全膝关节置换术中聚乙烯内衬设计对患者报告结局的影响。
The Effect of the Design of Polyethylene Inserts in Total Knee Arthroplasty on Patient Reported Outcomes.
作者信息
Gunda Bhavana, Goldberg Leah, Alban Angie, Strecker Sara, McCracken Caitlin, Carangelo Robert James, Witmer Dan
机构信息
From the Bone and Joint Institute, Hartford Hospital, Hartford, CT (Ms. Gunda, Ms. Goldberg, Ms. Alban, Dr. Strecker, McCracken, Dr. Carangelo, and Dr. Witmer); the University of Connecticut Medical School, Farmington, CT (Ms. Gunda); and the Orthopedic Associates of Hartford, Hartford, CT (Dr. Carangelo and Dr. Witmer).
出版信息
J Am Acad Orthop Surg Glob Res Rev. 2025 May 8;9(5). doi: 10.5435/JAAOSGlobal-D-25-00075. eCollection 2025 May 1.
INTRODUCTION
Several types of polyethylene liners have been developed to address the specific needs of patients' anatomy within total knee arthroplasty (TKA). In modern TKA, the posterior-stabilized (PS) and the cruciate-retaining (CR) designs are the most common, with the medial congruent (MC) design becoming more popular. The MC total knee arthroplasty has a posterior dwell point allowing for more flexion. The purpose of this study was to determine differences in patient-reported outcomes (PROMs) or postoperative outcomes between these three TKAs.
METHODS
Patients who underwent a primary, elective, unilateral TKA between June 2021 and July 2023 were identified. Demographics and perioperative and postoperative outcomes were extracted from the medical record. PROMs from 624 patients were obtained through a digital engagement platform. A P value ≤0.05 was considered statistically significant.
RESULTS
Patients were subdivided into three groups; 111 PS-TKA, 278 CR-TKA, and 235 MC-TKAs. Most implants were Zimmer (71.5%) and were cemented (92.9%). Patients in the CR group were predominantly male (P = 0.003) and had a lower body mass index (P < 0.001). No differences were seen in Knee Injury and Osteoarthritis Outcome Score for Joint Replacement scores at any time point (preoperative: P = 0.073; 12 weeks: P = 0.144; 6 months: P = 0.666; 1 year: P = 0.622). A similar percentage of patients met the minimal clinically important difference (P = 0.480), and Forgotten Joint Scores were equivalent (P = 0.930). Patient physical therapy parameters (Timed Up and Go test [P = 0.779] and ambulation distance [P = 0.103]), inpatient pain levels (at rest: P = 0.101, with activity: P = 0.052), or morphine milligram equivalents dosed (P = 0.608) were comparable. No differences were seen in 30-day complications.
CONCLUSION
This study fails to demonstrate a difference in PROMs, functional parameters, or complications between the PS-TKAs, CR-TKAs, and MC-TKAs. All three constructs perform similarly in the immediate postoperative period. Because equivalent outcomes occur with each polyethylene, implant choice should be left to physician preference.
引言
已经开发出几种类型的聚乙烯衬垫，以满足全膝关节置换术（TKA）中患者解剖结构的特定需求。在现代全膝关节置换术中，后稳定型（PS）和保留交叉韧带型（CR）设计最为常见，内侧匹配型（MC）设计也越来越受欢迎。MC全膝关节置换术有一个后驻点，可实现更多的屈曲。本研究的目的是确定这三种全膝关节置换术在患者报告结局（PROMs）或术后结局方面的差异。
方法
确定2021年6月至2023年7月期间接受初次、择期、单侧全膝关节置换术的患者。从病历中提取人口统计学数据以及围手术期和术后结局。通过数字参与平台获得624例患者的PROMs。P值≤0.05被认为具有统计学意义。
结果
患者被分为三组；111例PS-TKA、278例CR-TKA和235例MC-TKA。大多数植入物为 Zimmer品牌（71.5%），且采用骨水泥固定（92.9%）。CR组患者以男性为主（P = 0.003），体重指数较低（P < 0.001）。在任何时间点（术前：P = 0.073；12周：P = 0.144；6个月：P = 0.666；1年：P = 0.622），关节置换的膝关节损伤和骨关节炎结局评分均无差异。达到最小临床重要差异的患者比例相似（P = 0.480），遗忘关节评分相当（P = 0.930）。患者的物理治疗参数（定时起立行走测试[P = 0.779]和步行距离[P = 0.103]）、住院疼痛水平（休息时：P = 0.101，活动时：P = 0.052）或吗啡毫克当量剂量（P = 0.608）具有可比性。30天并发症方面未见差异。
结论
本研究未能证明PS-TKA、CR-TKA和MC-TKA在PROMs、功能参数或并发症方面存在差异。所有三种结构在术后即刻的表现相似。由于每种聚乙烯都能产生相当的结果，植入物的选择应留给医生根据个人偏好决定。
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