Institute of Physical Fitness, Sports Medicine and Rehabilitation, Aichi Medical University, Japan; Department of Rehabilitation, Aichi Medical University Hospital, Japan; Department of Orthopaedic Surgery, Aichi Medical University, Japan.
Department of Orthopaedic Surgery, Aichi Medical University, Japan.
J Orthop Sci. 2023 Nov;28(6):1311-1316. doi: 10.1016/j.jos.2022.09.010. Epub 2022 Oct 5.
Little attention has been focused on risk factors for undergoing bilateral total knee arthroplasty (TKA) after primary unilateral TKA among patients with knee osteoarthritis (OA). This study investigated the differences in characteristics between groups with and without additional TKA for the contralateral knee among patients with knee OA who underwent primary unilateral TKA.
Seventy-six patients who underwent primary unilateral TKA were included in this study. We defined patients who underwent additional TKA for the contralateral knee within one year of the primary TKA as a bilateral TKA group, and patients who did not undergo bilateral TKA as a unilateral TKA group. Femorotibial angle (FTA), percentage of mechanical axis (%MA), Kellgren-Lawrence (KL) grade, range of motion, Japan Orthopaedic Association (JOA) score, 10 m-walking time, C-reactive protein, estimated glomerular filtration rate, and serum albumin levels were selected as independent variables including covariates of age, sex, and body mass index for predicting bilateral TKA. We compared differences in variables between the two groups using the t-test or Mann-Whitney U-test and general linear models. A multivariate stepwise logistic regression model was also used to determine which variables correlated with bailateral TKA.
In pairwise comparisons, the KL grade, FTA, %MA, JOA score, and knee flexion angle in the contralateral knee were significantly worse in the bilateral TKA group than in the unilateral TKA group after controlling for covariates (P < 0.01, respectively). A stepwise logistic regression revealed that significant contributors to undergoing the contralateral TKA were FTA (OR = 1.47, P < 0.001) and knee flexion angle (OR = 0.96, P = 0.022) of the contralateral knee.
Severe varus deformity and limitations of flexion in the contralateral knee were found to be risk factors for undergoing additional TKA within one year of primary unilateral TKA among patients with knee OA.
在膝关节骨关节炎（OA）患者中，单侧初次全膝关节置换（TKA）后行双侧 TKA 的风险因素尚未得到充分关注。本研究旨在探讨单侧初次 TKA 后行对侧 TKA 的患者中，有和无对侧 TKA 的两组之间的特征差异。
本研究纳入了 76 例单侧初次 TKA 的患者。我们将在初次 TKA 后一年内对侧膝关节行 TKA 的患者定义为双侧 TKA 组，未行双侧 TKA 的患者定义为单侧 TKA 组。股胫角（FTA）、机械轴百分比（%MA）、Kellgren-Lawrence（KL）分级、关节活动度、日本矫形协会（JOA）评分、10 米步行时间、C 反应蛋白、估算肾小球滤过率和血清白蛋白水平被选为包括年龄、性别和体重指数在内的预测双侧 TKA 的独立变量。我们使用 t 检验或曼-惠特尼 U 检验和一般线性模型比较了两组之间变量的差异。还使用多变量逐步逻辑回归模型确定与双侧 TKA 相关的变量。
在配对比较中，在控制了协变量后，双侧 TKA 组的 KL 分级、FTA、%MA、JOA 评分和对侧膝关节的膝关节屈曲角度均明显差于单侧 TKA 组（P < 0.01，分别）。逐步逻辑回归显示，FTA（OR = 1.47，P < 0.001）和对侧膝关节的膝关节屈曲角度（OR = 0.96，P = 0.022）是行对侧 TKA 的显著因素。
在膝关节 OA 患者中，初次单侧 TKA 后 1 年内行对侧 TKA 的危险因素为严重的内翻畸形和对侧膝关节的屈曲受限。
