Cameron H U, Hu C, Vyamont D
Department of Surgery, University of Toronto, Ont.
Can J Surg. 1997 Aug;40(4):278-83.
To determine if aseptic loosening is a major problem in hinge total knee replacement.
A cohort study.
A university-affiliated institute, specializing in elective orthopedic surgery.
Fifty-eight patients, mainly those requiring revision, in whom the conditions were such that it was felt only a totally constrained implant was appropriate. In 7 patients the implant was press-fitted; in the remainder it was cemented. Five patients required fusion or revision, and 8 died less than 2 years after implantation, leaving 45 for review. Follow-up was 2 to 13 years.
Total knee replacement with a Guepar II prosthesis.
Radiolucency determined by the Cameron system and clinical scoring using the Hospital for Special Surgery system.
Of the cemented components, 91% of femoral stems were type IA (no lucency), 9% were type IB (partial lucency), with no type II or III lucency. Tibial lucency was 87% type IA and 13% type IB, with no type II or III lucency. Of the noncemented components, 58% of femoral components were type IA and 42% type IB. Tibial lucency was 71% type IA and 29% type IB. Lucency was mainly present in zones 1 and 2 adjacent to the knee. Clinical rating was 18% excellent, 20% good, 20% fair and 42% poor. Postoperative complications included infection (13%), aseptic loosening (7%), quadriceps lag (16%) and extensor mechanism problems (16%).
Aseptic loosening is an uncommon problem in hinge total knee replacement. The complication rate in cases of sufficient severity as to require a hinge replacement remains high. Current indications for a hinge prosthesis are anteroposterior instability with a very large flexion gap, complete absence of the collateral ligaments and complete absence of a functioning extensor mechanism.
确定无菌性松动是否为铰链式全膝关节置换中的一个主要问题。
队列研究。
一所大学附属机构，专门从事择期骨科手术。
58例患者，主要是那些需要翻修的患者，其病情使得认为仅完全限制型植入物是合适的。7例患者的植入物为压配式；其余患者为骨水泥固定式。5例患者需要融合或翻修，8例患者在植入后不到2年死亡，剩余45例进行评估。随访时间为2至13年。
使用Guepar II假体进行全膝关节置换。
采用卡梅隆系统测定的透亮度以及使用特种外科医院系统进行的临床评分。
在骨水泥固定组件中，91%的股骨柄为IA型（无透亮度），9%为IB型（部分透亮度），无II型或III型透亮度。胫骨透亮度为87% IA型和13% IB型，无II型或III型透亮度。在非骨水泥固定组件中，58%的股骨组件为IA型，42%为IB型。胫骨透亮度为71% IA型和29% IB型。透亮度主要出现在膝关节相邻的1区和2区。临床评级为18%优秀，20%良好，20%中等，42%差。术后并发症包括感染（13%）、无菌性松动（7%）、股四头肌迟缓（16%）和伸肌机制问题（16%）。
无菌性松动在铰链式全膝关节置换中是一个不常见的问题。严重程度足以需要铰链式置换的病例并发症发生率仍然很高。目前铰链式假体的适应证为前后位不稳定且屈曲间隙非常大、侧副韧带完全缺失以及伸肌机制完全缺失。
