目的:使用早期植入物设计的梅毒性神经关节病的全膝关节置换术(TKA)与较差的预后相关。关于使用现代当代假体治疗非梅毒性神经关节病的TKA的文献很少。我们旨在分析TKA在神经病变关节中的临床和放射学结果。
方法:在2013年1月至2019年1月期间接受原发性TKA的17例(21膝)诊断为神经性关节的患者纳入研究。术前卧床状态,运动范围,假体类型,从医疗记录中检索了约束水平和使用的任何增强。放射学评估包括Koshino的分期,由髋-膝-踝(HKA)角度定义的畸形程度,和任何渐进的松动。膝关节协会(KSS)和膝关节协会功能评分(KSS-F)获得术前和术后功能评分。所有并发症或再次手术均被记录到最后的随访。术前和随访功能评分,使用配对样品测试比较HGA和运动范围。
结果:平均随访时间为40.2个月(范围,15至75个月)。术前,根据Koshino的分期,5个膝盖处于第3阶段(23.8%)。外翻膝盖的平均HKA角为23.60(范围,11.10至42.50),内翻膝盖为19.30(范围,4.90至39.60)。使用的假体在7膝(33.3%)后稳定,内翻外翻限制在五个膝盖(23.8%),并且在九个膝盖(42.8%)中需要旋转铰链。在六个膝盖(28.6%)中使用了干phy端套筒和铰链假体。术后平均运动弧度从102.4±22.7度提高到105.7±15.5度(p=0.27)。膝关节社会和膝关节社会功能评分分别从术前的23.3±9.3和28.3±12.2提高到随访期间的81.1±5.4和80.4±8.5(p<0.001)。在最后的随访中,任何膝盖都没有进行性射线可透线。一名患者术中发生骨性内侧副韧带损伤,1例患者在初次手术5天后出现深静脉血栓形成,另1例患者在术后出现胫骨干假体周围骨折.
结论:根据我们的研究,TKA治疗神经关节病的临床结果与非梅毒性神经关节病的诊断有显著改善,利用现代约束假体,和早期康复,中期随访。胫骨和股骨茎是优选的应力分布相等,并防止早期松动。
OBJECTIVE: Total knee arthroplasty (TKA) in syphilitic
neuroarthropathy using earlier implant designs was associated with poorer outcomes. Literature on TKA for non-syphilitic
neuroarthropathy using modern contemporary prosthesis is scarce. We aim to analyse the clinical and radiological outcomes of TKA in neuropathic joints.
METHODS: A final cohort of 17 patients (21 knees) with the diagnosis of neuropathic joint undergoing primary TKA between January 2013 to January 2019 were included in the study. The preoperative ambulatory status, range of motion, type of prosthesis, level of constraint and any augmentation used were retrieved from medical records. Radiological evaluation includes Koshino\'s staging, the magnitude of deformity defined by the Hip-Knee-Ankle (HKA) angle, and any progressive loosening. Pre and postoperative functional scores were obtained by the Knee Society (KSS) and Knee Society Functional Score (KSS-F). Any complications or reoperation were noted till the final follow-up. Preoperative and follow-up functional scores, HKA and range of motion were compared using the paired Samples test.
RESULTS: The mean follow-up was 40.2 months (range, 15 to 75 months). Preoperatively, according to the Koshino staging, five knees were in stage 3 (23.8%). The mean HKA angle in valgus knees was 23.60 (range, 11.10 to 42.50) and for the varus knees was 19.30 (range, 4.90 to 39.60). The prosthesis used were posterior stabilized in 7 knees (33.3%), varus-valgus constrained in five knees (23.8%) and a rotating hinge was required in nine knees (42.8%). Metaphyseal sleeves were used along with hinge prosthesis in six knees (28.6%). The mean arc of motion improved from 102.4 ± 22.7 degrees to 105.7 ± 15.5 degrees postoperatively (p = 0.27). The knee society and knee society functional scores improved from 23.3 ± 9.3 and 28.3 ± 12.2 preoperatively to 81.1 ± 5.4 and 80.4 ± 8.5 during the follow up respectively (p < 0.001). There were no progressive radiolucent lines in any knees at the final follow-up. One patient had intraoperative bony medial collateral ligament injury, one patient had deep vein thrombosis after five days from the index surgery and another had postoperative periprosthetic tibial shaft fracture.
CONCLUSIONS: According to our study, the clinical outcomes of TKA for
neuroarthropathy show significant improvement with the diagnosis of non-syphilitic
neuroarthropathy, utilization of modern constrained prostheses, and early rehabilitation, at medium-term follow-up. Tibial and femoral stems are preferred for equal stress distribution and to prevent early loosening.