Dizin ileri derecede osteoartritinde bağ kesen total diz artroplastisinin orta dönem sonuçları

Öz

Amaç: Bu retrospektif çalışmanın amacı, ileri derece osteoartritli hastalarda posterior stabilize(PS) tasarımlı bağ kesen total diz artroplastisi (TDA) yapılan hastaların fonksiyonel ve radyolojik orta dönem sonuçlarını incelemektir. Gereç ve Yöntemler: Çalışma, primer veya sekonder osteoartrit tanısı nedeniyle PS TDA yapılan 52 hastanın toplam 68 dizi dahil edildi. 52 hastanın 45'i kadın (% 86,5) ve 7'si erkekti (% 13,5). Hastaların ortalama yaşı 65,2±9,32 (30-82) yıldı. Amerikan Diz Derneği kriterleri, hastaların diz ve fonksiyonel skorlarının değerlendirmek için kullanıldı. Hastaların radyolojik değerlendirmesi için Total Diz Protezi Radyolojik Değerlendirme kriterleri kullanıldı. Karşılaşılan komplikasyonlar kaydedildi. Bulgular: Hastaların ortalama takip süresi 32,1 ± 9,85 aydı (aralık: 18-60 ay). Ortalama Diz Derneği Diz skoru ameliyat öncesi 41,5 ± 8,83 (aralık: 26-58) değerinden ameliyat sonrası 84,3 ± 9,14'e (aralık: 51-97) yükselirken (p: 0,001), benzer şekilde fonksiyon skoru PS TDA uygulamasından sonra 38,8 ± 17,2 (aralık: 10-70) ila 77,7 ± 14,8 (aralık: 45-100) (p: 0,001). Ortalama preoperatif ve postoperatif hareket açıklığı sırasıyla 88,2º (aralık, 60º - 100º) ve 106,7º (aralık, 90º - 120º) idi. Geç dönem derin enfeksiyon nedeniyle bir hastaya iki aşamalı revizyon ameliyatı uygulandı. Aseptik gevşeme hiçbir hastada gözlemlenmedi. İmplant sağkalımı % 98,8 idi ve fonksiyonel diz skoruna göre mükemmel ve iyi sonuçlar sırasıyla,% 41,1 ve % 32,3 olarak bildirildi. Sonuç: İleri diz osteoartritinde, posterior stabilize tasarımlı bağ kesen total diz artroplastisi, orta dönem takipte mükemmel hasta memnuniyeti ve yüksek protez sağkalımına sahiptir.

Anahtar Kelimeler

• Diz
• Osteoartrit
• Total Diz Protezi
• Bağ Kesen

Mid-term outcomes of posterior stabilized total knee arthroplasty in severe osteoarthritis

Öz

Aim: The purpose of this study was to reveal mid-term outcomes by retrospectively investigating patients who underwent total knee arthroplasty with a posterior stabilized design. Material and methods: The study included a total of 68 knees of 52 patients with completed follow-up data who underwent PCL substituting (PS) total knee arthroplasty due to a diagnosis of primary or secondary osteoarthritis. The 52 patients comprised 45 (86.5%) females and 7 (13.5%) males with a mean age of 65.2±9.32 years (range, 30-82 years). The American Knee Society criteria were adopted for assessment of patient knee scores and functional knee scores. The Total Knee Prosthesis Radiological Evaluation criteria were applied for radiological evaluation of the patients. Results: The mean follow-up period of the patients was 32.1 ± 9.85 months (range: 18-60 months) and the Knee Society Scores (KSS) were 41.5 (range: 26 - 58) preoperatively, and 84.3 (range: 51 - 97) postoperatively. The mean preoperative and postoperative range of motion was 88.2º (range: 60º - 100º), and 106.7º (range: 90º - 120º), respectively. Two-stage revision surgery was applied to one patient due to deep infection. No cases of aseptic loosening were observed. Implant survivorship, and excellent and good results according to the functional knee score were reported as 98.8%, 41.1%, and 32.3%, respectively. Conclusion: Positive patient outcomes were obtained with the use of PS total knee arthroplasty in patients with severe osteoarthritis and there was no evidence of loss in mid-term follow-up.

Anahtar Kelimeler

• knee
• osteoarthritis
• total knee arthroplasty
• posterior stabilized

Kaynakça

1. 1. Pagnano MW, Cushner FD, Scott WN. Role of the posterior cruciate ligament in total knee arthroplasty. J Am Acad Orthop Surg 1998; 6: 176-87.
2. 2. Song SJ, Park CH, Bae DK. What to Know for Selecting Cruciate-Retaining or Posterior-Stabilized Total Knee Arthroplasty. Clin Orthop Surg. 2019; 11: 142-50.
3. 3. Matziolis G, Mehlhorn S, Schattat N et al. How much of the PCL is really preserved during the tibial cut? Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA 2012; 20: 1083-6.
4. 4. Bignozzi S, Zaffagnini S, Akkawi I et al. Three different cruciate-sacrificing TKA designs: minor intraoperative kinematic differences and negligible clinical differences. Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA 2014; 22: 3113-20.
5. 5. Mihalko WM, Miller C, Krackow KA. Total knee arthroplasty ligament balancing and gap kinematics with posterior cruciate ligament retention and sacrifice. Am J Orthop (Belle Mead NJ) 2000; 29: 610-6.
6. 6. Baldini A, Castellani L, Traverso F, Balatri A, Balato G, Franceschini V. The difficult primary total knee arthroplasty: a review. Bone Joint J 2015; 97: 30-9.
7. 7. Su EP. Fixed flexion deformity and total knee arthroplasty. J Bone Joint Surg Br. 2012; 94: 112-5.
8. 8. Scuderi GR, Sikorskii A, Bourne RB, Lonner JH, Benjamin JB, Noble PC. The Knee Society Short Form Reduces Respondent Burden in the Assessment of Patient-reported Outcomes. Clin Orthop Relat Res 2016; 474: 134-42.

9. 9. Eikelboom JW, Karthikeyan G, Fagel N, Hirsh J. American Association of Orthopedic Surgeons and American College of Chest Physicians guidelines for venous thromboembolism prevention in hip and knee arthroplasty differ: what are the implications for clinicians and patients? Chest 2009; 135: 513-20.
10. 10. Bosco JA, Bookman J, Slover J, Edusei E, Levine B. Principles of Antibiotic Prophylaxis in Total Joint Arthroplasty: Current Concepts. J Am Acad Orthop Surg 2015; 23: 27-35.
11. 11. Ewald FC. The Knee Society total knee arthroplasty roentgenographic evaluation and scoring system. Clin Orthop Relat Res 1989; 248: 9-12.
12. 12. Rand JA, Trousdale RT, Ilstrup DM, Harmsen WS. Factors affecting the durability of primary total knee prostheses. The Journal of bone and joint surgery American volume 2003; 85: 259-65.
13. 13. Serna-Berna R, Lizaur-Utrilla A, Vizcaya-Moreno MF, Miralles Muñoz FA, Gonzalez-Navarro B, Lopez-Prats FA. Cruciate-Retaining vs Posterior-Stabilized Primary Total Arthroplasty. Clinical Outcome Comparison With a Minimum Follow-Up of 10 Years. J Arthroplasty 2018; 33: 2491-5. E
14. 14. Lotke PA, Ecker ML. Influence of positioning of prosthesis in total knee replacement. The Journal of bone and joint surgery American volume 1977; 59: 77-9.
15. 15. Ritter MA, Faris PM, Keating EM, Meding JB. Postoperative alignment of total knee replacement. Its effect on survival. Clin Orthop Relat Res 1994; 299: 153-6.
16. 16. Ritter MA, Harty LD, Davis KE, Meding JB, Berend ME. Predicting range of motion after total knee arthroplasty. Clustering, log-linear regression, and regression tree analysis. The Journal of bone and joint surgery American volume. 2003; 85: 1278-85.
17. 17. Chang MJ, So S, Park CD, Seo JG, Moon YW. Long-term follow-up and survivorship of single-radius, posterior-stabilized total knee arthroplasty. J Orthop Sci. 2018; 23: 92-6.