Department of Orthopaedic Surgery; The George Washington University Hospital, WA.
Department of Orthopaedic Surgery; Hospital for Special Surgery, New York, NY.
J Arthroplasty. 2021 Oct;36(10):3432-3436.e1. doi: 10.1016/j.arth.2021.05.021. Epub 2021 May 21.
Prior studies on conversion total knee arthroplasty (cTKA) have reported increased technical challenges and risk of complications compared with primary knee arthroplasty. The purpose of this study was to compare two-year postoperative complication/revision rates between patients undergoing cTKA after prior periarticular open reduction and internal fixation (ORIF) and those undergoing primary TKA.
Patients who underwent cTKA after prior periarticular ORIF of the ipsilateral knee were identified in a national all-payer claims database from 2010 to 2018. This ORIF-cTKA cohort was propensity matched to participants undergoing primary TKA based on age, gender, Charlson comorbidity index, and obesity status. Univariate analysis was performed to analyze differences in two-year complication and revision rates.
After propensity matching, 823 patients were included in the ORIF-cTKA cohort and 1640 patients in the primary TKA cohort. No differences in demographics or comorbidities existed between cohorts. Relative to the primary TKA cohort, the ORIF-cTKA cohort had significantly higher incidences of all-cause revision (5.47% vs 2.47%, P = .001), periprosthetic joint infection (PJI; 4.74% vs 1.34%, P < .001), and intraoperative or postoperative periprosthetic fracture (1.58% vs 0.55%, P = .01) at two years postoperatively. There was also a nonsignificant trend toward increased rates of aseptic loosening (1.82% vs 0.91%, P = .052) in the ORIF-cTKA.
Relative to primary TKA, cTKA after periarticular ORIF is associated with significantly increased rates of all-cause revision, PJI, and periprosthetic fracture at two years postoperatively. Surgeons should counsel these patients about the increased risks of these postoperative complications and consider treating them as high risk for PJI in the perioperative period.
先前的研究表明，与初次全膝关节置换术（TKA）相比，翻修 TKA 具有更高的技术挑战和并发症风险。本研究旨在比较经关节周围切开复位内固定（ORIF）治疗的同侧膝关节患者行翻修 TKA（cTKA）与初次 TKA 的术后两年并发症/翻修率。
在 2010 年至 2018 年期间，从一个全国性的所有支付者索赔数据库中确定了在同侧膝关节行关节周围 ORIF 后行 cTKA 的患者。根据年龄、性别、Charlson 合并症指数和肥胖状况，对接受 cTKA 的患者进行倾向匹配，以匹配接受初次 TKA 的患者。采用单因素分析比较两组术后两年并发症和翻修率。
在倾向匹配后，ORIF-cTKA 组纳入 823 例患者，初次 TKA 组纳入 1640 例患者。两组患者在人口统计学和合并症方面无差异。与初次 TKA 组相比，ORIF-cTKA 组全因翻修的发生率显著更高（5.47% vs. 2.47%，P=0.001）、假体周围关节感染（PJI；4.74% vs. 1.34%，P<0.001）和术中或术后假体周围骨折（1.58% vs. 0.55%，P=0.01）。ORIF-cTKA 组也存在非显著性增加的无菌性松动发生率（1.82% vs. 0.91%，P=0.052）。
与初次 TKA 相比，关节周围 ORIF 后的 cTKA 术后两年的全因翻修、PJI 和假体周围骨折发生率显著增加。外科医生应告知这些患者这些术后并发症的风险增加，并考虑将他们在围手术期视为 PJI 的高危患者。
