Khow Yong Zhi, Liow Ming Han Lincoln, Goh Graham S, Chen Jerry Yongqiang, Lo Ngai Nung, Yeo Seng Jin
Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, Singapore, 169856, Singapore.
Knee Surg Sports Traumatol Arthrosc. 2023 Mar;31(3):822-829. doi: 10.1007/s00167-021-06776-5. Epub 2021 Oct 21.
The purpose of this study was to (1) longitudinally compare the patient-reported outcome measures (PROMs) of the same patients who underwent primary TKA and revision TKA, and (2) compared the results of these revision TKA with a matched cohort of well-functioning primary TKA. The hypothesis was revision TKA could result in equivalent outcomes to patients' own primary TKA or the primary TKA of patients who did not require revision.
Prospectively collected data of 123 patients who underwent primary TKA and subsequently aseptic revision TKA ("revised group"), were matched using nearest-neighbor method to 123 well-functioning primary TKA that did not require revision ("control group"). Preoperative (prior to primary TKA), at time of failure (prior to revision TKA), postoperative 6-month and 2-year PROMs included Knee Society scores (KSS), Oxford Knee Score (OKS) and Short Form-36 (SF-36). Minimal clinically important difference (MCID) attainment was analyzed. Wilcoxon and McNemar's tests were used to compare outcomes within the revised group (primary vs revision), Mann-Whitney U test and Chi-Square test for the revised and control groups.
The revised group had poorer KSS objective (p = 0.045), KSS functional (p < 0.001), OKS (p = 0.011) and SF-36 PCS (p < 0.001) at time of failure (prior to revision TKA), compared to their preoperative PROMs (prior to primary TKA). Revision TKA resulted in restoration of KSS objective, OKS and SF-36 PCS (NS) that were equivalent to their primary TKA, but poorer KSS functional (p < 0.050). Patients in the revised group had a lower proportion of MCID attainment in KSS objective (p = 0.014) and OKS (p < 0.001) at 2-year after primary TKA when compared to the control group. Revision TKA also led to poorer KSS objective, KSS functional and SF-36 PCS (p < 0.050) when compared to primary TKA of the control group.
Outcomes following aseptic revision were equivalent to patients' own pre-failure state but inferior to patients with non-revised implants. An individualized approach toward goal setting and assessing adequacy of aseptic revision TKA can be adopted based on patients' pre-failure outcomes.
III.
本研究的目的是(1)纵向比较接受初次全膝关节置换术(TKA)和翻修TKA的同一患者的患者报告结局指标(PROMs)，以及(2)将这些翻修TKA的结果与一组功能良好的初次TKA匹配队列进行比较。假设是翻修TKA可以为患者带来与自身初次TKA或无需翻修患者的初次TKA相当的结局。
前瞻性收集123例接受初次TKA并随后进行无菌翻修TKA的患者（“翻修组”）的数据，使用最近邻法将其与123例功能良好且无需翻修的初次TKA（“对照组”）进行匹配。术前（初次TKA之前）、失败时（翻修TKA之前）、术后6个月和2年的PROMs包括膝关节协会评分(KSS)、牛津膝关节评分(OKS)和简明健康状况调查量表(SF-36)。分析最小临床重要差异(MCID)的达成情况。采用Wilcoxon检验和McNemar检验比较翻修组内的结局（初次与翻修），采用Mann-Whitney U检验和卡方检验比较翻修组与对照组。
与术前PROMs（初次TKA之前）相比，翻修组在失败时（翻修TKA之前）的KSS客观评分(p = 0.045)、KSS功能评分(p < 0.001)、OKS评分(p = 0.011)和SF-36生理健康评分(p < 0.001)较差。翻修TKA使KSS客观评分、OKS评分和SF-36生理健康评分恢复到与初次TKA相当的水平（无统计学差异），但KSS功能评分较差(p < 0.050)。与对照组相比，翻修组患者在初次TKA后2年时KSS客观评分(p = 0.014)和OKS评分(p < 0.001)达到MCID的比例较低。与对照组的初次TKA相比，翻修TKA后的KSS客观评分、KSS功能评分和SF-36生理健康评分也较差(p < 0.050)。
无菌翻修后的结局与患者自身失败前的状态相当，但不如未翻修植入物的患者。可根据患者失败前的结局采用个体化方法来设定目标和评估无菌翻修TKA的充分性。
III级。
