Ten year follow-up study of total knee replacement (Okayama University type)
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概要
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A surface replacement type of total-knee prosthesis has been under development in our department since 1968. The design of the prosthesis was changed from the B, C, D, E and F type to the Mark-II type which is generally used at the present. In the initial cases, the B and D type were mainly used without any bone cement, and the posterior cruciate ligament was left intact.<BR>Twenty-five cases underwent our total knee replacement (TKR) up to 1975. Twenty knees of these, including one osteoarthritis (OA) and fourteen rheumatoid arthritis (RA) patients, minus six who had died and four who were not examined, were studied by a clinical score system (three university score) and roentogenography in a follow-up after ten years.<BR>Four patients (one OA, three RA) gained over 70 points in the total score ten years postoperatively. These cases had good range of motion (ROM) in extension/flexion from 0 to 90 degrees, and no loosening of the prosthesis was found roentogenographically. Three knees were revised because of prosthetic loosening with motor pain and instability. With respect to postoperative ROM, six knees had over 70 degrees in flexion, but contracture with gradual decrease of ROM was found in six knees. However, patient evaluation was good due to pain relief even if the ROM was less than 60 degrees. No infected cases and no broken prostheses were experienced, but prosthetic loosening was observed in cases with advanced osteoporosis.<BR>In the surface type of TKR without bone cement, significantly better long term fixation of the prosthesis with a good clinical course can be provided if the prosthesis is set in the correct position and the bone structure is not so porotic.
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