Insall J N, Hood R W, Flawn L B, Sullivan D J
J Bone Joint Surg Am. 1983 Jun;65(5):619-28.
We studied the first 100 consecutive patients (125 knees) to undergo knee arthroplasty with the original total condylar-I prosthesis for either osteoarthritis or osteonecrosis on the Knee Service at The Hospital for Special Surgery. They were followed for an average of 6.6 years (range, five to nine years), which is the longest follow-up of a total knee prosthesis that is still widely used in its original and unmodified form. At five to nine years of follow-up, eleven patients (fourteen knees) were dead and ten patients (eleven knees) could not be traced, leaving 100 knees (seventy-nine patients) for clinical evaluation. This included one knee from which the prosthesis was removed for sepsis at six months, four that were revised for pain, and two that were revised because of subluxation. Two patients had a loose tibial component. Sixty-four knees were rated as excellent and twenty-seven were rated as good. There were two fair and seven poor results. Detailed radiographic evaluation of the 100 knees showed that only minimum changes in the varus or valgus alignment or the fixation of the prosthetic components had occurred with time. At follow-up, 41 per cent of the tibial components showed some evidence of radiolucency, although with the exception of the two loose components just mentioned there were no complete or circumferential radiolucent lines. Most radiolucencies were present by the end of the first postoperative year, and in 81 per cent of the knees there was no further change. Although a special attempt was made to determine any evidence of wear of the polyethylene tibial component, we were unable to demonstrate unequivocal wear in any knee. Our experience had led us to conclude that the long-term success of current total knee designs will probably not be significantly affected by polyethylene wear or loss of component fixation. The majority of failures in our series were attributed to errors in surgical technique.
我们研究了纽约特种外科医院膝关节科首批连续接受初次全髁型I代人工膝关节置换术的100例患者（125个膝关节），病因包括骨关节炎或骨坏死。平均随访6.6年（范围5至9年），这是对目前仍在广泛使用的原始未改良型全膝关节假体最长时间的随访。随访5至9年时，11例患者（14个膝关节）死亡，10例患者（11个膝关节）失访，剩余100个膝关节（79例患者）接受临床评估。其中包括1例因术后6个月出现败血症而取出假体的膝关节、4例因疼痛而行翻修手术的膝关节以及2例因半脱位而行翻修手术的膝关节。2例患者的胫骨假体组件松动。64个膝关节评估为优，27个膝关节评估为良。结果为中2例，差7例。对这100个膝关节进行的详细影像学评估显示，随着时间推移，内翻或外翻对线或假体组件固定仅有极小变化。随访时，41%的胫骨组件显示有某种程度的透亮线，不过除上述2例松动组件外，没有完全或环绕的透亮线。大多数透亮线在术后第1年末出现，81%的膝关节没有进一步变化。尽管特别尝试确定聚乙烯胫骨组件的磨损迹象，但我们未能在任何膝关节中明确证实有磨损。我们的经验使我们得出结论，目前全膝关节设计的长期成功可能不会受到聚乙烯磨损或组件固定丧失的显著影响。我们系列中的大多数失败归因于手术技术失误。
