目的:严重的干phy端骨缺损仍然是一个挑战,并且在翻修全膝关节置换术(RTKA)中是一个日益严重的问题。这项研究的目的是检查第一代钽金属锥(TMC)的存活率,并评估从严重骨缺损的RTKA后的中长期随访(FU)获得的临床和影像学数据。
方法:该回顾性病例系列包括同一中心的100名连续患者,在2011年1月至2015年12月期间接受了TMC治疗胫骨和/或股骨骨缺损的RTKA手术。FU有14名患者死亡,6名患者丧生,总共留下80名患者(112名TMC)进行最终评估。临床参数包括膝关节协会评分(KSS),视觉模拟量表(VAS),西安大略省和麦克马斯特大学骨关节炎指数(WOMAC)和活动范围(ROM)在术前根据患者的医疗图表确定,并在术后平均6.1(5-9)年的最终FU期间再次评估。在FU的最后一次访视期间,对标准化的术后X射线进行了视锥骨整合分析,和植入物松动的任何迹象均采用改良的膝关节协会射线照相检查标准进行评估.围手术期和术后并发症,重新操作,以及植入物和圆锥重新修订进行了分析。使用(a)出于任何原因的锥形相关翻修和(b)出于任何原因的植入物部件翻修进行存活分析。
结果:由于64(80%)无菌和16(20%)败血症失败,必须进行先前的RTKA。在最后的FU,75(94%)胫骨和76(95%)股骨TMC和植入物临床稳定。一名患者在股骨和胫骨出现锥体和植入物松动,但拒绝进行重新翻修手术。有八次(10%)再次手术,包括两次早期伤口愈合问题,两个镶嵌变化,两个假体周围骨折,一次清创,抗生素和植入物滞留(DAIR),和一次二次髌骨置换。六次(7.5%)的重新修订包括两个无菌性松动的相反的植入物没有TMC,一次关节固定术治疗复发性不稳定,三个深度感染由两个两阶段的交流管理,和一次持续感染截肢。在重新修订时,所有TMC视锥均骨整合,无松动迹象。确定的临床参数显示显着(p<0.001)术后改善,客观KSS被评为优秀51%,在最终的FU中,22%的患者也一样好。TMC的估计8年Kaplan-Meier生存率为95%,植入物组件为92.5%。
结论:钽金属锥(TMC)在RTKA期间证明了治疗严重的股骨和胫骨干phy端骨缺损的安全固定。这种固定概念显示出优异的中长期临床和影像学结果,并且对于视锥细胞和植入物组件具有有希望的8年生存率。
方法:回顾性队列研究,四级。
OBJECTIVE: Severe metaphyseal bone defects remain a challenge and represent a growing problem in revision total knee arthroplasty (RTKA). The purpose of this study was to examine the survival of first-generation tantalum metal cones (TMC) and to assess clinical and radiographic data obtained from mid- to long-term follow-ups (FU) after RTKA with severe bony defects.
METHODS: This retrospective case series included 100 consecutive patients of the same centre, who underwent RTKA surgery with TMC for tibia and/or femur bone defects between January 2011 and December 2015. Fourteen patients had died and six were lost for FU, leaving a total of eighty patients (one hundred and twelve TMC) for final evaluation. Clinical parameters including the Knee Society Score (KSS), visual analogue scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and range of motion (ROM) were determined preoperatively based on the patients\' medical charts, and assessed again during the final FU after an average of 6.1 (5-9) years postoperative. Standardised postoperative X-rays were analysed during the final FU visit for osseointegration of the cones, and any signs of implant loosening were assessed with the modified Knee Society Radiographic review criteria. Perioperative and postoperative complications, reoperations, as well as implant and cone re-revisions were analysed. Survivorship analysis was performed with (a) cone-related revision for any reason and (b) implant component revision for any reason.
RESULTS: Previous RTKA had to be performed due to 64 (80%) aseptic and 16 (20%) septic failures. At the final FU, 75 (94%) tibia and 76 (95%) femur TMCs and implants were clinically stable. One patient experienced loosening of cones and implants at the femur and tibia but denied re-revision surgery. There were eight (10%) reoperations including two early wound healing problems, two inlay changes, two periprosthetic fractures, one debridement, antibiotics and implant retention (DAIR), and one secondary patella replacement. The six (7.5%) re-revisions included two aseptic loosening\'s of the opposite implant without TMC, one arthrodesis for recurrent instability, and three deep infections managed by two two-stage exchanges, and one amputation for persistent infection. At re-revision, all TMC cones were osteointegrated without signs of loosening. The determined clinical parameters showed significant (p < 0.001) postoperative improvement, and objective KSS was rated as excellent in 51%, and as good in 22% of patients at the final FU. The estimated 8-year Kaplan-Meier survival was 95% for TMC and 92.5% for implant components.
CONCLUSIONS: Tantalum metal cones (TMC) demonstrate a secure fixation for treatment of severe femoral and tibial metaphyseal bone defects during RTKA. This fixation concept showed excellent mid- to long-term clinical and radiographic outcomes with promising 8-year survival rates for cones and implant components.
METHODS: Retrospective cohort study, Level IV.