Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri.
J Knee Surg. 2022 Jul;35(8):904-908. doi: 10.1055/s-0040-1721091. Epub 2020 Nov 23.
Isolated polyethylene liner exchange (IPLE) is infrequently selected as a treatment approach for patients with primary total knee arthroplasty (TKA) prosthetic joint instability. Potential advantages of less immediate surgical morbidity, faster recovery, and lower procedural cost need to be measured against reoperation and re-revision risk. Few published studies have directly compared IPLE with combined tibial and femoral component revision to treat patients with primary TKA instability. After obtaining institutional review board (IRB) approval, we performed a retrospective comparison of 20 patients treated with IPLE and 126 patients treated with tibial and femoral component revisions at a single institution between 2011 and 2018. Patient demographic characteristics, medical comorbidities, time to initial revision TKA, and reoperation (90 days, <2 years, and >2 years) were assessed using paired Student's -test or Fisher's exact test with a -value <0.01 used to determine significance. Patients undergoing IPLE were more likely to undergo reoperation (60.0 vs. 17.5%, = 0.001), component revision surgery (45.0 vs. 8.7%, = 0.002), and component revision within 2 years (30.0 vs. 1.6%, < 0.0001). Differences in 90-day reoperation ( = 0.14) and revision >2 years ( = 0.19) were not significant. Reoperation for instability (30.0 vs. 4.0%, < 0.001) and infection (20.0 vs. 1.6%, < 0.01) were both higher in the IPLE group. IPLE does not provide consistent benefits for patients undergoing TKA revision for instability. Considerations for lower immediate postoperative morbidity and cost need to be carefully measured against long-term consequences of reoperation, delayed component revision, and increased long-term costs of multiple surgical procedures. This is a level III, case-control study.
单纯聚乙烯衬垫置换（IPLE）作为初次全膝关节置换术（TKA）假体关节不稳定患者的治疗方法选择并不常见。需要权衡手术发病率较低、恢复更快和手术成本更低等潜在优势与再次手术和再翻修风险。很少有发表的研究直接比较 IPLE 与胫骨和股骨组件翻修联合治疗初次 TKA 不稳定患者。在获得机构审查委员会（IRB）批准后，我们对 2011 年至 2018 年在一家机构接受 IPLE 治疗的 20 例患者和接受胫骨和股骨组件翻修的 126 例患者进行了回顾性比较。使用配对 Student's -检验或 Fisher's 精确检验评估患者人口统计学特征、合并症、初次翻修 TKA 的时间和再手术（90 天、<2 年和>2 年），采用单侧 -值<0.01 来确定统计学意义。接受 IPLE 治疗的患者更有可能进行再次手术（60.0%比 17.5%，=0.001）、组件翻修手术（45.0%比 8.7%，=0.002）和 2 年内组件翻修（30.0%比 1.6%，<0.0001）。90 天内再次手术（=0.14）和>2 年的翻修（=0.19）差异无统计学意义。不稳定的再次手术（30.0%比 4.0%，<0.001）和感染（20.0%比 1.6%，<0.01）在 IPLE 组均更高。IPLE 并不能为初次 TKA 翻修治疗不稳定的患者提供持续获益。需要仔细权衡较低的术后早期发病率和成本优势，与再次手术、延迟的组件翻修以及多次手术程序的长期成本增加的长期后果。这是一项三级、病例对照研究。
