Townley C O
Clin Orthop Relat Res. 1985 Jan-Feb(192):82-96.
The long-term results of total knee arthroplasty are largely dependent on the degree to which the implants and the technique for their insertion duplicate the normal joint anatomy, mechanics, and kinematics. Aberrations in these modalities, occasioned by technical malalignment of the joint or by nonanatomic designing, sizing, or positioning of the implants, are the predominant causes of postoperative limitation of motion and loosening of the implants. Although inadequacies in the bonding effect of cement and in the structural strength of polyethylene have been cited as contributing factors in the incidence of loosening of the tibial component, this complication occurred in less than 2% of 532 cemented Anatomic Total Knee (ATK) replacements that were available for review at a follow-up period of two to 11 years. The long-term follow-up results, based on pain relief, motion, and level of activity, were judged excellent or good in 89% of the knees. Problems related to the patella and loosening of the tibial component were the predominant mechanical complications that required revision. The incidence of loosening was routinely related to technical malalignment of the knee joint or the prosthesis. However, experimental and recent clinical studies indicate that porous-surfaced implants may provide a more durable and long-lasting mode of stabilization. Except for the adaptation of the implants to the porous-coated, noncemented technique, the ATK arthroplasty ensemble has remained essentially unchanged from the original 1972 design.
全膝关节置换术的长期效果在很大程度上取决于植入物及其植入技术对正常关节解剖结构、力学和运动学的复制程度。由关节技术排列不齐或植入物的非解剖学设计、尺寸或定位引起的这些方式的偏差，是术后运动受限和植入物松动的主要原因。尽管骨水泥的粘结效果和聚乙烯的结构强度不足被认为是胫骨部件松动发生率的促成因素，但在532例接受骨水泥固定的解剖型全膝关节（ATK）置换术患者中，在2至11年的随访期内可供评估的病例中，这种并发症的发生率不到2%。基于疼痛缓解、活动度和活动水平的长期随访结果显示，89%的膝关节被判定为优或良。与髌骨和胫骨部件松动相关的问题是需要翻修的主要机械并发症。松动的发生率通常与膝关节或假体的技术排列不齐有关。然而，实验和近期的临床研究表明，多孔表面植入物可能提供一种更持久耐用的稳定方式。除了植入物适应多孔涂层、非骨水泥技术外，ATK关节置换术组件自1972年最初设计以来基本保持不变。
