Shahcheraghi Gholam Hossain, Javid Mahzad, Tavakoli Alireza, Nirooei Elahe, Momtahan Elham
Bone and Joint Diseases Research Center, Department of Orthopedics, Shiraz University of Medical Sciences, Shiraz, Iran.
Department of Orthopedics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
Iran J Med Sci. 2024 Nov 1;49(11):707-715. doi: 10.30476/ijms.2024.100363.3265. eCollection 2024 Nov.
Knee arthroplasty procedures improve pain, function, stability, and appearance of the limb. Total knee arthroplasty (TKA) in severe, long-standing osteoarthritis (OA) with large medial tibial defects could be a challenge. This paper looks at TKA outcomes when large tibial defects are managed without metal wedges or stems.
TKA cases done for OA with tibial defects of 15-25 mm, without any metal wedge or stem from 2004 to 2017 by a single surgeon in Shiraz, Iran, were clinically and radiographically evaluated. The preoperative questionnaires of SF36, WOMAC, KSS, and radiographs were compared with the follow-up assessments of the same parameters. Data were analyzed by R programming language using student test, ANOVA, and Kruskal-Wallis. P<0.05 was considered significant.
91 knees in 72 patients at 65.99±8.66 years of age and 8.28±2.58 years follow-up were studied. The tibial defects were managed with extra tibial cuts and adjustment of tibial component position in all, and the addition of structural autograft in 14 knees. 89 (98%) knees survived with a knee society score (KSS) of 79.4±17.6 and were significantly functioning well (P<0.001). Two knees required revision surgery. Significant improvement in outcome measurements was seen in all cases (P<0.001). No radiographic loosening, alignment change, or clinical instability was detected. The tibial plateau reconstruction without bone grafting and the ones that had autologous bone grafting had similar functional results and radiographic outcomes.
TKA with tibial defects of 15-25 mm treated with a semi-constrained posterior-cruciate ligament (PCL) sacrificing condylar prosthesis without any metal wedges or stem extensions with or without additional autogenous bone graft obtained very good functional and radiographic outcome and 97% survival in 6-17 years follow-up.
膝关节置换手术可改善肢体的疼痛、功能、稳定性及外观。对于存在大的内侧胫骨缺损的重度、长期骨关节炎（OA）患者，全膝关节置换术（TKA）可能具有挑战性。本文探讨在不使用金属楔块或柄的情况下处理大的胫骨缺损时TKA的疗效。
对2004年至2017年期间由伊朗设拉子的一名外科医生为患有15 - 25毫米胫骨缺损的OA患者实施的TKA病例进行临床和影像学评估。将术前的SF36、WOMAC、KSS问卷及X线片与相同参数的随访评估结果进行比较。使用R编程语言通过学生检验、方差分析和克鲁斯卡尔 - 沃利斯检验对数据进行分析。P<0.05被认为具有统计学意义。
研究了72例患者的91个膝关节，患者年龄为65.99±8.66岁，随访时间为8.28±2.58年。所有患者均通过额外的胫骨截骨和调整胫骨假体位置来处理胫骨缺损，14个膝关节还添加了结构性自体骨移植。89个（98%）膝关节存活，膝关节协会评分（KSS）为79.4±17.6，功能显著良好（P<0.001）。两个膝关节需要翻修手术。所有病例的结局指标均有显著改善（P<0.001）。未检测到影像学松动、对线改变或临床不稳定。未进行骨移植的胫骨平台重建与进行自体骨移植的胫骨平台重建具有相似的功能结果和影像学结局。
使用牺牲后交叉韧带（PCL）的半限制性髁假体治疗15 - 25毫米胫骨缺损的TKA，在不使用任何金属楔块或柄延长物的情况下，无论是否额外进行自体骨移植，在6至17年的随访中均获得了非常好的功能和影像学结果以及97%的生存率。
