分期双侧全膝关节置换术：增加并发症复发风险。

Staged Bilateral Total Knee Arthroplasty: Increased Risk of Recurring Complications.

机构信息

Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California.

University of California, San Francisco School of Medicine, San Francisco, California.

出版信息

J Bone Joint Surg Am. 2020 Feb 19;102(4):292-297. doi: 10.2106/JBJS.19.00243.

DOI:10.2106/JBJS.19.00243

PMID:31663926

Abstract

BACKGROUND

As the demand for knee arthroplasty increases, risk assessment and counseling are critical for optimal patient outcomes perioperatively. The purpose of this study was to determine if specific complications occurring after unilateral knee replacement predict the risk of recurrence after a staged replacement of the contralateral knee for patients with bilateral symptomatic disease.

METHODS

Linked, nationwide data from the U.S. Hospital Cost and Utilization Project from 2005 to 2014 were used to measure the occurrence of complications after the first and second procedures in staged bilateral total knee arthroplasties (TKAs). Odds ratios (ORs) and conditional probabilities were determined to assess whether having a specific complication after the first TKA increased the chance that the same complication occurred after the second procedure.

RESULTS

A total of 36,278 patients who underwent staged bilateral TKAs were analyzed. All complications occurring after the first arthroplasty were associated with both a significantly increased probability and odds of recurrence following the second arthroplasty. These included myocardial infarction (OR, 56.63 [95% confidence interval (CI), 18.04 to 155.44]; p < 0.001), ischemic stroke (OR, 41.38 [95% CI, 1.98 to 275.82]; p = 0.03), other cardiac complications (OR, 7.73 [95% CI, 4.24 to 14.11]; p < 0.001), respiratory complications (OR, 8.58 [95% CI, 2.85 to 23.17]; p = 0.002), urinary complications (OR, 11.19 [95% CI, 5.44 to 22.25]; p = 0.001), hematoma (OR, 15.05 [95% CI, 7.90 to 27.27]; p < 0.001), deep vein thrombosis (OR, 7.40 [95% CI, 5.37 to 10.08]; p < 0.001), and pulmonary embolism (OR, 11.00 [95% CI, 5.01 to 23.92]; p < 0.001).

CONCLUSIONS

Medical complications that occur postoperatively after TKA are associated with a significantly increased risk of recurrence of these complications after staged replacement of the contralateral knee. Although overall complication rates remain low, patients who develop these medical complications after the first replacement should be counseled on their increased risk profile prior to the contralateral surgical procedure.

LEVEL OF EVIDENCE

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

摘要

背景

随着膝关节置换手术需求的增加，围手术期的风险评估和咨询对于获得最佳的患者预后至关重要。本研究旨在确定单侧膝关节置换术后发生的特定并发症是否会预测双侧有症状疾病患者分期置换对侧膝关节后再次发生的风险。

方法

利用美国医院成本与利用项目 2005 年至 2014 年的全国性关联数据，测量分期双侧全膝关节置换术（TKA）中第一次和第二次手术后并发症的发生情况。计算比值比（OR）和条件概率，以评估第一次 TKA 后发生特定并发症是否会增加第二次手术后同一并发症发生的可能性。

结果

共分析了 36278 例分期双侧 TKA 患者。第一次关节置换术后发生的所有并发症均与第二次关节置换后复发的概率和几率显著增加相关。这些并发症包括心肌梗死（OR，56.63 [95%置信区间（CI），18.04 至 155.44]；p < 0.001）、缺血性中风（OR，41.38 [95% CI，1.98 至 275.82]；p = 0.03）、其他心脏并发症（OR，7.73 [95% CI，4.24 至 14.11]；p < 0.001）、呼吸并发症（OR，8.58 [95% CI，2.85 至 23.17]；p = 0.002）、尿并发症（OR，11.19 [95% CI，5.44 至 22.25]；p = 0.001）、血肿（OR，15.05 [95% CI，7.90 至 27.27]；p < 0.001）、深静脉血栓形成（OR，7.40 [95% CI，5.37 至 10.08]；p < 0.001）和肺栓塞（OR，11.00 [95% CI，5.01 至 23.92]；p < 0.001）。