Poroz kaplı, vidalı çimentosuz total diz artroplastisinin uzun dönem sonuçları

Öz

Amaç: Çalışmamızda poroz kaplı, vidalı çimentosuz total diz artroplastisi (TDA) uygulamalarının uzun dönem sonuçlarını değerlendirmeyi amaçladık. Çalışma planı: Çalışma 54 hastanın (43 kadın, 11 erkek; ortalama yaş: 56.9, dağılım: 46-70) 68 dizi ile yapıldı. Tüm hastalara primer diz osteoartriti tanısıyla bağ koruyan çimentosuz total diz protezi uygulandı. Klinik, fonksiyonel ve radyografik değerlendirmede Diz Derneği’nin skorlama sistemi (Knee Scoring System, KSS) kullanıldı. Protez sağkalımı Kaplan-Meier eğrisi ile değerlendirildi. Ortalama izlem süresi 9.2 (dağılım: 8-12) yıl idi. Bulgular: Diz skoru ameliyat öncesi 42.3 (dağılım: 32-61) iken, son kontrollerde 88.6 (dağılım: 54-96) puana, fonksiyon skoru ameliyat öncesi 39.1 iken (dağılım: 35-66) son kontrollerde 82.8 (dağılım: 50-100) puana yükseldi (p<0.05). Ameliyat öncesi ortalama diz fleksiyonu 98 (dağılım: 80-110) dereceden, son kontrollerde 112 (dağılım: 85-130) dereceye yükseldi (p<0.05). Ameliyat öncesi ortalama dizilim açısı 9.2° varus iken ameliyat sonrasında 5.4° valgus idi. Bir hastada tibial komponentte aseptik gevşeme, bir hastada protez çevresi kırık ve bir hastada da patella dislokasyonu nedeniyle revizyon cerrahisine gerek duyuldu. İki dizde (%3) yüzeysel enfeksiyon görüldü. İzlem süresince hiçbir olguda vidaların etrafında osteoliz görülmedi. Protez sağkalım oranı 12 yılda %95.6 (dağılım: %91.56-99.60; %95 GA) idi. Çıkarımlar: Poroz kaplı, vidalı çimentosuz total diz artroplastisi, uzun dönem takiplerde iyi klinik ve radyografik sonuçlarla birlikte yüksek sağkalım oranları sağlamaktadır.

Anahtar Kelimeler

• Artroplasti; çimentosuz total diz artroplastisi; osteoartrit; poroz kaplı; protez; vidalı tespit.

Long-term results of porous-coated cementless total knee arthroplasty with screw fixation

Abstract

Objective: The aim of this study was to evaluate the long-term results of porous-coated, cementless total knee arthroplasty with screw fixation.
Methods: This study included 68 knees of 54 patients (43 female, 11 male; mean age: 56.9 years, range 46 to 70 years). Cruciate-retaining cementless total knee prostheses were implanted in all patients diagnosed with primary osteoarthritis. Clinical, functional and radiological evaluations were performed according to the Knee Society’s Knee Scoring System (KSS). Prosthesis survival was analyzed using Kaplan-Meier curves. Mean follow-up time was 9.2 (range: 8 to 12) years.
Results: Preoperative mean knee and function scores were 42.3 (range: 32 to 61) and 39.1 (range: 35 to 66), respectively, while they were 88.6 (range: 54 to 96) and 82.8 (range: 50 to 100), respectively at the final follow-up (p<0.05). Mean preoperative knee flexion was 98° (range: 80° to 110°) and 112° (range: 85° to 130°) at the final follow-up (p<0.05). Preoperative and postoperative mean alignments were 9.2° varus and 5.4° valgus, respectively. Revisions were performed due to aseptic loosening of the tibial component in one patient, periprosthetic fracture in one and dislocation of the patella in one. Two superficial infections (3%) were observed. There was no osteolysis around the screws during the follow-up period. The overall rate of implant survival was 95.6% (range: 91.56% to 99.60%; 95% CI) at 12 years.
Conclusion: Long-term outcomes of porous-coated, cementless total knee arthroplasty with screw fixation were successful in terms of clinical and radiological evaluation and yielded a high survival rate.

Keywords

• Arthroplasty
• cementless total knee arthroplasty
• osteoarthritis
• porous-coated
• prosthesis
• screw fixation

Kaynakça

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