Jones Hunter B, Turner Alexander C, Serbin Philip A, Sun Joshua J, Huo Michael H, Sambandam Senthil N
University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA.
Arch Orthop Trauma Surg. 2024 Jul;144(7):3211-3215. doi: 10.1007/s00402-024-05375-6. Epub 2024 Jun 7.
Discrepant data exists regarding the outcomes following total knee arthroplasty (TKA) with a prior anterior cruciate reconstruction (ACLR). The purpose of our study was to compare surgical and medical outcomes in the patients with prior ACLR undergoing TKAs compared to a matched control group of the patients who had undergone TKAs without prior ACLR. We hypothesized that the patients with prior ACLR would have inferior clinical outcomes.
MATERIAL/METHODS: We retrospectively queried the PearlDiver-database for patients who underwent TKA following ACLR from 2011 to 2020. We used propensity-score matching to create two cohorts. The two-sided independent t-test and Chi-Squared test were used.
We identified 2,174 patients who had prior ACLR before the TKAs. There were another 1,348,870 patients who did not have ACLR before the TKAs. After matching, each group had 2,171 patients. The ACLR-TKA group had significantly lower rates of aseptic revision at 2 years (1.2% vs. 4.0%, OR 0.3, p < 0.01), PJI requiring antibiotic spacer at 2 years (0.3% vs. 0.8%, OR 0.35, p = 0.02), and MUA at 90 days (0.4% vs. 7.5%, OR 0.05, p < 0.01). The rate of wound disruption was lower for the ACLR-TKA group at 90 days (p = 0.03) as were several medical complications including AKI at 90 days (p < 0.01), DVT at 90 days (p < 0.01), pneumonia at 90 days (0.04), and required blood transfusion at 90 days (p < 0.01).
These results differed from our expectations. Within the limitations of the study, we are unable to determine the factors for the lower complications in the ACLR-TKA group. The data from this study are different from what had been reported in the previous studies.
关于先前进行过前交叉韧带重建术（ACLR）后行全膝关节置换术（TKA）的结果存在不一致的数据。我们研究的目的是比较先前进行过ACLR的患者行TKA与未进行过先前ACLR的匹配对照组患者的手术和医疗结果。我们假设先前进行过ACLR的患者临床结果较差。
材料/方法：我们回顾性查询了PearlDiver数据库中2011年至2020年在ACLR后行TKA的患者。我们使用倾向评分匹配创建了两个队列。使用双侧独立t检验和卡方检验。
我们确定了2174例在TKA之前有过ACLR的患者。另有1348870例患者在TKA之前没有ACLR。匹配后，每组有2171例患者。ACLR-TKA组在2年时无菌翻修率显著较低（1.2%对4.0%，OR 0.3，p<0.01），2年时需要抗生素间隔物的假体周围感染（PJI）率（0.3%对0.8%，OR 0.35，p=0.02），以及90天时的关节镜下关节清理术（MUA）率（0.4%对7.5%，OR 0.05，p<0.01）。ACLR-TKA组在90天时伤口裂开率较低（p=0.03），包括90天时急性肾损伤（AKI）（p<0.01）、90天时深静脉血栓形成（DVT）（p<0.01）、90天时肺炎（0.04）以及90天时需要输血（p<0.01）等几种医疗并发症也较低。
这些结果与我们的预期不同。在研究的局限性内，我们无法确定ACLR-TKA组并发症较低的因素。本研究的数据与先前研究报道的不同。
