Swienckowski John J, Pennington Donald W
Botsford General Hospital, Farmington Hills, MI 48336, USA.
J Bone Joint Surg Am. 2004 Sep;86-A Suppl 1(Pt 2):131-42. doi: 10.2106/00004623-200409001-00004.
Unicompartmental knee arthroplasty has been used to treat elderly, low-demand patients, but the literature is sparse regarding the use of this procedure for younger, active patients. The purpose of the present retrospective study was to evaluate the results of unicompartmental knee arthroplasty in younger, more active patients.
Forty-one patients underwent forty-six consecutive unicompartmental knee arthroplasties with use of the Miller-Galante system between 1988 and 1996. All of the patients were sixty years of age or younger and all were physically active. The Hospital for Special Surgery knee score and the University of California at Los Angeles activity assessment were used to rate the function and to determine the activity level of each patient, respectively. Serial radiographs were used to evaluate the status of prosthetic fixation, femorotibial alignment, and the progression of arthrosis in the unreplaced compartment. Long-term survivorship was calculated with use of Kaplan-Meier analysis.
The mean duration of follow-up was eleven years. Of the forty-five knees that were available for follow-up, three had been revised. The Hospital for Special Surgery score was excellent for thirty-nine (93%) of the remaining forty-two knees and good for three. The University of California at Los Angeles activity assessment score was 6.6 +/- 1.4 for the knees in which the original prosthesis had been retained and 7.3 +/- 1.5 for those in which it had been revised. Two asymptomatic patients had revision of a modular tibial component because of substantial radiographic evidence of polyethylene wear; one of these patients had exchange of the polyethylene insert and the tibial tray, and the other had exchange of the polyethylene insert only. A third patient underwent revision total knee arthroplasty because of continuing knee pain and a progressive tibial radiolucent line that was >2 mm in width. The average postoperative femorotibial alignment was 5 degrees of valgus. Nine knees had progression of arthritis in the unresurfaced compartment; none of these knees were revised, and none of the patients had deterioration in the Hospital for Special Surgery score. Kaplan-Meier analysis demonstrated an eleven-year survivorship of 92%.
At an average duration of follow-up of eleven years, unicompartmental knee arthroplasty was associated with pain relief and excellent function in a cohort of patients who had been sixty years of age or younger and active at the time of surgery.
单髁膝关节置换术已被用于治疗老年、需求较低的患者，但关于该手术用于年轻、活动较多患者的文献较少。本回顾性研究的目的是评估单髁膝关节置换术在年轻、活动较多患者中的疗效。
1988年至1996年间，41例患者连续接受了46例使用Miller-Galante系统的单髁膝关节置换术。所有患者均60岁及以下，且身体活动活跃。分别使用特种外科医院膝关节评分和加利福尼亚大学洛杉矶分校活动评估来评定功能和确定每位患者的活动水平。连续的X线片用于评估假体固定情况、股胫关节对线以及未置换间室的关节病进展。使用Kaplan-Meier分析计算长期生存率。
平均随访时间为11年。在可进行随访的45个膝关节中，有3个进行了翻修。在其余42个膝关节中，特种外科医院评分为优的有39个（93%），评分为良的有3个。保留原假体的膝关节加利福尼亚大学洛杉矶分校活动评估评分为6.6±1.4，翻修的膝关节评分为7.3±1.5。两名无症状患者因大量影像学证据显示聚乙烯磨损而对模块化胫骨部件进行了翻修；其中一名患者更换了聚乙烯内衬和胫骨托，另一名患者仅更换了聚乙烯内衬。第三名患者因持续的膝关节疼痛和宽度>2 mm的胫骨透亮线进展而接受了全膝关节置换翻修术。术后平均股胫关节对线为5°外翻。9个膝关节在未置换间室出现了关节炎进展；这些膝关节均未进行翻修，且患者的特种外科医院评分均未恶化。Kaplan-Meier分析显示11年生存率为92%。
在平均11年的随访期内，单髁膝关节置换术在一组手术时年龄60岁及以下且活动活跃的患者中与疼痛缓解和良好功能相关。
