膝关节肿瘤患者无菌假体松动的翻修手术：步态和影像学参数的作用

IF 1.5 Q3 ORTHOPEDICS

Journal of orthopaedics Pub Date : 2025-07-08 DOI:10.1016/j.jor.2025.07.006

Sheng-Rui Chu , Meng-Yu Chen , Yang Liu , Kai Zhu , Jing-Yu Zhang , Yong-Cheng Hu , Yan-Cheng Liu , Jun Miao

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引用次数: 0

摘要

目的膝关节肿瘤患者假体植入后无菌性松动的手术治疗越来越普遍，但相关危险因素的分析仍然有限。本研究旨在系统识别无菌膝关节假体植入后松动的危险因素，并通过综合临床、影像学和定量步态参数的多模式分析建立早期预测指标。方法采用病例对照设计，回顾性收集2020年1月至2024年12月接受膝关节肿瘤治疗的患者数据。患者分为两组：实验组（n = 11）因无菌性松动需要翻修，对照组（n = 11）使用稳定的假体。所有患者都接受了由经验丰富的关节外科医生进行的相同类型的旋转铰链膝关节假体植入。为了探讨无菌性松动的危险因素，我们分析了临床资料、步态参数和影像学特征。采用多变量logistic回归分析来量化临床数据与无菌假体松动风险之间的关联。通过能量消耗和活动智能设备（idea®v3.1, MiniSun LLC）定量分析步态参数，以预测无菌性松动的早期指标。结果回归模型显示，患者身体质量指数（BMI）和髋关节-膝关节-踝关节角（HKAA）差异有统计学意义（p = 0.04, p = 0.043），而首次植入假体时性别和年龄差异无统计学意义。单因素回归分析显示，膝关节近端20 cm处股骨内径有显著性差异（p = 0.05），但多因素回归模型显示无显著性差异。皮质骨厚度差异不显著。与对照组相比，接受无菌松动翻修的患者在单支阶段时间（p = 0.045）和能量消耗（p = 0.05）上均显著减少。结论膝关节肿瘤治疗膝关节假体植入术后无菌性松动与多个因素有关，较高的BMI和HKAA是重要的危险因素。减少单支阶段时间和减少步态分析中的能量消耗可以帮助预测早期松动迹象并促进早期临床干预。

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Revision surgery for aseptic prosthetic loosening in patients treated for knee tumors: Role of gait and imaging parameters

Objective

Revision surgeries for aseptic loosening following prosthesis implantation in patients treated for knee tumors have become increasingly prevalent, although analyses of associated risk factors remain limited. This study aimed to systematically identify risk factors for aseptic knee prosthetic loosening following implantation and establish early predictive indicators through multimodal analysis integrating clinical, radiographic, and quantitative gait parameters.

Methods

Data from patients treated for knee tumors between January 2020 and December 2024 were retrospectively collected via a case‒control design. Patients were divided into two groups: an experimental group (n = 11) requiring revision due to aseptic loosening and a matched control group (n = 11) with stable prostheses. All patients underwent the same type of rotationally hinged knee prosthetic implantation performed by a team of experienced joint surgeons. To explore the risk factors for aseptic loosening, clinical data, gait parameters, and imaging characteristics were analyzed. Multivariate logistic regression analyses were implemented to quantify associations between clinical data and the risk of aseptic prosthetic loosening. Gait parameters were quantitatively analyzed via the Intelligent Device for Energy Expenditure and Activity (IDEEA® v3.1, MiniSun LLC) to predict early indicators of aseptic loosening.

Results

According to the regression models, a higher body mass index (BMI) and hip–knee-ankle angle (HKAA) were significant (p = 0.04, p = 0.043), whereas sex and age at first prosthetic implantation were not significant. The femoral internal diameter at 20 cm proximal to the knee was significant according to the univariate regression analysis (p = 0.05) but not according to the multivariate regression model. The difference in the cortical bone thickness was not significant. Significant reductions in the single-support phase time (p = 0.045) and energy expenditure (p = 0.05) were observed in patients who underwent revision for aseptic loosening relative to those in the control group.

Conclusion

Aseptic loosening after knee prosthetic implantation for knee tumor treatment is associated with several factors, and a higher BMI and HKAA constitute significant risk factors. A decreased single-support phase time and reduced energy expenditure in gait analysis can assist in predicting early signs of loosening and facilitate early clinical intervention.

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来源期刊

Journal of orthopaedics ORTHOPEDICS-

CiteScore

3.50

自引率

6.70%

发文量

202

审稿时长

56 days

期刊介绍： Journal of Orthopaedics aims to be a leading journal in orthopaedics and contribute towards the improvement of quality of orthopedic health care. The journal publishes original research work and review articles related to different aspects of orthopaedics including Arthroplasty, Arthroscopy, Sports Medicine, Trauma, Spine and Spinal deformities, Pediatric orthopaedics, limb reconstruction procedures, hand surgery, and orthopaedic oncology. It also publishes articles on continuing education, health-related information, case reports and letters to the editor. It is requested to note that the journal has an international readership and all submissions should be aimed at specifying something about the setting in which the work was conducted. Authors must also provide any specific reasons for the research and also provide an elaborate description of the results.