全踝关节置换与踝关节融合术的两年翻修率：基于纽约州和加利福尼亚州人群的倾向评分匹配比较
Two-Year Revision Rates in Total Ankle Replacement Versus Ankle Arthrodesis: A Population-Based Propensity-Score-Matched Comparison from New York State and California.
作者信息
Randsborg Per-Henrik, Jiang Hongying, Mao Jialin, Devlin Vincent, Marinac-Dabic Danica, Peat Raquel, Sedrakyan Art
机构信息
Department of Orthopedic Surgery, Akershus University Hospital, Lørenskog, Norway.
Office of Product Evaluation and Quality (OPEQ), U.S. Food and Drug Administration (FDA), Silver Spring, Maryland.
出版信息
JB JS Open Access. 2022 Apr 4;7(2). doi: 10.2106/JBJS.OA.21.00136. eCollection 2022 Apr-Jun.
UNLABELLED
The aim of this study was to compare outcomes between total ankle replacement (TAR) and ankle arthrodesis (AA) for ankle osteoarthritis using real-world data.
METHODS
We used longitudinal claims data from New York State from October 2015 to December 2018, and from California from October 2015 to December 2017. The primary outcome was revision. Secondary outcomes were in-hospital complications and below-the-knee amputation. Propensity-score matching adjusted for differences in baseline characteristics. To determine predictors of the main outcome, each group was analyzed using multivariable Cox regressions.
RESULTS
There were 1,477 TAR procedures (50.2%) and 1,468 AA procedures (49.8%). Patients undergoing TAR were less likely to belong to a minority group and had fewer comorbidities compared with those undergoing AA. Crude analyses indicated that the TAR group had a lower risk of revision (5.4% versus 9.1%), in-hospital complications (<1% versus 1.8%), and below-the-knee amputation (<1% versus 4.9%) (p < 0.001 for all). However, in the propensity-score-matched analysis, the risk of revision was no longer significantly lower (TAR, 5.6% versus AA, 7.6%; p = 0.16). In the multivariable analyses, older age was predictive of a lower risk of revision after TAR (hazard ratio [HR], 0.96 [95% confidence interval (CI), 0.93 to 1.00]), but age was not predictive of revision after AA (HR, 0.99 [95% CI, 0.97 to 1.01]). Female patients were less likely to undergo revision after AA (HR, 0.61 [95% CI, 0.39 to 0.96]), but sex was not predictive of revision after TAR (HR, 0.90 [95% CI, 0.51 to 1.60]).
CONCLUSIONS
The 2-year adjusted revision risk was 5.6% after TAR and 7.6% after AA. This difference did not reach significance. Older age was a predictor of lower revision risk after TAR. Men had a higher risk of revision than women after AA. The number of TAR procedures has now caught up with the number of AA procedures.
LEVEL OF EVIDENCE
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
未标注
本研究旨在使用真实世界数据比较全踝关节置换术（TAR）和踝关节融合术（AA）治疗踝关节骨关节炎的疗效。
方法
我们使用了2015年10月至2018年12月纽约州以及2015年10月至2017年12月加利福尼亚州的纵向索赔数据。主要结局是翻修。次要结局是住院并发症和膝下截肢。倾向评分匹配用于调整基线特征的差异。为了确定主要结局的预测因素，对每组进行多变量Cox回归分析。
结果
共进行了1477例TAR手术（50.2%）和1468例AA手术（49.8%）。与接受AA手术的患者相比，接受TAR手术的患者属于少数群体的可能性较小，合并症也较少。粗分析表明，TAR组翻修风险较低（5.4%对9.1%）、住院并发症较少（<1%对1.8%）以及膝下截肢较少（<1%对4.9%）（所有p<0.001）。然而，在倾向评分匹配分析中，TAR组的翻修风险不再显著较低（TAR为5.6%，AA为7.6%；p=0.16）。在多变量分析中，年龄较大是TAR术后翻修风险较低的预测因素（风险比[HR]，0.96[95%置信区间（CI），0.93至1.00]），但年龄不是AA术后翻修的预测因素（HR，0.99[95%CI，0.97至1.01]）。女性患者AA术后翻修的可能性较小（HR，0.61[95%CI，0.39至0.96]），但性别不是TAR术后翻修的预测因素（HR，0.90[95%CI，0.51至1.60]）。
结论
TAR术后2年调整后的翻修风险为5.6%，AA术后为7.6%。这种差异未达到显著水平。年龄较大是TAR术后翻修风险较低的预测因素。AA术后男性翻修风险高于女性。现在TAR手术的数量已赶上AA手术的数量。
证据水平
治疗性III级。有关证据水平的完整描述，请参阅作者指南。
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