Department of Orthopedic Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
Department of Orthopedic Surgery, Dongtan Sacred Heart Hospital, Hallym University School of Medicine, Hwaseong, Republic of Korea.
Arch Orthop Trauma Surg. 2021 Mar;141(3):477-488. doi: 10.1007/s00402-020-03675-1. Epub 2020 Nov 13.
Few large-scale studies using adjusted data from national registries have explored the risk factors of subsequent revision in patients with unicompartmental knee arthroplasty (UKA) compared to those with total knee arthroplasty (TKA). We investigated the incidence rate and risk factors of subsequent revision in patients with UKA and TKA.
We enrolled all patients who had undergone TKA or UKA as the primary surgical procedure without histories of having undergone either procedure during the preceding 2 years. Matched Cox regression models were used to compare the risks of revision between groups after propensity score matching. Revision was defined as conversion to revision TKA after primary TKA and conversion to TKA after UKA.
The study enrolled 418,806 TKA patients and 446,009 UKA patients. The risk of revision during the entire study period was higher for patients with UKA than for patients with TKA (adjusted hazard ratio [HR] 1.22, 95% confidence interval [95% CI]: 1.10-1.36). The Kaplan-Meier 8-year survival was 98.7% in the TKA group and 96.7% in the UKA group. Patients with UKA were at an increased risk of revision in cases of advanced age (70-79 years, HR 1.40, 95% CI: 1.15-1.71), female sex (HR 1.32, 95% CI: 1.16-1.49), the presence of chronic obstructive pulmonary disease (COPD) (HR 1.27, 95% CI: 1.05-1.54), the presence of peptic ulcer disease (PUD) (HR 1.34, 95% CI: 1.11-1.61) compared to patients with TKA. In patients with hemiplegia, however, UKA were associated with a lower risk of subsequent revision (HR 0.25, 95% CI: 0.07-0.94).
The risk of a complete exchange or failure was higher for patients with UKA than for patients with TKA. The most significant independent risk factors for subsequent a complete exchange or failure in patients with UKA were advanced age (70-79 years), female sex, and the presence of comorbidities such as COPD and PUD.
鲜有使用国家注册数据进行调整后的数据来研究单髁膝关节置换术（UKA）患者与全膝关节置换术（TKA）患者后续翻修风险因素的大规模研究。本研究旨在探讨 UKA 和 TKA 患者后续翻修的发生率和风险因素。
我们纳入了所有初次行 TKA 或 UKA 而在之前 2 年内均未行任何一种手术的患者。使用倾向评分匹配后的 Cox 比例风险回归模型比较两组间的翻修风险。翻修为初次 TKA 后翻修为翻修 TKA 及 UKA 后翻修为 TKA。
本研究纳入了 418806 例 TKA 患者和 446009 例 UKA 患者。在整个研究期间，UKA 患者的翻修风险高于 TKA 患者（校正风险比[HR]1.22，95%置信区间[95%CI]：1.10-1.36）。TKA 组的 8 年 Kaplan-Meier 生存率为 98.7%，UKA 组为 96.7%。年龄 70-79 岁（HR 1.40，95%CI：1.15-1.71）、女性（HR 1.32，95%CI：1.16-1.49）、慢性阻塞性肺疾病（COPD）（HR 1.27，95%CI：1.05-1.54）、消化性溃疡病（PUD）（HR 1.34，95%CI：1.11-1.61）患者发生 UKA 翻修的风险更高。然而，对于偏瘫患者，UKA 与较低的后续翻修风险相关（HR 0.25，95%CI：0.07-0.94）。
UKA 患者完全置换或失败的风险高于 TKA 患者。UKA 患者后续完全置换或失败的最重要独立风险因素为高龄（70-79 岁）、女性以及 COPD 和 PUD 等合并症的存在。
