Factors contributing to instability after primary total knee arthroplasty: a twenty five Year retrospective cohort study.

IF 2.6 3区医学 Q2 ORTHOPEDICS

International Orthopaedics Pub Date : 2025-09-01 Epub Date: 2025-07-26 DOI:10.1007/s00264-025-06620-2

Musa Ergin, Maximilian Budin, Osman Çiloğlu, Felipe Forero, Thorsten Gehrke, Mustafa Çıtak

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引用次数: 0

Abstract

Background: 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.

Methods: 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.

Results: 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).

Conclusion: 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.

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导致初次全膝关节置换术后不稳定的因素：一项25年回顾性队列研究。

背景：全膝关节置换术（TKA）是治疗终末期膝关节骨关节炎的一种非常有效的方法，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风险因素对于优化结果和减少并发症至关重要。方法：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39,572例未记录翻修的原发性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Charlson合并症指数（CCI）评分和合并症。统计分析包括二元逻辑回归，以确定不稳定的独立危险因素。结果：不稳定组（n = 859）的平均年龄为65.7岁，男性比例明显低于对照组（平均年龄67.5岁），p结论：年龄较小、女性、卒中、DVT、硬皮病等患者相关因素显著影响原发性TKA后不稳定的风险。这些发现强调了TKA不稳定的多因素性质，并强调了量身定制的术前评估和术后护理的重要性。解决这些风险因素可以改善患者的预后，减少TKA后不稳定的发生率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Orthopaedics 医学-整形外科

CiteScore

5.50

自引率

7.40%

发文量

360

审稿时长

1 months

期刊介绍： International Orthopaedics, the Official Journal of the Société Internationale de Chirurgie Orthopédique et de Traumatologie (SICOT) , publishes original papers from all over the world. The articles deal with clinical orthopaedic surgery or basic research directly connected with orthopaedic surgery. International Orthopaedics will also link all the members of SICOT by means of an insert that will be concerned with SICOT matters. Finally, it is expected that news and information regarding all aspects of orthopaedic surgery, including meetings, panels, instructional courses, etc. will be brought to the attention of the readers. Manuscripts submitted for publication must contain a statement to the effect that all human studies have been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki. It should also be stated clearly in the text that all persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study should be omitted. Reports of animal experiments must state that the "Principles of laboratory animal care" (NIH publication No. 85-23, revised 1985) were followed, as well as specific national laws (e.g. the current version of the German Law on the Protection of Animals) where applicable. The editors reserve the right to reject manuscripts that do not comply with the above-mentioned requirements. The author will be held responsible for false statements or for failure to fulfil the above-mentioned requirements.