Hip and Knee Surgery, Rizzoli Orthopedic Institute, Bologna, Italy.
Medical Technology Laboratory, Rizzoli Orthopedic Institute, Bologna, Italy.
J Arthroplasty. 2017 Nov;32(11):3368-3372. doi: 10.1016/j.arth.2017.05.052. Epub 2017 Jun 8.
The incidence of total knee replacements (TKRs) in young patients is increasing. Few reports described encouraging results and acceptable survival rates. However, many concerns still persist, in particular about the high rates of infection and aseptic loosening. Aim of this article was to investigate the survival of TKRs in patients aged 45 years or younger in a registry population.
The Emilia-Romagna registry RIPO was enquired about TKRs in patients ≤45 years; 238 TKRs were evaluated at a mean follow-up of 5.4 years (range 0-15.6 years), examining the features of the patients involved, the survival rate, and the reasons for revision of the knee implants.
The TKRs were generally performed in men, in private hospitals, and almost in half of the cases for other causes rather than primary osteoarthritis. The mean age was 40 years. Bicompartmental, cemented posterior-stabilized implants with fixed bearing were preferred. The survival rate was higher than 90% in the first 7 years, and then it decremented. The choice of implant did not apparently influence the survivorship. The final outcomes were acceptable, substantially in line with the previous literature about young patients. Twenty-one revisions occurred (8.8%), in particular 8 cases for aseptic loosening and 7 TKRs for infection. The rate of revision was higher than in overall population and even in some young cohorts.
TKRs in patients aged 45 years or younger seem a promising procedure, although the high rates of septic and aseptic loosening should be carefully evaluated. Prospective, well-designed studies are required to confirm and investigate these preliminary findings.
全膝关节置换术（TKR）在年轻患者中的发病率正在增加。少数报道描述了令人鼓舞的结果和可接受的生存率。然而，仍存在许多担忧，特别是感染和无菌性松动的高发生率。本文旨在研究注册人群中 45 岁或以下患者 TKR 的生存率。
询问 Emilia-Romagna 注册处 RIPO 有关 45 岁以下患者的 TKR；在平均 5.4 年（0-15.6 年）的随访中评估了 238 例 TKR，检查了所涉及患者的特征、生存率以及膝关节植入物翻修的原因。
TKR 通常在男性、私立医院进行，几乎一半的病例是其他原因而不是原发性骨关节炎。平均年龄为 40 岁。双间室、水泥固定后稳定型植入物、固定轴承是首选。在最初的 7 年内，生存率高于 90%，然后下降。植入物的选择显然不会影响生存率。最终结果是可以接受的，与之前关于年轻患者的文献基本一致。发生了 21 次翻修（8.8%），特别是 8 例因无菌性松动，7 例因感染而进行 TKR。翻修率高于总体人群，甚至高于某些年轻队列。
45 岁或以下患者的 TKR 似乎是一种有前途的手术，但应仔细评估感染和无菌性松动的高发生率。需要前瞻性、精心设计的研究来证实和研究这些初步发现。
