全膝关节置换术后主要无菌性翻修：来自澳大利亚矫形协会全国关节置换登记处的 478081 例全膝关节置换术研究。
Major Aseptic Revision Following Total Knee Replacement: A Study of 478,081 Total Knee Replacements from the Australian Orthopaedic Association National Joint Replacement Registry.
机构信息
Department of Orthopaedics, Ipswich General Hospital, Ipswich, Queensland, Australia.
St Andrews Hospital, Ipswich, Queensland, Australia.
出版信息
J Bone Joint Surg Am. 2019 Feb 20;101(4):302-310. doi: 10.2106/JBJS.17.01528.
BACKGROUND
Major revision is associated with less satisfactory outcomes, substantial complications, and added cost. Data from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) were analyzed to identify factors associated with major aseptic revision (MAR) of primary total knee replacement (TKR).
METHODS
The cumulative percent major aseptic revision rate following all primary TKRs performed in Australia from September 1, 1999, to December 31, 2015, was assessed. Kaplan-Meier estimates of survivorship were utilized to describe the time to first revision. Hazard ratios (HRs) from Cox proportional hazard models, adjusted for age and sex, were utilized to compare revision rates.
RESULTS
There were 5,973 MARs recorded from the total cohort of 478,081 primary TKRs. The cumulative percent MAR at 15 years was 3.0% (95% confidence interval [CI], 2.8% to 3.2%). Fixed bearings had a significantly lower rate of MAR at 15 years: 2.7% (95% CI, 2.4% to 2.9%) compared with 4.1% (95% CI, 3.8% to 4.5%) for mobile bearings (HR, 1.77 [95% CI, 1.68 to 1.86]; p < 0.001). Age had a significant effect on MAR rates, with a cumulative percent revision at 15 years for patients <55 years old of 7.8% (95% CI, 6.5% to 9.2%) compared with 1.0% for those ≥75 years old (95% CI, 0.8% to 1.1%; p < 0.001). Minimally stabilized TKR had a lower rate of MAR compared with posterior-stabilized TKR after 2 years (HR, 0.83 [95% CI, 0.77 to 0.90]; p < 0.001). Cementless fixation had a higher rate of revision than cemented or hybrid fixation. There was a higher rate of MAR with non-navigated compared with computer navigated TKR (HR, 1.32 [95% CI, 1.21 to 1.44], p < 0.001). The tibial component was revised more commonly than the femoral component.
CONCLUSIONS
Younger age, posterior stabilization, cementless fixation, a mobile bearing, and non-navigation were risk factors for higher rates of MAR following TKR.
LEVEL OF EVIDENCE
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
背景
大翻修与不太满意的结果、严重并发症和增加的成本有关。对澳大利亚矫形协会国家关节置换登记处（AOANJRR）的数据进行了分析，以确定与原发性全膝关节置换术（TKR）的主要无菌性翻修（MAR）相关的因素。
方法
评估了 1999 年 9 月 1 日至 2015 年 12 月 31 日期间在澳大利亚进行的所有原发性 TKR 的主要无菌性翻修（MAR）的累积百分率。使用 Kaplan-Meier 估计生存率来描述首次翻修的时间。使用 Cox 比例风险模型调整年龄和性别后的风险比（HR）用于比较翻修率。
结果
从总计 478081 例原发性 TKR 中记录了 5973 例 MAR。15 年时 MAR 的累积百分比为 3.0%（95%置信区间[CI]，2.8%至 3.2%）。固定轴承的 MAR 15 年时的比率显著较低：2.7%（95%CI，2.4%至 2.9%），而活动轴承为 4.1%（95%CI，3.8%至 4.5%）（HR，1.77[95%CI，1.68 至 1.86]；p<0.001）。年龄对 MAR 率有显著影响，<55 岁患者的 15 年累积翻修率为 7.8%（95%CI，6.5%至 9.2%），而≥75 岁患者为 1.0%（95%CI，0.8%至 1.1%）（p<0.001）。与后稳定型 TKR 相比，稳定型 TKR 2 年后的 MAR 率较低（HR，0.83[95%CI，0.77 至 0.90]；p<0.001）。非骨水泥固定的翻修率高于骨水泥或混合固定。与计算机导航 TKR 相比，非导航 TKR 的 MAR 率更高（HR，1.32[95%CI，1.21 至 1.44]，p<0.001）。胫骨组件的翻修频率高于股骨组件。
结论
年龄较小、后稳定、非骨水泥固定、活动轴承和非导航是 TKR 后 MAR 发生率较高的危险因素。
证据水平
治疗性 3 级。请参阅作者说明以获取完整的证据水平描述。
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