Barrack Robert L, Barnes C Lowry, Burnett R Stephen J, Miller Derek, Clohisy John C, Maloney William J
Department of Orthopaedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St Louis, Missouri 63110, USA.
J Arthroplasty. 2009 Jun;24(4):489-98. doi: 10.1016/j.arth.2009.02.004. Epub 2009 Apr 1.
A consecutive series of revision total knee arthroplasty (TKA) performed at 3 centers by 5 surgeons for a 3-year period was reviewed. Revisions performed for infection and rerevisions were excluded. Review of clinical and radiographic data determined incision type, sex, age, time to revision, and primary diagnosis at time of revision. Two-hundred thirty-seven first-time revision TKAs were performed, of which 44 (18.6%) had been a minimal incision surgery (MIS) primary TKA and 193 (81.4%) had been a standard primary TKA. Patients with MIS were younger (62.1 vs 66.2 years, P = .02). Most striking was the difference in time to revision, which was significantly shorter for the MIS group (14.8 vs 80 months, P < .001). Minimal incision surgery TKA accounted for a substantial percentage of revision TKA in recent years at these centers. The high prevalence of MIS failures occurring within 24 months is disturbing and warrants further investigation.
回顾了5位外科医生在3个中心进行的为期3年的连续系列全膝关节置换翻修术（TKA）。排除因感染进行的翻修术和再次翻修术。通过回顾临床和影像学数据来确定切口类型、性别、年龄、翻修时间以及翻修时的初步诊断。共进行了237例初次翻修全膝关节置换术，其中44例（18.6%）初次全膝关节置换术采用了微创切口手术（MIS），193例（81.4%）采用了标准初次全膝关节置换术。接受MIS的患者更年轻（62.1岁对66.2岁，P = 0.02）。最显著的是翻修时间的差异，MIS组的翻修时间明显更短（14.8个月对80个月，P < 0.001）。近年来，在这些中心，微创切口手术全膝关节置换术在翻修全膝关节置换术中占相当大的比例。24个月内发生的MIS失败的高发生率令人不安，值得进一步调查。
