Texas Healthcare Bone & Joint Clinic, Fort Worth, Texas, USA.
Stanford University Medical Center, Palo Alto, California, USA.
J Arthroplasty. 2020 Jun;35(6S):S348-S351. doi: 10.1016/j.arth.2020.03.009. Epub 2020 Mar 13.
Stiffness after total knee arthroplasty (TKA) is a multifactorial complication involving patient, implant, surgical technique, and rehabilitation, occasionally necessitating manipulation under anesthesia (MUA) or revision. Few modern databases contain sufficient longitudinal information of all factors. We characterized MUA after primary TKA and identified independent risk factors for revision TKA after MUA from the American Joint Replacement Registry.
We retrospectively reviewed primary TKAs for American Joint Replacement Registry patients ≥65 years from January 1, 2012 to 31 March, 2019. We linked these to the Centers for Medicare and Medicaid Services database to identify MUA and revision TKA procedure codes. We compared groups with chi-squared testing, identifying independent risk factors for subsequent revision with binary logistic regression presented as odds ratios with 95% confidence intervals.
Of 664,604 primary TKAs, 3918 (0.6%) underwent MUA after a median of 2.0 ± 1.0 months. Revision surgery occurred in 131 (3.4%) MUA patients after a median of 9.0 months. Timing of MUA was not different between revision and no revision patients (P = .09). Patients undergoing MUA compared to no MUA were older (age 71.5 vs 70.7, P < .01), predominantly female (63.9% vs 61.2%, P < .01), current/former tobacco users (24.2% vs 13.3%, P < .01), with osteoarthritis diagnoses (98.0% vs 84.3%, P < .01). Independent risk factors for revision after MUA were male gender (1.56, 1.09-2.22).
The incidence of MUA after primary TKA is low (0.6%) in Medicare patients ≥65 years of age; 3.4% progress to revision after a median of 9 months. Being male was significantly associated with revision TKA after MUA.
全膝关节置换术后僵硬是一种多因素并发症，涉及患者、植入物、手术技术和康复等因素，有时需要在全身麻醉下进行手法松解（MUA）或翻修。很少有现代数据库包含所有因素的足够纵向信息。我们对初次 TKA 后的 MUA 进行了特征描述，并从美国关节置换登记处确定了 MUA 后行翻修 TKA 的独立危险因素。
我们回顾性分析了 2012 年 1 月 1 日至 2019 年 3 月 31 日期间美国关节置换登记处≥65 岁患者的初次 TKA。我们将这些数据与美国医疗保险和医疗补助服务中心数据库相关联，以识别 MUA 和翻修 TKA 手术代码。我们使用卡方检验比较了这些组，使用二元逻辑回归确定了后续翻修的独立危险因素，并以 95%置信区间的比值比表示。
在 664604 例初次 TKA 中，3918 例（0.6%）在中位数为 2.0±1.0 个月后接受了 MUA。在 131 例 MUA 患者中，有 131 例（3.4%）在中位数为 9.0 个月后进行了翻修手术。MUA 患者和未行 MUA 患者的 MUA 时机无差异（P=0.09）。与未行 MUA 的患者相比，行 MUA 的患者年龄更大（71.5 岁比 70.7 岁，P＜0.01），女性比例更高（63.9%比 61.2%，P＜0.01），当前/曾经吸烟（24.2%比 13.3%，P＜0.01），诊断为骨关节炎（98.0%比 84.3%，P＜0.01）。MUA 后行翻修的独立危险因素是男性（1.56，1.09-2.22）。
在 Medicare 年龄≥65 岁的患者中，初次 TKA 后行 MUA 的发生率较低（0.6%）；中位时间为 9 个月后，有 3.4%进展为翻修。男性是 MUA 后行翻修 TKA 的显著相关因素。
