Kerzner Benjamin, Kunze Kyle N, O'Sullivan Michael B, Pandher Karan, Levine Brett R
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.
Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA.
Arthroplast Today. 2021 May 17;9:68-72. doi: 10.1016/j.artd.2021.04.001. eCollection 2021 Jun.
Temporal changes in revision total knee arthroplasty (rTKA) may have implications in determining the etiology for implant failure. The purpose of this study was to 1) perform an epidemiologic analysis of etiologies that required rTKA and 2) determine whether temporal changes existed for revision over the study period.
All rTKA procedures performed at a single institution from 2009 to 2019 were analyzed. Revision procedures were stratified into 2 time periods, 2009-2013 and 2014-2019, to assess for changes over time. Patients' electronic medical record, operative report, and radiographs were reviewed to ensure diagnosis information was accurately documented in relation to the predominate etiology necessitating the revision procedure.
Three thousand and nine patients undergoing rTKA between 2009 and 2019 were identified with a mean age of 64.6 years. A total of 1,666 (55.4%) patients were female, and the majority of patients were Caucasian (2,306, 76.6%). The 3 most frequent rTKA etiologies were aseptic loosening (35.1%), periprosthetic infection (33.2%), and instability (16.0%). A higher proportion of patients underwent rTKA for arthrofibrosis (5.1% vs 3.4%, = .023) and periprosthetic joint infection (38.9% vs 28.6%, < .001) between 2009 and 2013, while a significantly higher proportion of patients underwent rTKA for instability (12.6% vs 18.8%, < .001) between 2014 and 2019.
Aseptic loosening was the most common cause for rTKA over the last decade. rTKA for arthrofibrosis and periprosthetic joint infection was more frequent between 2009 and 2013, while a significantly higher proportion of patients underwent rTKA for instability in 2014-2019. Future studies will need to focus on identifying and reducing risk factors for the trending causes of rTKA.
翻修全膝关节置换术（rTKA）的时间变化可能对确定植入物失败的病因有影响。本研究的目的是：1）对需要进行rTKA的病因进行流行病学分析；2）确定在研究期间翻修是否存在时间变化。
分析了2009年至2019年在单一机构进行的所有rTKA手术。翻修手术被分为两个时间段，即2009 - 2013年和2014 - 2019年，以评估随时间的变化。回顾患者的电子病历、手术报告和X光片，以确保与需要翻修手术的主要病因相关的诊断信息被准确记录。
确定了2009年至2019年间3009例接受rTKA的患者，平均年龄为64.6岁。共有1666例（55.4%）患者为女性，大多数患者为白种人（2306例，76.6%）。rTKA最常见的3种病因是无菌性松动（35.1%）、假体周围感染（33.2%）和不稳定（16.0%）。2009年至2013年间，因关节纤维化接受rTKA的患者比例更高（5.1%对3.4%，P = 0.023），因假体周围关节感染接受rTKA的患者比例也更高（38.9%对28.6%，P < 0.001）；而在2014年至2019年间，因不稳定接受rTKA的患者比例显著更高（12.6%对18.8%，P < 0.001）。
无菌性松动是过去十年中rTKA最常见的原因。2009年至2013年间，因关节纤维化和假体周围关节感染进行rTKA的情况更为频繁，而在2014 - 2019年，因不稳定接受rTKA的患者比例显著更高。未来的研究需要专注于识别和降低rTKA趋势性病因的风险因素。
