Bornes Troy D, Puri Simarjeet, Neitzke Colin C, Chandi Sonia K, Gausden Elizabeth B, Sculco Peter K, Chalmers Brian P
Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York; Division of Orthopaedic Surgery, University of Alberta, Edmonton, Alberta, Canada.
Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York.
J Arthroplasty. 2025 Feb;40(2):460-466.e1. doi: 10.1016/j.arth.2024.08.013. Epub 2024 Aug 13.
The purpose of this study was to determine implant survivorship and functional outcomes for revision total knee arthroplasty (rTKA) with contemporary rotating-hinge knee implants.
A retrospective review identified 115 rTKAs using contemporary rotating-hinge implants from 2014 to 2018 for the treatment of instability (34, 30%), reimplantation after periprosthetic joint infection (PJI) (33, 29%), aseptic loosening (25, 22%), arthrofibrosis (14, 12%), periprosthetic fracture (4, 3%), osteolysis (4, 3%), and femoral component fracture (1, 1%). There were 70 women (61%), and the mean age was 67 years (range, 27 to 94). The mean follow-up was 3 years (range, 2 to 6). Kaplan-Meier analysis and Cox proportional hazard models estimated survivorship.
The re-revision rate was 20% (23 of 115) at an average of 18 months postoperatively. Re-revision indications included PJI (n = 14), aseptic loosening (n = 4), arthrofibrosis (n = 2), instability/malalignment (n = 1), femoral stem fracture (n = 1), and hinge mechanism disruption (n = 1). At 2 and 5 years, survivorship free from all-cause re-revision was 86 and 64%, and survivorship free from re-revision for aseptic loosening was 100 and 87%, respectively. Use of a rotating-hinge implant in reimplantation after PJI was a risk factor for subsequent re-revision (hazard ratio = 2.4, P = 0.046). On a radiographic review of unrevised rotating-hinges, there were major radiolucent lines around 2 femoral and 5 tibial components. The mean Knee Injury and Osteoarthritis Outcomes Score for Joint Replacement increased from 43 preoperatively to 60 at 1 year (P < 0.001).
In patients treated with a rotating-hinge implant for rTKA, there were relatively poor 2-year (86%) and 5-year (64%) survivorship free from all-cause re-revision, most commonly due to PJI. Midterm survivorship free from re-revision for aseptic loosening was modest (87%). There should be a goal to mitigate complications in complex rTKAs with rotating-hinge implants, namely PJI.
本研究的目的是确定使用当代旋转铰链膝关节假体进行翻修全膝关节置换术（rTKA）后的假体生存率和功能结果。
一项回顾性研究确定了2014年至2018年期间使用当代旋转铰链假体进行的115例rTKA，用于治疗不稳定（34例，30%）、假体周围关节感染（PJI）后再植入（33例，29%）、无菌性松动（25例，22%）、关节纤维化（14例，12%）、假体周围骨折（4例，3%）、骨溶解（4例，3%）和股骨组件骨折（1例，1%）。有70名女性（61%），平均年龄为67岁（范围27至94岁）。平均随访时间为3年（范围2至6年）。采用Kaplan-Meier分析和Cox比例风险模型估计生存率。
再翻修率为20%（115例中的23例），平均术后18个月。再翻修指征包括PJI（n = 14）、无菌性松动（n = 4）、关节纤维化（n = 2）、不稳定/对线不良（n = 1）、股骨干骨折（n = 1）和铰链机制破坏（n = 1）。在2年和5年时，无全因再翻修的生存率分别为86%和64%，无菌性松动再翻修的生存率分别为100%和87%。PJI后再植入时使用旋转铰链假体是随后再翻修的危险因素（风险比 = 2.4，P = 0.046）。在对未翻修的旋转铰链进行影像学检查时，2个股骨组件和5个胫骨组件周围出现了主要的透亮线。关节置换的平均膝关节损伤和骨关节炎结局评分从术前的43分提高到术后1年的60分（P < 0.001）。
在接受旋转铰链假体治疗的rTKA患者中，无全因再翻修的2年（86%）和5年（64%）生存率相对较低，最常见的原因是PJI。无菌性松动再翻修的中期生存率一般（87%）。应致力于减少使用旋转铰链假体的复杂rTKA中的并发症，即PJI。
