膝关节镜检查与全膝关节置换术之间时间间隔对翻修风险的比较。
Comparison of Revision Risk Based on Timing of Knee Arthroscopy Prior to Total Knee Arthroplasty.
机构信息
Department of Orthopaedic Surgery, George Washington University, Washington, DC.
The Stavros Niarchos Foundation Complex Joint Reconstruction Center (P.K.S.), Department of Orthopaedic Surgery (L.E.W., C.K., and M.P.A.), Hospital for Special Surgery, New York, NY.
出版信息
J Bone Joint Surg Am. 2021 Apr 21;103(8):660-667. doi: 10.2106/JBJS.20.00218.
BACKGROUND
Knee arthroscopy may be performed prior to total knee arthroplasty (TKA) in patients with symptomatic degenerative knee changes that do not yet warrant TKA. The purpose of this study was to determine whether the time interval between knee arthroscopy and subsequent primary TKA is associated with increased rates of revision and certain complications following TKA.
METHODS
Data from 2006 to 2017 were collected from a national insurance database. Patients who underwent knee arthroscopy within 1 year prior to primary TKA were identified and stratified into the following cohorts based on stratum-specific likelihood ratio (SSLR) analysis: 0 to 15, 16 to 35, 36 to 43, and 44 to 52 weeks from the time of knee arthroscopy to TKA. Univariate and multivariable analyses were conducted to determine the association between these specific time intervals and rates of revision surgery, periprosthetic joint infection (PJI), aseptic loosening, and manipulation under anesthesia.
RESULTS
In total, 130,128 patients were included in this study; 6,105 (4.7%) of those patients underwent knee arthroscopy within 1 year prior to TKA and 124,023 (95.3%) underwent TKA without any prior knee surgery, including arthroscopy (the control group). Relative to the control group, the likelihood of undergoing revision surgery was significantly greater in patients who underwent knee arthroscopy ≤15 weeks (odds ratio [OR]: 1.79; 95% confidence interval [CI]: 1.43 to 2.22; p < 0.001) or 16 to 35 weeks (OR: 1.20; 95% CI: 1.01 to 1.42; p = 0.035) prior to TKA. Patients were at significantly increased risk for PJI if knee arthroscopy was done ≤35 weeks prior to TKA, and all 4 time groups that underwent knee arthroscopy within 1 year before TKA were at increased risk for manipulation under anesthesia.
CONCLUSIONS
We found a time-dependent relationship between the timing of knee arthroscopy and complications following TKA, with the prevalence of revision surgery and PJI increasing as knee arthroscopy was performed closer to the time of TKA. This study suggests that an interval of at least 36 weeks should be maintained between the 2 procedures to minimize risks of PJI and revision surgery.
LEVEL OF EVIDENCE
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
背景
对于有症状的退行性膝关节改变但尚未需要全膝关节置换术（TKA）的患者，可能在 TKA 之前进行膝关节镜检查。本研究的目的是确定膝关节镜检查与随后的初次 TKA 之间的时间间隔是否与 TKA 后翻修率和某些并发症的增加有关。
方法
从国家保险数据库中收集了 2006 年至 2017 年的数据。确定了在初次 TKA 前 1 年内接受膝关节镜检查的患者，并根据分层特异性似然比（SSLR）分析将其分为以下队列：膝关节镜检查后 0 至 15、16 至 35、36 至 43 和 44 至 52 周。进行单变量和多变量分析以确定这些特定时间间隔与翻修手术、假体周围关节感染（PJI）、无菌性松动和麻醉下手法复位之间的关联。
结果
共有 130128 例患者纳入本研究；其中 6105 例（4.7%）患者在 TKA 前 1 年内接受了膝关节镜检查，124023 例（95.3%）患者在没有任何先前膝关节手术（包括关节镜检查）的情况下接受了 TKA（对照组）。与对照组相比，在膝关节镜检查后≤15 周（优势比[OR]：1.79；95%置信区间[CI]：1.43 至 2.22；p <0.001）或 16 至 35 周（OR：1.20；95% CI：1.01 至 1.42；p = 0.035）进行膝关节镜检查的患者进行翻修手术的可能性明显更大。如果膝关节镜检查在 TKA 前≤35 周进行，患者发生 PJI 的风险显著增加，并且所有在 TKA 前 1 年内进行膝关节镜检查的 4 个时间组都有接受麻醉下手法复位的风险增加。
结论
我们发现膝关节镜检查时间与 TKA 后并发症之间存在时间依赖性关系，随着膝关节镜检查时间接近 TKA 时间，翻修手术和 PJI 的发生率增加。本研究表明，这两种手术之间应至少保持 36 周的间隔，以最大程度降低 PJI 和翻修手术的风险。
证据水平
治疗性 III 级。请参阅作者说明，以获取完整的证据水平描述。
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