Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina.
J Arthroplasty. 2024 Aug;39(8S1):S183-S187. doi: 10.1016/j.arth.2024.02.010. Epub 2024 Feb 12.
Valgus knee deformity is observed in nearly 10% of patients undergoing total knee arthroplasty (TKA). The degree of polyethylene constraint required to balance a valgus knee remains controversial, and historically, posterior-stabilized (PS) designs have been favored. This study evaluated the survivorship of TKA done in valgus knees based on implant design and specifically compared posterior-stabilized (PS) and ultracongruent (UC) liners.
A total of 549 primary TKAs performed on valgus knees by fellowship-trained arthroplasty surgeons from 2013 to 2019 were reviewed. Demographics, comorbidities, degrees of preoperative deformity, implants used, and all-cause revisions until final follow-up were recorded. Cox regression analyses evaluated survival to all-cause revision in each cohort. The mean follow-up was 4.9 years (range, 2 to 9).
There were 403 UC liners compared to 146 PS liners. There was no difference in patient age (68 versus 67 years; P = .30), body mass index (30.9 versus 30.4; P = .36), or degree of deformity (8.6 versus 8.8 degrees; P = .75) between the cohorts. At final follow-up, there were 5 revisions in the PS cohort (3.4%) versus 11 revisions in the UC cohort (2.7%) (P = .90). The most common reason for revision in both cohorts was periprosthetic joint infection (4 PS; 8 UC). Multivariable regression analyses controlling for age, body mass index, Elixhauser comorbidity score, sex, and degree of deformity demonstrated UC polyethylene liners were not associated with revision (hazard ratio 0.76; 95% confidence interval [CI] 0.26 to 2.21; P = .62). There was no difference in eight-year survivorship to all-cause revision, including aseptic and septic failure.
Alternative polyethylene liners from the historically utilized PS liners for TKA for valgus deformity did not reduce survivorship. With modern polyethylene designs, UC inserts can be utilized for this deformity without increasing the risk of failure.
在接受全膝关节置换术（TKA）的患者中，几乎有 10%存在膝内翻畸形。为平衡膝内翻而需要的聚乙烯限制程度仍然存在争议，并且从历史上看，后稳定（PS）设计一直受到青睐。本研究根据植入物设计评估了在膝内翻畸形患者中进行的 TKA 的存活率，并特别比较了后稳定（PS）和超共面（UC）衬垫。
对 2013 年至 2019 年由关节置换术研究员进行的 549 例原发性膝内翻 TKA 进行了回顾性研究。记录了人口统计学，合并症，术前畸形程度，使用的植入物以及最终随访之前的所有原因修订。Cox 回归分析评估了每个队列中所有原因修订的生存率。平均随访时间为 4.9 年（范围 2 至 9 年）。
有 403 个 UC 衬垫与 146 个 PS 衬垫相比。两组患者的年龄（68 岁与 67 岁；P=.30），体重指数（30.9 与 30.4；P=.36）或畸形程度（8.6 与 8.8 度；P=.75）无差异。最终随访时，PS 队列中有 5 次修订（3.4％），UC 队列中有 11 次修订（2.7％）（P=.90）。两个队列中最常见的修订原因是假体周围关节感染（4 PS；8 UC）。在控制年龄，体重指数，Elixhauser 合并症评分，性别和畸形程度后进行的多变量回归分析表明，UC 聚乙烯衬垫与修订无关（危险比 0.76；95％置信区间 [CI] 0.26 至 2.21；P=.62）。在包括无菌和感染性失败在内的所有原因的 8 年生存率方面，没有差异。
对于膝内翻畸形的 TKA，从历史上使用的 PS 衬垫改为其他聚乙烯衬垫并不能提高生存率。随着现代聚乙烯设计的发展，可以在这种畸形中使用 UC 插入物，而不会增加失败的风险。
