Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia.
Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia; Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
J Arthroplasty. 2023 Sep;38(9):1748-1753.e1. doi: 10.1016/j.arth.2023.03.070. Epub 2023 Mar 31.
Literature regarding total knee arthroplasty (TKA) outcomes in sickle cell disease (SCD) is limited. Moreover, 10-year survivorship of SCD implants is unknown. This study aimed to observe 10-year cumulative incidence and indications for revision TKA in patients who did and did not have SCD.
Patients who underwent primary TKA were identified using a large national database. The SCD patients were matched by age, sex, and a comorbidity index to a control cohort in a 1:4 ratio. The 10-year cumulative incidence rates were determined using Kaplan-Meier survival analyses. Multivariable analyses were conducted using Cox proportional hazard modeling. Chi-squared analyses were conducted to compare indications for revision between cohorts. In total, 1,010 SCD patients were identified, 100,000 patients included in the unmatched control, and 4,020 patients included in the matched control.
Compared to the unmatched control cohort, SCD patients exhibited higher 10-year all-cause revision (HR: 1.86; P < .001) with higher proportions of revisions for periprosthetic joint infection (PJI) (P < .001), aseptic loosening (P < .001), and hematoma (P < .001). Compared to the matched control, SCD patients had higher 10-year all-cause revision (Hazard Ratio (HR): 1.39; P = .034) with a higher proportion of revisions for PJI (P = .044), aseptic loosening (P = .003), and hematoma (P = .019).
Independent of other comorbidities, SCD patients are more likely to undergo revisions for PJI, aseptic loosening, and hematoma compared to patients who do not have SCD. Due to the high-risk of these complications, perioperative and postoperative surgical optimization should be enforced in SCD patients.
镰状细胞病（SCD）患者行全膝关节置换术（TKA）的相关文献有限，SCD 植入物的 10 年生存率也尚不清楚。本研究旨在观察 SCD 患者与非 SCD 患者行 TKA 翻修的 10 年累积发生率和翻修指征。
使用大型国家数据库确定行初次 TKA 的患者。SCD 患者按年龄、性别和合并症指数与对照组 1:4 匹配。采用 Kaplan-Meier 生存分析确定 10 年累积发生率。采用 Cox 比例风险模型进行多变量分析。采用卡方检验比较两组的翻修指征。共纳入 1010 例 SCD 患者，100000 例未匹配的对照组患者和 4020 例匹配的对照组患者。
与未匹配的对照组相比，SCD 患者的全因翻修 10 年累积发生率更高（HR：1.86；P<0.001），其中因假体周围关节感染（PJI）（P<0.001）、无菌性松动（P<0.001）和血肿（P<0.001）行翻修的比例更高。与匹配的对照组相比，SCD 患者的全因翻修 10 年累积发生率更高（HR：1.39；P=0.034），因 PJI（P=0.044）、无菌性松动（P=0.003）和血肿（P=0.019）行翻修的比例更高。
与无 SCD 的患者相比，SCD 患者即使在考虑其他合并症的情况下，更有可能因 PJI、无菌性松动和血肿而行翻修。由于这些并发症的风险较高，应在 SCD 患者中加强围手术期和术后手术优化。
