高位胫骨截骨术后全膝关节置换术的生存率高于单髁膝关节置换术后的生存率。
Higher survival rate in total knee arthroplasty after high tibial osteotomy than that after unicompartmental knee arthroplasty.
作者信息
Lee Sun-Ho, Seo Hyoung-Yeon, Lim Jun-Hyuk, Kim Min-Gwang, Seon Jong-Keun
机构信息
Center for Joint Disease, Department of Orthopedic Surgery, Chonnam National University Medical School and Hospital, Seoyang-ro 322, Hwasun-eup, 58128, Hwasun-gun, Republic of Korea.
出版信息
Knee Surg Sports Traumatol Arthrosc. 2023 Mar;31(3):1132-1142. doi: 10.1007/s00167-021-06641-5. Epub 2021 Jun 24.
PURPOSE
The objective of this study was to evaluate the survival rates and complications in TKA after UKA and HTO as compared with primary TKA using national health data. It was hypothesized that survival and complication rates would be worse in patients with a history of UKA or HTO compared to primary TKA.
METHODS
Based on a list of patients who underwent TKA from Korean National Health Insurance database, 315,071 underwent primary TKA (group A); 2177 TKA after HTO (group B); and 1284 TKA after UKA (group C). Revision rates were compared between the groups using log-rank tests and adjusted hazard ratios (HR) of groups B and C were compared with those of the reference group (group A). A total of 1000 TKA matched patients were assigned to groups B and C according to propensity score for comparing revision rates after TKA and perioperative complication rates between TKA after HTO and UKA.
RESULTS
The overall revision rate was 2.1% in group A, 2.0% in group B, and 4.2% in group C. The revision rate until 10 years after TKA was significantly higher in group B (p = 0.03) or C (p < 0.0001) than in group A. The hazard ratios for revision was significantly higher in group A than in groups B and C at 10 years after index TKA (1.4 in group B and 3.7 in group C). The result of the comparison using PSM between TKA after HTO and UKA showed that TKA after HTO had lower risk of revision than TKA after UKA (HR: 0.41 at 10 years). However, no statistically significant differences in the perioperative complication rate between the two groups were found. (NS, not significant) CONCLUSIONS: TKA after UKA or HTO showed a significantly higher risk of revision than primary TKA. While TKA after HTO showed lower risk of revision than TKA after UKA, no significant differences in complications between TKA after UKA and HTO were found. Thus, surgeons must be aware of the low survival rate in TKA after UKA or HTO, especially in TKA after UKA.
LEVEL OF EVIDENCE
III (Retrospective cohort study).
目的
本研究旨在利用国家卫生数据评估单髁膝关节置换术（UKA）和胫骨高位截骨术（HTO）后行全膝关节置换术（TKA）的生存率和并发症情况，并与初次TKA进行比较。研究假设是，与初次TKA相比，有UKA或HTO病史的患者生存率和并发症发生率会更差。
方法
基于韩国国民健康保险数据库中接受TKA的患者名单，315,071例患者接受了初次TKA（A组）；2177例患者在HTO后行TKA（B组）；1284例患者在UKA后行TKA（C组）。采用对数秩检验比较各组间的翻修率，并将B组和C组的调整风险比（HR）与参照组（A组）进行比较。根据倾向得分将1000例TKA匹配患者分配到B组和C组，以比较HTO和UKA后TKA的翻修率及围手术期并发症发生率。
结果
A组的总体翻修率为2.1%，B组为2.0%，C组为4.2%。TKA后10年的翻修率在B组（p = 0.03）或C组（p < 0.0001）显著高于A组。在初次TKA后10年，A组的翻修风险比显著高于B组和C组（B组为1.4，C组为3.7）。使用倾向得分匹配法对HTO和UKA后TKA进行比较的结果显示，HTO后TKA的翻修风险低于UKA后TKA（10年时HR：0.41）。然而，两组间围手术期并发症发生率未发现统计学显著差异。（NS，无显著差异）结论：UKA或HTO后TKA的翻修风险显著高于初次TKA。虽然HTO后TKA的翻修风险低于UKA后TKA，但UKA和HTO后TKA的并发症无显著差异。因此，外科医生必须意识到UKA或HTO后TKA的低生存率，尤其是UKA后TKA。
证据水平
III级（回顾性队列研究）。
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