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Higher Risk of Loosening for a Four-Pegged TKA Tibial Baseplate Than for a Stemmed One: A Register-based Study.

四钉TKA胫骨底板松动的风险高于带柄TKA底板: 一项基于注册的研究。

  • 影响因子:2.55
  • DOI:10.1097/CORR.0000000000000774
  • 作者列表:"Robertsson O","Sundberg M","Sezgin EA","Lidgren L","W-Dahl A
  • 发表时间:2020-01-01
Abstract

BACKGROUND:Modern modular implants allow surgeons to mix different combinations of components within the same brand. From 1999 to 2012, the NexGen®-CR Option femoral component, together with a NexGen® Option Stemmed tibial plate (stemmed baseplate), which uses a short central stem, was the most-frequently used NexGen® combination in the Swedish Knee Arthroplasty Register. However, from 1999 to 2012, the same femoral component was also used along with the NexGen® Precoat four-pegged tibial baseplate (pegged baseplate). Considering the difference in the fixation concepts for these two tibial baseplates, we wanted to study whether their revision rates differed. QUESTIONS/PURPOSES:To investigate the difference in (1) all-cause revision and (2) the risk of revision for aseptic loosening between the NexGen® pegged and stemmed baseplates when used with the NG-CR Option femoral component and the same two types of inserts. METHODS:The Swedish Knee Arthroplasty Register provided data. The register, which was started in 1975, has since 1999 registered part numbers for individual implant components, allowing it to assess the combinations of components used in each patient. It has been shown to have high completeness (97%) and validity [12, 15]. The inclusion period was 1999 to 2012; during that time, 137,143 primary knee arthroplasties were registered, of which 125,094 were TKAs. Only TKAs performed for osteoarthritis and without patellar resurfacing were included, since not resurfacing the patella is the standard procedure in Sweden. This left 15,287 knees with the stemmed baseplate and 2479 with the pegged baseplate, or 12% and 2% of the total number of TKAs, respectively. Two general hospitals used the pegged baseplate exclusively during that period. Thus, specific patients were not selected for having the pegged plate. The mean age, mortality, and length of followup were similar for the two groups.We used the Kaplan-Meier statistics to calculate the cumulative revision rate (CRR) and Cox regression to compare risk ratios after adjusting for age and sex. The end point was a knee revision for respective all causes or aseptic loosening. The study ended on December 31, 2016. Due to the free healthcare system in Sweden it is highly unusual for patients to seek elective revision abroad, and by use of the extensive Swedish census register, we estimate the level of followup approximately 97%. RESULTS:Knees with the pegged baseplate had a higher risk for all-cause revision than did those with the stemmed baseplate (5.8% [95% confidence interval {CI}, 4-8.3] and 3% [95% CI, 2.6-3.5] at 15 years; p = 0.003). After controlling for age and sex, the aseptic loosening risk in the pegged baseplate group was still higher than that in the stemmed group (relative risk, 5.40; 95% CI, 3.64-8.02; p < 0.001). CONCLUSIONS:In this Swedish registry study, we observed a higher loosening risk with the pegged baseplate than the stemmed one, even after controlling for age and sex. Because this was only a comparison of implants from one vendor, and because there may have been other between-group differences for which we could not fully control, this concerning finding should be explored using data from other registries. LEVEL OF EVIDENCE:Level III, therapeutic study.

摘要

背景: 现代模块化植入物允许外科医生在同一品牌内混合不同的组件组合。从 1999 到 2012,NexGen®-CR选项股骨组件,与NexGen一起®选项Stemmed胫骨钢板 (stemmed底板),使用短的中央茎,是最常用的NexGen®瑞典膝关节置换术注册中的组合。然而,从 1999 年到 2012 年,相同的股骨部件也与NexGen一起使用。®预涂层四钉胫骨底板 (钉底板)。考虑到这两种胫骨底板固定概念的差异,我们想研究它们的翻修率是否不同。 问题/目的: 调查NexGen之间 (1) 全因翻修和 (2) 无菌性松动翻修风险的差异®当与NG-CR选项股骨部件和相同的两种类型的插入物一起使用时,钉住和stemmed底板。 方法: 瑞典膝关节置换术注册研究提供了数据。注册始于 1975 年,自 1999 年以来,注册了单个植入部件的零件号,使其能够评估每个患者使用的部件组合。它已被证明具有较高的完整性 (97%) 和有效性 [12,15]。纳入时间为 1999 至 2012 年; 在此期间,登记了 137,143 例初级膝关节置换术,其中 125,094 例为TKAs。仅包括因骨关节炎而未进行髌骨表面置换的TKAs,因为不进行髌骨表面置换是瑞典的标准手术。这左侧 15,287 个膝关节与stemmed底板和 2479 与钉住底板,或 12% 和 2% 的TKAs总数,分别。在此期间,两家综合医院专门使用了挂钩底板。因此,没有选择特定的患者进行钉板。两组的平均年龄、死亡率和随访时间相似。我们使用Kaplan-Meier统计计算累积翻修率 (CRR),并使用Cox回归比较校正年龄和性别后的风险比。终点是针对各自原因或无菌性松动的膝关节翻修。研究于 2016 年 12 月 31 日结束。由于瑞典的免费医疗保健系统,患者在国外寻求选择性修订是非常不寻常的,通过使用广泛的瑞典人口普查登记册,我们估计随访水平约为 97%。 结果: 与stemmed底板相比,使用钉住底板的膝关节发生全因翻修的风险更高 (5.8% [95% 置信区间 {CI},15 年时 4-8.3] 和 3% [95% CI,2.6-3.5]; p = 0.003)。在控制了年龄和性别后,钉住基板组的无菌性松动风险仍高于stemmed组 (相对危险度,5.40; 95% CI,3.64-8.02; p <0.001)。 结论: 在这项瑞典登记研究中,我们观察到即使在控制了年龄和性别之后,钉住底板的松动风险也高于带柄底板。因为这只是一个供应商的植入物的比较,因为可能还有其他我们无法完全控制的组间差异,应该利用其他登记册的数据来探讨这方面的调查结果。 证据级别: III级,治疗性研究。

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发表时间:2020-02-01
DOI:10.1007/s40520-019-01202-w
作者列表:["Gan J","Tu Q","Miao S","Lei T","Cui X","Yan J","Zhang J"]

METHODS:BACKGROUND:Postoperative cognitive dysfunction (POCD) is a common complication after orthopedic surgery, which is not conducive to the prognosis of the elderly. AIMS:We performed this study to investigate the effects of oxycodone applied for patient-controlled intravenous analgesia (PCIA) on postoperative cognitive function in elderly patients after total hip arthroplasty (THA). METHODS:Ninety-nine participants were enrolled and allocated into two groups: oxycodone group (group O) and sufentanil group (group S). The primary outcome was the incidence of POCD, diagnosed according to the changes in the Mini-mental status examination (MMSE) and Montreal Cognitive Assessment (MoCA) scores. The secondary outcomes included the plasma levels of S-100B protein and neuron-specific enolase (NSE), the amount of postoperative analgesic consumption and the incidence of adverse reactions. RESULTS:The incidence of POCD was significantly lower in patients receiving oxycodone up to the 3rd postoperative day (POD, 1st POD 27.3% vs. 51.1%, P = 0.021; 3rd POD 20.5% vs. 40.0%, P = 0.045), as compared to patients receiving sufentanil. The MMSE and MoCA scores of both groups decreased to varying degrees. However, compared with group S, the MMSE scores at 1st POD, 3rd POD, 5th POD and 7st POD in group O were higher than that in group S, while MoCA scores at 1st POD, 3rd POD and 5th POD in group O were higher. Compared with group S, the plasma levels of S-100B protein in group O at 4 h, 8 h, 12 h post-surgery were lower. While the plasma levels of NSE in group O at 4 h, 8 h, 12 h, 24 h post-surgery were lower. Number of PCIA boluses and consumption of analgesic drug during the first two POD were similar between two groups. However, postoperative incidence of nausea, vomiting and pruritus was significantly lower in patients receiving oxycodone. CONCLUSION:Oxycodone applied for PCIA in elderly patients after THA could reduce the incidence of POCD, improve postoperative cognitive function and decrease the adverse reactions.

影响因子:1.69
发表时间:2020-02-01
DOI:10.1097/BPO.0000000000001393
作者列表:["Jain MJ","Inneh IA","Zhu H","Phillips WA"]

METHODS:BACKGROUND:Primary treatment for Blount disease has changed in the last decade from osteotomies or staples to tension band plate (TBP)-guided hemiepiphysiodesis. However, implant-related issues have been frequently reported with Blount cases. The purpose of our study is to evaluate the surgical failure rates of TBP in Blount disease and characterize predictors for failure. METHODS:We performed an Institutional Review Board-approved retrospective chart-review of pediatric patients with Blount disease to evaluate the results of TBP from 2008 to 2017 and a systematic literature review. Blount cases defined as pathologic tibia-vara with HKA (hip-knee-ankle) axis and MDA (metaphyseal-diaphyseal angle) deviations ≥11 degrees were included in the analysis. Surgical failure was categorized as mechanical and functional failure. We studied both patient and implant-related characteristics and compared our results with a systematic review. RESULTS:In 61 limbs of 40 patients with mean follow-up of 38 months, we found 41% (25/61) overall surgical failure rate and 11% (7/61) mechanical failure rate corresponding to 11% to 100% (range) and 0% to 50% (range) in 8 other studies. Statistical comparison between our surgical failure and nonfailure groups showed significant differences in deformity (P=0.001), plate material (P=0.042), and obesity (P=0.044) in univariate analysis. The odds of surgical failure increased by 1.2 times with severe deformity and 5.9 times with titanium TBP in the multivariate analysis after individual risk-factor adjustment. All 7 mechanical failures involved breakage of cannulated screws on the metaphyseal side. CONCLUSIONS:Most of the studies have reported high failure rates of TBP in Blount cases. Besides patient-related risk factors like obesity and deformity, titanium TBP seems to be an independent risk factor for failure. Solid screws were protective for mechanical failure, but not for functional failure. In conclusion, efficacy of TBP still needs to be proven in Blount disease and implant design may warrant reassessment. LEVEL OF EVIDENCE:Level III-retrospective comparative study with a systematic review.

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影响因子:2.43
发表时间:2020-01-15
DOI:10.5435/JAAOS-D-18-00777
作者列表:["Chen DQ","Montgomery SR Jr","Cancienne JM","Werner BC"]

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