慢性関節リウマチに対するセメントレス人工膝関節置換術の成績と問題点

抄録

The results and problems with 34 knees in 23 cases of Okayama Mark II total knee replacement (TKR), and 16 cases of 23 Bioceram KOM type TKR were investigated.
Needless to say, one of the most important factors in operative results is surgical technique. Almost the same satisfactory results were obtained with both cementless (ceramic) TKR and cemented TKR.
Better results could be expected by setting a more adequate osteotomy angle. It is clear that instruments, design of prosthesis and principle of surgical techniques should be improved to accomplish this. One example would be cutting the tibia in a slightly posteriorly tilted angle.
In the Okayama Mark II TKR, good results could not always be obtained even in cases with good alignment, even those in which TKR was set in the posteriorly shifted position, and more accurate technique is required.
In contrast, satisfactory results were obtained in a wide range of alignments with the Bioceram TKR. However there was a case in which a structural defect was observed.
It was also shown that cementless TKR has an advantage with respect to salvaging; that is, fairly good knee function could be maintained after removal of the prosthesis.