Kotela Andrzej, Wilk-Frańczuk Magdalena, Żbikowski Piotr, Łęgosz Paweł, Ambroziak Paweł, Kotela Ireneusz
Department of Orthopaedics and Traumatology of the Musculoskeletal System, 1st Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland.
Department of Orthopaedic Surgery and Traumatology, Central Clinical Hospital of the Ministry of Interior, Warsaw, Poland.
Med Sci Monit. 2017 Jan 9;23:129-137. doi: 10.12659/msm.899580.
BACKGROUND The results of total knee arthroplasty (TKA) in patients with inherited bleeding disorders (IBDs) are poorer when compared with those in the general population, with a notably higher risk of complications and higher revision rates. Thus, revision procedures are becoming a growing concern in this group of patients. The aim of this study was to evaluate the results of revision TKA in patients with IBD. MATERIAL AND METHODS A retrospective cohort study with longitudinal assessment of hemophilia patients scheduled for revision TKA between January 2010 and September 2015 was performed. The clinical status of the patients was assessed based on the Knee Society Score, and the Numeric Rating Scale was used to assess knee pain severity and patient satisfaction with the surgery. Radiological examination, post-operative complications, and reinterventions were recorded and analyzed. RESULTS Very good results were obtained in all patients treated for aseptic loosening of the implant. However, inferior results were found in cases with infection. All patients operated on for aseptic loosening required only single-stage TKA, whereas patients with infection underwent multiple interventions. Complications were observed only in cases with infection. CONCLUSIONS Our study clearly outlined the differences in results based on failure mode, with far inferior results obtained in cases with infection. Given the lack of data in this area as well as the high specificity of this population, further high-quality studies are needed.
与普通人群相比，遗传性出血性疾病（IBD）患者全膝关节置换术（TKA）的结果较差，并发症风险显著更高，翻修率也更高。因此，翻修手术在这组患者中日益受到关注。本研究的目的是评估IBD患者TKA翻修的结果。
对2010年1月至2015年9月计划进行TKA翻修的血友病患者进行了一项纵向评估的回顾性队列研究。根据膝关节协会评分评估患者的临床状况，使用数字评分量表评估膝关节疼痛严重程度和患者对手术的满意度。记录并分析影像学检查、术后并发症和再次干预情况。
所有因植入物无菌性松动接受治疗的患者均取得了非常好的结果。然而，感染病例的结果较差。所有因无菌性松动接受手术的患者仅需进行一期TKA，而感染患者则接受了多次干预。仅在感染病例中观察到并发症。
我们的研究清楚地概述了基于失败模式的结果差异，感染病例的结果远差于其他情况。鉴于该领域缺乏数据以及该人群的高度特殊性，需要进一步开展高质量研究。
