Lars-Rene Tuecking, Mats Tobias Wormit, Henning Windhagen, Max Ettinger, Peter Savov
{"title":"单独股骨翻修术治疗保留十字骨全膝关节置换术不稳定的疗效：一项比较研究","authors":"Lars-Rene Tuecking, Mats Tobias Wormit, Henning Windhagen, Max Ettinger, Peter Savov","doi":"10.1002/jeo2.70337","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Purpose</h3>\n \n <p>This study compares clinical outcomes, implant survival rates and perioperative factors between isolated femoral total knee arthroplasty (TKA) revision (prTKA) and full TKA revision (frTKA) for flexion instability in cruciate-retaining (CR) prostheses.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>This retrospective, controlled case series included 66 consecutive patients treated with either full TKA revision (<i>n</i> = 34) or isolated femoral TKA revision (<i>n</i> = 32) with flexion instability after CR TKA between 2015 and 2021. To ensure that the groups were uniformly comparable, only patients with one implant system (Triathlon, Stryker) were included. Preoperative demographic data and radiological parameters (e.g., quantification of anteroposterior instability and midflexion instability) were compared between the groups. Postoperative evaluation of implant survival and clinical outcome scores was performed with a minimum follow-up of 2 years. Patient-reported outcome measures (PROM) analysis included the Visual Analogue Scale, Kujala, Oxford Knee Score, Western Ontario and McMaster Universities Osteoarthritis Index, Forgotten Joint Score, University of California at Los Angeles Activity-Level Scale and Knee Osteoarthritis Outcome scores. Statistical evaluations included unpaired, nonparametric <i>t</i>-tests and Wilcoxon tests for nominal data. Implant survival analysis was conducted using Kaplan–Meier analysis and log-rank test. Statistical significance was defined as a <i>p</i>-value < 0.05.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>No significant differences were found in the clinical outcomes between the prTKA and frTKA groups across various PROMs. Implant survival rates were comparable (96.9% for prTKA vs. 97.1% for frTKA). Compared to frTKA, prTKA resulted in significantly shorter hospital stays (<i>p</i> = 0.002), reduced operative time (<i>p</i> < 0.001), lower blood loss (<i>p</i> = 0.001) and a decreased inflammatory response (<i>p</i> < 0.001).</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>Partial femoral TKA revision for flexion instability in cruciate-retaining prostheses yielded clinical outcomes and implant survival rates comparable to full TKA revision in the short- to mid-term follow-up. These findings suggest that partial femoral revision may be a viable option for carefully selected patients with flexion instability, offering similar clinical efficacy and potential perioperative advantages over complete revision.</p>\n </section>\n \n <section>\n \n <h3> Level of Evidence</h3>\n \n <p>Level III.</p>\n </section>\n </div>","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"12 3","pages":""},"PeriodicalIF":2.7000,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://esskajournals.onlinelibrary.wiley.com/doi/epdf/10.1002/jeo2.70337","citationCount":"0","resultStr":"{\"title\":\"Efficacy of isolated femoral revision in cruciate-retaining total knee arthroplasty instability: A comparative study\",\"authors\":\"Lars-Rene Tuecking, Mats Tobias Wormit, Henning Windhagen, Max Ettinger, Peter Savov\",\"doi\":\"10.1002/jeo2.70337\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Purpose</h3>\\n \\n <p>This study compares clinical outcomes, implant survival rates and perioperative factors between isolated femoral total knee arthroplasty (TKA) revision (prTKA) and full TKA revision (frTKA) for flexion instability in cruciate-retaining (CR) prostheses.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>This retrospective, controlled case series included 66 consecutive patients treated with either full TKA revision (<i>n</i> = 34) or isolated femoral TKA revision (<i>n</i> = 32) with flexion instability after CR TKA between 2015 and 2021. To ensure that the groups were uniformly comparable, only patients with one implant system (Triathlon, Stryker) were included. Preoperative demographic data and radiological parameters (e.g., quantification of anteroposterior instability and midflexion instability) were compared between the groups. Postoperative evaluation of implant survival and clinical outcome scores was performed with a minimum follow-up of 2 years. Patient-reported outcome measures (PROM) analysis included the Visual Analogue Scale, Kujala, Oxford Knee Score, Western Ontario and McMaster Universities Osteoarthritis Index, Forgotten Joint Score, University of California at Los Angeles Activity-Level Scale and Knee Osteoarthritis Outcome scores. Statistical evaluations included unpaired, nonparametric <i>t</i>-tests and Wilcoxon tests for nominal data. Implant survival analysis was conducted using Kaplan–Meier analysis and log-rank test. Statistical significance was defined as a <i>p</i>-value < 0.05.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>No significant differences were found in the clinical outcomes between the prTKA and frTKA groups across various PROMs. Implant survival rates were comparable (96.9% for prTKA vs. 97.1% for frTKA). Compared to frTKA, prTKA resulted in significantly shorter hospital stays (<i>p</i> = 0.002), reduced operative time (<i>p</i> < 0.001), lower blood loss (<i>p</i> = 0.001) and a decreased inflammatory response (<i>p</i> < 0.001).</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusions</h3>\\n \\n <p>Partial femoral TKA revision for flexion instability in cruciate-retaining prostheses yielded clinical outcomes and implant survival rates comparable to full TKA revision in the short- to mid-term follow-up. These findings suggest that partial femoral revision may be a viable option for carefully selected patients with flexion instability, offering similar clinical efficacy and potential perioperative advantages over complete revision.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Level of Evidence</h3>\\n \\n <p>Level III.</p>\\n </section>\\n </div>\",\"PeriodicalId\":36909,\"journal\":{\"name\":\"Journal of Experimental Orthopaedics\",\"volume\":\"12 3\",\"pages\":\"\"},\"PeriodicalIF\":2.7000,\"publicationDate\":\"2025-08-20\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://esskajournals.onlinelibrary.wiley.com/doi/epdf/10.1002/jeo2.70337\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Experimental Orthopaedics\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://esskajournals.onlinelibrary.wiley.com/doi/10.1002/jeo2.70337\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Experimental Orthopaedics","FirstCategoryId":"1085","ListUrlMain":"https://esskajournals.onlinelibrary.wiley.com/doi/10.1002/jeo2.70337","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
Efficacy of isolated femoral revision in cruciate-retaining total knee arthroplasty instability: A comparative study
Purpose
This study compares clinical outcomes, implant survival rates and perioperative factors between isolated femoral total knee arthroplasty (TKA) revision (prTKA) and full TKA revision (frTKA) for flexion instability in cruciate-retaining (CR) prostheses.
Methods
This retrospective, controlled case series included 66 consecutive patients treated with either full TKA revision (n = 34) or isolated femoral TKA revision (n = 32) with flexion instability after CR TKA between 2015 and 2021. To ensure that the groups were uniformly comparable, only patients with one implant system (Triathlon, Stryker) were included. Preoperative demographic data and radiological parameters (e.g., quantification of anteroposterior instability and midflexion instability) were compared between the groups. Postoperative evaluation of implant survival and clinical outcome scores was performed with a minimum follow-up of 2 years. Patient-reported outcome measures (PROM) analysis included the Visual Analogue Scale, Kujala, Oxford Knee Score, Western Ontario and McMaster Universities Osteoarthritis Index, Forgotten Joint Score, University of California at Los Angeles Activity-Level Scale and Knee Osteoarthritis Outcome scores. Statistical evaluations included unpaired, nonparametric t-tests and Wilcoxon tests for nominal data. Implant survival analysis was conducted using Kaplan–Meier analysis and log-rank test. Statistical significance was defined as a p-value < 0.05.
Results
No significant differences were found in the clinical outcomes between the prTKA and frTKA groups across various PROMs. Implant survival rates were comparable (96.9% for prTKA vs. 97.1% for frTKA). Compared to frTKA, prTKA resulted in significantly shorter hospital stays (p = 0.002), reduced operative time (p < 0.001), lower blood loss (p = 0.001) and a decreased inflammatory response (p < 0.001).
Conclusions
Partial femoral TKA revision for flexion instability in cruciate-retaining prostheses yielded clinical outcomes and implant survival rates comparable to full TKA revision in the short- to mid-term follow-up. These findings suggest that partial femoral revision may be a viable option for carefully selected patients with flexion instability, offering similar clinical efficacy and potential perioperative advantages over complete revision.
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