Mori Yu, Tarasawa Kunio, Tanaka Hidetatsu, Kamimura Masayuki, Harada Kento, Mori Naoko, Fushimi Kiyohide, Aizawa Toshimi, Fujimori Kenji
Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan.
Department of Health Administration and Policy, Tohoku University Graduate School of Medicine, Sendai, Japan.
Arch Orthop Trauma Surg. 2025 Jun 2;145(1):327. doi: 10.1007/s00402-025-05943-4.
Total knee arthroplasty (TKA) is a widely used treatment for advanced knee osteoarthritis. While cemented fixation is the standard technique, cementless fixation has demonstrated comparable long-term outcomes. However, the association between cement use and postoperative complications, including venous thromboembolism and surgical site infections, remains unclear, particularly in Japanese patients. This study aimed to investigate the incidence of postoperative complications in cemented and cementless TKA using a nationwide database.
A nationwide cohort study was conducted using Japan's DPC database from April 2016 to March 2023. Patients who underwent TKA were identified, and postoperative complications, including deep vein thrombosis, pulmonary embolism, pneumonia, cerebrovascular events, postoperative cognitive dysfunction, and surgical site infection, were analyzed. One-to-one propensity score (PS) matching was performed based on age, sex, body mass index, type of anesthesia, simultaneous bilateral surgery, Charlson comorbidity index, and comorbidities to ensure comparability. Statistical analyses included χ² tests, Student's t-tests, and multivariate logistic regression analysis.
A total of 228,595 patients met the eligibility criteria, with 21,906 matched pairs in the cemented and cementless groups after PS matching. The incidence of deep vein thrombosis (OR: 1.231, 95% CI: 1.151-1.316, p < 0.0001) and surgical site infection (OR: 1.716, 95% CI: 1.420-2.073, p < 0.0001) was significantly higher in the cemented group. No significant differences were observed in pulmonary embolism or other complications.
Cement application was associated with an increased risk of deep vein thrombosis and surgical site infection. These findings suggest that careful perioperative management may be warranted in patients undergoing cemented TKA.
全膝关节置换术（TKA）是治疗晚期膝关节骨关节炎的一种广泛应用的方法。虽然骨水泥固定是标准技术，但非骨水泥固定已显示出相当的长期疗效。然而，骨水泥的使用与术后并发症（包括静脉血栓栓塞和手术部位感染）之间的关联仍不明确，尤其是在日本患者中。本研究旨在使用全国性数据库调查骨水泥型和非骨水泥型TKA术后并发症的发生率。
利用日本诊断程序组合（DPC）数据库，于2016年4月至2023年3月进行了一项全国队列研究。确定接受TKA的患者，并分析术后并发症，包括深静脉血栓形成、肺栓塞、肺炎、脑血管事件、术后认知功能障碍和手术部位感染。基于年龄、性别、体重指数、麻醉类型、同期双侧手术、查尔森合并症指数和合并症进行一对一倾向评分（PS）匹配，以确保可比性。统计分析包括χ²检验、学生t检验和多因素逻辑回归分析。
共有228,595例患者符合纳入标准，PS匹配后骨水泥型和非骨水泥型组中有21,906对匹配病例。骨水泥型组深静脉血栓形成（比值比：1.231，95%置信区间：1.151 - 1.316，p < 0.0001）和手术部位感染（比值比：1.716，95%置信区间：1.420 - 2.073，p < 0.0001）的发生率显著更高。肺栓塞或其他并发症未观察到显著差异。
骨水泥的应用与深静脉血栓形成和手术部位感染风险增加相关。这些发现表明，对于接受骨水泥型TKA的患者，可能需要进行仔细的围手术期管理。
