Department of orthopaedic surgery, college of Medicine, Kyung Hee university, 26, Kyunghee-daero, Dongdaemun-gu, Seoul 130-701, Republic of Korea.
Department of orthopaedic surgery, college of Medicine, Kyung Hee university, 26, Kyunghee-daero, Dongdaemun-gu, Seoul 130-701, Republic of Korea.
Orthop Traumatol Surg Res. 2018 Apr;104(2):171-176. doi: 10.1016/j.otsr.2017.10.003. Epub 2017 Oct 12.
Cognizance of common reasons for failure in primary and revision TKA, together with their time course, facilitates prevention. However, there have been few reports specifically comparing modes of failure for primary vs. revision TKA using a single prosthesis. The goal of the study was to compare the survival rates, modes of failure, and time periods associated with each mode of failure, of primary vs. revision TKA.
The survival rates, modes of failure, time period for each mode of failure, and risk factors would differ between primary and revision TKA.
Data from a consecutive cohort comprising 1606 knees (1174 patients) of primary TKA patients, and 258 knees (224 patients) of revision TKA patients, in all of whom surgery involved a P.F.C prosthesis (Depuy, Johnson & Johnson, Warsaw, IN), was retrospectively reviewed. The mean follow-up periods of primary and revision TKAs were 9.2 and 9.8 years, respectively.
The average 10- and 15-year survival rates for primary TKA were 96.7% (CI 95%,±0.7%) and 85.4% (CI 95%,±2.0%), and for revision TKA 91.4% (CI 95%,±2.5%) and 80.5% (CI 95%,±4.5%). Common modes of failure included polyethylene wear, loosening, and infection. The most common mode of failure was polyethylene wear in primary TKA, and infection in revision TKA. The mean periods (i.e., latencies) of polyethylene wear and loosening did not differ between primary and revision TKAs, but the mean period of infection was significantly longer for revision TKA (1.2 vs. 4.8 years, P=0.003).
Survival rates decreased with time, particularly more than 10 years post-surgery, for both primary and revision TKAs. Continuous efforts are required to prevent and detect the various modes of failure during long-term follow-up. Greater attention is necessary to detect late infection-induced failure following revision TKA.
Case-control study, Level III.
认识初次全膝关节置换术和翻修全膝关节置换术失败的常见原因及其发生时间有助于预防失败。然而，使用单一假体比较初次全膝关节置换术和翻修全膝关节置换术失败模式的报道很少。本研究的目的是比较初次全膝关节置换术和翻修全膝关节置换术的生存率、失败模式以及每种失败模式的时间阶段，分析两者之间的差异。
初次全膝关节置换术和翻修全膝关节置换术的生存率、失败模式、每种失败模式的时间阶段以及风险因素会有所不同。
回顾性分析了连续队列中 1606 例（1174 例患者）初次全膝关节置换术患者和 258 例（224 例患者）翻修全膝关节置换术患者的数据，所有患者均接受 P.F.C 假体（Depuy，Johnson & Johnson，Warsaw，IN）手术。初次全膝关节置换术和翻修全膝关节置换术的平均随访时间分别为 9.2 年和 9.8 年。
初次全膝关节置换术的 10 年和 15 年平均生存率分别为 96.7%（95%CI，±0.7%）和 85.4%（95%CI，±2.0%），翻修全膝关节置换术的 10 年和 15 年平均生存率分别为 91.4%（95%CI，±2.5%）和 80.5%（95%CI，±4.5%）。常见的失败模式包括聚乙烯磨损、松动和感染。初次全膝关节置换术最常见的失败模式是聚乙烯磨损，而翻修全膝关节置换术最常见的失败模式是感染。初次全膝关节置换术和翻修全膝关节置换术的聚乙烯磨损和松动的平均时间（潜伏期）没有差异，但感染的平均时间明显更长，分别为 1.2 年和 4.8 年（P=0.003）。
初次全膝关节置换术和翻修全膝关节置换术的生存率随时间的推移而下降，尤其是术后 10 年以上。需要在长期随访中持续努力预防和发现各种失败模式。在翻修全膝关节置换术后，需要更加注意检测迟发性感染引起的失败。
病例对照研究，III 级。
