Berend Keith R, Lombardi Adolph V, Mallory Thomas H, Adams Joanne B, Groseth Kari L
Joint Implant Surgeons, Inc., Columbus, OH 43215, USA.
Clin Orthop Relat Res. 2005 Nov;440:60-6. doi: 10.1097/01.blo.0000187062.65691.e3.
There has been increasing use of and expanding indications for unicompartmental knee arthroplasty using minimally invasive techniques. We sought to define contraindications by examining failures. We retrospectively reviewed the early results of a consecutive series of minimally invasive medial unicompartmental knee arthroplasty using two implant designs. Seventy-nine consecutive unicompartmental knee arthroplasty cases (48 instrumented and 31 noninstrumented) with minimum 2-year followup were reviewed. Patients with radiographic involvement with or without pain referable to the lateral compartment or to the patellofemoral joint were not considered candidates. Failure was defined as revision or pending revision. The average followup was 40.2 months. There were 16 failures (six tibial loosening, three plateau fracture, four persistent medial pain, one progressive arthritis, and two sepsis). Age, gender, disease severity and implant design did not predict failure. Body mass index greater than 32 did predict failure and was associated with a reduction in survivorship by log-rank and Wilcoxon analyses. These results show reliable success if obesity is considered a contraindication and technical errors resulting in fracture are eliminated. Better defining the ideal candidate for unicompartmental knee arthroplasty, with obesity remaining a contraindication, will make this a more predictable and reliable procedure.
Prognostic study, Level IV-2 (case series). See the Guidelines for Authors for a complete description of levels of evidence.
使用微创技术的单髁膝关节置换术的应用日益增多，适应证也不断扩大。我们试图通过研究失败病例来明确其禁忌证。我们回顾性分析了连续一系列采用两种植入物设计的微创内侧单髁膝关节置换术的早期结果。对79例连续的单髁膝关节置换术病例（48例使用器械辅助，31例未使用器械辅助）进行了至少2年的随访。有影像学证据显示外侧间室或髌股关节受累且伴有或不伴有疼痛的患者不被视为手术候选者。失败定义为翻修或即将翻修。平均随访时间为40.2个月。有16例失败（6例胫骨松动、3例平台骨折、4例持续性内侧疼痛、1例进行性关节炎和2例败血症）。年龄、性别、疾病严重程度和植入物设计均不能预测失败。体重指数大于32确实可预测失败，经对数秩和Wilcoxon分析，其与生存率降低相关。这些结果表明，如果将肥胖视为禁忌证并消除导致骨折的技术失误，手术成功率可靠。更好地明确单髁膝关节置换术的理想候选者，将肥胖仍列为禁忌证，会使该手术成为更可预测和可靠的手术。
预后研究，IV-2级（病例系列）。有关证据水平的完整描述，请参阅作者指南。
