Fiedler Benjamin, Bieganowski Thomas, Anil Utkarsh, Lin Charles C, Habibi Akram A, Schwarzkopf Ran
Department of Orthopedic Surgery, NYU Langone Orthopedic Center, NYU Langone Health, 301 East 17th Street, 14th Floor, New York, NY, USA.
Eur J Orthop Surg Traumatol. 2023 Dec;33(8):3395-3401. doi: 10.1007/s00590-023-03562-6. Epub 2023 May 4.
The purpose of the current study was to determine if differences exist between cruciate-retaining (CR) and posterior-stabilized (PS) implant articulations for total knee arthroplasty (TKA) with regards to early post-operative pain.
We retrospectively reviewed patients who underwent primary TKA, with the same TKA implant design, at our institution between January 2018 and July 2021. Patients were stratified based on whether they received a CR or non-constrained PS (PSnC) articulation and propensity score matched in a 1:1 ratio. A sub-analysis matching patient who received a constrained PS implant (PSC) to those undergoing CR TKA and PSnC TKA was also carried out. Opioid dosages were converted to morphine milligram equivalents (MME).
616 patients after CR TKA were matched 1:1 to 616 patients with a PSnC implant. There were no significant differences between demographic variables. There were no statistically significant differences in opioid usage measured by MME on post-operative day (POD) 0 (p = 0.171), POD1 (p = 0.839), POD2 (p = 0.307), or POD3 (p = 0.138); VAS pain scores (p = 0.175); or 90-day readmission rate for pain (p = 0.654). A sub-analysis of CR versus PSC TKA demonstrated no significant differences in opioid usage on POD0 (p = 0.765), POD1 (p = 0.747), POD2 (p = 0.564), POD3 (p = 0.309); VAS pain scores (p = 0.293); and 90-day readmission rate for pain (p > 0.9).
Our analysis demonstrated no significant difference in post-operative VAS pain scores and MME usage based on implant. The results suggest that neither the type of articulation or constraint used for primary TKA has a significant impact on immediate post-operative pain and opioid consumption.
Retrospective Cohort Study.
本研究的目的是确定全膝关节置换术（TKA）中保留交叉韧带（CR）和后稳定型（PS）植入物关节在术后早期疼痛方面是否存在差异。
我们回顾性分析了2018年1月至2021年7月在我院接受初次TKA且采用相同TKA植入物设计的患者。根据患者接受的是CR关节还是非限制性PS（PSnC）关节进行分层，并按1:1的比例进行倾向评分匹配。还对接受限制性PS植入物（PSC）的患者与接受CR TKA和PSnC TKA的患者进行了亚分析匹配。阿片类药物剂量转换为吗啡毫克当量（MME）。
616例CR TKA患者与616例PSnC植入物患者进行了1:1匹配。人口统计学变量之间无显著差异。术后第0天（POD）（p = 0.171）、POD1（p = 0.839）、POD2（p = 0.307）或POD3（p = 0.138）时，以MME衡量的阿片类药物使用量、视觉模拟评分法（VAS）疼痛评分（p = 0.175）或90天疼痛再入院率（p = 0.654）均无统计学显著差异。CR与PSC TKA的亚分析显示，POD0（p = 0.765）、POD1（p = 0.747）、POD2（p = 0.564）、POD3（p = 0.309）时的阿片类药物使用量、VAS疼痛评分（p = 0.293）以及90天疼痛再入院率（p > 0.9）均无显著差异。
我们的分析表明，基于植入物的术后VAS疼痛评分和MME使用量无显著差异。结果表明，初次TKA所使用的关节类型或限制方式对术后即刻疼痛和阿片类药物消耗均无显著影响。
III级证据：回顾性队列研究。
