Sequeira Sean B, McCormick Brian P, Hasenauer Mark D, McKinstry Robert, Ebert Frank, Boucher Henry R
Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA.
Arthroplast Today. 2024 Feb 20;26:101319. doi: 10.1016/j.artd.2024.101319. eCollection 2024 Apr.
Although extensor mechanism failure following total knee arthroplasty (TKA) is a devastating complication and has been heavily studied in the literature, the impact of extensor mechanism rupture and concomitant repair prior to TKA has not previously been evaluated. The purpose of this investigation was to evaluate how quadriceps and/or patellar tendon repairs prior to TKA would impact medical and surgery-related complications following TKA.
The PearlDiver database was retrospectively reviewed to identify all primary TKA patients from 2010 to 2019. Patients who underwent quadriceps or patellar tendon repair prior to TKA were matched using a propensity score algorithm to a control cohort. We compared medical and surgical complication rates, emergency room visits, readmissions, and 90-day cost of care between the groups.
A total of 1197 patients underwent extensor mechanism repair prior to TKA and were matched to 11,970 patients who did not undergo repair prior to TKA. Patients who underwent extensor mechanism repair had higher rates of 90-day medical complications, as well as 1-year surgery-related complications including revision TKA (odds ratio [OR] 6.06; < .001), lysis of adhesions (OR 2.18; = .026), aseptic loosening (OR 2.21; = .018), infection (OR 7.58; < .001), and fracture (OR 8.53; < .001). Patients with prior extensor mechanism repair were more likely to return to the emergency department (OR 1.66; < .001) and become readmitted (OR 4.15; < .001) within 90 days.
Patients with previous extensor mechanism repair exhibited higher medical and surgery-related complications, including lysis of adhesions, following TKA than a control cohort. These findings may suggest that patients may require additional surveillance in the early postoperative period to avoid these disastrous complications following primary TKA.
尽管全膝关节置换术（TKA）后伸肌机制失效是一种灾难性并发症，且在文献中已有大量研究，但TKA前伸肌机制破裂及同期修复的影响此前尚未得到评估。本研究的目的是评估TKA前股四头肌和/或髌腱修复如何影响TKA后的医疗及手术相关并发症。
对PearlDiver数据库进行回顾性分析，以确定2010年至2019年期间所有初次TKA患者。使用倾向评分算法将TKA前接受股四头肌或髌腱修复的患者与对照组进行匹配。我们比较了两组之间的医疗和手术并发症发生率、急诊就诊次数、再入院率以及90天护理费用。
共有1197例患者在TKA前接受了伸肌机制修复，并与11970例未在TKA前接受修复的患者进行匹配。接受伸肌机制修复的患者90天医疗并发症发生率较高，1年手术相关并发症发生率也较高，包括TKA翻修（比值比[OR]6.06；P<0.001）、粘连松解（OR 2.18；P = 0.026）、无菌性松动（OR 2.21；P = 0.018）、感染（OR 7.58；P<0.001）和骨折（OR 8.53；P<0.001）。既往有伸肌机制修复的患者在90天内更有可能返回急诊科（OR 1.66；P<0.001）并再次入院（OR 4.15；P<0.001）。
与对照组相比，既往有伸肌机制修复的患者在TKA后出现包括粘连松解在内的更高的医疗及手术相关并发症。这些发现可能表明，患者在术后早期可能需要额外的监测，以避免初次TKA后出现这些灾难性并发症。
