Van Meirhaeghe Jan Peter, Harris Ian A, Cuthbert Alana, Lorimer Michelle, McAuliffe Michael, Adie Sam, Molnar Robert
Sydney Orthopaedic Trauma and Reconstructive Surgery (SOTRS), Sydney, Australia.
Department of Orthopaedics, University Hospital of Ghent, Ghent, Belgium.
J Orthop. 2024 Jul 17;58:154-160. doi: 10.1016/j.jor.2024.07.011. eCollection 2024 Dec.
The influence of implant factors on patient-reported outcome measures (PROMS) after total knee arthroplasty (TKA) has previously been studied but findings are often inconsistent, restricted in scope and biased by confounding factors. This study aims to determine the association between implant-related factors and early post-operative PROMs after TKA.
Using data from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) PROMs program, the study included 9487 primary TKA procedures performed in 43 hospitals from July 31, 2018 to December 31, 2020. Data included baseline demographic data, surgical details and PROMs collected pre- and 6 months post-operatively. Seven prosthesis characteristics were incorporated in the multivariable model, with proportional odds ordinal regression analysis used to assess their effects on post-operative Oxford knee score (OKS) and joint pain. Adjustments were made for pre-operative OKS and joint pain, as well as potential patient confounders.
At six months, fixed bearing implants showed higher odds of better OKS compared to mobile bearing implants (odds ratio [OR] = 1.20, 95 % confidence interval [CI] 1.06-1.37. p < 0.004). Similar findings were found with the use of image derived instrumentation (IDI) (OR = 1.27, 95 % CI 1.11-1.46, p < 0.001), robotic assisted vs. non-navigated knees (OR = 1.21, 95 % CI 1.06-1.38, p < 0.005) and no patella resurfacing (OR = 1.10, 95 % CI 1.01-1.20, p < 0.032). For lower pain scores at six months, the use of highly crosslinked polyethylene (OR = 1.12, 95 % CI 1.02-1.22, p < 0.015), cemented femoral components (OR = 1.11, 95 % CI 1.01-1.22, p < 0.024), IDI (OR = 1.20, 95 % CI 1.05-1.37, p < 0.009) or no patella resurfacing (OR = 1.10, 95 % CI 1.01-1.20, p < 0.034) were associated.
Utilizing a fixed bearing or robotic assistance correlated with improved OKS scores, whereas highly crosslinked polyethylene or cemented femoral components were associated with improved pain scores. At six months, the use of IDI compared to non-navigated TKA, and patellar resurfacing showed both improved OKS and pain scores.
此前已有研究探讨了全膝关节置换术（TKA）后植入物因素对患者报告结局指标（PROMS）的影响，但研究结果往往不一致，范围有限且受混杂因素影响存在偏差。本研究旨在确定TKA后植入物相关因素与术后早期PROMS之间的关联。
利用澳大利亚骨科协会国家关节置换登记处（AOANJRR）的PROMS项目数据，本研究纳入了2018年7月31日至2020年12月31日期间在43家医院进行的9487例初次TKA手术。数据包括基线人口统计学数据、手术细节以及术前和术后6个月收集的PROMS。七个假体特征被纳入多变量模型，采用比例优势有序回归分析来评估它们对术后牛津膝关节评分（OKS）和关节疼痛的影响。对术前OKS和关节疼痛以及潜在的患者混杂因素进行了调整。
在术后六个月时，与活动轴承植入物相比，固定轴承植入物显示出获得更好OKS评分的更高几率（优势比[OR]=1.20，95%置信区间[CI]1.06 - 1.37，p<0.004）。使用影像引导器械（IDI）（OR = 1.27，95%CI 1.11 - 1.46，p<0.001）、机器人辅助与非导航膝关节（OR = 1.21，95%CI 1.06 - 1.38，p<0.005）以及未进行髌骨表面置换（OR = 1.10，95%CI 1.01 - 1.20，p<0.032）也有类似发现。对于术后六个月时较低的疼痛评分，使用高度交联聚乙烯（OR = 1.12，95%CI 1.02 - 1.22，p<0.015）、骨水泥固定股骨组件（OR = 1.11，95%CI 1.01 - 1.22，p<0.024）、IDI（OR = 1.20，95%CI 1.05 - 1.37，p<0.009）或未进行髌骨表面置换（OR = 1.10，95%CI 1.01 - 1.20，p<0.034）与之相关。
使用固定轴承或机器人辅助与改善的OKS评分相关，而高度交联聚乙烯或骨水泥固定股骨组件与改善的疼痛评分相关。在术后六个月时，与非导航TKA相比，使用IDI以及进行髌骨表面置换均显示出OKS和疼痛评分的改善。
