Department of Orthopedic Surgery, Chonnam National University Medical School and Hwasun Hospital, 322 Seoyang-Ro, Hwasun-Eup, Hwasun-Gun, Jeollanam-Do, Republic of Korea.
College of Natural Science, School of Statistics, University of Seoul, Seoul, Republic of Korea.
Arch Orthop Trauma Surg. 2023 Aug;143(8):4721-4729. doi: 10.1007/s00402-023-04773-6. Epub 2023 Jan 19.
Although the survival rate of total knee arthroplasty (TKA) in patients treated with anterior cruciate ligament reconstruction (ACLR) is not as favorable as that in patients treated with primary TKA without ligament reconstruction, the exact survival rates and complications associated with these procedures are still controversial. Therefore, the purpose of the current study was to compare the revision rates of TKA in patients with knee osteoarthritis (OA) with a previous ACLR and those of patients with primary TKA with no history of knee surgery by using propensity score matching analysis.
A list of patients who underwent TKA from January 1, 2008 to May 31, 2019 was obtained from the Korean National Health Insurance database. Among these, 460 patients underwent TKA in a knee with a previous ACLR and 569,766 patients who underwent primary TKA due to degenerative OA. We performed propensity scoring matching to compare the revision rates including septic revision due to prosthetic joint infection after TKA and perioperative complication rates within 90 days after revision TKA between the two groups.
Matched patients were assigned to one of the two groups (group A: 2,201 patients who underwent TKA due to primary OA, group B: 448 patients who underwent TKA in a knee with a previous ACLR) based on the propensity score. The total number of revisions per 1000 person-years was significantly higher in group B than in group A (10.16 vs 4.66, respectively). Group B showed a higher risk of revision than group A at 10 years post-TKA (hazard ratio: 2.49, 95% confidence interval: 1.30-4.77). However, group B showed a similar risk of septic revision as group A (p = 0.44). Perioperative complications within 90 days after TKA showed no significant differences between the groups.
Surgeons should be aware of the relatively higher revision rate of TKA in patients who had previously undergone an ACLR compared to that in patients who underwent primary TKA.
虽然接受前交叉韧带重建术 (ACLR) 治疗的全膝关节置换术 (TKA) 患者的生存率不如未接受韧带重建的原发性 TKA 患者，但这些手术的确切生存率和相关并发症仍存在争议。因此，本研究旨在通过倾向评分匹配分析比较膝关节骨性关节炎 (OA) 患者既往 ACLR 与原发性 TKA 无膝关节手术史患者的 TKA 翻修率。
从韩国国家健康保险数据库中获取了 2008 年 1 月 1 日至 2019 年 5 月 31 日期间接受 TKA 的患者名单。其中，460 例患者在膝关节接受 ACLR 后接受 TKA，569766 例患者因退行性 OA 接受原发性 TKA。我们进行了倾向评分匹配，以比较两组患者 TKA 后因人工关节感染导致的感染性翻修率以及翻修后 90 天内的围手术期并发症发生率。
根据倾向评分，将匹配的患者分配到两组中的一组（A 组：2201 例因原发性 OA 接受 TKA，B 组：448 例在膝关节接受 ACLR 后接受 TKA）。B 组的每 1000 人年翻修率明显高于 A 组（分别为 10.16 和 4.66）。与 A 组相比，B 组在 TKA 后 10 年翻修的风险更高（风险比：2.49，95%置信区间：1.30-4.77）。然而，B 组的感染性翻修风险与 A 组相似（p=0.44）。TKA 后 90 天内的围手术期并发症两组间无显著差异。
与原发性 TKA 患者相比，接受过 ACLR 的患者 TKA 的翻修率相对较高，外科医生应注意这一点。
