Hamilton David F, Simpson Philip M, Patton James T, Howie Colin R, Burnett Richard
Department of Orthopaedics and Trauma, University of Edinburgh, Edinburgh, United Kingdom.
J Arthroplasty. 2017 Apr;32(4):1234-1240.e1. doi: 10.1016/j.arth.2016.10.028. Epub 2016 Oct 31.
Patient function is poorly characterized following revision total knee arthroplasty (TKA), although is generally accepted to be inferior to that following primary procedures.
Fifty-three consecutive aseptic revisions to total stabilizer devices were prospectively evaluated, preoperatively and at 6, 26, 52, and 104 weeks postoperatively, using the Oxford Knee Score (OKS), range of motion, pain rating scale, and timed functional performance battery. Data were assessed longitudinally and in comparison to primary TKA data with identical outcome assessments at equivalent time points.
Mean outcome changes were: 13 point increase in the OKS (from 17.5 [standard deviation-SD 7.4]-32.4 [SD 7.9] points); 21 degree improvement in the knee flexion (80.6 [SD 20.5]-101.5 [SD 13.2] degrees); 60% reduction in the pain report (7.7 [SD 2.3]-1.3 [SD 0.4] points); and 15 second improvement in the timed performance assessment (47.2 [SD 19.1]-32.0 [SD 7.0] seconds; P < .001). No difference was seen between primary and revision cohorts in OKS or pain scores (analysis of variance, P = .2 and .19). Knee flexion and timed performance assessment were different between primary and revision groups (analysis of variance, P = .03 and P = .02); however, this was due to differing preoperative values. The revision cohort achieved the same postoperative scores as the primary cohort at all postoperative time points.
Patients undergoing revision TKA for aseptic failure with total stabilizer implants made substantial improvements in the initial 2 years following surgery in both patient-reported and directly assessed function, comparable with that achieved following primary knee arthroplasty.
尽管一般认为翻修全膝关节置换术(TKA)后患者功能比初次手术差,但对其特征描述不足。
对53例连续的全稳定型假体无菌性翻修患者进行前瞻性评估,在术前以及术后6周、26周、52周和104周,使用牛津膝关节评分(OKS)、活动范围、疼痛评分量表和定时功能表现测试组。纵向评估数据,并与初次TKA数据进行比较,在相同时间点进行相同的结局评估。
平均结局变化为:OKS增加13分(从17.5[标准差-SD 7.4]分增至32.4[SD 7.9]分);膝关节屈曲改善21度(从80.6[SD 20.5]度增至101.5[SD 13.2]度);疼痛报告减少60%(从7.7[SD 2.3]分降至1.3[SD 0.4]分);定时表现评估改善15秒(从47.2[SD 19.1]秒降至32.0[SD 7.0]秒;P <.001)。初次手术组和翻修手术组在OKS或疼痛评分上无差异(方差分析,P =.2和.19)。初次手术组和翻修手术组在膝关节屈曲和定时表现评估方面存在差异(方差分析,P =.03和P =.02);然而,这是由于术前值不同。翻修手术组在所有术后时间点的术后评分与初次手术组相同。
因无菌性失败接受全稳定型假体翻修TKA的患者在术后最初2年,患者报告的功能和直接评估的功能均有显著改善,与初次膝关节置换术后相当。