后十字韧带保留与后十字韧带替代 TKA 在翻修率或存活率方面无明显差异。

Young-Hoo Kim,Jang-Won Park,Young-Soo Jang,Eun-Jung Kim
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引用次数: 0

摘要

背景许多学者和多个登记处的数据表明,与使用后十字韧带保留(CR)TKA 相比,使用后十字韧带替代(后稳定 [PS])全膝关节置换术(TKA)会导致更高的翻修风险。本前瞻性、随机、长期研究的目的是比较 PS 和 CR TKA 的临床、影像学和计算机断层扫描(CT)结果、骨溶解发生率、翻修率和存活率。每位患者一侧接受 NexGen CR-Flex 假体,对侧接受 NexGen LPS-Flex 假体。结果在最近的随访中,NexGen CR和LPS-Flex TKA组在膝关节协会膝关节平均评分(分别为93分和92分)、西安大略和麦克马斯特大学骨关节炎指数评分(均为19.1分);加利福尼亚大学洛杉矶分校活动评分(两者均为6.1分);活动范围(125° ± 6.1°对126° ± 6.5°);X光和CT结果;以及翻修率(6.0%对6.3%)。没有膝关节发生骨溶解。以翻修或无菌性松动为终点,NexGen CR-Flex假体19.5年的估计存活率为94%(95%置信区间[CI],91%至100%),LPS-Flex假体为93.7%(95%置信区间[CI],91%至100%)。NexGen CR-Flex种植体与NexGen LPS-Flex种植体相比没有明显的临床优势。有关证据等级的完整描述,请参阅 "作者须知"。
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No Discernible Difference in Revision Rate or Survivorship Between Posterior Cruciate-Retaining and Posterior Cruciate-Substituting TKA.
BACKGROUND Many authors and the data of multiple registries have suggested that the use of posterior cruciate-substituting (posterior stabilized [PS]) total knee arthroplasty (TKA) leads to a higher risk of revision compared with the use of posterior cruciate-retaining (CR) TKA. The aim of the present prospective, randomized, long-term study was to compare PS and CR TKA with regard to the clinical, radiographic, and computed tomography (CT) results; the prevalence of osteolysis; revision rate; and survivorship. METHODS This study included a consecutive series of 300 patients (mean age [and standard deviation], 63.6 ± 6 years) who underwent simultaneous, bilateral TKA in the same anesthetic session. Each patient received a NexGen CR-Flex prosthesis on 1 side and a NexGen LPS-Flex prosthesis on the contralateral side. The mean follow-up period was 18 years (range, 17.5 to 19.5 years). RESULTS There were no significant differences between the NexGen CR and LPS-Flex TKA groups at the latest follow-up with regard to the mean Knee Society knee score (93 versus 92 points, respectively); the Western Ontario and McMaster Universities Osteoarthritis Index score (19.1 points for both); the University of California Los Angeles activity score (6.1 points for both); range of motion (125° ± 6.1° versus 126° ± 6.5°); radiographic and CT results; and revision rate (6.0% versus 6.3%). No knee had osteolysis. The estimated survival rate at 19.5 years was 94% (95% confidence interval [CI], 91% to 100%) for the NexGen CR-Flex prosthesis and 93.7% (95% CI, 91% to 100%) for the LPS-Flex prosthesis, with revision or aseptic loosening as the end point. CONCLUSIONS The findings of the present, long-term (minimum follow-up of 17.5 years) clinical study showed that NexGen CR-Flex and NexGen LPS-Flex implants produced excellent clinical and radiographic results. There was no notable clinical advantage of a NexGen CR-Flex implant over a NexGen LPS-Flex implant. LEVEL OF EVIDENCE Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
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