Mathis Dominic T, Hirschmann Michael T
University of Basel, CH-4051, Basel, Switzerland.
Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), CH-4101, Bruderholz, Switzerland.
J Orthop. 2020 Dec 31;23:52-59. doi: 10.1016/j.jor.2020.12.007. eCollection 2021 Jan-Feb.
The aim of this narrative review was to provide an overview of failure modes after total knee arthroplasty in different parts of the world based on data from worldwide representative studies and National Joint Registries.
A review of the available literature was performed using the keyword terms "total knee arthroplasty", "revision", "failure", "reasons", "causes", "complications", "epidemiology", "etiology"; "assessment", "painful knee", "registry" and "national" in several combinations. The following databases were assessed: Pubmed (https://pubmed.ncbi.nlm.nih.gov), Cochrane Reviews (https://www.cochrane.org), Google Scholar (https://scholar.google.com). In addition, registry data were obtained directly from national registry archives. Due to the heterogeneity of available data it was decided to present the review in a narrative manner.
Current literature report that infection has become the primary acute cause of TKA failure, while aseptic loosening and instability remain the overall most frequent reasons for revisions. Based on national registries certain tendencies can be deducted. The predominant overall failure mode of aseptic loosening is particularly found in Japan, United Kingdom, New Zealand and Switzerland. Leading early TKA failure mode represents infection with percentages of 20-30% in Sweden, Australia, New Zealand, Japan and the United States. Higher numbers could only be found in clinical studies on the Asian continent such as Korea (38%), China (53%), Iran (44%) and India (87%).
Although there are regional differences in TKA failure modes, TKA fails worldwide especially due to infections and aseptic loosening. It is important to diagnose these in good time and reliably using appropriate, standardized diagnostics in order to recommend the best possible therapy to the patient.
本叙述性综述旨在基于全球代表性研究和国家关节登记处的数据，概述世界各地全膝关节置换术后的失败模式。
使用关键词“全膝关节置换术”“翻修”“失败”“原因”“病因”“并发症”“流行病学”“评估”“膝关节疼痛”“登记处”和“国家”的几种组合对现有文献进行综述。评估了以下数据库：PubMed（https://pubmed.ncbi.nlm.nih.gov）、Cochrane系统评价（https://www.cochrane.org）、谷歌学术（https://scholar.google.com）。此外，登记处数据直接从国家登记处档案中获取。由于现有数据的异质性，决定以叙述方式呈现本综述。
当前文献报道，感染已成为全膝关节置换术失败的主要急性原因，而无菌性松动和不稳定仍然是翻修的总体最常见原因。基于国家登记处的数据可以推断出某些趋势。无菌性松动这一主要的总体失败模式尤其在日本、英国、新西兰和瑞士出现。早期全膝关节置换术的主要失败模式是感染，在瑞典、澳大利亚、新西兰、日本和美国，感染占比为20%-30%。只有在亚洲大陆的临床研究中发现了更高的感染率，如韩国（38%）、中国（53%）、伊朗（44%）和印度（87%）。
尽管全膝关节置换术的失败模式存在地区差异，但在全球范围内全膝关节置换术都会失败，尤其是由于感染和无菌性松动。及时且可靠地使用适当的标准化诊断方法来诊断这些问题很重要，以便为患者推荐最佳治疗方案。
