Patil Vishal S, Nair Vinod, Todkar Amogh, Shah Meet
Orthopaedics, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, IND.
Cureus. 2024 Aug 19;16(8):e67177. doi: 10.7759/cureus.67177. eCollection 2024 Aug.
Constrained implants have become more common in difficult primary total knee arthroplasty (TKA) cases in recent years because they may more effectively and conveniently handle the substantial instability that is evident in osteoarthritis of knees with severe varus deformity. However, the need for a constrained TKA in such conditions is controversial, as constraint implants come with a bargain of stability for longitivity. In this case report, we have successfully shown that even in cases of significant instability and bone loss, intraoperative conversion to a restricted device is rarely necessary. In our case report, a 83-year-old female had complaints of severe pain in bilateral knees, with the right knee more than the left knee, since 12 years with severe varus deformity in the right knee. Physical examination revealed swelling and medial joint line tenderness with restriction of range of motion in bilateral knees. Pre-anesthetic checkup of the patient was done and patient was given clearance for surgery under American Society of Anesthesiologist (ASA)-2, total knee arthroplasty with a long stem was done, extreme varus deformity was corrected, osteophytes removed and tibial bone loss was repaired with bone cement. Post operatively patient showed significant improvement and McMaster University and Western Ontario Osteoarthritis Index (WOMAC) and Knee Society Scores (KSS) for pain, stiffness, and physical function during everyday activities were significantly improved compared to pre-operative assessment.
近年来，在困难的初次全膝关节置换术（TKA）病例中，限制性植入物变得越来越普遍，因为它们可能更有效、更方便地处理严重内翻畸形膝关节骨关节炎中明显的严重不稳定情况。然而，在这种情况下使用限制性TKA的必要性存在争议，因为限制性植入物是以牺牲长期使用寿命来换取稳定性。在本病例报告中，我们成功表明，即使在存在明显不稳定和骨丢失的情况下，术中很少需要转换为限制性装置。在我们的病例报告中，一名83岁女性自12年前起双侧膝关节严重疼痛，右膝比左膝更严重，右膝存在严重内翻畸形。体格检查发现双侧膝关节肿胀、内侧关节线压痛，活动范围受限。对患者进行了麻醉前检查，并根据美国麻醉医师协会（ASA）-2标准给予患者手术许可，进行了带长柄的全膝关节置换术，纠正了极端内翻畸形，切除了骨赘，并用骨水泥修复了胫骨骨丢失。术后患者显示出显著改善，与术前评估相比，麦克马斯特大学和西安大略省骨关节炎指数（WOMAC）以及膝关节协会疼痛、僵硬和日常活动身体功能评分（KSS）均显著提高。
