Weis Sandy, Seifert Lisa, Oltmanns Moritz, Khury Farouk, Bieger Ralf, Faschingbauer Martin
Department of Orthopedic Surgery, University of Augsburg, 86159 Augsburg, Germany.
Clinic for Anesthesiology, University of Augsburg, 86159 Augsburg, Germany.
J Clin Med. 2024 Dec 16;13(24):7672. doi: 10.3390/jcm13247672.
Outcomes following total knee arthroplasty (TKA) revisions are variable, and it is hypothesized that the underlying cause of primary TKA failure impacts postoperative outcomes. This study analyzes the results of TKA revisions seven years after surgery, in relation to the etiology of primary failure and other influencing factors. A previous study conducted in 2013 examined the same cohort of patients three months after revision surgery. From the original study, 97 patients were followed up, and 49 patients were eligible for inclusion. Patients were classified into four groups: "periprosthetic infection" (PPI), "aseptic loosening," "instability," and "arthrofibrosis." Outcomes were analyzed using established scores (the Knee Society Score (KSS), New Knee Society Score (nKSS), and the Western Ontario and McMaster Universities (WOMAC) index) and considering factors such as age, gender, BMI, and ASA classification. The outcomes were analyzed using three time intervals: "Outcome Short" (preoperative to 3 months postoperative); "Outcome Long" (preoperative to 7 years postoperative); and "Delta PostOP" (3 months postoperative to 7 years postoperative). Significant improvements were observed in all time intervals, especially in the "Outcome Short" ( < 0.001) and "Delta PostOP" ( < 0.001) periods. The "instability" and "aseptic loosening" groups showed better outcomes in terms of range of motion and knee scores than the "arthrofibrosis" and "infection" groups ( < 0.05). A lower BMI and an ASA status of II were associated with better outcomes ( < 0.05). Women also showed superior results in the nKSS ( < 0.05). Patients with "aseptic loosening" and "instability" had the best long-term outcomes. Lower BMI and better ASA status also correlated with improved results. These findings can inform patients of the potential outcomes of revision surgery, thereby facilitating informed decision-making.
全膝关节置换术（TKA）翻修后的结果各不相同，据推测，初次TKA失败的潜在原因会影响术后结果。本研究分析了TKA翻修术后七年的结果，涉及初次失败的病因及其他影响因素。2013年进行的一项先前研究在翻修手术后三个月对同一组患者进行了检查。在原始研究中，对97例患者进行了随访，其中49例患者符合纳入标准。患者被分为四组：“假体周围感染”（PPI）、“无菌性松动”、“不稳定”和“关节纤维化”。使用既定评分（膝关节协会评分（KSS）、新膝关节协会评分（nKSS）以及西安大略和麦克马斯特大学（WOMAC）指数）并考虑年龄、性别、体重指数（BMI）和美国麻醉医师协会（ASA）分级等因素对结果进行分析。结果分析采用三个时间间隔：“短期结果”（术前至术后3个月）；“长期结果”（术前至术后7年）；以及“术后差值”（术后3个月至术后7年）。在所有时间间隔内均观察到显著改善，尤其是在“短期结果”（<0.001）和“术后差值”（<0.001）期间。“不稳定”和“无菌性松动”组在活动范围和膝关节评分方面的结果优于“关节纤维化”和“感染”组（<0.05）。较低的BMI和ASA分级为II与更好的结果相关（<0.05）。女性在nKSS方面也显示出更好的结果（<0.05）。“无菌性松动”和“不稳定”的患者长期结果最佳。较低的BMI和更好的ASA状态也与改善的结果相关。这些发现可以让患者了解翻修手术的潜在结果，从而促进明智的决策。
