Publication: Influencia del nivel de la línea articular sobre el resultado funcional de prótesis de rodilla realizadas con técnica navegada
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2018-04-16
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Universidad Complutense de Madrid
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Abstract
Con la artroplastia total de rodilla que realizamos en la actualidad, se consigue como resultado un alivio del dolor y una recuperación excelente de la función del paciente, con una tasa de supervivencia tan alta como el 98% a los 15 años tras la cirugía. En las últimas décadas se han desarrollado múltiples diseños de prótesis, y el debate sobre la conservación o no del ligamento cruzado posterior (LCP) se mantiene vivo. Los partidarios de conservar el LCP señalan que estas prótesis permiten mantener la línea articular, conservar una estructura ligamentosa estabilizadora central importante, mejorar la capacidad para subir escaleras y conservar mayor cantidad de hueso. Los diseños nuevos ofrecen resultados todavía más prometedores a medio plazo, lo que nos indica que nuevas modificaciones de diseño podrían continuar mejorando estos resultados. A partir del año 1970 la artroplastia total de rodilla ha tenido un verdadero desarrollo incrementándose de forma continuada hasta nuestros días. Uno de los primeros cálculos de navegación que involucraban tejido óseo fue diseñado en 1974 por Schlöndorff y colaboradores en Aachen, Alemania. Desde finales de la década de los ochenta se ha utilizado la imagen radiográfica y diferentes técnicas para cuantificar la movilidad de las prótesis de rodilla in vivo. Estos estudios han demostrado cómo se mueven las prótesis de rodilla in vivo, cómo afecta el diseño del implante a la cinemática de la rodilla y cómo diferentes factores quirúrgicos y de diseño influyen en la mecánica de la rodilla y en la función del paciente. En general los implantes de rodilla con mejor posición en el eje anteroposterior entre el fémur y la tibia, consiguen una mayor distribución de cargas y presentan una cinemática con más probabilidades de lograr una mejor función del paciente y una mayor longevidad del implante. Los estudios radioscópicos iniciales sobre cinemática de las artroplastias de rodilla demostraron que los movimientos dinámicos diferían mucho de los de una rodilla normal. Estos estudios y otros posteriores, demostraron que el centro de rotación de la rodilla puede cambiar con distintos limitadores articulares. Los estudios cinemáticos realizados durante diversas actividades cotidianas en pacientes con prótesis de rodilla con buenos resultados clínicos, demuestran un abanico amplio de patrones de movilidad que pueden deberse a muchas causas, entre ellas a variaciones de la línea articular. Cierta proporción de pacientes continúan presentando dolor de difícil explicación. Algunas veces la prótesis funciona objetivamente bien y la amplitud de movimiento es adecuada, pero el paciente presenta dolor que puede ser continuo o principalmente en reposo. Se pretende con este estudio dar algo de luz en este campo de la artroplastia total de rodilla para evitar que los pacientes presenten este tipo de complicaciones...
Nowadays we obtain a pain relief and an excellent patient´s recovery after a primary total knee replacement, with a survival rate of 98% in the next 15 years after surgery. Over the last several decades, multiple designs have been developed, and the discussion on the choice whether or not to retain the posterior cruciate ligament (PCL) is still alive. The supporters of maintaining the PCL point out that a total knee replacement allows to keep joint line height, to retain ligaments stabilizer structure, to improve the capacity of climbing stairs and to preserve larger quantity of bone. The new designs offer promising results in the medium term, which shows us that new design modifications could continue improving the results. It was in 1970 when the primary total knee replacement had a real development, which has been improving until today. One of the first navigation calculations that involve bone tissue was designed in 1974 by Schlöndorff and contributors in Aechen, Germany. Since the end of the 1980s, radiographic image and different techniques to quantify prosthesis mobility in real time have been used. These studies have demonstrated how the prosthesis moves in real time, how the replacement design affects knee kinematics and how different surgical and design factors affect knee mechanics and patient function. In general, a better antero-posterior axis between femur and tibia in a total knee replacement gets a better load distribution and it offers more kinematic possibilities to achieve the best function of the patient and a longer lifespan of the implant. The radioscopic initial studies about total knee replacement kinematics have demonstrated that dynamic movements were far to be like a normal knee. These and subsequent studies have demonstrated that centre of knee rotation can change with different joint limiter. The kinematic studies made during different daily activities in patients with positive total knee replacement clinical results, have demonstrated a wide range of mobility patterns that might be caused by multiple causes, for example by changes in joint line height. Some patients still have difficult explanation pain. Sometimes the total knee replacement works objectively well and the magnitude of the movement is suitable, but the patients present pain which can be continuous or mainly when he is at rest. The aim of this study is to show something new in the total knee replacement realm to avoid these patient complications...
Nowadays we obtain a pain relief and an excellent patient´s recovery after a primary total knee replacement, with a survival rate of 98% in the next 15 years after surgery. Over the last several decades, multiple designs have been developed, and the discussion on the choice whether or not to retain the posterior cruciate ligament (PCL) is still alive. The supporters of maintaining the PCL point out that a total knee replacement allows to keep joint line height, to retain ligaments stabilizer structure, to improve the capacity of climbing stairs and to preserve larger quantity of bone. The new designs offer promising results in the medium term, which shows us that new design modifications could continue improving the results. It was in 1970 when the primary total knee replacement had a real development, which has been improving until today. One of the first navigation calculations that involve bone tissue was designed in 1974 by Schlöndorff and contributors in Aechen, Germany. Since the end of the 1980s, radiographic image and different techniques to quantify prosthesis mobility in real time have been used. These studies have demonstrated how the prosthesis moves in real time, how the replacement design affects knee kinematics and how different surgical and design factors affect knee mechanics and patient function. In general, a better antero-posterior axis between femur and tibia in a total knee replacement gets a better load distribution and it offers more kinematic possibilities to achieve the best function of the patient and a longer lifespan of the implant. The radioscopic initial studies about total knee replacement kinematics have demonstrated that dynamic movements were far to be like a normal knee. These and subsequent studies have demonstrated that centre of knee rotation can change with different joint limiter. The kinematic studies made during different daily activities in patients with positive total knee replacement clinical results, have demonstrated a wide range of mobility patterns that might be caused by multiple causes, for example by changes in joint line height. Some patients still have difficult explanation pain. Sometimes the total knee replacement works objectively well and the magnitude of the movement is suitable, but the patients present pain which can be continuous or mainly when he is at rest. The aim of this study is to show something new in the total knee replacement realm to avoid these patient complications...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Cirugía, leída el 18/09/2017