Wear and Lysis is the Problem in Modular TKA in the Young OA Patient at 10 Years
Wear and Lysis is the Problem in Modular TKA in the Young OA Patient at 10 Years
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DOI：
10.1007/s11999-010-1429-y
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发表时间：
2011-01-01
影响因子：
4.2
通讯作者：
Wells, Christopher W.
中科院分区：
文献类型：
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作者：
Odland, Andrew N.;Callaghan, John J.;Wells, Christopher W.
背景大多数长期随访研究的年轻患者接受TKA包括一个相对较高的比例的类风湿性关节炎患者，其功能和植入物的耐久性可能不同于那些与骨关节炎（OA）。问题/目的本研究的目的是评估最低10年的随访TKA在更活跃的OA患者，使用模块化胫骨组件，以确定该结构的耐久性。具体而言，我们确定（1）生存率;（2）翻修率;（3）功能评分;（4）至少10年随访时的影像学失败率。方法我们回顾性分析了59例（67膝）OA患者，他们接受了后交叉韧带保留（27%）或后交叉韧带替代（73%）组件的模块化胫骨托初次全膝关节置换术。对患者的翻修需求和膝关节协会、SF-36和WO-MAC评分以及UCLA和Tegner活动评分进行临床评价。对X线片进行松动和骨质溶解评价。存活患者的最短随访时间为10年（平均12.4年;范围10 - 18.4年）。10例患者（11膝）死亡; 2例患者（2膝）失访。结果10例患者（11膝; 16%）因无菌性松动和/或骨质溶解翻修。31例患者（65%）仍在进行中度劳动或体育活动。平均UCLA评分为5.5（范围，2-9）。没有nonrevised膝关节表现出放射学loosen.Conclusion在这个活跃的患者人群中的大多数患者继续有可接受的功能，虽然16%的磨损和/或骨质溶解进行了修订。11例翻修膝关节中的4例（36%）单独进行了胫骨垫片更换。这些数据应提供使用新设计和新关节面材料在年轻患者中进行全膝关节置换术的比较。
Background Most long-term followup studies of younger patients who underwent TKA include a relatively high percentage of rheumatoid patients, whose function and implant durability may differ from those with osteoarthritis (OA).Questions/purposes The purpose of this study was to evaluate the minimum 10 year followup of TKA performed in more active patients with OA, using modular tibial components, to determine the durability of that construct. Specifically, we determined (1) survivorship; (2) revision rates; (3) functional scores; and (4) rates of radiographic failure at a minimum 10 year followup.Methods We retrospectively reviewed 59 patients (67 knees) with OA who underwent primary total knee arthroplasty with posterior cruciate retaining (27%) or posterior cruciate substituting (73%) components which had modular tibial trays. Patients were evaluated clinically for need of revision and Knee Society, SF-36 and WO-MAC scores as well as UCLA and Tegner activity scores. Radiographs were evaluated for loosening and osteolysis. The minimum followup of living patients was 10 years (mean, 12.4 years; range, 10 to 18.4 years). Ten patients (11 knees) died; two patients (2 knees) were lost to followup.Results Ten patients (11 knees; 16%) had revisions for aseptic loosening and/or osteolysis. Thirty-one patients (65%) were still performing moderate labor or sports activities. The average UCLA score was 5.5 (range, 2-9). No nonrevised knee demonstrated radiographic loosening.Conclusion Most patients in this active patient population continued to have acceptable function although 16% underwent revision for wear and/or osteolysis. Isolated tibial insert exchange alone was performed in four of the 11 (36%) revised knees. These data should provide comparison for total knee arthroplasties performed in younger patients with newer designs and newer bearing materials.