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膝关节镜检查在前次全膝关节翻修术前与僵硬的再次翻修有关。

Knee Arthroscopy Prior to Revision TKA Is Associated with Increased Re-Revision for Stiffness.

机构信息

Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.

出版信息

J Knee Surg. 2022 Sep;35(11):1223-1228. doi: 10.1055/s-0040-1722662. Epub 2021 Jan 28.

Abstract

This is an experimental study. As knee arthroscopy may be used as a suitable temporizing alternative prior to revision surgery, knee arthroscopy potentially may be a risk factor for subsequent adverse outcomes after revision total knee arthroplasty (TKA). This study aimed to evaluate the impact of prior knee arthroscopy on outcomes of subsequent TKA revision surgery. We identified 1,689 consecutive patients who underwent revision TKA: (1) patients with no prior knee arthroscopy ( = 1,549) and (2) patients with knee arthroscopy prior to revision TKA ( = 140). A control group of matched revision TKA patients who did not undergo prior knee arthroscopy was identified (700 patients), using one-to-five matching. Matched patients with prior knee arthroscopy demonstrated an increased likelihood of requiring re-revision (odds ratio [OR], 2.06,  < 0.001), particularly for stiffness (OR, 2.72,  < 0.02) compared with patients who underwent revision TKA without prior knee arthroscopy. Knee arthroscopy demonstrated a time-dependent impact on revision TKA outcomes, with an increased likelihood of requiring re-revision for patients who underwent knee arthroscopy within 6 months prior to revision TKA compared with patients who underwent knee arthroscopy within 6 to 12 months prior to revision TKA (OR, 3.16,  < 0.04). This cohort matched study shows that patients who had prior knee arthroscopy demonstrated a significantly higher likelihood of requiring re-revision compared with patients who underwent revision TKA without prior knee arthroscopy. Additionally, there was a significant increased likelihood in requiring re-revision for patients who had prior knee arthroscopy within 6 months. This provides clinically useful information for counseling of patients who are considering temporizing their symptoms with knee arthroscopy prior to revision TKA.

摘要

这是一项实验研究。由于膝关节镜检查术可能作为翻修手术前的一种合适的临时替代方法,因此膝关节镜检查术可能成为翻修全膝关节置换术(TKA)后不良结局的危险因素。本研究旨在评估膝关节镜检查术史对后续 TKA 翻修手术结局的影响。我们共纳入了 1689 例连续接受 TKA 翻修的患者:(1)无膝关节镜检查术史患者( = 1549 例)和(2)膝关节镜检查术史患者( = 140 例)。通过 1:5 匹配,我们确定了无膝关节镜检查术史的 TKA 翻修患者的对照组(700 例)。与未行膝关节镜检查术的 TKA 翻修患者相比,有膝关节镜检查术史的匹配患者更有可能需要再次翻修(比值比 [OR],2.06, < 0.001),尤其是僵硬(OR,2.72, < 0.02)。膝关节镜检查术对 TKA 翻修结局具有时间依赖性影响,与膝关节镜检查术距 TKA 翻修 6 个月内的患者相比,膝关节镜检查术距 TKA 翻修 6 至 12 个月的患者再次翻修的可能性更高(OR,3.16, < 0.04)。这项匹配队列研究表明,与未行膝关节镜检查术的 TKA 翻修患者相比,有膝关节镜检查术史的患者再次翻修的可能性显著更高。此外,膝关节镜检查术距 TKA 翻修 6 个月内的患者再次翻修的可能性显著增加。这为考虑在 TKA 翻修前使用膝关节镜检查术暂时缓解症状的患者提供了有用的临床信息。

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