Chen Zhongming, Bains Sandeep S, Dubin Jeremy A, Hameed Daniel, Sax Oliver C, Moore Mallory C, Patel Saarang, Nace James, Delanois Ronald E
Rubin Institute for Advanced Orthopedics, 14 Sinai Hospital of Baltimore 15 2401 West Belvedere Avenue, 16, Baltimore, MD, 21215, USA.
J Orthop. 2023 Oct 5;45:67-71. doi: 10.1016/j.jor.2023.10.002. eCollection 2023 Nov.
Arthrofibrosis occurs in up to 10% of patients who undergo total knee arthroplasty (TKA). For cases that are not amenable to manipulation under anesthesia (MUA), there is little consensus on how many components should be revised. We compared outcomes of polyethylene exchanges, when doing lysis of adhesions (LOA) versus full component revision. Specifically, we assessed: (1) re-operation rates at one and two years; (2) rates of surgical complications at one year; and (3) associated risk factors for requiring a LOA.
A database queried all patients who underwent revision TKA for arthrofibrosis. A total of 2410 patients were identified, 1120 (46.5%) of which underwent all-component knee revision, while the remaining 1290 (53.5%) underwent polyethylene spacer revision. Multivariate logistic regressions assessed re-operation rates and risk factors for requiring LOA.
The incidence and odds of re-operation within one year following polyethylene exchange was not significantly different than full component revision (10.9 versus 12.9%, odds ratio (OR) 0.83, 95% confidence interval (CI) [0.64-1.06], = 0.145). However, the adjusted models for re-operation within one- and two-years following LOA in the form of polyethylene exchange revision was significantly higher than the full component revision cohort (OR 1.52 CI [1.07-2.17], 0.022 and OR 1.44 CI [1.06-1.97] 0.022). Risk factors associated with the need for lysis of adhesions included age less than 60 years, depression, fibromyalgia, and anxiety.
Full component revision TKA for arthrofibrosis was associated with lower two-year re-operation rate than polyethylene exchange. Risk factors for LOA include younger age and fibromyalgia.
关节纤维化发生在高达10%接受全膝关节置换术（TKA）的患者中。对于那些不适合在麻醉下手法松解（MUA）的病例，对于应该翻修多少组件几乎没有共识。我们比较了在进行粘连松解（LOA）与全组件翻修时聚乙烯置换的结果。具体而言，我们评估了：（1）一年和两年时的再次手术率；（2）一年时的手术并发症发生率；以及（3）需要进行LOA的相关危险因素。
一个数据库查询了所有因关节纤维化接受翻修TKA的患者。共识别出2410例患者，其中1120例（46.5%）接受了全膝关节翻修，而其余1290例（53.5%）接受了聚乙烯垫片翻修。多变量逻辑回归评估了再次手术率和需要进行LOA的危险因素。
聚乙烯置换后一年内再次手术的发生率和几率与全组件翻修无显著差异（分别为10.9%和12.9%，优势比（OR）0.83，95%置信区间（CI）[0.64 - 1.06]，P = 0.145）。然而，以聚乙烯置换翻修形式进行LOA后一至两年内再次手术的校正模型显著高于全组件翻修队列（OR 1.52，CI [1.07 - 2.17]，P = 0.022；OR 1.44，CI [1.06 - 1.97]，P = 0.022）。与需要粘连松解相关的危险因素包括年龄小于60岁、抑郁、纤维肌痛和焦虑。
因关节纤维化进行全组件翻修的TKA与聚乙烯置换相比，两年再次手术率更低。LOA的危险因素包括年龄较小和纤维肌痛。
