Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.
NIHR Leeds Biomedical Research Centre, Leeds, UK.
Bone Joint J. 2022 Jan;104-B(1):59-67. doi: 10.1302/0301-620X.104B1.BJJ-2021-0032.R2.
The aim of this study was to conduct a cross-sectional, observational cohort study of patients presenting for revision of a total hip, or total or unicompartmental knee arthroplasty, to understand current routes to revision surgery and explore differences in symptoms, healthcare use, reason for revision, and the revision surgery (surgical time, components, length of stay) between patients having regular follow-up and those without.
Data were collected from participants and medical records for the 12 months prior to revision. Patients with previous revision, metal-on-metal articulations, or hip hemiarthroplasty were excluded. Participants were retrospectively classified as 'Planned' or 'Unplanned' revision. Multilevel regression and propensity score matching were used to compare the two groups.
Data were analyzed from 568 patients, recruited in 38 UK secondary care sites between October 2017 and October 2018 (43.5% male; mean (SD) age 71.86 years (9.93); 305 hips, 263 knees). No significant inclusion differences were identified between the two groups. For hip revision, time to revision > ten years (odds ratio (OR) 3.804, 95% confidence interval (CI) (1.353 to 10.694), p = 0.011), periprosthetic fracture (OR 20.309, 95% CI (4.574 to 90.179), p < 0.001), and dislocation (OR 12.953, 95% CI (4.014 to 41.794), p < 0.001), were associated with unplanned revision. For knee, there were no associations with route to revision. Revision after ten years was more likely for those who were younger at primary surgery, regardless of route to revision. No significant differences in cost outcomes, length of surgery time, and access to a health professional in the year prior to revision were found between the two groups. When periprosthetic fractures, dislocations, and infections were excluded, healthcare use was significantly higher in the unplanned revision group.
Differences between characteristics for patients presenting for planned and unplanned revision are minimal. Although there was greater healthcare use in those having unplanned revision, it appears unlikely that routine orthopaedic review would have detected many of these issues. It may be safe to disinvest in standard follow-up provided there is rapid access to orthopaedic review. Cite this article: 2022;104-B(1):59-67.
本研究旨在对因全髋关节置换术、全膝关节置换术或单髁膝关节置换术而进行翻修的患者进行横断面、观察性队列研究，以了解当前翻修手术的途径，并探讨接受常规随访的患者与未接受常规随访的患者之间在症状、医疗保健利用、翻修原因和翻修手术（手术时间、假体类型、住院时间）方面的差异。
从参与者和病历中收集了翻修前 12 个月的数据。排除了有既往翻修、金属对金属关节和髋关节半髋关节置换术的患者。患者被回顾性地分为“计划”或“非计划”翻修。采用多水平回归和倾向评分匹配来比较两组。
分析了 2017 年 10 月至 2018 年 10 月在英国 38 个二级护理站点招募的 568 名患者的数据（43.5%为男性；平均（SD）年龄 71.86 岁（9.93）；305 髋，263 膝）。两组之间没有显著的纳入差异。对于髋关节翻修，翻修时间超过十年（比值比（OR）3.804，95%置信区间（CI）（1.353 至 10.694），p=0.011）、假体周围骨折（OR 20.309，95%CI（4.574 至 90.179），p<0.001）和脱位（OR 12.953，95%CI（4.014 至 41.794），p<0.001）与非计划翻修有关。对于膝关节，与翻修途径无关。无论翻修途径如何，初次手术时年龄较小的患者更有可能在十年后进行翻修。在翻修前一年，两组之间在手术时间、手术时间、术前一年获得卫生保健专业人员的机会方面没有显著的成本结果差异。当排除假体周围骨折、脱位和感染后，非计划翻修组的医疗保健利用率显著更高。
计划翻修和非计划翻修患者的特征差异很小。尽管非计划翻修组的医疗保健利用率更高，但似乎常规矫形复查不太可能发现这些问题。只要能够快速获得矫形科的复查，减少对标准随访的投资可能是安全的。 引用本文：2022；104-B（1）：59-67。
