Revision total knee arthroplasty using the porous-coated anatomic revision prosthesis: Six- to twelve-year results

The porous-coated anatomic (PCA) revision prosthesis was one of the earliest revision total knee systems to feature more constraint for stability, stems for fixation, and thicker femoral components to address bone loss. From 1981 to 1989, 36 revision total knee arthroplasties were performed using the PCA prosthesis. Patients were evaluated by clinical examination, radiographs, and the Hospital for Special Surgery Knee Rating Scale. Six patients died and three were lost to follow-up; 27 knees remained for follow-up. The average age at surgery was 66 years. Follow-up averaged 9.8 years (range, 6–12.4 years). Range of motion averaged 4° to 91° before surgery and 1° to 92° after surgery. Knee scores averaged 48 before surgery and 86 after surgery. Three femoral and 10 tibial components showed lucent lines, with 3 tibial components showing progressive lucency. Six patients required reoperation: 3 for tibial component loosening, 1 for wound infection, 1 for deep infection, and 1 for persistent pain. These results suggest that the use of an implant specifically designed for revision can yield successful long-term results.     

Tibial component fixation in porous- and hydroxyapatite-coated total knee arthroplasty: a radiostereo metric evaluation of migration and inducible displacement after 5 years

A total of 51 knees (45 patients) with osteoarthrosis were stratified in a randomized study to receive a hydroxyapatite-coated Freeman-Samuelson (FS HA) or a porous-coated Miller-Galante II (MG II) uncemented total knee arthroplasty. Repeated clinical, radiographic, and radiostereometric analysis (RSA) evaluations of the tibial components were done for 5 years. The clinical outcome was equal at the 5-year follow-up (mean Hospital for Special Surgery score, 93). Standard radiographs displayed more zones around the tibial stem in the MG II group. RSA revealed that the FS HA components migrated less (smaller maximum total point motion and maximum subsidence) after 5 years and showed less inducible displacements at the 1-year follow-up. The stability of the implants obtained is equal to or better than cemented implants after 5 years. Key words: knee prosthesis, cementless, hydroxyapatite, radiostereometry, inducible displacement.     

Cementless porous-coated total knee arthroplasty: 10-year results in a consecutive series

We report the results of 114 AGC 2000 porous-coated, cementless total knee arthroplasties (TKA) performed consecutively in 102 patients during the period 1984-1986. After 10 years, 58 TKAs in 52 patients were evaluated with patient assessment, Hospital for Special Surgery knee score, weight-bearing radiographs done under fluoroscopic control, and survivorship analysis. All dropouts within the first 9 years were patients dying with a functioning TKA except 1 revision secondary to a supracondylar fracture after 8.5 years. Of the patients, 53 (92%) were satisfied or very satisfied with their TKA, and 55 (95%) of the knees were rated good or excellent. There was no pain in 53 knees, and the median knee flexion was 110 degrees. Six radiolucencies >1 mm were found beneath parts of the tibial component, and 5 radiolucencies were seen beneath the femoral component. None had progressed compared with the 5-year follow-up, and in all cases trabeculae could be seen reaching the prosthetic component. No migrations had occurred since the 5-year follow-up. No obvious joint space reduction was seen. Osteolysis presenting as an isolated cyst was found in 1 knee in the lateral tibial condyle and was not progressive. Two tibial components had been revised because of aseptic loosening and 1 because of septic loosening, all within the first 3 years. No femoral or patellar components were revised. The cumulative prosthesis survival rate after 10 to 11 years was 97%. When pain and radiographic loosening also were considered, the success rate was 87%. Cementless insertion of a nonmodular, porous-coated TKA resulted in a long-term durable bone-prosthesis interface. The flat-on-flat articulation did not result in catastrophic polyethylene wear or osteolysis within the first 10 years.     

A prospective clinical and radiological study comparing hydroxyapatite-coated with cemented tibial components in total knee replacement

This prospective study compares the outcome of 157 hydroxyapatite (HA)-coated tibial components with 164 cemented components in the ROCC Rotating Platform total knee replacement in 291 patients. The mean follow-up was 7.6 years (5.2 to 11). There were two revisions for loosening: one for an HA-coated and one for a cemented tibial component. Radiological evaluation demonstrated no radiolucent lines with the HA-coated femoral components. A total of three HA-coated tibial components exhibited radiolucent lines at three months post-operatively and these disappeared after three further months of protected weight-bearing. With HA-coated components the operating time was shorter (p?相似文献   

Posterior cruciate-retaining modular total knee arthroplasty: a 9- to 12-year follow-up investigation

Between November 1988 and January 1991, 101 press-fit condylar (PFC; Johnson & Johnson, Raynham, MA) posterior cruciate-retaining total knee arthroplasties were performed in 75 patients. All tibial components were modular metal-backed, and all patellar components were all-polyethylene. All living patients were evaluated at an average 10.5 years (range, 9.5-11.8 years). Only 1 knee required revision (at 11.1 years after the procedure), and only 1 other knee had evidence of radiographic failure. The average range of motion was 1 degrees (range, 0 degrees -10 degrees ) to 110 degrees (range, 86 degrees -130 degrees ). At 10 years of follow-up, the probability of prosthesis survival was 100%, and at 12 years, the probability of prosthesis survival was 93.3% (endpoint defined as revision for any reason).     

Osteolysis associated with a cemented modular posterior-cruciate-substituting total knee design : five to eight-year follow-up

BACKGROUND: Most intermediate and long-term studies of cemented posterior-cruciate-substituting total knee prostheses were performed with nonmodular tibial components. The purpose of this study was to evaluate the intermediate-term results of posterior-cruciate-substituting total knee arthroplasties in which a cemented modular tibial component had been used, with a particular focus on evaluating the prevalence of radiographic osteolysis. METHODS: Between 1992 and 1995, 176 consecutive primary total knee arthroplasties with use of the Insall-Burstein II system were performed in 134 patients at our institution. A modular metal-backed tibial component was inserted in 145 knees, and an all-polyethylene tibial component of the same design was inserted in thirty-one. Standard-terminology questionnaires were completed or Knee Society and The Hospital for Special Surgery scores were determined preoperatively and at the time of final follow-up, at an average of 6.4 years (range, 5.0 to 7.9 years). Initial postoperative radiographs were compared with those made at the time of final follow-up to assess component position, wear, radiolucent lines, and osteolysis. RESULTS: Ninety-two patients (128 knees) treated with the modular tibial component were alive at the time of final follow-up. No patient was lost to follow-up. Radiographs were available for 105 knees (82%). Three knees had been revised because of instability or infection; none had been revised because of loosening or osteolysis. The mean Knee Society clinical and functional scores were 85 points (range, 41 to 100 points) and 79 points (range, 30 to 100 points), respectively, at the time of final follow-up. According to The Hospital for Special Surgery score, 94% of the knees had a good or excellent result. Knee flexion averaged 113 degrees (range, 90 degrees to 130 degrees ) at the time of final follow-up. Osteolysis was present in seventeen (16%) of the knees with radiographic follow-up. Osteolysis did not develop in any knee in which an all-polyethylene tibial component had been used. Two knees (in one patient) were revised because of osteolytic lesions found at the time of follow-up for the study. Both of these knees had anterior wear of the tibial post due to impingement and backside tibial polyethylene wear. CONCLUSIONS: Modular Insall-Burstein II total knee prostheses were found to function well after five to eight years of follow-up. However, the high prevalence of osteolysis in patients who had good or excellent clinical scores is worrisome. Particular attention should be paid to preventing flexion of the femoral component, posterior slope of the tibial component, or hyperextension of the knee when posterior-cruciate-substituting total knee arthroplasty is performed. We also recommend routine follow-up radiographs after all total joint arthroplasties to detect asymptomatic osteolytic changes.     

Poor outcomes of isolated tibial insert exchange and arthrolysis for the management of stiffness following total knee arthroplasty.

BACKGROUND: Severe stiffness after total knee arthroplasty is a debilitating problem. In patients with securely fixed and appropriately aligned components, arthrolysis of adhesions and exchange to a thinner tibial polyethylene insert may appear to be a reasonable and logical solution. We reviewed our experience with this procedure to determine its efficacy. METHODS: From 1992 through 1998, seven knees with marked stiffness after total knee arthroplasty were treated at our institution with arthrolysis of adhesions and conversion to a thinner tibial polyethylene insert. Only patients in whom the total knee prosthesis was well aligned, well fixed, and not associated with infection were included. There were five women and two men with a mean age at revision of sixty-one years (range, thirty-eight to seventy-four years). The average time to revision was twelve months, and the mean arc of motion prior to revision was 38.6 degrees (range, 15 degrees to 60 degrees ). The duration of follow-up after the insert exchange averaged 4.2 years (range, two to eight years). RESULTS: Mean Knee Society pain and function scores changed from 44 and 36.4 points preoperatively to 39.6 and 46 points at the time of final follow-up. Two knees were rerevised, one because of infection and the other because of aseptic loosening of the components. The five remaining knees were painful and stiff at the time of final follow-up. Four of these five knees were severely painful, and one knee was moderately and occasionally painful. The mean arc of motion of these five knees was 58 degrees (range, 40 degrees to 70 degrees ) at the time of final follow-up. CONCLUSION: Isolated tibial insert exchange, arthrolysis, and débridement failed to provide a viable solution to the difficult and poorly understood problem of knee stiffness in a group of carefully selected patients following total knee arthroplasty. We therefore have little enthusiasm for the continued use of this strategy.     

Uncemented rotating-platform total knee replacement: a five to twelve-year follow-up study

BACKGROUND: Mobile-bearing knee designs represent an alternative to conventional fixed-bearing total knee arthroplasty. We present the results of a prospective, intermediate-term clinical follow-up study of the bicruciate ligament-sacrificing porous-coated Low Contact Stress rotating-platform total knee design. METHODS: Between February 1984 and January 1994, 528 uncemented primary knee replacements were performed in 421 patients. All patellae were resurfaced with use of the Low Contact Stress rotating patellar component. The average age of the patients at the time of the index procedure was sixty-nine years. The study group included 261 women and 160 men. Patients were evaluated at three months, six months, and yearly thereafter with use of the 100-point New Jersey Orthopaedic Hospital knee-scoring system. In addition, a radiographic analysis of the tibial, femoral, and patellar components was performed at each interval. RESULTS: There were twenty-nine failures that resulted in revision. The Kaplan-Meier estimate of implant survival at twelve years was 89.5% (95% confidence interval, 83.4% to 95.6%). The total clinical scores improved significantly compared with the preoperative scores for the first twelve months postoperatively and then plateaued. Three hundred and twenty-one knees had adequate radiographic follow-up (average, 8.1 years; range, five to twelve years). Zonal radiographic analysis revealed ninety-three instances of radiolucent lines (eighty-two of which measured <1 mm in width), with the greatest number of radiolucent lines (thirty-nine) being located around the tibial tray stem. None of these lines were deemed to be progressive, and no knee with a radiolucent line that measured >2 mm was revised because of failure. CONCLUSIONS: This first-generation uncemented, mobile-bearing, bicruciate ligament-sacrificing knee replacement was associated with a good survival rate and demonstrated clinical efficacy during the five to twelve-year follow-up interval. .     

Survivorship analysis of the uncemented porous-coated anatomic knee replacement

Ninety-six patients who had a total of 108 replacements with an uncemented porous-coated anatomic knee prosthesis were followed for an average of sixty-four months (range, thirty-nine to ninety-three months). At the time of the most recent follow-up, twenty-one implants (19 per cent) had failed, all due to problems with the tibial component. A patellar component was not used, and no noteworthy patellar problems were encountered after the operation. There were no infections about the prostheses, and no femoral implant was revised. The most common cause of failure was collapse of the anteromedial part of the tibial plateau, which occurred in fourteen knees. The prosthesis loosened without collapse of bone in two knees, and five knees were revised because of gross wear of the polyethylene. When the time of failure was defined as the point at which revision of the prosthesis was recommended, the cumulative rate of survival was 84 per cent (95 per cent confidence interval, +/- 7 per cent) at five years and 77 +/- 10 per cent at six years. When the time of failure was defined as the point at which the knee replacement was actually done, the five-year rate of survival was the same. No significant differences were demonstrated between groups that were stratified by age, sex, weight, or primary diagnosis. We therefore do not recommend the use of an uncemented porous-coated anatomic knee replacement of the design that was evaluated in this study.     

Roentgenographic evaluation of geometric total knee arthroplasty with a six-year average follow-up period

The geometric total knee prosthesis was used in the reconstruction of 70 damaged knee joints in 56 patients from November 1973 through March 1979. The average follow-up period extended to six years and seven months. Eleven patients had died and four could not be located. Eighty-one percent of the remaining knees had little or no pain at the time of the review. Pain in the patellofemoral joints was an insignificant problem in this series. The femorotibial shaft angle ranged from 0 degrees to 10 degrees of valgus in 43 (82.7%) of 52 knees. Six knees showed varus deformity at the time of follow-up examination. Stress fracture of the medial condyle of the tibia was found in two of these six knees. The absence of a radiolucent zone at the tibial cement-bone interface was noted in only ten (19.2%) of the 52 knee roentgenograms. New formation or progression of a radiolucent zone from six to 12 months after the operation was found in 36.5%. Positional abnormality of the marker wires seen in serial roentgenograms existed in 51.9% of the knees. Nine knees (17.3%) disclosed a gap between the metallic articular surface and the tibial component and also showed the collision of the tibial intercondylar eminence against the femur in the standing position. The tibial component of the prosthesis was fractured in one knee.     

Total knee replacement following high tibial osteotomy

There have been conflicting reports in the literature regarding the results of post high tibial osteotomy knee arthroplasty. This study aims to assess the clinical and radiological results as well as patient satisfaction following post high tibial osteotomy knee arthroplasty and to identify the variables affecting the results. A total of 29 cases of post osteotomy knee arthroplasties were retrospectively analyzed. Preoperative and postoperative range of movement and deformity were recorded with knee scores at latest follow-up. Weightbearing radiographs were taken preoperatively and at latest follow-up. Patients were asked if they were satisfied with their results. Average follow-up was 7.5 years with an average interval between osteotomy and knee arthroplasty of 4.7 years. Average age at osteotomy was 62.5 years. Seventeen patients had Maquet's dome osteotomy and 12 had closing wedge osteotomy. The average knee score was 117.4. Overall 5 (17.2%) patients had a poor result. There was a significantly greater pre-osteotomy subluxation (9 mm) in the failed knees compared to the successful arthroplasties (3.64 mm) with p = 0.033 using the Mann-Whitney U test. This has to be tempered by the fact that numbers were small. Failed arthroplasties had a valgus cut of the tibia (1.5 degrees) compared to either a neutral or slight varus cut in successful arthroplasties (average 2.42 degrees varus). Lateral translation of tibial tray was greater in the failed knees whereas posterior translation was greater in the successful knees. However, differences in tibial tray angle and translation were not statistically significant. Four (21.05%) cases went on to revision of their arthroplasty in less than 8 years, 2 for painful valgus instability. This study concludes that post high tibial osteotomy knee arthroplasty is a technically demanding operation with altered anatomy and significant balancing problems. Results of knee arthroplasty after high tibial osteotomy are inferior to that of primary arthroplasties and the amount of lateral subluxation prior to surgery may adversely affect results.     

旋转铰链型人工膝关节临床应用近期疗效观察

目的探讨旋转铰链型人工膝关节临床应用的近期疗效。方法2002年7月～2005年4月，应用旋转铰链型人工膝关节假体进行全膝关节置换术治疗膝关节严重畸形和不稳定17例17膝。其中男8例，女9例；年龄41～79岁，平均59岁。左侧10例，右侧7例。患者均因膝关节疼痛人院，病程1～7年。其中骨性关节炎10例，类风湿性关节炎5例，左股骨骨折术后创伤性关节炎1例，左胫骨平台骨折术后创伤性关节炎合并前交叉韧带、内侧半月板损伤及内侧侧副韧带断裂1例。术前HSS（hospital for special surgery）评分36-58分，平均48．6分；术前膝关节屈曲活动度21～80°，平均57．4°。结果术后患者均获随访7个月～3年，平均23．6个月。无下肢静脉血栓形成或肺栓塞，无腓总神经麻痹、骨折或伸膝装置断裂等并发症发生。1例患者术后3个月出现迟发感染，再次手术取出假体，应用抗生素骨水泥间隔行膝关节旷置待二期置换。其余16例最后随访时，HSS评分78～98分，平均91．1分，较术前平均增加45．5分，且差异有统计学意义（P〈0．05）；术后2周，膝关节屈曲活动度为75～100°，平均85．2°，最后随访时膝关节屈曲活动度为85～123°，平均108．3°，与术前比较差异有统计学意义（P〈0．05）。结论旋转铰链型人工膝关节置换术近期疗效肯定，远期疗效尚待进一步随访。     

Effect of bone marrow grafting on the titanium porous-coated implant in bilateral total knee arthroplasty

Background and purpose Poor bone ingrowth into the porous coating of tibial components has been reported. We hypothesized that iliac marrow grafting might be useful to enhance bone ingrowth into a porous-coated implant. The first part of this study was to examine the presence of fibroblast colony-forming units (CFUF) containing osteogenic precursor cells in tibial bone marrow and iliac bone marrow. The second aim was to compare the clinical and radiographic results after bilateral total knee arthroplasty (TKA) with and without autologous bone marrow transplantation to the bone-implant interface.

Methods Simultaneous bilateral TKA was performed in 21 patients with osteoarthritis. Aspirated iliac bone marrow was transplanted to the interface of one randomly selected porous-coated tibial component in each patient, and contralateral knees served as controls. All of the 21 patients were followed for 5 years.

Results The average number of CFU-F was significantly lower in tibial marrow than in iliac marrow (p = 0.008). The final fluoroscopically-guided radiographs revealed a decrease in the number of knees with radiolucent lines after marrow grafting compared to those without grafting (p = 0.004).

Interpretation Iliac bone marrow is useful as a bone grafting material to enhance the biological fixation in porous-coated implants.     

High complication rate in the early experience of minimally invasive total hip arthroplasty by the direct anterior approach

Background and purpose?Poor bone ingrowth into the porous coating of tibial components has been reported. We hypothesized that iliac marrow grafting might be useful to enhance bone ingrowth into a porous-coated implant. The first part of this study was to examine the presence of fibroblast colony-forming units (CFUF) containing osteogenic precursor cells in tibial bone marrow and iliac bone marrow. The second aim was to compare the clinical and radiographic results after bilateral total knee arthroplasty (TKA) with and without autologous bone marrow transplantation to the bone-implant interface.

Methods?Simultaneous bilateral TKA was performed in 21 patients with osteoarthritis. Aspirated iliac bone marrow was transplanted to the interface of one randomly selected porous-coated tibial component in each patient, and contralateral knees served as controls. All of the 21 patients were followed for 5 years.

Results?The average number of CFU-F was significantly lower in tibial marrow than in iliac marrow (p = 0.008). The final fluoroscopically-guided radiographs revealed a decrease in the number of knees with radiolucent lines after marrow grafting compared to those without grafting (p = 0.004).

Interpretation?Iliac bone marrow is useful as a bone grafting material to enhance the biological fixation in porous-coated implants.     

Total knee arthroplasty after open reduction and internal fixation of fractures of the tibial plateau: a minimum five-year follow-up study

BACKGROUND: There is little information in the literature regarding the outcome of total knee arthroplasty following open reduction and internal fixation of fractures of the tibial plateau. The goal of this study was to evaluate the results of such procedures after a minimum of five years of follow-up. METHODS: We retrospectively analyzed the outcomes of fifteen total knee arthroplasties performed at an average of 38.6 months (range, eight months to eleven years) after open reduction and internal fixation of a fracture of the tibial plateau in fifteen consecutive patients. The average duration of follow-up after the total knee arthroplasty procedures was 6.2 years (range, 5.4 to 11.1 years). The average age of the patients was fifty-six years (range, thirty-seven to sixty-eight years) at the time of the arthroplasty. We evaluated the outcomes on the basis of the Hospital for Special Surgery knee score, the Short Form-36 score, and radiographs of the knees. RESULTS: The average Hospital for Special Surgery knee score was 51 points (range, 20 to 74 points) before the arthroplasty, and it increased to 80 points (range, 44 to 91 points) postoperatively. Four knees were scored as excellent, eight had a good result, one was rated as fair, and two had a poor result. The average Short Form-36 scores were 58.0 points for general health, 72.4 points for bodily pain, 72.1 points for mental health, 58.3 points for physical functioning, 84.6 points for physical role functioning, 81.0 points for social functioning, and 57.7 points for vitality. The average active postoperative arc of motion was 105 degrees (range, 70 degrees to 135 degrees ) compared with 87 degrees (range, 20 degrees to 125 degrees ) preoperatively. Incomplete radiolucencies were noted on all of the postoperative radiographs made after the total knee arthroplasties. There was a high rate of infection (three patients), patellar tendon disruption (two patients), and postoperative secondary procedures (three patients required closed manipulation). The patients with infection were considered to have a failure of treatment: two required arthrodesis, and one required a two-stage exchange. CONCLUSION: On the basis of our results, we concluded that total knee arthroplasty after open reduction and internal fixation of a fracture of the tibial plateau decreases pain and improves knee function, but the procedure is technically demanding and is associated with a high failure rate (five of fifteen).     

Cemented rotating-platform total knee replacement. A nine to twelve-year follow-up study

BACKGROUND: Although the LCS (low contact stress) rotating-platform mobile-bearing knee replacement has been used extensively, there have been few intermediate or long-term clinical and radiographic follow-up studies evaluating the device. The purpose of this study was to report the nine to twelve-year results of a consecutive series of patients who had a primary total knee replacement performed with this device. METHODS: Between November 1985 and November 1988, the senior author (R. C. J.) performed 119 consecutive total knee arthroplasties in eighty-six patients with LCS rotating-platform femoral and tibial components and a Townley all-polyethylene dome patellar component. All components were fixed with cement. The average age of the patients at the time of the operation was seventy years (range, thirty-seven to eighty-eight years). Fifty-two patients (seventy-six knees) were female, and thirty-four patients (forty-three knees) were male. The patients were evaluated with clinical knee ratings and radiographic analysis nine to twelve years following the knee replacement. RESULTS: At the time of the nine to twelve-year follow-up, sixty-four patients (eighty-six knees) were alive, eighteen patients (twenty-eight knees) had died, and four patients (five knees) had been lost to follow-up. Of the 114 knees in the eighty-two patients for whom the final outcome was known, none required a reoperation and none had a dislocation of the mobile-bearing prosthesis. For the forty-five patients (sixty-six knees) who returned for final clinical and radiographic follow-up examinations at nine to twelve years, the average clinical and functional Knee Society ratings were 30 points (range, 2 to 70 points) and 44 points (range, 0 to 80 points) preoperatively and 90 points (range, 63 to 102 points) and 75 points (range, 30 to 100 points) at the final follow-up evaluation. The average Hospital for Special Surgery knee rating was 57 points (range, 28 to 80 points) preoperatively and 84 points (range, 59 to 97 points) at the final follow-up evaluation. The average active range of knee flexion was from 0 degrees (range, 0 to 10 degrees) to 102 degrees (range, 15 to 120 degrees) at the final follow-up evaluation. Seven of the sixty-six knees were painful anteriorly. There was no periprosthetic osteolysis and no evidence of loosening on follow-up radiographs. CONCLUSIONS: After nine to twelve years of follow-up, the cemented LCS rotating-platform knee replacement was found to be performing well, with durable clinical and radiographic results.     

Retrieval analysis of porous-coated components for total knee arthroplasty. A report of two cases

Retrieval analysis of two total knee replacements incorporating porous-coated components for biologic fixation was performed. The significant finding in a 63-year-old woman was fracture of the porous-coated metal backing of the tibial component, secondary to aseptic loosening. The significant findings at the time of revision surgery in an 82-year-old woman were nonuniform bone ingrowth (primarily around fixation pegs) and fracture of metal beads from the metal backing of the patellar component.     

髌上入路胫骨髓内钉治疗胫骨近端骨折

目的:探讨膝关节半伸直位髌上入路胫骨髓内钉治疗胫骨近端骨折的临床疗效。方法:2013年1月至2014年1月共收治胫骨近端骨折16例,男14例,女2例;年龄26～57岁,平均42.2岁。所有患者为单侧闭合骨折,采用膝关节半伸直位髌上入路META-NAIL胫骨髓内钉内固定治疗。记录手术时间、术后并发症、骨愈合时间、胫骨力线和膝关节活动范围,并采用视觉模拟评分法(visual analogue scale,VAS)和Lysholm膝关节评分评定手术疗效。结果:所有16例患者手术时间65～95 min,平均(75.7±8.3) min.无明显围手术期并发症发生。所有患者获随访,时间12～24个月,平均(15.6±8.1)个月。15例获得Ⅰ期骨愈合,平均骨愈合时间(3.6±1.8)个月(3～5个月).末次随访时,所有患者胫骨力线良好,无膝前疼痛。患侧膝关节屈伸活动范围平均(124.4±18.8)°,健侧(127.5±16.7)°。Lysholm膝关节评分77～92分,平均86.4±12.3.结论:膝关节半伸直位髌上入路胫骨髓内钉治疗胫骨近端骨折,术中复位及固定操作方便,术后并发症少,患肢功能恢复良好,临床疗效满意。     

The accuracy of extramedullary guides for tibial component placement in total knee arthroplasty

Anteroposterior radiographs that included the whole tibia were taken before and after 75 total knee arthroplasties in 48 patients. The same tibial extra-medullary alignment guide system was used in every knee. The average tibial component alignment was 0.4 (SD 2.5, range -4.9 to 6.4) degrees of valgus post-operatively. 59 tibial components (78.7%) had a tibial cut within 3 degrees from being perpendicular to the mechanical axis, ten were too valgus (13.3%) and six were too varus (8%). The chance of the tibial components becoming too varus was higher if there was lateral tibial bowing, compared with no tibial bowing (p = 0.048). A smaller lateral width of the leg increased the chance of the tibial components becoming too valgus (p = 0.047).     

Anterior knee pain and thigh muscle strength after intramedullary nailing of a tibial shaft fracture: an 8-year follow-up of 28 consecutive cases

OBJECTIVES: Chronic anterior knee pain is a common complication after intramedullary nailing of a tibial shaft fracture. The source of pain is often not known, although it correlates with a simultaneous decrease in thigh muscle strength. No long-term follow-up study has assessed whether weakness of the thigh muscles is associated with anterior knee pain after the procedure in question. DESIGN: Prospective study. SETTING: University Hospital of Tampere, University of Tampere. PATIENTS: The muscular performance of 40 consecutive patients with a nailed tibial shaft fracture was tested isokinetically in a follow-up examination an average of 3.2 +/- 0.4 (SD) years after the initial surgery. An 8-year follow-up was possible in 28 of these cases. MAIN OUTCOME MEASUREMENTS: Isokinetic muscle strength measurements were made in 28 patients at an average 8.1 +/- 0.3 (SD) years after nail insertion and an average 6.6 +/- 0.3 (SD) years after nail extraction. All nails were extracted at an average 1.6 +/- 0.2 years after the nailing. RESULTS:: Seven patients were painless initially and still were at final follow-up (never pain, or NP). In 13 patients, the previous symptom of anterior knee pain was no longer present at final follow-up [pain, no pain (PNP)], and the remaining 8 had anterior knee pain initially and at final follow-up [always pain group (AP)]. With reference to the hamstring muscles, the mean peak torque difference between the injured and uninjured limb was -2.2% +/- 12% in the NP group, 1.6% +/- 15% in the PNP group, and 10.3% +/- 30% in the AP group at a speed of 60 degrees/second (Kruskal-Wallis test; chi(2) = 1.0; P = 0.593). At a speed of 180 degrees/second, the corresponding differences were -2.9% +/- 23% and 7.0% +/- 19% and 4.4% +/- 16% (Kruskal-Wallis test; chi = 1.7; P = 0.429). With reference to the quadriceps muscles, the mean peak torque difference was -2.8% +/- 9% in the NP group, 5.9% +/- 15% in the PNP group, and -13.0% +/- 16% in the AP group at a speed of 60 degrees/second (Kruskal-Wallis test; chi(2) = 7.9; P = 0.019). At 180 degrees/second, the corresponding differences were -9.4% +/- 13% and 4.9% +/- 16% and -1.9% +/- 9%, respectively (Kruskal-Wallis test; chi(2) = 4.8; P = 0.092). CONCLUSION: Based on this prospective long-term follow-up study, it appears that the anterior knee pain symptoms that are present after intramedullary nailing of a tibial shaft fracture disappear in a number of patients 3 to 8 years after surgery. Quadriceps, but not hamstring weakness, and lower functional knee scores are associated with anterior knee pain at 8 years.