Rand J A, Bryan R S
Orthop Clin North Am. 1982 Jan;13(1):201-12.
Revision of a total knee arthroplasty is most frequently required because of prosthetic loosening, instability, and failure to restore proper axial alignment. The instability and improper axial alignment may result in abnormal stresses that predispose to component loosening, component failure, and stress fracture of the tibia. Therefore, it is essential to obtain correct axial alignment and soft tissue balance at the time of the initial arthroplasty. Approximately two thirds of those knees having one or more revisions of their arthroplasty will have a satisfactory result. One third will have an unsatisfactory result related to continued pain or restricted motion, or both. We have reported the results in 142 knees, 95 of which had one revision, 37 of which had two revisions, and 10 of which had three revisions. It is essential in such revisions, in our opinion, to thoroughly debride the knee, restore quadriceps balance, establish the correct alignment, minimize bone loss, and use the least possible constraint in the prosthesis combined with an external brace for three to six months.
全膝关节置换术翻修最常见的原因是假体松动、不稳定以及未能恢复正确的轴向对线。不稳定和不正确的轴向对线可能导致异常应力，进而易引发假体松动、假体失效以及胫骨应力性骨折。因此，在初次关节置换时获得正确的轴向对线和软组织平衡至关重要。接受过一次或多次关节置换翻修的膝关节中，约三分之二会有满意的结果。三分之一会因持续疼痛或活动受限，或两者皆有，而有不满意的结果。我们报告了142例膝关节的结果，其中95例进行了一次翻修，37例进行了两次翻修，10例进行了三次翻修。我们认为，在这类翻修手术中，彻底清创膝关节、恢复股四头肌平衡、确立正确对线、尽量减少骨量丢失，并在假体中使用尽可能少的限制性部件，同时结合使用外部支具三至六个月，是必不可少的。
