Debbi Eytan M, Durst Caleb R, Rezzadeh Kevin T, Spitzer Andrew I, Rajaee Sean S
Department of Orthopedic Surgery, Cedars-Sinai Medical System, Los Angeles, California; Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York.
Department of Orthopedic Surgery, Cedars-Sinai Medical System, Los Angeles, California.
J Arthroplasty. 2024 Mar;39(3):778-781. doi: 10.1016/j.arth.2023.09.007. Epub 2023 Sep 15.
Instability is a common cause for revision total knee arthroplasty (TKA). The risks and benefits of polyethylene liner exchange (LE) as compared to full metal component revision continue to be debated. The purpose of this study was to investigate the success rate and complication profiles of revision TKA for instability based on surgical procedure.
This was a retrospective study of patients undergoing revision TKA for instability from 2015 to 2019. Patients with prior revisions were excluded. 42 patients undergoing isolated polyethylene LE without an increase in constraint were compared with 48 patients undergoing full component revision revision (FCR) of both tibial and femoral components. The primary outcome was differences in rerevision for instability. Noninstability reoperations, 90-day readmissions, and lengths-of-stay were also compared.
LEs had a 10.1% higher rerevision for instability rate that approached statistical significance (LE 14.3% versus FCR 4.2%, P = .092). Additionally, FCR had a 4.2% rate of aseptic loosening and a 4.2% rate of periprosthetic-joint-infection, whereas LE had none (P = .181). FCR also had a longer length-of-stay (FCR 3.0 ± 1.3 versus LE: 1.8 ± 0.9 days, P < .001). No differences were found in 90-day readmissions (LE 7.1% versus FCR 4.2%, P = .661).
All component revision may have a higher success rate than isolated LE in addressing instability but is associated with higher rates of surgical complications. With appropriate patient selection and risk-benefit discussion, isolated LE may be a reasonable surgical option for TKA instability with a lower complication profile and length-of-stay.
不稳定是全膝关节置换术（TKA）翻修的常见原因。与全金属部件翻修相比，聚乙烯衬垫置换（LE）的风险和益处仍存在争议。本研究的目的是根据手术方法探讨因不稳定而行TKA翻修的成功率和并发症情况。
这是一项对2015年至2019年因不稳定而行TKA翻修患者的回顾性研究。排除既往有翻修史的患者。将42例行单纯聚乙烯LE且未增加约束的患者与48例行胫骨和股骨部件全部件翻修（FCR）的患者进行比较。主要结局是因不稳定再次翻修的差异。还比较了非不稳定再次手术、90天再入院率和住院时间。
LE因不稳定再次翻修的发生率高10.1%，接近统计学意义（LE为14.3%，FCR为4.2%，P = 0.092）。此外，FCR的无菌性松动率为4.2%，假体周围关节感染率为4.2%，而LE均无（P = 0.181）。FCR的住院时间也更长（FCR为3.0±1.3天，LE为1.8±0.9天，P < 0.001）。90天再入院率无差异（LE为7.1%，FCR为4.2%，P = 0.661）。
在解决不稳定问题方面，全部件翻修可能比单纯LE有更高的成功率，但与更高的手术并发症发生率相关。通过适当的患者选择和风险效益讨论，单纯LE可能是TKA不稳定的一种合理手术选择，并发症情况和住院时间较低。
