Mathis Dominic T, Lohrer Leif, Amsler Felix, Hirschmann Michael T
University of Basel, 4051, Basel, Switzerland.
Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), 4101, Bruderholz, Switzerland.
J Orthop. 2020 Dec 31;23:60-66. doi: 10.1016/j.jor.2020.12.008. eCollection 2021 Jan-Feb.
The aim of this study was to determine the causes leading to a first revision of primary total knee arthroplasty (TKA) in a specialized knee centre and compare the results with previously published data.
Prospectively collected data of a consecutive number of 195 patients after primary TKA and who underwent first revision surgery after completing the diagnostic algorithm for persistent knee pain were included. Data was prospectively collected from a specialized knee centre in which the patients presented between 2015 and 2020 and retrospectively analysed. Indications for revision surgery were categorized using all available information from patients' records. Patients were divided into early (up to two years) and late revision (more than two years).
Overall mean time from index to revision surgery was 3.6 years. 49% of knee revisions occurred in the first two years, 51% after two years. 86% of the patients were referred to the knee centre from other surgeons. The most frequent reason for revision was instability, followed by patellofemoral problems, extensor mechanism insufficiency and malalignment. The most frequently performed revision was complete removal and re-implantation of a semi constrained implant design (52.5%) followed by revision using a full constrained implant design (16%). Secondary patella-resurfacing as part of complete revision was carried out in 71.5% of the cases. The majority of the patients showed concurrent reasons for TKA failure with significant correlations amongst another. Furthermore, correlations were identified between indications for revision surgery and revision implant designs.
In a specialized knee centre the most common indications for the first TKA revision were instability and patellofemoral and/or extensor mechanism insufficiency followed by malalignment. In most patients there was not only one failure mode, but a combination of many. It is important to establish a standardized diagnostic algorithm to facilitate comprehensive and efficient diagnostics and the optimal treatment.
本研究旨在确定导致一家专业膝关节中心初次全膝关节置换术（TKA）首次翻修的原因，并将结果与先前发表的数据进行比较。
纳入前瞻性收集的195例初次TKA患者的数据，这些患者在完成持续性膝关节疼痛的诊断流程后接受了首次翻修手术。数据是从一家专业膝关节中心前瞻性收集的，患者于2015年至2020年期间就诊，并进行回顾性分析。使用患者病历中的所有可用信息对翻修手术的指征进行分类。患者分为早期（两年内）和晚期翻修（两年后）。
从初次手术到翻修手术的总体平均时间为3.6年。49%的膝关节翻修发生在头两年，51%发生在两年后。86%的患者是由其他外科医生转诊至膝关节中心的。最常见的翻修原因是不稳定，其次是髌股问题、伸肌机制功能不全和对线不良。最常进行的翻修是完全移除并重新植入半限制型植入物设计（52.5%），其次是使用全限制型植入物设计进行翻修（16%）。71.5%的病例将二次髌骨表面置换作为完全翻修的一部分。大多数患者显示出TKA失败的并发原因，且相互之间存在显著相关性。此外，在翻修手术指征与翻修植入物设计之间发现了相关性。
在一家专业膝关节中心，初次TKA翻修最常见的指征是不稳定以及髌股和/或伸肌机制功能不全，其次是对线不良。大多数患者不仅有一种失败模式，而是多种模式的组合。建立标准化的诊断流程对于促进全面、高效的诊断和最佳治疗非常重要。
