Morcos Mina W, Beckers Gautier, Salvi Andrea Giordano, Bennani Mourad, Massé Vincent, Vendittoli Pascal-André
Surgery Department, Hôpital Maisonneuve-Rosemont, Montreal University, Montreal, Quebec, Canada.
Clinique Orthopédique Duval, Laval, Quebec, Canada.
Knee Surg Sports Traumatol Arthrosc. 2025 Feb;33(2):654-665. doi: 10.1002/ksa.12452. Epub 2024 Sep 9.
While restricted kinematic alignment (rKA) total knee arthroplasty (TKA) with cemented implants has been shown to provide a similar survivorship rate to mechanical alignment (MA) in the short term, no studies have reported on the long-term survivorship and function.
One hundred four consecutive cemented cruciate retaining TKAs implanted using computer navigation and following the rKA principles proposed by Vendittoli were reviewed at a minimum of 10 years after surgery. Implant revisions, reoperations and clinical outcomes were assessed using knee injury and osteoarthritis outcome score (KOOS), forgotten joint score (FJS), patients' satisfaction and joint perception questionnaires. Radiographs were analyzed to identify signs of osteolysis and implant loosening.
Implant survivorship was 99.0% at a mean follow-up of 11.3 years (range: 10.3-12.9) with one early revision for instability. Patients perceived their TKA as natural or artificial without limitation in 50.0% of cases, and 95.3% were satisfied or very satisfied with their TKA. The mean FJS was 67.6 (range: 0-100). The mean KOOS were as follows: pain 84.7 (range: 38-100), symptoms 85.5 (range: 46-100), function in daily activities 82.6 (range: 40-100), function in sport and recreation 35.2 (range: 0-100) and quality of life 79.1 (range: 0-100). No radiological evidence of implant aseptic loosening or osteolysis was identified.
Cemented TKA implanted with the rKA alignment protocol demonstrated excellent long-term implant survivorship and is a safe alternative to MA to improve patient function and satisfaction.
Level IV, continuous case series with no comparison group.
虽然有研究表明，采用骨水泥固定植入物的限制性运动学对线（rKA）全膝关节置换术（TKA）在短期内的生存率与机械对线（MA）相似，但尚无关于长期生存率和功能的研究报道。
对连续104例采用计算机导航并遵循Vendittoli提出的rKA原则植入的骨水泥固定保留交叉韧带的TKA患者进行了至少10年的术后随访。使用膝关节损伤和骨关节炎疗效评分（KOOS）、遗忘关节评分（FJS）、患者满意度和关节感知问卷对植入物翻修、再次手术和临床结果进行评估。分析X线片以确定骨溶解和植入物松动的迹象。
平均随访11.3年（范围：10.3 - 12.9年）时，植入物生存率为99.0%，其中1例因不稳定进行了早期翻修。50.0%的患者认为其TKA自然或无限制，95.3%的患者对其TKA满意或非常满意。平均FJS为67.6（范围：0 - 100）。平均KOOS如下：疼痛84.7（范围：38 - 100），症状85.5（范围：46 - 100），日常活动功能82.6（范围：40 - 100），运动和娱乐功能35.2（范围：0 - 100），生活质量79.1（范围：0 - 100）。未发现植入物无菌性松动或骨溶解的放射学证据。
采用rKA对线方案植入的骨水泥固定TKA显示出优异的长期植入物生存率，是MA的安全替代方案，可改善患者功能和满意度。
IV级，无对照组的连续病例系列。
