Background: A previous report evaluated the initial 310 cementless, Buechel-Pappas (B-P), Semi-Constrained Rotating Platform total knee replacements in 257 patients followed for an average of 7.6 years, range 2 - 18 y...Background: A previous report evaluated the initial 310 cementless, Buechel-Pappas (B-P), Semi-Constrained Rotating Platform total knee replacements in 257 patients followed for an average of 7.6 years, range 2 - 18 years. Diagnoses were osteoarthritis in 233 patients, post traumatic arthritis in 4 patients and rheumatoid arthritis in 22 patients. Knee Scores, using a strict knee scoring scale were 86.4% excellent, 12.3% good, 0.3% fair and 1.0% poor results. Survivorship, using an end point of revision for any mechanical reason (including component loosening, bearing wear and bearing dislocation) was 99.4%. Survivorship for a poor knee score (including persistent pain, loosening, instability and infection was 97.6%. The purpose of the present study is to report the updated results of this same patient cohort at a minimum follow-up of twenty years. Methods: The average age of patients at the time of surgery was 67 years, range 34 to 91 years. A total of 20 patients (22 knees) were still living, with a follow-up of 20 - 30 years (mean 23.47 years). The same strict knee scoring scale and survivorship analysis were used to evaluate patient outcomes at the 20 to 30 years interval. Results: Survivorship, in the current study, using the same end points as in the previous study, was 96.5% at the 20 and 30-year intervals. Late mechanical failure and osteolysis were not identified. Conclusion: This cementless, semi-constrained rotating platform total knee replacement has stood the test of time for more than 20 years and can be considered acceptable for long-term use, in properly selected patients.展开更多
Background: Sagittal plane placement of the tibial component in total knee replacement (TKR) has important implications for maximizing the range of flexion motion, allowing collateral ligaments to function more normal...Background: Sagittal plane placement of the tibial component in total knee replacement (TKR) has important implications for maximizing the range of flexion motion, allowing collateral ligaments to function more normally, as well as providing ideal compressive loading on the tibial bone-prosthesis interface. This study attempts to quantify the normal posterior tibial slope (PTS) angle pre-operatively and post-operatively in osteoarthritic patients after using a conventional extramedullary tibial resection guide to assess its effectiveness. Methods: Forty-nine primary cementless total knee replacements in 34 osteoarthritic patients were measured radiographically pre-operatively and one year post-operatively to determine the PTS and its effect on range of motion. Lateral X-rays, using the anterior cortical line of the tibia, were employed for all measurements. Results: Pre-operative PTS measured 11.83˚ (range 5˚ - 18˚), while post-operative PTS of implanted tibial components measured 11.30o (range 4˚ - 18˚). The pre-operative range of motion of 112˚ (range 30˚ to 135˚) was improved to 119˚ (range 90˚ to 135˚) post-operatively after 1 year. Conclusions: Anterior tibial shaft referencing using a conventional extramedullary tibial resection guide provides an easy and convenient method for reproducing the anatomical PTS during TKR. This methodology provided improvement in average range of motion from 112˚ pre-operatively to 119˚ post-operatively at one year.展开更多
文摘Background: A previous report evaluated the initial 310 cementless, Buechel-Pappas (B-P), Semi-Constrained Rotating Platform total knee replacements in 257 patients followed for an average of 7.6 years, range 2 - 18 years. Diagnoses were osteoarthritis in 233 patients, post traumatic arthritis in 4 patients and rheumatoid arthritis in 22 patients. Knee Scores, using a strict knee scoring scale were 86.4% excellent, 12.3% good, 0.3% fair and 1.0% poor results. Survivorship, using an end point of revision for any mechanical reason (including component loosening, bearing wear and bearing dislocation) was 99.4%. Survivorship for a poor knee score (including persistent pain, loosening, instability and infection was 97.6%. The purpose of the present study is to report the updated results of this same patient cohort at a minimum follow-up of twenty years. Methods: The average age of patients at the time of surgery was 67 years, range 34 to 91 years. A total of 20 patients (22 knees) were still living, with a follow-up of 20 - 30 years (mean 23.47 years). The same strict knee scoring scale and survivorship analysis were used to evaluate patient outcomes at the 20 to 30 years interval. Results: Survivorship, in the current study, using the same end points as in the previous study, was 96.5% at the 20 and 30-year intervals. Late mechanical failure and osteolysis were not identified. Conclusion: This cementless, semi-constrained rotating platform total knee replacement has stood the test of time for more than 20 years and can be considered acceptable for long-term use, in properly selected patients.
文摘Background: Sagittal plane placement of the tibial component in total knee replacement (TKR) has important implications for maximizing the range of flexion motion, allowing collateral ligaments to function more normally, as well as providing ideal compressive loading on the tibial bone-prosthesis interface. This study attempts to quantify the normal posterior tibial slope (PTS) angle pre-operatively and post-operatively in osteoarthritic patients after using a conventional extramedullary tibial resection guide to assess its effectiveness. Methods: Forty-nine primary cementless total knee replacements in 34 osteoarthritic patients were measured radiographically pre-operatively and one year post-operatively to determine the PTS and its effect on range of motion. Lateral X-rays, using the anterior cortical line of the tibia, were employed for all measurements. Results: Pre-operative PTS measured 11.83˚ (range 5˚ - 18˚), while post-operative PTS of implanted tibial components measured 11.30o (range 4˚ - 18˚). The pre-operative range of motion of 112˚ (range 30˚ to 135˚) was improved to 119˚ (range 90˚ to 135˚) post-operatively after 1 year. Conclusions: Anterior tibial shaft referencing using a conventional extramedullary tibial resection guide provides an easy and convenient method for reproducing the anatomical PTS during TKR. This methodology provided improvement in average range of motion from 112˚ pre-operatively to 119˚ post-operatively at one year.
