Department of Public Health Sciences, Seoul National University, Seoul, South Korea.
Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea; Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, South Korea; CONNECTEVE, Co LTD, Seoul, South Korea.
J Arthroplasty. 2023 Aug;38(8):1470-1476.e1. doi: 10.1016/j.arth.2023.01.058. Epub 2023 Feb 9.
Total knee arthroplasty (TKA) and medications are both considered as a treatment for knee osteoarthritis. However, the impact of the TKA on long-term survival remains controversial. This study aimed to compare 9-year follow-up survival between a TKA group with a nonoperative medication group.
From 2007 to 2009, knee osteoarthritis patients were divided into TKA (N = 2,228) and nonoperative medication (N = 76,430) groups, and followed for up to 9 years. The hazard ratio (HR) and subdistribution HR (SHR) were derived from Cox proportional hazards regressions and Fine and Gray analyses, respectively.
The TKA group had a significantly lower adjusted mortality rate (adjusted HR , 0.78, 95% confidence interval [CI], 0.68-0.9) than the nonoperative medication group. Dose-response relationship between medication possession ratio and mortalities for overall (adjusted HR , 1.02; 95% CI, 1.01-1.04) and cardiovascular (CV) death (adjusted SHR, 1.03; 95% CI, 1.01-1.05) was also found. Also, there were significant interactions that indicate stronger protective survival effects of the TKA in several covariates: age >75 years (P = .04 for overall; P = .009 for CV), hypertension (P = .006 for overall), and ischemic heart disease (P = .009 for CV).
This study suggests that TKA patients had better mean 9-year follow-up survival than the nonoperative medication group after adjusting for baseline differences. For overall death, including CV death, adjusted mortality rates were higher in the medication group and showed a dose-response relationship. Specifically, the protective effect of the TKA for overall or CV deaths was found to be higher for age >75, hypertension, or ischemic heart disease patients.
III.
全膝关节置换术（TKA）和药物治疗均被认为是膝关节骨关节炎的治疗方法。然而，TKA 对长期生存的影响仍存在争议。本研究旨在比较 TKA 组与非手术药物治疗组 9 年随访的生存情况。
2007 年至 2009 年，将膝关节骨关节炎患者分为 TKA（N=2228）和非手术药物治疗（N=76430）组，随访时间最长 9 年。使用 Cox 比例风险回归和 Fine 和 Gray 分析分别得出风险比（HR）和亚分布 HR（SHR）。
TKA 组调整后的死亡率明显低于非手术药物治疗组（调整后的 HR，0.78，95%置信区间[CI]，0.68-0.9）。药物持有率与总体死亡率（调整后的 HR，1.02；95%CI，1.01-1.04）和心血管（CV）死亡（调整后的 SHR，1.03；95%CI，1.01-1.05）之间也存在剂量-反应关系。此外，还存在显著的交互作用，表明 TKA 在几个协变量下具有更强的保护生存效应：年龄>75 岁（总体：P=0.04；CV：P=0.009）、高血压（总体：P=0.006）和缺血性心脏病（CV：P=0.009）。
本研究表明，在调整基线差异后，TKA 患者在 9 年的平均随访中比非手术药物治疗组有更好的生存。对于包括 CV 死亡在内的总死亡，药物治疗组的调整死亡率更高，且存在剂量-反应关系。具体来说，对于年龄>75 岁、高血压或缺血性心脏病患者，TKA 对总体或 CV 死亡的保护作用更高。
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