背景:许多患者患有多个关节的骨关节炎,可能导致多次全关节置换术(MJA)。首先,我们确定了长达10年的髋关节和膝关节中MJA的累积发生率(Cin)。其次,我们计算了第一次和随后的关节置换术之间的平均时间,并评估了不同的MJA轨迹。最后,我们比较了MJA患者和单髋或膝关节置换术(HA和KA)患者的患者特征和术后结局(功能和疼痛).
方法:从荷兰关节成形术注册中提取骨关节炎的主要指标(第一)HA或KA。MJA的1、2、5和10年Cin(包括竞争风险死亡),平均时间间隔,计算和MJA轨迹,并对主要指标HA或KA进行分层。性,术前年龄,使用序数逻辑回归比较BMI。结果,术前测量,术后3、6和12个月(功能:髋关节残疾或膝关节损伤和骨关节炎结果评分;疼痛:数字评定量表),使用线性回归进行比较。
结果:共包括140,406例HA患者和140,268例KA患者。一,第二次关节置换术的2、5和10年Cin分别为8.9%[95%置信区间(CI):8.7至9.0],14.3%[95CI:14.1至14.5],24.0%[95CI:23.7至24.2],指数HA后的32.7%[95CI:32.2至33.1],和9.5%[95CI:9.4至9.7],16.0%[95CI:15.9至16.2],26.4%[95CI:26.1至26.6],指数KA后的35.8%[95CI:35.4至36.3]。在指数HA和KA组中,>2次关节置换术的10年Cin均较小。从第一到第二的时间间隔,第三,第四次关节成形术为26[95CI:26.1至26.7],47[95CI:46.4至48.4],和58[95CI:55.4至61.1]个月后,和26[95CI:25.9至26.3],52[95CI:50.8至52.7],指数KA后61个月[95CI:58.3至63.4]。有83%的第二关节置换位于对侧同源关节中(即,膝盖或臀部)。MJAs与单个HAs和KAs之间的术后功能和疼痛差异很小。
结论:10年的Cin显示,大约三分之一的患者在大约2年后接受了第二次关节置换术,大多数在对侧同源关节。很少有患者在10年内接受了>2次关节置换术。作为一个女人,具有较高的BMI,年轻增加了MJA的几率。术后结果受到MJA的轻微负面影响。
BACKGROUND: Many patients suffer from osteoarthritis (OA) in
multiple joints, possibly resulting in
multiple joint arthroplasties (MJAs). Primarily, we determined the cumulative incidence (Cin) of MJA in hip and knee joints up to 10 years. Secondly, we calculated the mean time between the first and subsequent joint arthroplasty, and evaluated the different MJA trajectories. Lastly, we compared patient characteristics and outcomes (functionality and pain) after surgery between MJA patients and single hip arthroplasty or knee arthroplasty (HA and KA) patients.
METHODS: Primary index (first) HA or KA for OA were extracted from the Dutch Arthroplasty Register. The 1, 2, 5, and 10-year Cin (including competing risk death) of MJA, mean time intervals, and MJA-trajectories were calculated and stratified for primary index HA or KA. Sex, preoperative age, and body mass index were compared using ordinal logistic regression. Outcomes, measured preoperatively, 3, 6, and 12 months postoperatively (function: Hip Disability or Knee Injury and OA Outcome Score; Pain: Numerical Rating Scale), were compared using linear regression.
RESULTS: A total of 140,406 HA-patients and 140,268 KA-patients were included. One, 2, 5, and 10-year Cin for a second arthroplasty were respectively 8.9% [95% confidence interval (CI): 8.7 to 9.0], 14.3% [95% CI: 14.1 to 14.5], 24.0% [95% CI: 23.7 to 24.2], and 32.7% [95% CI: 32.2 to 33.1] after index HA, and 9.5% [95% CI: 9.4 to 9.7], 16.0% [95% CI: 15.9 to 16.2], 26.4% [95% CI: 26.1 to 26.6], and 35.8% [95% CI: 35.4 to 36.3] after index KA. The 10-year Cin for > 2 arthroplasties were small in both the index HA and KA groups. Time-intervals from first to second, third, and fourth arthroplasty were 26 [95% CI: 26.1 to 26.7], 47 [95% CI: 46.4 to 48.4], and 58 [95% CI: 55.4 to 61.1] months after index HA, and 26 [95% CI: 25.9 to 26.3], 52 [95% CI: 50.8 to 52.7], and 61 [95% CI: 58.3 to 63.4] months after index KA. There were 83% of the second arthroplasties placed in the contralateral cognate joint (ie, knee or hip). Differences in postoperative functionality and pain between MJAs and single HAs and KAs were small.
CONCLUSIONS: The 10-year Cin showed that about one-third of patients received a second arthroplasty after approximately 2 years, with the majority in the contralateral cognate joint. Few patients received > 2 arthroplasties within 10 years. Being a women, having a higher body mass index, and being younger increased the odds of MJA. Postoperative outcomes were slightly negatively affected by MJA.