Mow C S, Wiedel J D
Department of Orthopaedics, University of Colorado Health Sciences Center, Denver, CO.
Clin Orthop Relat Res. 1994 Dec(309):110-5.
From 1985 to 1991, 16 patients underwent 17 revision total knee arthroplasties using porous-coated tibial or femoral components, or both, without cement. Eight knees had both components implanted without cement, 4 the femoral component without cement and 5 the tibial component without cement. Fifteen revisions were performed for aseptic loosening, 1 for instability, and 1 for infection. Patients were evaluated by clinical examination, radiographs, and the Hospital for Special Surgery Knee Rating Scale. Two patients died, leaving 15 revision total knee arthroplasties for followup. The average age at surgery was 65 years old. Followup averaged 5.6 years (range, 2.4-10.0 years). Range of motion preoperatively averaged 4 degrees to 96 degrees, and postoperatively 0 degree to 102 degrees. Average knee scores were 52 points preoperatively and 87 points postoperatively. Two tibial components showed lucent lines > or = 1 mm in 1 or more zones, 1 of which showed progressive lucencies. One femoral component showed a 1-mm lucent line in 1 zone, which was not progressive. Two tibial components were revised, 1 for a proximal tibial fracture below the prosthesis, and the other for prosthesis loosening and breakage. There was 1 stitch abcess with intrarticular extension, but no other infections. These results show that successful revision total knee arthroplasty can be accomplished using noncemented porous-coated components, with results comparable with those of cemented revisions.
1985年至1991年期间，16例患者接受了17次全膝关节置换翻修手术，使用了多孔涂层胫骨或股骨假体组件，或两者皆用，均未使用骨水泥。8例膝关节同时植入了两种无骨水泥的组件，4例仅植入了无骨水泥的股骨组件，5例仅植入了无骨水泥的胫骨组件。15次翻修手术是因无菌性松动进行的，1次是因不稳定进行的，1次是因感染进行的。通过临床检查、X线片以及特种外科医院膝关节评分量表对患者进行评估。2例患者死亡，剩余15例全膝关节置换翻修手术可供随访。手术时的平均年龄为65岁。随访平均时间为5.6年（范围为2.4 - 10.0年）。术前活动范围平均为4度至96度，术后为0度至102度。术前膝关节平均评分为52分，术后为87分。2个胫骨组件在1个或多个区域出现了≥1 mm的透亮线，其中1个显示透亮线有进展。1个股骨组件在1个区域出现了1 mm的透亮线，但无进展。2个胫骨组件进行了翻修，1个是因为假体下方近端胫骨骨折，另1个是因为假体松动和断裂。有1例缝线脓肿并累及关节内，但无其他感染。这些结果表明，使用无骨水泥的多孔涂层组件可以成功完成全膝关节置换翻修手术，其结果与使用骨水泥进行翻修的结果相当。
