Murray P B, Rand J A, Hanssen A D
Department of Orthopedics, Mayo Clinic/Mayo Foundation, Rochester, MN 55905.
Clin Orthop Relat Res. 1994 Dec(309):116-23.
Theoretical concerns about the use of cemented long-stemmed revision total knee arthroplasty include inducing stress shielding with adverse effects on prosthesis fixation. This study details the clinical outcome of 35 patients with 40 cemented long-stemmed kinematic stabilizer revision total knee arthroplasties at followup evaluation averaging 58.2 months (range, 24-111 months). Of these 40 revision arthroplasties, there were 25 long-stemmed tibial components and 38 long-stemmed femoral components. The Knee Society pain score improved from a preoperative value of 38 points (range, 4-80 points) to 83 points (range, 33-100 points) at last evaluation. The Knee Society function score improved from a preoperative value of 46 points (range, 5-100 points) to 64 points (range, 0-100 points) at last evaluation. Initial postoperative radiographs showed tibial bone-cement radiolucencies in 5 knees, but at final followup none of these radiolucencies had progressed. Radiolucencies developed in 5 additional tibial components by the time of final followup, but these were all incomplete and < 1 mm in width. Two femoral components had initial postoperative radiolucencies. These radiolucencies remained stable in 1 knee, whereas the other knee had asymptomatic radiographic loosening. Incomplete radiolucencies of < 1 mm developed in 3 additional femoral components at final followup. The incidence of tibial radiolucencies of 32% in the present study is similar to the incidence of radiolucencies with a nonstemmed revision cemented total knee arthroplasty, with the same prosthetic design, previously reported from the authors' institution.(ABSTRACT TRUNCATED AT 250 WORDS)
关于使用骨水泥固定长柄翻修全膝关节置换术的理论担忧包括诱发应力遮挡,对假体固定产生不利影响。本研究详细介绍了35例患者接受40例骨水泥固定长柄运动稳定型翻修全膝关节置换术的临床结果,随访评估平均为58.2个月(范围24 - 111个月)。在这40例翻修关节置换术中,有25个长柄胫骨组件和38个长柄股骨组件。膝关节协会疼痛评分从术前的38分(范围4 - 80分)在最后一次评估时提高到83分(范围33 - 100分)。膝关节协会功能评分从术前的46分(范围5 - 100分)在最后一次评估时提高到64分(范围0 - 100分)。术后初期X线片显示5例膝关节胫骨骨水泥有透亮区,但在最终随访时这些透亮区均未进展。到最终随访时,另外5个胫骨组件出现了透亮区,但均不完整且宽度<1mm。2个股骨组件术后初期有透亮区。其中1例膝关节的透亮区保持稳定,而另1例膝关节出现无症状的影像学松动。在最终随访时,另外3个股骨组件出现了宽度<1mm的不完整透亮区。本研究中胫骨透亮区32%的发生率与作者所在机构之前报道的采用相同假体设计的非柄型翻修骨水泥全膝关节置换术的透亮区发生率相似。(摘要截断于250字)