Feb 13

Resultados clínicos después del uso de rodillas condilares constreñidas en la artroplastia total primaria de rodilla

Clinical Outcomes Following the Use of Constrained Condylar Knees in Primary Total Knee Arthroplasty

 

Fuente
Este artículo es originalmente publicado en:

 

https://www.ncbi.nlm.nih.gov/pubmed/28189441

http://www.arthroplastyjournal.org/article/S0883-5403(17)30002-5/abstract

 

De:

 

Moussa ME1, Lee YY2, Patel AR1, Westrich GH1.

J Arthroplasty. 2017 Jan 11. pii: S0883-5403(17)30002-5. doi: 10.1016/j.arth.2017.01.001. [Epub ahead of print]

 

Todos los derechos reservados para:

 

Copyright © 2017 Elsevier Inc. All rights reserved.

 

Abstract

BACKGROUND:

Certain clinical or adverse intraoperative situations require the use of increased constraint in primary total knee arthroplasty (TKA). These include significant angular deformities causing incompetent collateral ligaments, or inadvertent intraoperative injury to collateral structures as well as the inability to achieve a balanced flexion and extension gap. Clinical success has been described with the use of constrained condylar knee arthroplasty in the primary setting in these situations. Traditionally, increasing constraint has been in conjunction with intramedullary stems, referred to as stemmed constrained condylar knees (SCCK); however, some devices provide an intermediary option by increasing constraint without the use of stems, herein referred to as nonstemmed constrained condylar knees (NSCCK). The aim of this study was to compare the clinical outcomes of both these devices in primary TKA in terms of revision rates and change in outcome measures over the follow-up period.

CONCLUSION:

Both cohorts demonstrated improvement in clinical outcome measures at 2-year follow-up. None of the SCCKs performed in the primary setting were revised for a mechanical complication. Although both groups had overall low revision rates, there was trend toward a higher revision rate with NSCCKs. Many of these were revised for component loosening. In summary, when necessary, constrained options in the primary TKA setting provide excellent clinical outcome at short-term follow-up. However, constrained constructs with stemmed fixation may provide more rigid fixation and be less susceptible to mechanical failure.

 

Resumen

ANTECEDENTES:
Ciertas situaciones clínicas o intraoperatorias adversas requieren el uso de una restricción aumentada en la artroplastia total primaria de rodilla (TKA). Estas incluyen deformidades angulares significativas que causan ligamentos colaterales incompetentes, o lesiones intraoperatorias inadvertidas a estructuras colaterales, así como la incapacidad para lograr un espacio de flexión y extensión equilibrado. Se ha descrito el éxito clínico con el uso de artroplastia condilar de rodilla restringida en el entorno primario en estas situaciones. Tradicionalmente, la restricción creciente se ha asociado con tallos intramedulares, denominados rodillas condilares constreñidas (SCCK); Sin embargo, algunos dispositivos proporcionan una opción intermedia aumentando la restricción sin el uso de tallos, denominados en la presente memoria como rodillas condilares constreñidas y sin punta (NSCCK). El objetivo de este estudio fue comparar los resultados clínicos de ambos dispositivos en TKA primaria en términos de tasas de revisión y el cambio en las medidas de resultado durante el período de seguimiento.
CONCLUSIÓN:
Ambas cohortes demostraron mejoría en las medidas de resultado clínico a los 2 años de seguimiento. Ninguno de los SCCK realizados en el entorno primario fueron revisados ​​para una complicación mecánica. Aunque ambos grupos tuvieron tasas de revisión globalmente bajas, hubo una tendencia hacia una tasa de revisión más alta con NSCCKs. Muchos de estos fueron revisados ​​para el aflojamiento de los componentes. En resumen, cuando es necesario, las opciones restringidas en el ajuste TKA primario proporcionan excelente resultado clínico en el seguimiento a corto plazo. Sin embargo, las construcciones constreñidas con fijación con vástago pueden proporcionar una fijación más rígida y ser menos susceptibles a fallas mecánicas.

 

 

KEYWORDS:

clinical outcomes; constrained condylar knee; total knee arthroplasty

PMID: 28189441   DOI:   10.1016/j.arth.2017.01.001
[PubMed – as supplied by publisher]

 

 

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