Department of Orthopaedic Surgery, Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, New York.
Division of Adult Reconstruction and Joint Replacement, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York.
J Knee Surg. 2021 Aug;34(10):1126-1132. doi: 10.1055/s-0040-1701651. Epub 2020 Feb 19.
Recently, a variety of studies have analyzed the potential correlation between lumbar degenerative disease (LDD) and inferior clinical outcomes after total hip arthroplasty. However, there has been limited data concerning the role of LDD as a risk factor for failure after total knee arthroplasty (TKA). The aim of our study was to determine: (1) what is the association of LDDs with TKA failure (all-cause revision) within 2 years of index arthroplasty and (2) if patients with LDD and lumbar fusion are at increased risk of TKA revision within 2 years compared with LDD patients without fusion. Data were collected from the Humana insurance database using the PearlDiver database from 2007 to 2017. To assess aim 1, patients were stratified into two groups based on a prior history of LDD (International Classification of Diseases [ICD]-9 or -10 diagnostic codes). To analyze aim 2, patients within the LDD cohort were stratified based on the presence of lumbar fusion (lumbar fusion Current Procedural Terminology code). All-cause revision rate was 3.4% among LDD patients versus 2.4% of patients with non-LDD ( < 0.001) at 2 years. Following multivariate analysis, LDD patients were at increased risk of all-cause revision surgery at 2 years (odds ratio [OR]: 1.361; 95% confidence interval [CI]: 1.238-1.498; < 0.001) as well as aseptic loosening (OR: 1.533; 95% CI: 1.328-1.768; < 0.001), periprosthetic joint infection (OR: 1.245; 95% CI: 1.129-1.373; < 0.001), and periprosthetic fracture (OR: 1.521; 95% CI: 1.229-1.884; < 0.001). Among LDD patients, patients who have a lumbar fusion had an all-cause revision rate of 5.0%, compared with 3.2% among LDD with no lumbar fusion patients at 2 years ( = 0.021). Following multivariate analysis, lumbar fusion patients were at increased risk of all-cause revision surgery (OR: 1.402; 95% CI: 1.362-1.445; = 0.028), aseptic loosening (OR: 1.432; 95% CI: 1.376-1.489; = 0.042), and periprosthetic fracture (OR: 1.302; 95% CI: 1.218-1.392; = 0.037). Based on these findings, TKA candidates with preoperative LDD should be counseled that TKA outcome may be impaired by the coexistence of lumbar spine degenerative disease. This is Level III therapeutic study.
最近，各种研究分析了腰椎退行性疾病（LDD）与全髋关节置换术后临床结果较差之间的潜在相关性。然而，关于 LDD 作为全膝关节置换术（TKA）失败的危险因素的数据有限。我们的研究目的是确定：（1）LDD 与索引关节置换后 2 年内 TKA 失败（所有原因翻修）之间的关联；（2）与无融合的 LDD 患者相比，LDD 和腰椎融合的患者在 2 年内是否有更高的 TKA 翻修风险。数据来自 Humana 保险数据库，使用 PearlDiver 数据库从 2007 年到 2017 年。为了评估目标 1，根据先前的 LDD 病史（国际疾病分类 [ICD]-9 或 -10 诊断代码）将患者分为两组。为了分析目标 2，在 LDD 队列中，根据腰椎融合的存在（腰椎融合当前程序术语代码）对患者进行分层。在 LDD 患者中，所有原因的翻修率为 3.4%，而非 LDD 患者为 2.4%（<0.001），2 年后。在多变量分析后，LDD 患者在 2 年内所有原因翻修手术的风险增加（优势比[OR]：1.361；95%置信区间[CI]：1.238-1.498；<0.001），无菌性松动（OR：1.533；95%CI：1.328-1.768；<0.001），假体周围关节感染（OR：1.245；95%CI：1.129-1.373；<0.001），假体周围骨折（OR：1.521；95%CI：1.229-1.884；<0.001）。在 LDD 患者中，有腰椎融合的患者在 2 年内的所有原因翻修率为 5.0%，而无腰椎融合的 LDD 患者为 3.2%（=0.021）。在多变量分析后，腰椎融合患者所有原因翻修手术的风险增加（OR：1.402；95%CI：1.362-1.445；=0.028），无菌性松动（OR：1.432；95%CI：1.376-1.489；=0.042）和假体周围骨折（OR：1.302；95%CI：1.218-1.392；=0.037）。基于这些发现，术前患有 LDD 的 TKA 候选者应接受咨询，即 TKA 结果可能因腰椎退行性疾病的共存而受到影响。这是三级治疗研究。
