ABSTRACT
Introducción La artroplastia total de rodilla es un procedimiento exitoso que mejora significativamente la calidad de vida de los pacientes disminuyendo el dolor e incrementando su capacidad funcional. Sin embargo, la literatura reporta hasta 25% de pacientes insatisfechos. El objetivo de este estudio es presentar los resultados clínicos y la satisfacción de un grupo de pacientes operados con implantes de tipo pivote medial y ultra-congruente. Materiales y métodos Se realizó un estudio observacional retrospectivo. Se revisaron las historias clínicas de todos los pacientes operados con los sistemas mencionados con mínimo 12 meses post-operatorios. Se analizaron resultados de 100 rodillas (96 pacientes) que completaron los cuestionarios, con una media de seguimiento de 33.5 meses. Se aplicaron los cuestionarios KSS, KOOS y WOMAC. Se estudiaron diferencias en dolor y función entre la etapa pre-operatoria y el último seguimiento. Se analizó la satisfacción de los pacientes con respecto al dolor y la capacidad funcional. Se evaluaron complicaciones presentadas. Resultados Todos los criterios presentaron una mejora estadísticamente significativa entre la etapa pre-operatoria y el último seguimiento. 97% de los pacientes reportaron estar satisfechos con los resultados. Las medias de los cuestionarios fueron entre 83.97 y 95.3. Se presentó 1 caso de revisión por infección peri-protésica. Discusión Las prótesis de pivote medial y ultra-congruente constituyen opciones eficaces y seguras para el tratamiento de artrosis de rodilla. Es necesario realizar estudios prospectivos y comparativos que generen evidencia de más alto nivel para confirmar los beneficios de estos diseños.
Background Total knee arthroplasty is a successful procedure that improves patient quality of life by reducing pain and increasing their functional capacity. However, literature reports up to 25% dissatisfaction in patients. The objective of the study is to present the clinical results and satisfaction of a group of patients operated on using ultra-congruent medial pivot-type implants. Methods A retrospective observational study was carried out. The medical records of all the patients who underwent knee arthroplasty surgery with a specific system were reviewed, including patients with a minimum of 12 months follow up. An analysis was performed on the results of 100 knees (96 patients) that had completed questionnaires. There was a mean follow-up of 33.5 months. The KSS, KOOS, and WOMAC questionnaires were used. Differences in pain and function between the pre-surgical stage and the last follow-up were studied. An analysis was made on patient satisfaction with regard to pain and functional capacity. Specific complications were evaluated. Results All evaluation criteria showed a statistically significant improvement between the pre-surgical stage and the last follow-up. Almost all (97%) of patients reported being satisfied with the results. The means of the questionnaires were between 83.97 and 95.3. One case of revision due to peri-prosthetic infection was presented. Discussion Medial pivot and ultra-congruent prostheses designs are effective and safe options for the treatment of osteoarthritis of the knee. Prospective and comparative studies that generate higher level evidence are necessary to confirm the benefits of these designs.
Subject(s)
Humans , Knee , Arthroplasty , Patient SatisfactionABSTRACT
PURPOSE: Recently, a mobile ultracongruent polyethylene insert was used to increase joint stability in the posterior cruciate ligament sacrificed total knee arthroplasty with non-posted mobile bearing. However, as yet there have been no reports about this implant. In this study, the clinical and radiological results of surgery using the implant were analyzed through a navigation system. MATERIALS AND METHODS: The subjects included 95 cases of 70 patients to whom the rotating tibial implant was applied after posterior cruciate ligament resection among the patients who underwent total knee arthroplasty from September 2006 to December 2008. The follow-up duration was at least 24 months, and 40 months on average. For clinical evaluation, the knee score and functional scores were measured preoperatively and at the time of final follow-up. With reference to a 5 mm joint line change measurement recorded by the navigation system, which can affect the clinical result, the comparison and evaluation were performed by dividing the subjects into group I (5 mm). Radiological evaluation was performed by measuring the angle of the mechanical axis of the lower extremities and the patella tilting angle preoperatively and at the time of final follow-up using plain radiographs. RESULTS: Seventy subjects (95 cases) were followed up for at least 24 months. According to the clinical results, the mean KSS knee score improved from a preoperative score of 43.4 to a final follow-up score of 90.6 (p<0.0001). In addition, the mean functional score improved from a preoperative score of 51 to a final follow-up score of 88.4 (p<0.0001). Finally, the mean joint line change, which can affect the clinical result, was 5.82 mm, ranging from -1 to 12 mm. The clinical and radiological evaluations were performed by dividing the subjects into two groups in relation to the reference value of 5 mm, but no significant difference was found. The mechanical axis angles of the lower extremities improved from the preoperative value of varus 10.01degrees to the final follow-up value of varus 1.89degrees, and the difference was significant (p<0.0001). The mean patella tilting angles were 8.8degrees and 9.3degrees, respectively, at the time before the operation and after the final follow-up; this difference was not significant (p=0.89). CONCLUSION: Good clinical and radiological results were observed after at least two years of follow-up subsequent to total knee arthroplasty, in which a rotating ultracongruent polyethylene insert was applied after posterior cruciate ligament resection using a navigation system.