Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN.
J Arthroplasty. 2020 Nov;35(11):3161-3165. doi: 10.1016/j.arth.2020.06.033. Epub 2020 Jun 17.
Ankylosing spondylitis (AS) is a seronegative spondyloarthropathy affecting the axial spine and peripheral joints. Despite innovations in medical management, patients with AS experience two-fold the lifetime risk of total knee arthroplasty (TKA) compared to the general population. Moreover, recent data have indicated a correlation between spinal pathology and outcomes of TKAs.
Our institutional total joint registry identified 19 patients (28 knees) with a diagnosis of AS treated with primary TKA from 2000 to 2016. The mean age at TKA was 68 years, and 84% of patients were men. The mean follow-up period was 6 years. Outcomes included implant survivorship, clinical outcomes, and complications.
Survivorship free from any revision was 88% at 10 years. A single patient required revision at 8 years for aseptic loosening. Survivorship free from any reoperation was 77% at 10 years. Reoperations included 2 manipulations under anesthesia and 1 superficial wound irrigation and debridement. Mean Knee Society score improved from 46 preoperatively to 89 postoperatively (P < .0001). The mean arc of motion improved from 108 preoperatively to 116° postoperatively (P = .01). There were 6 complications that did not require reoperation.
Primary TKAs in patients with AS resulted in significant improvement in clinical outcomes with excellent 10-year implant survivorship. Although 2 manipulations under anesthesia were required, the range of motion was restored postoperatively. These data suggest that the contemporary primary TKA can achieve durable and reliable outcomes in patients with axial skeletal disease resulting from AS.
IV.
强直性脊柱炎（AS）是一种影响脊柱和外周关节的血清阴性脊柱关节病。尽管医学治疗取得了创新，但与普通人群相比，AS 患者接受全膝关节置换术（TKA）的终身风险增加了一倍。此外，最近的数据表明脊柱病变与 TKA 结果之间存在相关性。
我们的机构全关节登记处确定了 19 名（28 膝）患有 AS 的患者，他们在 2000 年至 2016 年间接受了初次 TKA 治疗。TKA 的平均年龄为 68 岁，84%的患者为男性。平均随访时间为 6 年。结果包括植入物存活率、临床结果和并发症。
10 年时无任何翻修的存活率为 88%。1 例患者因无菌性松动在 8 年时需要翻修。10 年时无任何再次手术的存活率为 77%。再次手术包括 2 例麻醉下手法复位和 1 例浅表伤口冲洗和清创术。术前膝关节协会评分从 46 分提高到术后 89 分（P<0.0001）。术前活动度从 108°提高到术后 116°（P=0.01）。有 6 例并发症无需再次手术。
AS 患者的初次 TKA 可显著改善临床结果，10 年时植入物存活率高。尽管需要进行 2 次麻醉下手法复位，但术后可恢复活动度。这些数据表明，现代初次 TKA 可以为 AS 引起的轴性骨骼疾病患者提供持久可靠的结果。
IV 级。
