Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA.
Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.
Arch Orthop Trauma Surg. 2024 Sep;144(9):4085-4094. doi: 10.1007/s00402-024-05299-1. Epub 2024 Apr 13.
While total knee arthroplasty (TKA) is typically implemented in patients > 65 years old, young patients may need to undergo TKA for pain relief and functional improvement. Current data are limited by older cohorts and short-term survival rates. This study aimed to examine a large sample size of patients with degenerative and inflammatory conditions who underwent primary TKA at a young (≤ 40) age to identify predictors of reoperation, as well 15-year survivorship.
A retrospective study was performed on 77 patients (92 surgeries) who underwent primary TKA at ≤ 40 years old, between January 1990 and January 2020. Patient charts were reviewed and a multivariable logistic regression model identified independent predictors of reoperation. Kaplan-Meier analysis was employed to build survival curves and log-rank tests analyzed survival between groups.
Of the 77 patients, the median age at the time of surgery was 35.7 years (IQR: 31.2-38.7) and median follow-up time was 6.88 years. Twenty-one (22.8%) primary TKAs underwent 24 reoperations, most commonly due to stiffness (n = 9, 32.1%) and infection (n = 13, 46.4%) more significantly in the OA group (p = 0.049). There were no independent predictors of reoperation in multivariable analysis, and 15-year revision-free survivorship after TKA did not differ by indication (77.3% for OA/PTOA vs. 96.7% for autoimmune, p = 0.09) or between ≤ 30 and 31-40 year age groups (94.7% vs. 83.6%, p = 0.55).
In this cohort of patients ≤ 40 years old, revision-free survival was comparable to that reported in the literature for older TKA patients with osteoarthritis/autoimmune conditions (81-94% at 15-years). Though nearly a quarter of TKAs required reoperation and causes of secondary surgery differed between degenerative and inflammatory arthritis patients, there were no significant predictors of increased reoperation rate. Very young patients ≤ 30 years old did not have an increased risk of revision compared to those aged 31-40 years.
虽然全膝关节置换术（TKA）通常用于 65 岁以上的患者，但年轻患者可能需要接受 TKA 以缓解疼痛和改善功能。目前的数据受到年龄较大的队列和短期生存率的限制。本研究旨在检查大量患有退行性和炎症性疾病的年轻（≤40 岁）患者行初次 TKA 的样本，以确定再次手术的预测因素，以及 15 年的生存率。
对 1990 年 1 月至 2020 年 1 月期间接受初次 TKA 的 77 名患者（92 例手术）进行回顾性研究。对患者的病历进行了回顾，并通过多变量逻辑回归模型确定了再次手术的独立预测因素。采用 Kaplan-Meier 分析构建生存曲线，对数秩检验分析组间生存情况。
77 名患者中，手术时的中位年龄为 35.7 岁（IQR：31.2-38.7），中位随访时间为 6.88 年。21 例（22.8%）初次 TKA 进行了 24 次翻修手术，最常见的原因是僵硬（n=9，32.1%）和感染（n=13，46.4%），OA 组更为显著（p=0.049）。多变量分析中没有独立的再手术预测因素，TKA 后 15 年的无翻修生存率不因适应证（OA/PTOA 为 77.3%，自身免疫性疾病为 96.7%，p=0.09）或年龄组（≤30 岁为 94.7%，31-40 岁为 83.6%，p=0.55）而异。
在这个≤40 岁的患者队列中，无翻修生存率与文献报道的老年 OA/自身免疫性 TKA 患者相似（15 年时为 81-94%）。尽管近四分之一的 TKA 需要再次手术，退行性和炎症性关节炎患者的二次手术原因不同，但再次手术率增加的预测因素并无显著差异。非常年轻的患者（≤30 岁）与 31-40 岁的患者相比，翻修风险并未增加。
