Fidler Erik, Sloviak Matúš, Langová Kateřina, Gallo Jiří
Ortopedicka klinika Lekarske fakulty Univerzity Palackeho a Fakultni nemocnice Olomouc.
Oddeleni biostatistiky, Ustav lekarske fyziky a biofyziky Lekarske fakulty Univerzity Palackeho, Olomouc.
Acta Chir Orthop Traumatol Cech. 2025 Jun;92(2):67-76. doi: 10.55095/achot2024/066.
The aim of this study was to analyze the outcomes of knee arthroscopy (KA) for degenerative meniscal tears in relation to early total knee arthroplasty (TKA) in the elderly population. The study focused on identifying the factors that influence the need for TKA within seven years after previous arthroscopic partial meniscectomy (APM).
A total of 526 patients older than 64 years who underwent APM between January 1, 2010, and December 31, 2015, were included in the study. The patients were divided into three groups according to age. Specific patient data were extracted from the hospital information system. Preoperative, intraoperative, and postoperative data were collected according to a predefined protocol.
A total of 118 patients (22.4%) underwent TKA within seven years after KA, with a mean time to TKA of 35.5 months. Notably, up to 30% of patients required TKA within one year of their initial KA. The mean age at the time of TKA was 72.2 years. Women had a higher risk than men (24.4% vs. 19.2% men; p = 0.195). When all factors were analyzed, postoperative pain (OR = 4.17; 95% CI: 2.03-8.553), varus knee alignment (OR = 2.45; 95% CI: 1.20-5.01), and BMI (OR = 1.11; 95% CI: 0.02-1.20) were significant predictors of TKA. When considering only preoperative factors, varus alignment on radiographs (OR = 2.39; 95% CI: 1.21-4.71), a higher radiographic grade of knee osteoarthritis (OR = 1.85; 95% CI: 1.12-3.07), and BMI (OR = 1.09; 95% CI: 1.01-1.17) were the strongest predictors of early TKA. Among intraoperative/postoperative findings, the presence of medial chondropathy confirmed during KA (OR = 2.07; 95%CI: 1.52-2.83) and postoperative pain (OR = 5.02; 95% CI: 2.75-9.17) were the only significant predictors.
This study highlights the risk of TKA in elderly patients undergoing APM. Previous studies have cautioned against performing this procedure in older patients, yet the optimal treatment for symptomatic knees with degenerative meniscal tears remains uncertain. Several factors may influence the progression of knee osteoarthritis in these patients, with knee biomechanics and pre-existing osteoarthritis being the most critical. Both can potentially be addressed with appropriate knee osteotomy, a procedure that has recently been shown to be effective in patients with knee osteoarthritis. Interestingly, age itself did not increase the risk of TKA in our study. In conclusion, our retrospective analysis showed that more than one-fifth of patients undergoing KA for degenerative meniscal tears may require TKA within seven years. In addition, preoperative varus knee alignment, advanced knee osteoarthritis, and higher BMI were identified as the strongest risk factors, suggesting that KA should be indicated with caution in such patients.
本研究旨在分析老年人群中，膝关节镜检查（KA）治疗退行性半月板撕裂与早期全膝关节置换术（TKA）的疗效。该研究着重于确定影响先前关节镜下部分半月板切除术（APM）后7年内进行TKA需求的因素。
本研究纳入了2010年1月1日至2015年12月31日期间接受APM的526例64岁以上患者。根据年龄将患者分为三组。从医院信息系统中提取特定患者数据。按照预先定义的方案收集术前、术中和术后数据。
共有118例患者（22.4%）在KA后7年内接受了TKA，TKA的平均时间为35.5个月。值得注意的是，高达30%的患者在初次KA后1年内需要进行TKA。TKA时的平均年龄为72.2岁。女性比男性风险更高（女性为24.4%，男性为19.2%；p = 0.195）。在分析所有因素时，术后疼痛（OR = 4.17；95% CI：2.03 - 8.553）、膝内翻（OR = 2.45；95% CI：1.20 - 5.01）和体重指数（BMI）（OR = 1.11；95% CI：0.02 - 1.20）是TKA的显著预测因素。仅考虑术前因素时，X线片显示的膝内翻（OR = 2.39；95% CI：1.21 - 4.71）、更高的膝关节骨关节炎X线分级（OR = 1.85；95% CI：1.12 - 3.07）和BMI（OR = 1.09；95% CI：1.01 - 1.17）是早期TKA的最强预测因素。在术中/术后发现中，KA期间确认的内侧软骨病（OR = 2.07；95%CI：1.52 - 2.83）和术后疼痛（OR = 5.02；95% CI：2.75 - 9.17）是仅有的显著预测因素。
本研究强调了接受APM的老年患者进行TKA的风险。先前的研究告诫不要对老年患者进行此手术，但对于有症状的退行性半月板撕裂膝关节的最佳治疗方法仍不确定。几个因素可能影响这些患者膝关节骨关节炎的进展，其中膝关节生物力学和已存在的骨关节炎最为关键。两者都有可能通过适当的膝关节截骨术来解决，最近的研究表明该手术对膝关节骨关节炎患者有效。有趣的是，在我们的研究中年龄本身并未增加TKA的风险。总之，我们的回顾性分析表明，超过五分之一因退行性半月板撕裂接受KA的患者可能在7年内需要进行TKA。此外，术前膝内翻、晚期膝关节骨关节炎和更高的BMI被确定为最强的风险因素，这表明对此类患者应谨慎进行KA手术。
