Total knee replacement using the stabilized gliding prosthesis.

The stabilized gliding knee prosthesis has been designed as a compromise between the restrained hinged joints and the unconnected surface prostheses. It is a two-piece implant, allowing normal gliding movements of flexion and extension, and is stabilized by a rod between the femoral and tibial components which allows some lateral mobility and rotation while acting in place of the cruciate ligaments and in place of or in addition to the collateral ligaments. The indications for and the techniwue of implantation are described and the results of the first 53 operations are reported. Follow-up time is between 1 year and 2 1/2 years. The results of these operations using the stabilized gliding prosthesis are at least equal to those using hinged or condylar prostheses. So far there has been no case of loosening of either component, and the implant can be used successfully in patients in whom condylar prostheses fail owing to their lac of inbuilt stability.     

Total knee replacement with the Kodama-Yamamoto knee prosthesis

Since 1970, 170 knees have been operated upon using the Kodama-Yamamoto knee prosthesis. Of these 127 had the revised Mark-II prosthesis and of this group 91 cases have been followed for more than a year. Interim results suggest that the total knee score has improved. on the average, from 38 points preoperatively to 74 points after one year. A single early complication involved loosening of the prosthesis in a case of knee infection. Except for this case, no loosening and no radiolucent lines have been observed. Methacrylate bone cement is known to be harmful to bone and soft tissues, and our basic and clinical studies reveal that results improve when the total knee replacement is done without using cement.     

Total knee arthroplasty using the total condylar III knee prosthesis

Twenty-seven total knee arthroplasties (TKAs) were performed in 24 patients using the total condylar III knee prosthesis (TCP III) and were evaluated clinically and radiographically with a mean follow-up period of 4 years. Eighteen were revision TKAs, and nine were primary knee arthroplasties. Evaluations were made using the Hospital for Special Surgery (HSS) knee scale as well as the Knee Society radiographic evaluation method. Clinical results for all knees were 11% (3 of 27) excellent, 70% (19 of 27) good, 15% (4 of 27) fair, and 4% (1 of 27) poor. The one poor rating resulted from an intraoperative vascular injury. The results showed no statistical difference between revision and primary TKA. After operation, pain relief, range of motion, walking, function, and activity level improved in both the primary and revision patients. Radiolucencies 2 mm or greater in width were found in 6 of the 27 tibial components, in none of the 27 femoral components, and in 1 of the 19 patellar components. Only two tibial implants showed progressive radiolucencies. No correlation was found between the radiographic position of the implants and the clinical results. The authors conclude that the TCP III is a satisfactory choice for TKA in selected knees in which there is significant instability and in which intramedullary fixation is required.     

Total wrist replacement using the modified Volz prosthesis

Eighteen total wrist arthroplasties in sixteen patients were done using the modified Volz prosthesis. The length of follow-up ranged from twenty-four to sixty-six months, with a mean of forty months. A 100-point scoring system was used to evaluate the outcome. Muscle imbalance developed in five wrists, the carpal component became loose in three wrists, and two prostheses dislocated. In five patients six arthroplasties (33 per cent) were considered to have failed because one reoperation or more was required for loosening of the components in two wrists, dislocation in two wrists, and muscle imbalance in two wrists. Of the remaining twelve arthroplasties (eleven patients) eight (45 per cent) had an excellent result; two (11 per cent), a good; and two (11 per cent), a poor result. The over-all rate of complications was 44 per cent. Patients who had significant preoperative deformity did poorly postoperatively. The surgeon should be prepared to perform other types of arthroplasty or an arthrodesis if the extensor tendons are structurally inadequate, as this may lead to progressive flexion deformity postoperatively.     

Total knee arthroplasty using the kinematic rotating hinge prosthesis

Patients receiving a Kinematic Rotating Hinge total knee prosthesis with a 25-month minimum follow up were reviewed. A total of 46 patients and 54 knees were included in the study. A detailed clinical assessment was available on 38 knees. Twenty of these knees had primary arthroplasties performed with the Kinematic Rotating Hinge prosthesis and 18 knees had revision arthroplasty. Ninety-five percent of primary knees and 83% of revision knees caused no or mild pain postoperatively. Using the Brigham and Women's Hospital and Harvard Medical School knee rating system, 80% of primary knees and 61% of revision knees were rated as good to excellent. Using the criteria defined in this article, 90% of primary knees and 83% of revision knees were labeled as having a satisfactory result. Forty-five percent of primary components and 52% of revision components demonstrated lucent lines on radiographic review. Seven percent of primary knees and 20% of revision knees showed evidence of aseptic lucency progression in one or more zones. No radiographic evidence of aseptic loosening was noted in this review. Documented sepsis occurred in one primary knee and two revision knees. Patellar instability occurred in 21% of primary knees and 36% of revision knees, representing the major complication. The Kinematic Rotating Hinge prosthesis is intended for use in arthroplasty cases where there is functional absence of collateral ligament stability. This review suggests that a high percentage of satisfactory clinical results can be achieved with this prosthesis with long-term radiographic stability.     

Total knee arthroplasty using the S-ROM mobile-bearing hinge prosthesis

A retrospective study was performed on 15 patients receiving 16 S-ROM mobile-bearing hinge total knee prostheses that were evaluated with at least a 2-year follow-up (range, 27-71 months). Indications for its use included severe instability and bone loss. The average patient age was 63 years (range, 33-83 years). There were 15 revision arthroplasties and 1 primary arthroplasty. Knee Society scores showed notable improvement in pain, motion, and stability (33.6 preoperatively vs 76.5 postoperatively; P <.0001) and approached significant improvement in function (29.2 preoperatively vs 43.5 postoperatively; P =.11). After excluding a patient with a traumatically ruptured patellar tendon, the probability of the latter comparison improved (P <.01). There was no evidence of loosening, and complete bone apposition was seen in nearly all cases. A high percentage of satisfactory results can be achieved when using this mobile-bearing hinge knee prosthesis for these indications.     

Total knee arthroplasty using a total condylar prosthesis

The authors studied the cases of 52 patients (56 knees) treated with a total knee prosthesis of the type "total condylar" and "total condylar with posterior stabilization" over a 3-year period. Gonarthrosis (41 cases) and rheumatoid arthritis (12 cases) were the major indications. The analysis of functional results proves the success concerning mobility, pain and ability to negotiate stairs after knee arthroplasty. The postoperative radiological results of 44 knees were reviewed and compared to the literature. Proof of the importance of the postoperative axis and the inclination of the tibial component is provided. Few complications were observed. Review of the literature confirms the good results of this type of total knee prosthesis.     

Total knee arthroplasty using cruciate-retaining kinematic condylar prosthesis.

The purpose of the current study was to evaluate the long-term results of the Kinematic I condylar prosthesis with retention of the posterior cruciate ligament. One hundred sixty-eight total knee arthroplasties in 118 patients (mean age, 65.2 years; range, 21-88 years) were inserted with cement, an all-polyethylene patella, metal-backed tibia, and posterior cruciate ligament retention. Sixty-one patients (86 knees) died, one patient had an above-knee amputation, and three patients (five knees) were lost to followup; therefore, 66 knees (excluding revisions) in 50 patients were available for followup at a mean of 15.7 +/- 1.1 years (range, 14-20 years). Of the entire cohort of 168 knees, 13 have been revised: one for medial femoral condyle fracture, one for tibiofemoral instability, one for femoral and two for tibial component aseptic loosening, four for tibial polyethylene wear, and four for patellar component aseptic loosening. The 15-year survivorship free of any component revision excluding infections was 88.7% (confidence interval, 82%-95%). The 15-year survivorship free of radiographic loosening and/or revision of any component was 85.1% (confidence interval, 78%-92%). The current study shows good function and survivorship of the posterior cruciate-sparing Kinematic I condylar prosthesis at a mean of 15.7 +/- 1.1 years.     

膝关节外翻畸形的人工全膝关节置换术

目的探讨膝关节外翻畸形患者行人工全膝关节置换术(TKA)的手术方法和临床效果。方法对1996年1月至2004年8月74例87个膝关节外翻畸形TKA手术进行回顾分析。患者男11例,女63例,平均年龄63岁(26~80岁);股胫角(股骨和胫骨解剖轴线的夹角)平均为21·59°(12°~40°);应用后稳定型假体,采用髌旁内侧入路、常规截骨加单纯外侧软组织松解方法。随访检查膝关节活动度、X线外翻角度及KSS评分以评价手术效果。结果术后评价随访时间33·8个月(5个月~9年),根据膝关节活动度数及KSS评分评估关节功能情况。膝关节平均活动度为112·4°(80°~130°),KSS评分平均为81·7分(71~93分),比术前提高了59分;功能评分平均为86·3分,比术前提高了59·8分。所有膝关节在行TKA后外翻畸形基本得到矫正,随访时外翻度数(股胫角)平均为8·7°(0°~11°),较术前有明显改善。随访时1例患者有膝关节轻度不稳症状,1例术前严重髌脱位患者术后髌骨存在半脱位,其余正常。结论对于膝关节外翻畸形患者,采用髌旁内侧入路、常规截骨加单纯外侧软组织松解以及安装后稳定型假体的方法,可取得比较满意的临床效果。     

人工全膝关节置换术在外翻膝的临床应用

[目的]探讨人工全膝关节置换术在外翻膝中的手术技术和临床疗效.[方法]2004年3月～2008年9月,对14例16个外翻膝行膝前正中、髌旁内侧入路,常规截骨、外侧软组织松解,后方稳定型假体或后交叉韧带保留型假体的人工全膝关节置换术进行回顾性研究.患者男3例,女11例,平均年龄60.5岁(45～77岁).经过随访比较手术前后膝关节屈伸活动度、KSS评分、膝关节X线情况来评估手术临床效果.[结果]术后平均随访42个月(24～54个月),膝关节屈伸活动度由术前平均82°(伸直0°～屈曲120°)提高到术后120°(伸直0°～屈曲150°);KSS评分:临床评分由术前平均43分(10～65分)提高到术后平均83.9分(70～100分),功能评分由术前平均52.9分(30～70分)提高到术后平均89.3分(75～100分);胫股角由术前平均16.5°(8°～30°)改善纠术后平均7°(5°～10°),膝外翻畸形得到良好的矫正.随访中无深静脉血栓、膝关节感染、髌骨半脱位或脱位并发症发生.[结论]膝前正中、髌旁内侧入路,常规截骨、外侧软组织松解,后方稳定型假体或后交叉韧带保留型假体的TKA治疗外翻膝临床疗效满意.