膝关节翻修术：低手术量能否实现良好的效果？

Revision knee arthroplasty: Can good outcomes be achieved at lower volumes?

机构信息

Lancashire Teaching Hospitals NHS Foundation Trust, United Kingdom.

出版信息

Knee. 2021 Jun;30:63-69. doi: 10.1016/j.knee.2021.03.012. Epub 2021 Apr 16.

DOI:10.1016/j.knee.2021.03.012

PMID:33873087

Abstract

BACKGROUND

The National Joint Registry (NJR) demonstrates a re-revision rate for primary knee arthroplasty of 14.2% at 7 years. The 2015 Getting it Right First Time (GIRFT) report highlighted that 58% of surgeons undertaking revision knee arthroplasty (RKA) performed fewer than five cases per year. It has been suggested that revision cases be centralised in specialist centres with a multidisciplinary team (MDT) approach. Such a hub and spoke or cluster models may still require revision surgery to be performed at relatively low volume units.

METHODS

An analysis of RKA surgery performed in a four surgeon, lower volume revision knee unit over 10 years to December 2016 was undertaken. The effect of the introduction of a MDT was reviewed. The minimum follow up was two years. The primary outcome measure was re-revision. Hospital data as well as individual surgeon NJR reports were used to ensure all re-revisions were accounted for. Outcome scores were available for 68% of cases.

RESULTS

There were 192 RKAs performed in 187 patients at a mean (stdev) of 6.3 (5.4) years from the index procedure. The mean age at surgery was 68.2 (10.9) years. Twenty nine (15.5%) patients had died at the time of final review. Twelve (6.3%) cases required a further revision procedure. The commonest complication was stiffness requiring MUA. The overall 7 year survivorship was 94.9% (95% CI 90.2-97.3). The mean Oxford score at 5.4 years was 30.4 (10.4).

CONCLUSIONS

RKA can be reliably performed at lower volume centres with appropriate MDT systems in place.

摘要

背景

国家联合登记处（NJR）显示，初次膝关节置换术后 7 年的再翻修率为 14.2%。2015 年“首次正确治疗”（GIRFT）报告强调，58%的进行膝关节翻修术（RKA）的外科医生每年完成的手术少于 5 例。有人建议将翻修手术集中在具有多学科团队（MDT）方法的专业中心进行。这种中心辐射或集群模式可能仍然需要在相对低容量的单位进行翻修手术。

方法

对 4 名外科医生在一个低容量的膝关节翻修单位进行的 10 年来的 RKA 手术进行了分析，该单位于 2016 年 12 月结束。对 MDT 的引入效果进行了回顾。最低随访时间为两年。主要观察指标为再翻修。使用医院数据和每位外科医生的 NJR 报告，以确保所有再翻修都被记录在案。有 68%的病例获得了结果评分。

结果

187 名患者中有 192 例接受了 RKA，平均（标准差）从初次手术到再次手术为 6.3（5.4）年。手术时的平均年龄为 68.2（10.9）岁。截至最终审查时，29 例（15.5%）患者死亡。12 例（6.3%）患者需要进一步的翻修手术。最常见的并发症是需要行关节松解术的僵硬。7 年总体生存率为 94.9%（95%可信区间为 90.2-97.3）。5.4 年时的平均牛津评分是 30.4（10.4）。