| Objictive: To analyze the indication selection of the total knee prosthesis. Method: From February, 1991 to March, 2005, 91 cases (105 knees) TKR operation were performed in our academy. The age at the time of operation were 15-76 years old, average 52. 4 years old. Male is 29 cases (31. 9%), female is 62 (68. 1%). The mean follow-up period was 5. 9 years (range 1 month to 13. 6 years). The diagnoses were osteoarthritis in 53 cases (67 knees, 63.8%), tumor in 38 cases (38 knees, 36.2%). The number of domestic prosthesis adopted was 53 knees (Chun Li prosthesis 23 knees, Beijing Jinghang prosthesis 15 knees, He Ping prosthesis 12 knees, others 3 knee), and the number of import prosthesis adopted was 52 knees (Zimmer prosthesis 31 knees, LINK prosthesis 21 knees ). The types of primary implant were as follows: the constrained prosthesis was 42 knees (pure hinged prosthesis 38 knees, new type of Chun Li hinged prosthesis 2 knees , LINK rotation hinge prosthesis 2 knees), semi-constrained prosthesis(PS) was 10 knees, the total condylar prosthesis was 35 knees, LINK Meniscus-Bearing knee was 18 knees. The result were used the HSS of knee joint to grade and analyse systematically. Bone cement was used in all cases. Result: The 91 patients were all primary TKR cases, and all followed up after operation, the mean follow-up period was 5.9 years (range 0.1-13.6 years). The method of grading before and after the TKR was (HSS knee rating score) according to the knee joint point scale of hospital of specific surgery of New York, there were 7 items to evaluate the content, among them 6 are score items, including pain, function, range of motion, flexion deformity , joint stability and muscular force. The other was the project of deducting points, the content involves whether needing brace or not, medial-lateral deformity and the degree of the stagnate lacking. The total score is 100 point, 85-100 point is excellent, 70-84 point is Well, 60-69 point is acceptable, smaller than 59 point is unacceptable. Incline the location X-ray one and understand whether there are bright districts between the prosthesis and bone edge through the knee joint; Measuring the angle of medial-lateral deformity in the knee joint on the X-ray obverse location; Notice whether there was the sign that the meniscus dislocates or not at the same time. Of 91 cases, 10 have already died, 9 patient of malignant tumor among them died with metastasis, a 79-years-old bone arthritis patient died from the lung infected. Unconstrained domestic prosthesis implanted half a year after the operation appeared knee infection, and was taken out. The remaining prosthesis of 94 knees all survived. Among them, 3 knees happened to infect after the operation, all recovered after treatment with antibiotics; 8 knees of deep vein thrombus of lower limbs, accounts for 8.79% guard after treating the symptom disappeared; 2 cases of disease took place low potassium blood, the symptom disappeared after treatment according to the disease. 42 knees planted in the hinged prosthesis, the follow-up rating score was 38.7% of fine rate. Among them RHK planted into 2 cases with excellent follow-up HSS score recently. It proves that it was a kind of prosthesis with the worth to expecting very much. One point needed to explain here is: Though generally the malignant tumour is not the indication of TKR, if the purpose is raised the living qualities and under the circumstances that the patient requires strongly, we can consider the TKR operation. Post-stabilizing prosthesis and the total constrained condylar prosthesis are the main type of semi-constrained prosthesis. The main characteristic is that they need cut out cross ligament, range of flexion is around in 90 degrees generally, but it is higher to grade and follow up a case by regular visits to and divide after the operation, the statistics of data relevant to the fact that both at home and abroad are similar. Surface prosthesis were all adopted osteoarthritis case, according to the access on soft tissue and extent of pathological changes determined whether to reserve PCL or not according to operation. The surface prosthesis of LINK with the rotatory meniscus begined to appeared in our department after 2000, were planted into 18 knees altogether, and follows-up by regular visits to the result, there were no obvious difference with domestic and international... |
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