University of Maryland Medical Center, Baltimore, Maryland, USA.
Orthopaedic Associates, Towson, Maryland, USA.
Bone Joint J. 2020 Jun;102-B(6_Supple_A):96-100. doi: 10.1302/0301-620X.102B6.BJJ-2019-1674.R1.
Enhanced perioperative protocols have significantly improved patient recovery following primary total knee arthroplasty (TKA). Little has been investigated the effectiveness of these protocols for revision TKA (RTKA). We report on a matched group of aseptic revision and primary TKA patients treated with an identical pain and rehabilitation programmes.
Overall, 40 aseptic full-component RTKA patients were matched (surgical date, age, sex, and body mass index (BMI)) to a group of primary cemented TKA patients. All RTKAs had new uncemented stemmed femoral and tibial components with metaphyseal sleeves. Both groups were treated with an identical postoperative pain protocol. Patients were followed for at least two years. Knee Society Scores (KSS) at six weeks and at final follow-up were recorded for both groups.
There was no difference in mean length of stay between the primary TKA (1.2 days (0.83 to 2.08)) and RTKA patients (1.4 days (0.91 to 2.08). Mean oral morphine milligram (mg) equivalent dosing (MED) during the hospitalization was 42 mg/day for the primary TKA and 38 mg/day for the RTKA groups. There were two readmissions: gastrointestinal disturbance (RTKA) and urinary retention (primary TKA). There no were reoperations, wound problems, thromboembolic events or manipulations in either group. Mean overall KSS for the RTKA group was 87.3 (45 to 99) at six-week follow-up and 89.1 (52 to 100) at final follow-up (mean 3.9 years, (3.9 to 9.0)). Mean overall KSS for the primary group was 89.9 (71 to 100) at six-week follow-up and 93.42 (73 to 100) at final follow-up (mean 3.5 years (2.5 to 9.2)).
An identical pain and rehabilitation protocol used for primary TKA patients can enable certain full-component aseptic RTKA patients to have a similar early functional outcome. Cite this article: 2020;102-B(6 Supple A):96-100.
增强的围手术期方案显著改善了初次全膝关节置换术（TKA）后的患者康复情况。对于翻修 TKA（RTKA），这些方案的效果研究甚少。我们报告了一组接受相同疼痛和康复方案治疗的无菌翻修和初次 TKA 患者的匹配组。
总体而言，40 例无菌全关节置换 RTKA 患者与初次水泥固定 TKA 患者进行了匹配（手术日期、年龄、性别和体重指数（BMI））。所有 RTKA 均采用新的非骨水泥固定股骨和胫骨组件以及干骺端套管。两组均采用相同的术后疼痛方案进行治疗。至少随访 2 年。记录两组患者术后 6 周和最终随访时的膝关节学会评分（KSS）。
初次 TKA（1.2 天（0.83 至 2.08））和 RTKA 患者的平均住院时间无差异（1.4 天（0.91 至 2.08））。初次 TKA 患者的平均口服吗啡毫克当量剂量（MED）为 42mg/天，RTKA 患者为 38mg/天。两组均有 2 例再入院：胃肠道紊乱（RTKA）和尿潴留（初次 TKA）。两组均无再次手术、伤口问题、血栓栓塞事件或翻修。RTKA 组的平均整体 KSS 为 87.3（45 至 99），最终随访时为 89.1（52 至 100）（平均 3.9 年（3.9 至 9.0））。初次 TKA 组的平均整体 KSS 在术后 6 周时为 89.9（71 至 100），在最终随访时为 93.42（73 至 100）（平均 3.5 年（2.5 至 9.2））。
用于初次 TKA 患者的相同疼痛和康复方案可以使某些全关节置换无菌 RTKA 患者获得类似的早期功能结果。
