Abstract：
BACKGROUND: Severe idiopathic arthrofibrosis after total knee arthroplasty (TKA) is a challenging problem to treat. Low-dose irradiation may decrease fibro-osseous proliferation, while rotating-hinge (RH) revision allows for distal femur shortening and collateral ligament sacrifice. This study reports the clinical outcomes and implant survivorship in patients treated with low-dose irradiation and RH revision for severe idiopathic arthrofibrosis following TKA.
METHODS: A retrospective review was performed on 60 consecutive patients. Patients who had greater than 80° arc of knee motion or less than 15° flexion contracture were excluded. Mean follow-up was 6 years (range, 2 to 14). Kaplan-Meier survivorship analyses were performed, and logistic regressions were used to determine associations between preoperative patient characteristics and clinical outcomes.
RESULTS: Median flexion contracture and median terminal flexion at presentation were 20 and 70°, respectively; at final follow-up, 59 of 60 patients (98%) had ≤10° flexion contracture and 49 of 60 patients (82%) had ≥90° of flexion. The 10-year survivorship free from reoperation for any reason, revision for any reason, and revision for aseptic loosening were 63, 87, and 97%, respectively. There were 27% percent of patients who underwent a manipulation under anesthesia postoperatively, which was the most common reason for return to the operating room. A greater number of prior surgeries was significantly associated with worse range of motion at the final follow-up (P = .004). There were no known radiation-associated complications.
CONCLUSIONS: Patients with severe idiopathic arthrofibrosis following TKA treated with low-dose irradiation and RH revision maintained a gain in knee range of motion of 60° with reliable flexion contracture correction at a mean 6-year follow-up. A manipulation under anesthesia was common in the postoperative period. Survivorship free from revision for aseptic loosening was excellent at 10 years.
METHODS: A retrospective review was performed on 60 consecutive patients. Patients who had greater than 80° arc of knee motion or less than 15° flexion contracture were excluded. Mean follow-up was 6 years (range, 2 to 14). Kaplan-Meier survivorship analyses were performed, and logistic regressions were used to determine associations between preoperative patient characteristics and clinical outcomes.
RESULTS: Median flexion contracture and median terminal flexion at presentation were 20 and 70°, respectively; at final follow-up, 59 of 60 patients (98%) had ≤10° flexion contracture and 49 of 60 patients (82%) had ≥90° of flexion. The 10-year survivorship free from reoperation for any reason, revision for any reason, and revision for aseptic loosening were 63, 87, and 97%, respectively. There were 27% percent of patients who underwent a manipulation under anesthesia postoperatively, which was the most common reason for return to the operating room. A greater number of prior surgeries was significantly associated with worse range of motion at the final follow-up (P = .004). There were no known radiation-associated complications.
CONCLUSIONS: Patients with severe idiopathic arthrofibrosis following TKA treated with low-dose irradiation and RH revision maintained a gain in knee range of motion of 60° with reliable flexion contracture correction at a mean 6-year follow-up. A manipulation under anesthesia was common in the postoperative period. Survivorship free from revision for aseptic loosening was excellent at 10 years.
摘要：
背景：全膝关节置换术（TKA）后严重的特发性关节纤维化是一个具有挑战性的治疗问题。低剂量照射可以减少纤维骨增殖，而旋转铰链（RH）翻修允许股骨远端缩短和侧副韧带牺牲。这项研究报告了TKA后接受低剂量照射和RH翻修治疗的严重特发性关节纤维化患者的临床结果和植入物存活率。
方法：对60例连续患者进行回顾性分析。排除膝关节运动弧度大于80°或屈曲挛缩小于15°的患者。平均随访时间为6年（范围2至14年）。进行了Kaplan-Meier生存分析，和逻辑回归用于确定术前患者特征和临床结局之间的关联.
结果：表现时的正中屈曲挛缩和正中末端屈曲分别为20和70°，分别；在最后的后续行动中，60例患者中有59例（98％）屈曲挛缩≤10°，60例患者中有49例（82％）屈曲≥90°。十年的幸存者没有因任何原因再次手术，以任何理由修订,无菌性松动的翻修率分别为63％、87％和97％，分别。有27％的患者在麻醉下进行手术（MUA）术后，这是回手术室最常见的原因。在最终随访时，更多的先前手术与更差的运动范围（ROM）显着相关（P=0.004）。没有已知的辐射相关并发症。
结论：在接受低剂量照射和RH翻修的TKA治疗后，患有严重特发性关节纤维化的患者在平均6年的随访中，膝关节ROM增加了60°，并进行了可靠的屈曲挛缩矫正。MUA在术后期间很常见。十年来，无无菌性松动的生存能力非常出色。
方法：对60例连续患者进行回顾性分析。排除膝关节运动弧度大于80°或屈曲挛缩小于15°的患者。平均随访时间为6年（范围2至14年）。进行了Kaplan-Meier生存分析，和逻辑回归用于确定术前患者特征和临床结局之间的关联.
结果：表现时的正中屈曲挛缩和正中末端屈曲分别为20和70°，分别；在最后的后续行动中，60例患者中有59例（98％）屈曲挛缩≤10°，60例患者中有49例（82％）屈曲≥90°。十年的幸存者没有因任何原因再次手术，以任何理由修订,无菌性松动的翻修率分别为63％、87％和97％，分别。有27％的患者在麻醉下进行手术（MUA）术后，这是回手术室最常见的原因。在最终随访时，更多的先前手术与更差的运动范围（ROM）显着相关（P=0.004）。没有已知的辐射相关并发症。
结论：在接受低剂量照射和RH翻修的TKA治疗后，患有严重特发性关节纤维化的患者在平均6年的随访中，膝关节ROM增加了60°，并进行了可靠的屈曲挛缩矫正。MUA在术后期间很常见。十年来，无无菌性松动的生存能力非常出色。
