索引肩、髋或膝关节置换术后对侧或不同关节后续关节置换术的风险：与索引关节、人口统计学和患者特定因素的关联。
Risk of Subsequent Joint Arthroplasty in Contralateral or Different Joint After Index Shoulder, Hip, or Knee Arthroplasty: Association with Index Joint, Demographics, and Patient-Specific Factors.
机构信息
Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri.
Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY.
出版信息
J Bone Joint Surg Am. 2018 Oct 17;100(20):1750-1756. doi: 10.2106/JBJS.17.00948.
BACKGROUND
The risk of subsequent joint replacement following an index joint replacement for osteoarthritis and the association of this risk with demographic and patient-specific factors are not well understood. The purpose of this study was to determine how demographic and other patient-specific factors are associated with the risk of subsequent joint replacement in the contralateral or a different joint following an index joint replacement for osteoarthritis.
METHODS
The Healthcare Cost and Utilization Project (HCUP) State Inpatient Database (SID) of New York was used to identify the first (primary) total hip arthroplasty (THA), total knee arthroplasty (TKA), or total shoulder arthroplasty (TSA) and the risk of subsequent joint replacement in the contralateral or a different joint over 5 to 8 years. The association of demographic and other patient-specific factors with subsequent joint replacement was assessed via multivariable Cox proportional hazards modeling. We also investigated the time between the index and subsequent joint replacement.
RESULTS
Of 85,616 patients, 20,223 (23.6%) underwent a subsequent replacement of the contralateral joint within 5 to 8 years (median, 343 days) after the index joint replacement. The strongest predictors were obesity (adjusted hazard ratio [HR] = 1.28; p < 0.001) and index TKA compared with THA (1.72; p < 0.001). A total of 3,197 patients (3.7%) underwent a subsequent replacement of a different joint within 5 to 8 years (median, 876 days) after the index joint replacement. The strongest predictors were obesity (adjusted HR = 1.41; p < 0.001) and index TSA compared with THA (adjusted HR = 2.52; p < 0.001).
CONCLUSIONS
There is a relatively high risk of subsequent replacement of the contralateral joint and a relatively low risk of subsequent replacement of a different joint within 5 to 8 years after an index THA, TKA, or TSA. Obesity was associated with a higher risk of subsequent replacement of the contralateral joint or a different joint.
LEVEL OF EVIDENCE
Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
背景
对于因骨关节炎而进行初次关节置换的患者，其随后进行关节置换的风险以及该风险与人口统计学和患者特定因素的关联尚不清楚。本研究的目的是确定人口统计学和其他患者特定因素与初次因骨关节炎进行关节置换后的 5 至 8 年内对另一侧或不同关节进行后续关节置换的风险之间的关联。
方法
使用医疗保健成本和利用项目（HCUP）纽约州住院患者数据库（SID）来确定初次（原发性）全髋关节置换术（THA）、全膝关节置换术（TKA）或全肩关节置换术（TSA），并在 5 至 8 年内对另一侧或不同关节进行后续关节置换的风险。通过多变量 Cox 比例风险模型评估人口统计学和其他患者特定因素与后续关节置换的关联。我们还研究了指数关节置换与随后的关节置换之间的时间间隔。
结果
在 85616 名患者中，有 20223 名（23.6%）在初次关节置换后 5 至 8 年内（中位数为 343 天）对另一侧关节进行了后续置换。最强的预测因素是肥胖（校正风险比 [HR] = 1.28；p < 0.001）和与 THA 相比的指数 TKA（1.72；p < 0.001）。共有 3197 名患者（3.7%）在初次关节置换后 5 至 8 年内（中位数为 876 天）对不同关节进行了后续置换。最强的预测因素是肥胖（校正 HR = 1.41；p < 0.001）和与 THA 相比的指数 TSA（校正 HR = 2.52；p < 0.001）。
结论
初次 THA、TKA 或 TSA 后 5 至 8 年内，对另一侧关节进行后续置换的风险相对较高，对不同关节进行后续置换的风险相对较低。肥胖与对另一侧关节或不同关节进行后续置换的风险增加有关。
证据水平
预后 IV 级。请参阅作者说明，以获取完整的证据水平描述。
Zotero 插件