Abstract
Aims: Mid and long term results of a continuous series, including learning curve, of 500 TKR cruciate sparing implanted between September 1992 and February 1995 by different surgeons of GUEPAR (staff members and residents) Material: Patients average age70.3 years (26–93). Etiology: Primary OA 74%, post traumatic 6%, RA 6%, associated aetiology in 14% (osteonecrosis, microcristalline arthropathy...). No previous surgery in 325 knees. 175 knees operated before (tibial osteotomy: 37, femoral osteotomy: 4, patella:13, other knee surgery: 74% knee arthroplasty mainly unicompartmental: 19.) Operation procedureby medial approach, except 16 lateral (3.2%) and 6 tibial osteotomy (1.2%). Lateral retinacular release in 19.6% aligned patella and 29.2% subluxed or luxed patella. Per operative complications: PCL weakness (24), tibial plateau fissure (16), condylar fracture (1), patellar fracture (3) without consequence on weight bearing. Although anatomic shape of Wallaby 1 trochl, 86.5% inlay and 11.1% resurfacing patellar component have been done. Very few patella (2%) are not resurfaced at the beginning of our experience. Postoperative complications: No specific earliest complications related to the prosthesis. Latest compliations are: 2 infections in the first month treated by lavage debridement with total recovery and 6 latest infections (> 5th month) with prosthesis removed. 1 bipolar aseptic loosening, 1 patellar loosening without fracture and only 2 of 21 patellar fractures have been fixed by wires. 3 reoperations for persistent pain: 2 patella resurfacing and 1 patellar lateral retinacular release, 3 periprosthetic femoral fractures, 2 fixed by plate, 1 treated by conservative treatment with good results.1 medial collateral ligament rupture after trauma revised with another prosthesis. 5 Sudeck syndrome. Results: Femoro tibial alignment is good (between 3° valgus and 2° varus) in 71.1% and reach 90% if between 5° valgus and 5° varus in%. 38 patients (38 knees: 7.6%) are deceased or lost for follow-up before 1 year (without any revision); 462 knees (92.4%) are follow-up between 1 to 5 years and 381 (76.%) more then 5 years. According to International Knee Score results on these 381 knees are: 104∞ of average flexion (pre op. 109∞), 90.6% had any or mild pain. IKS Knee score 90,6 (45–100) (pre op. 25) IKS function score: 59,7 (0–100) (pre op. 28,5) Survival rates at 8 years: 98.2%(confidence interval of 95%: 99.4–96.9) for removed prosthesis whatever the reasons, and 99.2% (confidence interval of 95% 100–98.4)for revision for mechanical failure only. Conclusions: Encouraging results with a true condylar divergent device encourage us to continue Alignment has to be improved, perhaps with navigation tools.
Theses abstracts were prepared by Professor Dr. Frantz Langlais. Correspondence should be addressed to him at EFORT Central Office, Freihofstrasse 22, CH-8700 Küsnacht, Switzerland.
