Naranja R J, Lotke P A, Pagnano M W, Hanssen A D
Department of Orthopaedics, University of Pennsylvania, Philadelphia 19104, USA.
Clin Orthop Relat Res. 1996 Oct(331):234-7. doi: 10.1097/00003086-199610000-00033.
Few reports address the reconstructive challenge of total knee arthroplasty after a surgically fused or ankylosed knee. The long term results and complications of a large series of patients who have had their ankylosed or arthrodesed knee converted to a total knee replacement were evaluated. Thirty-seven knees (35 patients, 28 female and 7 male) without any motion in the knee were retrospectively reviewed in a multicenter study after total knee arthroplasty. The mean age was 53 years, and the average length of followup was 90 months. The results at followup showed an average 7 degrees lack of extension and 62 degrees flexion. Complications included 24% short term complications and 35% major complications with a 14% infection rate. The total complication rate was 57%. A satisfactory outcome (no pain and an unlimited ambulation distance) was obtained in only 10 patients (29%). Patients with a satisfactory outcome had an average age of 45, and postoperative knee flexion of 87 degrees, significantly different from those with an unsatisfactory outcome. There was no relationship between results and the angle at which the knee was ankylosed preoperatively. This analysis indicates that although success in reconstructing a previously ankylosed or arthrodesed knee is possible, the lack of consistent adequate motion and the complication rate may suggest that the surgeon reconsider the risks and benefits of this difficult procedure.
很少有报告涉及手术融合或强直膝关节后全膝关节置换术的重建挑战。对一系列接受膝关节强直或关节融合转换为全膝关节置换术患者的长期结果和并发症进行了评估。在一项多中心研究中，对37例膝关节完全无活动的患者（35例患者，28例女性和7例男性）进行全膝关节置换术后的回顾性分析。平均年龄为53岁，平均随访时间为90个月。随访结果显示平均伸直受限7度，屈曲62度。并发症包括24%的短期并发症和35%的主要并发症，感染率为14%。总并发症发生率为57%。只有10例患者（29%）获得了满意的结果（无疼痛且行走距离不受限）。获得满意结果的患者平均年龄为45岁，术后膝关节屈曲87度，与结果不满意的患者有显著差异。结果与术前膝关节强直角度之间没有关系。该分析表明，虽然重建先前强直或关节融合的膝关节是可能的，但缺乏一致的足够活动度和并发症发生率可能提示外科医生重新考虑这一困难手术的风险和益处。
