Pearson Zachary C, Harris Andrew B, Agarwal Amil R, Kreulen R Timothy, Martin Jalen, Ahiarakwe Uzoma, Golladay Gregory J, Thakkar Savyasachi C
Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD, 21287, USA.
Department of Orthopaedic Surgery, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI, USA.
Knee Surg Sports Traumatol Arthrosc. 2023 Nov;31(11):4920-4926. doi: 10.1007/s00167-023-07520-x. Epub 2023 Aug 18.
The purpose of this study was to compare the incidence of revision in those with pes planovalgus deformity to those without using a large national database. Given the reciprocal changes in lower extremity alignment associated with planovalgus foot deformity, it has been suggested that patients with this deformity has worse outcomes following total knee arthroplasty (TKA).
A retrospective cohort analysis of patients undergoing elective TKA was conducted using the PearlDiver database. Patients were stratified into three cohorts: those without pes planovalgus, patients with ipsilateral or bilateral pes planovalgus relative to the TKA, and patients with contralateral pes planovalgus. Patients with prior foot reconstructive surgery were excluded. The cohorts were each matched to those without pes planovalgus. Bivariate analysis was performed comparing 90-day medical complications and 2- and 4-year revisions following TKA. An adjusted number needed to be exposed for one additional person to be harmed (NNEH) was calculated using the adjusted odds ratio (OR) and unexposed event rate.
Following matched analysis, those with contralateral pes planovalgus had similar odds (OR 3.41; 95% CI 0.93-12.54; p = n.s.) for aseptic revision within 2 years but significantly higher odds (OR 3.35; 95% CI 1.08-10.41; p = 0.03) within 4 years when compared to those without a pes planovalgus deformity. Within 4 years, there was no significant difference in the incidence of aseptic revision (p = n.s.) in patients with ipsilateral/bilateral pes planovalgus. No patients in any cohort underwent septic revision within 4 years of TKA.
This study found that patients with contralateral pes planovalgus deformity had higher odds of aseptic revision within 4 years following primary TKA in a national database, suggesting that the change in gait kinematics associated with this deformity could possibly be associated with increased revision rates.
Level III.
本研究旨在利用一个大型国家数据库，比较扁平外翻足畸形患者与无该畸形患者的翻修发生率。鉴于扁平外翻足畸形与下肢对线的相互变化，有人提出患有这种畸形的患者在全膝关节置换术（TKA）后预后较差。
使用PearlDiver数据库对接受择期TKA的患者进行回顾性队列分析。患者被分为三组：无扁平外翻足的患者、相对于TKA同侧或双侧扁平外翻足的患者、对侧扁平外翻足的患者。排除既往有足部重建手术史的患者。将每组患者与无扁平外翻足的患者进行匹配。进行双变量分析，比较TKA后90天的医疗并发症以及2年和4年的翻修情况。使用调整后的优势比（OR）和未暴露事件发生率计算额外一人受到伤害所需暴露的调整人数（NNEH）。
匹配分析后，与无扁平外翻足畸形的患者相比，对侧扁平外翻足的患者在2年内无菌性翻修的几率相似（OR 3.41；95% CI 0.93 - 12.54；p = 无统计学意义），但在4年内几率显著更高（OR 3.35；95% CI 1.08 - 10.41；p = 0.03）。在4年内，同侧/双侧扁平外翻足的患者无菌性翻修发生率无显著差异（p = 无统计学意义）。在TKA后4年内，任何一组均无患者发生感染性翻修。
本研究发现，在一个国家数据库中，对侧扁平外翻足畸形患者在初次TKA后4年内无菌性翻修的几率更高，这表明与这种畸形相关的步态运动学变化可能与翻修率增加有关。
三级。
