同期双侧全膝关节置换与单侧全膝关节置换的比较研究。
Same-day bilateral total knee replacement versus unilateral total knee replacement: A comparative study.
机构信息
Service de Chirurgie Orthopédique-Traumatologique-Chirurgie Vertébrale, Institut Universitaire Locomoteur et du Sport, CHU de Nice, Hôpital Pasteur 2, 30, voie Romaine, 06100 Nice, France.
Institut de Chirurgie Réparatrice Locomoteur & Sports, Groupe Kantys, 7, avenue Durante, 06000 Nice, France.
出版信息
Orthop Traumatol Surg Res. 2022 Dec;108(8):103301. doi: 10.1016/j.otsr.2022.103301. Epub 2022 May 1.
INTRODUCTION
Bilateral total knee arthroplasty (TKA) in a single session is rarely done in France, mainly due to the increased risk of perioperative and late complications. The primary objective of this study was to compare the complication rates of same-day bilateral TKA (TKA bilat) with that of unilateral TKA (TKA unilat). The hypothesis was bilateral TKA increases the rate of early and late complications in a group of selected patients (ASA 1 or 2, less than 80 years of age).
MATERIAL AND METHODS
Retrospective comparative study of 91 bilat TKA and 182 unilat TKA cases operated on between 2009 and 2016 (1 bilat TKA paired with 2 controls). The patients were matched based on age, sex, indication and ASA score. The minimum follow-up was 2 years. Mortality along with early and late complications were documented. The secondary endpoints were implant survival, functional outcomes, and patient satisfaction.
RESULTS
The early mortality rate was zero in both groups. The early complication rate was lower in the bilat TKA group (9%) than in the unilat TKA group (22%) (p<0.001). The late complications did not differ between groups. Implant survival at 5 years was 99% (95% CI=[95.6-99.7]) in the bilat TKA group and 97% (95% CI=[92.8-98.8]) in the unilat TKA group. The autologous blood transfusion rate was 33% in the bilat TKA group and 2.2% in the unilat TKA group (p<0.001). There was no difference between groups in the satisfaction rate or the KOOS and New IKS scores. A larger share of patients in the unilat TKA group (54%) said they had forgotten about their knee than in the bilat TKA group (43%) (p=0.036).
DISCUSSION
There were few early complications in the bilat TKA group. There was no significant difference in the number of late complications, survival, functional scores, or patient satisfaction between the two groups. The transfusion rate was higher in the bilat TKA group, while the forgotten knee rate was higher in the unilat TKA group.
CONCLUSION
Our hypothesis was not confirmed: in the context of this study, in patients who are ASA 1 or 2, and less than 80 years old, same-day bilateral TKA does not increase the complication rate relative to unilateral TKA.
LEVEL OF EVIDENCE
III, comparative study of continuous paired cases.
简介
在法国，同期双侧全膝关节置换术（TKA）很少进行，主要是因为围手术期和晚期并发症的风险增加。本研究的主要目的是比较同期双侧全膝关节置换术（TKA 双侧）与单侧全膝关节置换术（TKA 单侧）的并发症发生率。假设是在一组选定的患者（ASA 1 或 2 级，年龄小于 80 岁）中，双侧 TKA 会增加早期和晚期并发症的发生率。
材料和方法
回顾性比较了 2009 年至 2016 年间进行的 91 例双侧 TKA 和 182 例单侧 TKA 病例（1 例双侧 TKA 配对 2 例对照）。患者根据年龄、性别、适应证和 ASA 评分进行匹配。最低随访时间为 2 年。记录死亡率以及早期和晚期并发症。次要终点为假体生存率、功能结果和患者满意度。
结果
两组的早期死亡率均为零。双侧 TKA 组的早期并发症发生率（9%）低于单侧 TKA 组（22%）（p<0.001）。两组晚期并发症无差异。双侧 TKA 组 5 年假体生存率为 99%（95%CI=[95.6-99.7]），单侧 TKA 组为 97%（95%CI=[92.8-98.8]）。双侧 TKA 组自体输血率为 33%，单侧 TKA 组为 2.2%（p<0.001）。两组在满意度或 KOOS 和新 IKS 评分方面无差异。单侧 TKA 组（54%）有更多的患者表示他们已经忘记了自己的膝盖，而双侧 TKA 组（43%）则较少（p=0.036）。
讨论
双侧 TKA 组早期并发症较少。两组间晚期并发症、生存率、功能评分或患者满意度无显著差异。双侧 TKA 组输血率较高，单侧 TKA 组“忘记膝盖”率较高。
结论
我们的假设未得到证实：在本研究中，对于 ASA 1 或 2 级且年龄小于 80 岁的患者，同期双侧 TKA 并不会增加与单侧 TKA 相比的并发症发生率。
证据等级
III 级，连续配对病例的比较研究。
Zotero 插件