Ergin Musa, Budin Maximilian, Çiloğlu Osman, Forero Felipe, Gehrke Thorsten, Çıtak Mustafa
Department of Orthopaedic Surgery, Helios Endo-Klinik Hamburg, Hamburg, Germany.
Department of Orthopedics and Traumatology, Cihanbeyli State Hospital, Konya, Turkey.
Int Orthop. 2025 Jul 26. doi: 10.1007/s00264-025-06620-2.
Total knee arthroplasty (TKA) is a highly effective procedure for end-stage knee osteoarthritis, but postoperative instability remains a major concern, impacting patient satisfaction and leading to potential revision surgeries. Understanding patient-related risk factors for instability is crucial for optimizing outcomes and minimizing complications.
We conducted a retrospective cohort study of patients who underwent revision TKA at our clinic between 1996 and 2021, focusing on those who required revision specifically due to instability. We analyzed a dataset of 39,572 primary TKA patients without documented revisions and 859 revision patients. Data extraction included age, gender, body mass index (BMI), age-adjusted Charlson Comorbidity Index (CCI) score, and comorbidities. Statistical analyses, including binary logistic regression, were performed to identify independent risk factors for instability.
The instability group (n = 859) had a mean age of 65.7 years and a significantly lower proportion of males compared to the control group (mean age 67.5 years, p < 0.001; males 30.7% vs. 38.1%, p < 0.001). Notable risk factors included younger age, female gender, stroke, deep vein thrombosis (DVT), and scleroderma. Specifically, scleroderma was associated with a high risk of instability (P < 0.01 OR [odds ratio] 9.27, CI [confidence interval] 2.01 to 42.7), stroke (P = 0.01 OR 1.8, CI: 1.1 to 3.1), and DVT (p < 0.01 OR: 2.0, CI: 1.4 to 2.8).
Patient-related factors such as younger age, female gender, stroke, DVT, and scleroderma significantly influence the risk of instability following primary TKA. These findings highlight the multifactorial nature of TKA instability and underscore the importance of tailored preoperative assessment and postoperative care. Addressing these risk factors can improve patient outcomes and reduce the incidence of instability following TKA.
全膝关节置换术（TKA）是治疗终末期膝关节骨关节炎的一种高效手术，但术后不稳定仍然是一个主要问题，影响患者满意度并导致潜在的翻修手术。了解与患者相关的不稳定危险因素对于优化手术效果和减少并发症至关重要。
我们对1996年至2021年间在我们诊所接受翻修TKA的患者进行了一项回顾性队列研究，重点关注那些因不稳定而需要翻修的患者。我们分析了39572例未记录翻修情况的初次TKA患者和859例翻修患者的数据集。数据提取包括年龄、性别、体重指数（BMI）、年龄校正的Charlson合并症指数（CCI）评分和合并症。进行了包括二元逻辑回归在内的统计分析，以确定不稳定的独立危险因素。
不稳定组（n = 859）的平均年龄为65.7岁，与对照组相比，男性比例显著更低（对照组平均年龄67.5岁，p < 0.001；男性分别为30.7%和38.1%，p < 0.001）。显著的危险因素包括年龄较小、女性、中风、深静脉血栓形成（DVT）和硬皮病。具体而言，硬皮病与不稳定的高风险相关（P < 0.01，比值比[OR] 9.27，置信区间[CI] 2.01至42.7）、中风（P = 0.01，OR 1.8，CI：1.1至3.1）和DVT（p < 0.01，OR：2.0，CI：1.4至2.8）。
年龄较小、女性、中风、DVT和硬皮病等与患者相关的因素显著影响初次TKA术后不稳定的风险。这些发现凸显了TKA不稳定的多因素性质，并强调了针对性术前评估和术后护理的重要性。解决这些危险因素可改善患者手术效果并降低TKA术后不稳定的发生率。
