Total knee replacement for posttraumatic degenerative arthritis of the knee

(整期优先)网络出版时间:2005-04-14
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Objective:Toevaluatetheresultsoftotalkneearthroplasty(TKA)inpatientswithposttraumaticdegenerativearthritisduetoapreviousfracturearoundtheknee.Methods:Weanalyzedtheresultsof15TKAs,performedfrom1997to2003,in15patientswithpost-traumaticdegenerativearthritisduetoapreviousfracturearoundknee.Therewere3womenand12menwithanaverageageof58years(range,31-76years).Thetimefromfracturetoarthroplastyaveraged8.2years(range,2-27years).Internalfixationhadpreviouslybeenperformedin8patientsresultinginretainedhardware.Atthetimeofarthroplastyafemoralfracturemalunionwaspresentintwoknees.Lateralretinacularrelease(4knees),extensormechanismrealignment(1knee)ormedialcollateralligamentreconstruction(1knee)wereneededatthetimeofarthroplasty.Results:Follow-upaveraged35months(range,12-73months).Nopatientwaslostforfollow-up.AccordingtotheKneeSocietyScorescale,themeanpreoperativekneescorewas37(range,10-70)andfunctionalscorewas41(range,0-60).Theywereimprovedsignificantlytoameanof84(range,10-100)and76(range,20-100)points,respectivelyatthelatestfollow-up.Themeankneearcofmotionwereimprovedfrom84°preoperationto94°atthelatestfollow-up.Postoperativemanipulationunderanesthesiaforpoormotionwascarriedoutin4knees.Nokneehadasepticlooseningthatrequiredsubsequentrevision.Twokneesdevelopedsuperficialinfectionandweretreatedwithdebridement.Itsubsequentlyrecoveredwiththeretentionofcomponents.Conclusions:SignificantimprovementinfunctionandreliefofpainhasbeenachievedinpatientswithpreviousfracturesundergoingsubsequentTKA.However,thisprocedureistechnicallydemandingandpatientsareatincreasedriskforrestrictedmotionandneedmorecarefollowingTKA.ThisstudysuggeststhattheoutcomeofTKAmaybeimprovedfurtherbymakingspecialeffortstorestorelimbalignment,toensurecorrectcomponent