骨溶解与骨水泥模块化后十字置换全膝关节设计相关:5 - 8年随访

M. O'rourke, J. Callaghan, D. Goetz, P. Sullivan, R. Johnston
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引用次数: 217

摘要

背景:大多数中期和长期的骨水泥后十字置换全膝关节假体研究都是用非模块化胫骨假体进行的。本研究的目的是评估使用骨水泥模块化胫骨假体的后十字骨置换全膝关节置换术的中期结果,特别关注于评估x线片骨溶解的患病率。方法:1992年至1995年间,我们医院对134例患者进行了176例使用Insall-Burstein II系统的连续一期全膝关节置换术。145个膝关节植入模块化金属背板胫骨组件,31个膝关节植入相同设计的全聚乙烯胫骨组件。在术前和最后随访时(平均6.4年,范围5.0至7.9年),完成标准术语问卷调查或膝关节学会和特殊外科医院评分。将术后初始x线片与最后随访时的x线片进行比较,以评估假体位置、磨损、放射线线和骨溶解情况。结果:92例患者(128个膝关节)在最后随访时存活。无患者失访。105个膝关节(82%)有x线片。有3例膝关节因不稳定或感染进行了膝关节矫正;没有一例因松动或骨溶解而进行翻修。最终随访时膝关节学会临床和功能评分的平均值分别为85分(范围41至100分)和79分(范围30至100分)。根据特殊外科医院的评分,94%的膝关节有良好或优秀的结果。最后随访时膝关节屈曲平均为113°(范围90°至130°)。经x线随访,17例(16%)膝关节出现骨溶解。所有使用全聚乙烯胫骨组件的膝关节均未发生骨溶解。由于在研究随访时发现溶骨性病变,对一名患者的两个膝关节进行了修改。这两个膝关节由于撞击和胫骨后部聚乙烯磨损而有胫骨前柱磨损。结论:经过5 - 8年的随访,发现模块化Insall-Burstein II全膝关节假体功能良好。然而,在临床评分良好或优异的患者中,骨溶解的高患病率令人担忧。当进行后十字置换全膝关节置换术时,应特别注意防止股骨假体屈曲、胫骨假体后斜或膝关节过伸。我们还建议在所有全关节置换术后进行常规随访x线片检查,以发现无症状的溶骨改变。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Osteolysis Associated with a Cemented tModular Posterior-Cruciate-Substituting Total Knee Design: Five to Eight-Year Follow-up
Background: Most intermediate and long-term studies of cemented posterior-cruciate-substituting total knee prostheses were performed with nonmodular tibial components. The purpose of this study was to evaluate the intermediate-term results of posterior-cruciate-substituting total knee arthroplasties in which a cemented modular tibial component had been used, with a particular focus on evaluating the prevalence of radiographic osteolysis.Methods: Between 1992 and 1995, 176 consecutive primary total knee arthroplasties with use of the Insall-Burstein II system were performed in 134 patients at our institution. A modular metal-backed tibial component was inserted in 145 knees, and an all-polyethylene tibial component of the same design was inserted in thirty-one. Standard-terminology questionnaires were completed or Knee Society and The Hospital for Special Surgery scores were determined preoperatively and at the time of final follow-up, at an average of 6.4 years (range, 5.0 to 7.9 years). Initial postoperative radiographs were compared with those made at the time of final follow-up to assess component position, wear, radiolucent lines, and osteolysis.Results: Ninety-two patients (128 knees) treated with the modular tibial component were alive at the time of final follow-up. No patient was lost to follow-up. Radiographs were available for 105 knees (82%). Three knees had been revised because of instability or infection; none had been revised because of loosening or osteolysis. The mean Knee Society clinical and functional scores were 85 points (range, 41 to 100 points) and 79 points (range, 30 to 100 points), respectively, at the time of final follow-up. According to The Hospital for Special Surgery score, 94% of the knees had a good or excellent result. Knee flexion averaged 113° (range, 90° to 130°) at the time of final follow-up. Osteolysis was present in seventeen (16%) of the knees with radiographic follow-up. Osteolysis did not develop in any knee in which an all-polyethylene tibial component had been used. Two knees (in one patient) were revised because of osteolytic lesions found at the time of follow-up for the study. Both of these knees had anterior wear of the tibial post due to impingement and backside tibial polyethylene wear.Conclusions: Modular Insall-Burstein II total knee prostheses were found to function well after five to eight years of follow-up. However, the high prevalence of osteolysis in patients who had good or excellent clinical scores is worrisome. Particular attention should be paid to preventing flexion of the femoral component, posterior slope of the tibial component, or hyperextension of the knee when posterior-cruciate-substituting total knee arthroplasty is performed. We also recommend routine follow-up radiographs after all total joint arthroplasties to detect asymptomatic osteolytic changes.
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