全膝关节置换术的计算机导航降低了65岁以下患者的翻修率。

Computer navigation for total knee arthroplasty reduces revision rate for patients less than sixty-five years of age.

作者信息

de Steiger Richard N, Liu Yen-Liang, Graves Stephen E

机构信息

Australian Orthopaedic Association National Joint Replacement Registry, School of Population Health and Clinical Practice, University of Adelaide, MDP DX650 511, Adelaide, SA 5005, Australia. E-mail address for R.N. de Steiger:

Data Management and Analysis Centre, University of Adelaide, MDP DX650 511, Adelaide, SA 5005, Australia.

出版信息

J Bone Joint Surg Am. 2015 Apr 15;97(8):635-42. doi: 10.2106/JBJS.M.01496.

DOI:10.2106/JBJS.M.01496

PMID:25878307

Abstract

BACKGROUND

Computer navigation for total knee arthroplasty has improved alignment compared with that resulting from non-navigated total knee arthroplasty. This study analyzed data from the Australian Orthopaedic Association National Joint Replacement Registry to examine the effect of computer navigation on the rate of revision of primary total knee arthroplasty.

METHODS

The cumulative percent revision following all non-navigated and navigated primary total knee arthroplasties performed in Australia from January 1, 2003, to December 31, 2012, was assessed. In addition, the type of and reason for revision as well as the effect of age, surgeon volume, and use of cement for the prosthesis were examined. Kaplan-Meier estimates of survivorship were used to describe the time to first revision. Hazard ratios (HRs) from Cox proportional hazards models, with adjustment for age and sex, were used to compare revision rates.

RESULTS

Computer navigation was used in 44,573 (14.1% of all) primary total knee arthroplasties, and the rate of its use increased from 2.4% in 2003 to 22.8% in 2012. Overall, the cumulative percent revision following non-navigated total knee arthroplasty at nine years was 5.2% (95% confidence interval [CI] = 5.1 to 5.4) compared with 4.6% (95% CI = 4.2 to 5.1) for computer-navigated total knee arthroplasty (HR = 1.05 [95% CI = 0.98 to 1.12], p = 0.15). There was a significant difference in the rate of revision following non-navigated total knee arthroplasty compared with that following navigated total knee arthroplasty for younger patients (HR = 1.13 [95% CI = 1.03 to 1.25], p = 0.011). Patients less than sixty-five years of age who had undergone non-navigated total knee arthroplasty had a cumulative percent revision of 7.8% (95% CI = 7.5 to 8.2) at nine years compared with 6.3% (95% CI = 5.5 to 7.3) for those who had undergone navigated total knee arthroplasty. Computer navigation led to a significant reduction in the rate of revision due to loosening/lysis (HR = 1.38 [95% CI = 1.13 to 1.67], p = 0.001), which is the most common reason for revision of total knee arthroplasty.

CONCLUSIONS

Computer navigation reduced the overall rate of revision and the rate revision for loosening/lysis following total knee arthroplasty in patients less than sixty-five years of age.

摘要

背景

与非计算机导航全膝关节置换术相比，计算机导航全膝关节置换术改善了对线情况。本研究分析了澳大利亚骨科协会国家关节置换登记处的数据，以检验计算机导航对初次全膝关节置换术翻修率的影响。

方法

评估了2003年1月1日至2012年12月31日在澳大利亚进行的所有非计算机导航和计算机导航初次全膝关节置换术后的累积翻修百分比。此外，还检查了翻修的类型和原因以及年龄、外科医生手术量和假体使用骨水泥的影响。采用Kaplan-Meier生存估计来描述首次翻修的时间。来自Cox比例风险模型的风险比（HRs），经年龄和性别调整后，用于比较翻修率。

结果

44573例（占所有初次全膝关节置换术的14.1%）初次全膝关节置换术使用了计算机导航，其使用率从2003年的2.4%增至2012年的22.8%。总体而言，非计算机导航全膝关节置换术9年后的累积翻修百分比为5.2%（95%置信区间[CI]=5.1至5.4），而计算机导航全膝关节置换术为4.6%（95%CI=4.2至5.1）（HR=1.05[95%CI=0.98至1.12]，p=0.15）。对于年轻患者，非计算机导航全膝关节置换术的翻修率与计算机导航全膝关节置换术相比存在显著差异（HR=1.13[95%CI=1.03至1.25]，p=0.011）。65岁以下接受非计算机导航全膝关节置换术的患者9年后的累积翻修百分比为7.8%（95%CI=7.5至8.2），而接受计算机导航全膝关节置换术的患者为6.3%（95%CI=5.5至7.3）。计算机导航使因松动/溶解导致的翻修率显著降低（HR=1.38[95%CI=1.13至1.67]，p=0.001），而松动/溶解是全膝关节置换术最常见的翻修原因。