Szymski Dominik, Straub Josina, Walter Nike, Wu Yinan, Melsheimer Oliver, Grimberg Alexander, Alt Volker, Steinbrueck Arnd, Rupp Markus
Department of Trauma Surgery, University Medical Centre Regensburg, Regensburg, Germany.
Deutsches Endoprothesenregister gGmbH (EPRD), Berlin, Germany.
Knee Surg Relat Res. 2025 May 23;37(1):25. doi: 10.1186/s43019-025-00276-3.
The implantation rate of knee arthroplasty and, in particular of unicondylar knee arthroplasty (UKA), is increasing, and revision is a feared complication. The aim of this study was to identify factors influencing aseptic and septic revision that are of high interest for establishing preventive measures.
Data were collected using the German Arthroplasty Registry (EPRD). Patients with UKA were analyzed using the multiple Log-rank test with Holm's method. Septic and aseptic revisions were calculated using Kaplan-Meier estimates. In total, 300,998 cases of knee arthroplasty were identified in the registry, and 36,861 patients with UKA were analyzed with a maximum follow-up of 7 years.
The primary reason for UKA revision surgery was aseptic loosening (32.5%), particularly loosening of the tibial component (19.0%), followed by infection (11.0%) and the progression of arthritis (10.0%). Over 7 years, 8.7% of UKA procedures required revision, 7.8% for aseptic causes and 0.9% for infection. Risk factors for aseptic revision included uncemented implants [hazard ratio (HR) 1.38] and low annual surgical volume (fewer than 25 UKAs/year, HR 1.86; fewer than 50 UKAs/year, HR 1.43). Significant risks for septic revision were grade III obesity (HR 1.83), male sex (HR 1.69), and high comorbidity scores (Elixhauser > 5, HR 1.67). The surgical volume did not affect septic revision rates.
Aseptic loosening is the primary cause of UKA revision, influenced by implant type and low surgical volume, while septic revisions are associated with patient factors such as obesity, male sex, and comorbidities. Improvements in implant selection, surgical expertise, and patient risk management may reduce revision rates.
III, retrospective case-control study.
膝关节置换术，尤其是单髁膝关节置换术（UKA）的植入率正在上升，而翻修是一种令人担忧的并发症。本研究的目的是确定影响无菌性和感染性翻修的因素，这些因素对于制定预防措施至关重要。
使用德国关节置换登记处（EPRD）收集数据。采用带有霍尔姆方法的多重对数秩检验对UKA患者进行分析。使用Kaplan-Meier估计法计算感染性和无菌性翻修率。登记处共识别出300998例膝关节置换病例，对36861例UKA患者进行了分析，最长随访时间为7年。
UKA翻修手术的主要原因是无菌性松动（32.5%），尤其是胫骨部件松动（19.0%），其次是感染（11.0%）和关节炎进展（10.0%）。在7年时间里，8.7%的UKA手术需要翻修，其中7.8%是无菌性原因，0.9%是感染性原因。无菌性翻修的危险因素包括非骨水泥型植入物[风险比（HR）1.38]和每年手术量低（每年少于25例UKA，HR 1.86；每年少于50例UKA，HR 1.43）。感染性翻修的显著风险因素是III级肥胖（HR 1.83）、男性（HR 1.69）和高合并症评分（埃利克斯豪泽评分>5，HR 1.67）。手术量不影响感染性翻修率。
无菌性松动是UKA翻修的主要原因，受植入物类型和手术量低的影响，而感染性翻修与肥胖、男性和合并症等患者因素有关。改善植入物选择、手术专业技能和患者风险管理可能会降低翻修率。
III级，回顾性病例对照研究。
