Abstract：
BACKGROUND: Long-term complications following total joint arthroplasty are not well established for patients who have Ehlers-Danlos syndrome (EDS), a group of connective tissue disorders. This study compared 10-year incidence of revision surgery after total hip arthroplasty (THA) and total knee arthroplasty (TKA) in patients who have and do not have EDS.
METHODS: A retrospective cohort analysis was conducted using a national all-payer claims database from 2010 to 2021 to identify patients who underwent primary TKA or THA. Patients who had and did not have EDS were propensity score-matched by age, sex, and a comorbidity index. Kaplan-Meier analyses and Cox proportional hazard models were used to determine the cumulative incidence and risks of revision experienced by patients who have and do not have EDS.
RESULTS: The EDS patients who underwent TKA had a higher risk of all-cause revision (hazard ratio [HR]: 1.50, 95% confidence interval [95% CI]: 1.09 to 2.07, P < .014) and risk of revision due to instability (HR = 2.49, 95% CI: 1.37 to 4.52, P < .003). The EDS patients who underwent THA had a higher risk of all-cause revision (HR = 2.32, 95% CI: 1.47 to 3.65, P < .001), revision due to instability (HR = 4.26, 95% CI: 2.17 to 8.36, P < .001), and mechanical loosening (HR = 3.63, 95% CI: 2.05 to 6.44, P < .001).
CONCLUSIONS: Patients who had EDS were found to have a higher incidence of revision within 10 years of undergoing TKA and THA compared to matched controls, especially for instability. Patients who have EDS should be counseled accordingly. Surgical technique and implant selection should include consideration for increased constraint in TKA and larger femoral heads or dual mobility articulations for THA.
METHODS: A retrospective cohort analysis was conducted using a national all-payer claims database from 2010 to 2021 to identify patients who underwent primary TKA or THA. Patients who had and did not have EDS were propensity score-matched by age, sex, and a comorbidity index. Kaplan-Meier analyses and Cox proportional hazard models were used to determine the cumulative incidence and risks of revision experienced by patients who have and do not have EDS.
RESULTS: The EDS patients who underwent TKA had a higher risk of all-cause revision (hazard ratio [HR]: 1.50, 95% confidence interval [95% CI]: 1.09 to 2.07, P < .014) and risk of revision due to instability (HR = 2.49, 95% CI: 1.37 to 4.52, P < .003). The EDS patients who underwent THA had a higher risk of all-cause revision (HR = 2.32, 95% CI: 1.47 to 3.65, P < .001), revision due to instability (HR = 4.26, 95% CI: 2.17 to 8.36, P < .001), and mechanical loosening (HR = 3.63, 95% CI: 2.05 to 6.44, P < .001).
CONCLUSIONS: Patients who had EDS were found to have a higher incidence of revision within 10 years of undergoing TKA and THA compared to matched controls, especially for instability. Patients who have EDS should be counseled accordingly. Surgical technique and implant selection should include consideration for increased constraint in TKA and larger femoral heads or dual mobility articulations for THA.
摘要：
背景：对于患有Ehlers-Danlos综合征（EDS）的患者，全关节置换术后的长期并发症尚不明确，一组结缔组织疾病。这项研究比较了患有和未患有EDS的患者全髋关节置换术（THA）和全膝关节置换术（TKA）后翻修手术的10年发生率。
方法：使用2010年至2021年的全国所有付款人索赔数据库进行回顾性队列分析，以确定接受原发性TKA或THA的患者。有和没有EDS的患者倾向评分按年龄匹配，性别,和合并症指数。使用Kaplan-Meier分析和Cox比例风险模型来确定患有和未患有EDS的患者的累积发生率和修订风险。
结果：接受TKA的EDS患者具有更高的全因翻修风险（风险比（HR）：1.50，95％置信区间（95％CI）：1.09至2.07，P<0.014）和由于不稳定引起的翻修风险（HR=2.49，95％CI：1.37至4.52，P<0.003）。接受THA的EDS患者发生全因修正的风险较高(HR=2.32,95%CI:1.47~3.65,P<0.001),不稳定导致的修正(HR=4.26,95%CI:2.17~8.36,P<0.001),机械松动(HR=3.63,95%CI:2.05~6.44,P<0.001)。
结论：发现EDS患者在接受TKA和THA后10年内的翻修发生率高于对照组。尤其是不稳定。EDS患者应得到相应的建议。手术技术和植入物的选择应包括考虑增加TKA的约束和较大的股骨头或THA的双活动关节。
方法：使用2010年至2021年的全国所有付款人索赔数据库进行回顾性队列分析，以确定接受原发性TKA或THA的患者。有和没有EDS的患者倾向评分按年龄匹配，性别,和合并症指数。使用Kaplan-Meier分析和Cox比例风险模型来确定患有和未患有EDS的患者的累积发生率和修订风险。
结果：接受TKA的EDS患者具有更高的全因翻修风险（风险比（HR）：1.50，95％置信区间（95％CI）：1.09至2.07，P<0.014）和由于不稳定引起的翻修风险（HR=2.49，95％CI：1.37至4.52，P<0.003）。接受THA的EDS患者发生全因修正的风险较高(HR=2.32,95%CI:1.47~3.65,P<0.001),不稳定导致的修正(HR=4.26,95%CI:2.17~8.36,P<0.001),机械松动(HR=3.63,95%CI:2.05~6.44,P<0.001)。
结论：发现EDS患者在接受TKA和THA后10年内的翻修发生率高于对照组。尤其是不稳定。EDS患者应得到相应的建议。手术技术和植入物的选择应包括考虑增加TKA的约束和较大的股骨头或THA的双活动关节。
