Bicompartmental individualized knee replacement. Use of patient-specific implants and instruments (iDuo™)
Bicompartmental individualized knee replacement. Use of patient-specific implants and instruments (iDuo™)
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DOI：
10.1007/s00064-017-0484-x
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发表时间：
2017-02-01
影响因子：
0.7
通讯作者：
Arnholdt, J.
中科院分区：
文献类型：
--
作者：
Steinert, A. F.;Beckmann, J.;Arnholdt, J.
内侧或外侧和髌股间室合并骨关节炎（OA）患者的双间室膝关节置换术。患者专用手术工具和植入物（ConforMIS iDuo（TM）），具有最佳植入物匹配的计划方案。膝关节双间室OA（Kellgren & Lawrence IV期），在保守或关节保留手术失败后影响内侧或外侧以及髌股间室。三间室OA，膝关节韧带不稳定，膝关节畸形> 15 A度（内翻，外翻，伸展缺陷）。相对禁忌症：身体质量指数> 40;既往单髁膝关节置换术或截骨术;中线或髌旁内侧皮肤切口，内侧关节切开术;确定完整股骨髁的机械接触区（终线）;清除可能干扰单独设计器械正确放置的剩余软骨和所有骨赘。使用患者专用平衡芯片平衡膝关节伸展。使用单个截骨块切除胫骨近端;使用髓外对线导向器确认轴向对线，在90 A屈曲时使用间隔块平衡屈曲间隙。最终股骨准备，切除前股骨转子。在平衡和确定胫骨垫片高度后，进行最终胫骨准备。在45 A膝关节屈曲度下使用骨水泥固定植入物。清除多余的骨水泥，最后冲洗，然后缝合。无菌伤口敷料;加压绷带。主动/被动活动度（ROM）无限制。前2周部分负重，然后过渡到完全负重。术后随访1 - 2周和52周，然后每1-2年随访一次，共治疗了44例内侧和髌股间室双间室OA患者。平均年龄59岁。至少随访12个月。由于胫骨松动，植入物转为TKA（1例患者）;髌骨表面置换（3例患者）。无进一步翻修或并发症。影像学分析表明，植入物匹配理想，下沉或悬垂小于2 mm。KSS疼痛评分从术前的5.7改善到术后的1.7（水平行走），从术前的7.3改善到术后的2.8（爬楼梯或斜坡）。WOMAC评分从术前的43分提高到术后的79分。
Bicompartmental knee replacement in patients with combined osteoarthritis (OA) of the medial or lateral and patellofemoral compartment. Patient-specific instruments and implants (ConforMIS iDuo (TM)) with a planning protocol for optimal implant fit.Bicompartmental OA of the knee (Kellgren & Lawrence stage IV) affecting both the medial or lateral and patellofemoral compartment after unsuccessful conservative or joint-preserving surgery.Tricompartmental OA, knee ligament instabilities, knee deformities > 15A degrees (varus, valgus, extension deficit). Relative contraindication: body mass index > 40; prior unicompartmental knee replacement or osteotomies.Midline or parapatellar medial skin incision, medial arthrotomy; identify mechanical contact zone of the intact femoral condyle (linea terminalis); remove remaining cartilage and all osteophytes that may interfere with the correct placement of the individually designed instruments. Balance knee in extension with patient-specific balancing chips. Resection of proximal tibia with an individual cutting block; confirm axial alignment using an extramedullary alignment guide, balance flexion gap using spacer blocks in 90A degrees flexion. Final femur preparation with resection of the anterior trochlea. After balancing and identification of insert heights, final tibial preparation is performed. Implant is cemented in 45A degrees of knee flexion. Remove excess cement and final irrigation, followed by closure.Sterile wound dressing; compressive bandage. No limitation of active/passive range of motion (ROM). Partial weight bearing the first 2 weeks, then transition to full weight bearing. Follow-up directly after surgery, at 12 and 52 weeks, then every 1-2 years.In all, 44 patients with bicompartmental OA of the medial and patellofemoral compartment were treated. Mean age 59 years. Minimum follow-up 12 months. Implant converted to TKA due to tibial loosening (1 patient); patella resurfacing (3 patients). No further revisions or complications. Radiographic analyses demonstrated ideal fit of the implant with less than 2 mm subsidence or overhang. KSS pain scores improved from preoperatively 5.7 to 1.7 postoperatively with level walking, and from 7.3 preoperatively to 2.8 postoperatively with climbing stairs or inclines. The WOMAC score improved from preoperatively 43 to 79 postoperatively.