Orthopaedic Research Unit, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Department of Clinical Research, University of Southern Denmark, Denmark; Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement, Copenhagen, Denmark.
Section for Surgical Pathophysiology, Rigshospitalet, Copenhagen, Denmark.
Knee. 2022 Jan;34:24-33. doi: 10.1016/j.knee.2021.09.001. Epub 2021 Dec 8.
Limited data exist on fast-track protocols in relation to revision knee arthroplasty. Hence, the aim of this study was to report length of stay (LOS), risk of LOS > 5 days and readmission ≤ 90 days after revision knee arthroplasty in centers with a well-established fast-track protocol in both primary and revision surgery.
An observational cohort study from the Centre for Fast-track Hip and Knee Replacement and the Danish Knee Arthroplasty Register. We included elective aseptic major component revision knee arthroplasties consecutively from 6 dedicated fast-track centers from 2010 to 2018.
1439 revision knee arthroplasties were analyzed, including 900 total revisions, 171 large partial revisions (revision of either femoral or tibia component) and 368 revisions of unicompartmental knee arthroplasty (UKA) to total knee arthroplasty (TKA). Mean age was 65 years (SD 10.9) and 66% were females. Mean LOS was 3.7 days (SD 3.9) in the study period, but decreased to 2.4 days (SD 1.3) in 2018. Risk factors for LOS > 5 days was ≥ 1 previous revision, use of walking aid, BMI > 35, ages < 50, 70-79 and ≥ 80 years, whereas revision of UKA to TKA and large partial revision were negatively associated. The 90-day readmission and mortality risk was 9.1% and 0.5%. Cardiac disease and use of walking aid were associated with increased risk of readmission ≤ 90 days.
Elective aseptic major component revision knee arthroplasty using similar fast-track protocols as in primary TKA is safe with short and decreasing LOS.
关于翻修膝关节置换术的快速通道方案，相关数据有限。因此，本研究旨在报告在初级和翻修手术中均建立了完善的快速通道方案的中心，翻修膝关节置换术后的住院时间（LOS）、LOS＞5 天的风险和 90 天内再入院率。
这是一项来自快速通道髋关节和膝关节置换中心以及丹麦膝关节置换登记处的观察性队列研究。我们连续纳入了 2010 年至 2018 年来自 6 个专门的快速通道中心的择期无菌大部件翻修膝关节置换术。
共分析了 1439 例翻修膝关节置换术，包括 900 例全膝关节翻修术、171 例大部分翻修术（股骨或胫骨部件翻修）和 368 例单髁膝关节置换术翻修为全膝关节置换术。患者的平均年龄为 65 岁（标准差 10.9），66%为女性。研究期间的平均 LOS 为 3.7 天（标准差 3.9），但在 2018 年降至 2.4 天（标准差 1.3）。LOS＞5 天的风险因素包括：≥1 次翻修、使用助行器、BMI＞35、年龄＜50、70-79 和≥80 岁，而翻修为 TKA 和大部分翻修与 LOS 减少呈负相关。90 天再入院率和死亡率分别为 9.1%和 0.5%。心脏疾病和使用助行器与 90 天内再入院风险增加相关。
使用与初次 TKA 相似的快速通道方案进行择期无菌大部件翻修膝关节置换术是安全的，LOS 短且呈下降趋势。
