Sint Maartenskliniek, Nijmegen, The Netherlands.
Clin Orthop Relat Res. 2013 Jul;471(7):2296-302. doi: 10.1007/s11999-013-2940-8. Epub 2013 Mar 30.
There is limited knowledge regarding the relationship between the reason for revising a TKA and the clinical outcome in terms of satisfaction, pain, and function with time.
QUESTIONS/PURPOSES: In a cohort of patients receiving a fully revised TKA, we hypothesized (1) outcomes would differ according to reason for revision at 2 years, (2) outcomes would improve gradually during those 2 years, (3) rates of complications differ depending on the reason for revision, and (4) patients with complications have lower scores.
We studied a prospective cohort of 150 patients receiving a fully revised TKA using a single implant system in two high-volume centers at 24 months of followup. VAS satisfaction, VAS pain, The Knee Society Scoring System(©) (KSS) clinical and functional scores, and complication rate were correlated with their reasons for revision, including septic loosening, aseptic loosening, component malposition, instability, and stiffness.
The aseptic loosening group showed better outcomes compared with the instability, malposition, and septic loosening groups, which showed intermediate results (p < 0.05). The stiffness group performed significantly worse on all outcome measures. The outcome for patients with a complication, after treatment of the complication, was less favorable.
The reason for revision TKA predicts clinical outcomes. Satisfaction, pain reduction, and functional improvement are better and complication rates are lower after revision TKA for aseptic loosening than for other causes of failure. For component malposition, instability, and septic loosening groups, there may be more pain and a higher complication rate. For stiffness, the outcomes are less favorable in all scores.
Level III, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
关于初次全膝关节置换术（TKA）翻修的原因与术后满意度、疼痛和功能等方面的临床结果之间的关系，目前我们的认知还很有限。
问题/目的：在一组接受全膝关节翻修术的患者中，我们假设：(1)翻修的原因不同，术后 2 年的结果也会不同；(2)术后 2 年内结果会逐渐改善；(3)并发症的发生率取决于翻修的原因；(4)出现并发症的患者评分较低。
我们对在两家高容量中心接受同一植入物系统全膝关节翻修术的 150 例患者进行前瞻性队列研究，随访 24 个月。采用视觉模拟评分法（VAS）评估满意度、疼痛、膝关节学会评分系统（KSS）临床评分和功能评分，同时记录并发症发生率，并与翻修原因（包括感染性松动、无菌性松动、假体位置不当、不稳定和僵硬）相关联。
与不稳定、假体位置不当和感染性松动组相比，无菌性松动组的结果更好，而不稳定、假体位置不当和感染性松动组的结果居中（p<0.05）。僵硬组在所有结果测量中表现明显较差。并发症治疗后，出现并发症的患者的结果更不理想。
初次 TKA 翻修的原因可以预测临床结果。与其他失败原因相比，无菌性松动导致的 TKA 翻修后，患者满意度更高，疼痛减轻，功能改善，并发症发生率更低。对于假体位置不当、不稳定和感染性松动组，可能会有更多的疼痛和更高的并发症发生率。对于僵硬组，所有评分的结果都不理想。
III 级，预后研究。有关证据水平的完整描述，请参见作者指南。
