Klasan Antonio, Magill Paul, Frampton Chris, Zhu Mark, Young Simon W
North Shore Hospital, 124 Shakespeare Road, Takapuna, Auckland, 0620, New Zealand.
Craigavon Area Hospital, Craigavon, Northern Ireland.
Knee Surg Sports Traumatol Arthrosc. 2021 Feb;29(2):579-585. doi: 10.1007/s00167-020-05985-8. Epub 2020 Apr 11.
The number of Revision TKAs performed continues to increase; however there is limited data on risk factors for failure. Additionally, clinical decisions regarding when and how to revise a failed TKA may be as important as the technical aspects of the procedure. The purpose of this study was to analyze factors predicting repeat revision following aseptic revision TKA.
Of 85,769 primary TKAs recorded on the New Zealand National Joint Registry, 1720 patients undergoing subsequent revision for aseptic indications between January 1999 and December 2015 were identified. Re-revision was recorded in 208 patients (12.1%). The analysis included demographic characteristics, surgeon revision case volume, surgical time, surgical ownership of index TKA as independent variables using logistic and linear regression. The primary outcome measure was incidence of subsequent re-revision and Oxford Knee Scores of revised TKAs (OKS). The secondary outcome measure was the influence of component exchange in major revisions on re-revision rate.
Younger patients undergoing a revision (HR 0.974) and male gender (HR 0.666) were predictors of re-revision. Elapsed time since index surgery (unstandardized coefficient 0.060) and lower ASA score (UC - 2.749) were significant predictors of OKS. Femoral component revision was a predictor of re-revision (HR 1.696) and had the lowest OKS, compared to tibial and all component revision (p = 0.003).
Repeat revision TKA is a rare and complex procedure influenced by a number of confounding factors. Using raw registry data, younger and male patients were found to be at a higher risk of re-revision after aseptic revision TKA. A longer time between primary TKA and revision was associated with better clinical outcomes. Isolated femoral component exchange led to worse outcomes both in terms of survivorship and functional scores.
III.
翻修全膝关节置换术（TKA）的数量持续增加；然而，关于失败风险因素的数据有限。此外，关于何时以及如何翻修失败的TKA的临床决策可能与手术的技术方面同样重要。本研究的目的是分析无菌性翻修TKA后再次翻修的预测因素。
在新西兰国家关节登记处记录的85769例初次TKA中，确定了1720例在1999年1月至2015年12月期间因无菌性指征接受后续翻修的患者。208例患者（12.1%）进行了再次翻修。分析包括人口统计学特征、外科医生翻修病例数量、手术时间、初次TKA的手术所属机构等自变量，采用逻辑回归和线性回归分析。主要结局指标是后续再次翻修的发生率以及翻修TKA的牛津膝关节评分（OKS）。次要结局指标是在主要翻修中组件更换对再次翻修率的影响。
接受翻修的年轻患者（风险比[HR]0.974）和男性（HR0.666）是再次翻修的预测因素。初次手术后的时间间隔（非标准化系数0.060）和较低的美国麻醉医师协会（ASA）评分（UC -2.749）是OKS的显著预测因素。与胫骨组件翻修和所有组件翻修相比，股骨组件翻修是再次翻修的预测因素（HR1.696），且OKS最低（p =0.003）。
重复翻修TKA是一种罕见且复杂的手术，受多种混杂因素影响。利用原始登记数据发现，年轻和男性患者在无菌性翻修TKA后再次翻修的风险较高。初次TKA与翻修之间的时间间隔较长与更好的临床结局相关。单纯股骨组件更换在生存率和功能评分方面均导致更差的结局。
III级
