患者和假体特征对全膝关节置换翻修常见原因的影响：来自澳大利亚、瑞典和美国的 36626 例翻修病例的注册研究。
Impact of patient and prosthesis characteristics on common reasons for total knee replacement revision: a registry study of 36,626 revision cases from Australia, Sweden, and USA.
机构信息
Australian Orthopaedic Association National Joint Replacement Registry, South Australian Health and Medical Research Institute, Adelaide, South Australia; Department of Orthopedics, Clinical Science Lund, Faculty of Medicine, Lund University, Lund, Sweden.
Swedish Knee Arthroplasty Register, Lund, Sweden; Department of Orthopedics, Clinical Science Lund, Faculty of Medicine, Lund University, Lund, Sweden.
出版信息
Acta Orthop. 2022 Jul 5;93:623-633. doi: 10.2340/17453674.2022.3512.
BACKGROUND AND PURPOSE
Total knee replacement (TKR) studies usually analyze all-cause revision when considering relationships with patient and prosthesis factors. We studied how these factors impact different revision diagnoses.
PATIENTS AND METHODS
We used data from 2003 to 2019 of TKR for osteoarthritis from the arthroplasty registries of Sweden, Australia, and Kaiser Permanente, USA to study patient and prosthesis characteristics for specific revision diagnoses. There were 1,072,924 primary TKR included and 36,626 were revised. Factors studied included age, sex, prosthesis constraint, fixation method, bearing mobility, polyethylene type, and patellar component use. Revision diagnoses were arthrofibrosis, fracture, infection, instability, loosening, pain, patellar reasons, and wear. Odds ratios (ORs) for revision were estimated and summary effects were calculated using a meta-analytic approach.
RESULTS
We found between-registry consistency in 15 factor/reason analyses. Risk factors for revision for arthrofibrosis were age < 65 years (OR 2.0; 95% CI 1.4-2.7) and mobile bearing designs (MB) (OR 1.7; CI 1.1-2.5), for fracture were female sex (OR 3.2; CI 2.2-4.8), age ≥ 65 years (OR 2.8; CI 1.9-4) and posterior stabilized prostheses (PS) (OR 2.1; CI 1.3-3.5), for infection were male sex (OR 1.9; CI 1.7-2.0) and PS (OR 1.5; CI 1.2-1.8), for instability were age < 65 years (OR 1.5; CI 1.3-1.8) and MB (OR 1.5; CI 1.1-2.2), for loosening were PS (OR 1.5; CI 1.4-1.6), MB (OR 2.2; CI 1.6-3.0) and use of ultra-high molecular weight polyethylene (OR 2.3; CI 1.8-2.9), for patellar reasons were not resurfacing the patella (OR 13.6; CI 2.1-87.2) and MB (OR 2.0; CI 1.2-3.3) and for wear was cementless fixation (OR 4.9; CI 4.3-5.5).
INTERPRETATION
Patients could be counselled regarding specific age and sex risks. Use of minimally stabilized, fixed bearing, cemented prostheses, and patellar components is encouraged to minimize revision risk.
背景与目的
全膝关节置换术（TKR）研究在考虑患者和假体因素与关系时，通常分析所有原因的翻修。我们研究了这些因素如何影响不同的翻修诊断。
患者与方法
我们使用了来自瑞典、澳大利亚和美国 Kaiser Permanente 的关节置换登记处的 2003 年至 2019 年的 TKR 数据，研究了特定翻修诊断的患者和假体特征。共有 1,072,924 例初次 TKR 纳入研究，其中 36,626 例进行了翻修。研究的因素包括年龄、性别、假体约束、固定方法、轴承活动度、聚乙烯类型和髌骨组件的使用。翻修诊断为关节纤维粘连、骨折、感染、不稳定、松动、疼痛、髌骨原因和磨损。使用 meta 分析方法估计了翻修的优势比（OR）并计算了汇总效应。
结果
我们在 15 项因素/原因分析中发现了不同登记处之间的一致性。关节纤维粘连翻修的危险因素包括年龄<65 岁（OR 2.0；95%CI 1.4-2.7）和活动轴承设计（MB）（OR 1.7；CI 1.1-2.5），骨折的危险因素为女性（OR 3.2；CI 2.2-4.8），年龄≥65 岁（OR 2.8；CI 1.9-4）和后稳定假体（PS）（OR 2.1；CI 1.3-3.5），感染的危险因素为男性（OR 1.9；CI 1.7-2.0）和 PS（OR 1.5；CI 1.2-1.8），不稳定的危险因素为年龄<65 岁（OR 1.5；CI 1.3-1.8）和 MB（OR 1.5；CI 1.1-2.2），松动的危险因素为 PS（OR 1.5；CI 1.4-1.6）、MB（OR 2.2；CI 1.6-3.0）和使用超高分子量聚乙烯（OR 2.3；CI 1.8-2.9），髌骨原因的危险因素为不覆盖髌骨（OR 13.6；CI 2.1-87.2）和 MB（OR 2.0；CI 1.2-3.3），磨损的危险因素为非骨水泥固定（OR 4.9；CI 4.3-5.5）。
结论
可以针对特定的年龄和性别风险对患者进行咨询。鼓励使用最小化稳定、固定轴承、骨水泥固定假体和髌骨组件，以最大程度降低翻修风险。
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