Mooney Luke, Lewis Peter L, Campbell David G, Peng Yi, Hatton Alesha
Wakefield Orthopaedic Clinic, Adelaide, South Australia, Australia.
Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), Adelaide, South Australia, Australia.
ANZ J Surg. 2019 Mar;89(3):184-190. doi: 10.1111/ans.15035. Epub 2019 Feb 15.
Total knee replacement (TKR) has been shown to perform differently in patients with rheumatoid arthritis (RA) when compared to osteoarthritis (OA). In this study, we compare the survivorship between these two groups and examine patient and prosthesis factors that impact the revision rate.
All RA and OA patients undergoing TKR in Australia from 1 September 1999 to 31 December 2016 were included. Revision rates were assessed using Kaplan-Meier estimates of survivorship. The cumulative percent revision analysed age, gender, prosthesis constraint and revision for infection.
There were 541 744 TKR procedures performed including 7542 patients with RA. RA declined as the primary diagnosis from 2.4% of all TKR in 2003 to 0.9% in 2016. Male sex was an independent revision risk in RA patients (hazard ratio (HR) = 1.66, P < 0.001) and OA patients (3.5 years+: HR = 1.09 (1.04-1.15), P < 0.001). Male RA patients had a higher revision rate for infection than females (HR = 3.14, P < 0.001). Females with RA had a lower cumulative percent revision compared to OA females, but males showed no difference between diagnoses. Revision in RA patients was not influenced by age. Compared to OA, RA patients had a decreased revision rate for those aged <65 years, but not for patients aged ≥65 years.
The rate of revision after TKR in RA patients is lower than those with OA, but patients with RA are at increased risk of infection, particularly the male group. Prosthesis constraint had no influence on revision rate. Mortality in those undergoing TKR with RA was higher than in those with OA.
与骨关节炎（OA）患者相比，全膝关节置换术（TKR）在类风湿关节炎（RA）患者中的表现有所不同。在本研究中，我们比较了这两组患者的假体生存率，并研究了影响翻修率的患者和假体因素。
纳入1999年9月1日至2016年12月31日在澳大利亚接受TKR的所有RA和OA患者。使用Kaplan-Meier生存率估计值评估翻修率。累积翻修百分比分析了年龄、性别、假体限制和感染翻修情况。
共进行了541744例TKR手术，其中包括7542例RA患者。RA作为主要诊断的比例从2003年所有TKR的2.4%下降至2016年的0.9%。男性是RA患者（风险比（HR）=1.66，P<0.001）和OA患者（3.5岁及以上：HR=1.09（1.04-1.15），P<0.001）翻修的独立风险因素。男性RA患者的感染翻修率高于女性（HR=3.14，P<0.001）。与OA女性相比，RA女性的累积翻修百分比更低，但男性在两种诊断之间无差异。RA患者的翻修不受年龄影响。与OA相比，RA患者年龄<65岁时翻修率降低，但年龄≥65岁的患者则不然。
RA患者TKR后的翻修率低于OA患者，但RA患者感染风险增加，尤其是男性群体。假体限制对翻修率无影响。接受TKR的RA患者死亡率高于OA患者。
