Notice bibliographique
Résumé
Total knee replacement is one of the most successful procedures in orthopaedic surgery. Although originally limited to more elderly and less active individuals, the inclusion criteria for TKA have changed, with ever younger, more active and heavier patients receiving TKA. Currently, wear debris related osteolysis and associated prosthetic loosening are major modes of failure for TKA implants of all designs. Initially, tibial components were cemented all-polyethylene monoblock constructs. Subsequent long-term follow up studies of these implants have demonstrated excellent durability in survivorship studies out to twenty years. Aseptic loosening of the tibial component was one of the main causes of failure in these implants. Polyethylene wear with osteolysis around well fixed implants was rarely (if ever) observed. Cemented metal-backed nonmodular tibial components were subsequently introduced to allow for improved tibial load distribution and to protect osteoporotic bone. Long-term studies have established that many one-piece nonmodular tibial components have maintained excellent durability. Eventually, modularity between the polyethylene tibial component and the metal-backed tray was introduced in the mid-80s mainly to facilitate screw fixation for cementless implants. These designs also provided intra-operative versatility by allowing interchange of various polyethylene thicknesses, and to also aid the addition of stems and wedges. Other advantages included the reduction of inventory, and the potential for isolated tibial polyethylene exchanges as a simpler revision procedure. However, since the late 19809s, the phenomena of polyethylene wear and osteolysis have been observed much more frequently when compared with earlier eras. The reasons for this increased prevalence of synovitis, progressive osteolysis, and severe polyethylene wear remain unclear, but it is likely associated with the widespread use of both cementless and cemented modular tibial designs. Backside wear between the metal tray and polyethylene has been implicated. Recent RSA studies comparing fixation of all-polyethylene to modular components has shown that their RSA migration patterns are superior and fixation is in fact better with the all-polyethylene construct. Further, in a recent meta-analysis, all-polyethylene components were equivalent to metal-backed components regarding revision rates and clinical scores. The promise of modular tibial components affording a simple liner exchange to revise a knee has not borne out in the literature. Several studies have revealed that the effectiveness of isolated tibial insert exchange in revision TKR is of limited value. Isolated tibial insert exchange led to a surprisingly high rate of early failure. Tibial insert exchange as an isolated method of total knee revision should therefore be undertaken with caution even in circumstances for which the modular insert was designed and believed to be of greatest value. Because of the modularity, extra materials, and extra processing, modular tibial components are significantly more expensive than all-polyethylene components.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».