Clement Nick D, Avery Peter, Mason James, Baker Paul N, Deehan David J
Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.
School of Mathematics, Statistics and Physics, Newcastle University, Newcastle upon Tyne, UK.
Bone Joint J. 2023 Jan;105-B(1):47-55. doi: 10.1302/0301-620X.105B1.BJJ-2022-0522.R1.
The aim of this study was to identify variables associated with time to revision, demographic details associated with revision indication, and type of prosthesis employed, and to describe the survival of hinge knee arthroplasty (HKA) when used for first-time knee revision surgery and factors that were associated with re-revision.
Patient demographic details, BMI, American Society of Anesthesiologists (ASA) grade, indication for revision, surgical approach, surgeon grade, implant type (fixed and rotating), time of revision from primary implantation, and re-revision if undertaken were obtained from the National Joint Registry data for England, Wales, Northern Ireland, and the Isle of Man over an 18-year period (2003 to 2021).
There were 3,855 patient episodes analyzed with a median age of 73 years (interquartile range (IQR) 66 to 80), and the majority were female (n = 2,480, 64.3%). The median time to revision from primary knee arthroplasty was 1,219 days (IQR 579 to 2,422). Younger age (p < 0.001), decreasing ASA grade (p < 0.001), and indications for revision of sepsis (p < 0.001), unexplained pain (p < 0.001), non-polyethylene wear (p < 0.001), and malalignment (p < 0.001) were all associated with an earlier time to revision from primary implantation. The median follow-up was 4.56 years (range 0.00 to 17.52), during which there were 410 re-revisions. The overall unadjusted probability of re-revision for all revision HKAs at one, five, and ten years after surgery were 2.7% (95% confidence interval (CI) 2.2 to 3.3), 10.7% (95% CI 9.6 to 11.9), and 16.2% (95% CI 14.5 to 17.9), respectively. Male sex (p < 0.001), younger age (p < 0.001), revision for septic indications (p < 0.001) or implant fracture (p = 0.010), a fixed hinge (p < 0.001), or surgery performed by a non-consultant grade (p = 0.023) were independently associated with an increased risk of re-revision.
There were several factors associated with time to first revision. The re-revision rate was 16.2% at ten years; however, the risk factors associated with an increased risk of re-revision could be used to counsel patients regarding their outcome.Cite this article: 2023;105-B(1):47-55.
本研究旨在确定与翻修时间相关的变量、与翻修指征相关的人口统计学细节以及所使用的假体类型，并描述铰链式膝关节置换术（HKA）用于初次膝关节翻修手术时的生存率以及与再次翻修相关的因素。
从英格兰、威尔士、北爱尔兰和马恩岛的国家关节注册数据中获取患者的人口统计学细节、体重指数（BMI）、美国麻醉医师协会（ASA）分级、翻修指征、手术入路、外科医生级别、植入物类型（固定和旋转）、初次植入后翻修的时间以及是否进行再次翻修，时间跨度为18年（2003年至2021年）。
共分析了3855例患者，中位年龄为73岁（四分位间距（IQR）为66至80岁），大多数为女性（n = 2480，64.3%）。初次膝关节置换术后至翻修的中位时间为1219天（IQR为579至2422天）。年龄较小（p < 0.001）、ASA分级降低（p < 0.001）以及败血症翻修指征（p < 0.001）、不明原因疼痛（p < 0.001）、非聚乙烯磨损（p < 0.001）和对线不良（p < 0.001）均与初次植入后较早的翻修时间相关。中位随访时间为4.56年（范围为0.00至17.52年），在此期间有410例再次翻修。所有翻修的HKA在术后1年、5年和10年的总体未调整再次翻修概率分别为2.7%（95%置信区间（CI）为2.2至3.3）、10.7%（95%CI为9.6至11.9）和16.2%（95%CI为14.5至17.9）。男性（p < 0.001）、年龄较小（p < 0.001）、因败血症指征（p < 0.001）或植入物骨折（p = 0.010）进行翻修、固定铰链（p < 0.001）或由非顾问级别外科医生进行手术（p = 0.023）与再次翻修风险增加独立相关。
有几个因素与初次翻修时间相关。10年时再次翻修率为16.2%；然而，与再次翻修风险增加相关的危险因素可用于向患者提供关于其预后的咨询。引用本文：2023；105 - B(1):47 - 55。
