School of Medicine, University of Louisville, Louisville, Kentucky.
Orthopaedic Surgery, University of Louisville, Louisville, Kentucky.
J Knee Surg. 2020 Dec;33(12):1219-1224. doi: 10.1055/s-0039-1693415. Epub 2019 Jul 29.
The etiology of failure following primary total knee arthroplasty (TKA) leading to revision surgery are multifactorial, including infection, instability, loosening, contracture, and wear. Although the majority of patients have successful outcomes following revision TKA, postoperative complications are still increased in these patients when compared to primary patients. For this reason, there has been a continued search to identify options, including prosthesis types, to potentially improve outcomes. Therefore, the purpose of this study was to determine if the clinical results achieved following revision TKA are comparatively similar to primaries using the same implant design. Specifically, we compared (1) Knee Society Functional and Range-of-Motion Knee Scores and (2) component survivorship. This was a retrospective analysis of 100 patients undergoing revision TKA due to an aseptic etiology, who were matched to a cohort of 100 patients who underwent primaries with the same prosthesis. There were no differences in the groups with respect to age at surgery, sex, and body mass index. The mean follow-up was 57 months in the revision group (range 24-105 months) and 67 months in the primary TKA group (range 55-123 months). American Knee Society Scores (KSS) and range of motion measurements recorded preoperatively and at the most recent postoperative visit were compared between both cohorts in order to compare postoperative outcomes. A p value of 0.05 was used for significance. The average improvement between the pre- and postoperative KSS function scores in both groups was similar, with both cohorts demonstrating a 28-point improvement. At 2-year follow-up, all-cause survivorship of the aseptic revision surgeries was 87%. Patients undergoing revision TKA for aseptic loosening can potentially expect similar improvements in clinical function scores and survivorship compared to primary TKA when controlling for implant type.
初次全膝关节置换术（TKA）后导致翻修手术的失败病因是多因素的，包括感染、不稳定、松动、挛缩和磨损。尽管大多数患者在接受翻修 TKA 后都有良好的结果，但与初次患者相比，这些患者的术后并发症仍然增加。因此，人们一直在寻找选择，包括假体类型，以潜在地改善结果。因此，本研究的目的是确定在使用相同假体设计的情况下，翻修 TKA 后的临床结果是否与初次 TKA 相比相似。具体来说，我们比较了（1）膝关节学会功能和活动范围评分和（2）组件存活率。这是一项对 100 例因无菌病因接受翻修 TKA 的患者的回顾性分析，这些患者与 100 例接受相同假体的初次 TKA 的患者相匹配。在手术时的年龄、性别和体重指数方面，两组没有差异。翻修组的平均随访时间为 57 个月（范围 24-105 个月），初次 TKA 组为 67 个月（范围 55-123 个月）。为了比较术后结果，比较了两组患者术前和最近一次术后的美国膝关节学会评分（KSS）和活动范围测量值。使用 0.05 的 p 值表示显著性。两组患者术前和术后 KSS 功能评分的平均改善相似，两组患者的改善均为 28 分。在 2 年的随访中，无菌翻修手术的总生存率为 87%。对于无菌性松动的翻修 TKA 患者，在控制假体类型的情况下，他们可能会期望在临床功能评分和存活率方面获得类似的改善。
