Samuel F Schaible, Sophie C Eberlein, Raymond Schaefer, Frank M Klenke, Andreas Hecker
{"title":"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。","authors":"Samuel F Schaible, Sophie C Eberlein, Raymond Schaefer, Frank M Klenke, Andreas Hecker","doi":"10.1186/s13018-025-05961-3","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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).</p><p><strong>Results: </strong>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).</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"20 1","pages":"575"},"PeriodicalIF":2.8000,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12144791/pdf/","citationCount":"0","resultStr":"{\"title\":\"Clinical outcomes of standard primary vs. primary rotating hinge total knee arthroplasty: a retrospective matched-pair analysis.\",\"authors\":\"Samuel F Schaible, Sophie C Eberlein, Raymond Schaefer, Frank M Klenke, Andreas Hecker\",\"doi\":\"10.1186/s13018-025-05961-3\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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).</p><p><strong>Results: </strong>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).</p><p><strong>Conclusion: </strong>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.</p>\",\"PeriodicalId\":16629,\"journal\":{\"name\":\"Journal of Orthopaedic Surgery and Research\",\"volume\":\"20 1\",\"pages\":\"575\"},\"PeriodicalIF\":2.8000,\"publicationDate\":\"2025-06-07\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12144791/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Orthopaedic Surgery and Research\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1186/s13018-025-05961-3\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Orthopaedic Surgery and Research","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s13018-025-05961-3","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
Clinical outcomes of standard primary vs. primary rotating hinge total knee arthroplasty: a retrospective matched-pair analysis.
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.
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.
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