双侧膝关节置换术的最佳时机——来自德国关节置换登记处（EPRD）的翻修率和死亡率分析
Best timing of bilateral knee arthroplasty- an analysis of revision and mortality rates from the German Arthroplasty Registry (EPRD).
作者信息
Postler Anne Elisabeth, Krull Paula, Wu Yinan, Günther Klaus-Peter, Melsheimer Oliver, Steinbrück Arnd, Lützner Jörg
机构信息
University Center of Orthopaedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Fetscherstr. 74, 01307, Dresden, Germany.
German Arthroplasty Registry (EPRD), Berlin, Germany.
出版信息
BMC Musculoskelet Disord. 2025 Mar 31;26(1):311. doi: 10.1186/s12891-025-08548-5.
BACKGROUND
The burden of osteoarthritis (OA) in multiple joints is high. For patients with bilateral knee OA there is no clear recommendation when to time the second surgery. The purpose of this study was therefore to compare revision and mortality rate in bilateral unicondylar and bicondylar knee arthroplasties after different strategies of surgical timing in bilateral knee OA from the German Arthroplasty Registry (EPRD).
METHODS
Data from the German Arthroplasty Registry (EPRD) was used. Since 2012 a total of 15,154 patients had bilateral knee arthroplasty within one year. Patellofemoral arthroplasties and constraint total knee arthroplasties (TKA) were excluded. 1,144 TKA and 682 unicondylar arthroplasties (UKA) were simultaneously performed, 772 TKA and 292 UKA between 1 and 90 days (short interval) and 24,496 TKA and 2,922 UKA between 91 and 365 days (intermediate interval). Revision and mortality rates were analyzed up to 7 years after surgery. Cox regression was performed to evaluate the influence of different patient characteristics on these outcomes.
RESULTS
The highest cumulative revision rate for any of the bilateral TKA was found for simultaneous surgery with 3.4% (95% CI 2.1-5.5). Lower risk for revision was seen in two-staged surgery in short interval (HR 0.42; 95% CI 0.20-0.90) and intermediate interval (HR 0.58; 95% CI 0.39-0.85). The cumulative one year mortality rate for TKA was comparable in all three groups with 0.8% for simultaneous TKA, 1.3% for short interval two-staged and 0.7% for intermediate interval. In UKA there were no differences between the groups regarding cumulative revision rate and mortality rate.
CONCLUSION
TKA should be performed simultaneously in selected patients only, the two-staged procedure demonstrated lower revision risks. For UKA we found no differences in timing, simultaneous surgery seems to be a safe option.
TRIAL REGISTRATION
Clinical trial number not applicable.
LEVEL OF EVIDENCE
III.
背景
多关节骨关节炎（OA）的负担很重。对于双侧膝关节OA患者，何时进行第二次手术尚无明确建议。因此，本研究的目的是比较德国关节置换登记处（EPRD）中双侧膝关节OA不同手术时机策略后双侧单髁和双髁膝关节置换术的翻修率和死亡率。
方法
使用德国关节置换登记处（EPRD）的数据。自2012年以来，共有15154例患者在一年内进行了双侧膝关节置换术。排除髌股关节置换术和限制性全膝关节置换术（TKA）。同时进行了1144例TKA和682例单髁置换术（UKA），1至90天（短间隔）内进行了772例TKA和292例UKA，91至365天（中间间隔）内进行了24496例TKA和2922例UKA。分析术后7年内的翻修率和死亡率。进行Cox回归以评估不同患者特征对这些结果的影响。
结果
双侧TKA中，同期手术的累积翻修率最高，为3.4%（95%CI 2.1-5.5）。短间隔（HR 0.42；95%CI 0.20-0.90）和中间间隔（HR 0.58；95%CI 0.39-0.85）的两阶段手术翻修风险较低。TKA的累积一年死亡率在所有三组中相当，同期TKA为0.8%，短间隔两阶段为1.3%，中间间隔为0.7%。在UKA中，各组之间的累积翻修率和死亡率没有差异。
结论
仅在选定患者中应同时进行TKA，两阶段手术显示出较低的翻修风险。对于UKA，我们发现在手术时机上没有差异，同期手术似乎是一个安全的选择。
试验注册
临床试验编号不适用。
证据级别
III级。
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