Survivorship and Clinical Outcomes of Primary Total Knee Arthroplasty Performed in Patients 35 Years of Age and Younger.

Autor: Cheng R; Department of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York., Krell EC; Department of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York., Chiu YF; Department of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York., Stimac JD; Department of Orthopedic Surgery, Norton Healthcare, Louisville, Kentucky., Heyse TJ; Medical Faculty, Philipps-University of Marburg, Marburg, Germany; Red Cross Hospital, Frankfurt, Germany., Abdel MP; Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota., Figgie MP; Department of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York., Blevins JL; Department of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York.
Jazyk: angličtina
Zdroj: The Journal of arthroplasty [J Arthroplasty] 2023 Nov; Vol. 38 (11), pp. 2316-2323.e1. Date of Electronic Publication: 2023 Jun 05.
DOI: 10.1016/j.arth.2023.05.068
Abstrakt: Background: Total knee arthroplasties (TKAs) for patients aged ≤35 years are rare but necessary for patients who have diseases such as juvenile idiopathic arthritis, osteonecrosis, osteoarthritis, and rheumatoid arthritis. Few studies have examined the 10-year and 20-year survivorship and clinical outcomes of TKAs for young patients.
Methods: A retrospective registry review identified 185 TKAs in 119 patients aged ≤ 35 years performed between 1985 and 2010 at a single institution. The primary outcome was implant survivorship free of revision. Patient-reported outcomes were assessed at 2 time points: 2011 to 2012 and 2018 to 2019. The average age was 26 years (range, 12 to 35). Mean follow-up was 17 years (range, 8 to 33).
Results: Survivorship decreased from 84% (95% confidence interval [CI]: 79 to 90) at 5 years to 70% (95% CI: 64 to 77) at 10 years and to 37% (95% CI: 29 to 45) at 20 years. The most common reasons for revision were aseptic loosening (6%) and infection (4%). Risk factors for revision included increasing age at time of surgery (Hazards Ratio [HR] 1.3, P = .01) and use of constrained (HR 1.7, P = .05) or hinged prostheses (HR 4.3, P = .02). There were 86% of patients reporting that their surgery resulted in "a great improvement" or better.
Conclusion: Survivorship of TKAs in young patients is less favorable than expected. However, for the patients who responded to our surveys, TKA demonstrated substantial pain relief and improvement in function at 17-year follow-up. Revision risk increased with older age and higher levels of constraint.
(Published by Elsevier Inc.)
Databáze: MEDLINE
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