Department of Orthopedics, Nijmegen, The Netherlands.
Department of Operating Rooms, Radboud University Medical Center, Nijmegen, The Netherlands.
J Arthroplasty. 2020 Jun;35(6):1671-1677. doi: 10.1016/j.arth.2020.01.053. Epub 2020 Jan 24.
There is limited information about long-term clinical outcomes following revision total knee arthroplasty (TKA) in relation to the indication for revision. Previously, a clear relation between indication for revision and clinical outcome was shown after 2 years. Present study evaluated (1) whether the reported association at 2 year remains present at 7.5 years, and (2) how clinical outcome at 7.5 years developed compared to baseline and 2-year follow-up, and (3) whether patients had additional adverse events.
A cohort of 129 patients with a total system revision TKA was selected. Range of motion, Visual Analog Scale for pain and satisfaction, and clinical and functional Knee Society Score were obtained preoperatively, at 3 months, 1, 2, and 7.5 years. Reasons for revision were septic loosening, aseptic loosening, malposition, instability, and severe stiffness.
Patients revised for severe stiffness had significantly worse outcomes. No difference was found between the other indications. The clinical outcome after revision TKA at 7.5 years remained stable for septic and aseptic loosening, malposition, and instability but deteriorated slightly for the severe stiffness group. Visual Analog Scale satisfaction remained constant for all indications. There were 11 additional complications between 2- and 7.5-year follow-up, 9 of which necessitated reoperation.
All indications except severe stiffness had a similar clinical outcome which was maintained up to 7.5-year follow-up. The severe stiffness group had worse outcomes and deteriorated slightly at longer follow-up. Outcome at 3 months seems predictive for long-term outcome. Additional complications did not differ significantly for the different reasons for revision.
Level III, prognostic study.
关于翻修全膝关节置换术（TKA）后的长期临床结果，与翻修的适应证相关的信息有限。此前，在术后 2 年已经显示了适应证与临床结果之间的明确关系。本研究评估了（1）2 年时报告的相关性在 7.5 年时是否仍然存在；（2）与基线和 2 年随访相比，7.5 年时的临床结果如何发展；（3）患者是否有其他不良事件。
选择了 129 例全系统翻修 TKA 患者的队列。在术前、术后 3 个月、1 个月、2 个月和 7.5 年时，获得了关节活动度、疼痛视觉模拟量表（VAS）和满意度，以及临床和功能膝关节协会评分。翻修的原因包括感染性松动、无菌性松动、位置不当、不稳定和严重僵硬。
因严重僵硬而翻修的患者结果明显较差。其他适应证之间没有差异。翻修 TKA 后 7.5 年的临床结果对感染性和无菌性松动、位置不当和不稳定仍然稳定，但严重僵硬组略有恶化。所有适应证的 VAS 满意度保持不变。在 2 年至 7.5 年随访期间，有 11 例出现了 11 例额外并发症，其中 9 例需要再次手术。
除严重僵硬外，所有适应证的临床结果相似，在 7.5 年随访时保持稳定。严重僵硬组的结果较差，在长期随访中略有恶化。3 个月时的结果似乎可以预测长期结果。不同翻修原因的并发症没有显著差异。
III 级，预后研究。
