Department of Orthopedic Surgery, Baylor College of Medicine, Houston, Texas.
Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
J Arthroplasty. 2024 Aug;39(8):2014-2021. doi: 10.1016/j.arth.2024.02.068. Epub 2024 Feb 28.
A recent rapid increase in cementless total knee arthroplasty (TKA) has been noted in the American Joint Replacement Registry (AJRR). The purpose of our study was to compare TKA survivorship based on the mode of fixation reported to the AJRR in the Medicare population.
Primary TKAs from Medicare patients submitted to AJRR from 2012 to 2022 were analyzed. The Medicare and AJRR databases were merged. Cox regression stratified by sex compared revision outcomes (all-cause, infection, mechanical loosening, and fracture) for cemented, cementless, and hybrid fixation, controlling for age and the Charlson comorbidity index (CCI).
A total of 634,470 primary TKAs were analyzed. Cementless TKAs were younger (71.8 versus 73.1 years, P < .001) than cemented TKAs and more frequently utilized in men (8.2 versus 5.8% women, P < .001). Regional differences were noted, with cementless fixation more common in the Northeast (10.5%) and South (9.2%) compared to the West (4.4%) and Midwest (4.3%) (P < .001). No significant differences were identified in all-cause revision rates in men or women ≥ 65 for cemented, cementless, or hybrid TKA after adjusting for age and CCI. Significantly lower revision for fracture was identified for cemented compared to cementless and hybrid fixation in women ≥ 65 after adjusting for age and CCI (P = .0169).
No survivorship advantage for all-cause revision was noted based on the mode of fixation in men or women ≥ 65 after adjusting for age and CCI. A significantly lower revision rate for fractures was noted in women ≥ 65 utilizing cemented fixation. Cementless fixation in primary TKA should be used with caution in elderly women.
美国关节置换登记处（AJRR）注意到，非骨水泥全膝关节置换术（TKA）的数量近期迅速增加。本研究旨在比较 AJRR 报告的美国 Medicare 人群中固定方式与 TKA 生存率之间的关系。
分析了 Medicare 患者于 2012 年至 2022 年向 AJRR 提交的初次 TKA。将 Medicare 和 AJRR 数据库合并。Cox 回归按性别分层，比较了骨水泥固定、非骨水泥固定和混合固定的翻修结果（所有原因、感染、机械松动和骨折），控制年龄和 Charlson 合并症指数（CCI）。
共分析了 634470 例初次 TKA。非骨水泥 TKA 患者比骨水泥 TKA 患者更年轻（71.8 岁 vs. 73.1 岁，P <.001），男性更多（8.2% vs. 5.8%女性，P <.001）。区域差异明显，东北（10.5%）和南部（9.2%）非骨水泥固定较常见，而西部（4.4%）和中西部（4.3%）较少（P <.001）。调整年龄和 CCI 后，在≥65 岁的男性或女性中，骨水泥固定、非骨水泥固定或混合 TKA 的全因翻修率无显著差异。调整年龄和 CCI 后，≥65 岁女性的骨水泥固定较非骨水泥固定和混合固定的骨折翻修率显著降低（P=.0169）。
调整年龄和 CCI 后，在≥65 岁的男性或女性中，固定方式与全因翻修生存率无明显相关性。≥65 岁女性使用骨水泥固定时，骨折翻修率显著降低。在老年女性中，初次 TKA 应谨慎使用非骨水泥固定。
