Gwam Chukwuweike U, George Nicole E, Etcheson Jennifer I, Rosas Samuel, Plate Johannes F, Delanois Ronald E
Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland.
Department of Orthopaedic Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina.
J Knee Surg. 2019 Nov;32(11):1081-1087. doi: 10.1055/s-0038-1675413. Epub 2018 Nov 5.
Cemented fixation has been the gold standard in total knee arthroplasty (TKA). However, with younger and more active patients requiring TKA, cementless (press-fit) fixation has sparked renewed interest. Therefore, we investigated differences in (1) patient demographics, (2) inpatient costs, (3) short-term complications, and (4) discharge disposition between patients who underwent TKA with cemented and cementless fixation. The National Inpatient Sample database was queried for TKA patients with cement or cementless fixation between October 1 and December 31, 2015. Primary outcomes of interest included complications, length of stay (LOS), discharge disposition, and inpatient costs. Student's -test and chi-square analysis were used to assess continuous and categorical data, respectively. Multivariable analysis evaluated the effects of fixation type on the continuous and categorical dependent variables. Patients who received cementless fixation were more often younger (63.5 vs. 65.9 years), male (47.4 vs. 40.3%), Black (10.7 vs. 7.7%), from the Northeast census region (29.1 vs. 17.1%), and under private insurance (49.2 vs. 40.3%; < 0.001 for all). Cementless fixation involved higher inpatient hospital costs (US$17,357 vs. US$16,888) and charges (US$67,366 vs. US$64,190; < 0.001 for both), lower mean LOS (2.63 vs. 2.71 days; < 0.001), and higher odds of being discharged to home (odds ratio = 1.99; = 0.002). This study revisited the outcomes of TKA with cementless fixation and demonstrated higher inpatient charges and costs, shorter mean LOS, and higher odds of being discharged home. Future studies should investigate patient outcomes and complications past the inpatient period, evaluate long-term survivorship and failure rates, and implement a prospective study design.
骨水泥固定一直是全膝关节置换术（TKA）的金标准。然而，随着越来越多年轻且活动量较大的患者需要进行TKA，非骨水泥（压配式）固定引发了新的关注。因此，我们调查了接受骨水泥固定和非骨水泥固定的TKA患者在以下方面的差异：（1）患者人口统计学特征，（2）住院费用，（3）短期并发症，以及（4）出院处置情况。我们查询了国家住院患者样本数据库中2015年10月1日至12月31日期间接受骨水泥或非骨水泥固定的TKA患者。感兴趣的主要结局包括并发症、住院时间（LOS）、出院处置情况和住院费用。分别使用学生t检验和卡方分析来评估连续数据和分类数据。多变量分析评估了固定类型对连续和分类因变量的影响。接受非骨水泥固定的患者更常为年轻人（63.5岁对65.9岁）、男性（47.4%对40.3%）、黑人（10.7%对7.7%）、来自东北人口普查地区（29.1%对17.1%），且拥有私人保险（49.2%对40.3%；所有比较均P<0.001）。非骨水泥固定涉及更高的住院费用（17357美元对16888美元）和收费（67366美元对64190美元；两者均P<0.001）、更低的平均住院时间（2.63天对2.71天；P<0.001），以及更高的回家出院几率（比值比=1.99；P=0.002）。本研究重新审视了非骨水泥固定TKA的结局，表明住院收费和费用更高、平均住院时间更短，以及回家出院几率更高。未来的研究应调查住院期过后的患者结局和并发症，评估长期生存率和失败率，并采用前瞻性研究设计。
