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.
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。