内侧单室膝关节置换术后再手术的全国真实数据分析:来自高使用率国家的启示。

IF 4.9 1区 医学 Q1 ORTHOPEDICS
Christian Bredgaard Jensen, Martin Lindberg-Larsen, Andreas Kappel, Cecilie Henkel, Troels Mark-Christensen, Kirill Gromov, Anders Troelsen
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引用次数: 0

摘要

目的:本研究的目的是检查进一步手术的适应症和一年内内侧单室膝关节置换术(mUKA)患者的特征,为高容量国家的日常临床实践和结果提供评估。方法:纳入来自丹麦膝关节置换术登记处(DKAR)的所有在2020年4月1日至2021年3月31日期间进行并在一年内接受进一步手术的muka。对于初次手术和再手术,我们从每个丹麦私人和公共关节置换术中心获得了关于患者特征、手术适应症、手术类型和部件大小的数据。所有后续的再手术都被记录下来,无论从最初的手术开始的时间。结果:在研究期间,共有2,303例患者的2,431例原发性mUKAs报告给DKAR, 55例患者(55例mUKAs;2.3%;(95% CI 1.7 ~ 3.0))在一年内接受了进一步的手术。再手术最常见的指征是假体周围骨折(n = 16;0.7% (95% CI 0.4 ~ 1.1)),假体周围关节感染(PJI) (n = 13;0.5% (95% CI 0.3 ~ 0.9))和轴承错位(n = 9;0.4% (95% CI 0.2 ~ 0.7))。6例假体周围骨折采用内固定治疗,但其中5例患者后来接受了全膝关节置换术(TKA)翻修。10例pji采用清创、抗生素和种植体保留(DAIR)治疗。由于持续感染,其中4例患者后来接受了TKA翻修。所有9例脱位均采用内套置换治疗,其中7例患者根据其性别和身高,可能股骨假体过小。结论:在高容量的国家,mUKA术后再手术是罕见的。进一步手术的最常见适应症是假体周围骨折、PJI和轴承脱位。使用内固定治疗mUKA术后假体周围骨折效果不佳。DAIR是否是muka患者PJI的适当治疗形式,以及如何确保有效根除这些患者的感染仍不确定。股骨假体过小可能会增加轴承脱位的风险。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Analysis of national real-world data on reoperations after medial unicompartmental knee arthroplasty : insights from a high-usage country.

Aims: The aim of this study was to examine the indications for further surgery and the characteristics of the patients within one year of medial unicompartmental knee arthroplasty (mUKA), providing an assessment of everyday clinical practice and outcomes in a high-volume country.

Methods: All mUKAs which were performed between 1 April 2020 and 31 March 2021 and underwent further surgery within one year, from the Danish Knee Arthroplasty Registry (DKAR), were included. For primary procedures and reoperations, we received data on the characteristics of the patients, the indications for surgery, the type of procedure, and the sizes of the components individually, from each Danish private and public arthroplasty centre. All subsequent reoperations were recorded regardless of the time since the initial procedure.

Results: A total of 2,431 primary mUKAs in 2,303 patients were reported to the DKAR during the study period and 55 patients (55 mUKAs; 2.3%; (95% CI 1.7 to 3.0)) underwent further surgery within one year. The most frequent indications for reoperation were periprosthetic fracture (n = 16; 0.7% (95% CI 0.4 to 1.1)), periprosthetic joint infection (PJI) (n = 13; 0.5% (95% CI 0.3 to 0.9)), and bearing dislocation (n = 9; 0.4% (95% CI 0.2 to 0.7)). Six periprosthetic fractures were treated with internal fixation, but five of these patients later underwent revision to a total knee arthroplasty (TKA). Ten PJIs were treated with debridement, antibiotics, and implant retention (DAIR). Due to persistent infection, four of these patients later underwent revision to a TKA. All nine bearing dislocations were treated with exchange of the liner, and seven occurred in patients who, based on their sex and height, probably had undersized femoral components.

Conclusion: Reoperations are rare following mUKA in a high-volume country. The most frequent indications for further surgery were periprosthetic fracture, PJI, and bearing dislocation. Using internal fixation to treat periprosthetic fractures after mUKA gives poor results. Whether DAIR is an appropriate form of treatment for PJI in mUKAs, and how to ensure the effective eradication of infection in these patients, remains uncertain. Undersizing the femoral component might increase the risk of bearing dislocation.

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来源期刊
Bone & Joint Journal
Bone & Joint Journal ORTHOPEDICS-SURGERY
CiteScore
9.40
自引率
10.90%
发文量
318
期刊介绍: We welcome original articles from any part of the world. The papers are assessed by members of the Editorial Board and our international panel of expert reviewers, then either accepted for publication or rejected by the Editor. We receive over 2000 submissions each year and accept about 250 for publication, many after revisions recommended by the reviewers, editors or statistical advisers. A decision usually takes between six and eight weeks. Each paper is assessed by two reviewers with a special interest in the subject covered by the paper, and also by members of the editorial team. Controversial papers will be discussed at a full meeting of the Editorial Board. Publication is between four and six months after acceptance.
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