Yapp Liam Z, Clement Nick D, Moran Matthew, Clarke Jon V, Simpson A Hamish R W, Scott Chloe E H
Department of Orthopaedics, Division of Clinical and Surgical Sciences, University of Edinburgh, Edinburgh, UK.
Scottish Arthroplasty Project, NHS Public Health Scotland, Edinburgh, UK.
Bone Joint J. 2022 Dec;104-B(12):1313-1322. doi: 10.1302/0301-620X.104B12.BJJ-2021-1631.R3.
The aim of this study was to assess factors associated with the estimated lifetime risk of revision surgery after primary knee arthroplasty (KA).
All patients from the Scottish Arthroplasty Project dataset undergoing primary KA during the period 1 January 1998 to 31 December 2019 were included. The cumulative incidence function for revision and death was calculated up to 20 years. Adjusted analyses used cause-specific Cox regression modelling to determine the influence of patient factors. The lifetime risk was calculated as a percentage for patients aged between 45 and 99 years using multiple-decrement life table methodology.
The estimated lifetime risk of revision ranged between 32.7% (95% confidence interval (CI) 22.6 to 47.3) for patients aged 45 to 49 years and 0.6% (95% CI 0.1 to 4.5) for patients aged over 90 years. At 20 years, the overall cumulative incidence of revision (6.8% (95% CI 6.6 to 7.0)) was significantly less than that of death (66.3% (95% CI 65.4 to 67.1)). Adjusted analyses demonstrated converse effect of increasing age on risk of revision (hazard ratio (HR) 0.5 (95% CI 0.5 to 0.6)) and death (HR 3.6 (95% CI 3.4 to 3.7)). Male sex was associated with increased risks of revision (HR 1.1 (95% CI 1.1 to 1.2); p < 0.001) and death (HR 1.4 (95% CI 1.3 to 1.4); p < 0.001). Compared to patients undergoing primary KA for osteoarthritis, patients with inflammatory arthropathy had a higher risk of death (HR 1.7 (95% CI 1.7 to 1.8); p < 0.001), but were less likely to be revised (HR 0.9 (95% CI 0.7 to 1.0); p < 0.001). Patients with a greater number of comorbidities (HR 1.4 (95% CI 1.3 to 1.4)) and greater levels of socioeconomic deprivation (HR 1.4 (95% CI 1.4 to 1.5)) were at increased risk of death, but neither increased the risk of revision.
The estimated lifetime risk of revision KA varied depending on patient sex, age, and underlying diagnosis. Patients aged between 45 and 49 years had a one in three risk of undergoing revision surgery within their lifetime, which decreased with age to one in 159 in those aged 90 years or more.Cite this article: 2022;104-B(12):1313-1322.
本研究旨在评估与初次膝关节置换术（KA）后翻修手术的估计终生风险相关的因素。
纳入了苏格兰关节置换项目数据集中在1998年1月1日至2019年12月31日期间接受初次KA的所有患者。计算了截至20年的翻修和死亡累积发生率函数。采用特定病因的Cox回归模型进行校正分析，以确定患者因素的影响。使用多重递减生命表方法计算45至99岁患者的终生风险百分比。
45至49岁患者的翻修估计终生风险在32.7%（95%置信区间（CI）22.6至47.3）之间，90岁以上患者为0.6%（95%CI 0.1至4.5）。在20年时，翻修的总体累积发生率（6.8%（95%CI 6.6至7.0））显著低于死亡累积发生率（66.3%（95%CI 65.4至67.1））。校正分析表明，年龄增加对翻修风险（风险比（HR）0.5（95%CI 0.5至0.6））和死亡风险（HR 3.6（95%CI 3.4至3.7））有相反的影响。男性与翻修风险增加（HR 1.1（95%CI 1.1至1.2）；p<0.001）和死亡风险增加（HR 1.4（95%CI 1.3至1.4）；p<0.001）相关。与因骨关节炎接受初次KA的患者相比，炎性关节病患者的死亡风险更高（HR 1.7（95%CI 1.7至1.8）；p<0.001），但翻修的可能性较小（HR 0.9（95%CI 0.7至1.0）；p<0.001）。合并症数量较多（HR 1.4（95%CI 1.3至1.4））和社会经济剥夺程度较高（HR 1.4（95%CI 1.4至1.5））的患者死亡风险增加，但均未增加翻修风险。
翻修KA的估计终生风险因患者性别、年龄和基础诊断而异。45至49岁的患者一生中接受翻修手术的风险为三分之一，随着年龄增长，这一风险在90岁及以上患者中降至159分之一。引用本文：2022；104-B(12):1313-1322。
