Undergoing cartilage procedures before total knee arthroplasty is not associated with worse postoperative functional outcomes, readmission rates or complication rates.
Irfan A Khan, Nicholas F Cozzarelli, Alexandra L Hohmann, Hassan Siddiqui, Fotios P Tjoumakaris, Kevin B Freedman, Yale A Fillingham
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引用次数: 0
Abstract
Purpose: Patients undergoing total knee arthroplasty (TKA) with prior knee cartilage surgery have unclear outcomes in the literature. This study compared outcomes after TKA in patients with or without prior knee cartilage surgery, and we hypothesized there would be equivocal outcomes between groups.
Methods: A retrospective matched case-control study was conducted on patients from our institution who underwent ipsilateral cartilage procedure(s) and TKA (cases) or TKA alone (controls) from 2000 to 2022. Cartilage procedures included Autologous Chondrocyte Implantation (ACI), Osteochondral Allograft (OCA) and Microfracture (MFx). Matching was performed in 1:3 (case:control) ratio for age, sex, body mass index, Charlson Comorbidity Index, pre-TKA Kellgren-Lawrence osteoarthritis grade and follow-up for knee injury and osteoarthritis outcome score for joint replacement (KOOS-JR). Mann-Whitney U and χ2 analyses were conducted, with significance being a p < 0.05. A priori power analysis required 29 patients per cohort to reach a clinically detectable difference of 11 for KOOS-JR.
Results: Forty-three cases (one ACI, eight OCA and 34 MFx) and 129 controls were included after matching, with no significant demographic differences. Cases underwent TKA after cartilage surgery at a mean of 4.6 years. No significant differences existed between cases and controls for the preoperative KOOS-JR (45.2 vs. 47.8; p = 0.353), postoperative KOOS-JR (69.8 vs. 69.9; p = 0.974) or Delta KOOS-JR (30.4 vs. 26.0; p = 0.387). No significant differences existed for 90-day readmission rates (4.7% vs. 2.3%; p = 0.600) or revision TKA rates (11.6% vs. 5.4%; p = 0.177).
Conclusion: Patients with and without prior cartilage surgery experience similar functional outcomes, readmission rates and revision rates after TKA on the same knee. Patients who are candidates for TKA with a history of cartilage surgery may be counselled that their surgical history on that knee does not convey the risk of worse functional outcomes.
目的：在接受全膝关节置换术（TKA）的患者中，曾接受过膝关节软骨手术的患者在文献中的疗效并不明确。本研究比较了接受过或未接受过膝关节软骨手术的患者在接受全膝关节置换术（TKA）后的疗效，我们假设两组患者的疗效会存在差异：我们对 2000 年至 2022 年期间本院接受同侧软骨手术和 TKA（病例）或单独接受 TKA（对照）的患者进行了一项回顾性匹配病例对照研究。软骨手术包括自体软骨细胞植入术（ACI）、骨软骨异体移植术（OCA）和显微骨折术（MFx）。在年龄、性别、体重指数、Charlson综合指数、TKA前Kellgren-Lawrence骨关节炎分级、膝关节损伤随访和关节置换骨关节炎结果评分（KOOS-JR）方面，按1:3（病例:对照）的比例进行配对。进行了 Mann-Whitney U 和 χ2 分析，显著性以 p 表示：43例病例（1 例 ACI、8 例 OCA 和 34 例 MFx）和 129 例对照组在匹配后无明显人口统计学差异。病例在软骨手术后平均 4.6 年接受全膝关节置换术。病例和对照组在术前 KOOS-JR (45.2 vs. 47.8; p = 0.353)、术后 KOOS-JR (69.8 vs. 69.9; p = 0.974)或 Delta KOOS-JR (30.4 vs. 26.0; p = 0.387)方面无明显差异。90天再入院率（4.7% vs. 2.3%; p = 0.600）或翻修TKA率（11.6% vs. 5.4%; p = 0.177）无明显差异：结论：既往接受过软骨手术和未接受过软骨手术的患者在同一膝关节接受TKA手术后的功能预后、再入院率和翻修率相似。对于有软骨手术史的TKA候选患者，可以告知他们该膝关节的手术史并不会带来更差的功能预后风险：III级病例对照研究。
期刊介绍：
Few other areas of orthopedic surgery and traumatology have undergone such a dramatic evolution in the last 10 years as knee surgery, arthroscopy and sports traumatology. Ranked among the top 33% of journals in both Orthopedics and Sports Sciences, the goal of this European journal is to publish papers about innovative knee surgery, sports trauma surgery and arthroscopy. Each issue features a series of peer-reviewed articles that deal with diagnosis and management and with basic research. Each issue also contains at least one review article about an important clinical problem. Case presentations or short notes about technical innovations are also accepted for publication.
The articles cover all aspects of knee surgery and all types of sports trauma; in addition, epidemiology, diagnosis, treatment and prevention, and all types of arthroscopy (not only the knee but also the shoulder, elbow, wrist, hip, ankle, etc.) are addressed. Articles on new diagnostic techniques such as MRI and ultrasound and high-quality articles about the biomechanics of joints, muscles and tendons are included. Although this is largely a clinical journal, it is also open to basic research with clinical relevance.
Because the journal is supported by a distinguished European Editorial Board, assisted by an international Advisory Board, you can be assured that the journal maintains the highest standards.
Official Clinical Journal of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA).
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