Revision Total Hip and Knee Arthroplasties After Solid Organ Transplant
Revision Total Hip and Knee Arthroplasties After Solid Organ Transplant
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DOI：
10.1016/j.arth.2016.11.047
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发表时间：
2017-05-01
影响因子：
3.5
通讯作者：
Abdel, Matthew P.
中科院分区：
文献类型：
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作者：
Ledford, Cameron K.;Statz, Joseph M.;Abdel, Matthew P.
背景：随着实体器官移植(SOT)患者存活率的提高，接受全髋关节置换术(THA)和全膝关节置换术(TKA)的患者越来越多。相应地，这一高风险群体的修订程序的数量也在增加。本研究的目标是确定SOT患者在翻修THA或TKA后最常见的失败机制、相关并发症、临床结果和患者生存。方法：对2000年至2013年间37例SOT患者完成39次翻修手术(30次翻修THA和9次翻修TKA)进行回顾性分析。翻修手术的平均年龄为62岁，平均随访6年。结果：翻修手术最常见的失败模式是无菌性松动(10/30，33%)，其次是假体周围关节感染(7/30，23%)。翻修TKA最常见的失败模式是PJI(5/9，56%)。PJI(3/30；10%)和不稳定(3/30；10%)有6个再次翻修的THA。TKA术后再手术2例，均为急性PJI(2/9；22%)。最终的Harris髋关节评分显著提高(P=.03)，膝关节协会评分也有显著提高(P=.01)。THA翻修术后5年和10年无死亡生存率分别为71%和60%，TKA翻修后分别为65%和21%。结论：实体器官移植术后THA和TKA翻修有较大的再翻修风险，尤其是PJI。尽管接受SOT的患者在翻修手术后临床功能有所改善，但患者中长期随访时的存活率很低。(C)2016 Elsevier Inc.保留所有权利。
Background: As solid organ transplant (SOT) patients' survival improves, the number undergoing total hip (THA) and total knee arthroplasty (TKA) is increasing. Accordingly, the number of revision procedures in this higher-risk group is also increasing. The goals of this study were to identify the most common failure mechanisms, associated complications, clinical outcomes, and patient survivorship of SOT patients after revision THA or TKA.Methods: A retrospective review identified 39 revision procedures (30 revision THAs and 9 revision TKAs) completed in 37 SOT patients between 2000 and 2013. The mean age at revision surgery was 62 years with a mean follow-up of 6 years.Results: The most common failure mode for revision THA was aseptic loosening (10/30, 33%), followed by periprosthetic joint infection (PJI; 7/30, 23%). The most common failure mode for revision TKA was PJI (5/9, 56%). There were 6 re-revision THAs for PJI (3/30; 10%) and instability (3/30; 10%). There were 2 reoperations after revision TKA, both for acute PJI (2/9; 22%). Final Harris Hip Scores significantly (P=.03) improved as did Knee Society Scores (P=.01). Estimated survivorship free from mortality at 5 and 10 years was 71% and 60% after revision THA and 65% and 21% after revision TKA, respectively.Conclusion: Revision THA and TKA after solid organ transplantation carry considerable risk for re-revision, particularly for PJI. Although SOT recipients demonstrate improved clinical function after revision procedures, patient survivorship at mid- to long-term follow-up is low. (C) 2016 Elsevier Inc. All rights reserved.