Barton S B, McLauchlan G J, Canty S J
Department of Orthopaedic Surgery, Chorley District Hospital, Lancashire Teaching Hospitals NHS Trust, Preston, United Kingdom.
Department of Orthopaedic Surgery, Chorley District Hospital, Lancashire Teaching Hospitals NHS Trust, Preston, United Kingdom.
Knee. 2017 Mar;24(2):396-401. doi: 10.1016/j.knee.2016.12.003. Epub 2017 Jan 9.
Prior knee surgery and arthroscopy is known to increase complications and re-operations in subsequent total knee arthroplasty (TKA). We set out to examine the time dependant effect of arthroscopy on Patient Reported Outcome Measures following subsequent TKA.
A retrospective review of theatre and clinical records identified 186 patients who underwent TKA within a year of arthroscopy (2009-2013). Oxford knee score (OKS) data was compared with a published cohort from the same department (1708 patients).
One hundred and eighty six patients were identified who underwent TKA within a year of arthroscopy; 112 females, 74 males; mean age 64 (SD 10); mean BMI 31.4 (SD 4.6). There was no significant difference between groups with respect to sex, age, BMI, or pre-operative OKS. One hundred and three patients underwent TKA within six months of arthroscopy. This group had a significant reduction in OKS compared to the previously published cohort (32.8 vs 36.3, p<0.005). There was no significant difference in OKS when TKA was performed more than six months after arthroscopy (35.3). The re-operation rate was 14% in the arthroscopy group, with a revision rate of 3.8% vs 1.6% in a previously published large cohort from the same institution.
There appears to be a negative impact of arthroscopy in relation to subsequent TKA which seems to be time dependent. TKA should not routinely be performed within six months of arthroscopy. This should inform guidelines on the management knee osteoarthritis.
已知既往膝关节手术和关节镜检查会增加后续全膝关节置换术（TKA）的并发症和再次手术率。我们旨在研究关节镜检查对后续TKA后患者报告结局指标的时间依赖性影响。
对手术和临床记录进行回顾性分析，确定了186例在关节镜检查后一年内接受TKA的患者（2009 - 2013年）。将牛津膝关节评分（OKS）数据与同一科室发表的队列研究（1708例患者）进行比较。
确定了186例在关节镜检查后一年内接受TKA的患者；其中女性112例，男性74例；平均年龄64岁（标准差10）；平均体重指数31.4（标准差4.6）。两组在性别、年龄、体重指数或术前OKS方面无显著差异。103例患者在关节镜检查后6个月内接受了TKA。与先前发表的队列相比，该组的OKS显著降低（32.8对36.3，p<0.005）。在关节镜检查后6个月以上进行TKA时，OKS无显著差异（35.3）。关节镜检查组的再次手术率为14%，翻修率为3.8%，而同一机构先前发表的大型队列中的翻修率为1.6%。
关节镜检查似乎对后续TKA有负面影响，且这种影响似乎与时间有关。TKA不应在关节镜检查后6个月内常规进行。这应为膝关节骨关节炎的管理指南提供参考。
