Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University
Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University.
Acta Orthop. 2024 Aug 21;95:454-459. doi: 10.2340/17453674.2024.41257.
The primary aim of our study was to identify the absolute incidence and implant survival of multiply revised knee arthroplasties based on nationwide register data. The secondary aim was to determine the change in the absolute incidence and implant survival of multiply revised knee arthroplasties Methods: We performed a retrospective observational study of primary knee arthroplasties using several nationwide Danish registers. All primary knee arthroplasties performed in Denmark from 1998 to 2021 were identified. From these primary arthroplasties, revision procedures were identified. Kaplan-Meier plots were used in survival analysis to estimate the likelihood of implant survival.
161,384 primary knee arthroplasties and their revisions performed between 1998 and 2021 were identified; of 13,786 (8.5%) revisions there were 10,638 1st revisions, 2,148 2nd revisions, 624 3rd revisions, 223 4th revisions, and 153 procedures that had been revised more than 4 times. The 10-year revision-free survival of primary arthroplasties was 92.3% (95% confidence interval [CI] 92.2-92.5). First-time revisions had a 10-year revision-free survival of 75.9% (CI 74.9-76.9). The 10-year survival of second- and third-time revisions was 65.1% (CI 62.6-67.6) and 57.8% (CI 53.4-62.5), respectively. The 10-year implant survival probabilities of primary knee arthroplasties were 91.4% in 1998-2009 and 93.3% in 2010-2021 (difference 2.2%). The 10-year implant survival probabilities of 1st revisions were 77% in 1998-2009 and 75% in 2010-2021 (difference -2.4%).
We found that 0.3% of all primary knee arthroplasties resulted in 3 or more revisions. The implant survival decreased for each consecutive revision, with almost half of the 3rd revisions being re-revised within 10 years. The 10-survival of the primary implant was higher in 2010-2021, and the 10-year survival of the 1st revision was higher in 1998-2009.
本研究的主要目的是基于全国登记数据，确定多次翻修膝关节置换术的绝对发病率和植入物存活率。次要目的是确定多次翻修膝关节置换术的绝对发病率和植入物存活率的变化。
我们使用几个丹麦全国性登记处对原发性膝关节置换术进行了回顾性观察性研究。从 1998 年至 2021 年在丹麦进行的所有原发性膝关节置换术均被确定。从这些原发性关节置换术中，确定了翻修手术。生存分析中使用 Kaplan-Meier 图估计植入物存活率。
在 1998 年至 2021 年间，确定了 161384 例原发性膝关节置换术及其翻修术；在 13786 例（8.5%）翻修术中有 10638 例为初次翻修术，2148 例为第二次翻修术，624 例为第三次翻修术，223 例为第四次翻修术，153 例翻修次数超过 4 次。原发性关节置换术的 10 年无翻修存活率为 92.3%（95%置信区间[CI]92.2-92.5）。初次翻修术的 10 年无翻修存活率为 75.9%（CI 74.9-76.9）。第二次和第三次翻修术的 10 年生存率分别为 65.1%（CI 62.6-67.6）和 57.8%（CI 53.4-62.5）。1998-2009 年原发性膝关节置换术的 10 年植入物存活率为 91.4%，2010-2021 年为 93.3%（差异为 2.2%）。1998-2009 年初次翻修术的 10 年植入物存活率为 77%，2010-2021 年为 75%（差异为-2.4%）。
我们发现，0.3%的原发性膝关节置换术需要进行 3 次或更多次翻修。每次连续翻修后，植入物存活率都会下降，近一半的第三次翻修术在 10 年内再次翻修。2010-2021 年原发性植入物的 10 年生存率较高，1998-2009 年初次翻修的 10 年生存率较高。
