School of Medicine, University of Auckland, Auckland, New Zealand.
Department of Orthopaedics, Counties Manukau District Health Board, Auckland, New Zealand.
Arch Orthop Trauma Surg. 2021 Aug;141(8):1373-1383. doi: 10.1007/s00402-020-03698-8. Epub 2021 Jan 30.
The purpose of this study was to clarify the medium to long term survival of aseptic revision total knee arthroplasty (RTKAs) and identify the common modes of failure following RTKAs.
A multi-center, retrospective study included all aseptic RTKAs performed at three tertiary referral hospitals between 2003 and 2016. Patients were excluded if the revision was for prosthetic joint infection (PJI) or they had previously undergone revision surgery. Minor revisions not involving the tibial or femoral components were also excluded. Demographics, surgical data and post-operative outcomes were recorded and analyzed. Survival analysis was performed and the reasons for revision failure identified.
Of 235 aseptic RTKAs identified, 14.8% underwent re-revision at mean follow-up of 8.3 years. Survivorship of RTKA was 93% at 2 years and 83% at 8 years. Average age at revision was 72.9 years (range 53-91.5). The most common reasons for failure following RTKA were periprosthetic joint infection (PJI) (40%), periprosthetic fracture (25.7%) and aseptic loosening (14.3%). Of those whose RTKA failed, the average survival was 3.33 years (8 days-11.4 years). No demographic or surgical factors were found to influence RTKA survival on univariate or multivariate analysis.
PJI and periprosthetic fracture are the leading causes of re-revision surgery following aseptic revision TKA. Efforts to improve outcomes of aseptic revision TKA should focus on these areas, particularly prevention of PJI.
本研究旨在阐明无菌性翻修全膝关节置换术（RTKA）的中远期生存率，并确定 RTKA 后常见的失败模式。
一项多中心、回顾性研究纳入了 2003 年至 2016 年期间在三家三级转诊医院进行的所有无菌性 RTKA。如果翻修为假体关节感染（PJI）或患者之前已接受过翻修手术，则将患者排除在外。也排除了不涉及胫骨或股骨部件的小翻修。记录并分析患者的人口统计学、手术数据和术后结果。进行生存分析并确定翻修失败的原因。
在 235 例无菌性 RTKA 中，14.8%在平均 8.3 年的随访时进行了再次翻修。RTKA 的 2 年生存率为 93%，8 年生存率为 83%。再次翻修时的平均年龄为 72.9 岁（53-91.5 岁）。RTKA 后失败的最常见原因是假体周围关节感染（PJI）（40%）、假体周围骨折（25.7%）和无菌性松动（14.3%）。在 RTKA 失败的患者中，平均生存时间为 3.33 年（8 天-11.4 年）。单因素和多因素分析均未发现任何人口统计学或手术因素对 RTKA 生存率有影响。
PJI 和假体周围骨折是无菌性翻修 TKA 后再次翻修手术的主要原因。改善无菌性翻修 TKA 结果的努力应集中在这些方面，特别是预防 PJI。
