Erossy Michael P, Emara Ahmed K, Rothfusz Christopher A, Klika Alison K, Bloomfield Michael R, Higuera Carlos A, Jin Yuxuan, Krebs Viktor E, Mesko Nathan W, Molloy Robert M, Murray Trevor G, Patel Preetesh D, Stearns Kim L, Schaffer Jonathan L, Strnad Gregory J, Piuzzi Nicolas S
Cleveland Clinic Foundation, Orthopedic & Rheumatologic Institute, Cleveland, Ohio.
Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio.
J Knee Surg. 2023 Apr;36(5):530-539. doi: 10.1055/s-0041-1739201. Epub 2021 Nov 15.
Cementless fixation for total knee arthroplasty (TKA) has gained traction with the advent of newer fixation technologies. This study assessed (1) healthcare utilization (length of stay (LOS), nonhome discharge, 90-day readmission, and 1-year reoperation); (2) 1-year mortality; and (3) 1-year joint-specific and global health-related patient-reported outcome measures (PROMs) among patients who received cementless versus cemented TKA. Patients who underwent cementless and cemented TKA at a single institution (July 2015-August 2018) were prospectively enrolled. A total of 424 cementless and 5,274 cemented TKAs were included. The cementless cohort was propensity score-matched to a group cemented TKAs (1:3-cementless: = 424; cemented: = 1,272). Within the matched cohorts, 76.9% ( = 326) cementless and 75.9% ( = 966) cementless TKAs completed 1-year PROMs. Healthcare utilization measures, mortality and the median 1-year change in knee injury and osteoarthritis outcome score (KOOS)-pain, KOOS-physical function short form (PS), KOOS-knee related quality of life (KRQOL), Veteran Rand (VR)-12 mental composite (MCS), and physical composite (PCS) scores were compared. The minimal clinically important difference (MCID) for PROMs was calculated. Cementless TKA exhibited similar rates of median LOS ( = 0.109), nonhome discharge disposition ( = 0.056), all-cause 90-day readmission ( = 0.226), 1-year reoperation ( = 0.597), and 1-year mortality ( = 0.861) when compared with cemented TKA. There was no significant difference in the median 1-year improvement in KOOS-pain ( = 0.370), KOOS-PS ( = 0.417), KOOS-KRQOL ( = 0.101), VR-12-PCS ( = 0.269), and VR-12-MCS ( = 0.191) between the cementless and cemented TKA cohorts. Rates of attaining MCID were similar in both cohorts for assessed PROMs ( > 0.05, each) except KOOS-KRQOL (cementless: = 313 (96.0%) vs. cemented: = 895 [92.7%]; = 0.036). Cementless TKA provides similar healthcare-utilization, mortality, and 1-year PROM improvement versus cemented TKA. Cementless fixation in TKA may provide value through higher MCID improvement in quality of life. Future episode-of-care cost-analyses and longer-term survivorship investigations are warranted.
随着更新的固定技术的出现，全膝关节置换术（TKA）的非骨水泥固定越来越受到关注。本研究评估了接受非骨水泥型与骨水泥型TKA的患者的（1）医疗资源利用情况（住院时间（LOS）、非家庭出院、90天再入院和1年再次手术）；（2）1年死亡率；以及（3）1年关节特异性和与整体健康相关的患者报告结局指标（PROMs）。对在单一机构（2015年7月至2018年8月）接受非骨水泥型和骨水泥型TKA的患者进行前瞻性登记。共纳入424例非骨水泥型和5274例骨水泥型TKA。非骨水泥队列与一组骨水泥型TKA进行倾向评分匹配（1:3 - 非骨水泥型：= 424；骨水泥型：= 1272）。在匹配队列中，76.9%（= 326）的非骨水泥型和75.9%（= 966）的骨水泥型TKA完成了1年的PROMs。比较了医疗资源利用指标、死亡率以及膝关节损伤和骨关节炎结局评分（KOOS）-疼痛、KOOS-身体功能简表（PS）、KOOS-膝关节相关生活质量（KRQOL）、退伍军人兰德（VR）-12精神综合评分（MCS）和身体综合评分（PCS）的1年中位数变化。计算了PROMs的最小临床重要差异（MCID）。与骨水泥型TKA相比，非骨水泥型TKA的中位LOS（= 0.109）、非家庭出院处置（= 0.056）、全因90天再入院（= 0.226）、1年再次手术（= 0.597）和1年死亡率（= 0.861）相似。非骨水泥型和骨水泥型TKA队列在KOOS-疼痛（= 0.370）、KOOS-PS（= 0.417）、KOOS-KRQOL（= 0.101）、VR-12-PCS（= 0.269）和VR-12-MCS（= 0.191）的1年中位数改善方面没有显著差异。除KOOS-KRQOL外，两个队列中达到MCID的比例在评估的PROMs中相似（每个PROMs均> 0.05）（非骨水泥型：= 313 [96.0%] 对骨水泥型：= 895 [92.7%]；= 0.036）。与骨水泥型TKA相比，非骨水泥型TKA在医疗资源利用、死亡率和1年PROM改善方面相似。TKA中的非骨水泥固定可能通过在生活质量方面更高的MCID改善提供价值。未来需要进行护理期间成本分析和长期生存率调查。
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