Department of Surgical Sciences, University of Turin, Corso Dogliotti 24, 10126, Turin, Italy.
Orthopaedic and Trauma Unit, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milano, Italy.
Arch Orthop Trauma Surg. 2024 Dec;144(12):5293-5299. doi: 10.1007/s00402-024-05600-2. Epub 2024 Oct 4.
The total number of total knee arthroplasty performed is rising, and the number of revisions is rising accordingly. Periprosthetic joint infection emerged in recent years as a leading cause of total knee revisions. Bone loss is a real challenge when facing septic knee revisions since radical debridement is crucial to overcome infection. Many devices have already demonstrated to reliably address bone loss and guarantee enhanced fixation. However, the role of balancing metaphyseal fixation and its interplay with the level of constraint has not been elucidated yet.
An institutional arthroplasty registry was retrospectively reviewed looking for patients who underwent two-stage revision of the knee and metaphyseal cones implantation. Patients were divided into two groups based on the presence of cones only on one side (femoral or tibial, Group U) or both femoral and tibial side (Group B). Failure, aseptic loosening, and revision rates were compared between groups, as were values of patient-reported outcome measure. Kaplan-Meier analysis was used to assess survival of implants.
A total of 65 patients were included in the analysis and were evaluated at a mean final follow-up of 4 years (range, 2-7). Mean age was 67 (range, 43-81) years. Mean BMI was 27.4 (range, 20-37) kg/m. The overall mean KSS, OKS, ROM significantly increased from baseline values to last follow-up (p < 0.001). Kaplan-Meier analysis demonstrated that patients included in Group U had a significantly lower rate of implant survival compared to those included in Group B.
Patients undergoing revision total knee arthroplasty for periprosthetic infection present considerable rates of complication and failure. Management of bone loss represents a concern for the surgeon, who must achieve a stable fixation. Our study demonstrated that implants characterized by an unbalanced metaphyseal fixation are at higher risk of aseptic loosening and consequent revision, especially when coupled with hinged inserts.
全膝关节置换术的总数正在增加，相应地，翻修手术的数量也在增加。近年来，假体周围关节感染成为全膝关节翻修的主要原因。在面对感染性膝关节翻修时，骨量丢失是一个真正的挑战，因为彻底清创对于克服感染至关重要。许多设备已经被证明可以可靠地解决骨量丢失问题，并保证增强固定。然而，在稳定固定骨干和平衡其与约束程度的作用方面，仍未得到阐明。
回顾性分析了机构关节置换登记处，寻找接受二期翻修膝关节和骨干圆锥植入术的患者。根据圆锥体仅存在于一侧（股骨或胫骨，U 组）或双侧股骨和胫骨（B 组），将患者分为两组。比较两组之间的失败率、无菌性松动率和翻修率，以及患者报告的结果测量值。采用 Kaplan-Meier 分析评估植入物的生存率。
共纳入 65 例患者进行分析，平均随访时间为 4 年（范围 2-7 年）。平均年龄为 67 岁（范围 43-81 岁）。平均 BMI 为 27.4kg/m2（范围 20-37kg/m2）。总体平均 KSS、OKS、ROM 从基线值到最后随访时显著增加（p<0.001）。Kaplan-Meier 分析表明，U 组患者的植入物存活率明显低于 B 组患者。
接受假体周围感染全膝关节翻修术的患者存在较高的并发症和失败率。骨量丢失的管理是外科医生的关注点，外科医生必须实现稳定的固定。我们的研究表明，具有骨干固定不平衡特征的植入物具有更高的无菌性松动和随后翻修的风险，尤其是当与铰链插入物结合使用时。
