Department of Orthopaedic Surgery, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH 44106, USA.
Clin Orthop Relat Res. 2010 Jan;468(1):82-9. doi: 10.1007/s11999-009-1061-x.
Revision total knee arthroplasty in patients with rheumatoid arthritis can be challenging. We asked whether we could confirm previously reported high failure rates following revision total knee arthroplasty in patients with rheumatoid arthritis. We therefore determined the Knee Society knee score and function scores, radiographic evidence of failure, and overall survival of the revision procedure in these patients. We retrospectively reviewed 39 patients with rheumatoid arthritis who underwent 45 TKA revisions from 1994 to 2006. Twenty-seven of the 45 TKA revisions were for mechanical failure of the prosthetic components and 18 for infection. Five of the 27 knees (19%) revised for mechanical failure subsequently failed a second time. Five of the 18 patients who underwent revision for infection died within 6 months and three of the remaining knees failed secondary to reinfection. Excluding the knees that failed, the average Knee Society knee score and function score improved in both subgroups. Two knees had radiographic evidence of nonprogressive tibial radiolucencies. The probability of survival for all knees (revision as the end point) was 76% +/- 9% at 5 years. We confirmed the previously reported high mortality and subsequent failure rates following revision total knee arthroplasty for both mechanical issues and infection in patients with rheumatoid arthritis and emphasize the potential difficulties in treating these patients.
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
类风湿关节炎患者的翻修全膝关节置换术可能具有挑战性。我们想知道是否可以证实先前报道的类风湿关节炎患者翻修全膝关节置换术后的高失败率。因此，我们确定了这些患者的膝关节学会膝关节评分和功能评分、假体组件失败的放射学证据以及翻修手术的总体存活率。我们回顾性地分析了 1994 年至 2006 年间接受 45 例 TKA 翻修的 39 例类风湿关节炎患者。45 例 TKA 翻修中有 27 例是由于假体组件的机械故障，18 例是由于感染。27 例因机械故障而翻修的膝关节中有 5 例（19%）再次失败。18 例因感染而接受翻修的患者中有 5 例在 6 个月内死亡，其余 3 例因再次感染而失败。排除失败的膝关节后，两组的膝关节学会膝关节评分和功能评分均有所提高。有 2 例膝关节有胫骨放射透亮区无进展的放射学证据。所有膝关节（以翻修为终点）的存活率为 76% +/- 9%，5 年时。我们证实了先前报道的类风湿关节炎患者翻修全膝关节置换术后因机械问题和感染导致的高死亡率和随后的失败率，并强调了治疗这些患者的潜在困难。
IV 级，治疗研究。欲了解完整的证据水平描述，请参见作者指南。
