可旋转铰链式膝关节置换的初步报告

目的：探讨可旋转铰链式膝关节假体的应用。方法：自1997年6月～2002年5月，采用可旋转铰链式膝关节对12例16膝进行了置换，所有病例均进行了随访，随访时间6个月～5年，平均随访时间2．4年。采用HSS(Hospital for Special Surgery)评分标准对手术疗效进行评价。结果：总优良率93．75％。结论：可旋转铰链式膝关节疗效肯定，远期疗效需进一步随访。     

旋转铰链型膝关节置换治疗膝关节骨关节炎

目的 探讨旋转铰链型膝关节置换治疗膝关节骨关节炎的疗效。方法 采用旋转铰链型膝关节置换治疗30例膝关节骨关节炎患者。记录手术情况及并发症发生情况,比较手术前后膝关节活动度、疼痛VAS评分、HSS评分。结果 手术时间80～96(85.2±6.4) min,术中出血量50～90 (74.5±6.5) ml,术后引流量60～300(150.4±30.6) ml。患者均获得随访,时间14～30个月。术后6个月膝前区疼痛4例,末次随访时疼痛症状消失,患膝关节负重良好。末次随访时,膝关节X线片显示关节假体位置良好、假体骨骼界面稳固、无松动。疼痛VAS评分、HSS评分及膝关节活动度:末次随访及术后1周均较术前明显改善(P <0.05),末次随访均较术后1周明显改善(P <0.05)。结论 旋转铰链型膝关节置换治疗膝关节骨关节炎效果良好,可以缓解疼痛,恢复患者膝关节活动度。     

旋转铰链型膝关节假体临床应用30例随访观察

[目的]探讨采用旋转铰链式人工膝关节假体进行全膝关节置换术的早期及中期临床疗效、并发症、假体选择的适应证.[方法]回顾性分析1998年7月～2008年7月10年间使用旋转铰链式膝关节假体行人工全膝关节置换的28例患者(30例膝) 临床效果.其中男7例,女21例;平均年龄62岁(42～75岁);左膝10例,右膝20例.病因: 膝内翻合并重度骨关节炎8膝, 类风湿关节炎2膝,创伤性关节炎3膝,畸形性骨炎1膝,严重膝外翻畸形6膝,全膝关节置换术后假体松动翻修10膝(6例感染后松动,4例无菌性松动).术前术后使用KSS评分进行评价.[结果]本组病例平均手术时间为3 h10 min(1 h 30 min～6 h30 min),术中平均失血量为990 ml(150～3 000 ml),术中及术后平均输异体血1 300 ml.28例病例平均随访51个月(12～120个月).膝关节评分从术前的19.5分增加到术后的平均77.9分(28～93 分),功能评分从术前的22.5(0～50分)增加到术后的50.5分(0～90分).膝关节平均活动范围从术前58.4°( 0°～90°)提高到术后的72.8°(10°～100°).1例发生髌腱断裂,1例发生假体断裂,5例发生>10°的伸膝迟滞,8例出现明显的膝前痛.[结论]旋转铰链式膝关节假体作为治疗严重膝关节疾病的方法,可以一定程度恢复膝关节功能,中期随访结果满意,但因其手术损伤大,要严格把握手术适应证,预防并发症的发生.     

旋转铰链型人工膝关节置换治疗胫骨近端骨肿瘤

目的 探讨定制旋转铰链型人工膝关节置换治疗胫骨近端骨肿瘤的临床效果.方法 对14例胫骨近端骨肿瘤患者(骨巨细胞瘤8例,动脉瘤样骨囊肿1例,转移性肿瘤2例,骨肉瘤3例)采用定制旋转铰链型人工膝关节置换重建,骨肉瘤同时采用新辅助化疗治疗.结果 患者切口均一期愈合,无皮肤感染及坏死发生.14例均获随访,时间12~68个月.膝关节功能采用Enneking标准进行评定:优8例,良4例,差2例.1例骨肉瘤患者术后48个月因肺转移死亡;2例转移性骨肿瘤患者局部无复发,但分别在术后9个月及24个月死于原发肿瘤;1例患者50个月后出现假体松动,翻修后效果良好;其余患者生活质量良好.结论 定制旋转铰链型人工膝关节置换治疗胫骨近端骨肿瘤能保留良好的关节功能,是有效的保肢方法.     

旋转铰链膝关节置换术治疗严重膝关节畸形近期疗效观察

[目的]探讨旋转铰链膝关节置换术治疗严重膝关节畸形的近期疗效。[方法]对2012年1月~2015年4月应用旋转铰链型膝关节假体置换治疗严重膝关节畸形患者的临床资料进行分析,其中男17例,女13例,平均年龄60.5岁(51~70岁),原发疾病分别为骨性关节炎合并严重的膝内翻、膝外翻畸形20例,类风湿性关节炎10例,比较手术前后膝关节活动度及HSS(hospital for special surgery)评分,明确其疗效。[结果]手术时间平均(62.00±10.20)min。无1例发生感染、血栓、神经血管损伤等并发症。所有患者均获得随访,随访时间9~27个月,平均14个月,所有病例患膝疼痛明显缓解,内外翻和屈曲畸形均纠正,关节活动范围由术前的89.0°(60°~110°)改善为术后的117°(100°~130°)。HSS评分从术前的42.5分(21~62分)增加到术后的平均90分(80~98分)。[结论]旋转铰链型膝关节置换对严重膝关节畸形患者近期效果良好,可以很好的解除膝关节疼痛,矫正畸形,改善关节功能及提高生活质量,但远期效果有待进一步观察。     

旋转铰链式膝关节假体临床使用的初步体会

目的观察采用旋转铰链式膝关节假体行人工全膝关节置换术的临床疗效和并探讨其运用经验。方法对我科近三年来采用旋转铰链式膝关节假体治疗严重膝关节病变12例病人(12个膝)进行回顾性分析。结果术后膝关节功能较术前改善明显,关节功能评分从术前平均48分提高到术后平均86分,优为8例、良为4例,没有近期并发症发生,病人主观满意度百分之百。结论旋转铰链式膝关节假体对治疗严重的膝关节病患疗效满意。     

铰链式全膝关节置换术后假体周围骨折

假体周围骨折是人工关节置换术术后并发症之一,其发生与假体类型及患者自身因素密切相关,并且治疗方法相对复杂,本文针对铰链式全膝关节置换术后假体周围骨折的产生机理及其治疗手段进行回顾性的文献复习,以期对此类骨折的认识及治疗策略的选择有所帮助。     

可旋转铰链式膝关节假体在膝关节严重畸形治疗中的应用研究

[目的]探讨可旋转铰链式膝关节假体在膝关节严重畸形治疗中的应用效果.[方法]膝关节严重畸形病例22例(24膝),男10例,女12例,平均年龄56.2岁,右侧12侧,左侧8例,双侧2例,应用可旋转铰链式膝关节假体行全膝关节置换术.采用HSS(hospital for special surgery)评分标准对手术疗效进行评价[2].[结果]手术切口一期愈合,畸形全部矫正,1例术后出现轻度深静脉血栓.随访6～55个月,功能良好,无感染及假体松动发生.[结论]采用可旋转铰链式膝关节假体置换术治疗膝关节严重畸形病例,手术操作简单,效果可靠.     

全膝关节置换术中旋转平台假体与固定平台假体短期随访对比(英文)

[目的]观察对照全膝关节置换术中旋转平台假体与固定平台假体的早期效果。[方法]从2011年8月~2012年12月收集了120位患者的样本,包括162例在此期间进行了膝关节置换术的膝关节。膝关节假体(旋转平台与固定平台)是通过随机抽样选出的。对所有患者在手术前与手术后1、6、12个月进行评估,全部使用标准评分方法 (美国膝关节协会评分,功能评分,活动度)。[结果]A组66位患者共85膝使用的是旋转平台假体,平均年龄为(63.13±7.18)岁。B组54位患者共77膝使用的是固定平台假体。平均年龄为(61.35±6.75)岁。平均随访时间为(8.25±6.22)个月。全膝关节置换术固定平台假体与旋转平台假体的平均膝关节协会评分在1年之后分别为(84.5±13.8)分和(82.2±15.7)分,平均膝关节功能评分在1年之后分别为(70.3±20.5)分和(71.4±19.3)分,全膝置换的固定平台假体与旋转平台假体平均活动度在一年之后分别为(103.2±13.5)°和(104.3±13.7)°。两组的术后效果并无差异(P0.05)。[结论]在旋转平台假体与固定平台假体设计中,当前研究表示没有明显的临床性、功能性和影像学上的差异。研究表明,控制其他可变因素,不论使用旋转平台假体或者固定平台假体设计,都不会在短期随访时间内影响到效果。     

Mid-term results of rotating hinge knee prostheses

Between December 2002 and December 2007, we retrospectively assessed the mid term results of the Nexgen rotating hinge prosthesis in the hands of a single surgeon in difficult primary and complex revision situations. Forty four patients (46 knees) were included in the study: they were followed for an average of 62 months. Knee Society knee score improved from a preoperative mean value of 47 to a mean value of 81 at follow-up (p < 0.05) whereas the mean function score improved from 17 (0-40) to 67.5 (0-90) at follow-up (p < 001). Mean flexion range improved from 65 degrees to 96 degrees at follow-up (p < 0.05). In conclusion, rotating hinge knees gave satisfactory results in difficult revision situations associated with major bone loss, instability or periprosthetic fracture. They also provided satisfactory results in selected cases of advanced primary osteoarthritis.     

Dislocation of rotating hinge total knee prostheses. A biomechanical analysis

BACKGROUND: Symptomatic instability and implant dislocation are occasionally encountered in patients with a rotating hinge total knee prosthesis. A biomechanical study of rotating hinge total knee implants was performed to determine the association between the design (length and taper) of the central rotational stem and the stability of the implant. METHODS: The stem lengths and tapers of knee implants made by seven manufacturers were measured. The tilting laxity of each design was tested by measuring the degree of tilting of the central rotational stem within the tibial housing that occurred with increasing amounts of distraction. The maximum amount of distraction that was possible before the stem dislocated was determined for each design. RESULTS: Implant designs with a short and/or markedly tapered central rotational stem had the greatest tilting, laxity, and instability of that stem. The Howmedica, Techmedica, Intermedics/Sulzer Medica, and Wright Medical Technology/ Dow Corning Wright designs required > or = 39 mm of distraction before they dislocated. The Biomet knee implant required 33 or 44 mm of distraction to dislocate, depending on the thickness of the polyethylene tray that was utilized. The S-ROM knee required only 26 mm of distraction before dislocation occurred. CONCLUSIONS: The measurements confirmed that the shorter the stem and the greater its taper, the greater the instability and laxity at any given amount of joint distraction.     

Application of the Endomodel rotating hinge knee prosthesis for knee osteoarthritis

One hundred thirty-six knees were treated with the Endomodel rotating hinge knee prosthesis as primary total knee arthroplasty (TKA). The indications for surgery included osteoarthritis (110 knees), rheumatoid arthritis (18 knees), and osteonecrosis (8 knees). Patients were divided into four study groups according to follow-up duration. Group A was followed up from 10 to 15 years, group B from 8 to 10 years, group C from 5 to 8 years, and group D from 2 to 5 years. The Hospital for Special Surgery knee score, as well as each parameter individually, showed statistically significant improvement in all groups postoperatively. A total of 88.23% were rated as excellent, 3.67% as good, and 8.08% as fair. The results suggest that the Endomodel rotating hinge prosthesis can be considered a good alternative for primary TKA in cases of serious axial deformity and collateral ligament deficiency and in rheumatoid arthritis patients.     

Early catastrophic failure of rotating hinge total knee prosthesis

The mechanical failure of a prosthesis component is usually observed as a late complication of total knee arthroplasty (TKA). In knees with severe ligament instability and bone deficiency, either a true hinge prosthesis or a rotating hinge implant is commonly used. Failure of the polyethylene bearing bush in a hinge-type prosthesis is a complication that has not been reported to date. We report the cases of 2 rotating hinge TKA prostheses that dislocated as a result of mechanical failure of the prosthetic component within 5 months of initial implantation. Clinicians should be aware of this potential complication when selecting rotating hinge prostheses for certain patients.     

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.     

The kinematic rotating hinge prosthesis for complex knee arthroplasty.

Fifty-eight patients (69 knees) treated with the Kinematic Rotating Hinged knee prosthesis for complex primary and salvage revision total knee arthroplasty were followed up for an average of 75.2 months (range, 24-199 months). The indications for use of the Kinematic Rotating Hinged knee prosthesis included severe bone loss combined with ligamentous instability (30 knees), nonunion of a periprosthetic fracture (10 knees), an acute periprosthetic fracture (nine knees), severe collateral ligamentous instability (five knees), reimplantation for infection (six knees), nonunion of a supracondylar femoral fracture (four knees), congenital dislocation of the knee (three knees), and treatment of a severely comminuted distal femur (two knees). At the time of surgery, the average patient age was 72 years (range, 46-92 years). Preoperatively, knee extension averaged 4.94 degrees (range, 0 degrees-40 degrees) and flexion averaged 81 degrees (range, 15 degrees-125 degrees). At final followup, knee extension averaged 1.25 degrees (range, -5 degrees-25 degrees) and flexion averaged 94.2 degrees (range, 5 degrees-125 degrees). The preoperative Knee Society Knee score averaged 40.3 points (range, 2-93 points) and improved to 77 points (range, 33-99 points) at final followup. Complications were numerous: 23 (32%) patients experienced at least one complication and 12 (17%) patients had two or more complications. Deep periprosthetic infection was the most common complication (14.5%), followed by patellar complications (13%), and prosthetic component breakage (10%). During the period of this study, there were 15,798 primary and 2673 revision total knee arthroplasties done at the authors' institution. The patients receiving a Kinematic Rotating Hinged knee prosthesis represent a highly complex and small subset (0.37%) of the overall population having knee arthroplasty. Although the use of the Kinematic Rotating Hinged knee prosthesis for these limited indications has been useful for the authors, the incidence of complications and the poor outcome of these complications is disconcerting. Hinged total knee arthroplasty should be reserved for the final salvage option of the treatment options available when doing complex primary and salvage revision knee arthroplasties.     

Follow-up of a modular rotating hinge knee system in salvage revision total knee arthroplasty

We evaluated the clinical and radiographic outcomes of salvage knee revisions using a modern-generation, modular, rotating hinge total knee prosthesis in 24 cases with a minimum follow-up of 36 months (mean, 56 months). Indications for revision included aseptic loosening, combined with bone loss and gross collateral ligament instability in all cases. Patients were evaluated clinically and radiographically (Knee Society scores). Knee Society scores improved from 25 preoperatively to 91 postoperatively, and function scores improved from 35 to 85. No loosening of implants was observed. Nonprogressive radiolucent lines were identified around 2 tibial components. One patient required a revision due to patellofemoral subluxation.