[A comparative analysis of the efficacy of Advance(®) medial pivot prosthesis knee arthroplasty with posterior cruciate ligament retention or substituting based on propensity score matching]

Zhonghua Yi Xue Za Zhi. 2020 Jan 21;100(3):187-191. doi: 10.3760/cma.j.issn.0376-2491.2020.03.006.
[Article in Chinese]

Abstract

Objective: To compare the clinical outcome of posterior cruciate ligament (PCL) retention type and PCL substituting type using Advance(®) Medial Pivot (AMP) inner-axis knee prosthesis. Methods: A retrospective analysis was conducted on the cases of total knee arthroplasty (TKA) with AMP prosthesis in the Affiliated Hospital of Qingdao University from January 2011 to September 2016. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), American Knee Society Knee Score (KSS) clinical scores, KSS functional scores and knee-joint range of motion (ROM) before and after TKA, and Forgotten Joint Scores (FJS) after TKA were collected. The matching group was obtained by 1∶1 propensity score matching (PSM). Results: Complete scoring data were obtained in 47 knees of CR group and 1 059 knees of CS group, there were statistical differences in age, sex, body mass index, preoperative WOMAC score, preoperative KSS function score and ROM between the two groups (all P<0.05), except preoperative KSS clinical score (25±4 and 24±7, respectively, t=0.82, P=0.41). With the PSM matching, 37 knees in CR group and 37 knees in CS group were obtained. No significant differences in preoperative indexes were found between the matching groups (all P>0.05). The WOMAC, KSS clinical scores, KSS functional scores and ROM after TKA in each matching group were all much better than those before TKA (all P<0.05); no statistical differences existed in WOMAC, KSS clinical scores, KSS functional scores, ROM and FJS after TKA between the matching groups (all P>0.05). One PCL injury was found in CR matching group after TKA. Incidence of complications in the CR matching group (8.1%) was higher than that in the CS matching group (2.7%), but there was no statistical difference (χ(2)=1.04, P=0.31). Conclusions: When using AMP prosthesis, both CR insert and CS insert can obtain good clinical results in TKA. The potential risk of PCL injury and other complications after CR TKA makes it necessary for surgeons to carefully select an appropriate type of prosthesis.

目的: 对比使用Advance(®)内轴型(AMP)膝关节置换假体保留后交叉韧带(PCL)与否的临床疗效分析。 方法: 回顾性分析青岛大学附属医院自2011年1月至2016年9月收治的使用AMP假体进行全膝关节置换(TKA)的病例,收集术前术后患者的西安大略和麦克马斯特大学骨关节炎指数评分(WOMAC)、膝关节协会评分(KSS)临床评分、KSS功能评分、膝关节活动度(ROM)及术后人工关节被遗忘指数(FJS),通过1∶1倾向得分匹配(PSM)获得匹配组后进行相关对比分析。 结果: 后交叉韧带保留(CR)组47膝、后交叉韧带代替(CS)组1 059膝获得完整评分数据,PSM匹配前两组除术前KSS临床评分差异无统计学意义外(分别为25±4和24±7,t=0.82,P=0.41),年龄、性别、体质指数(BMI)、术前WOMAC评分、术前KSS功能评分、术前ROM差异均有统计学意义(均P<0.05)。匹配获得CR组37膝与CS组37膝,匹配后两组在各术前指标方面差异均无统计学意义(均P>0.05)。各匹配组内术后在WOMAC评分、KSS临床评分、KSS功能评分、ROM均较术前优异(均P<0.05);两匹配组间术后WOMAC评分、KSS临床评分、KSS功能评分、ROM及FJS评分差异均无统计学意义(均P>0.05)。CR匹配组1膝术后PCL损伤。CR匹配组并发症发生率(8.1%)高于CS匹配组(2.7%),但差异无统计学意义(χ(2)=1.04,P=0.31)。 结论: 使用AMP假体时,CR型和CS型假体均可获得良好的临床疗效,CR型术后存在潜在PCL损伤等相关风险,术者需审慎选择合适类型假体。.

Keywords: Medial pivot; Posterior cruciate ligament; Propensity score matching; Total knee arthroplasty.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Arthroplasty, Replacement, Knee / methods*
  • Female
  • Humans
  • Knee Joint / physiopathology
  • Knee Joint / surgery*
  • Knee Prosthesis*
  • Male
  • Middle Aged
  • Osteoarthritis, Knee / surgery*
  • Posterior Cruciate Ligament / surgery*
  • Propensity Score
  • Prosthesis Design
  • Range of Motion, Articular
  • Retrospective Studies
  • Treatment Outcome