BERK GÜÇLÜ, MEHMET BAHADDİN GÜZEL, Kerem BAŞARIR, Bülent ERDEMLİ, İlker ÇETİN

İleri derecede deformiteye yol açan dejeneratif diz eklemi hastalıklarında total diz artroplastisinin orta dönem sonuçları

Amaç: İleri derecede deformiteye yol açan dejeneratif diz eklemi hastalıklarında total diz artroplastisinin orta dönem sonuçları değerlendirildi. Çalışma planı: İleri derecede deformiteye yol açan dejeneratif hastalık nedeniyle 86 hastanın (75 kadın, 11 erkek; ort. yaş 69; dağılım 39-85) 125 dizine total diz artroplastisi uygulandı. Dizlerin büyük çoğunluğunda tanı osteoartrit (n=100, %80) veya romatoid artrit (n=22, %17.6) idi. İki taraflı tutulumu olan 39 olguda ameliyatlar eşzamanlı (n=20) veya basamaklı (n=19) olarak yapıldı. Dizlerin 108’inde arka çapraz bağı kesen tipte, 17’sinde bağı koruyan tipte artroplasti uygulandı. Ameliyat öncesi ve ameliyat sonrası değerlendirmelerde Diz Derneği’nin skorlama sistemleri kullanıldı. Ortalama izlem süresi 53 ay (dağılım 24-96 ay) idi. Sonuçlar: Dizlerin %80.2’sinde sonuçlar iyi veya çok iyi olarak değerlendirildi. Dokuz dizde (%7.2) revizyon cerrahisi gerekti. Bunların beşinde ameliyat öncesi tanı romatoid artrit idi. Revizyon nedenleri enfeksiyona bağlı sorunlar (n=5), aseptik gevşeme (n=3) ve periprostetik kırık (n=1) idi. Ameliyat öncesine göre, olguların diz puanı ortalama 60.9 (26.2’den 87.1’e), fonksiyonel puanı 42.6 (33.2’den 75.8’e) puan artış gösterdi (p

Anahtar Kelimeler:

Artrit, romatoid, Sonuç değerlendirilmesi (Sağlık bakımı), Osteoartrit, diz, Diz eklemi, Hastalık ciddiyet indeksi, Hareket açıklığı, eklem, Tedavi sonucu, Eklem deformiteleri, edinsel, Artroplasti, replasman, diz

Midterm results of total knee arthroplasty in degenerative knee joint diseases with severe deformity

Objectives: We evaluated the midterm results of total knee arthroplasty in degenerative knee joint diseases with severe deformity. Methods: Total knee arthroplasty was performed in 125 knees of 86 patients (75 women, 11 men; mean age 69 years; range 39 to 85 years) with degenerative knee joint diseases accompanied by severe deformity. Almost all the patients had osteoarthritis (100 knees, 80%) or rheumatoid arthritis (22 knees, 17.6%). Thirty-nine patients with bilateral involvement underwent single- stage (n=20) or two-stage (n=19) surgery. During surgery, the posterior cruciate ligament was sacrificed in 108 knees and retained in 17 knees. Pre- and postoperative assessments were made according to the Knee Society clinical scoring system. The mean follow-up was 53 months (range 24 to 96 months). Results: The results were excellent or good in 80.2% of the knees. Nine knees (7.2%) required revision surgery, of which preoperative diagnosis was rheumatoid arthritis in five. The reasons for revision were infection-related problems (n=5), aseptic loosening (n=3), and periprosthetic fracture (n=1). Compared with preoperative values, the mean knee score increased by 60.9 (from 26.2 to 87.1), and the mean functional score increased by 42.6 (from 33.2 to 75.8) (p<0.05), with a mean range of knee joint motion of 93.2°. The mean preoperative and postoperative alignments were 17.8° of varus and 4.1° of valgus (range 0° to 6°), respectively. The number of knees with a flexion contracture decreased from 68 (mean 28.8°) to 8 (mean 8.4°), all of which had a flexion contracture angle below 10°. Conclusion: Total knee arthroplasty performed in degenerative knee joint diseases with severe deformity significantly improves patients’ complaints and functional results.

Keywords:

Arthritis, Rheumatoid, Outcome Assessment (Health Care), Osteoarthritis, Knee, Knee Joint, Severity of Illness Index, Range of Motion, Articular, Treatment Outcome, Joint Deformities, Acquired, Arthroplasty, Replacement, Knee,

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