臨床整形外科55巻9号

2020年09月発行

特集 インプラント周囲骨折の治療戦略—THA・TKA・骨折後のプレート・髄内釘

【TKA】RA患者におけるTKA周囲骨折—OA患者との比較

著者： 岡田宗一郎¹ 針生光博¹ 鈴木朱美² 高木理彰² 高窪祐弥³

所属機関： ¹山形県立新庄病院整形外科 ²山形大学医学部整形外科学講座 ³山形大学医学部リハビリテーション部

ページ範囲：P.1055 - P.1064

　関節リウマチ(RA)患者の人工膝関節全置換術(TKA)周囲骨折は，RA疾患特有の問題のため，その治療には困難を伴うことが多い．自験例の検討では，RAのTKA周囲骨折の頻度は変形性関節症(OA)よりも高かった(1.8％対0.5％)．治療法は，OA患者に比べ保存療法と再置換術が多い傾向があり，周術期の合併症も多かった(感染18.2％対0％，再手術9.1％対3.3％)．RA患者では，多関節障害による上下肢機能障害や受傷前からの歩行能低下，TKA周囲を含む全身の骨粗鬆症，易感染性，心肺機能障害，サルコペニアなど，局所だけでなく全身的な併発症にも対応した周術期管理と治療計画が必要と考えられた．

参考文献

1) Smolen JS, Landewe RBM, Bijlsma JWJ, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs:2019 update. Ann Rhem Dis 2020;79(6):685-99.

2) Momohara S, Inoue E, Ikari K, et al. Decrease in orthopaedic operations, including total joint replacements, in patients with rheumatoid arthritis between 2001 and 2007:data from Japanese outpatients in a single institute-based large observational cohort (IORRA). Ann Rhem Dis 2010;69(1):312-3.

3) Matsushita I, Motomura H, Seki E, et al. Radiographic changes and factors associated with subsequent progression of damage in weight-bearing joints of patients with rheumatoid arthritis under TNF-blocking therapies-three-year observational study. Mod Rheumatol 2017;27(4):570-5.

4) 砂原伸彦，瀬戸口啓夫，徳本寛人．関節リウマチに伴う骨脆弱性骨折治療のキーポイント．関節外科2019；38(7)：717-27．

5) Molvik H, Khan W. Bisphosphonates and their influence on fracture healing:a systematic review. Osteoporos Int 2015;26(4):1251-60.

6) 斎藤政克，松下和彦．関節リウマチにおける周術期感染予防．日本臨床2016；74(6)：993-9．

7) Scott DL, Wolfe F, Huizinga TW. Rheumatoid Arthritis. Lancet 2010;376(9746):1094-108.

8) Konan S, Sandiford N, Unno F, et al. periprosthetic fractures associated with total knee arthroplasty:An Update. Bone Joint J 2016;98(11):1489-96.

9) Rhee SJ, Cho JY, Choi YY, et al. Femoral periprosthetic fractures after total knee arthroplasty:new surgically oriented classification with a review of current treatments. Knee Surg Relat Res 2018;30(4):284-92.

10) Bouras T, Bitas V, Fennema P, et al. Good long-term results following cementless tka with a titanium plasma coating. Knee Surg Sports Traumatol Arthrosc 2017;25(9):2801-8.

11) Collados-Maestre I, Lizaur-Utrilla A, Gonzalez-Navarro B, et al. Better functional outcome after single-radius TKA compared with multi-radius TKA. Knee Surg Sports Traumatol Arthrosc 2017;25(11):3508-14.

12) Archibeck MJ, Berger RA, Barden RM, et al. Posterior cruciate ligament-retaining total knee arthroplasty in patients with rheumatoid Arthritis. J Bone Joint Surg Am 2001;83(8):1231-6.

13) 山内　潔，芳賀千明．RA膝に対するセメントレス人工膝関節置換術の長期成績．日本人工関節学会誌2007；37：64-5．

14) Yamanaka H, Goto K, Suzuki M. Clinical results of Hi-tech Knee II total knee arthroplasty in patients with rheumatoid athritis:5- To 12-year Follow-Up. J Orthop Surg Res 2012;7:9.

15) 黒瀬理恵，柿崎　寛，秋元博之．関節リウマチに対する後十字靱帯温存型人工膝関節置換術についての検討．臨床リウマチ2015；27(2)：111-6．

16) Lee JK, Kee YM, Chung HK, et al. Long-term results of cruciate-retaining total knee replacement in patients with rheumatoid arthritis:a minimum 15-year review. Can J Surg 2015;58(3):193-7.

17) 内田　理，十河敏晴，後藤　仁・他．関節リウマチにおけるTKA周囲骨折の特徴と問題点．関節の外科2019；46(3-4)：129-33．

18) Zhang K, Han Q, Xu X, et al. Metal Artifact reduction of orthopedics metal artifact reduction algorithm in total hip and knee arthroplasty. Medicine 2020;99(11):e19268.

19) Rorabeck CH, Taylor JW. Periprosthetic fractures of the femur complicating total knee arthroplasty. Orthop Clin North Am 1999;30(2):265-77.

20) Ortiguera CJ, Berry DJ. Patellar fracture after total knee arthroplasty. J Bone Joint Surg Am 2002;84(4):532-40.

21) Felix NA, Stuart MJ, Hanssen AD. Periprosthetic fractures of the tibia associated with total knee arthroplasty. Clin Orthop Relat Res 1997;345:113-24.

22) Verma N, Jain A, Pal C, et al. Management of periprosthetic fracture following total knee arthroplasty- a retrospective study to decide when to fix or when to revise? J Clin Orthop Trauma 2020;11(Suppl 2):S246-54.

23) Zehntner MK, Ganz R. Internal fixation of supracondylar fractures after condylar total knee arthroplasty. Clin Orthop Relat Res 1993;293:219-24.

24) Kim K. Usefulness of bilateral plate fixation for periprosthetic distal femur fracture after total knee arthroplasty. Int J Surg Case Rep 2020;68:43-7.

25) Walcher MG, Giesinger K, Sart Rd, et al. Plate positioning in periprosthetic or interprosthetic femur fractures with stable implants-a biomechanical study. J Arthroplasty 2016;31(12):2894-9.

26) Chalidis BE, Tsiridis E, Tragas AA, et al. Management of periprosthetic patellar fractures. a systematic review of literature. Injury 2007;38(6):714-24.

27) 西　英治，谷口浩人，斎藤　力・他．人工膝関節置換術後の膝蓋骨骨折の検討．関東整形災害外科学会雑誌2016；47(3)：145-50．

28) Lombardo DJ, Siljander MP, Sobh A, et al. Periprosthetic fractures about total knee arthroplasty. Musculoskelet Surg 2019 Online Ahead of print doi:10.1007/s12306-019-00628-9.

29) Morwood MP, Gebhart SS, Zamith N, et al. Outcomes of fixation for periprosthetic tibia fractures around and below total knee arthroplasty. Injury 2019;50(4):978-82.

30) Kim HJ, Park KC, Kim JW, et la. Successful outcome with minimally invasive plate osteosynthesis for periprosthetic tibial fracture after total knee arthroplasty. Orthop Traumatol Surg Res 2017;103(2):263-8.