Schneider R, Abenavoli A M, Soudry M, Insall J
Radiology. 1984 Aug;152(2):309-15. doi: 10.1148/radiology.152.2.6739790.
The authors reviewed 55 failed total condylar knee replacements, correlating the radiographic and surgical findings at removal or revision. Failure was due to infection in 20 cases, mechanical loosening in 18, instability without loosening in 10, malalignment without loosening in 4, a supracondylar fracture in 2, and unknown causes in 1. In infection with loosening or chronic infection, radiographs usually showed a wide, extensive radiolucent region at the cement-bone interface around one or more components without shifting, while in acute infection without loosening the radiographs were normal. In mechanical loosening, in addition to a similar lucent region, the prosthesis became tilted in 16 out of 18 cases. Most loosening involved tilting of the tibial component into the varus position with subsidence into the medial tibial plateau, collapse of the cancellous bone, and plastic deformation. Radiographs can be helpful in determining the reason for failure of a total knee replacement, which is important in planning surgery.
作者回顾了55例全髁膝关节置换失败病例，将取出或翻修时的影像学和手术结果进行了关联分析。失败原因包括：感染20例，机械性松动18例，无松动的不稳定10例，无松动的对线不良4例，髁上骨折2例，原因不明1例。在伴有松动或慢性感染的情况下，X线片通常显示围绕一个或多个组件的骨水泥-骨界面处有广泛的、较宽的透射线区域，且假体无移位；而在无松动的急性感染中，X线片正常。在机械性松动时，除了类似的透射线区域外，18例中有16例假体发生倾斜。大多数松动表现为胫骨组件向内翻位倾斜，下沉至胫骨内侧平台，松质骨塌陷和塑性变形。X线片有助于确定全膝关节置换失败的原因，这对手术规划很重要。
