Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York.
J Knee Surg. 2023 Jan;36(1):1-5. doi: 10.1055/s-0041-1727180. Epub 2021 May 14.
Well-powered studies evaluating the effects of Paget's disease on patient outcomes following primary total knee arthroplasty (TKA) are limited. The objective of this study was to determine whether Paget's disease patients undergoing primary TKA have higher rates of complications. A query of an administrative database was performed identifying Paget's disease patients undergoing primary TKA as the study cohort. Patients who did not have Paget's disease served as a matching cohort. Study group patients were matched in a 1:5 ratio by age, sex, and comorbidities. The query yielded 34,284 patients in the study ( = 5,714) and matched ( = 28,570) cohorts. Outcomes analyzed included length of stay (LOS), costs of care, 90-day medical and surgical complications, and 2-year implant-related complications. Multivariate logistic regression analyses were used to calculate the odds ratios (ORs) of complications. Paget's disease patients undergoing primary TKA were found to have significantly longer in-hospital LOS (4 vs. 3 days, < 0.0001). Study group patients incurred significantly higher 90-day episode-of-care costs ($15,124.55 vs. $14,610.01, < 0.0001). Additionally, Paget's disease patients were found to have higher incidences and odds of medical/surgical (25.93 vs. 13.58%; OR: 1.64, < 0.0001) and implant-related complications (8.97 vs. 5.02%; OR: 1.71, < 0.0001). Specifically, Paget's disease patients were more likely to have periprosthetic fractures, mechanical loosening, and revision TKAs ( < 0.0001). This study demonstrated that Paget's disease was associated with longer in-hospital LOS, increased costs, and higher rates of complications. The study can be utilized by physicians to adequately educate patients with Paget's disease concerning potential complications following their primary TKA.
患有佩吉特病（Paget's disease）的患者在接受初次全膝关节置换术（TKA）后，其预后情况的相关研究中，有力的证据非常有限。本研究旨在确定患有佩吉特病的患者在接受初次 TKA 后是否会出现更高的并发症发生率。我们对一个行政数据库进行了查询，以确定患有佩吉特病并接受初次 TKA 的患者作为研究队列。没有佩吉特病的患者作为匹配队列。通过年龄、性别和合并症，对研究组患者进行了 1:5 的配比。查询结果显示，研究队列中有 34284 名患者（ = 5714）和匹配队列中有 28570 名患者（ = 5714）。分析的结果包括住院时间（LOS）、医疗费用、90 天内的医疗和手术并发症以及 2 年内与植入物相关的并发症。使用多变量逻辑回归分析计算并发症的比值比（OR）。研究发现，接受初次 TKA 的佩吉特病患者的住院时间明显延长（4 天比 3 天， < 0.0001）。研究组患者的 90 天内医疗费用明显更高（15124.55 美元比 14610.01 美元， < 0.0001）。此外，佩吉特病患者的医疗/手术（25.93%比 13.58%；OR：1.64， < 0.0001）和与植入物相关的并发症（8.97%比 5.02%；OR：1.71， < 0.0001）发生率和比值更高。具体而言，佩吉特病患者更容易发生假体周围骨折、机械性松动和翻修 TKA（ < 0.0001）。本研究表明，佩吉特病与住院时间延长、费用增加和并发症发生率升高有关。该研究可以为医生提供帮助，让他们能够充分教育患有佩吉特病的患者，让他们了解初次 TKA 后可能出现的并发症。
