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Title: [Comparison of effectiveness of total knee arthroplasty with tantalum monoblock tibial component and cemented tibial plateau prosthesis in patients of different ages].
Author: Jiao Y, Zhang X, Askar Mamtimin, Xu B, Li G, Cao L.
Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi; 2021 Dec 15; 35(12):1563-1573. PubMed ID: 34913313.
Abstract:
OBJECTIVE: To investigate the difference of total knee arthroplasty (TKA) with tantalum monoblock tibial component (TMT) and cemented tibial plateau prosthesis in patients of different ages. METHODS: The clinical data of 248 patients (392 knees) who underwent primary TKA between May 2014 and May 2019 and met the selection criteria were retrospectively analyzed. There were 54 males (98 knees) and 194 females (294 knees). Of the 122 patients (183 knees), less than 65 years old, 52 (75 knees, group A1) were treated with TMT and 70 (108 knees, group B1) were treated with cemented tibial plateau prosthesis; of the 126 patients (209 knees), more than 65 years old, 57 (82 knees, group A2) were treated with TMT and 69 (127 knees, group B2) were treated with cemented tibial plateau prosthesis. The baseline data of patients, perioperative indicators [hemoglobin (Hb), hematocrit (Hct), total blood loss, unilateral operation time], effectiveness evaluation indicators [Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, visual analogue scale (VAS) score, Knee Society Scoring System (KSS) score, active flexion and extension range of motion (ROM) of the knee joint], complications, and imaging indicators [tibial prosthesis varus angle (β angle), tibial prosthesis posterior slope angle (δ angle), tibio-femoral angle, occurrence of radiolucent line, prosthesis survival rate] were recorded and compared. RESULTS: There was no significant difference in gender, age, height, weight, body mass index, Kellgren-Lawrence grading, the length of hospital stay, and follow-up time between groups A1, B1 and groups A2, B2 ( P>0.05). The unilateral operation time in groups A1 and A2 was significantly shorter than that in the corresponding groups B1 and B2 ( P<0.05). There was no significant difference in differences of pre- and post-operative Hb and Hct and total blood loss between groups A1, B1 and groups A2, B2 ( P>0.05). There was no significant difference in preoperative effectiveness evaluation indicators between groups A1, B1 and groups A2, B2 ( P>0.05). There were significant differences in the differences of pre- and post-operative WOMAC activity and pain scores, KSS function and pain scores, and VAS scores between groups A1 and B1 ( P<0.05); there was no significant difference in WOMAC stiffness score and ROM ( P>0.05). There was no significant difference in the above indicators between groups A2 and B2 ( P>0.05). There was no significant difference in the incidence of complications (2.7% vs 6.5%, 3.7% vs 3.1%) and prosthesis survival rate (100% vs 97.2%, 100% vs 99.2%) between groups A1, B1 and groups A2, B2 ( P>0.05). During follow-up, there was no significant difference in β angle, δ angle, and tibio-femoral angle between groups A1, B1 and groups A2, B2 ( P>0.05). In the evaluation of knee X-ray radiolucent line, 2 knees of group A1 and 2 knees of group A2 had radiolucent line at prosthesis-bone interface immediately after operation, and the radiolucent line was gradually filled by new bone, without new radiolucent line. During follow-up, 1 knee of group B1 and 1 knee of group B2 had prosthesis-bone interface radiolucent line, without radiolucent line widening or prosthesis loosening. CONCLUSION: TMT is recommended in patients less than 65 years old, and the two types of prostheses are available for patients nore than 65 years old. However, the long-term effectiveness of the two types of prosthesis in patients of different ages needs further follow-up. 目的: 探讨不同年龄段患者采用多孔钽金属胫骨平台假体（tantalum monoblock tibial component，TMT）以及骨水泥型胫骨平台假体行人工全膝关节置换术（total knee arthroplasty，TKA）的疗效差异。. 方法: 回顾分析2014年5月—2019年5月行初次TKA且符合选择标准的248例（392膝）患者临床资料。其中，男54例（98膝），女194例（294膝）。年龄≤65岁的122例（183膝）患者中，采用TMT假体52例（75膝，A1组）、骨水泥型胫骨平台假体70例（108膝，B1组）；>65岁的126例（209膝）患者中，采用TMT假体57例（82膝，A2组）、骨水泥型胫骨平台假体69例（127膝，B2组）。记录并比较患者基线资料，围术期相关指标［血红蛋白（hemoglobin，Hb）、红细胞压积（hematocrit，Hct）、总失血量、单侧手术时间］，疗效评价指标［西安大略和麦克马斯特大学骨关节炎指数（WOMAC）评分、疼痛视觉模拟评分（VAS）、膝关节学会评分系统（KSS）评分、膝关节主动屈伸活动度（range of motion，ROM）］，并发症发生情况，以及影像学观测指标［胫骨假体内翻角（β角）、胫骨假体后倾角（δ角）、股胫角、透亮线发生情况、假体生存率］。. 结果: A1、B1组间以及A2、B2组间患者性别、年龄、身高、体质量、身体质量指数、Kellgren-Lawrence分级及住院时间、随访时间比较，差异均无统计学意义（ P>0.05）。A1、A2组单侧手术时间较对应B1、B2组缩短（ P<0.05）。A1、B1组间以及A2、B2组间Hb及Hct手术前后差值、总失血量比较，差异均无统计学意义（ P>0.05）。A1、B1组间以及A2、B2组间术前膝关节评价指标比较，差异均无统计学意义（ P>0.05）。A1、B1组间WOMAC活动及疼痛评分、KSS功能及疼痛评分、VAS评分手术前后差值比较，差异均有统计学意义（ P<0.05）；WOMAC僵硬评分及ROM手术前后差值组间差异无统计学意义（ P>0.05）。A2、B2组间上述指标比较，差异均无统计学意义（ P>0.05）。A1、B1组间以及A2、B2组间并发症发生率（2.7% vs 6.5%，3.7% vs 3.1%）及假体生存率（100% vs 97.2%，100% vs 99.2%）比较，差异均无统计学意义（ P>0.05）。末次随访时，A1、B1组间以及A2、B2组间β角、δ角、股胫角比较，差异均无统计学意义（ P>0.05）。膝关节X线透亮线评价中，A1、A2组各2膝术后即刻存在假体-骨界面透亮线，随访期间透亮线逐渐被新生骨填充，无新透亮线产生；B1、B2组末次随访时各1膝胫骨平台假体存在假体-骨界面透亮线，暂无透亮线增宽或假体松动现象。. 结论: 对于≤65岁患者建议选择TMT假体置换，>65岁患者两类假体均可选择。但不同年龄段患者两类假体置换后远期疗效有待进一步随访观察。.

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