2024 · Clinics in Orthopedic Surgery
TKA 불안정성에 대한 삽입물 단독 교환(IPIE)의 생존율과 임상 결과는 과신전 유무에 따라 다를까?
전체 IPIE 생존율은 5년 83%, 10년 57%였습니다. 과신전 유무에 따른 생존율 차이는 통계적으로 유의하지 않았습니다.
대상과 방법
그림을 읽는 순서
주요 결과
진료·수술에서 읽을 지점
해석의 제한
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이 연구가 확인한 것은 무엇인가요?
전체 IPIE 생존율은 5년 83%, 10년 57%였습니다. 과신전 유무에 따른 생존율 차이는 통계적으로 유의하지 않았습니다.
개별 환자의 치료 결정에 바로 적용할 수 있나요?
선별된 46례의 후향적 연구입니다. 완전 재치환과 직접 비교하지 않았으며 10년 추정치는 평균 추적보다 길어 해석에 주의가 필요합니다.
Keywords · 주제어
- Hyperextension
- Isolated polyethylene insert exchange
- Joint instability
- Polyethylene
- Reoperation
- Arthroplasty, Replacement, Knee
- Joint Instability
- Range of Motion, Articular
Abstract · 원문 초록
Byung Sun Choi, Du Hyun Ro, Myung Chul Lee, Hyuk-Soo Han. Isolated Polyethylene Insert Exchange for Instability after Total Knee Arthroplasty: Comparable Survival Rates and Range of Motion and Improved Clinical Scores Regardless of Hyperextension. Clinics in orthopedic surgery. 2024;16(4):550-558. doi:10.4055/cios23163.
BACKGROUND
Isolated polyethylene insert exchange (IPIE) has not been established as a treatment option for hyperextension instability after primary total knee arthroplasty (TKA). The purpose of the study was to evaluate the survival rate and clinical outcomes of IPIE for the treatment of instability with or without hyperextension after TKA.
METHODS
This study retrospectively reviewed 46 patients who underwent IPIE for symptomatic prosthetic knee instability by dividing them into 2 groups based on the presence of hyperextension (without for group I and with for group IH). Patient demographics, clinical scores, radiographic data, range of motion (ROM), and surgical information were collected. Clinical failure was defined as a subsequent surgery following IPIE for any reason. The survival rate of IPIE and differences in demographics, clinical scores, and ROM were compared.
RESULTS
There were 46 patients (91% were women) with an average age of 70.1 years and a mean follow-up of 44.8 months. The average time between primary TKA and IPIE surgery was 6.5 ± 4.2 years, and during IPIE, 2 out of the 8 cruciate-retaining inserts were converted to "deep-dish" ultracongruent inserts while the insert thickness increased from 11.9 ± 1.8 mm to 17.1 ± 3.1 mm. After IPIE surgery, a significantly thicker tibial insert was used in the group with hyperextension (15.39 ± 2.4 mm for group I, 18.3 ± 2.9 mm for group IH; p < 0.001 by independent t-test), and no significant differences were observed in the ROM and clinical scores before and after IPIE between the 2 groups. The overall survival rate for IPIE was 83% at 5 years and 57% at 10 years, and there were no statistically significant differences between the groups using the Cox proportional hazards regression model.
CONCLUSIONS
IPIE demonstrated an overall survival rate of 83% at 5 years with no difference in the recurrence of instability regardless of hyperextension. This study highlighted the effectiveness of using thicker inserts to resolve instability without significant differences in the ROM or clinical scores between the groups, suggesting its potential as a decision-making reference for surgeons.
Copyright © 2024 by The Korean Orthopaedic Association
원래 논문
Isolated Polyethylene Insert Exchange for Instability after Total Knee Arthroplasty: Comparable Survival Rates and Range of Motion and Improved Clinical Scores Regardless of Hyperextension
Byung Sun Choi, Du Hyun Ro, Myung Chul Lee, Hyuk-Soo Han
Clinics in Orthopedic Surgery · 2024