在平均26年的随访中，双节段截骨术（DLO）治疗内翻畸形的平均生存率超过十年，而不影响随后的全膝关节置换术功能。

IF 2 Q2 ORTHOPEDICS Journal of Experimental Orthopaedics Pub Date : 2025-01-08 DOI:10.1002/jeo2.70140

Sean C. Clark, Karissa N. Simon, Daniel B. F. Saris, Michael J. Taunton, Aaron J. Krych, Mario Hevesi

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引用次数: 0

摘要

目的：双节段截骨术（DLOs）在膝关节保存方面显示出有希望的结果，然而，大多数最终进展是退行性疾病导致全膝关节置换术（TKA）的转变。因此，本研究的目的是研究先前同侧DLO后接受TKA的患者到TKA转换的时间，长期临床结果和翻修率。方法：对1997年至2022年在单一学术机构同时或分期接受DLO并随后转为TKA的患者进行评估。记录截骨术的类型（开放楔形或闭合楔形）、截骨五金固定、何时以及是否取出截骨五金、植入TKA组件和翻修率。术后结果包括遗忘关节评分-12 （FJS-12）、Tegner活动量表评分和主观膝关节偏好。结果：22例患者（24膝）在DLO术后接受TKA，平均随访26.1±7.7年。从DLO到TKA的平均时间为14.1±6.5年，其中70.8%的膝关节在DLO后10年以上转化为TKA。转换为TKA后的平均随访时间为12.0±7.7年。只有12.5%的患者接受了内翻-外翻或铰链约束TKA。末次随访时，FJS-12评分平均为75.8±23.1分，Tegner活动量表评分平均为2.5±1.1分。77%的患者没有主观的膝关节偏好或更喜欢他们的DLO-TKA膝关节。只有两个膝关节（7.4%）在平均术后9.3年接受了关节置换术后的后续翻修。结论：大多数DLOs（70.8%）在10多年后转化为TKA。随后的TKA功能良好，因为大多数患者要么没有主观的膝关节偏好，要么更喜欢他们的DLO-TKA膝关节。本研究表明，在先前的DLO后，长期的关节保护和未受损的TKA功能。证据等级：四级。

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Double-level osteotomy (DLO) for varus deformity results in over a decade of mean survival without compromising subsequent total knee arthroplasty function at a mean 26-year follow-up

Purpose

Double-level osteotomies (DLOs) have shown promising results for knee joint preservation, however, most ultimately progress in terms of degenerative disease resulting in conversion to total knee arthroplasty (TKA). Therefore, the purpose of this study was to examine the time to TKA conversion, long-term clinical outcomes and revision rates of patients who have undergone TKA after prior ipsilateral DLO.

Methods

Patients who underwent simultaneous or staged DLO and subsequently underwent conversion to TKA at a single academic institution from 1997 to 2022 were evaluated. The type of osteotomy performed (opening- vs. closing-wedge), osteotomy hardware fixation, when and if osteotomy hardware was removed, implanted TKA components and revision rates were recorded. Postoperative outcomes, including Forgotten Joint Score-12 (FJS-12), Tegner Activity Scale score and subjective knee preference were also obtained.

Results

A total of 22 patients (24 knees) underwent TKA following DLO and were followed for an average of 26.1 ± 7.7 years. The average time from DLO to TKA conversion was 14.1 ± 6.5 years, with 70.8% of knees converting to TKA more than 10 years after DLO. The mean follow-up after conversion to TKA was 12.0 ± 7.7 years. Only 12.5% of patients received a varus-valgus or hinged-constrained TKA. At the final follow-up, the mean FJS-12 was 75.8 ± 23.1, while the mean Tegner Activity Scale score was 2.5 ± 1.1. Seventy-seven percent of patients had no subjective knee preference or preferred their DLO-TKA knee. Only two knees (7.4%) underwent subsequent revision after index arthroplasty at a mean of 9.3 years postoperatively.

Conclusions

A majority of DLOs (70.8%) converted to TKA after more than a decade. Subsequent TKA function was favorable as most patients had either no subjective knee preference or preferred their DLO-TKA knee. This study demonstrates both long-term joint preservation and uncompromised TKA function after prior DLO.