| Objective: To evaluate the short-term clinical effects and applicable techniques and experiences of the Legacy Constrained Condylar Knee Prosthesis(LCCK) and discuss its indications and advanteages and disadvanteages in Complex Total K nee Arthroplasty(TKA) based on the retrospective analysis of the clinical application of LCCK in TKA. Materials and Methods: During the period of 2013 Mar. to 2014 Sep,seventy patients(24 knees) underwent TKA with the use of LCCK(Zimmer company) in the Department of joint surgery, the Second Affiliated Hospital of Dalian Medical University, were eligible to this study. There are 5 Males and 12 female, of which 7 cases were double knees and the rest 10 cases were single knees. The 24 knees could be classified into 10 valgus knees, 9 knee varus and 5 knee ankylosis form four cases. The mean age of patients at the time of TKA was 63.8 years(47 years to 88 years). The original diagnosis for TK A included rheumatoid arthritis(3 cases), congenital dysplasia of lateral femoral condyle(1 case), mal union after external epicondyle of femur fracture(1 case), lankylosing spondylitis(1 case), knee ankylosis after septic arthritis(3 cases), traumatic arthritis after the medial tibial platform fracture(1 case), and osteoarthritis of the knee(10 cases). The 24 knees were peformed with median incision of the knee and patellar medial approach. 15 cases were used the common extension handle, 2 cases the extension handle with eccentricity. The extension handle all were fixed with the bone cement. The thchniques such as metal pad implanted or autologous bone graft or filling the bone defect with the screw and bone cement were used in 4 cases of valgus knees and 1cases of knee varus. All patients just underwent the patella arthroplasty. All patients were followed up. The shortest follow-up time was 6 month, the mean 14 months and the longest 18 months. At last, we estimated systematically the knee functions with the American K nee Society score(KSS), which includes knee score and knee functions score. Results: About the postoperational knee pain: 2 cases of all subjects were still suffered mild knee pain 6 months after the operation and knee pain disappeared completely after 2 months more, and the remaining patients didn’t subject to the knee pain at all. 1 case of all subjects couldn’t dorsiflex his left foot, which was lessened 2 months after the operation and completely recovered after 2 months more. After the operation, no cases underwent the infection and dislocation phenomenal and all patients displayed an excellent extension and flexion and a stable varus and valgus. As far as the extension and flexion of the knee,the maximum flexion on average was 106 degrees(rang: 80 degrees to 125 degrees) and the maximum flexion of knee ankylosis 95 degrees(rang: 80 degrees-115 degrees). All patients could fully extended their knees and no one appeared knee extensor activity hysteresis and patella trajectory anomalies. Form preoperation to postoperation, the KSS knee score was raised from(23.5±3.3) to(89.3±3.3) and the KSS knee function score was increased from(18.6±2.8) to(87.9±4.5).The statistical results shown that the preoperational KSS knee score and knee function score were significantly higher than the postoperational.In radiographically, the postoperational X-ray film appeared that LCCK was in a proper and stable location without loosening, subsiding, transposing and the bone resorption. The force line of lower limbs was corrected. The overall satisfaction rate of patients to the TKA was 100%. Conclusion: LCCK can be applied to complex primary total knee arthroplasty for the patients who were still unable to obtain the equal flexion gap or equally medial and lateral tension after undergoing the feasible and effective soft tissue balancing technology, with an exact effect and a high satisfaction from patients. In addition, it can also be used in the uncontained bone defect of the medial and lateral tibial plateau of the knee. The combined metal gasket(block) and stem extension implant is conducive to shorten the operation time, transfer the mechanical load, obtain instant stability, and enhance the operational success rate. The follow- up of 6 months to 18 months after operation shows a well clinical effect in the treatment group. |
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