Krebbekx G G J, Smithuis F F, Duivenvoorden M J C, Hemke R, Sierevelt I N, Schaap G R, Bramer J A M, Kerkhoffs G M M J, Verspoor F G M
Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC, Amsterdam Movement Sciences, University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands.
Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, the Netherlands.
Osteoarthr Cartil Open. 2025 Jun 26;7(3):100644. doi: 10.1016/j.ocarto.2025.100644. eCollection 2025 Sep.
Rotationplasty is a surgical procedure primarily performed in patients with malignancies around the knee. Altered gait mechanics after surgery, such as reduced flexion of the (pseudo)knee and ipsilateral hip and changes in ground reaction forces, may predispose patients to osteoarthritis (OA) in the lower extremities. This study evaluated the long-term prevalence of OA and its association with pain and daily functioning.
Rotationplasty survivors who underwent surgery between 1980 and 2002 in Amsterdam received radiographic assessment of the (pseudo)knee, contralateral ankle, and both hips (weight-bearing mortise, lateral and AP views). OA was graded using the Kellgren-Lawrence scale. Functional outcomes, pain, quality of life, and sports participation were evaluated with the FAOS, AOFAS, and Harris Hip Score questionnaires. Statistical analyses included t-tests, Mann-Whitney U, chi-square, and Fisher's exact tests.
Thirty patients (mean age 49.4 ± 9.2 years; mean follow-up 32.4 ± 4.6 years) participated. Moderate-to-severe OA was found in 43 % of ipsilateral (pseudo)knees, 10 % of contralateral ankles, 33 % of ipsilateral hips, and 11 % of contralateral hips. Osteophytes were most common in the anterior tibial and subtalar regions (20 %), and joint space narrowing was most frequent in the subtalar (20 %) and medial tibiotalar (13 %) regions. Functional scores were generally favorable. The presence of osteoarthritis in the pseudo-knee was significantly associated with longer follow-up time.
Functional outcomes after rotationplasty are well preserved over time, despite a higher prevalence of osteoarthritis in the (pseudo)knee compared to the contralateral ankle as a long-term consequence of the procedure.
旋转成形术是一种主要针对膝关节周围恶性肿瘤患者实施的外科手术。术后步态力学改变，如（假）膝关节和同侧髋关节屈曲减少以及地面反作用力变化，可能使患者易患下肢骨关节炎（OA）。本研究评估了OA的长期患病率及其与疼痛和日常功能的关联。
1980年至2002年期间在阿姆斯特丹接受手术的旋转成形术幸存者接受了（假）膝关节、对侧踝关节和双侧髋关节的影像学评估（负重位、侧位和前后位片）。使用Kellgren-Lawrence量表对OA进行分级。通过FAOS、AOFAS和Harris髋关节评分问卷评估功能结局、疼痛、生活质量和运动参与情况。统计分析包括t检验、Mann-Whitney U检验、卡方检验和Fisher精确检验。
30名患者（平均年龄49.4±9.2岁；平均随访32.4±4.6年）参与研究。同侧（假）膝关节中43%、对侧踝关节中10%、同侧髋关节中33%以及对侧髋关节中11%发现中重度OA。骨赘在前胫骨和距下区域最常见（20%），关节间隙变窄在距下（20%）和胫距内侧（13%）区域最常见。功能评分总体良好。假膝关节中骨关节炎的存在与更长的随访时间显著相关。
尽管作为该手术的长期后果，（假）膝关节中骨关节炎的患病率高于对侧踝关节，但旋转成形术后的功能结局随时间推移得到了良好的保留。
