| Backgrounds:At present, total knee arthrolasty (TKA) has become the main therapy to cure the terminal stage knee-joint disease. Because it could effectively relieve pain and improve the knee-joint function, so that patients’living quality could be highly promoted. With the rapid increasing in obesity and aging population, TKA has carried on more and more old obese patients. However, obesity has been considered as one of the major factors for the failure of TKA. The published literatures have reported that the adverse reactions of the obese patients after receiving TKA like prosthesis’aseptic loosening, infection, operative incision and joint revision rate are much higher than those of the patients who are not obese. The joint surgeons has done many researches on the postoperative influence of obesity for TKA tried to find the optimal surgical options. This research applies the ordinary prosthesis in cooperation with tibial stem extension for the TKA operations on the severe obese patients with the knee osteoarthritis, aiming to analyze its clinical rescults.ObjectiveTo analyze the application and therapeutic effect of total knee arthroplasty with tibial stem extension for the severe obese patients.MethodsFrom May 2009 to May 2012,19 patients (23 knees) carried on TKA with tibial stem extension were retrospectively followed. There were 4 male and 15 female with an average age of 65.2 years (53-78 years).15 patients received one-side TKA (left 9 cases, right 6 cases), and 4 patients received both-side TKA. All patients were severe obesity, the mean BMI was 37.77 ± 1.27 kg/m2.Knees were evaluated by the knee society score (KSS) system and WOMAC index. The preoperative and postoperative scores were statistically analyzed to evaluate the clinical therapeutic effect and the implant survival rate with the SPSS 17.0.ResultsTwo patients were lost to follow-up and 17 patients (21 knees) had a mean follow-up time of 44 months (27～65 months). No one has intraoperative comlication, such as common peroneal nerve injury or rupture of patellar tendon. One patient (1 knee) with fat liquefaction of incision was recorded, and no one has complications such as infection, prosthesis loosening or VTE. All patients had good alingment of lower limb, stable prosthesis and excellent patellar tracking. At the last follow-up, no clinical symptoms and radiograph showing complications such as prosthesis adjacent fracture, infection, aseptic loosening, over-hang, or patella fracture. The mean knee score was improved from 20.9 ± 4.5 points preoperatively to 90.7 ± 3.5 points at the last follow-up after operation. The mean function score was improved from 25.7 ± 4.7 points preoperatively to 87.0 ±3.7 points at the last follow-up after operation. The mean WOMAC score was improved from 157.1±20.0 points preoperatively to 42.5 ± 18.6 points at the last follow-up after operation. According to the WOMAC index, among them 18 knees were mild (85.7%),3 knees were moderate (14.3%),0 knee was severe (0%)。The P value was less than 0.05 and the results had statistical significance.ConclusionFor severe obese patients undergoing total knee arthrolasty treatment using tibial stem extension can disperse stress, enhance the stability of prostheses, reduce revision rate and postoperative complications, therefore could obtain an excellent clinical results. |
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