Retrospective analysis of the function and clinical applications of different knee prostheses after implantation
- VernacularTitle:根据患者类型选择不同类型人工膝关节假体植入后临床应用效果的回顾性分析
- Author:
Jiyuan DONG
;
Jian ZHANG
;
Yan WANG
- Publication Type:Journal Article
- From:
Chinese Journal of Tissue Engineering Research
2007;11(8):1563-1566
- CountryChina
- Language:Chinese
-
Abstract:
BACKGROUND: The total knee replacement is considered as one of the most effective and successful operations to cure terminal or severe gonarthritis. How to lower the revision rate as well as increace the effect of prostheses after the knee replacement should be solved urgently.OBJECTIVE: To retrospectively analyse the clinical applications and curative effects of different knee prostheses.DESIGN: Based on patients who accepted knee replacement, preoperative and postoperative condition was observed and compared so as to compare the postoperative effect of different types of knee prostheses replacements.SETTING: Department of Orthopedics, General Hospital of Chinese PLA.PARTICIPANTS: A total of 398 patients (523 knees) were selected from the Department of Orthopedics, General Hospital of Chinese PLA from January 2002 to January 2005, including 276 unilateral knee replacements (276 knees) and 122 bilateral knee replacements (244 knees). Patients were respectively diagnosed as osteoarthritis (OA), rheumatoid arthritis (RA), ankylosing spondylitis (AS), pigmented villonodular synovitis (PVNS), etc.METHODS: According to the pathogenetic condition, patients received total knee replacements with different knee prostheses. Types of knee prostheses: ① According to the replacing range, it could be divided into unicondylar prostheses and total condylar prostheses; total condylar prostheses could be subdivided into posterior cruciate ligament (PCL)-retaining and PCL-substituting prostheses. ②According to the degree of mechanical constraint, it could be divided into unconstrained, semiconstrained or fully constrained prostheses. ③ According to whether imitating meniscus-function, it could be divided into tibial plateau rotatable sliding type and fixed type. Follow-up was conducted on patients that mentioned above after half a year. Knee joints were scored by using knee joint scoring system of American special surgical hospital (HSS scoring with the total score of 100 points, those above 85 were considered as excellent; 70-84 as good;60-69 as fair; below 60 as poor). Feller scoring (total score of 30 points; the higher the points were, the better the symptom was) criteria was used in patellar scoring. Investigation and comparison on pain-degree of anterior region of knee,range of motion of knee joint and the stabilization were done during the follow-up, ap and lateral views of patella from 30 degrees and 90 degrees were taken in radiography.MAIN OUTCOME MEASURES: Preoperative and postoperative scores of HSS, patella, anterior pain of knee, function of patella, the maximum flexion and tibiofemoral angle.RESULTS: Follow-up was conducted in 372 patients (490 knees) with the follow-up rate of 93.4%. ①Therapeutic effect:Excellent and good rate of the operation was 89%. Pain and function of patients after operation were obviously ameliorated, effect on pain-amelioration and range of motion of knee joint activation were significant. ② Score of HSS, patellar,anterior pain of knee, function of patellar and the maximum flexion were markedly increased than those before operation (P ＜ 0.01). ③ There were no marked significances in comparison of score of HSS, patellar, anterior pain of knee, function of patellar, the maximum flexion and tibiofemoral angle on different knee prostheses replacements (P ＞ 0.05).CONCLUTION: Prostheses should be chosen carefully and appropriately according to the indications, contraindications,anticipated attainable functions, service life as well as pathogenetic conditions, and then satisfactory curative effect will accordingly be achieved.
