后交叉韧带保留型与后交叉韧带替代型全膝关节置换术在翻修率和生存率方面无明显差异。

No Discernible Difference in Revision Rate or Survivorship Between Posterior Cruciate-Retaining and Posterior Cruciate-Substituting TKA.

机构信息

The Joint Replacement Center of Seoul Metropolitan Government, SeoNam Hospital, Seoul, Republic of Korea.

Department of Orthopedic Surgery, Seoul Hospital, Ewha Womans University, Seoul, Republic of Korea.

出版信息

J Bone Joint Surg Am. 2024 Nov 6;106(21):1978-1985. doi: 10.2106/JBJS.24.00007. Epub 2024 Sep 27.

DOI:10.2106/JBJS.24.00007

PMID:39331723

Abstract

BACKGROUND

Many authors and the data of multiple registries have suggested that the use of posterior cruciate-substituting (posterior stabilized [PS]) total knee arthroplasty (TKA) leads to a higher risk of revision compared with the use of posterior cruciate-retaining (CR) TKA. The aim of the present prospective, randomized, long-term study was to compare PS and CR TKA with regard to the clinical, radiographic, and computed tomography (CT) results; the prevalence of osteolysis; revision rate; and survivorship.

METHODS

This study included a consecutive series of 300 patients (mean age [and standard deviation], 63.6 ± 6 years) who underwent simultaneous, bilateral TKA in the same anesthetic session. Each patient received a NexGen CR-Flex prosthesis on 1 side and a NexGen LPS-Flex prosthesis on the contralateral side. The mean follow-up period was 18 years (range, 17.5 to 19.5 years).

RESULTS

There were no significant differences between the NexGen CR and LPS-Flex TKA groups at the latest follow-up with regard to the mean Knee Society knee score (93 versus 92 points, respectively); the Western Ontario and McMaster Universities Osteoarthritis Index score (19.1 points for both); the University of California Los Angeles activity score (6.1 points for both); range of motion (125° ± 6.1° versus 126° ± 6.5°); radiographic and CT results; and revision rate (6.0% versus 6.3%). No knee had osteolysis. The estimated survival rate at 19.5 years was 94% (95% confidence interval [CI], 91% to 100%) for the NexGen CR-Flex prosthesis and 93.7% (95% CI, 91% to 100%) for the LPS-Flex prosthesis, with revision or aseptic loosening as the end point.

CONCLUSIONS

The findings of the present, long-term (minimum follow-up of 17.5 years) clinical study showed that NexGen CR-Flex and NexGen LPS-Flex implants produced excellent clinical and radiographic results. There was no notable clinical advantage of a NexGen CR-Flex implant over a NexGen LPS-Flex implant.

LEVEL OF EVIDENCE

Therapeutic Level II . See Instructions for Authors for a complete description of levels of evidence.

摘要

背景

许多作者和多个登记处的数据表明，与使用后交叉韧带保留（CR）全膝关节置换术（TKA）相比，使用后交叉韧带替代（后稳定型[PS]）TKA 会增加翻修的风险。本前瞻性、随机、长期研究的目的是比较 PS 和 CR TKA 在临床、影像学和计算机断层扫描（CT）结果、骨溶解的发生率、翻修率和生存率方面的差异。

方法

本研究纳入了 300 例连续患者（平均年龄[和标准差]，63.6±6 岁），这些患者在同一次麻醉下同时接受双侧 TKA。每位患者一侧使用 NexGen CR-Flex 假体，另一侧使用 NexGen LPS-Flex 假体。平均随访时间为 18 年（范围 17.5 至 19.5 年）。

结果

在末次随访时，NexGen CR 和 LPS-Flex TKA 组之间在平均膝关节学会膝关节评分（分别为 93 分和 92 分）、西安大略和麦克马斯特大学骨关节炎指数评分（均为 19.1 分）、加利福尼亚大学洛杉矶活动评分（均为 6.1 分）、运动范围（125°±6.1°和 126°±6.5°）、影像学和 CT 结果以及翻修率（6.0%和 6.3%）方面均无显著差异。无膝关节发生骨溶解。在 19.5 年时，NexGen CR-Flex 假体的估计生存率为 94%（95%置信区间[CI]，91%至 100%），LPS-Flex 假体的估计生存率为 93.7%（95%CI，91%至 100%），以翻修或无菌性松动为终点。