨水泥型MP TKA的术后结果。我们旨在比较：（1）90天、1年和2年的并发症及翻修情况，（2）术前和术后的活动范围（ROM），（3）膝关节损伤和骨关节炎转归（KOOS-JR），以及（4）3个月、6个月、1年和2年时的视觉模拟量表（VAS）疼痛评分。
方法
进行一项回顾性分析，以确定所有在我们机构之前接受过TKA的患者，并比较非骨水泥型CR系统与非骨水泥型MP设计。分类变量，包括人口统计学、合并症和并发症，在双变量分析中采用卡方检验。连续变量，如年龄，使用学生t检验进行比较。显著性定义为p < 0.05。
结果
非骨水泥型CR和非骨水泥型MP队列的术后并发症发生率较低，且患者报告的结局指标（PROMs）良好。MP队列在1年时（1.70对3.76，p < 0.001）和2年时（1.43对2.60，p < 0.001）的VAS疼痛评分较低，在3个月时（118对100，p < 0.001）、6个月时（113对103，p < 0.0001）和1年时（117对110，p = 0.02）的ROM较高。
结论
本研究是首次比较非骨水泥型CR TKA和非骨水泥型MP TKA设计的术后结果。植入物设计和固定类型是影响TKA术后患者满意度的重要因素。与非骨水泥型CR队列相比，疼痛评分和活动范围更有利于非骨水泥型MP队列。
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