Polascik Breanna A, Levin Jay M, Wixted Colleen M, Warren Eric, Bethell Mikhail A, Briggs Damon V, Faraz Khushnood, Goltz Daniel, Helmkamp Joshua, Bolognesi Michael P, Jiranek William, Seyler Thorsten
Duke University School of Medicine, Durham, USA.
Northwestern Memorial Hospital, Chicago, USA.
Arch Orthop Trauma Surg. 2024 Dec 31;145(1):104. doi: 10.1007/s00402-024-05737-0.
Studies demonstrate similar long-term Total Knee Arthroplasty (TKA) outcomes in patients with significant versus minimal preoperative coronal plane deformity. Limited short-term outcomes data, which determine costs of care, exist.
We retrospectively explored the impact of preoperative coronal plane deformity on operative time, length of stay (LOS), and discharge to skilled nursing facility (SNF) in TKA. A total of 3,964 patients undergoing unilateral primary TKA at our institution from 2014 to 2019 were included (1,158 > 10˚ deformity: mean age 67.2 years, 47% male; 2,806 < 10˚ deformity: mean age 67 years, 37.4% male). The degree of coronal plane deformity (mechanical axis deviation on preoperative radiographs) was recorded. Patients with no knee radiographs ≤ 3 years preoperatively were excluded. Statistical analysis included Chi-Square tests, Student's t-tests, Mann-Whitney U tests, and uni- and multivariable linear and logistic regression analyses.
The > 10˚ deformity cohort had a longer time from procedure start to finish (113.56 vs. 110.68 min; p = 0.020), greater deviation from surgeon mean operative time (+ 6.19 vs. + 0.69 min; p < 0.001), and higher proportion of cases requiring > 15 (26.8% vs. 22%;p = 0.001) and > 30 (12.3% vs. 7.8%;p < 0.001) additional minutes over their scheduled times. LOS was similar between cohorts (median 2 days, IQR 1-3). The deformity cohort more likely discharged to SNF (19.9% vs. 15.8%;p = 0.002). For every 1˚ increase in coronal plane deformity, operative time increased by 0.566 min (p = 0.000). The odds of SNF discharge increased with increasing coronal plane deformity (OR 1.029 [1.009,1.050]; p = 0.004).
Greater preoperative coronal deformity is associated with increased operative time and odds of discharge to SNF in TKA.
研究表明，术前冠状面畸形严重程度不同的患者，全膝关节置换术（TKA）的长期疗效相似。但关于决定护理成本的短期疗效数据有限。
我们回顾性探讨了术前冠状面畸形对TKA手术时间、住院时间（LOS）和转至专业护理机构（SNF）的影响。纳入了2014年至2019年在我院接受单侧初次TKA的3964例患者（1158例畸形>10°：平均年龄67.2岁，男性占47%；2806例畸形<10°：平均年龄67岁，男性占37.4%）。记录冠状面畸形程度（术前X线片上的机械轴偏差）。排除术前3年内无膝关节X线片的患者。统计分析包括卡方检验、学生t检验、曼-惠特尼U检验以及单变量和多变量线性及逻辑回归分析。
畸形>10°组从手术开始到结束的时间更长（113.56分钟对110.68分钟；p = 0.020），与外科医生平均手术时间的偏差更大（+6.19分钟对+0.69分钟；p < 0.001），且超过预定时间需要额外>15分钟（26.8%对22%；p = 0.001）和>30分钟（12.3%对7.8%；p < 0.001）的病例比例更高。两组的住院时间相似（中位数2天，四分位间距1 - 3天）。畸形组更有可能转至SNF（19.9%对15.8%；p = 0.002）。冠状面畸形每增加1°，手术时间增加0.566分钟（p = 0.000）。转至SNF的几率随着冠状面畸形的增加而增加（比值比1.029 [1.009, 1.050]；p = 0.004）。
术前冠状面畸形程度越大，TKA手术时间越长，转至SNF的几率越高。
