Risk assessment of contralateral knee arthroplasty after unilateral total knee arthroplasty

doi:10.3969/j.issn.2095-4344.2987

Abstract

Abstract: BACKGROUND: After total knee arthroplasty, some patients will receive the contralateral total knee arthroplasty again, but the influencing factors of contralateral knee surgery are not clear at present.
OBJECTIVE: To evaluate the risk ratio of contralateral knee to total knee arthroplasty in patients with osteoarthritis of both knees after total knee arthroplasty, and to analyze the risk factors of contralateral total knee arthroplasty by clinical and radiographic indicators.
METHODS: Data of 193 patients admitted to Affiliated Hospital of Xuzhou Medical University from 2013 to 2015 with bilateral knee osteoarthritis and undergoing unilateral total knee arthroplasty (follow-up time of 1-66 months) were retrospectively analyzed. The patients were divided into bilateral arthroplasty and unilateral arthroplasty groups based on whether the contralateral knee joint was replaced. K-M survival analysis was used to evaluate the risk ratio of contralateral knee total knee arthroplasty. Age, gender, body mass index, primary surgical side, non-operative knee Hospital for Special Surgery score, pain, mechanical axis perpendicular angle, medial and lateral joint space, femoral tibial angle, hip knee ankle angle, and Kellgren-Lawrence grade at initial surgery were used to assess the risk of contralateral total knee arthroplasty.
RESULTS AND CONCLUSION: (1) Fifty-eight patients (30.1%) received contralateral total knee arthroplasty. The risk of nonoperative knee surgery at 1 year was 8%, and the risk of nonoperative knee surgery at 5 years was 32%. (2) The K-L grade was highly correlated with the risk of future nonoperative total knee arthroplasty (P < 0.001). The mean survival time of the nonoperative knee with K-L grade 4 was 45.7 months, and the 5-year surgical risk was 44.3%. (3) Age, gender, initial surgery side and body mass index, medial and lateral joint space, and hip knee ankle angle were not risk factors for progression to contralateral total knee arthroplasty. Nonoperative knee mechanical axis perpendicular angle (risk ratio=1.437, P < 0.001), femoral tibial angle (risk ratio=1.232, P < 0.001) and K-L classification (risk ratio=2.110, P=0.005) were independent risk factors. Patients with femoral tibial angle ≥185.8° and mechanical axis perpendicular angle ≥2.75° had a higher risk of contralateral total knee arthroplasty (P < 0.001). (4) The preoperative Hospital for Special Surgery score of the bilateral arthroplasty group was significantly lower than that of the unilateral arthroplasty group (P=0.039). Visual analogue scale pain score in the preoperative bilateral arthroplasty group was significantly higher than that in the unilateral arthroplasty group (P=0.013). At 6 months postoperatively, Hospital for Special Surgery score was improved in both groups, but still lower in the bilateral arthroplasty group than that in the unilateral arthroplasty group (P=0.003). (5) Not all patients with bilateral knee osteoarthritis need to receive contralateral total knee arthroplasty after unilateral total knee arthroplasty, and patients with severe knee osteoarthritis (K-L grade 4) are at high risk of needing contralateral total knee arthroplasty. Preoperative contralateral knee mechanical axis perpendicular angle, femoral tibial angle, Hospital for Special Surgery score and pain degree can be used as important factors to recommend patients or arrange a reoperation plan.

Key words: bone, joint, knee, joint replacement, osteoarthritis, contralateral knee

CLC Number:

Zheng Li, Li Dadi, Hu Weifan, Tang Jinlong, Zhao Fengchao. Risk assessment of contralateral knee arthroplasty after unilateral total knee arthroplasty[J]. Chinese Journal of Tissue Engineering Research, 2021, 25(3): 374-379.

Figures/Tables 8

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