Unikompartmental diz replasmanı sonrası revizyon total diz replasmanının sonuçları

Öz

Amaç: Bu geriye dönük, gözleme dayalı çalışmanın amacı, başarısız Oxford Faz 3 medial unikompartmental diz replasmanı (UDR) sonrası uygulanan total diz replasmanının (TDR) sonuçlarını tanımlamaktı.

Çalışma planı: Çalışmaya başarısız aseptik UDR sonrası revizyon TDR’si uygulanan 24 hasta (20 kadın, dört erkek; ortalama yaş: 61) alındı. Sonuçlar Diz Derneği Skorlaması (DDS) ile değerlendirildi.

Bulgular: Hareketli insert dislokasyonu ve açıklanamayan ağrı en sık revizyon nedenleriydi. Ortalama DDS UDR öncesi 50.3 (dağılım: 37-66) ve TDR sonrası 82.2 (dağılım: 58-97) olarak ölçüldü. On yedi hastada mükemmel, dört hastada iyi, iki hastada orta ve bir hastada kötü sonuç elde edildi.

Çıkarımlar: Unikompartmental diz replasmanı yönteminin (çimentolu veya çimentosuz) TDR başarısına etkisi yoktur. Başarısız UDR’nin TDR ile revize edilmesi, tatmin edici erken dönem klinik sonuçlarıyla birlikte kolay bir işlemdir.

Anahtar Kelimeler

• Diz; osteoartrit; revizyon cerrahisi; total diz replasmanı; unikompartmental diz replasmanı.

Outcomes for revision total knee replacement after unicompartmental knee replacement

Öz

Objective: The aim of this retrospective, observational study was to describe the outcomes of total knee replacement (TKR) after failed Oxford phase 3 medial unicompartmental knee replacement (UKR).

Methods: The study included 24 revision TKRs (20 females, 4 males; mean age: 61 years) performed following failed aseptic UKR. Outcomes were assessed using the Knee Society Score (KSS).

Results: The most common causes for revision were mobile bearing dislocation and unexplained pain. Mean preoperative KSS was 50.3 (range: 37 to 66) and 82.2 (range: 58 to 97) after TKR. There were 17 excellent, 4 good, 2 fair and 1 poor results.

Conclusion: The type of UKR performed (cemented versus uncemented) had no effect on TKR success. Revision for failed UKR with TKR appears to be a technically straightforward procedure with satisfactory early clinical results.

Anahtar Kelimeler

• Knee
• osteoarthritis
• revision surgery
• total knee replacement
• unicompartmental knee replacement

Kaynakça

1. Murray DW, Goodfellow JW, O’Connor JJ. The Oxford medial unicompartmental arthroplasty: a ten-year survival study. J Bone Joint Surg Br 1998;80:983-9.
2. Saenz CL, McGrath MS, Marker DR, Seyler TM, Mont MA, Bonutti PM. Early failure of a unicompartmental knee arthroplasty design with an all-polyethylene tibial component. Knee 2010;17:53-6.
3. National Joint Registry for England and Wales. In: 7th Annual Report 2010. p. 116-17.
4. Furnes O, Espehaug B, Lie SA, Vollset SE, Engesaeter LB, Havelin LI. Failure mechanisms after unicompartmental and tricompartmental primary knee replacement with cement. J Bone Joint Surg Am 2007;89:519-25.
5. Padgett DE, Stern SH, Insall JN. Revision total knee arthroplasty for failed unicompartmental replacement. J Bone Joint Surg Am 1991;73:186-90.
6. Barrett WP, Scott RD. Revision of failed unicondylar unicompartmental knee arthroplasty. J Bone Joint Surg Am 1987;69:1328-35.
7. Newman J, Pydisetty RV, Ackroyd C. Unicompartmental or total knee replacement: the 15-year results of a prospective randomised controlled trial. J Bone Joint Surg Br 2009 Jan;91:52-7.
8. Goodfellow JW, O’Connor JJ, Murray DW. A critique of revision rate as an outcome measure: re-interpretation of knee joint registry data. J Bone Joint Surg Br 2010;92:1628-31.

9. Otte KS, Larsen H, Jensen TT, Hansen EM, Rechnagel K. Cementless AGC revision of unicompartmental knee arthroplasty. J Arthroplasty 1997;12:55-9.
10. Järvenpää J, Kettunen J, Miettinen H, Kröger H. The clinical outcome of revision knee replacement after unicompartmental knee arthroplasty versus primary total knee arthroplasty: 8-17 years follow-up study of 49 patients. Int Orthop 2010;34:649-53.
11. Pearse AJ, Hooper GJ, Rothwell A, Frampton C. Survival and functional outcome after revision of a unicompartmental to a total knee replacement: the New Zealand National Joint Registry. J Bone Joint Surg Br 2010;92:508
12. Saragaglia D, Estour G, Nemer C, Colle PE. Revision of 33 unicompartmental knee prostheses using total knee arthroplasty: strategy and results. Int Orthop 2009;33:969
13. Levine WN, Ozuna RM, Scott RD, Thornhill TS. Conversion of failed modern unicompartmental arthroplasty to total knee arthroplasty. J Arthroplasty 1996;11:79780
14. O’Donnell TM, Abouazza O, Neil MJ. Revision of minimal resection resurfacing unicondylar knee arthroplasty to total knee arthroplasty: results compared with primary total knee arthroplasty. J Arthroplasty 2013;28:33-9.
15. Sarraf KM, Konan S, Pastides PS, Haddad FS, Oussedik S. Bone loss during revision of unicompartmental to total knee arthroplasty: an analysis of implanted polyethylene thickness from the National Joint Registry data. J Arthroplasty 2013;28:1571-4.
16. Saldanha KA, Keys GW, Svard UC, White SH, Rao C. Revision of Oxford medial unicompartmental knee arthroplasty to total knee arthroplasty - results of a multicentre study. Knee 2007;14:275-9.
17. Pandit H, Jenkins C, Gill HS, Barker K, Dodd CA, Murray DW. Minimally invasive Oxford phase 3 unicompartmental knee replacement: results of 1000 cases. J Bone Joint Surg Br 2011;93:198-204.
18. Smith H, Jan M, Mahomed NN, Davey JR, Gandhi R. Meta-analysis and systematic review of clinical outcomes comparing mobile bearing and fixed bearing total knee arthroplasty. J Arthroplasty 2011;26:1205-13.
19. Kim KT, Lee S, Kim TW, Lee JS, Boo KH. The influence of postoperative tibiofemoral alignment on the clinical results of unicompartmental knee arthroplasty. Knee Surg Relat Res 2012;24:85-90.
20. The Norwegian Arthroplasty Register Report 2010. p. 57Murray DW, Pandit H, Weston-Simons JS, Jenkins C, Gill HS, Lombardi AV, et al. Does body mass index affect the outcome of unicompartmental knee replacement? Knee 2013;20:461-5.