Department of Orthopaedics, Toowoomba Hospital, Toowoomba, Australia.
Eastern Health Clinical School, Monash University, Melbourne, Australia.
Bone Joint J. 2022 Jul;104-B(7):894-901. doi: 10.1302/0301-620X.104B7.BJJ-2021-1136.R3.
The aim of this study was to investigate the rate of revision for distal femoral arthroplasty (DFA) performed as a primary procedure for native knee fractures using data from the Australian Orthopaedic Association National Joint Arthroplasty Registry (AOANJRR).
Data from the AOANJRR were obtained for DFA performed as primary procedures for native knee fractures from 1 September 1999 to 31 December 2020. Pathological fractures and revision for failed internal fixation were excluded. The five prostheses identified were the Global Modular Arthroplasty System, the Modular Arthroplasty System, the Modular Universal Tumour And Revision System, the Orthopaedic Salvage System, and the Segmental System. Patient demographic data (age, sex, and American Society of Anesthesiologists grade) were obtained, where available. Kaplan-Meier estimates of survival were used to determine the rate of revision, and the reasons for revision and mortality data were examined.
The AOANJRR identified 153 primary DFAs performed for native knee fractures in 151 patients during the study period, with 63.3% of these (n = 97) performed within the last five years. The median follow-up was 2.1 years (interquartile range 0.8 to 4.4). The patient population was 84.8% female (n = 128), with a mean age of 76.1 years (SD 11.9). The cumulative percent revision rate at three years was 10%. The most common reason for revision was loosening, followed by infection. Patient survival at one year was 87.5%, decreasing to 72.8% at three years postoperatively.
The use of DFA to treat native knee fractures is increasing, with 63.3% of cases performed within the last five years. While long-term data are not available, the results of this study suggest that DFA may be a reasonable option for elderly patients with native knee fractures where fixation is not feasible, or for whom prolonged non-weightbearing may be detrimental. Cite this article: 2022;104-B(7):894-901.
本研究旨在通过澳大利亚矫形协会全国关节置换登记处（AOANJRR）的数据，调查因原发性膝关节骨折行股骨远端置换术（DFA）的翻修率。
从 1999 年 9 月 1 日至 2020 年 12 月 31 日，从 AOANJRR 中获取因原发性膝关节骨折行 DFA 的病例数据。排除病理性骨折和内固定失败的翻修病例。所确定的 5 种假体分别是全球模块化关节置换系统、模块化关节置换系统、模块化通用肿瘤和翻修系统、矫形挽救系统和节段式系统。如果有，获取患者的人口统计学数据（年龄、性别和美国麻醉医师协会分级）。使用 Kaplan-Meier 生存估计来确定翻修率，并检查翻修和死亡率的原因。
AOANJRR 在研究期间确定了 151 例患者的 153 例原发性 DFA 用于治疗原发性膝关节骨折，其中 63.3%（n=97）在过去 5 年内进行。中位随访时间为 2.1 年（四分位间距 0.8 至 4.4）。患者人群中 84.8%为女性（n=128），平均年龄为 76.1 岁（标准差 11.9）。3 年时的累积翻修率为 10%。最常见的翻修原因是松动，其次是感染。1 年时患者的生存率为 87.5%，术后 3 年时降至 72.8%。
因原发性膝关节骨折而行 DFA 的使用率正在增加，其中 63.3%的病例是在过去 5 年内进行的。虽然目前还没有长期数据，但本研究结果表明，DFA 可能是一种合理的选择，适用于固定不可行或长期非负重可能有害的老年原发性膝关节骨折患者。
2022;104-B(7):894-901.
