Total knee arthroplasty for the treatment of severe knee disease

doi:10.3969/j.issn.2095-4344.2013.09.003

Abstract

Abstract:

BACKGROUND: Total knee arthroplasty used for the treatment of knee joint deformity is difficult and involves multi-aspects, including the surgical approach, intraoperative osteotomy, order, method and extent of soft tissue release and soft tissue balance, There are a lot of controversies due to different scholarly opinions.
OBJECTIVE: To explore the surgical methods and clinical efficacy of total knee arthroplasty for the treatment of severe knee disease.
METHODS: A total of 42 cases (48 knees) with severe knee disease and knee joint deformity were selected, and all the patients were treated with total knee arthroplasty using posterior stabilized prosthesis. Through patellar medial approach and correct osteotomy, selective soft tissue release was performed to restore normal knee alignment and soft tissue balance to harvest knee stability. The targeted rehabilitation training was performed after replacement and the knee range of motion and maximum knee flex degree were detected regularly. The Hospital for Special Surgery score and the Western Ontario and Mcmaster Universities Arthritis Index score were performed.
RESULTS AND CONCLUSION: All patients were followed-up for 25 to 84 months, 35.5 months in average. The knee range of motion, maximum knee flex degree, Hospital for Special Surgery score and the Western Ontario and Mcmaster Universities Arthritis Index score of all the patients were significantly increased after replacement compared with those before replacement (P < 0.01). The wound was in stage Ⅰ recovery. No knee joint rigidity, blood vessel and nerve injury, patella fracture, patella low-site and prosthesis loosening were observed after replacement. The lower limb alignment was restored to normal level. The adult severe knee deformity can be corrected through total knee arthroplasty, and the function is improved significantly with satisfactory clinical results.

Key words: bone and joint implants, artificial prosthesis, total knee arthroplasty, deformity, posterior stabilized prosthesis, soft tissue balance, osteotomy, knee range of motion, maximum flexion, Hospital for Special Surgery system, Western Ontario and Mcmaster Universities Arthritis Index, patellar fracture, prosthesis loosening, compatibility

CLC Number:

R318

Li Guang-wei, Wang Hong-jun, Sun Xiao-zhi. Total knee arthroplasty for the treatment of severe knee disease[J]. Chinese Journal of Tissue Engineering Research, 2013, 17(9): 1535-1542.

Figures/Tables 2

References

[1] Lv HS, Yuan YL, Kou BL, et al. Beijing Daxue Xuebao (Yixueban). 2002;34(5):618-622. 吕厚山,袁燕林,寇伯龙,等. 1336 个人工膝关节置换术的临床特点分析[J].北京大学学报:医学版,2002,34(5):618-622.

[2] Zhou YX. Zhonghua Guke Zazhi. 2006;26(9):646-648. 周一新.人工膝关节假体设计对全膝关节置换术后髌股关节功能的影响[J].中华骨科杂志,2006,26(9):646-648.

[3] Zhang X, Wang ZW. Zhongguo Zuzhi Gongcheng Yanjiu Yu Linchuang Kangfu. 2011;15(13):2421-2424. 张欣,王志伟.人工全膝关节表面置换中髌骨的处理[J]. 中国组织工程研究与临床康复. 2011,15(13):2421-2424.

[4] Li S, Chen Y, Su W, et al. Systematic review of patellar resurfacing in total knee arthroplasty. Int Orthop. 2011;35(3): 305-316.

[5] Radcliff KE, Orozco FR, Quinones D, et al. Preoperative risk stratification reduces the incidence of perioperative complications after total knee arthroplasty. J Arthroplasty. 2012; 27(8 Suppl):77-80.e8.

[6] Chen HS, Jin W, Xu F, et al. Shiyong Guke Zazhi. 2009;15(7): 540-541. 陈焕诗,金伟,许峰.人工全膝关节置换术治疗膝关节骨关节炎[J]. 实用骨科杂志,2009,15(7):540-541.

[7] Insall JN, Dorr LD, Scott RD, et al. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res. 1989;(248):13-14.

[8] Li BW. Zhongguo Zuzhi Gongcheng Yanjiu Yu Linchuang Kangfu. 2008;12(17):3313-3316. 李宝文. 全膝人工关节置换涉及的生物力学变化[J].中国组织工程研究与临床康复, 2008,12(17):3313-3316.

[9] Zhou YX. ZHonghua Guke Zazhi. 2006;26(9):646-648. 周一新.人工膝关节假体设计对全膝关节置换术后髌股关节功能的影响[J].中华骨科杂志,2006,26(9):646-648.

[10] Havet E, Gabrion A, Leiber-Wackenheim F, et al. Radiological study of the knee joint line position measured from the fibular head and proximal tibial landmarks. Surg Radiol Anat. 2007; 29(4):285-289.

[11] Lv HS. Zhonghua Guanjie Waike Zazhi. 2007;1(4):193-195. 吕厚山.当前膝关节置换存在的问题与思考[J].中华关节外科杂志, 2007,1(4):193-195.

[12] Zhang HM, Sun G, Zhao TJ, et al. Zhongguo Gushang. 2006; 19(7):389-391. 张洪美,孙钢,赵铁军.全膝人工关节股骨假体屈曲原因分析及其对疗效影响[J].中国骨伤,2006,19(7):389-391.

[13] Lu H, Mow CS, Lin J. tal knee arthroplasty in the presence of severe flexion contracture: a report of 37 cases. J Arthroplasty. 1999;14(7):775-780.

[14] Lv HS, Kou BL, Yuan YL,et al. ZHonghua Waike Zazhi. 1997, 7:424-427. 吕厚山,寇伯龙,袁燕林,等.高度屈膝畸形的人工全膝关节置换术[J].中华外科杂志,1997,7:424-427.

[15] Lv HS, Guan ZP, Zhou DG, et al. ZHonghua Waike Zazhi. 2005; 43(20):1305-1308. 吕厚山,关振鹏,周殿阁,等. 膝关节外翻畸形的人工全膝关节置换术[J].中华外科杂志,2005,43(20):1305-1308.

[16] Zeng W, Wei YZ, Gao X, et al. Zhonghua Sunshang yu Xiufu Zazhi(dianziban). 2009;4(2):212-215. 曾伟,魏艳珍,高曦,等.软组织平衡在膝外翻畸形全膝关节置换中的意义[J].中华损伤与修复杂志(电子版),2009,4(2):212-215.

[17] Xu MT, Zha ZG, Liu N, et al. Zhongguo Jiaoixng Waike Zazhi. 2011;19(2):109-122. 徐美涛,查振刚,刘宁,等.人工全膝关节置换术在外翻膝的临床应用[J].中国矫形外科杂志,2011,19(2):109-122.

[18] Lädermann A, Saudan M, Riand N, et al. Fixed-bearing versus mobile-bearing total knee arthroplasty: a prospective randomized clinical and radiological study. Rev Chir Orthop Reparatrice Appar Mot. 2008;94(3):247-251.

[19] Shi FJ, Zhang JH, Wang F, et al. Shiyong Guke Zazhi. 2011; 17(8):701-703. 史法见,张锦洪,王芳,等.全膝关节置换术治疗膝外翻畸形疗效观察[J].实用骨科杂志,2011,17(8):701-703.

[20] Zhou SG, Lv HS. Zhonghua Guke Zazhi. 2001;21(12):714- 717. 周殿阁,吕厚山. 软组织平衡在膝内翻全关节置换术中的效果[J]. 中华骨科杂志,2001,21(12):714-717.

[21] Liu XY, Li XS, Liu XD, et al. Zhongguo Gushang. 2010;23 (2): 139-142. 刘兴炎,李旭升,刘旭东,等.重度畸形膝关节病全膝关节置换的疗效分析[J].中国骨伤,2010,23(2):139-142.

[22] Seon JK, Park SJ, Lee KB, et al. Range of motion in total knee arthroplasty: a prospective comparison of high-flexion and standard cruciate-retaining designs. J Bone Joint Surg Am. 2009;91(3):672-679.

[23] Kim YH, Choi Y, Kwon OR, et al. Functional outcome and range of motion of high-flexion posterior cruciate-retaining and high-flexion posterior cruciate-substituting total knee prostheses. A prospective, randomized study. J Bone Joint Surg Am. 2009;91(4):753-760.

[24] Li J, Zheng K, Hu PX, et al. Zhongguo Xiufu Chongjian Waike Zazhi. 2010;24(3):278-281. 李瑾,郑慷,胡培兴.高屈曲度与普通后稳定假体的人工全膝关节置换术近期疗效比较[J]. 中国修复重建外科杂志,2010,24(3): 278-281.

[25] Ranawat CS. Design may be counterproductive for optimizing flexion after TKR. Clin Orthop Relat Res. 2003;(416):174-176.

[26] Lv SJ, Li WQ. Zhongguo Zuzhi Gongcheng Yanjiu yu Linchuang Kangfu. 2009;13(9):1715-1718. 吕尚军,李文强.膝关节置换治疗膝内翻畸形的力学分析[J].中国组织工程研究与临床康复,2009,13(9):1715-1718.

[27] Robertsson O, Dunbar M, Pehrsson T, et al. Patient satisfaction after knee arthroplasty: a report on 27,372 knees operated on between 1981 and 1995 in Sweden. Acta Orthop Scand. 2000;71(3):262-267.

[28] Sun YB, Liu J, Tian ZW, et al. Zhongguo Jiaoxing Waike Zazhi. 2011;19(13):1073-1076. 孙云波,刘军,田峥巍,等.全膝关节置换股骨切迹发生因素分析及远期随访研究[J].中国矫形外科杂志,2011,19(13):1073-1076.

[29] Khatod M, Codsi M, Bierbaum B. Results of resurfacing a native patella in patients with a painful total knee arthroplasty. J Knee Surg. 2004;17(3):151-155.

[30] Hsu RW. The management of the patella in total knee arthroplasty. Chang Gung Med J. 2006;29(5):448-457.

[31] Zou YG, Chen ZW, Feng ZQ, et al. Nanfang Yike Daxue Xuebao. 2011;31(8):1428-1430. 邹勇根,陈志维,冯宗权,等. 影响膝关节置换术术后膝前痛的相关因素[J].南方医科大学学报,2011,31(8):1428-1430.

[32] Epinette JA, Manley MT. Outcomes of patellar resurfacing versus nonresurfacing in total knee arthroplasty: a 9-year experience based on a case series of scorpio PS knees. J Knee Surg. 2008;21(4):293-298.

[33] Oztürk A, Bilgen S, Atici T, et al. The evaluation of patients undergoing total knee arthroplasty with or without patellar resurfacing. Acta Orthop Traumatol Turc. 2006;40(1):29-37.

[34] Yim SJ, Jang MS, Kim WJ,et al. The Effect of Electrocautery around the Patellar Rim in Patellar Non-Resurfacing Total Knee Arthroplasty. Knee Surg Relat Res. 2012;24(2): 104-107.

[35] Zhou YX, Zhang H, Huang DY, et al. Zhonghua Guke Zazhi. 2003;23(2):82-85. 周一新,张洪,黄德勇,等.股骨假体设计对保留髌骨全膝关节置换术后膝前痛的影响[J].中华骨科杂志,2003,23(2):82-85.