Takahashi Y, Gustilo R B
Minneapolis Orthopaedic and Arthritis Institute, MN.
Clin Orthop Relat Res. 1994 Dec(309):156-62.
From March 1989 to March 1992, 39 knees were studied in 36 patients who had undergone revision total knee arthroplasty. A posterior stabilized modular prosthesis was used in 31 knees, and a standard condylar modular prosthesis was used in 8. Average followup was 20 months. The mean tibiofemoral angle was 2.1 degrees valgus (range, 22 degrees varus-23 degrees valgus) preoperatively, and 5.9 degrees valgus (range, 2 degrees varus-14 degrees valgus) postoperatively. Component placement in anteroposterior and lateral view was improved postoperatively. Postoperative patellar height was normal in 63.6% of the knees. Partial radiolucent lines were present in at least 1 prosthetic component in 72.7% of the knees, but no lines were complete. The Knee Society Pain Score improved from 50.5 points preoperatively to 82.7 points postoperatively. The Knee Society Function Score improved from 35.5 points to 56.1 points. Complications occurred in 20.5%. Since then, there has been 1 failure, an infection that subsequently led to knee fusion. Revision total knee arthroplasty presents difficult challenges, such as bone loss and ligamentous instability. A modular total knee replacement system allows the surgeon to do accurate preoperative planning and also to tackle unexpected problems intraoperatively. The authors' early results of revision total knee arthroplasty using a modular semiconstrained system are satisfactory.
1989年3月至1992年3月，对36例接受全膝关节翻修术的患者的39个膝关节进行了研究。31个膝关节使用了后稳定型模块化假体，8个使用了标准髁间模块化假体。平均随访时间为20个月。术前胫股角平均为外翻2.1度（范围为内翻22度至外翻23度），术后为外翻5.9度（范围为内翻2度至外翻14度）。术后前后位和侧位的假体位置得到改善。63.6%的膝关节术后髌腱高度正常。72.7%的膝关节至少有1个假体部件出现部分透光线，但无完全透光线。膝关节协会疼痛评分从术前的50.5分提高到术后的82.7分。膝关节协会功能评分从35.5分提高到56.1分。并发症发生率为20.5%。此后，出现了1例失败病例，即感染，随后导致膝关节融合。全膝关节翻修术面临着诸如骨丢失和韧带不稳定等困难挑战。模块化全膝关节置换系统使外科医生能够进行准确的术前规划，并在术中解决意外问题。作者使用模块化半限制系统进行全膝关节翻修术的早期结果令人满意。
