Design Modifications of the Posterior-Stabilized Knee System May Reduce Anterior Knee Pain and Complications following Total Knee Replacement
Design Modifications of the Posterior-Stabilized Knee System May Reduce Anterior Knee Pain and Complications following Total Knee Replacement
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DOI：
10.1007/s11420-019-09742-7
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发表时间：
2020-12-01
期刊：
影响因子：
2.5
通讯作者：
Westrich, Geoffrey H.
中科院分区：
文献类型：
--
作者：
Dubin, Jeremy A.;Muskat, Ahava;Westrich, Geoffrey H.
背景：在全膝关节置换术（TKA）中，后稳定（PS）膝关节植入物设计的进展解决了髌骨股骨力学和凸轮-桩接合问题，以减少髌骨股骨疼痛并改善膝关节运动学。这些改良包括改良股骨回退，改良股骨脱位阻力，减少磨损和延长使用寿命。在本研究中，我们比较了一种新型的PS膝关节设计，该设计结合了左右特定的股骨部件和更光滑的滑车沟，以改善髌股力学，并与一种较旧的PS设计进行了比较，以评估髌股疼痛、操作率和翻修率。方法通过一个机构数据库，我们回顾性地确定了由同一位外科医生使用Logic(R) PS膝关节系统和较老的Optetrak PS膝关节系统（Exactech Inc., Gainesville， FL， USA）进行的tka，并进行了至少2年的随访。每个队列的临床结果采用膝关节学会临床评分系统、加州大学洛杉矶分校活动量表、疼痛视觉模拟量表（VAS）、退伍军人兰德12项健康调查和西安大略和麦克马斯特大学骨关节炎指数进行测量。此外，比较两种膝关节系统前膝关节疼痛、操作和翻修的发生率，并计算Kaplan-Meier生存曲线，定义失败是否需要翻修，以便在队列之间进行比较。结果2000年至2018年，使用Logic PS（不包括12例死亡）和Optetrak PS组（不包括20例死亡）分别进行了1482例和445例tka。Logic PS组和Optetrak PS组手术时平均年龄分别为66.7岁和68.6岁，平均体重指数分别为30.8和31.2。Logic PS组疼痛VAS评分明显低于Optetrak组（分别为1.72分和2.75分，满分10分）。与Optetrak组相比，Logic组报告膝关节前侧疼痛的患者比例也有显著差异（分别为5.6%和11.8%）。此外，Logic组和Optetrak组的操作率差异显著（分别为0.34%和10.70%）。Logic组修正率为1.15%，Optetrak组修正率为2.0%。然而，由于骨溶解而进行的翻修率有显著差异，有利于Logic组（0.07%对0.6%）。Kaplan-Meier生存曲线显示Logic组和Optetrak组在修订前的时间有显著差异。结论改善髌股力学的设计改进可显著改善整体疼痛和髌股疼痛，并降低术后操作率。
Background In total knee arthroplasty (TKA), advances in posterior-stabilized (PS) knee implant designs address patellofemoral mechanics and cam-post engagement in an effort to reduce patellofemoral pain and improve knee kinematics. Such modifications may include improved femoral rollback, improved femoral dislocation resistance, minimized wear, and improved longevity. Questions/Purposes In this study, we compared a newer PS knee design that incorporates a left and right specific femoral component and smoother trochlear groove to improve patellofemoral mechanics with an older PS design in order to assess patellofemoral pain, manipulation rates, and revision rates. Methods Using an institutional database, we retrospectively identified TKAs performed by the same surgeon using the Logic(R) PS knee system and the older Optetrak PS knee system (Exactech Inc., Gainesville, FL, USA), with a minimum 2-year follow-up. Clinical outcomes for each cohort were measured using the Knee Society Clinical Rating System, University of California Los Angeles Activity Scale, pain visual analog scale (VAS), Veterans Rand 12-Item Health Survey, and Western Ontario and McMaster Universities Osteoarthritis Index. In addition, rates of anterior knee pain, manipulation, and revision were compared between the two knee systems, and a Kaplan-Meier survivorship curve defining failure as need for revision was calculated to allow comparison between the cohorts. Results From 2000 to 2018, there were 1482 TKAs performed using the Logic PS (not counting 12 patients who had died) and 445 in the Optetrak PS group (not counting 20 patients who had died). In the Logic PS and Optetrak PS groups, respectively, the average age at operation was 66.7 years and 68.6 years and the average body mass index was 30.8 and 31.2. Pain VAS scores were significantly lower in the Logic PS group than in the Optetrak group (1.72 vs. 2.75 out of 10, respectively). There was also a significant difference in the percentages of patients reporting anterior knee pain in the Logic group, as compared with the Optetrak group (5.6% vs. 11.8%, respectively). In addition, manipulation rates differed significantly between the Logic and Optetrak groups (0.34% vs. 10.70%, respectively). The revision rates were 1.15% for the Logic group and 2.0% for the Optetrak group. However, there was a significant difference in rates of revision performed because of osteolysis, favoring the Logic group (0.07% vs. 0.6%). The Kaplan-Meier survivorship curve shows a significant difference in time until revision between the Logic and Optetrak groups. Conclusion Design modifications to improve patellofemoral mechanics demonstrated significant improvements in overall pain and patellofemoral pain and reduced manipulation rates post-operatively.