臨床整形外科55巻2号

2020年02月発行

論述

人工膝関節全置換術施行例における前十字靱帯と外側大腿脛骨関節軟骨の状態についての検討

著者： 琴浦健¹ 田中聡一¹ 岡本剛治¹ 藤代高明¹ 安喰健祐¹ 長田尚介¹ 北澤大也¹ 平中崇文¹

所属機関： ¹愛仁会高槻病院整形外科

ページ範囲：P.155 - P.159

目的：人工膝関節全置換術における前十字靱帯と外側大腿脛骨関節軟骨の状態を明らかにすること．

対象と方法：当院で人工膝関節全置換術を施行した84例130膝を対象とし，術中に前十字靱帯と外側大腿脛骨関節軟骨の状態を確認し分類した．

結果：前十字靱帯が機能し外側大腿脛骨関節軟骨が保たれている膝は40膝(31％)，前十字靱帯が機能し外側大腿脛骨関節軟骨が保たれていない膝は14膝(11％)であった．

まとめ：正確な術前評価による，適切な人工関節の選択・術式の選択が重要である．

参考文献

1) Scott CE, Howie CR, MacDonald D, et al. Predicting dissatisfaction following total knee replacement:a prospective study of 1217 patients. J Bone Joint Surg Br 2010;92(9):1253-8.

2) Choi YJ, Ra HJ. Patient satisfaction after total knee arthroplasty. Knee Surg Relat Res 2016;28(1):1-15.

3) Hiranaka T, Hida Y, Fujishiro T, et al. Approximately 30% of functioning anterior cruciate ligaments are sacrificed for knee arthroplasty. J Knee Surg 2019 Mar 25. doi:10.1055/s-0039-1683928.

4) White SH, Ludkowski PF, Goodfellow JW. Anteromedial osteoarthritis of the knee. J Bone Joint Surg Br 1991;73(4):582-6.

5) Hamilton TW, Pandit HG, Lombardi AV, et al. Radiological decision aid to determine suitability for medial unicompartmental knee arthroplasty:development and preliminary validation. Bone Joint J 2016;98-B(10 Supple B):3-10.

6) Goodfellow J, O'Conner J, Dodd C, et al. Unicompartmental Arthroplasty with the Oxford Knee. Oxford:Goodfellow Publishers;2006:p.35

7) Harman MK, Markovich GD, Banks SA, et al. Wear patterns on tibial plateaus from varus and valgus osteoarthritic knees. Clin Orthop Relat Res 1998;352:149-58.

8) Cloutier JM, Sabouret P, Deghrar A. Total knee arthroplasty with retention of both cruciate ligaments. A nine to eleven-year follow-up study. J Bone Joint Surg Am 1999;81(5):697-702.

9) Lee GC, Cushner FD, Vigoritta V, et al. Evaluation of the anterior cruciate ligament integrity and degenerative arthritic patterns in patients undergoing total knee arthroplasty. J Arthroplasty 2005;20(1):59-65.

10) Johnson AJ, Howell SM, Costa CR, et al. The ACL in the arthritic knee:how often is it present and can preoperative tests predict its presence? Clin Orthop Relat Res 2013;471(1):181-8.

11) Ishii Y, Noguchi H, Sato J, et al. Macro scopic evaluation of the anterior cruciate ligament in osteoarthritic patients undergoing total knee arthroplasty. Eur J Orthop Surg Traumatol 2016;26(2):205-8.

12) Jacobs CA, Christensen CP, Karthikeyan T. An intact anterior cruciate ligament at the time of posterior cruciate ligament- retaining total knee arthroplasty was associated with reduced patient satisfaction and inferior pain and stair function. J Arthroplasty 2016;31(8):1732-5.

13) Abdelbadie A, Toreih AA, Radwan MA. ACL status in arthroplasty patients, why not to preserve? SICOT J 2018;4:1.

14) Liddle AD, Judge A, Pandit H, et al. Adverse outcomes after total and unicompartmental knee replacement in 101,330 matched patients:a study of data from the National Joint Registry for England and Wales. Lancet 2014;384(9952):1437-45.

15) Liddle AD, Pandit H, Judge A, et al. Effect of surgical caseload on revision rate following total and unicompartmental knee replacement. J Bone Joint Surg Am 2016;98(1):1-8.

16) Pandit H, Jenkins C, Gill HS, et al. Unnecessary contraindications for mobile-bearing unicompartmental knee replacement. J Bone Joint Surg Br 2011;93(5):622-8.

17) Yoshida K, Tada M, Yoshida H, et al. Oxford phase 3 unicompartmental knee arthroplasty in Japan--clinical results in greater than one thousand cases over ten years.J Arthroplasty 2013;28(9 Suppl):168-71.

18) Campi S, Pandit H, Hooper G, et al. Ten-year survival and seven-year functional results of cementless Oxford unicompartmental knee replacement:A prospective consecutive series of our first 1000 cases. Knee 2018;25(6):1231-7.

19) Price AJ, Svard U. A second decade lifetable survival analysis of the Oxford unicompartmental knee arthroplasty. Clin Orthop Relat Res 2011;469(1):174-9.

20) Keyes GW, Carr AJ, Miller RK, et al. The radiographic classification of medial gonarthrosis. Correlation with operation methods in 200 knees. Acta Orthop Scand 1992;63(5):497-501.

21) Hamilton TW, Pandit HG, Lombardi AV, et al. Radiological decision aid to determine suitability for medial unicompartmental knee arthroplasty:development and preliminary validation. Bone Joint J 2016;98-B(10 Supple B):3-10.

22) Pandit H, Beard DJ, Jenkins C, et al. Combined anterior cruciate reconstruction and Oxford unicompartmental knee arthroplasty. J Bone Joint Surg Br 2006;88(7):887-92.

23) Boissonneault A, Pandit H, Pegg E, et al. No difference in survivorship after unicompartmental knee arthroplasty with or without an intact anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc 2013;21(11):2480-6.

24) Engh GA, Ammeen D. Is an intact anterior cruciate ligament needed in order to have a well-functioning unicondylar knee replacement? Clin Orthop Relat Res 2004;428:170-3.

25) Mancuso F, Hamilton TW, Kumar V, et al. Clinical outcome after UKA and HTO in ACL deficiency:a systematic review. Knee Surg Sports Traumatol Arthrosc 2016;24(1):112-22.

26) Mancuso F, Dodd CA, Murray DW, et al. Medial unicompartmental knee arthroplasty in the ACL-deficient knee. J Orthop Traumatol 2016;17(3):267-75.

27) Confalonieri N, Manzotti A, Cerveri P et al. Bi-unicompartmental versus total knee arthroplasty:a matched paired study with early clinical results. Arch Orthop Trauma Surg 2009;129(9):1157-63.

28) Okada Y, Teramoto A, Takagi T, et al. ACL function in bicruciate-retaining total knee arthroplasty. J Bone Joint Surg Am 2018;100(17):e114.