| Total knee arthroplsty(TKA)was used widely for serious lesion of the knee. The design theory about knee prosthesis and operation techniche had been improving since the first TKA was made 1960s. Now we have gotton a more and more better successful rate even in 20 years posteroperatively . For the moment there are some limitation after TKA, such as instability anteriorly, a limit flexion angle, etc. Try to solve te question, Smith&Nephew company afforded a new anatomy knee prosthesis and now it has been used clinically. We do not see the report about the outcome and the adaptability of the JOURNEY prosthesis.The purpose of this study was to evaluate the adaptabilitity of the JOURNEY prosthesis, the early clinical outcome and the factors which affected the clinical outcome.MethodsThis study was divided into 2 parts.The first was to test the adaptability of the journey prosthesis. 192 cases was divided into 3 groups and gived a MRI examination,we get the anatomical data from 192 healthy case which include in the sagital length of medial femoral condyle, the sagital length of the lateral femoral condyle, the width of femoral condyle, the width of tibia plate, the sagital length of lateral tibia plate, the sagital length of medial tibia plate, the width of the notch, the hight of the notch. Then compared the anatomical data from the MRI with the parameters of the joutney prosthesis from the manufacturer.The second part of this study was to evaluate the the early clinical outcome and the factors which affected the early clinical outcome. 32 cases was treated with total knee arthroplasty with the journey prosthesis which include in 5 cases of traumatic arthritis, 19 cases of osteoarthritis, 8 cases of rheumatoid arthritis. The fuction of the knee was evaluated by american knee society score. All the cases were followed up 3, 6, 12, 18 monthes postoperatively and fill in the kss papers at that time. The factors which affected the clinical outcome ,including age, gender, the type of the prosthesis, etc, was evaluated by the spss 11.0 software.Results1. The sagital length of medial femoral condyle was 71.6±3.73cm,65.4±4.20 cm,62.2±1.37 cm respectively; the sagital length of lateral femoral condyle was 70.5±3.55 cm,64.2±4.33 cm, 61.9±2.60 cm respectively;the width of the notch is 22.9±2.22 cm, 20.5±2.87 cm,21.9±1.55 cm respectively; the hight of the notch wass 69.8±3.06 cm, 54.8±3.61cm, 33.5±0.99 cm respectively;the width of the tibia plate was 76.53±3.44 cm, 68.41±3.57 cm, 65.7±4.26 cm respectively; the sagital length of medial tibia plate was 55.19±4.06 cm,49.39±1.92 cm, 46.8±2.64 cm respectively; the sagital length of lateral tibia plate was 52.13±2.39 cm, 45.58±2.84 cm,43.78±2.83 cm respectively。2. The parameters which include the sagital length of medial femoral condyle, the sagital length of lateral femoral condyle, the width of the femoral condyle, the width of tibia plate, tha sagital length of medial and lateral tibia plate were adaped to the anaotomical data accprding the spss output ,there was no siganificant difference between them.3. 32 cases was treated with total knee arthroplasty with the journey prosthesis. The pain score was 13.44±8.03 preoperatively. The kss score at 3, 6, 12 monthes postoperatively was 40.53±5.86, 43.92±4.66, 47.72±4.83 respectively. There was siganificant difference between the score preoperatively and the one postoperatively (p=0.000). There is siganificant difference too amond the 3, 6, 12 monthes postoperatively (p=0.000).4. The motion of the knee was 108.57±19.95o preoperatively, the motion of the knee at 3, 6, 12 monthes postoperatively was 104.76±18.13°,122.94±15.92°, 123.57±13.65°respectively. The score at 6, 12 monthes postoperatively had siganificnt difference compared with the score preoperatively, but there is no siganificant difference between the score 3 monthes postoperatively and the one preoperatively. The score at 3 monthes postoperatively had siganificant difference with the score at 6, 12 mointhes postoperatively respectively. The score at 6 monthes postoperatively had siganificant difference with the one at the 12monthes postoperativly.5. The satifaction rate at 3, 6, 12 monthes postoperatively was 85.13%, 94.63%,96.91% respectively。From the data we can see the satisfaction rate was increasing step by step and the satisfaction was coeffient with the pain score. 81% cases went back to the original motion and 94% cases can deal with the daily life.6. The operation pcocess of the journey was more easier compared with other prosthesis, the average operating time was 75±21.7 min. The average blood loss was 280±130ml. There was no fracture, serious thomblism during the operation.Conclusion:Total knee arthroplasty with journey prosthesis reconstructed the anatomy of the knee, it adapted to the anatomy of the knee very well. There was a low complication rate. Total knee arthroplasty with ourney prosthesis got a good early clinical outcome... |
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