Rougereau Grégoire, Hollier-Larousse Bernard, Carpentier Vincent, Bauer Thomas, Genêt François, Salga Marjorie, Cale Fabien
Department of Orthopaedic and Trauma Surgery, Raymond-Poincaré Hospital, APHP, Garches, France.
Clinique du Sport, Paris, France.
Arch Orthop Trauma Surg. 2024 Dec 18;145(1):63. doi: 10.1007/s00402-024-05708-5.
Total knee arthroplasty (TKA) in patients with sequelae of poliomyelitis is a surgical challenge due to muscle weakness, bone deformities or post-polio syndrome (PPS). Few data exist to determine the factors contributing to poor functional results. This study aimed: (1) to describe a cohort of patients with poliomyelitis sequelae who underwent TKA; (2) to examine risk factors for poor functional outcome.
A monocentric retrospective cohort study of all patients with poliomyelitis sequelae who underwent TKA between January 2006 and December 2019. Clinical, functional outcomes, radiographic results and occurrence of complications were collected.
A total of 22 patients (24 knees) were included in the analysis, with a mean follow-up of 6.6 years (from 2 to 13.7 years). There was an improvement in KSS (28 +/- 23 vs. 81 +/- 6, respectively; p < 0.0001) as well as functional KSS (25 +/- 12 vs. 57.5 +/- 21, respectively; p = 0.0001). There was less occurrence of annual knee giving way episodes after total knee replacement (11.9+/-16.1 vs. 5.1+/-13.7, respectively; p = 0.04). Even though the total knee replacement allowed a slight recurvatum, it was smaller than the preoperative recurvatum (13° vs. 8°, respectively; p = 0.04). Seven complications with reintervention (7/24; 29%) were found. The presence of a residual post operative recurvatum correlated with better KSS (ρ = 0.53, CI95% [0.15; 0.77]; p = 0.008). The number of postoperative annual knee giving way episodes was inversely correlated with persistent postoperative recurvatum (ρ = -0.42, CI95% [-0.69; -0.01]; p = 0.04) but was not correlated with the type of constraint (ρ = -0.26, CI95% [-0.6; 0.15]; p = 0.21) nor with quadricipital muscle strength (ρ = 0.21, CI95% [-0.21; 0.56]; p = 0.33).
TKA has a good mid-term functional outcome for knee osteoarthritis in patients with sequelae of poliomyelitis. Preserving a residual recurvatum postoperatively gives better clinical results without increasing the risk of ligament instability or early aseptic loosening.
IV.
由于肌肉无力、骨骼畸形或小儿麻痹后遗症（PPS），小儿麻痹后遗症患者的全膝关节置换术（TKA）是一项外科挑战。几乎没有数据可用于确定导致功能结果不佳的因素。本研究旨在：（1）描述一组接受TKA的小儿麻痹后遗症患者；（2）检查功能结果不佳的危险因素。
对2006年1月至2019年12月期间接受TKA的所有小儿麻痹后遗症患者进行单中心回顾性队列研究。收集临床、功能结果、影像学结果和并发症的发生情况。
共有22例患者（24膝）纳入分析，平均随访6.6年（2至13.7年）。膝关节协会评分（KSS）有改善（分别为28±23与81±6；p＜0.0001）以及功能KSS（分别为25±12与57.5±21；p = 0.0001）。全膝关节置换术后每年膝关节打软的发生率较低（分别为11.9±16.1与5.1±13.7；p = 0.04）。尽管全膝关节置换允许轻微的膝反屈，但小于术前膝反屈（分别为13°与8°；p = 0.04）。发现7例需要再次干预的并发症（7/24；29%）。术后残留膝反屈与更好的KSS相关（ρ = 0.53，95%CI[0.15；0.77]；p = 0.008）。术后每年膝关节打软的次数与术后持续膝反屈呈负相关（ρ = -0.42，95%CI[-0.69；-0.01]；p = 0.04），但与限制类型无关（ρ = -0.26，95%CI[-0.6；0.15]；p = 0.21），也与股四头肌力量无关（ρ = 0.21，95%CI[-0.21；0.56]；p = 0.33）。
TKA对小儿麻痹后遗症患者的膝关节骨关节炎具有良好的中期功能结果。术后保留残留膝反屈可带来更好的临床结果，而不会增加韧带不稳定或早期无菌性松动的风险。
IV级。
