BACKGROUND The posterior cruciate ligament(PCL) is important for cruciate-retaining(CR)total knee arthroplasty(TKA). Whether the entire PCL should be retained during CR-TKA is controversial.AIM To evaluate the clinica...BACKGROUND The posterior cruciate ligament(PCL) is important for cruciate-retaining(CR)total knee arthroplasty(TKA). Whether the entire PCL should be retained during CR-TKA is controversial.AIM To evaluate the clinical outcomes of PCL preservation in CR-TKA and the methods used to deal with the PCL during surgery.METHODS A retrospective review of patients with osteoarthritis undergoing primary CRTKA(176 patients, 205 knees) in our institution between March 2012 and March 2014 was performed. A PCL protector was used to preserve the intact PCL bone block. The status of the PCL was recorded during surgery. Intact PCL preserved,pie-crusting and repairing were used to balance the tension of the PCL. Range of motion(ROM) and the Knee Society Clinical Rating system(KSS) were evaluated preoperatively and at the endpoint of follow-up.RESULTS The mean ROM of the knee was 103.2 ± 17.2°, KSS clinical score was 47.6 ± 9.5 and KSS functional score was 46.3 ± 11.9 before surgery. The mean ROM of the knee was 117.5 ± 9.7°, KSS clinical score was 89.2 ± 3.6 and KSS functional score was 84.6 ± 9.8 at 5 years follow-up. ROM, KSS clinical scores and KSS functional scores were significantly improved after surgery(P < 0.01). Thirty-two(23.7%)TKAs involved PCL pie-crusting and 18(13.3%) involved PCL repair. Eighty-five(63.0%) TKAs applied standard operating procedures and preserved intact PCL.At 5 years follow-up, in the intact PCL group, the mean ROM of the knee was 118.0 ± 8.3°, KSS clinical score was 89.1 ± 3.7 and KSS functional score was 84.9 ±9.6. In the PCL pie-crusting group, mean ROM of the knee was 114.0 ± 13.5°, KSS clinical score was 88.8 ± 3.4 and KSS functional score was 83.8 ± 10.5. In the PCL repair group, mean ROM of the knee was 120.3 ± 7.0°, KSS clinical score was 89.0± 3.6 and KSS functional score was 89.4 ± 4.5. There were no significant differences in ROM, KSS clinical scores and KSS functional scores among the three groups(P > 0.05).CONCLUSION The clinical outcomes of preserving the PCL in CR-TKA are encouraging. Piecrusting and PCL repair do not affect the function. The PCL protector effectively protected the PCL bone block.展开更多
Objective; TO observe the clinical outcome of total knee arthroplasty (TKA ) with posterior cruciate ligament (PCL ) retention in patients with severe varus deformity. Methods We reviewed the clinical treatment result...Objective; TO observe the clinical outcome of total knee arthroplasty (TKA ) with posterior cruciate ligament (PCL ) retention in patients with severe varus deformity. Methods We reviewed the clinical treatment results of primary TKA in patients with severe varus deformity (≥20°) between January 1990 and July 1995. All patients, suffered from ostecoarthritis, were performed on a single surgeon using a minimally constrained "Hybrid" Miller-Galante knees (MG-I). Cliniccal evaluation were assessed by using the Knee Society clinical rating system. The Student’s t test was used to analyse the data. Results At a mean follow-up of 6 years (4-9years), 56 knees in 38 patients were available for review. 5 patients (7 knees) lost follow-up and 3 patients (4 knees) died. The average knee score improved from 33 points before operation to 91 points in the latest follow-up with excellent results in 84% of all patients. The Knee Society functional score improved from 39 to 76 points. The improvements were statistically significant (P < 0. 01 ). A functionally acceptable range of motion (ROM) of more than 90° were achieved in 86% of all patients. Most of cases (50/56 ) had postoperative alignment inside the normal range of 5° to 7° valgus. The other 6 cases had postoperative residual deformity of 5°-10°varus. Total revision rate was 21 % (12 /56 ), the average revision time was 5. 5 years after surgery. Other complications included patellar subluxation in 1 case, anterior pain of knee in 4 cases, and superficial cellulitis in 1 case. No early or late infection, aseptic loosening or anterioposterior instability occurred in this series. Conclusion Severs varus deformity can he successfully corrected at the time of primary TKA by using PCL-retention prosthesis. There were more problems from postoperative medial-lateral instability of knee which contributed significantly to early failure after an average of 6. 0 years.展开更多
文摘BACKGROUND The posterior cruciate ligament(PCL) is important for cruciate-retaining(CR)total knee arthroplasty(TKA). Whether the entire PCL should be retained during CR-TKA is controversial.AIM To evaluate the clinical outcomes of PCL preservation in CR-TKA and the methods used to deal with the PCL during surgery.METHODS A retrospective review of patients with osteoarthritis undergoing primary CRTKA(176 patients, 205 knees) in our institution between March 2012 and March 2014 was performed. A PCL protector was used to preserve the intact PCL bone block. The status of the PCL was recorded during surgery. Intact PCL preserved,pie-crusting and repairing were used to balance the tension of the PCL. Range of motion(ROM) and the Knee Society Clinical Rating system(KSS) were evaluated preoperatively and at the endpoint of follow-up.RESULTS The mean ROM of the knee was 103.2 ± 17.2°, KSS clinical score was 47.6 ± 9.5 and KSS functional score was 46.3 ± 11.9 before surgery. The mean ROM of the knee was 117.5 ± 9.7°, KSS clinical score was 89.2 ± 3.6 and KSS functional score was 84.6 ± 9.8 at 5 years follow-up. ROM, KSS clinical scores and KSS functional scores were significantly improved after surgery(P < 0.01). Thirty-two(23.7%)TKAs involved PCL pie-crusting and 18(13.3%) involved PCL repair. Eighty-five(63.0%) TKAs applied standard operating procedures and preserved intact PCL.At 5 years follow-up, in the intact PCL group, the mean ROM of the knee was 118.0 ± 8.3°, KSS clinical score was 89.1 ± 3.7 and KSS functional score was 84.9 ±9.6. In the PCL pie-crusting group, mean ROM of the knee was 114.0 ± 13.5°, KSS clinical score was 88.8 ± 3.4 and KSS functional score was 83.8 ± 10.5. In the PCL repair group, mean ROM of the knee was 120.3 ± 7.0°, KSS clinical score was 89.0± 3.6 and KSS functional score was 89.4 ± 4.5. There were no significant differences in ROM, KSS clinical scores and KSS functional scores among the three groups(P > 0.05).CONCLUSION The clinical outcomes of preserving the PCL in CR-TKA are encouraging. Piecrusting and PCL repair do not affect the function. The PCL protector effectively protected the PCL bone block.
文摘Objective; TO observe the clinical outcome of total knee arthroplasty (TKA ) with posterior cruciate ligament (PCL ) retention in patients with severe varus deformity. Methods We reviewed the clinical treatment results of primary TKA in patients with severe varus deformity (≥20°) between January 1990 and July 1995. All patients, suffered from ostecoarthritis, were performed on a single surgeon using a minimally constrained "Hybrid" Miller-Galante knees (MG-I). Cliniccal evaluation were assessed by using the Knee Society clinical rating system. The Student’s t test was used to analyse the data. Results At a mean follow-up of 6 years (4-9years), 56 knees in 38 patients were available for review. 5 patients (7 knees) lost follow-up and 3 patients (4 knees) died. The average knee score improved from 33 points before operation to 91 points in the latest follow-up with excellent results in 84% of all patients. The Knee Society functional score improved from 39 to 76 points. The improvements were statistically significant (P < 0. 01 ). A functionally acceptable range of motion (ROM) of more than 90° were achieved in 86% of all patients. Most of cases (50/56 ) had postoperative alignment inside the normal range of 5° to 7° valgus. The other 6 cases had postoperative residual deformity of 5°-10°varus. Total revision rate was 21 % (12 /56 ), the average revision time was 5. 5 years after surgery. Other complications included patellar subluxation in 1 case, anterior pain of knee in 4 cases, and superficial cellulitis in 1 case. No early or late infection, aseptic loosening or anterioposterior instability occurred in this series. Conclusion Severs varus deformity can he successfully corrected at the time of primary TKA by using PCL-retention prosthesis. There were more problems from postoperative medial-lateral instability of knee which contributed significantly to early failure after an average of 6. 0 years.
