Department of Orthopedics and Traumatology, Exercise and Sports Medicine Group, School of Medical Sciences, State University of Campinas, UNICAMP, Campinas, Brazil,
Knee Surg Sports Traumatol Arthrosc. 2013 Dec;21(12):2737-43. doi: 10.1007/s00167-012-2139-7. Epub 2012 Jul 25.
Bone surgery around the knee joint could represent a more traumatic prior surgical procedure compared to soft tissue knee surgery and may predispose to differing postoperative total knee arthroplasty (TKA) outcomes. The objective of this study was to analyse the postoperative results as well as complications and failures in two groups of patients that had undergone knee surgery prior to primary TKA (bone surgery and soft tissue surgery) when compared to the no prior surgery group.
A retrospective and cohort series of 1,474 primary TKA were evaluated at minimum follow-up period of 2 years: 1,119 primary TKA underwent no prior surgery (1,119 patients) (group A), 85 primary TKA (85 patients) (group B) had prior bone procedure [high tibial osteotomy (n = 64), tibial plateau fracture (n = 10) and patellar realignment (n = 11)], and third group of 146 primary TKA (146 patients) (group C) had undergone a soft tissue procedure [arthroscopy (n = 60) and menisectomy (n = 86)] before primary TKA. All the patients underwent a clinical and radiological evaluation as well as International Knee Society (IKS) scores.
Preoperatively, group B had 40 % of cases classified as stage IV knee arthritis (p < 0.02); while 57 % of cases in group A showed higher levels of knee malalignment (p = 0.001) and group C had lower BMI (p = 0.001). Intraoperative complications revealed no difference. Although group B had the poorest postoperative mean values of knee flexion, TKA procedure improved the preoperative mean values of knee flexion in all the study groups. The postoperative complications were more prevalent in group C (p < 0.001), while the percentage of revision TKA was similar for all study groups (p = 0.5). At 120-month follow-up, the Kaplan-Meier survival curve rates showed no difference (p = 0.29).
This study confirms that prior knee surgery could be considered a clinical condition predisposed to higher postoperative complication rate in primary TKA compared to the no prior surgery group. After analysing the three study groups, group C showed a higher rate of postoperative local complications and lower IKS knee scores, while the group B showed the poorest postoperative mean values of knee flexion as well as the need for extended surgical approach (TTO approach) was more prevalent in this study group. However, statistical analysis did not reveal a direct correlation between the type of prior knee surgery and TKA failures.
与膝关节软组织手术相比，膝关节周围的骨外科手术可能是一种更具创伤性的既往手术操作，并且可能导致不同的全膝关节置换术（TKA）术后结果。本研究的目的是分析两组患者（既往行骨外科手术和软组织手术的患者）与无既往手术组患者相比，在初次 TKA 术前的术后结果以及并发症和失败率。
对 1474 例初次 TKA 进行回顾性队列研究，随访时间至少为 2 年：1119 例初次 TKA 无既往手术（1119 例患者）（A 组），85 例初次 TKA（85 例患者）（B 组）行既往骨外科手术[高位胫骨截骨术（n=64）、胫骨平台骨折（n=10）和髌骨再排列术（n=11）]，第三组 146 例初次 TKA（146 例患者）（C 组）行软组织手术[关节镜检查（n=60）和半月板切除术（n=86）]。所有患者均进行临床和影像学评估以及国际膝关节学会（IKS）评分。
术前，B 组有 40%的病例为 IV 期膝关节关节炎（p＜0.02）；而 A 组有 57%的病例膝关节对线不良程度更高（p=0.001），C 组 BMI 更低（p=0.001）。术中并发症无差异。尽管 B 组术后膝关节屈曲的平均数值最差，但 TKA 手术改善了所有研究组的术前膝关节屈曲的平均数值。C 组术后并发症更为常见（p＜0.001），而所有研究组的 TKA 翻修率相似（p=0.5）。120 个月随访时，Kaplan-Meier 生存曲线率无差异（p=0.29）。
本研究证实，与无既往手术组相比，既往膝关节手术可能是一种导致初次 TKA 术后并发症发生率更高的临床状况。在分析三组研究后，C 组术后局部并发症发生率较高，IKS 膝关节评分较低，而 B 组术后膝关节屈曲的平均数值最差，且更需要广泛的手术入路（TTO 入路）。然而，统计学分析并未显示既往膝关节手术类型与 TKA 失败之间存在直接相关性。
