Clinical outcomes of standard primary vs. primary rotating hinge total knee arthroplasty: a retrospective matched-pair analysis.

IF 2.8 3区医学 Q1 ORTHOPEDICS

Journal of Orthopaedic Surgery and Research Pub Date : 2025-06-07 DOI:10.1186/s13018-025-05961-3

Samuel F Schaible, Sophie C Eberlein, Raymond Schaefer, Frank M Klenke, Andreas Hecker

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引用次数: 0

Abstract

Background: In complex primary cases- marked by significant ligamentous instability, extensive bone loss, or severe deformities- standard total knee arthroplasty (TKA) may be insufficient. Rotating-hinge (RH) TKA offers a higher-constraint alternative. We retrospectively compared the clinical outcomes of primary RH TKA with those of standard primary (SP) TKA.

Methods: Nineteen patients per group were matched for age, sex, and follow-up (SP: 68.8 ± 6.8 years; RH: 68.2 ± 8.1 years; 11 females each). Patients with < 2 years of follow-up were excluded. Outcomes included stability, range of motion (ROM), radiographic loosening, leg alignment, and the following scores: Hospital for Special Surgery (HSS), Knee Society Score (KSS), Oxford Knee Score (OKS), EuroQol-5 Dimension-3 Level (EQ-5D-3 L), and Visual Analogue Scale (VAS).

Results: At follow-up (SP: 34 ± 7 months; RH: 32 ± 6 months, p = 0.346), medio-lateral instability was present in 26% of SP knees and absent in RH knees (p = 0.023). RH TKA had higher ROM by a mean 9° (126 ± 12° vs. 117 ± 9°; mean Δ = 9°, 95% CI 1.7-16.3°, Cohen d = 0.86; p = 0.012). No cases of antero-posterior instability, radiographic loosening, or axis malalignment occurred. Group differences were non-significant for HSS (89 ± 8 vs. 87 ± 19, p = 0.564), KSS (85 ± 14 vs. 87 ± 26, p = 0.790), OKS (17 ± 7 vs. 22 ± 11, p = 0.118), EQ-5D-3 L index (0.694 ± 0.314 vs. 0.781 ± 0.265, p = 0.364), and VAS (78 ± 27 vs. 77 ± 17, p = 0.886).

Conclusion: Primary RH TKA is a viable alternative to standard TKA in selected cases, demonstrating significantly less medio-lateral instability (0% in RH vs. 26% in SP, p = 0.023) and greater range of motion (126 ± 12° in RH vs. 117 ± 9° in SP, p = 0.012) in this cohort.

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标准原发性与原发性旋转铰链全膝关节置换术的临床结果：回顾性配对分析。

背景：在复杂的原发性病例中——以显著的韧带不稳定、广泛的骨质流失或严重的畸形为特征——标准的全膝关节置换术（TKA）可能是不够的。旋转铰链（RH） TKA提供了更高约束的替代方案。我们回顾性比较了原发性RH TKA与标准原发性（SP） TKA的临床结果。方法：每组19例患者进行年龄、性别和随访匹配(SP: 68.8±6.8岁；RH: 68.2±8.1岁；雌性各11只)。结果：随访时(SP: 34±7个月；RH: 32±6个月，p = 0.346)， 26%的SP膝存在中外侧不稳，RH膝不存在中外侧不稳（p = 0.023）。RH TKA的ROM平均高9°（126±12°vs 117±9°）；平均值Δ = 9°，95% CI 1.7 ~ 16.3°，Cohen d = 0.86；p = 0.012)。无前后不稳定、影像学松动或椎体轴线不对准病例发生。组差异与高速钢(89±8和87±19,p = 0.564), KSS(85±14 vs 87±26,p = 0.790),书(17±7与22±11,p = 0.118), EQ-5D-3 L指数(0.694±0.314和0.781±0.265,p = 0.364),和血管(78±27和77±17,p = 0.886)。结论：在选定的病例中，原发性RH TKA是标准TKA的可行替代方案，在该队列中显示出更少的中外侧不稳定性（RH为0%，SP为26%，p = 0.023）和更大的运动范围（RH为126±12°，SP为117±9°，p = 0.012）。

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来源期刊

Journal of Orthopaedic Surgery and Research ORTHOPEDICS-

CiteScore

4.10

自引率

7.70%

发文量

494

审稿时长

>12 weeks

期刊介绍： Journal of Orthopaedic Surgery and Research is an open access journal that encompasses all aspects of clinical and basic research studies related to musculoskeletal issues. Orthopaedic research is conducted at clinical and basic science levels. With the advancement of new technologies and the increasing expectation and demand from doctors and patients, we are witnessing an enormous growth in clinical orthopaedic research, particularly in the fields of traumatology, spinal surgery, joint replacement, sports medicine, musculoskeletal tumour management, hand microsurgery, foot and ankle surgery, paediatric orthopaedic, and orthopaedic rehabilitation. The involvement of basic science ranges from molecular, cellular, structural and functional perspectives to tissue engineering, gait analysis, automation and robotic surgery. Implant and biomaterial designs are new disciplines that complement clinical applications. JOSR encourages the publication of multidisciplinary research with collaboration amongst clinicians and scientists from different disciplines, which will be the trend in the coming decades.