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1.
Evan S. Nielsen Albert Hsu Shantanu Patil Clifford W. Colwell Darryl D. D&#x;Lima 《The Journal of arthroplasty》2018,33(7):2293-2300
Background
Knee instability is emerging as a major complication after total knee arthroplasty (TKA), with ligament laxity and component alignment listed as important contributory factors. Knee balancing remains an art and is largely dependent on the surgeon's subjective “feel.” The objectives were to measure the accuracy of an electronic balancing device to document the magnitude of correction in knee balance after soft-tissue releases and measure change in knee laxity after medial release.Methods
The accuracy of a second-generation electronic ligament-balancing device was compared with that of 2 mechanical balancing instruments. TKA was performed in 12 cadaver knees. Soft-tissue balance was measured sequentially before TKA, after mounting a trial femoral component, after medial release, and after resecting the posterior cruciate ligament. Coronal laxity of the knee under a 10 Nm valgus moment was measured before and after medial release.Results
The electronic balancing instrument was more accurate than mechanical instruments in measuring distracted gap and distraction force. On average, before TKA, the flexion gap was wider than the extension gap, and the medial gap was tighter than the lateral gap. Medial release increased the medial gap in flexion and increased passive knee valgus laxity. Posterior cruciate ligament release increased the tibiofemoral gap in both flexion and extension with a greater increase in the lateral gap.Conclusion
The second-generation electronic balancing device was significantly more accurate than mechanical instruments and could record knee balance over the entire range of flexion. More accurate soft-tissue balance may enhance outcomes after TKA. 相似文献2.
Jae Ang Sim Ji Hoon Kwak Sang Hoon Yang Sung Hoon Moon Beom Koo Lee Joon Yub Kim 《Clinics in Orthopedic Surgery》2009,1(2):110-113
Background
This study evaluated the preoperative distractive stress radiographs in order to quantify and predict the extent of medial release according to the degree of varus deformity in primary total knee arthroplasty.Methods
We evaluated 120 varus, osteoarthritic knee joints (75 patients). The association of the angle on the distractive stress radiograph with extent of medial release was analyzed. The extent of medial release was classified into the following 4 groups according to the stage: release of the deep medial collateral ligament (group 1), release of the posterior oblique ligament and/or semimembranous tendon (group 2), release of the posterior capsule (group 3) and release of the superficial medial collateral ligament (group 4).Results
The mean femorotibial angle on the preoperative distractive stress radiograph was valgus 2.4° (group 1), valgus 0.8° (group 2), varus 2.1° (group 3) and varus 2.7° (group 4). The extent of medial release increased with increasing degree of varus deformity seen on the preoperative distractive stress radiograph.Conclusions
The preoperative distractive stress radiograph was useful for predicting the extent of medial release when performing primary total knee arthroplaty. 相似文献3.
Keizo Wada Daisuke Hamada Shunsuke Tamaki Kosaku Higashino Yoshihiro Fukui Koichi Sairyo 《The Journal of arthroplasty》2017,32(1):270-273
Background
Previous studies suggested that changes in kinematics in total knee arthroplasty (TKA) affected satisfaction level. The aim of this cadaveric study was to evaluate the effect of medial collateral ligament (MCL) release by multiple needle puncture on knee rotational kinematics in posterior-stabilized TKA.Methods
Six fresh, frozen cadaveric knees were included in this study. All TKA procedures were performed with an image-free navigation system using a 10-mm polyethylene insert. Tibial internal rotation was assessed to evaluate intraoperative knee kinematics. Multiple needle puncturing was performed 5, 10, and 15 times for the hard portion of the MCL at 90° knee flexion. Kinematic analysis was performed after every 5 punctures. After performing 15 punctures, a 14-mm polyethylene insert was inserted, and kinematic analysis was performed.Results
The tibial internal rotation angle at maximum knee flexion without multiple needle puncturing was significantly larger (9.42°) than that after 15 punctures (3°). Negative correlation (Pearson r = ?0.715, P < .001) between tibial internal rotation angle at maximum knee flexion and frequency of puncture was observed. The tibial internal rotation angle with a 14-mm insert was significantly larger (7.25°) compared with the angle after 15 punctures.Conclusion
Tibial internal rotation during knee flexion was reduced by extensive MCL release using multiple needle puncturing and was recovered by increasing of medial tightness. From the point of view of knee kinematics, medial tightness should be allowed to maintain the internal rotation angle of the tibia during knee flexion which might lead to patient satisfaction. 相似文献4.
Jong Hun Ji Sang Eun Park In Soo Song Hanvit Kang Ji Yoon Ha Jae Jung Jeong 《Clinics in Orthopedic Surgery》2014,6(4):365-372
Background
We report intra- and postoperative complications of unicompartmental knee arthroplasty (UKA).Methods
This study was conducted on 246 cases of UKA which were performed for degenerative osteoarthritis confined to the medial compartment, from May 2002 to May 2010, for which follow-up periods longer than one year were available. Complications were divided into intra- and postoperative complications. Pre- and postoperative clinical scores, the range of motion, and radiologic findings were analyzed.Results
Complications developed in a total of 24 cases (9.8%, 24/246). Among them, 6 cases had intraoperative complications while 18 had postoperative complications. Among the 6 intraoperative complications, one fracture of the medial tibial condyle, two fractures of the intercondylar eminence, one rupture of the medial collateral ligament, one widening of the peg hole leading to femoral component malposition and late failure, and one total knee arthroplasty (TKA) conversion of a large bony defect of tibial avascular necrosis were observed. Among the 18 postoperative complications, four cases of aseptic loosening of the femoral component, one soft tissue impingement due to malalignment, nine cases of polyethylene bearing dislocation, one case of suprapatellar bursitis, one periprosthetic fracture, one TKA conversion due to medial component overhanging, and one TKA conversion due to pain of unexplained cause were observed.Conclusions
The mid-term clinical outcomes of UKA were excellent in our study. However, the incidence of complications was very high (9.8%). To prevent intra- and postoperative complications, proper selection of the patients and accurate surgical techniques are required. 相似文献5.
Man S. Kim In J. Koh Young J. Choi Yong D. Kim Yong In 《The Journal of arthroplasty》2017,32(5):1488-1495
Background
Extensive medial soft tissue release may be necessary to correct severe varus deformity during total knee arthroplasty (TKA). However, this procedure may result in instability. Here, we describe a novel soft tissue balancing technique, which can minimize medial release in severe varus deformity during TKA.Methods
Fifty knees (40 patients) with hip-knee-ankle angle of more than 20° of varus were corrected using this technique (group 1). After achieving flexion gap balancing by needle puncturing and spreading of the superficial medial collateral ligament, extension gap balancing was obtained by gradual extension with the trial components in place. After group 1 was set, a one-to-one patient-matched control group who had mild varus deformity was selected by propensity score matching (50 knees, 48 patients, group 2). At postoperative 1 year, mediolateral laxity was compared between the 2 groups using the stress radiographs. Clinical outcomes were also compared using the Knee Society Score and Western Ontario and McMaster Universities Osteoarthritis Index score.Results
There were no differences in mean medial and lateral laxities between groups 1 and 2 at 1 year after the operation (medial laxity: 2.3° ± 1.4° and 2.7° ± 1.3°, respectively, P = .310) (lateral laxity: 3.6° ± 1.7° and 3.2° ± 2.0°, respectively, P = .459). There were no significant differences in postoperative clinical scores and knee alignment.Conclusion
Our technique of obtaining extension gap balancing using trial components led to safe and effective balancing by avoiding unnecessary extensive release in severe varus deformity during TKA. 相似文献6.
Background
Degenerative osteoarthritis of the knee usually shows arthritic change in the medial tibiofemoral joint with severe varus deformity. In total knee arthroplasty (TKA), the medial release technique is often used for achieving mediolateral balancing. But, in a more severe varus knee, there are more difficult technical problems. Bony resection of the medial proximal tibia (MPT) as an alternative technique for achieving soft tissue balancing was assessed in terms of its effectiveness and possibility of quantification.Methods
TKAs were performed in 78 knees (60 patients) with vertical bone resection of the MPT for soft tissue balancing from September 2011 to March 2013. During operation, the medial and lateral gaps were measured before and after the bony resection technique. First, the correlation between the measured thickness of the resected bone and the change in medial and lateral gaps was analyzed. Second, the possibility of quantification of each parameter was evaluated by linear regression and the coefficient ratio was obtained.Results
A significant correlation was identified between alteration in the medial gap change in extension and the measured thickness of the vertically resected MPT (r = 0.695, p = 0.000). In the medial gap change in flexion, there was no statistical significance (r = 0.214, p = 0.059). When the MPT was resected at an average thickness of 8.25 ± 1.92 mm, the medial gap in extension was increased by 2.94 ± 0.87 mm. In simple linear regression, it was predictable that MPT resection at a thickness of 2.80 mm was required to increase the medial gap by 1.00 mm in knee extension.Conclusions
The method of bone resection of the MPT can be considered effective with a predictable result for achieving soft tissue balancing in terms of quantification during TKA. 相似文献7.
8.
Alejandro Lizaur-Utrilla Daniel Martinez-Mendez Santiago Gonzalez-Parreño Luis Marco-Gomez Francisco A. Miralles Muñoz Fernando A. Lopez-Prats 《The Journal of arthroplasty》2018,33(7):2141-2145
Background
Few studies have analyzed the outcomes of total knee arthroplasty (TKA) in patients with prior anterior cruciate ligament (ACL) reconstruction, and the reported outcomes are controversial. The purpose of this study is to assess if prior ACL reconstruction had any impact on the outcome of subsequent TKA.Methods
A matched case-control study was conducted in patients who underwent TKA, including 37 with prior ACL reconstruction and 37 patients without ACL reconstruction. Preoperative and postoperative clinical and radiological data were collected from a prospective arthroplasty database with a minimum follow-up of 5 years. The mean age was 69.6 years, and 59.4% were men. The Knee Society scores, Short Form-12, and Western Ontario and McMaster Universities questionnaires were used for functional evaluations. Visual analogue scale 0-10 was used for patient satisfaction.Results
The mean follow-up after TKA was 6.1 (range 5-7.3) years. Two patients in the ACL group developed knee stiffness requiring manipulation under anesthesia, while 1 patient in the control group suffered superficial wound infection. At last follow-up, no significant differences in functional or radiologic outcomes were found between both groups. The performance of TKA in ACL patients had increased technical difficulty and significantly longer time of surgery, but this had no influence on the outcomes. In the ACL group, 24 knees had technical difficulty in surgery. The main difficulty in most ACL patients was due to varus deformity and increased retraction of the medial soft structures which required progressive medial release. Other 2 knees had difficult knee exposure. One was an unexpected partial patellar tendon avulsion and the other required planned quadriceps snip.Conclusion
TKA was an effective procedure for patients with prior ACL reconstruction. The surgeon should be warned of the possible difficulties in the knee exposure and possible need of medial release to obtain an appropriate ligament balance. However, these additional procedures had no negative effect on the outcomes of TKA. 相似文献9.
Won-Sik Choy Kap Jung Kim Sang Ki Lee Dae Suk Yang Choon Myeon Kim Ju Sang Park 《Clinics in Orthopedic Surgery》2011,3(4):279-284
Background
We analyzed the clinical and radiologic results of patients with spontaneous osteonecrosis of the knee treated by minimally invasive medial unicompartmental arthroplasty using Oxford Uni.Methods
We reviewed 22 knees in 21 patients which were treated for spontaneous osteonecrosis between 2002 and 2006. Patients included one male and 20 females. The mean age was 70.8 years (range, 53 to 82 years). The mean follow-up period was 70.3 months (range, 48 to 93 months). The clinical results were evaluated using the Hospital for Special Surgery (HSS) knee score and the range of motion of the knee preoperatively and at the final follow-up. Preoperative plain radiographs and magnetic resonance images were analyzed to determine the size and stage of osteonecrotic lesions.Results
The mean HSS knee score was 64.3 (range, 54 to 75) preoperatively and 92.0 (range, 71 to 100) at the final follow-up. The mean preoperative flexion contracture was 8.9° (range, 0 to 15°) and 0.2° (range, 0 to 5°) at the final follow-up. The mean further flexion increased from 138.6° (range, 100 to 145°) preoperatively to 145.6° (range, 140 to 150°) at the final follow-up. Active full flexion was possible within 2 months of the operation. The squatting position was possible in 16 patients (84.2%) out of 19, except one case of bronchiectasis and one case of spine fracture. The cross-leg posture was possible in 19 patients (90.5%) out of 21. The mean tibiofemoral angle was improved from varus 0.98° to valgus 3.22°. Meniscal bearing dislocation occurred in 2 cases and femoral component loosening occurred in 1 case.Conclusions
Unicompartmental knee arthroplasty using Oxford Uni could be an alternative treatment option in spontaneous osteonecrosis of the knee. 相似文献10.
Semimembranosus Release as the Second Step of Soft Tissue Balancing in Varus Total Knee Arthroplasty
There have been limited clinical data on the effect of semimembranosus release in patients with varus knees treated with total knee arthroplasty (TKA). The purposes of this study were to determine the effect of semimembranosus release and to evaluate the effectiveness of our release technique based on the three-step algorithm which consisted of sequential release of 1) deep medial collateral ligament (MCL), 2) semimembranosus, 3) superficial MCL in 104 consecutive varus knees treated with TKA. Semimembranosus release had the desired effect on gap balancing in varus knees and our algorithmic medial release approach to the varus knee has shown to be favorable in correcting varus deformities during TKA. 相似文献
11.
Won-Sik Choy Kap Jung Kim Sang Ki Lee Dae Suk Yang Neung Ki Lee 《Clinics in Orthopedic Surgery》2011,3(3):178-183
Background
This study examined the clinical and radiologic mid-term results of patients treated by Oxford minimally invasive unicompartmental knee arthroplasty.Methods
One hundred and eighty-eight knees of unicompartmental knee arthroplasties with Oxford Uni® in 166 patients (16 males and 150 females), which were performed between 2002 and 2005, were reviewed. The mean age was 65.3 years (range, 44 to 82 years) and the mean follow-up period was 79.8 months (range, 56 to 103 months). The preoperative diagnosis was osteoarthritis in 166 patients, osteonecrosis of the medial femoral condyle in 20 and chondrocalcinosis in 2.Results
The mean Hospital for Special Surgery (HSS) knee score was 67.5 (range, 52 to 75) preoperatively and 89.9 (range, 85 to 100) at the final follow-up. The mean preoperative flexion contracture was 6.5° (range, 0 to 15°) and 0.8° (range, 0 to 5°) at the final follow-up. The mean full flexion increased from 135° (range, 90 to 150°) preoperatively to 150° (range, 140 to 165°) at the final follow-up. Active full flexion was possible within 2 postoperative months. The squatting and cross-leg postures were possible in 133 patients (80.1%) and 152 patients (91.6%) at the final follow-up. The mean tibiofemoral angle was improved from varus 1.5° to valgus 4.8°. Complications were encountered in 18 cases (9.5%). A bearing dislocation occurred in 10 cases (5.3%), tibial component loosening in 4 cases (2.1%), femoral loosening in 3 cases (1.6%) and lateral translation in 1 case (0.5%). The mean time for a bearing dislocation was 22.6 months (range, 3 to 70 months) postoperatively. Seven cases returned to the predislocation level of activity with the insertion of a thicker bearing and 3 cases converted to total knee arthroplasty.Conclusions
Minimally invasive unicompartmental knee arthroplasty with Oxford Uni® provided rapid recovery, good pain relief and excellent function suitable for the Korean lifestyle. In contrast, the high complication rates of Oxford Uni® encountered in the mid-term results suggested less reliability than total knee arthroplasty. 相似文献12.
Objective
Distalization of the insertion of the lateral collateral ligament and popliteus tendon by sliding osteotomy of the lateral femur condyle in order to correct a residual contracture in extension in total knee arthroplasty (TKA) of the severe valgus deformity.Indications
Genuine and other valgus deformity of the knee.Contraindications
Severe laxity of the medial collateral ligament; common contraindications of joint replacement.Surgical technique
Lateral parapatellar approach and stepwise osteotomy of the tubercle of the tibia, subperiostal release of the lateral contracted structures such as iliotibial band (ITB) and lateral collateral ligament (LCL) in flexion. Tibia first technique, verification of a balanced and stable flexion gap parallel to the epicondylar line. Posterior cruciate ligament (PCL) is preserved. Referencing of the distal femoral cut by a spacer filled only in the medial extension gap. Finishing femoral chamfer cuts. If extension gap remains trapezoidal, further release of the residual lateral contracted structures in extension by means of sliding osteotomy of the lateral condyle and subperiostal release of the capsule and the lateral septum intermusculare is required. Termporary fixation of the lateral condyle by K-wires, resection of the bony excess, trial of test components, definite screw fixation.Postoperative management
Comparable to TKA in varus deformities by a medioparapatellar approach.Results
A total of 79?patients (61 women, 18 men, average age 71?years at the time of surgery) with fixed valgus deformities were operated between June 2001 and December?2010 using TKA and sliding osteotomy of the lateral femoral condyle. The preoperative valgus angle under defined valgus and varus stress was 19.5° (8?C40), postoperative 4.7° (2?C11). Mean medial angle (valgus stress) of the follow-up was 2.1° (0.5?C5°), lateral angle (varus stress) 2.3° (0.5?C5°). A total of 35?patients were followed-up, at a mean of 73.3?month (24?C109?months). The postoperative Knee Society Score was 95 points (56?C100?points), while the postoperative Function Score was 90 points (55?C100?points) postoperatively. The Oxford Score improved from 22?points (3?C43?points) preoperatively to 45 points (21?C48?points) postoperatively. One knee had to be revised due to infection, one knee due to non-union of the tibial tubercle. Finally, there were 3?cases with complications associated with the procedure due to the sliding osteotomy of the lateral femoral condyle; all were revised successfully. No conversion to a semi-constrained or constrained knee prosthesis was necessary. 相似文献13.
Masanori Tsubosaka Hirotsugu Muratsu Koji Takayama Hidetoshi Miya Ryosuke Kuroda Tomoyuki Matsumoto 《The Journal of arthroplasty》2018,33(3):729-734
Background
Medial stability of the knee is considered to be associated with good clinical results after total knee arthroplasty (TKA). This study aimed to compare intraoperative soft tissue balance between cruciate-retaining (CR) and posterior-stabilized (PS) TKA performed by a newly developed medial preserving gap technique, which aimed at preserving medial stability throughout the range of motion.Methods
Seventy CR-TKAs and 70 PS-TKAs were performed in patients with varus type osteoarthritis with the novel technique guided by tensor measurements. Final intraoperative soft tissue balance with femoral trial component in place and patellofemoral joint reduced, including the joint component gap and varus/valgus ligament balance (varus angle), with the knee at 0° (full extension), 10° (extension), 30°, 45°, 60°, 90° (flexion), 120°, and 135° (deep flexion), was measured with Offset Repo-Tensor under 40 lbs of joint distraction force. The medial compartment gap (MCG), lateral compartment gap, and medial joint looseness (MCG-polyethylene insert thickness) at each flexion angle were calculated from the measured joint component gap and varus ligament balance, and compared between CR-TKA and PS-TKA.Results
The MCGs from extension to deep flexion of the knee showed no significant differences between CR-TKA and PS-TKA. The lateral compartment gaps in PS-TKA from 30° to 60° of knee flexion was significantly larger than those in CR-TKA (P < .05). Medial joint looseness showed no significant differences between CR-TKA and PS-TKA which is consistent within 1 mm from extension to flexion of the knee.Conclusion
PS-TKA similarly achieved medial stability comparable to CR-TKA using the medial preserving gap technique. 相似文献14.
《The Journal of arthroplasty》2020,35(2):380-387
BackgroundThe aims of this study were to (1) describe our functional stepwise multiple needle puncturing (MNP) technique as the final step in medial ligament balancing during total knee arthroplasty (TKA) and (2) evaluate whether this technique can provide sufficient medial release with safety.MethodsA total of 137 patients with 212 consecutive knees who underwent TKAs with or without functional stepwise MNP of superficial medial collateral ligament was recruited in this prospective cohort. Eighty-one patients with 129 knees who performed serial stress radiographs were enrolled in the final assessment. Superficial medial collateral ligament was punctured selectively (anteriorly or posteriorly or both) and sequentially depending on the site and degree of tightness. Mediolateral stability was assessed using serial stress radiographs and comparison was performed between the MNP and the non-MNP groups at postoperative 6 months and 1 year. Clinical outcomes were also evaluated between 2 groups.ResultsFifty-five TKAs required additional stepwise MNP (anterior needling 19, posterior needling 3, both anterior and posterior needling 33). Preoperative hip-knee-ankle angle and the difference in varus-valgus stress angle showed significant difference between the MNP and the non-MNP groups, respectively (P = .009, P = .037). However, there was no significant difference when comparing the varus-valgus stress angle between the MNP and the non-MNP groups during serial assessment. Clinical outcomes including range of motion also showed no significant differences between the 2 groups.ConclusionFunctional medial ligament balancing with stepwise MNP can provide sufficient medial release with safety in TKA with varus aligned knee without clinical deterioration or complication such as instability.Level of EvidenceLevel II, Prospective cohort study. 相似文献
15.
16.
Background
Multiple surgical techniques exist to restore limb alignment and to balance soft tissues in valgus knees during total knee arthroplasty (TKA). One technique is to perform a lateral femoral epicondylar osteotomy.Methods
A retrospective analysis was performed on all patients with a fixed valgus deformity that was corrected with a lateral femoral epicondylar osteotomy during TKA. Preoperative and postoperative Knee Society Knee Scores, knee stability, range of motion, and radiographic alignment were recorded.Results
Ten patients (3 male and 7 female) underwent 12 TKAs by a single surgeon using a lateral femoral epicondylar osteotomy to correct a fixed valgus deformity. Implants used included 7 posterior stabilized, 3 constrained posterior stabilized, and 2 constrained condylar knees. Average age was 68 years (range 48-89) and average follow-up was 34.7 months (4-109). Average postoperative range of motion was 125° of flexion (range 95°-145°). The mean radiographic preoperative and postoperative anatomic tibiofemoral angles were 16.4° of valgus (range 12°-26°) and 5.5° of valgus (range 4°-7°), respectively. The mean preoperative knee society objective, satisfaction, expectation, and functional activity scores were 71, 20, 11, and 30, respectively. The mean postoperative knee society objective, satisfaction, expectation, and functional activity scores were 88, 34, 13, and 64, respectively. There was 1 postoperative deep vein thrombosis and 1 temporary peroneal nerve palsy.Conclusion
Lateral femoral epicondylar osteotomy is a useful technique to restore mechanical alignment in fixed valgus deformities in TKA. 相似文献17.
Ricardo Bastos Filho Robert A. Magnussen Victoria Duthon Guillaume Demey Elvire Servien José Mauro Granjeiro Philippe Neyret 《International orthopaedics》2013,37(3):427-431
Purpose
High tibial osteotomy (HTO) is frequently used to treat varus osteoarthritis in younger patients with the goal of delaying the need for total knee arthroplasty (TKA). While it has been reported that the results of TKA following HTO are worse than those in patients without prior knee surgery, the influence of osteotomy technique (medial opening-wedge versus lateral closing-wedge) has not been explored. The purpose of this study was to evaluate the influence of HTO technique on the performance and results of TKA.Methods
A total of 141 TKA’s performed in 118 patients with prior HTO (24 opening wedge and 117 closing wedge) were reviewed at a mean follow-up of two years. Reviewed data included intra-operative factors (tourniquet time, the need for additional exposure, and intra-operative complications), clinical results (International Knee Score (IKS)) and radiographic assessment of limb alignment.Results
The average IKS knee and function scores improved from 54.0 and 60.3 to 87.0 and 79.5 (p < 0.0001). There was no significant difference in IKS scores based on osteotomy technique. There was a trend toward an increased need for tibial tubercle osteotomy in the closing wedge group. There was an increased need for extensive medial release in the opening wedge group and extensive lateral release in the closing wedge group. No differences in tourniquet time, complication rates, or hip-knee-ankle angle were noted between the two groups.Conclusions
Radiographic limb alignment, patient-reported outcomes, and complication rates are equal in patients undergoing TKA after opening and closing wedge HTO. 相似文献18.
19.
Jason M. Hurst Riccardo Ranieri Keith R. Berend Michael J. Morris Joanne B. Adams Adolph V. Lombardi 《The Journal of arthroplasty》2018,33(10):3268-3272
Background
Persistent pain after medial unicompartmental knee arthroplasty (UKA) is a prevailing reason for revision to total knee arthroplasty (TKA). Many of these pathologies can be addressed arthroscopically. The purpose of this study is to examine the outcomes of patients who undergo an arthroscopy for any reason after medial UKA.Methods
A query of our practice registry revealed 58 patients who had undergone medial UKA between October 2003 and June 2015 with subsequent arthroscopy. Mean interval from medial UKA to arthroscopy was 22 months (range 1-101 months). Indications for arthroscopy were acute anterior cruciate ligament tear (1), arthrofibrosis (7), synovitis (12), recurrent hemarthrosis (2), lateral compartment degeneration including isolated lateral meniscus tears (11), and loose cement fragments (25).Results
Mean follow-up after arthroscopy was 49 months (range 1-143 months). Twelve patients have been revised from UKA to TKA. Relative risk of revision after arthroscopy for lateral compartment degeneration was 4.27 (6 of 11; 55%; P = .002) and for retrieval of loose cement fragments was 0.05 (0 of 25; 0%; P = .03). Relative risk for revision after arthroscopy for anterior cruciate ligament tear, arthrofibrosis, synovitis, or recurrent hemarthrosis did not meet clinical significance secondary to the low number of patients in these categories.Conclusion
The results of this study suggest that arthroscopic retrieval of cement fragments does not compromise UKA longevity. However, arthroscopy for lateral compartment degradation after UKA, while not the cause of revision, appears to be an ineffective treatment and predicts a high risk of revision to TKA regardless of its relative radiographic insignificance. 相似文献20.
Young Wan Moon Jae Gyoon Kim Jung Hoon Han Kwan Hong Do Jai Gon Seo Hong Chul Lim 《Clinics in Orthopedic Surgery》2013,5(1):36-43