Rand James A, Trousdale Robert T, Ilstrup Duane M, Harmsen W Scott
Department of Orthopedic Surgery, Mayo Clinic Scottsdale, AZ 85259, USA.
J Bone Joint Surg Am. 2003 Feb;85(2):259-65. doi: 10.2106/00004623-200302000-00012.
Failure of total knee arthroplasty is problematic. The purpose of this study was to evaluate the factors that influence the durability of a primary total knee prosthesis.
A survivorship analysis of 11,606 primary total knee arthroplasties carried out between January 1, 1978, and December 31, 2000, was performed. An analysis of patient and implant-related factors affecting survivorship was done with use of a multivariate Cox model.
The survivorship was 91% (95% confidence interval, 90% to 91%) at ten years (2943 knees), 84% (95% confidence interval, 82% to 86%) at fifteen years (595 knees), and 78% (95% confidence interval, 74% to 81%) at twenty years (104 knees) following the surgery. Prosthetic survivorship at ten years was 83% for patients fifty-five years of age or less compared with 94% for those older than seventy years of age (p < 0.0001), 90% for those with a diagnosis of osteoarthritis compared with 95% for those with inflammatory arthritis (p < 0.005), and 91% for those with retention of the posterior cruciate ligament compared with 76% for those with substitution of the posterior cruciate ligament (a posterior stabilized prosthesis) (p < 0.0001). Survivorship at ten years was 92% for nonmodular metal-backed tibial components, 90% for modular metal-backed tibial components, and 97% for all-polyethylene tibial components (p < 0.0001). Survivorship at ten years was 92% for prostheses fixed with cement compared with 61% for those fixed without cement (p < 0.0001).
Significant risk factors for failure of total knee arthroplasty were the type of implant, age and gender of the patient, diagnosis, type of fixation, and design of the patellar component. In the ideal situation-treatment of a woman over the age of seventy years who has inflammatory arthritis with a nonmodular, metal-backed tibial component, cement fixation, an all-polyethylene patellar component, and retention of the posterior cruciate ligament-the ten-year survivorship of the prosthesis was estimated to be 98% (95% confidence interval, 97% to 99%).
全膝关节置换术失败是个问题。本研究的目的是评估影响初次全膝关节假体耐用性的因素。
对1978年1月1日至2000年12月31日期间进行的11606例初次全膝关节置换术进行生存分析。使用多变量Cox模型对影响生存率的患者和植入物相关因素进行分析。
术后十年（2943例膝关节）生存率为91%（95%置信区间，90%至91%），十五年（595例膝关节）生存率为84%（95%置信区间，82%至86%），二十年（104例膝关节）生存率为78%（95%置信区间，74%至81%）。五十五岁及以下患者十年假体生存率为83%，而七十岁以上患者为94%（p<0.0001）；诊断为骨关节炎的患者十年假体生存率为90%，而炎性关节炎患者为95%（p<0.005）；保留后交叉韧带的患者十年假体生存率为91%，而后交叉韧带置换（后稳定型假体）的患者为76%（p<0.0001）。非模块化金属背衬胫骨组件十年生存率为92%，模块化金属背衬胫骨组件为90%，全聚乙烯胫骨组件为97%（p<0.0001）。骨水泥固定假体十年生存率为92%，非骨水泥固定假体为61%（p<0.0001）。
全膝关节置换术失败的显著危险因素包括植入物类型、患者年龄和性别、诊断、固定类型以及髌骨组件设计。在理想情况下，即治疗一名七十岁以上患有炎性关节炎的女性，使用非模块化金属背衬胫骨组件、骨水泥固定、全聚乙烯髌骨组件并保留后交叉韧带，假体的十年生存率估计为98%（95%置信区间，97%至99%）。
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