Evaluation of a radiological grading system for the early detection of total knee arthroplasties at risk for revision surgery.

IF 2 3区医学 Q2 ORTHOPEDICS Archives of Orthopaedic and Trauma Surgery Pub Date : 2024-11-01 Epub Date: 2024-09-28 DOI:10.1007/s00402-024-05572-3

Nina Hörlesberger, Maria Anna Smolle, Lukas Leitner, Viktor Labmayr, Andreas Leithner, Patrick Sadoghi

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Abstract

Introduction: X-rays are regularly performed after primary total knee arthroplasty (TKA). While soft tissue management and ligament tension cannot be evaluated, important information, such as inadequate component positioning and loose cement location, as well as subsequent loosening, can be detected. The aim of this study was to correlate radiological findings, referring to the radiological grading system (previously published by the same study group, henceforth abbreviated as "RGS"), with long-term outcomes and implant survival.

Materials and methods: A total of 266 patients who underwent titanium-coated TKA were included. In addition to implant survival, visual analogue scale score, Tegner activity score, knee society score (KSS), Western Ontario and McMaster Universities Osteoarthritis Index, and short form-12 score as well as range of motion were evaluated. Clinical examination as well as anterior-posterior, lateral, full-length weight bearing, and patellar view radiographs were performed pre- and postoperatively, at the 3-, 6-, and 12-month postoperative follow-ups and at the final follow-up. The radiological grading system was evaluated and correlated with long-term outcome and survivorship.

Results: The revision-free survival rate was 88.4% at a median follow-up of 9.8 years (IQR: 9.3-10.3 years; range: 0.1-11.8 years). Revision surgery was required in 31 TKAs (11.7%). The multivariate Cox regression model showed a significant association between an RGS score ≥ 3 deviation points (DP) and an increased risk for revision (hazard ratio: 2.092; 95% CI: 1.020-4.290; p = 0.044). Moreover, the KSS for pain was significantly worse in patients with a RGS score ≥ 3 DP (median, 85 [74-92] vs. 90 [80-94]; p = 0.007).

Conclusions: This is the first study indicating that deviation in component positioning, having an inadequate long leg axis, the presence of free cement or residual bony structures on postoperative X-rays significantly correlate with TKA outcome and implant survival. Therefore RGS can be of high predicable value for the survivorship of the prosthesis.

Level of evidence: Level IV - retrospective cohort study.

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评估用于早期发现有翻修手术风险的全膝关节置换术的放射学分级系统。

简介：初级全膝关节置换术（TKA）后定期进行 X 光检查。虽然不能对软组织管理和韧带张力进行评估，但可以发现一些重要信息，如组件定位不当、松动的骨水泥位置以及随后的松动。本研究的目的是参照放射学分级系统（由同一研究小组先前发表，以下简称 "RGS"），将放射学结果与长期疗效和植入物存活率联系起来：共纳入了 266 例接受钛涂层 TKA 的患者。除假体存活率外，还评估了视觉模拟量表评分、Tegner 活动评分、膝关节社会评分（KSS）、西安大略和麦克马斯特大学骨关节炎指数、短表格-12 评分以及活动范围。在术前、术后、术后 3 个月、6 个月和 12 个月的随访以及最终随访时，均进行了临床检查以及前后、侧位、全长负重和髌骨视图X光片检查。对放射学分级系统进行了评估，并将其与长期疗效和存活率相关联：中位随访 9.8 年（IQR：9.3-10.3 年；范围：0.1-11.8 年），无翻修生存率为 88.4%。需要进行翻修手术的 TKAs 有 31 例（11.7%）。多变量 Cox 回归模型显示，RGS 评分≥ 3 个偏差点 (DP) 与翻修风险增加之间存在显著关联（危险比：2.092；95% CI：1.020-4.290；P = 0.044）。此外，RGS评分≥3个DP的患者疼痛的KSS值明显更差（中位数，85 [74-92] vs. 90 [80-94]; p = 0.007）：这是第一项研究表明，组件定位偏差、长腿轴线不足、术后 X 光片上存在游离骨水泥或残留骨结构与 TKA 结果和植入物存活率有显著相关性。因此，RGS 对假体的存活率具有很高的预测价值：证据等级：IV 级--回顾性队列研究。

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来源期刊

Archives of Orthopaedic and Trauma Surgery 医学-外科

CiteScore

4.30

自引率

13.00%

发文量

424

审稿时长

2 months

期刊介绍： "Archives of Orthopaedic and Trauma Surgery" is a rich source of instruction and information for physicians in clinical practice and research in the extensive field of orthopaedics and traumatology. The journal publishes papers that deal with diseases and injuries of the musculoskeletal system from all fields and aspects of medicine. The journal is particularly interested in papers that satisfy the information needs of orthopaedic clinicians and practitioners. The journal places special emphasis on clinical relevance. "Archives of Orthopaedic and Trauma Surgery" is the official journal of the German Speaking Arthroscopy Association (AGA).