Laver Lior, Maman David, Hirschmann Michael T, Mahamid Assil, Bar Ofek, Steinfeld Yaniv, Berkovich Yaron
Department of Orthopedics, Hillel Yaffe Medical Center, Hadera, Israel.
Rappaport Faculty of Medicine, Technion University Hospital (Israel Institute of Technology), Haifa, Israel.
Knee Surg Sports Traumatol Arthrosc. 2025 Mar;33(3):1015-1024. doi: 10.1002/ksa.12499. Epub 2024 Oct 9.
Despite significant advancements in total knee arthroplasty (TKA), some patients require revision surgery (R-TKA) due to complications such as infection, mechanical loosening, instability, periprosthetic fractures, and persistent pain. This study aimed to explore the specific causes leading to R-TKA, associated complications, including infection, mechanical failure, and wound issues, as well as costs, mortality rates, and hospital length of stay (LOS) using data from a large national database.
Data from the nationwide inpatient sample (NIS), the largest publicly available all-payer inpatient care database in the United States were analysed from 1 January 2016 to 31 December 2019. The study included 44,649 R-TKA cases, corresponding to 223,240 patients, with exclusions for nonelective admissions. Various statistical analyses were used to assess clinical outcomes, including in-hospital mortality, postoperative complications, LOS, and hospitalization costs.
Among 2,636,880 TKA patients, 8.4% underwent R-TKA. R-TKA patients had higher rates of chronic conditions, including mental disorders (36.4%) and renal disease (9.9%). Additionally, these patients often experienced instability, necessitating revision surgery. Infection (22.3%) was the primary reason for R-TKA, followed by mechanical loosening (22.9%) and instability. Compared to primary TKA patients, R-TKA patients exhibited higher in-hospital mortality (0.085% vs. 0.025%), longer LOS (3.1 vs. 2.28 days), and higher total charges ($97,815 vs. $62,188). Postoperative complications, including blood transfusion (4.6% vs. 1.3%), acute kidney injury (4.4% vs. 1.8%), venous thromboembolism (0.55% vs. 0.29%), infection, and wound problems, were significantly higher in R-TKA patients.
This study provides detailed insights into t LOS, costs, and complications associated with specific etiologies of revision TKA. Our findings emphasize the need for targeted preoperative optimization and patient education. This approach can help reduce the incidence and burden of R-TKA, improve patient care, optimize resource allocation, and potentially decrease the overall rates of complications in revision surgeries.
Level III.
尽管全膝关节置换术（TKA）取得了重大进展，但由于感染、机械松动、不稳定、假体周围骨折和持续性疼痛等并发症，一些患者仍需要进行翻修手术（R-TKA）。本研究旨在利用一个大型国家数据库的数据，探讨导致R-TKA的具体原因、相关并发症，包括感染、机械故障和伤口问题，以及成本、死亡率和住院时间（LOS）。
分析了来自美国最大的公开可用的全支付方住院护理数据库——全国住院样本（NIS）中2016年1月1日至2019年12月31日的数据。该研究纳入了44,649例R-TKA病例，对应223,240名患者，排除了非选择性入院病例。采用各种统计分析方法评估临床结局，包括住院死亡率、术后并发症、住院时间和住院费用。
在2,636,880例TKA患者中，8.4%接受了R-TKA。R-TKA患者患有慢性疾病的比例较高，包括精神障碍（36.4%）和肾病（9.9%）。此外，这些患者经常出现不稳定，需要进行翻修手术。感染（22.3%）是R-TKA的主要原因，其次是机械松动（22.9%）和不稳定。与初次TKA患者相比，R-TKA患者的住院死亡率更高（0.085%对0.025%），住院时间更长（3.1天对2.28天），总费用更高（97,815美元对62,188美元）。R-TKA患者的术后并发症，包括输血（4.6%对1.3%）、急性肾损伤（4.4%对1.8%）、静脉血栓栓塞（0.55%对0.29%）、感染和伤口问题，明显更高。
本研究提供了与翻修TKA的特定病因相关的住院时间、成本和并发症的详细见解。我们的研究结果强调了有针对性的术前优化和患者教育的必要性。这种方法有助于降低R-TKA的发生率和负担，改善患者护理，优化资源分配，并可能降低翻修手术中并发症的总体发生率。
三级。
