Quan Theodore, Wang Kevin Y, Gu Alex, Gioia Casey, Malahias Michael-Alexander, Stoll William T, Thakkar Savyasachi C, Campbell Joshua C
Department of Orthopedic Surgery, George Washington Hospital, Washington, DC, USA.
Johns Hopkins Department of Orthopaedic Surgery, Adult Reconstruction Division, Columbia, MD, USA.
Knee. 2021 Aug;31:180-187. doi: 10.1016/j.knee.2021.06.008. Epub 2021 Jul 10.
Conversion total knee arthroplasty (TKA) may represent a more complex procedure compared with primary TKA. The purpose of this study was to compare 30-day complications between conversion TKA and primary, non-conversion TKA as well as between conversion TKA and revision TKA on a national scale using a multi-center surgical registry.
Adult patients undergoing conversion TKA from 2006 to 2018 were identified in the National Surgical Quality Improvement Program database and were compared with patients who underwent primary TKA and aseptic revision TKA. In this analysis, 30-day complications were assessed. Bivariate analyses, including chi-squared and analysis of variance, and multivariate logistic regressions were performed.
Of 299,065 total patients undergoing knee arthroplasty, 1,310 (0.4%) underwent conversion TKA, 275,470 (92.1%) underwent primary TKA, and 22,285 (7.5%) underwent revision TKA. Following adjustment, patients who underwent conversion TKA were more likely to have increased risks of any complications (P < 0.001), mortality (P = 0.021), wound complications (P < 0.001), cardiac issues (P = 0.018), bleeding requiring transfusion (P < 0.001), and reoperation (P = 0.002) relative to primary TKA patients. Compared with patients who underwent revision TKA, conversion TKA patients were less likely to have septic complications (P = 0.009).
Conversion TKA is associated with significantly higher rates of complications compared with primary, non-conversion TKA, but less risk of sepsis compared with revision TKA. Because current reimbursement classifications do not account for the case complexity of a conversion TKA, new classifications should be implemented with reimbursements for conversion TKA approximating reimbursements for revision TKA.
与初次全膝关节置换术（TKA）相比，翻修全膝关节置换术可能是一个更复杂的手术。本研究的目的是使用多中心手术登记系统，在全国范围内比较翻修TKA与初次、非翻修TKA以及翻修TKA与再次手术TKA之间的30天并发症情况。
在国家外科质量改进计划数据库中识别出2006年至2018年接受翻修TKA的成年患者，并与接受初次TKA和无菌性翻修TKA的患者进行比较。在该分析中，评估了30天并发症情况。进行了双变量分析，包括卡方检验和方差分析，以及多变量逻辑回归分析。
在299,065例接受膝关节置换术的患者中，1,310例（0.4%）接受了翻修TKA，275,470例（92.1%）接受了初次TKA，22,285例（7.5%）接受了再次手术TKA。调整后，与初次TKA患者相比，接受翻修TKA的患者出现任何并发症（P < 0.001）、死亡（P = 0.021）、伤口并发症（P < 0.001）、心脏问题（P = 0.018）、需要输血的出血（P < 0.001）和再次手术（P = 0.002）的风险更高。与接受再次手术TKA的患者相比，翻修TKA患者发生感染性并发症的可能性较小（P = 0.009）。
与初次、非翻修TKA相比，翻修TKA的并发症发生率显著更高，但与再次手术TKA相比，感染风险更低。由于目前的报销分类未考虑翻修TKA的病例复杂性，应实施新的分类，使翻修TKA的报销金额接近再次手术TKA的报销金额。
