Reemplazo Total de Rodilla en pacientes menores de 55 años de edad con gonartrosis Seguimiento de 2 a 13 años. [Total Knee Arthroplasty for gonarthrosis in patients 55 years old or younger. 2-13 years follow-up.]
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Publicado:
may 12, 2017
Palabras clave:
RTR, jóvenes, artrosis primaria, artrosis secundariaTotal replacement, knee, young patients, osteoarthritis, posttraumatic arthritis.
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Resumen
IntroducciónEl número de reemplazos totales de rodilla (RTR) en pacientes jóvenes continua en aumento. La literatura muestra resultados contradictorios y la mayoría incluyen pacientes con Artritis Reumatoide (AR). El propósito de este estudio fue analizar un grupo de RTR en menores de 55 años, excluyendo pacientes con AR, evaluando la sobrevida protésica, las fallas radiológicas y sus resultados funcionales.Materiales y MétodosSe analizaron retrospectivamente 53 RTR en 46 pacientes, con una edad promedio de 49 (26-54) años y un seguimiento promedio de 6,5 (2-15) años. Los diagnósticos preoperatorios correspondieron a 46 gonartrosis idiopáticas, 5 postraumáticas y 2 osteonecrosis. 22 presentaban antecedentes de cirugías previas. Se utilizaron 49 implantes importados y 4 nacionales. Los resultados clínico-funcionales se objetivaron mediante Knee Society Score y WOMAC, mientras que para la evaluación radiológica se utilizo el sistema de la Knee Society.ResultadosLa puntuación funcional del KSS mejoró de 49,3 a 92,6 en promedio, mientras que la puntuación propia de rodilla paso de 46,8 a 91,4 puntos en el posoperatorio. La puntuación WOMAC en promedio fue de 2,3 para dolor, 2,6 para rigidez y 27,3 para la capacidad funcional. El 16% presento líneas de radiolúcidas <1mm que no progresaron en el tiempo. Hubieron 3 infecciones que requirieron de una revisión en dos tiempos evolucionando favorablemente y 4 rigideces que fueron tratadas mediante movilización artrocópica. La sobrevida protésica fue del 94,34%.ConclusionesEl RTR en pacientes <55 años mostró ser un procedimiento confiable en lo que respecta a la mejora de la función, con una aceptable sobrevida protésica teniendo en cuenta los antecedentes quirúrgicos previos. No observamos fallas radiológicas al final del seguimiento.
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Garabano, G., Lopreite, F., & del Sel, H. (2017). Reemplazo Total de Rodilla en pacientes menores de 55 años de edad con gonartrosis Seguimiento de 2 a 13 años. [Total Knee Arthroplasty for gonarthrosis in patients 55 years old or younger. 2-13 years follow-up.]. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 82(2), 94-101. https://doi.org/10.15417/618
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Investigación Clínica
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Citas
1. Meding JB, Meding LK, Ritter MA, Keating EM. Pain relief and functional improvement remain 20 years after knee arthroplasty. Clin Orthop Relat Res 2012;470:144-149.
2. Callahan, CM, Drake BG, Heck DA, Dittus RS. Patients outcomes following tricompartimental total knee replacement: a Meta-Analisis. JAMA 1994;217-17:1349-1357.
3. Gioe TJ, Novak C, Sinner P, Ma W, Mehle S. Knee arthroplasty in the young patient: survival in a community registry. Clin Orthop Relat Res. 2007; 464:83–87.
4. Lachiewicz PF, Soileau ES. Fifteen-year survival and osteolysis associated with a modular posterior stabilized knee replacement: a concise follow-up of a previous report. J Bone Joint Surg Am. 2009; 91:1419–1423.
5. Ma HM, Lu YC, Ho FY, Huang CH. Long-term results of total condylar knee arthroplasty. J Arthroplasty. 2005; 20:580–584.
6. Ritter MA. The Anatomical Graduated Component total knee replacement: a long-term evaluation with 20-year survival analysis. J Bone Joint Surg Br. 2009; 91:745–749.
7. Kurtz SM, Lau E, Ong K, Zhao K, Kelly M, Bozic KJ. Future young patient demand for primary and revision joint replacement: national projections from 2010 to 2030. Clin Orthop Relat Res. 2009; 467:2606–2612.
8. W-Dahl A, Robertsson O, Lidgren L. Surgery for knee osteoarthritis in younger patients: a Swedish Register Study. Acta Orthop. 2010; 81:161–164.
9. Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res.1989; 248: 13–14.
10. Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: A health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatology. 1988; 15: 1833–1840.
11. Ewald FC. The Knee Society total knee arthroplasty roentgenographic evaluation and scoring system. Clin Orthop Relat Res. 1989; 248:9–12.
12. O’Rourke MR, Callaghan JJ, Goetz DD, Sullivan PM, Johnston RC. Osteolysis associated with a cemented modular posterior cruciate- substituting total knee design: five to eight-year followup. J Bone Joint Surg Am. 2002; 84:1362–1371.
13. Lonner JH, Pedlow FX, Siliski JM. Total knee arthroplasty for posttraumatic arthrosis of the knee. J Arthroplasty 1999; 14:969–975.
14. Larson AN, Hanssen AD, Cass JR. Does prior infection alter de outcome of TKA after tibial plateau fracture? Clin Orthop Relat Res. 2009;467:1793-1799.
15. Pulido L, Ghanem E, Joshi A, Purtill JJ, Parvizi J. Periprosthetic joint infection. The incidence, timing and predisposing factors. Clin Orthop Relat Res. 2008; 466:1710-5.
16. Messner K, Maletius W. The long-term prognosis for severe damage to weight-bearing cartilage in the knee. Acta Orthop Scand. 1996; 67:165–168.
17. McDaniel Jr WJ, Dameron Jr TB: The untreated anterior cruciate ligament rupture. Clin Orthop Relat Res. 1983; 172:158–163.
18. Tegner Y, Lysholm J. Rating systems and evaluation of knee ligament injury. Clin Orthop Relat Res. 1985; 198:43–49.
19. Insall JN, Joseph DM, Masika C. High tibial osteotomy for varus gonarthrosis. A long term followup study. J Bone Joint Surg. 1984; 66A:1040–1048.
20. Nagle A, Insall JN, Scuderi GR. Proximal tibial osteotomy. A subjective outcome study. J Bone Joint Surg. 1996; 78A:1353–1358.
21. Tai CC, Cross MJ. Five- to 12-year follow-up of a hydroxyapatite-coated, cementless total knee replacement in young, active patients. J Bone Joint Surg Br. 2006; 88: 1158-63.
22. Himanen AK, Belt E, Nevalainen J, Ha¨ma¨la¨inen M, Lehto MU. Survival of the AGC total knee arthroplasty is similar for arthrosis and rheumatoid arthritis: Finnish Arthroplasty Register report on 8,467 operations carried out between 1985 and 1999. Acta Orthop. 2005; 76:85–88.
23. Harrison O, Robertsson O, Nayfeh J. Higher cumulative revision rate of knee arthrioplasties in younger patients with osteoarthritis. Clin Orthop Relat Res 2004;421:162-168.
24. Rand JA, Trousdale RT, Ilstrup DM, Harmsen WS. Factors affecting the durability of primary total knee prostheses. J Bone Joint Surg Am. 2003; 85:259–265.
25. Keneey JA, Eunice S, Pashos PGS, Wrhight RW, Clohisy JC. What is the evidence for total knee arthroplasty in young patients? A systematic review of the literature. Clin Orthop Relat Res 2011;469:574-583.
26. Diduch DR, Insall JN, Scott WN, Scuderi GR, Font-Rodriguez D. Total knee replacement in young, active patients. Long-term follow-up and functional outcome. J Bone Joint Surg Am. 1997; 79:575-82.
27. Duffy GP, Crowder AR, Trousdale RR, Berry DJ. Cemented total knee arthroplasty using a modern prosthesis in young patients with osteoarthritis. J Arthroplasty. 2007; 22(6 Suppl 2):67-70.
28. Mont MA, Lee CW, Sheldon M, Lennon WC, Hungerford DS. Total knee arthroplasty in patients
29. Stern SH, Bowen MK, Insall JN, Scuderi GR. Cemented total knee arthroplasty for gonarthrosis in patients 55 years old or younger. Clin Orthop Relat Res. 1990; 260:124-9.
30. Odland A, Callaghan J, Liu S, Wells C. Wear and Lysis is the Problem in Modular TKA in the Young OA Patient at 10 Years. Clin Orthop Relat Res 2011; 469:41–47.
31. Lonner JH; Hershman S; Mont M; Lotke PA. Total knee arthroplasty in patients 40 years of age and younger with osteoarthritis. Clin Orthop Relat Res.2000;(380): p85-90.
32. Crowder AR, Duffy GP, Trousdale RT. Long-term results of total knee arthroplasty in young patients with rheumatoid arthritis. J Arthroplasty. 2005; 20(7 Suppl3):12-6.
33. Hofmann AA, Heithoff SM, Camargo M. Cementless total knee arthroplasty in patients 50 years or younger. Clin Orthop Relat Res. 2002; 404:102-7.
34. Sorrells BR, Stichl JB, Voorhorst PE. Mildterm results of mobile-bearing total knee arthroplasty in patients younger than 65 years. Clin Orthop Relat Res 2001;390:182-189.
35. Duffy GP, Trousdale RT, Stuart MJ. Total knee arthroplasty in patients 55 years old or younger. 10- to 17-year results. Clin Orthop Relat Res. 1998; 356:22-7.
36. Gill GS, Chan KC, Mills DM. 5- to 18-year follow-up study of cemented total knee arthroplasty for patients 55 years old or younger. J Arthroplasty. 1997; 12:49-54.
37. Ranawat CS, Padgett DE, Ohashi Y. Total knee arthroplasty for patients younger than 55 years. Clin Orthop Relat Res 1989; 248:27–33.
38. Garabano G, Lopreite F y del Sel H. Artroplastía total de rodilla en pacientes jóvenes con Artritis Reumatoide. Rev Asoc Argent Ortop Traumatol 2014;79-2:92-98.
39. Dalury DF, Ewald FC, Christie MJ, Scott RD: Total knee arthroplasty in a group of patients less than 45 years of age. J Arthroplasty 1995;10:598–602.
40. Fehring TK, Murphy JA, Hayes TD, Roberts DW, Pomeroy DL, Griffin WL. Factors influencing wear and osteolysis in Press-Fit Condylar modular total knee arthroplastys. Clin Orthop Relat Res. 2004; 428:40–50.
2. Callahan, CM, Drake BG, Heck DA, Dittus RS. Patients outcomes following tricompartimental total knee replacement: a Meta-Analisis. JAMA 1994;217-17:1349-1357.
3. Gioe TJ, Novak C, Sinner P, Ma W, Mehle S. Knee arthroplasty in the young patient: survival in a community registry. Clin Orthop Relat Res. 2007; 464:83–87.
4. Lachiewicz PF, Soileau ES. Fifteen-year survival and osteolysis associated with a modular posterior stabilized knee replacement: a concise follow-up of a previous report. J Bone Joint Surg Am. 2009; 91:1419–1423.
5. Ma HM, Lu YC, Ho FY, Huang CH. Long-term results of total condylar knee arthroplasty. J Arthroplasty. 2005; 20:580–584.
6. Ritter MA. The Anatomical Graduated Component total knee replacement: a long-term evaluation with 20-year survival analysis. J Bone Joint Surg Br. 2009; 91:745–749.
7. Kurtz SM, Lau E, Ong K, Zhao K, Kelly M, Bozic KJ. Future young patient demand for primary and revision joint replacement: national projections from 2010 to 2030. Clin Orthop Relat Res. 2009; 467:2606–2612.
8. W-Dahl A, Robertsson O, Lidgren L. Surgery for knee osteoarthritis in younger patients: a Swedish Register Study. Acta Orthop. 2010; 81:161–164.
9. Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res.1989; 248: 13–14.
10. Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: A health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatology. 1988; 15: 1833–1840.
11. Ewald FC. The Knee Society total knee arthroplasty roentgenographic evaluation and scoring system. Clin Orthop Relat Res. 1989; 248:9–12.
12. O’Rourke MR, Callaghan JJ, Goetz DD, Sullivan PM, Johnston RC. Osteolysis associated with a cemented modular posterior cruciate- substituting total knee design: five to eight-year followup. J Bone Joint Surg Am. 2002; 84:1362–1371.
13. Lonner JH, Pedlow FX, Siliski JM. Total knee arthroplasty for posttraumatic arthrosis of the knee. J Arthroplasty 1999; 14:969–975.
14. Larson AN, Hanssen AD, Cass JR. Does prior infection alter de outcome of TKA after tibial plateau fracture? Clin Orthop Relat Res. 2009;467:1793-1799.
15. Pulido L, Ghanem E, Joshi A, Purtill JJ, Parvizi J. Periprosthetic joint infection. The incidence, timing and predisposing factors. Clin Orthop Relat Res. 2008; 466:1710-5.
16. Messner K, Maletius W. The long-term prognosis for severe damage to weight-bearing cartilage in the knee. Acta Orthop Scand. 1996; 67:165–168.
17. McDaniel Jr WJ, Dameron Jr TB: The untreated anterior cruciate ligament rupture. Clin Orthop Relat Res. 1983; 172:158–163.
18. Tegner Y, Lysholm J. Rating systems and evaluation of knee ligament injury. Clin Orthop Relat Res. 1985; 198:43–49.
19. Insall JN, Joseph DM, Masika C. High tibial osteotomy for varus gonarthrosis. A long term followup study. J Bone Joint Surg. 1984; 66A:1040–1048.
20. Nagle A, Insall JN, Scuderi GR. Proximal tibial osteotomy. A subjective outcome study. J Bone Joint Surg. 1996; 78A:1353–1358.
21. Tai CC, Cross MJ. Five- to 12-year follow-up of a hydroxyapatite-coated, cementless total knee replacement in young, active patients. J Bone Joint Surg Br. 2006; 88: 1158-63.
22. Himanen AK, Belt E, Nevalainen J, Ha¨ma¨la¨inen M, Lehto MU. Survival of the AGC total knee arthroplasty is similar for arthrosis and rheumatoid arthritis: Finnish Arthroplasty Register report on 8,467 operations carried out between 1985 and 1999. Acta Orthop. 2005; 76:85–88.
23. Harrison O, Robertsson O, Nayfeh J. Higher cumulative revision rate of knee arthrioplasties in younger patients with osteoarthritis. Clin Orthop Relat Res 2004;421:162-168.
24. Rand JA, Trousdale RT, Ilstrup DM, Harmsen WS. Factors affecting the durability of primary total knee prostheses. J Bone Joint Surg Am. 2003; 85:259–265.
25. Keneey JA, Eunice S, Pashos PGS, Wrhight RW, Clohisy JC. What is the evidence for total knee arthroplasty in young patients? A systematic review of the literature. Clin Orthop Relat Res 2011;469:574-583.
26. Diduch DR, Insall JN, Scott WN, Scuderi GR, Font-Rodriguez D. Total knee replacement in young, active patients. Long-term follow-up and functional outcome. J Bone Joint Surg Am. 1997; 79:575-82.
27. Duffy GP, Crowder AR, Trousdale RR, Berry DJ. Cemented total knee arthroplasty using a modern prosthesis in young patients with osteoarthritis. J Arthroplasty. 2007; 22(6 Suppl 2):67-70.
28. Mont MA, Lee CW, Sheldon M, Lennon WC, Hungerford DS. Total knee arthroplasty in patients
29. Stern SH, Bowen MK, Insall JN, Scuderi GR. Cemented total knee arthroplasty for gonarthrosis in patients 55 years old or younger. Clin Orthop Relat Res. 1990; 260:124-9.
30. Odland A, Callaghan J, Liu S, Wells C. Wear and Lysis is the Problem in Modular TKA in the Young OA Patient at 10 Years. Clin Orthop Relat Res 2011; 469:41–47.
31. Lonner JH; Hershman S; Mont M; Lotke PA. Total knee arthroplasty in patients 40 years of age and younger with osteoarthritis. Clin Orthop Relat Res.2000;(380): p85-90.
32. Crowder AR, Duffy GP, Trousdale RT. Long-term results of total knee arthroplasty in young patients with rheumatoid arthritis. J Arthroplasty. 2005; 20(7 Suppl3):12-6.
33. Hofmann AA, Heithoff SM, Camargo M. Cementless total knee arthroplasty in patients 50 years or younger. Clin Orthop Relat Res. 2002; 404:102-7.
34. Sorrells BR, Stichl JB, Voorhorst PE. Mildterm results of mobile-bearing total knee arthroplasty in patients younger than 65 years. Clin Orthop Relat Res 2001;390:182-189.
35. Duffy GP, Trousdale RT, Stuart MJ. Total knee arthroplasty in patients 55 years old or younger. 10- to 17-year results. Clin Orthop Relat Res. 1998; 356:22-7.
36. Gill GS, Chan KC, Mills DM. 5- to 18-year follow-up study of cemented total knee arthroplasty for patients 55 years old or younger. J Arthroplasty. 1997; 12:49-54.
37. Ranawat CS, Padgett DE, Ohashi Y. Total knee arthroplasty for patients younger than 55 years. Clin Orthop Relat Res 1989; 248:27–33.
38. Garabano G, Lopreite F y del Sel H. Artroplastía total de rodilla en pacientes jóvenes con Artritis Reumatoide. Rev Asoc Argent Ortop Traumatol 2014;79-2:92-98.
39. Dalury DF, Ewald FC, Christie MJ, Scott RD: Total knee arthroplasty in a group of patients less than 45 years of age. J Arthroplasty 1995;10:598–602.
40. Fehring TK, Murphy JA, Hayes TD, Roberts DW, Pomeroy DL, Griffin WL. Factors influencing wear and osteolysis in Press-Fit Condylar modular total knee arthroplastys. Clin Orthop Relat Res. 2004; 428:40–50.