Arthritis Care and Research Center, Peking University People's Hospital, No.11, Xizhimen South Street, Xicheng District, Beijing, 100044, China.
J Orthop Surg Res. 2020 Dec 1;15(1):573. doi: 10.1186/s13018-020-02112-8.
To investigate the feasibility, safety and therapeutic efficacy of arthroscopy in managing the 3 most common soft tissue complications, peripatellar impingement (PI), arthrofibrosis (AF) and generalized synovitis (GS), after total knee arthroplasty (TKA).
A retrospective review of patients undertaking arthroscopy for PI, AF and GS was conducted. Outcome measures included complications, postoperative range of motion (ROM), Knee Society Score (KSS) and rates of symptom recurrence, prosthesis revision. Intraoperative findings and surgical procedures were also recorded. Paired t test, Fisher's exact test, Kruskal-Wallis test and post hoc analysis with Bonferroni correction were used for statistical evaluation.
A total of 74 patients, including 35 patients with peripatellar impingement, 25 patients with arthrofibrosis and 14 patients with generalized synovitis, with a mean age of 66.1 ± 7.9 years, were analysed. The mean follow-up (FU) duration was 81.3 ± 40.6 months. All patients underwent arthroscopic surgery safely without intraoperative complications. However, there were 4 postoperative complications, including 1 acute myocardial infarction and 3 periprosthetic joint infections. Overall, patients acquired improvements in ROM from 81.7 ± 23.1° to 96.8 ± 20.5° (p < 0.05), in KSS knee score from 64.2 ± 9.6 to 78.7 ± 12.1 (p < 0.05) and in KSS function score from 61.1 ± 7.4 to 77.3 ± 12.2 (p < 0.05) postoperatively. Patients in all 3 groups had improvements in ROM (p < 0.05), KSS knee score (p < 0.05) and KSS function score (p < 0.05). The overall recurrence rate was 22.9% (95% confidence interval (CI) 15.1-34.9%), and the overall revision rate was 14.9% (95% CI 8.6-25.6%). There were significant differences in both the symptom recurrence and prosthesis revision rates among the groups (p < 0.05). The PI group had a significantly lower symptom recurrence rate (11.4%, 95% CI 4.5-28.7%) and revision rate (8.6%, 95% CI 2.9-25.3%) (p < 0.017), while the GS group had a significantly higher recurrence rate (42.9%, 95% CI 23.4-78.5%) and revision rate (35.7%, 95% CI 17.6-72.1%) (p < 0.017).
In the setting of symptomatic TKA, although carrying certain risks for PJI and other complications, arthroscopic intervention could be feasible and provide clinical improvement in most cases at an average of 81.3 months follow-up. Patients with PI had the best outcomes, while patients with GS had the worst outcomes.
Level IV.
研究关节镜治疗全膝关节置换术后 3 种最常见软组织并发症（髌周撞击症、关节僵硬和弥漫性滑膜炎）的可行性、安全性和疗效。
回顾性分析了因髌周撞击症、关节僵硬和弥漫性滑膜炎而行关节镜治疗的患者。观察指标包括并发症、术后关节活动度（ROM）、膝关节学会评分（KSS）和症状复发率、假体翻修率。记录术中发现和手术过程。采用配对 t 检验、Fisher 确切概率法、Kruskal-Wallis 检验和 Bonferroni 校正后进行单因素方差分析进行统计学评估。
共纳入 74 例患者，其中髌周撞击症 35 例，关节僵硬 25 例，弥漫性滑膜炎 14 例，平均年龄 66.1±7.9 岁，平均随访（FU）时间 81.3±40.6 个月。所有患者均安全地接受了关节镜手术，术中无并发症。但有 4 例术后并发症，包括 1 例急性心肌梗死和 3 例假体周围关节感染。总的来说，ROM 从 81.7°±23.1°改善到 96.8°±20.5°（p＜0.05），KSS 膝关节评分从 64.2°±9.6 改善到 78.7°±12.1（p＜0.05），KSS 功能评分从 61.1°±7.4 改善到 77.3°±12.2（p＜0.05）。3 组患者的 ROM（p＜0.05）、KSS 膝关节评分（p＜0.05）和 KSS 功能评分（p＜0.05）均有改善。总的复发率为 22.9%（95%可信区间为 15.1%至 34.9%），总的翻修率为 14.9%（95%可信区间为 8.6%至 25.6%）。各组间症状复发率和假体翻修率差异均有统计学意义（p＜0.05）。髌周撞击症组症状复发率（11.4%，95%可信区间为 4.5%至 28.7%）和翻修率（8.6%，95%可信区间为 2.9%至 25.3%）均显著较低（p＜0.017），而弥漫性滑膜炎组复发率（42.9%，95%可信区间为 23.4%至 78.5%）和翻修率（35.7%，95%可信区间为 17.6%至 72.1%）均显著较高（p＜0.017）。
在有症状的 TKA 中，虽然存在 PJI 和其他并发症的风险，但关节镜介入在平均 81.3 个月的随访中在大多数情况下是可行的，并能提供临床改善。髌周撞击症患者的结局最好，弥漫性滑膜炎患者的结局最差。
IV 级。
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