手术治疗的膝关节损伤与膝关节置换术的关联：基于芬兰全国登记数据的探索性研究
简介
基于芬兰全国注册数据，纳入逾300万人年随访，分析手术治疗的膝关节损伤（骨折与非骨折）与后续全膝关节置换术（KA）的关联。结果显示，非骨折损伤手术组KA发生率是普通人群的3.74倍，骨折手术组为2.08倍，其中15-54岁年轻患者的风险增幅最大（非骨折组SIR 6.05，骨折组SIR 8.12）。该流行病学发现提示，对年轻膝关节损伤术后患者应警惕远期骨关节炎…
英文摘要
BACKGROUND AND PURPOSE: Knee injuries are established risk factors for knee osteoarthritis (OA). We aimed to investigate whether surgically treated knee injuries are associated with an increased incidence of end‑stage knee OA necessitating knee arthroplasty (KA). METHODS: Using nationwide Finnish registers, we identified all individuals aged 15-99 years who underwent surgery for knee injuries between 1986 and 2024. Injuries were categorized as knee fracture surgeries or non‑fracture knee injury surgeries. The date of the first identified injury surgery served as the index point from which person years under the exposure of interest were accrued. The control population comprised all Finnish residents without a recorded knee injury diagnosis and surgical treatment. Diagnoses and procedures were retrieved from the Care Register for Health Care (CRHC); KAs were identified from the Finnish Arthroplasty Register (FAR) and CRHC. Incidence rates of KA were calculated for both injury categories and the control population, stratified by age, sex, and year. Incidence comparisons between exposure and control groups were performed using age‑, sex‑, and year-standardized standardized incidence ratios (SIRs). RESULTS: In the fracture surgery cohort, there were 2,163 KAs with over 489,000 person‑years of follow‑up. In the non‑fracture injury surgery cohort there were 13,570 KAs with over 3.01 million person‑years of follow‑up. In the control population there were 205,440 KAs with over 167 million person‑years of follow‑up. Relative to the corresponding general population, the incidence of KA was increased in both injury categories, non-fracture injury surgery SIR 3.74 (95% confidence interval [CI] 3.68-3.80) and fracture surgery SIR 2.08 (CI 1.99-2.17). The greatest excess was among the youngest group (15-54 years): fracture surgery SIR 8.12 (CI 7.40-8.89); non‑fracture injury surgery SIR 6.05 (CI 5.84-6.27). CONCLUSION: Surgically treated knee injuries were associated with an increased incidence of KA, most notably in those aged 15-54 years. In older age groups, the additional effect of the injury surgery appears smaller, likely because age itself markedly increases the baseline incidence of KA.