Thiele Kathi, Perka Carsten, Matziolis Georg, Mayr Hermann Otto, Sostheim Michael, Hube Robert
Centrum für Muskuloskeletale Chirurgie Charite, Chariteplatz 1, 10117 Berlin, Germany. E-mail address for K. Thiele:
Waldkrankenhaus "Rudolf Elle," Klosterlausnitzer Straße 81, 07607 Eisenberg, Germany. E-mail address:
J Bone Joint Surg Am. 2015 May 6;97(9):715-20. doi: 10.2106/JBJS.M.01534.
The present study was designed to clarify which underlying indications can be currently considered the main reasons for failure after total knee arthroplasty as a function of time.
We conducted a retrospective study that included all first revisions of total knee replacements during 2005 to 2010 at two high-volume arthroplasty centers. A revision was defined as the replacement of at least one prosthetic component. In the descriptive analysis, polyethylene wear, aseptic loosening, periprosthetic infection, malalignment, instability, arthrofibrosis, extensor mechanism deficiency, periprosthetic fracture, and retropatellar arthritis were given as the failure mechanism associated with an early, intermediate, or late time interval (less than one year, one to three years, and more than three years, respectively) after the index total knee arthroplasty.
Three hundred and fifty-eight revision total knee arthroplasties were included. Of those revisions, 19.8% were performed within the first year after the index arthroplasty. The most common indications for revision, besides aseptic loosening (21.8%), were instability (21.8%), malalignment (20.7%), and periprosthetic infection (14.5%). Revisions due to polyethylene wear (7%) rarely occurred. In the early failure group, the primary causes of revision were periprosthetic infection (26.8%) and instability (23.9%). In the intermediate group, instability (23.3%) and malalignment (29.4%) required revision surgery, whereas late failure mechanisms were aseptic loosening (34.7%), instability (18.5%), and polyethylene wear (18.5%).
Aseptic loosening, instability, malalignment, and periprosthetic infection continue to be the primary failure mechanisms leading to revision surgery. Contrary to previous literature, the results in the present study showed a substantial reduction in implant-associated revisions such as those due to polyethylene wear. Failure mechanisms that occur persistently early and in the intermediate term, such as periprosthetic infection, instability, and malalignment, remain common causes of revision surgery.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
本研究旨在明确目前哪些潜在指征可被视为全膝关节置换术后不同时间段失败的主要原因。
我们进行了一项回顾性研究，纳入了2005年至2010年期间在两个大型关节置换中心进行的所有初次全膝关节置换翻修手术。翻修手术定义为至少更换一个假体组件。在描述性分析中，给出了聚乙烯磨损、无菌性松动、假体周围感染、对线不良、不稳定、关节纤维化、伸肌机制缺陷、假体周围骨折和髌后关节炎等与初次全膝关节置换术后早期、中期或晚期（分别为少于一年、一至三年和超过三年）相关的失败机制。
共纳入358例全膝关节置换翻修手术。其中，19.8%的翻修手术在初次关节置换术后第一年内进行。除无菌性松动（21.8%）外，最常见的翻修指征是不稳定（21.8%）、对线不良（20.7%）和假体周围感染（14.5%）。因聚乙烯磨损导致的翻修（7%）很少发生。在早期失败组中，翻修的主要原因是假体周围感染（26.8%）和不稳定（23.9%）。在中期组中，不稳定（23.3%）和对线不良（29.4%）需要翻修手术，而晚期失败机制是无菌性松动（34.7%）、不稳定（18.5%）和聚乙烯磨损（18.5%）。
无菌性松动、不稳定、对线不良和假体周围感染仍然是导致翻修手术的主要失败机制。与以往文献相反，本研究结果显示与植入物相关的翻修（如因聚乙烯磨损导致的翻修）大幅减少。早期和中期持续出现的失败机制，如假体周围感染、不稳定和对线不良，仍然是翻修手术的常见原因。
治疗性IV级。有关证据水平的完整描述，请参阅作者指南。
