单髁膝关节置换与全膝关节置换术后短期并发症的差异：倾向评分匹配分析。

Differences in short-term complications between unicompartmental and total knee arthroplasty: a propensity score matched analysis.

机构信息

Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 01008 JPP, Iowa City, IA 52242. E-mail address for: K.R. Duchman:

出版信息

J Bone Joint Surg Am. 2014 Aug 20;96(16):1387-94. doi: 10.2106/JBJS.M.01048.

DOI:10.2106/JBJS.M.01048

PMID:25143499

Abstract

BACKGROUND

Knee arthroplasty has emerged as an effective treatment for end-stage gonarthrosis. Although total knee arthroplasty remains the gold standard, unicompartmental knee arthroplasty is an appropriate alternative for select patients. We sought to use a large, heterogeneous national database to identify differences in thirty-day complication rates between unicompartmental and total knee arthroplasty as well as to identify risk factors for complications.

METHODS

Patients in the ACS NSQIP (American College of Surgeons National Surgical Quality Improvement Program) database who had undergone total or unicompartmental knee arthroplasty from 2005 to 2011 were identified. CPT (Current Procedural Terminology) codes were used to select cases of elective primary knee arthroplasty. Statistical models employing univariate and multivariate logistic regression identified risk factors associated with the thirty-day incidence of morbidity and mortality after total and unicompartmental knee arthroplasty. Propensity score matching addressed demographic differences between the total and unicompartmental knee arthroplasty cohorts.

RESULTS

A total of 29,333 patients were identified; 27,745 (94.6%) underwent total knee arthroplasty and 1588 (5.41%) underwent unicompartmental knee arthroplasty. Prior to matching, the total knee arthroplasty cohort was 63.7% female and had a mean BMI of 32.8 ± 7.3 kg/m(2), whereas the values for the unicompartmental cohort were 55.3% and 31.5 ± 6.5 kg/m(2) (p < 0.0001). The mean ages of these cohorts were 67.2 ± 10.1 and 64.0 ± 10.7 years, respectively (p < 0.0001). A previously developed and implemented propensity score matching algorithm was used to address the demographic differences. Following matching, the total complication rate did not differ significantly between the total and unicompartmental knee arthroplasty cohorts (5.29% compared with 4.16%, p = 0.35), whereas the rate of deep venous thrombosis (1.50% compared with 0.50%, p = 0.02) and the duration of hospital stay (3.4 compared with 2.2 days, p < 0.0001) were significantly higher in the total knee arthroplasty cohort.

CONCLUSIONS

Comparison of total and unicompartmental knee arthroplasty revealed no differences in overall short-term (thirty-day) morbidity and mortality. Although this study does not address long-term subjective outcomes or implant survival, these findings should provide helpful information for surgeons counseling patients considering total and/or unicompartmental knee arthroplasty.

LEVEL OF EVIDENCE

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

摘要

背景

膝关节置换术已成为治疗终末期膝关节炎的有效方法。尽管全膝关节置换术仍然是金标准，但单髁膝关节置换术是一种合适的选择，适用于特定的患者。我们试图使用大型、异质的国家数据库，确定单髁和全膝关节置换术 30 天并发症发生率的差异，并确定并发症的风险因素。

方法

在 ACS NSQIP（美国外科医师学会国家手术质量改进计划）数据库中，确定了 2005 年至 2011 年期间接受全膝关节置换术或单髁膝关节置换术的患者。使用 CPT（当前程序术语）代码选择择期原发性膝关节置换术的病例。使用单变量和多变量逻辑回归的统计模型确定了与全膝关节置换术和单髁膝关节置换术 30 天发病率和死亡率相关的风险因素。倾向评分匹配解决了全膝关节置换术和单髁膝关节置换术队列之间的人口统计学差异。

结果

共确定了 29333 例患者；27745 例（94.6%）接受了全膝关节置换术，1588 例（5.41%）接受了单髁膝关节置换术。在匹配之前，全膝关节置换术队列中女性占 63.7%，平均 BMI 为 32.8 ± 7.3kg/m²，而单髁膝关节置换术队列中的值为 55.3%和 31.5 ± 6.5kg/m²（p<0.0001）。这些队列的平均年龄分别为 67.2 ± 10.1 岁和 64.0 ± 10.7 岁（p<0.0001）。使用先前开发并实施的倾向评分匹配算法来解决人口统计学差异。匹配后，全膝关节置换术和单髁膝关节置换术队列的总并发症发生率无显著差异（5.29%比 4.16%，p=0.35），但深静脉血栓形成率（1.50%比 0.50%，p=0.02）和住院时间（3.4 比 2.2 天，p<0.0001）均显著更高。