University of Missouri School of Medicine - School of Medicine, Columbia, Missouri.
University of Missouri - Orthopaedic Surgery, Columbia, Missouri.
J Knee Surg. 2022 Sep;35(11):1204-1208. doi: 10.1055/s-0040-1722351. Epub 2021 Jan 23.
Instability is a common indication for early revision total knee arthroplasty (rTKA). The comparative performance of instability rTKA performed after primary TKA and instability rerevision TKA (rrTKA) performed after a previous rTKA performed for any aseptic indication have not been defined. This study was performed to determine the rate of adverse outcomes for patients undergoing aseptic instability TKA revision following a primary TKA or a previous aseptic any-cause rTKA. After obtaining Institutional Review Board approval, we retrospectively identified 126 rTKA and 28 rrTKA component revision procedures performed for an exclusive instability diagnosis between January 1, 2011 and April 30, 2018. We excluded patients undergoing isolated liner exchange, single component revision for mid-flexion instability, and patients treated with a constrained hinge. Patient demographic characteristics, medical comorbidities, time to initial revision TKA, and adverse postrevision outcomes (reoperation, component revision, infection, amputation) were assessed using paired Student's -test or Fisher's exact test with a -value < 0.05 used to determine significance. Patients in the rrTKA cohort were more commonly female (57.1 vs. 27.8%, < 0.01), with no other demographic differences. The rrTKA cohort had higher reoperation (39.3 vs. 18.4%, = 0.02) and component revision rates (25.0 vs. 8.7%, = 0.03), with a trend towards early reoperation < 2 years after surgery (25.0 vs. 11.1%, = 0.07). The rrTKA cohort also had higher adverse outcomes related to infection (14.3 vs. 1.6%, = 0.01), extensor mechanism failure (14.3 vs. 3.2%, = 0.04) and above-knee amputation (14.3 vs. 2.4%, = 0.02). Component revision is beneficial for patients with TKA instability; however, higher adverse outcome rates occur after instability rrTKA performed after a previous aseptic any-cause rTKA. Infection prevention and extensor mechanism protection are important to minimize the most common adverse outcomes identified among patients undergoing aseptic rrTKA for instability.
不稳定是初次全膝关节置换术（TKA）后早期翻修的常见指征。初次 TKA 后因无菌原因行不稳定 TKA 翻修与初次 TKA 后因任何无菌原因行不稳定再翻修（rrTKA）的比较性能尚未明确。本研究旨在确定因无菌性不稳定行 TKA 翻修的患者，在初次 TKA 或初次无菌性任何原因 rTKA 后行翻修的不良结局发生率。在获得机构审查委员会批准后，我们回顾性地确定了 2011 年 1 月 1 日至 2018 年 4 月 30 日期间，仅因不稳定诊断而行的 126 例 rTKA 和 28 例 rrTKA 翻修手术。我们排除了单独行衬垫置换、中屈膝位不稳定行单组件翻修和使用约束铰链治疗的患者。使用配对 Student's t 检验或 Fisher's 确切检验评估患者的人口统计学特征、合并症、初次翻修 TKA 的时间以及不良翻修后结局（再次手术、翻修组件、感染、截肢），P 值 < 0.05 用于确定统计学意义。rrTKA 组的患者更常见为女性（57.1%比 27.8%，P < 0.01），但无其他人口统计学差异。rrTKA 组的再次手术（39.3%比 18.4%，P = 0.02）和翻修组件（25.0%比 8.7%，P = 0.03）发生率更高，并且手术 2 年内早期再次手术的趋势更高（25.0%比 11.1%，P = 0.07）。rrTKA 组还与感染（14.3%比 1.6%，P = 0.01）、伸膝装置失败（14.3%比 3.2%，P = 0.04）和膝上截肢（14.3%比 2.4%，P = 0.02）相关的不良结局发生率更高。TKA 翻修对不稳定的患者有益；然而，在初次无菌性任何原因 rTKA 后行不稳定 rrTKA 后，不良结局发生率更高。感染预防和伸膝装置保护对于减少无菌性 rrTKA 不稳定患者最常见的不良结局至关重要。
