Daher Mohammad, Liu Jonathan, Daniels Alan H, Cohen Eric M, Antoci Valentin, El-Othmani Mouhanad M
Department of Orthopedics, Brown University, 1 Kettle Point Avenue, Providence, RI, 02914, USA.
Knee Surg Relat Res. 2025 Mar 24;37(1):14. doi: 10.1186/s43019-025-00267-4.
The need for total knee arthroplasty (TKA) and spinal fusion (SF) for degenerative spine disease (DSD) is increasing. However, it is still unknown if prior SF for DSD impacts outcomes following TKA. This study aims to fill this gap by comparing the risk of complications and revisions in patients undergoing TKA with DSD between patients with and without SF.
This study is a retrospective review of the PearlDiver Mariner Database between 2010 and 2020. On the basis of whether or not patients had had prior SF, the patients undergoing TKA were divided into two groups: patients with DSD and SF and patients with DSD and without SF. The two groups were matched on the basis of age, gender, the Charlson Comorbidity Index (CCI), and obesity. Surgical complications (mechanical loosening, prosthetic dislocation, periprosthetic fractures, and stiffness) and revisions at 1, 2, and 3 years were compared between the groups.
The patients in the TKA with DSD and no SF cohort were older (64.9 ± 8.4 versus 63.3 ± 8.1 years, p < .001), had higher CCI (2.0 ± 2.2 versus 1.6 ± 2.0, p < .001), and had a lower rate of obesity (58.7% versus 61.7%, p < .001). After being matched, 8887 patients remained in each group. There was a higher rate of stiffness and manipulation under anesthesia (MUA) in the no-fusion cohort at 1 year (0.7% versus 0.1%, p < .001; and 0.5% versus 0.2%, p < .001, respectively), 2 years (1.2% versus 0.5%, p < .001; and 1.1% versus 0.6%, p < .001, respectively), and 3 years (1.7% versus 0.7%, p < .001; and 1.6% versus 0.9%, p < .001, respectively).
This study shows no increase in risk of surgical complications and revisions after TKA in patients with DSD and SF compared with patients without SF. Notably, SF was shown to be protective of stiffness and MUA after TKA in patients with DSD.
因退行性脊柱疾病（DSD）而行全膝关节置换术（TKA）和脊柱融合术（SF）的需求日益增加。然而，既往因DSD行SF是否会影响TKA术后的结局仍不清楚。本研究旨在通过比较患有和未患有SF的DSD患者在接受TKA时的并发症风险和翻修情况来填补这一空白。
本研究是对2010年至2020年PearlDiver Mariner数据库的回顾性分析。根据患者既往是否接受过SF，将接受TKA的患者分为两组：患有DSD且接受过SF的患者和患有DSD但未接受过SF的患者。两组在年龄、性别、Charlson合并症指数（CCI）和肥胖方面进行匹配。比较两组在1年、2年和3年时的手术并发症（机械性松动、假体脱位、假体周围骨折和僵硬）及翻修情况。
患有DSD且未接受过SF的TKA队列患者年龄更大（64.9±8.4岁对63.3±8.1岁，p<0.001），CCI更高（2.0±2.2对1.6±2.0，p<0.001），肥胖率更低（58.7%对61.7%，p<0.001）。匹配后，每组各有8887例患者。未行融合术的队列在1年时僵硬和麻醉下手法松解（MUA）的发生率更高（分别为0.7%对0.1%，p<0.001；0.5%对0.2%，p<0.001），2年时（分别为1.2%对0.5%，p<0.001；1.1%对0.6%，p<0.001），3年时（分别为1.7%对0.7%，p<0.001；1.6%对0.9%，p<0.001）。
本研究表明，与未接受过SF的患者相比，患有DSD且接受过SF的患者在TKA术后手术并发症和翻修风险并未增加。值得注意的是，对于患有DSD的患者，SF被证明对TKA术后的僵硬和MUA具有保护作用。
