带多孔胫骨锥形增强旋转铰链膝关节假体的2至6年生存率及患者报告结局评估
Two- to Six-year Assessment of Survivorship and Patient-Reported Outcomes in Rotating Hinge Knee Prostheses With Porous Tibial Cone Augmentation.
作者信息
Van Engen Matthew, Den Hartog Taylor, Glass Natalie, Noiseux Nicolas
机构信息
Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
出版信息
Arthroplast Today. 2025 Jun 2;33:101724. doi: 10.1016/j.artd.2025.101724. eCollection 2025 Jun.
BACKGROUND
Rotating hinge knee (RHK) implants are a highly constrained prosthesis designed for knee arthroplasty cases involving significant knee instability. RHK systems are often augmented with metaphyseal tibial cones (MTCs). This study investigated structural stability and patient-reported outcomes (PROs) of RHKs with MTC augmentation.
METHODS
All RHKs utilizing MTC were identified at a single institution from 2016 to 2021. Patients returned for radiographic evaluation, physical exam, and PROs. A total of 84 knees (80 patients) were identified, 44 cases (43 patients) followed up greater than 2 years after their RHK procedure. A cumulative incidence function curve was constructed, and failure was defined as a subsequent revision. PROs included Knee Injury Osteoarthritis Outcome Score for Joint Replacement and Patient-Reported Outcome Measurement Information System (PROMIS)-10. Patient Acceptable Symptom State and postoperative rating of improvement scores were collected.
RESULTS
Cumulative incidence function all-cause failure (N = 84) was 18% at 2.8 years. The diagnoses for failed cases were infection (6 cases), mechanical failure (1 case), and persistent pain (1 case). The mechanical failure was due to loosening of the femoral component requiring femoral only revision. No follow-up cases (N = 44) demonstrated evidence of loosening at the MTC-RHK interface, median follow-up time of 3.82 years. Mean range-of-motion was 0°-120°. Mean PROs were 61.4 for Knee Injury Osteoarthritis Outcome Score for Joint Replacement, 41.2 for PROMIS Mental Health, and 47.9 for PROMIS Physical Health. Patient Acceptable Symptom State was attained by 68% of follow-up cases and 75% reported moderate or better improvement in their quality of life after their RHK.
CONCLUSIONS
RHK with MTC augmentation did not reveal any cases of loosening of the MTC with only 1 case of femoral loosening.
LEVEL OF EVIDENCE
III.
背景
旋转铰链膝关节（RHK）植入物是一种高度受限的假体，设计用于膝关节置换术中膝关节严重不稳定的病例。RHK系统通常采用胫骨干骺端锥体（MTC）进行增强。本研究调查了采用MTC增强的RHK的结构稳定性和患者报告结局（PRO）。
方法
2016年至2021年在一家机构识别出所有使用MTC的RHK。患者返回进行影像学评估、体格检查和PRO评估。共识别出84个膝关节（80例患者），44例（43例患者）在RHK手术后随访超过2年。构建累积发病率函数曲线，失败定义为随后的翻修。PRO包括关节置换的膝关节损伤骨关节炎结局评分和患者报告结局测量信息系统（PROMIS）-10。收集患者可接受症状状态和术后改善评分。
结果
2.8年时全因失败的累积发病率函数（N = 84）为18%。失败病例的诊断为感染（6例）、机械性失败（1例）和持续性疼痛（1例）。机械性失败是由于股骨部件松动，仅需进行股骨翻修。在中位随访时间3.82年时，没有随访病例（N = 44）显示MTC-RHK界面有松动迹象。平均活动范围为0°-120°。关节置换的膝关节损伤骨关节炎结局评分的平均PRO为61.4，PROMIS心理健康评分为41.2，PROMIS身体健康评分为47.9。68%的随访病例达到患者可接受症状状态，75%的患者报告RHK术后生活质量有中度或更好改善。
结论
采用MTC增强的RHK未发现MTC松动病例，仅1例股骨松动。
证据水平
III级
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