全膝置换术经小切口股内侧肌入路与标准髌旁入路临床疗效比较的META分析

目的：系统评价经小切口股内侧肌入路行全膝关节置换术的疗效及安全行。方法使用计算机检索Cochrane图书馆、PubMed和CBM等数据库,并行手工检索,全面搜索关于经小切口股内侧肌入路及髌骨旁入路行全膝关节置换术的临床对比研究。由两名评价员独立筛选及纳入研究、提取数据资料及行方法学质量评估,采用Cochrane协作网提供的RevMan5．2软件进行Meta分析。结果共纳入符合本研究的试验文献11篇,其中小切口股内侧肌入路组395例,传统髌骨旁入路组372例。两组在术后并发症发生率、出血量、术后6周及3个月KSS临床与功能评分、手术时间、假体力线等方面未发现统计学差异。术后膝关节屈曲活动度、切口长度等方面,小切口股内侧肌入路组表现优于传统髌骨旁入路组。结论现有证据表明,小切口股内侧肌入路同髌骨旁入路对比,在并发症发生率、手术时间、假体力线、术后KSS评分、出血量以及术后关节屈曲活动度方面效果相似。但小切口股内侧肌入路行全膝关节置换切口更小,且能获得更快的膝关节功能恢复速度。受纳入研究质量的限制,上述结果还有待开展更多高质量的临床试验来进一步证实。     

微创全膝关节置换术中不干扰股四头肌和经股内侧肌入路的比较

目的比较不干扰股四头肌（QS）和经股内侧肌入路进行微创全膝置换术（MIS—TKA）的早期临床和影像学结果。方法从2005年9月至2006年9月，采用不干扰股四头肌和经股内侧肌入路分别完成33例和46例微创全膝置换术，观察手术时间、出血量、关节屈曲活动度、VAS（visual analog scale）疼痛评分，支持带松解率和直腿抬高时间；采用膝关节协会TKA放射线评估表评估假体位置和力线等。结果手术时间不干扰股四头肌组明显比经股内侧肌组长（P〈0．01）。而失血量，VAS评分，关节屈曲度和直腿抬高时间两组间的差异无统计学意义（P〉0．05）。影像学胫骨假体内移不干扰股四头肌组为5例，而经股内侧肌组为1例，两组间的差异有统计学意义（P〈0．01）。股骨外移两组分别为3例和4例，两组间的差异无统计学意义（P〉0．05）。术后胫股角和假体的对线指标两组间无差异。不干扰股四头肌组发生有症状的深静脉血栓为3例，经股内侧肌微创组为4例。两组都未发现皮肤坏死，深部感染，和神经血管损伤的并发症。结论不干扰股四头肌和经股内侧肌入路微创全膝置换早期功能恢复和早期结果没有差异。不干扰股四头肌入路要注意后外侧角的暴露，经股内侧肌入路要限制股内侧肌劈裂的长度和方向。     

经股内侧肌下入路与髌旁入路对初次全膝关节置换术后膝关节早期功能锻炼的影响

目的 观察经股内侧肌下入路与髌旁入路对初次全膝关节置换术后膝关节早期功能锻炼的影响。方法 回顾性分析自2018-01—2018-12采用经股内侧肌下入路和内侧髌旁入路行全膝关节置换术治疗的45例膝关节骨性关节炎,根据手术入路不同分为经股内侧肌下入路组与内侧髌旁入路组,比较两组手术时间、切口长度、术中出血量、术后初次行直腿抬高动作及屈曲至90°的时间,以及术后疼痛VAS评分、膝关节HSS功能评分。结果 所有患者均获得随访,随访时间至少3年。经股内侧肌下入路组手术时间比内侧髌旁入路长,但切口长度比内侧髌旁入路组短,两组术中出血量无明显差异。经股内侧肌下入路组术后首次行直腿抬高及屈曲90°均较内侧髌旁入路组早（P<0.05）。两组均无血管神经损伤、感染及下肢深静脉血栓形成。经股内侧肌下入路组术后第1天疼痛VAS评分低于内侧髌旁入路组（P<0.05）,但是两组术后1、3个月疼痛VAS评分差异无统计学意义（P>0.05）。经股内侧肌下入路组术后1个月膝关节HSS功能评分高于内侧髌旁入路组（P<0.05）,但是两组术后3个月、3年膝关节HSS功能评分差异无统计学意义（P&g...     

小切口股内侧与髌旁内侧入路行全膝置换术的比较研究

[目的]探讨经小切口股内侧肌入路行TKA的优点并与传统髌旁内侧入路的疗效进行比较.[方法]自2002年5月～2006年5月共收治行TKA56例60膝,其中采用小切口股内侧肌入路和传统髌旁内侧人路各28例30膝.分别对术后切口长度、疼痛度、引流出血量、手术前后Hb减少量、直腿抬高时间、术后住院天数、假体力线对位、术后6、12周、1年的活动度(ROM)及术后1年HSS评分进行比较分析.[结果]56例患者均获得随访,随访1～1.5年(平均13.2个月).两组除各有1例胫骨假体对位不良外,其余均获得准确的力线对位.微创组,平均切口11.3 cm,VAS评分平均2.76分,平均引流出血量96.8 ml、术后Hb平均减少25.5 g,直腿抬高平均3.8 d,术后平均住院8.6 d,术后6、12周的ROM分别为107°、117°;传统组,平均切口20.6 cm,VAS评分平均3.8分,平均引流出血量276.3 ml、术后Hb平均减少32.5 g,直腿抬高平均5.8 d,术后平均住院12.1 d,术后6、12周的ROM分别为98°、108°.以上各观察指标的手术疗效比较,经统计学分析显示差异有显著性意义(P＜0.01).微创组术后1年的ROM及HSS评分为121°和95分相对于传统组的118°和94分差异无显著性意义(P＞0.05).[结论]经微创中股入路行全膝置换术,术后膝关节功能恢复快,早期疗效满意.     

全膝关节置换术髌骨旁内侧入路和股内侧肌下入路对比研究

目的探讨研究全膝关节置换术不同手术入路方式对髌股关节并发症及髌骨内外倾运动的影响。方法将我院骨关节科于2011年1月至2013年2月收治的40例首次行全膝关节置换术的骨关节炎患者按照随机数字表法分为髌旁内侧入路(medial parapatellar approach,MPA)组和股内侧肌下入路(subvastus approach,SVA)组,每组各20例。MPA组采用髌旁内侧入路方式行全膝关节置换术,SVA组采用股内侧肌下入路行全膝关节置换术。对比两种手术入路方式对髌股关节并发症和髌骨内外倾运动的影响。结果 MPA组置换时间较SVA组显著减少,但前者切口长度和下床活动时间均远高于后者,差异具有统计学意义(P0.05)。两组术中出血量和置换后引流量差异无统计学意义(P0.05);两组术前、术后1年和术后2年KSS评分和髌骨倾斜角差异均无统计学意义(P0.05),术后3个月时MPA组KSS评分和胫骨关节屈30°时髌骨倾斜角差异显著(P0.05);MPA组并发症发生率为5%,SVA为0,差异无统计学意义(P0.05)。结论股内侧肌下入路全膝关节置换术较髌旁内侧入路方式对患者的伤害性刺激小,前者术后短期膝关节功能和髌骨倾斜角明显优于后者,但中远期疗效和并发症情况差异无统计学意义。     

经股内侧肌下方入路行全膝关节置换术的早期疗效

目的探讨经股内侧肌下方入路行全膝关节置换术(TKA)的早期疗效。方法通过回顾性研究方法,比较分析经股内侧肌下方入路和经典内侧髌旁入路行TKA治疗60例64膝原发性骨关节炎患者。其中经股内侧肌下方入路32例33膝,经典内侧髌旁入路28例31膝,随访时间超过3个月。比较两组患者的手术时间、切口长度、术后伤口引流量,术后2周、6周及3个月时关节活动度、疼痛程度以及膝关节功能。结果两组患者在手术时间、切口长度间的差异无统计学意义。术后经股内侧肌下方入路组伤口引流量200.2 m l,较经典内侧髌旁入路组340.6 m l明显减少。两组患者术后直腿抬高时间分别是2.8 d和5.2 d(t=-10.0208,P=0.0000),术后2周时两组患者关节活动度分别为97.2°和83.8°(t=2.5657,P=0.0128),疼痛程度经视觉模拟评分(VAS评分)分别为3.2分和4.6分(t=-0.6545,P=0.0000),组间差异有统计学意义。而术后6周、3个月时两组患者关节活动度(6周:t=0.2274,P=0.8209;3个月:t=0.6411,P=0.5239)、疼痛程度(6周:t=-0.6146,P=0.5423;3个月:t=-1.1358,P=0.2606)和关节功能(6周:t=0.3937,P=0.6955;3个月:t=1.0541,P=0.2960)差异没有统计学意义。结论与经典内侧髌旁入路相比,经股内侧肌下方入路行TKA具有术后出血少,术后早期膝关节功能恢复快等优点,其远期疗效和经典入路没有明显差异。     

两种入路在全膝关节置换术中的应用比较

目的 比较两种入路在全膝关节置换术（TKA）中的应用效果。方法 将行TKA治疗的100例膝骨关节炎患者按照手术入路不同分为经内侧髌旁入路组（51例）和经股内侧肌下入路组（49例）。比较两组手术时间、术中出血量、术后引流量、膝关节活动度。采用HSS评分评价膝关节功能。结果 患者均获得随访,时间3～5(3.52±0.38)个月。手术时间、术中出血量、术后引流量：两组比较差异均无统计学意义（P> 0.05）。术后3个月膝关节HSS评分、末次随访时膝关节屈曲活动度：经股内侧肌下入路组均明显大于经内侧髌旁入路组（P<0.05）。结论 与经内侧髌旁入路相比,经股内侧肌下入路行TKA治疗膝骨关节炎具有早期膝关节功能好的优势,且不会延长手术时间及增加术中出血量、术后引流量。     

股内侧肌下入路全膝关节置换术初步观察研究

[目的]探讨股内侧肌下入路小切口微创全膝关节置换术的优点、风险及手术要点。[方法]自2005年4月-2006年12月本院共行全膝关节置换术204例（344膝），其中传统切口（convention incision，CI）置换组146例（246膝），经股内侧肌下入路微创（minimally invasive，MIS）置换组58例（98膝），均采用Zimmer公司NEXGEN-LPS人工全膝关节，记录麻醉时间、手术时间、住院时间；比较患者术后第一次下地时间，不同时间阶段行走距离、膝关节主动活动度、手术前后HSS评分以及手术并发症情况。[结果]204例均获随访，时间4—7个月（平均5个月），微创组和对照组麻醉时间、切口长度、手术时间、住院时间、下地时间比较差异均有统计学意义（u检验，P〈0．05），微创组麻醉时间、手术时间均大于对照组，切口长度、住院时间、下地时间均小于对照组。术后24h、1周、1月行走距离两组之间存在显著性差异（u检验，P〈0．05），术后3个月行走距离两组之间无显著性差异（u检验，P〉0．05）。术后24h、1周、2周非负重主动活动度两组之间存在显著性差异（u检验，P〈0．05），术后1个月行走距离两组之间无显著性差异（u检验，P〉0．05）。HSS评分术后24h、1周、2周膝关节HSS评分两组之间存在显著性差异（u检验，P〈0．05），术后1月HSS评分两组之间无显著性差异（u检验，P〉0．05）。[结论]股内侧肌下入路小切口微创全膝关节置换术股四头肌损伤小，术后膝关节主动活动时间较早，膝关节功能恢复较快，术后远期步行距离、膝关节非负重主动活动度及HSS评分两者无明显差别。     

运用微创髌旁内侧入路行内侧单髁膝关节置换术

目的：评价运用微创髌旁内侧入路行内侧单髁膝关节置换术的临床效果。方法前瞻性分析2009年1月至2013年12月在广州市正骨医院膝关节外科用微创髌旁内侧入路行内侧单髁置换的41例患者（41膝）,手术均采用Biomet Oxford Ⅲ骨水泥型人工单髁假体,随访时间最少12个月。根据术前Kujala膝前痛评分将所有病例分为膝前痛组（19例）和对照组（22例）,记录并分析其手术前后的膝关节活动度,HSS评分及Kujala膝前痛评分,以评价其手术前后膝关节尤其是髌股关节功能的恢复程度。结果两组的术前和术后HSS评分、Kujala膝前痛评分存在统计学差异,膝前痛组的分值更低。两组术后HSS评分的提高程度无统计学差异,而Kujala膝前痛评分的提高则是膝前痛组更显著。结论运用微创髌旁内侧入路行内侧单髁膝关节置换术安全可行,创伤小,疗效良好,术中可观察、处理髌股关节病变,甚至改善髌骨轨迹,提示该入路对内侧间室合并髌股关节病变的患者更加适合。     

小切口经股内侧肌入路行全膝关节置换术

目的 探讨小切口经股内侧肌入路行全膝关节置换术的早期临床疗效和特点.方法 小切口经股内侧肌入路行全膝置换28例(30膝).分别对术后切口长度、疼痛度、镇痛剂使用量、手术前后Hb减少量、输血量、引流量、直腿抬高时间、术后住院时间、假体力线对位,术后6、12周、1年的活动度(ROM)及术后1年膝关节HSS评分等观察指标进行疗效分析.结果 28例患者均获得随访,时间1年～1年6个月.切口长度8.5～14(11.3±0.8) cm,VAS评分1.2～4(2.76±0.76)分,术后2例患者肌注75 mg杜冷丁,5例口服塞来昔布(西乐葆)0.4 g,余患者均未给予镇痛剂,引流量25～300(96.8±55.9)ml、Hb减少10～55(25.5±10.5)g/L,距能直腿抬高时间1～8(3.8±1.57)d,术后住院6～14(8.6±2.0)d,术后6、12周、1年的平均ROM分别为107°±6.3°、117°±5.5°、121°±6°,1年HSS评分平均95分±1.7分;除有1例胫骨假体对位不良外,其余均获得正确的力线对位.结论 小切口经股内侧肌入路行全膝关节置换,术后膝关节功能恢复快,早期疗效满意.     

女性高屈曲度假体与普通高屈曲度假体治疗女性膝骨关节炎的近期临床疗效比较

背景：全膝关节置换术（total knee arthroplasty,TKA）已成为治疗膝骨关节炎（osteoarthritis of the knee,OA）的有效方法。但在治疗满意度上,男女之间差别较大。 目的：比较采用Gender Solutions Nex-Gen膝关节假体与普通高屈曲度假体治疗女性膝骨关节炎的近期临床疗效。 方法：2008年3月至2011年11月,55例（79膝）女性OA患者接受全膝关节表面置换手术。A组：24例37膝,采用Gen-der Solutions Nex-Gen膝关节假体（美国Zimmer公司）;B组：31例42膝,采用普通高屈曲度假体（美国Zimmer公司）治疗。对比两组手术并发症、KOOS （Knee injury and Osteoarthritis Outcome Score）评分、主观满意指数（satisfaction in-dex,SI）、膝关节活动度、膝关节最大屈曲度、膝前疼痛发生率。 结果：55例患者中4例失访,平均随访35.2个月（24~50个月）,KOOS各项评分两组间比较无统计学意义（P〉0.05）,但组内比较均有统计学意义（〈0.01）。组间及组内膝关节活动度、最大屈曲度比较差异均有统计学意义（〈0.01）。组间主观满意度比较有统计学意义（〈0.01）。A组下肢静脉血栓1例,给予抗凝治疗后痊愈;B组膝关节浅度感染1例,膝前反复痛7例,两组膝前疼痛率比较有统计学意义（〈0.05）。两组病例无膝关节僵直、神经血管损伤、假体松动。 结论：Gender Solutions Nex-Gen与普通高屈曲度假体均能有效治疗女性膝骨关节炎,但Gender Solutions Nex-Gen膝关节假体符合女性膝关节解剖,满意度、临床疗效更高。     

Midterm Outcomes and Survivorship of Anterior Stabilized Versus Cruciate Retaining Bearing in Primary Total Knee Arthroplasty

BackgroundThere has been increasing utilization of ultracongruent bearings with a cruciate retaining (CR) femoral component in primary total knee arthroplasty. The purpose of this study is to compare outcomes and survivorship between an ultracongruent anterior stabilized (AS) and CR bearing.MethodsA retrospective review was performed from 2010 through 2014 of all primary total knee arthroplasties with a single knee systems identical CR femur and AS or CR bearing with minimum 2-year follow-up yielding a study cohort of 3323 patients (4164 knees). Knee range of motion, Knee Society pain scores, Knee Society clinical scores, Knee Society functional scores, and University of California Los Angeles activity scores were evaluated. The need for manipulation under anesthesia (MUA), nonrevision surgery and revisions were assessed.ResultsAS bearing was used in 1471 knees (35%) and CR bearing used in 2693 knees (65%). Mean follow-up was 5.4 years. The AS group had significantly higher improvements in knee range of motion, Knee Society clinical, Knee Society functional, and Knee Society pain scores. MUAs were performed on 120 knees (8.2%) in the AS group compared with 158 knees (5.9%) in the CR group (P = .005). The AS group had significantly less all-cause failure, aseptic failures, revisions for instability, and revisions for isolated polyethylene wear. The 10-year aseptic survival for AS was 98.3% and for 92.3% for the CR group (P = .002).ConclusionThese mid-term results demonstrate the AS bearing had significantly higher improvements in clinical and functional outcomes as well as greater survivorship. Knees in which an AS bearing was used did have a higher incidence of MUA.     

Total knee arthroplasty after high tibial osteotomy. A comparison study in patients who had bilateral total knee replacement

BACKGROUND: The outcome of total knee replacement after high tibial osteotomy remains uncertain. We hypothesized that the results of total knee replacement with or without a previous high tibial osteotomy are similar. METHODS: The results of a consecutive series of thirty-nine bilateral total knee arthroplasties performed with cement at an average of 8.7 years after unilateral high tibial osteotomy were reviewed. There were twenty-seven men and twelve women. Preoperatively, the knee scores according to the system of the Knee Society were similar for all of the knees; however, valgus alignment and patella infera were more common in the knees with a previous high tibial osteotomy. Bilateral total knee replacement was staged in seven patients and was simultaneous in thirty-two patients. The results of the total knee arthroplasties were retrospectively reviewed with respect to the knee and function scores according to the system of the Knee Society, the radiographic findings, and the complications. RESULTS: Intraoperatively, no notable differences were identified in the number of medial, lateral, or lateral patellar releases required. However, less lateral tibial bone was resected in the group with a previous high tibial osteotomy (average, 3.3 millimeters) than in the group without a high tibial osteotomy (average, 7.5 millimeters). The average duration of follow-up was 7.5 years (range, three to sixteen years) in the group with a previous high tibial osteotomy and 6.8 years (range, two to ten years) in the group without a high tibial osteotomy. At the time of the final follow-up, the knee and function scores were similar for the two groups (89.0 and 81.0 points, respectively, for the group with a previous high tibial osteotomy, and 89.6 and 83.9 points, respectively, for the group without a high tibial osteotomy). Although more knees were free of pain in the group without a previous high tibial osteotomy (thirty-six) than in the group with a previous osteotomy (thirty-three), this difference was not found to be significant with the numbers available (p = 0.4810). Knee alignment and stability, femoral and tibial component alignment, and range of motion also were similar in both groups postoperatively. One allpolyethylene tibial component was revised in the high tibial osteotomy group. Two knees in each group required manipulation. There were no deep infections. CONCLUSIONS: While patients with a previous high tibial osteotomy may have important differences preoperatively, including valgus alignment, patella infera, and decreased bone stock in the proximal part of the tibia, the present study suggests that the clinical and radiographic results of primary total knee arthroplasty in knees with and without a previous high tibial osteotomy are not substantially different. In our relatively small group of patients, the previous high tibial osteotomy had no adverse effect on the outcome of the subsequent total knee replacement.     

Total knee arthroplasty in patients </=50 years old

Thirty patients (30 knees) who underwent total knee arthroplasty at age 相似文献   

Total knee arthroplasty in patients 40 years of age and younger with osteoarthritis

The results of 32 total knee arthroplasties performed for osteoarthritis in 32 patients who were 40 years of age or younger are reviewed. At a mean followup of 7.9 years (minimum, 5 years), the Knee Society knee scores increased from an average of 47 to 88 points, and the function scores increased from 45 to 70 points. Overall, Knee Society knee scores were considered good or excellent in 82% of patients (26 knees) and fair or poor in 18% (six knees). Postoperative function scores were good or excellent in only 40% (13 knees). The average postoperative flexion arc was 110 degrees. If patients involved in worker's compensation cases are excluded from analysis, the results improved substantially, with range of motion averaging 113 degrees, and Knee Society knee scores and function scores averaging 92 points and 77 points, respectively. Excluding the five patients involved in workmen's compensation cases, knee scores were good or excellent in 91% of patients (25 knees) and function scores were good or excellent in 50% of patients (14 knees). Three revisions were performed for aseptic failure; one additional patient has radiographic evidence of tibial loosening, representing an aseptic failure rate of 12.5% at 8 years. Although slightly higher than observed in older patients, this failure rate still may be considered acceptable for this population of patients with severely affected knees who are not considered candidates for nonarthroplasty surgery. Despite a slightly higher tendency for aseptic failures in this group of patients, cemented total knee arthroplasty may provide some patients younger than 40 years of age with severe debilitating and recalcitrant osteoarthrosis, an important option with reasonable mid- and long-term results.     

Ten-Year Minimum Outcomes and Survivorship With a High Flexion Knee System

BackgroundThe purpose of this study is to report the long-term outcomes and survivorship of a high flexion knee system.MethodsWe identified 1312 patients (1664 knees) who underwent primary total knee arthroplasty with the Vanguard Complete Knee System with 10-year minimum follow-up. Preoperative and postoperative range of motion, Knee Society scores, complications, and reoperations were evaluated.ResultsAt an average of 11.9 years of follow-up, 88 knees were revised (5.3%). The deep infection rate was 1.4%. There was an average range of motion improvement of 3.9°, pain level decreased by 35.8, Knee Society clinical scores improved by 48, and Knee Society functional scores improved by 15.1 (all P < .001). Survival was 96.4% at 10 years for aseptic causes and 95.5% for all causes.ConclusionAt a 10-year minimum follow-up, this high flexion knee system demonstrates excellent survivorship.     

Radiographic analysis of low contact stress meniscal bearing total knee replacements

BACKGROUND: Meniscal bearing total knee replacements were developed to decrease the contact stresses on polyethylene and to reduce polyethylene wear. The kinematics of meniscal bearing knee replacements is poorly understood. The present study was designed to evaluate, with radiographic analyses, the motion of the meniscal bearings and the femoral rollback of the Low Contact Stress meniscal bearing knee replacement during knee flexion. METHODS: Eighty-one Low Contact Stress meniscal bearing total knee replacements in seventy-six male patients were assessed on fluoroscopically centered lateral radiographs made with the knee in full extension and in full flexion at an average of six years (range, twenty-four to 147 months) after the operation. The distance and direction of motion of the meniscal bearings and the center contact position of the femoral condyles were measured. Knee evaluations were performed with use of the Knee Society rating system. RESULTS: The average range of motion of the knees, measured on lateral radiographs, was 90 degrees (range, 45 degrees to 136 degrees). As they moved from terminal extension to terminal flexion, thirty-nine knees (48%) exhibited anterior motion of both bearings and sixteen (20%) demonstrated posterior motion of both bearings. Ten knees (12%) had reciprocal motion of the two bearings (one bearing moving anteriorly and one bearing moving posteriorly) with flexion, nine knees (11%) had motion of only one bearing, and seven knees (9%) had no motion of either bearing. When moving from full extension to full flexion, eighteen knees (22%) demonstrated femoral rollback, six knees (7%) showed no change in the position of femoral contact, and fifty-seven knees (70%) exhibited anterior sliding of the femoral condyles. Flexion of the knees demonstrating femoral rollback averaged 104 degrees (range, 76 degrees to 128 degrees), and flexion of the knees demonstrating anterior sliding averaged 94 degrees (range, 45 degrees to 125 degrees). The difference was significant (p = 0.03). According to the Knee Society rating system, the average clinical score for the entire group was 76 points (range, 27 to 100 points) and the average functional score for the entire group was 72 points (range, 30 to 100 points). The average clinical score was 79 points (range, 27 to 98 points) for the knees that exhibited anterior sliding of the femoral condyles and 87 points (range, 52 to 100 points) for those exhibiting femoral rollback (p = 0.09). The average functional scores were 64 points (range, 30 to 100 points) and 72 points (range, 45 to 100 points), respectively (p = 0.15). CONCLUSIONS: Radiographic analysis of meniscal bearing total knee replacements demonstrated an average anterior motion of both the medial and the lateral meniscal bearing of 4.7 mm (range, 1 to 14 mm) in thirty-nine knees (48%) as they moved from terminal extension to terminal flexion. Sixty-three knees (78%) demonstrated no femoral rollback as they were flexed. Knees with anterior sliding of the condyles had a significantly smaller average range of flexion (p = 0.03) and a lower average Knee Society score than did knees demonstrating femoral rollback. We believe that lack of rollback indicates a functional insufficiency of the posterior cruciate ligament.     

Total condylar knee replacement: a 20-year followup study.

Between 1976 and 1979, 220 total knee replacements were done on 164 patients using the Total Condylar Knee replacement. The diagnosis was rheumatoid arthritis in 111 knees and osteoarthritis in 109 knees. Patients with 157 knees are known to have died as of December 1998, leaving 63 knees in patients who are still alive. Twelve patients with 18 knees were lost to followup. The average 20-year followup data (range, 18-22 years) are presented for 45 knees in 30 patients using Knee Society evaluations. The average Knee Society clinical score for the surviving patients was 88 points, and the average functional score was 58 points. The radiographic followup averaged 19 years. The average overall alignment was 3 degrees valgus. Femoral lucencies were present in 17 of 40 adequate lateral views, most commonly about the anterior and posterior surfaces. Two femoral components were loose. Twenty-two tibial components had radiolucencies; four radiolucencies were circumferential. The remaining 41 knees retained a well-fixed cemented central peg despite proximal interface lucencies. From the group of 220 knees, 14 revisions have been done at an average of 11.4 years postoperative. Two knee replacements were revised for isolated tibial loosening, whereas one knee replacement had isolated femoral loosening. Three knee replacements were revised for loosening of both components, and one was revised for isolated patellar loosening. Four patients had sepsis develop; three of these four patients were treated with two-stage revision, and one underwent fusion. Three patients were treated for supracondylar fractures. The Total Condylar Knee replacement maintains excellent durability at 20-years followup.