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Reduced survival of total knee arthroplasty after previous unicompartmental knee arthroplasty compared with previous high tibial osteotomy: a propensity-score weighted mid-term cohort study based on 2,133 observations from the Danish Knee Arthroplasty Registry.

与既往胫骨高位截骨术相比,既往单髁膝关节置换术后全膝关节置换的生存率降低: 一项基于丹麦膝关节置换登记处 2,133 项观察的倾向评分加权中期队列研究。

  • 影响因子:0
  • DOI:10.1080/17453674.2019.1709711
  • 作者列表:"El-Galaly A","Nielsen PT","Kappel A","Jensen SL
  • 发表时间:2020-04-01
Abstract

:Background and purpose - Both medial unicompartmental knee arthroplasties (UKA) and high tibial osteotomies (HTO) are reliable treatments for isolated medial knee osteoarthritis. However, both may with time need conversion to a total knee arthroplasty (TKA). We conducted the largest nationwide registry comparison of the survival of TKA following UKA with TKA following HTO.Patients and methods - From the Danish Knee Arthroplasty Registry, aseptic conversions to TKA from UKA and TKA converted from HTO within the period of 1997-2018 were retrieved. The Kaplan-Meier method and the Cox proportional hazards regression were used to estimate the survival and hazard ratio (HR) for revision, considering confounding by indication utilizing propensity-score based inverse probability of treatment weighting (PS-IPTW).Results - PS-IPTW yielded a well-balanced pseudo-cohort (standard mean difference (SMD) < 0.1 for all covariates, except implant supplementation) of 963.8 TKAs following UKA and 1139.1 TKAs following HTO. The survival of TKA following UKA was significantly less than that of TKA following HTO with a 5-year estimated survival of 0.88 (95% confidence interval (CI) 0.85-0.90) and 0.94 (CI 0.93-0.96), respectively. The differences in survival corresponded to an implant-supplementation adjusted HR of 2.7 (CI 2.4-3.1) for TKA following UKA compared with TKA following HTO.Interpretation - Previous UKA more than doubled the revision risk of a subsequent TKA compared with previous HTO. This potential risk should be considered in the shared treatment decision of patients who are candidates for both UKA and HTO.

摘要

背景和目的: 内侧单髁膝关节成形术 (UKA) 和胫骨高位截骨术 (HTO) 都是孤立性内侧膝骨关节炎的可靠治疗方法。然而,两者都可能随着时间的推移需要转为全膝关节置换术 (TKA)。我们对UKA后TKA与HTO后TKA的生存率进行了最大规模的全国注册比较。患者和方法-从丹麦膝关节置换术登记处检索到 1997-2018 期间从UKA无菌转换为TKA,从HTO转换为TKA。使用Kaplan-Meier方法和Cox比例风险回归估计生存和风险比 (HR) 进行翻修,考虑使用基于倾向评分的治疗加权逆概率 (PS-IPTW) 的适应症的混杂。结果-PS-IPTW产生了一个平衡良好的伪队列 (所有协变量的标准平均差 (SMD) <0.1,除植入物补充外) UKA后 963.8 TKAs和HTO后 1139.1 TKAs。UKA术后TKA的生存率明显低于HTO术后TKA的生存率,5 年估计生存率为 0.88 (95% 置信区间 (CI) 0.85-0.90) 和 0.94 (CI 0.93-0.96)。存活率的差异对应于UKA术后TKA与HTO术后TKA的植入物补充调整HR为 2.7 (CI 2.4-3.1)。解释-以前的UKA与以前的HTO相比,随后的TKA的修订风险增加了一倍多。这种潜在的风险应该在UKA和HTO候选患者的共同治疗决策中考虑。

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