Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands.
Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands.
J Arthroplasty. 2024 Nov;39(11):2661-2668.e1. doi: 10.1016/j.arth.2024.05.060. Epub 2024 May 24.
Many patients suffer from osteoarthritis (OA) in multiple joints, possibly resulting in multiple joint arthroplasties (MJAs). Primarily, we determined the cumulative incidence (C) of MJA in hip and knee joints up to 10 years. Secondly, we calculated the mean time between the first and subsequent joint arthroplasty, and evaluated the different MJA trajectories. Lastly, we compared patient characteristics and outcomes (functionality and pain) after surgery between MJA patients and single hip arthroplasty or knee arthroplasty (HA and KA) patients.
Primary index (first) HA or KA for OA were extracted from the Dutch Arthroplasty Register. The 1, 2, 5, and 10-year C (including competing risk death) of MJA, mean time intervals, and MJA-trajectories were calculated and stratified for primary index HA or KA. Sex, preoperative age, and body mass index were compared using ordinal logistic regression. Outcomes, measured preoperatively, 3, 6, and 12 months postoperatively (function: Hip Disability or Knee Injury and OA Outcome Score; Pain: Numerical Rating Scale), were compared using linear regression.
A total of 140,406 HA-patients and 140,268 KA-patients were included. One, 2, 5, and 10-year C for a second arthroplasty were respectively 8.9% [95% confidence interval (CI): 8.7 to 9.0], 14.3% [95% CI: 14.1 to 14.5], 24.0% [95% CI: 23.7 to 24.2], and 32.7% [95% CI: 32.2 to 33.1] after index HA, and 9.5% [95% CI: 9.4 to 9.7], 16.0% [95% CI: 15.9 to 16.2], 26.4% [95% CI: 26.1 to 26.6], and 35.8% [95% CI: 35.4 to 36.3] after index KA. The 10-year C for > 2 arthroplasties were small in both the index HA and KA groups. Time-intervals from first to second, third, and fourth arthroplasty were 26 [95% CI: 26.1 to 26.7], 47 [95% CI: 46.4 to 48.4], and 58 [95% CI: 55.4 to 61.1] months after index HA, and 26 [95% CI: 25.9 to 26.3], 52 [95% CI: 50.8 to 52.7], and 61 [95% CI: 58.3 to 63.4] months after index KA. There were 83% of the second arthroplasties placed in the contralateral cognate joint (ie, knee or hip). Differences in postoperative functionality and pain between MJAs and single HAs and KAs were small.
The 10-year C showed that about one-third of patients received a second arthroplasty after approximately 2 years, with the majority in the contralateral cognate joint. Few patients received > 2 arthroplasties within 10 years. Being a women, having a higher body mass index, and being younger increased the odds of MJA. Postoperative outcomes were slightly negatively affected by MJA.
许多患者患有多处关节骨关节炎（OA），可能需要进行多次关节置换术（MJAs）。主要目的是确定髋关节和膝关节首次关节置换后 10 年内 MJA 的累积发生率（C）。其次，计算首次和后续关节置换之间的平均时间，并评估不同的 MJA 轨迹。最后，比较 MJA 患者与单髋关节置换或膝关节置换（HA 和 KA）患者手术后的患者特征和结果（功能和疼痛）。
从荷兰关节置换登记处提取原发性指数（首次）HA 或 KA 的 OA 数据。计算 MJA 的 1、2、5 和 10 年 C（包括竞争风险死亡）、平均时间间隔和 MJA 轨迹，并按原发性指数 HA 或 KA 进行分层。使用有序逻辑回归比较术前性别、年龄和体重指数。使用线性回归比较术前、术后 3、6 和 12 个月的结果（功能：髋关节残疾或膝关节损伤和骨关节炎结局评分；疼痛：数字评分量表）。
共纳入 140406 例 HA 患者和 140268 例 KA 患者。首次 HA 后，第二次关节置换的 1、2、5 和 10 年 C 分别为 8.9%[95%置信区间（CI）：8.7 至 9.0]、14.3%[95% CI：14.1 至 14.5]、24.0%[95% CI：23.7 至 24.2]和 32.7%[95% CI：32.2 至 33.1]，首次 KA 后分别为 9.5%[95% CI：9.4 至 9.7]、16.0%[95% CI：15.9 至 16.2]、26.4%[95% CI：26.1 至 26.6]和 35.8%[95% CI：35.4 至 36.3]。首次 HA 和 KA 组中，超过 2 次关节置换的 10 年 C 均较小。首次至第二次、第三次和第四次关节置换的时间间隔分别为 26[95% CI：26.1 至 26.7]、47[95% CI：46.4 至 48.4]和 58[95% CI：55.4 至 61.1]个月，首次 HA 后分别为 26[95% CI：25.9 至 26.3]、52[95% CI：50.8 至 52.7]和 61[95% CI：58.3 至 63.4]个月。第二次关节置换中有 83%的手术部位位于对侧同源关节（即膝关节或髋关节）。MJAs 和单髋关节置换或膝关节置换之间的术后功能和疼痛差异较小。
10 年 C 表明，大约三分之一的患者在大约 2 年后接受了第二次关节置换，其中大多数在对侧同源关节。在 10 年内，很少有患者接受了 > 2 次关节置换。女性、较高的体重指数和年龄较小增加了 MJA 的可能性。MJA 术后结果略受负面影响。
