2024 · Clinics in Orthopedic Surgery
TKA不安定性に対するポリエチレンインサート単独交換（IPIE）の生存率と臨床結果は、過伸展の有無で異なるか？
IPIE全体の生存率は5年83%、10年57%でした。過伸展の有無による生存率差は統計学的に有意ではありませんでした。
対象と方法
絵を読んだ順序です
主な結果
手術に関する読書のポイント
解釈の限界
簡単に説明しましょう
この研究で何が確認されましたか?
IPIE全体の生存率は5年83%、10年57%でした。過伸展の有無による生存率差は統計学的に有意ではありませんでした。
治療決定に直接適用できるか?
選択した46例の後ろ向き研究で、全再置換との直接比較はありません。10年推定値は平均追跡期間より長く、慎重な解釈が必要です。
Keywords・キーワード
- Hyperextension
- Isolated polyethylene insert exchange
- Joint instability
- Polyethylene
- Reoperation
- Arthroplasty, Replacement, Knee
- Joint Instability
- Range of Motion, Articular
Abstract・原文の抄録
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
オリジナル紙だ
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