Ranawat C S, Luessenhop C P, Rodriguez J A
Center for Total Joint Replacement, Lenox Hill Hospital, New York City, N.Y. 10021, USA.
J Bone Joint Surg Am. 1997 Mar;79(3):342-8. doi: 10.2106/00004623-199703000-00004.
One hundred and eighteen patients who had had 150 consecutive primary total knee replacements (sixteen bilateral procedures) between February 1988 and February 1990, with insertion of the press-fit condylar modular total knee system with cement, were enrolled in a prospective study. Ninety-six patients (125 knees) were followed for an adequate interval (mean, 4.8 years; range, 3.8 to 6.2 years). Thirteen patients (fifteen knees) died, and nine patients (ten knees) were lost to follow-up. The mean age of the patients at the time of the index arthroplasty was seventy years (range, twenty-nine to eighty-five years). The patients were evaluated clinically and radiographically, according to the scoring system of the Knee Society, and the results on a self-administered questionnaire were used to evaluate pain, function, satisfaction, and patellofemoral symptoms. A Kaplan-Meier survivorship analysis was performed with a revision operation as the end point. The mean functional and clinical scores, according to the system of the Knee Society, were 78 and 93 points, respectively, at the most recent follow-up examination. The result was excellent for 103 knees, good for thirteen, fair for three, and poor for six. Three revision operations were necessary: two because of infection and one because of instability. The over-all rate of patellofemoral symptoms was 8 per cent (ten knees). Three knees had tibiofemoral instability; subsequent modification of the design of the tibial cam decreased the prevalence of this problem. Non-progressive radiolucent lines were present at the cement-bone interface in 39 per cent (thirty-nine) of the ninety-nine knees that had complete radiographic follow-up. No prosthesis had loosened by the time of the most recent follow-up examination. The rate of survival of the implant was 97 per cent at six years, and the standard error of the mean was 1.6 per cent. In the present series, total knee arthroplasties with the press-fit condylar modular knee system resulted in excellent relief of pain, an excellent range of motion, and restoration of function. They were also associated with a low prevalence of patellofemoral problems.
1988年2月至1990年2月期间，118例患者接受了连续150次初次全膝关节置换术（16例双侧手术），采用骨水泥固定的压配型髁间模块化全膝关节系统，这些患者被纳入一项前瞻性研究。96例患者（125个膝关节）接受了足够长的随访期（平均4.8年；范围3.8至6.2年）。13例患者（15个膝关节）死亡，9例患者（10个膝关节）失访。初次关节置换时患者的平均年龄为70岁（范围29至85岁）。根据膝关节协会评分系统对患者进行临床和影像学评估，并使用一份自我管理问卷的结果来评估疼痛、功能、满意度和髌股症状。以翻修手术为终点进行Kaplan-Meier生存分析。根据膝关节协会系统，在最近一次随访检查时，平均功能和临床评分分别为78分和93分。103个膝关节结果为优，13个为良，3个为中，6个为差。需要进行3次翻修手术：2次因感染，1次因不稳定。髌股症状的总体发生率为8%（10个膝关节）。3个膝关节存在胫股关节不稳定；随后对胫骨凸轮设计的改进降低了该问题的发生率。在99个有完整影像学随访的膝关节中，39%（39个）在骨水泥-骨界面出现非进行性透亮线。到最近一次随访检查时，没有假体松动。植入物在6年时的生存率为97%，平均标准误差为1.6%。在本系列中，采用压配型髁间模块化膝关节系统的全膝关节置换术能有效缓解疼痛，获得极佳的活动范围并恢复功能。它们还与髌股问题的低发生率相关。
