Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Orthopaedic Surgery, University of Washington School of Medicine, Seattle, Washington.
Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
J Arthroplasty. 2024 Dec;39(12):2930-2934.e1. doi: 10.1016/j.arth.2024.06.037. Epub 2024 Jun 25.
Long-term complications following total joint arthroplasty are not well established for patients who have Ehlers-Danlos syndrome (EDS), a group of connective tissue disorders. This study compared 10-year incidence of revision surgery after total hip arthroplasty (THA) and total knee arthroplasty (TKA) in patients who have and do not have EDS.
A retrospective cohort analysis was conducted using a national all-payer claims database from 2010 to 2021 to identify patients who underwent primary TKA or THA. Patients who had and did not have EDS were propensity score-matched by age, sex, and a comorbidity index. Kaplan-Meier analyses and Cox proportional hazard models were used to determine the cumulative incidence and risks of revision experienced by patients who have and do not have EDS.
The EDS patients who underwent TKA had a higher risk of all-cause revision (hazard ratio [HR]: 1.50, 95% confidence interval [95% CI]: 1.09 to 2.07, P < .014) and risk of revision due to instability (HR = 2.49, 95% CI: 1.37 to 4.52, P < .003). The EDS patients who underwent THA had a higher risk of all-cause revision (HR = 2.32, 95% CI: 1.47 to 3.65, P < .001), revision due to instability (HR = 4.26, 95% CI: 2.17 to 8.36, P < .001), and mechanical loosening (HR = 3.63, 95% CI: 2.05 to 6.44, P < .001).
Patients who had EDS were found to have a higher incidence of revision within 10 years of undergoing TKA and THA compared to matched controls, especially for instability. Patients who have EDS should be counseled accordingly. Surgical technique and implant selection should include consideration for increased constraint in TKA and larger femoral heads or dual mobility articulations for THA.
患有埃勒斯-当洛斯综合征（EDS）的患者，这是一组结缔组织疾病，其全关节置换术后的长期并发症尚不清楚。本研究比较了 EDS 患者和非 EDS 患者全髋关节置换术（THA）和全膝关节置换术（TKA）后 10 年的翻修手术发生率。
回顾性队列分析使用 2010 年至 2021 年全国所有支付者索赔数据库，以确定接受初次 TKA 或 THA 的患者。通过年龄、性别和合并症指数对 EDS 患者和非 EDS 患者进行倾向评分匹配。Kaplan-Meier 分析和 Cox 比例风险模型用于确定 EDS 患者和非 EDS 患者的累积翻修发生率和风险。
接受 TKA 的 EDS 患者全因翻修的风险更高（风险比[HR]：1.50，95%置信区间[95%CI]：1.09 至 2.07，P <.014）和因不稳定而翻修的风险（HR=2.49，95%CI：1.37 至 4.52，P <.003）。接受 THA 的 EDS 患者全因翻修的风险更高（HR=2.32，95%CI：1.47 至 3.65，P <.001）、因不稳定而翻修的风险（HR=4.26，95%CI：2.17 至 8.36，P <.001）和机械松动的风险（HR=3.63，95%CI：2.05 至 6.44，P <.001）。
与匹配对照组相比，患有 EDS 的患者在接受 TKA 和 THA 后 10 年内发现翻修发生率更高，尤其是不稳定的情况。患有 EDS 的患者应相应地接受咨询。TKA 中应考虑增加约束，THA 中应选择更大的股骨头或双动关节，以考虑植入物的选择。
