FIFA Medical Center of Excellence, Orthopaedics Surgery and Sports Medicine Department, Croix-Rousse Hospital, Lyon France.
Melbourne Orthopaedic Group, Windsor, Victoria, Australia.
J Arthroplasty. 2020 Sep;35(9):2550-2560. doi: 10.1016/j.arth.2020.04.043. Epub 2020 Apr 21.
The aim of this study was to analyze why contemporary reintervention after total knee arthroplasty (RiTKA) fails.
Between January 2006 and December 2010, from a multicenter cohort of 1170 RiTKAs, we assessed all failures of RiTKA requiring additional surgery. All indications for the index reintervention were included. The minimum follow-up period was 3 years.
A total of 192 (16.4%) patients required additional surgery after RiTKA (re-reintervention). The mean follow-up period was 7.7 years. Mean age was 69.2 years. The mean time to re-reintervention was 9.6 months with 90.1% of rTKA failure occurring within the first two years. Infection was the main cause of new surgery after RiTKA (47.9%; n = 92/192). Other causes included extensor mechanism pathology (14.6%), stiffness (13.5%), pain (6.8%), aseptic loosening (5.2%), laxity (5.2%), periprosthetic fracture (3.6%), and wound pathology (3.1%). In four groups, the main indication for re-reintervention was recurrence of the pathology leading to the first reintervention: RiTKA for infection (59/355, 16.6%, P < .05), stiffness (18/174, 10.3%, P < .05), extensor mechanism failure (9/167, 5.4%, P < .05), and RiTKA for pain (4/137, 2.9%, P = .003). Global survival curve analysis found 87.9% survivorship without re-reintervention at one year and 83% at eight years.
Contemporary RiTKA failures mainly occur in the first two postoperative years. Infection is the main cause of failure in RiTKA. Recurrence of the initial pathology occurs in four groups of RiTKA and is the main indication for re-reintervention in these groups; infection (16.6%), stiffness (10.3%), extensor mechanism failure (5.4%), and pain (2.9%).
本研究旨在分析为什么当代全膝关节置换术后再次干预（RiTKA）会失败。
2006 年 1 月至 2010 年 12 月，我们对 1170 例接受 RiTKA 的多中心队列患者进行评估，所有需要进一步手术的 RiTKA 失败都被列入评估。所有的再次干预指征都包括在内。最小随访时间为 3 年。
共有 192 例（16.4%）患者在 RiTKA 后需要再次手术（再次干预）。平均随访时间为 7.7 年。平均年龄为 69.2 岁。再次干预的平均时间为 9.6 个月，90.1%的 rTKA 失败发生在最初两年内。感染是 RiTKA 后新手术的主要原因（47.9%；n=92/192）。其他原因包括伸肌机制病理（14.6%）、僵硬（13.5%）、疼痛（6.8%）、无菌性松动（5.2%）、松弛（5.2%）、假体周围骨折（3.6%）和伤口病理（3.1%）。在四个组中，再次干预的主要指征是导致第一次干预的病理复发：RiTKA 治疗感染（59/355，16.6%，P<.05）、僵硬（18/174，10.3%，P<.05）、伸肌机制失败（9/167，5.4%，P<.05）和 RiTKA 治疗疼痛（4/137，2.9%，P=0.003）。全生存曲线分析发现，1 年时无再次干预的生存率为 87.9%，8 年时为 83%。
当代 RiTKA 失败主要发生在术后的头两年。感染是 RiTKA 失败的主要原因。初始病理在四个 RiTKA 组中复发，是这些组再次干预的主要指征；感染（16.6%）、僵硬（10.3%）、伸肌机制失败（5.4%）和疼痛（2.9%）。
