初次翻修全膝关节置换术中植入假体后生存率较低。
Poorer survival after a primary implant during revision total knee arthroplasty.
机构信息
Department of Orthopaedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
出版信息
Int Orthop. 2013 Mar;37(3):415-9. doi: 10.1007/s00264-012-1739-7. Epub 2012 Dec 21.
PURPOSE
Revision total knee arthroplasty (rTKA) is a complex procedure. Depending on the degree of ligament and bone damage, either primary or revision implants are used. The purpose of this study was to compare survival rates of primary implants with revision implants when used during rTKA.
METHODS
A retrospective comparative study was conducted between 1998 and 2009 during which 69 rTKAs were performed on 65 patients. Most common indications for revision were infection (30%), aseptic loosening (25%) and wear/osteolysis (25%). During rTKA, a primary implant was used in nine knees and a revision implant in 60.
RESULTS
Survival of primary implants was 100% at one year, 73% [95% confidence interval (CI) 41-100] at two years and 44% (95% CI 7-81) at five years. Survival of revision implants was 95% (95% CI 89-100) at one year, 92% (95% CI 84-99) at two years and 92% (95% CI 84-99) at five years. Primary implants had a significantly worse survival rate than revision implants when implanted during rTKA [P = 0.039 (hazard ratio = 4.56, 95% CI 1.08-19.27)].
CONCLUSIONS
Based on these results, it has to be considered whether primary implants are even an option during rTKA.
目的
翻修全膝关节置换术（rTKA）是一种复杂的手术。根据韧带和骨损伤的程度，可使用初次置换植入物或翻修植入物。本研究的目的是比较在 rTKA 中使用初次植入物和翻修植入物的生存率。
方法
在 1998 年至 2009 年期间进行了回顾性比较研究，在此期间对 65 例患者的 69 例 rTKA 进行了研究。翻修的最常见指征是感染（30%）、无菌性松动（25%）和磨损/骨溶解（25%）。在 rTKA 中，9 例膝关节使用初次植入物，60 例膝关节使用翻修植入物。
结果
初次植入物的 1 年生存率为 100%，2 年生存率为 73%（95%CI 41-100），5 年生存率为 44%（95%CI 7-81）。翻修植入物的 1 年生存率为 95%（95%CI 89-100），2 年生存率为 92%（95%CI 84-99），5 年生存率为 92%（95%CI 84-99）。初次植入物在 rTKA 中植入时的生存率明显低于翻修植入物[P=0.039（风险比=4.56，95%CI 1.08-19.27）]。
结论
基于这些结果，在 rTKA 中是否使用初次植入物甚至需要考虑。
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