Anne Elisabeth Postler, Paula Krull, Yinan Wu, Klaus-Peter Günther, Oliver Melsheimer, Arnd Steinbrück, Jörg Lützner
{"title":"双侧膝关节置换术的最佳时机——来自德国关节置换术登记处（EPRD）的修正和死亡率分析。","authors":"Anne Elisabeth Postler, Paula Krull, Yinan Wu, Klaus-Peter Günther, Oliver Melsheimer, Arnd Steinbrück, Jörg Lützner","doi":"10.1186/s12891-025-08548-5","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The burden of osteoarthritis (OA) in multiple joints is high. For patients with bilateral knee OA there is no clear recommendation when to time the second surgery. The purpose of this study was therefore to compare revision and mortality rate in bilateral unicondylar and bicondylar knee arthroplasties after different strategies of surgical timing in bilateral knee OA from the German Arthroplasty Registry (EPRD).</p><p><strong>Methods: </strong>Data from the German Arthroplasty Registry (EPRD) was used. Since 2012 a total of 15,154 patients had bilateral knee arthroplasty within one year. Patellofemoral arthroplasties and constraint total knee arthroplasties (TKA) were excluded. 1,144 TKA and 682 unicondylar arthroplasties (UKA) were simultaneously performed, 772 TKA and 292 UKA between 1 and 90 days (short interval) and 24,496 TKA and 2,922 UKA between 91 and 365 days (intermediate interval). Revision and mortality rates were analyzed up to 7 years after surgery. Cox regression was performed to evaluate the influence of different patient characteristics on these outcomes.</p><p><strong>Results: </strong>The highest cumulative revision rate for any of the bilateral TKA was found for simultaneous surgery with 3.4% (95% CI 2.1-5.5). Lower risk for revision was seen in two-staged surgery in short interval (HR 0.42; 95% CI 0.20-0.90) and intermediate interval (HR 0.58; 95% CI 0.39-0.85). The cumulative one year mortality rate for TKA was comparable in all three groups with 0.8% for simultaneous TKA, 1.3% for short interval two-staged and 0.7% for intermediate interval. In UKA there were no differences between the groups regarding cumulative revision rate and mortality rate.</p><p><strong>Conclusion: </strong>TKA should be performed simultaneously in selected patients only, the two-staged procedure demonstrated lower revision risks. For UKA we found no differences in timing, simultaneous surgery seems to be a safe option.</p><p><strong>Trial registration: </strong>Clinical trial number not applicable.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":9189,"journal":{"name":"BMC Musculoskeletal Disorders","volume":"26 1","pages":"311"},"PeriodicalIF":2.2000,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11956241/pdf/","citationCount":"0","resultStr":"{\"title\":\"Best timing of bilateral knee arthroplasty- an analysis of revision and mortality rates from the German Arthroplasty Registry (EPRD).\",\"authors\":\"Anne Elisabeth Postler, Paula Krull, Yinan Wu, Klaus-Peter Günther, Oliver Melsheimer, Arnd Steinbrück, Jörg Lützner\",\"doi\":\"10.1186/s12891-025-08548-5\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>The burden of osteoarthritis (OA) in multiple joints is high. For patients with bilateral knee OA there is no clear recommendation when to time the second surgery. The purpose of this study was therefore to compare revision and mortality rate in bilateral unicondylar and bicondylar knee arthroplasties after different strategies of surgical timing in bilateral knee OA from the German Arthroplasty Registry (EPRD).</p><p><strong>Methods: </strong>Data from the German Arthroplasty Registry (EPRD) was used. Since 2012 a total of 15,154 patients had bilateral knee arthroplasty within one year. Patellofemoral arthroplasties and constraint total knee arthroplasties (TKA) were excluded. 1,144 TKA and 682 unicondylar arthroplasties (UKA) were simultaneously performed, 772 TKA and 292 UKA between 1 and 90 days (short interval) and 24,496 TKA and 2,922 UKA between 91 and 365 days (intermediate interval). Revision and mortality rates were analyzed up to 7 years after surgery. Cox regression was performed to evaluate the influence of different patient characteristics on these outcomes.</p><p><strong>Results: </strong>The highest cumulative revision rate for any of the bilateral TKA was found for simultaneous surgery with 3.4% (95% CI 2.1-5.5). Lower risk for revision was seen in two-staged surgery in short interval (HR 0.42; 95% CI 0.20-0.90) and intermediate interval (HR 0.58; 95% CI 0.39-0.85). The cumulative one year mortality rate for TKA was comparable in all three groups with 0.8% for simultaneous TKA, 1.3% for short interval two-staged and 0.7% for intermediate interval. In UKA there were no differences between the groups regarding cumulative revision rate and mortality rate.</p><p><strong>Conclusion: </strong>TKA should be performed simultaneously in selected patients only, the two-staged procedure demonstrated lower revision risks. For UKA we found no differences in timing, simultaneous surgery seems to be a safe option.</p><p><strong>Trial registration: </strong>Clinical trial number not applicable.</p><p><strong>Level of evidence: </strong>III.</p>\",\"PeriodicalId\":9189,\"journal\":{\"name\":\"BMC Musculoskeletal Disorders\",\"volume\":\"26 1\",\"pages\":\"311\"},\"PeriodicalIF\":2.2000,\"publicationDate\":\"2025-03-31\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11956241/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"BMC Musculoskeletal Disorders\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1186/s12891-025-08548-5\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"BMC Musculoskeletal Disorders","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s12891-025-08548-5","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
引用次数: 0
摘要
背景：骨关节炎（OA）在多个关节的负担很高。对于双侧膝关节炎患者，没有明确的建议何时进行第二次手术。因此，本研究的目的是比较来自德国关节成形术登记处（EPRD）的双侧单髁和双髁膝关节置换术在不同手术时机策略后双侧膝关节OA的翻修率和死亡率。方法：采用德国关节成形术登记处（EPRD）的数据。自2012年以来，一年内共有15154例患者接受了双侧膝关节置换术。髌骨股骨置换术和限制性全膝关节置换术（TKA）除外。1144例TKA和682例单髁关节置换术（UKA）同时进行，772例TKA和292例UKA在1 - 90天（短间隔），24496例TKA和2922例UKA在91 - 365天（中间间隔）。分析手术后至7年的修正率和死亡率。采用Cox回归来评估不同患者特征对这些结果的影响。结果：任何双侧TKA的累积翻修率最高的是同时手术，为3.4% （95% CI 2.1-5.5）。两期短间隔手术的翻修风险较低(HR 0.42；95% CI 0.20-0.90)和中间区间(HR 0.58；95% ci 0.39-0.85)。三组TKA的累积1年死亡率相当，同期TKA为0.8%，短间隔两期为1.3%，中间间隔为0.7%。在UKA中，两组之间在累积修正率和死亡率方面没有差异。结论：TKA只应在选定的患者中同时进行，两阶段手术具有较低的翻修风险。对于UKA，我们没有发现时间上的差异，同时手术似乎是一个安全的选择。试验注册：临床试验编号不适用。证据水平：III。
Best timing of bilateral knee arthroplasty- an analysis of revision and mortality rates from the German Arthroplasty Registry (EPRD).
Background: The burden of osteoarthritis (OA) in multiple joints is high. For patients with bilateral knee OA there is no clear recommendation when to time the second surgery. The purpose of this study was therefore to compare revision and mortality rate in bilateral unicondylar and bicondylar knee arthroplasties after different strategies of surgical timing in bilateral knee OA from the German Arthroplasty Registry (EPRD).
Methods: Data from the German Arthroplasty Registry (EPRD) was used. Since 2012 a total of 15,154 patients had bilateral knee arthroplasty within one year. Patellofemoral arthroplasties and constraint total knee arthroplasties (TKA) were excluded. 1,144 TKA and 682 unicondylar arthroplasties (UKA) were simultaneously performed, 772 TKA and 292 UKA between 1 and 90 days (short interval) and 24,496 TKA and 2,922 UKA between 91 and 365 days (intermediate interval). Revision and mortality rates were analyzed up to 7 years after surgery. Cox regression was performed to evaluate the influence of different patient characteristics on these outcomes.
Results: The highest cumulative revision rate for any of the bilateral TKA was found for simultaneous surgery with 3.4% (95% CI 2.1-5.5). Lower risk for revision was seen in two-staged surgery in short interval (HR 0.42; 95% CI 0.20-0.90) and intermediate interval (HR 0.58; 95% CI 0.39-0.85). The cumulative one year mortality rate for TKA was comparable in all three groups with 0.8% for simultaneous TKA, 1.3% for short interval two-staged and 0.7% for intermediate interval. In UKA there were no differences between the groups regarding cumulative revision rate and mortality rate.
Conclusion: TKA should be performed simultaneously in selected patients only, the two-staged procedure demonstrated lower revision risks. For UKA we found no differences in timing, simultaneous surgery seems to be a safe option.
Trial registration: Clinical trial number not applicable.
期刊介绍：
BMC Musculoskeletal Disorders is an open access, peer-reviewed journal that considers articles on all aspects of the prevention, diagnosis and management of musculoskeletal disorders, as well as related molecular genetics, pathophysiology, and epidemiology.
The scope of the Journal covers research into rheumatic diseases where the primary focus relates specifically to a component(s) of the musculoskeletal system.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
