Clement Nick D, Yapp Liam Z, Scott Chloe E H
Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom.
J Arthroplasty. 2025 Jun;40(6):1547-1553.e5. doi: 10.1016/j.arth.2024.11.054. Epub 2024 Dec 2.
The aim of this study was to determine the lifetime risk of revision surgery after primary knee arthroplasty (KA) according to implant choice and patient age.
The risk of revision according to the implant type (unicondylar, unconstrained, semiconstrained, and fully constrained) was obtained from the National Joint Registry of England and Wales. Mortality risk according to age was estimated from the Scottish Arthroplasty Project (1998 to 2019). The cumulative incidence of revision and death was calculated up to 20 years. The lifetime risk was calculated as a percentage using a multiple decrement life-table methodology.
The lifetime risk of revision varied according to the implant, with unconstrained having the lowest risk and fully constrained and unicondylar having the highest risks, which increased with younger age. For an "average" patient aged between 65 and 69 years, the revision risks for an unconstrained (3.6%, 95% confidence interval [CI] 3.4 to 3.9), semiconstrained (7.2%, 95% CI 3.9 to 13.6), unicondylar (13.7%, 95% CI 12.4 to 15.2), and fully constrained (15.4%, 95% CI 9.2 to 25.7) total KA gradually increased. Relative to an unconstrained KA, the risk of revision for a semiconstrained implant was similar in patients aged < 65 years (relative risk < 2), whereas when this was employed in those ≥ 65 years, the relative risk was more than double (relative risk ≥ 2). Relative to an unconstrained KA, the risk of revision for a fully constrained or a unicondylar KA was more than double in patients aged < 55 years (relative risk > 2) and more than triple (relative risk ≥ 3) in patients ≥ 55 years CONCLUSION: The estimated lifetime risk of revision following KA was dependent on patient age and implant type, with fully constrained and unicondylar KA being associated with a higher lifetime revision risk. There are limitations in the data, and the indication for surgery and the reasons for revision were not assessed.
III.
本研究的目的是根据植入物选择和患者年龄确定初次膝关节置换术（KA）后翻修手术的终生风险。
根据植入物类型（单髁、非限制性、半限制性和全限制性）的翻修风险数据来自英格兰和威尔士国家关节注册中心。根据年龄的死亡风险是根据苏格兰关节置换术项目（1998年至2019年）估算的。计算至20年的翻修和死亡累积发生率。使用多重递减寿命表方法将终生风险计算为百分比。
翻修的终生风险因植入物而异，非限制性植入物风险最低，全限制性和单髁植入物风险最高，且风险随年龄降低而增加。对于年龄在65至69岁之间的“普通”患者，非限制性（3.6%，95%置信区间[CI]3.4至3.9）、半限制性（7.2%，95%CI 3.9至13.6）、单髁（13.7%，95%CI 12.4至15.2）和全限制性（15.4%，95%CI 9.2至25.7）全膝关节置换术的翻修风险逐渐增加。相对于非限制性全膝关节置换术，半限制性植入物在年龄<65岁的患者中翻修风险相似（相对风险<2），而在年龄≥65岁的患者中使用时，相对风险增加一倍以上（相对风险≥2）。相对于非限制性全膝关节置换术，全限制性或单髁全膝关节置换术在年龄<55岁的患者中翻修风险增加一倍以上（相对风险>2），在年龄≥55岁的患者中增加两倍以上（相对风险≥3）。结论：全膝关节置换术后翻修的估计终生风险取决于患者年龄和植入物类型，全限制性和单髁全膝关节置换术的终生翻修风险较高。数据存在局限性，未评估手术指征和翻修原因。
III级。
