Myers Thomas G, Cui Quanjun, Kuskowski Michael, Mihalko William M, Saleh Khaled J
J Bone Joint Surg Am. 2006 Nov;88 Suppl 3:76-82. doi: 10.2106/JBJS.F.00568.
The reported outcomes of patients who underwent total or unicompartmental knee arthroplasty for secondary and spontaneous osteonecrosis of the knee are often from studies that lack the number of subjects necessary to generate meaningful conclusions. We systematically reviewed the available literature in order to define the outcomes of patients after total knee arthroplasty for secondary osteonecrosis and after total or unicompartmental knee arthroplasty for spontaneous osteonecrosis of the knee.
A literature review yielded twenty cohorts with demographic patient information and outcome scores (global knee scores, radiographic outcomes, and revision rates) for patients who had knee arthroplasty as treatment for either secondary or spontaneous osteonecrosis of the knee. The mean preoperative and postoperative global knee scores, the mean revision rate, and the categorization of the mean "poor" and mean "good" outcomes for the knees with each underlying disease were tabulated and reported. The demographic data and the reported mean global knee scores were weighted by the number of knees in each study.
Total knee arthroplasty was performed in 150 knees with secondary osteonecrosis and 148 knees with spontaneous osteonecrosis, and unicompartmental knee arthroplasty was performed in sixty-four knees with spontaneous osteonecrosis. Total knee arthroplasty for spontaneous osteonecrosis of the knee was associated with the best outcomes (higher "good" and postoperative global knee scores and lower revision [3%] and "poor" outcome [6%] rates compared with the other two groups). The outcomes after total knee arthroplasty in knees with secondary osteonecrosis as well as in knees with spontaneous osteonecrosis were better in the cohorts operated on during or after 1985 than in those operated on before 1985. Similarly, the outcomes after unicompartmental knee arthroplasty in knees with spontaneous osteonecrosis of the knee were also better in the cohorts operated on during or after 1985 than in those operated on before 1985.
Total knee arthroplasty performed as treatment for either secondary osteonecrosis or spontaneous osteonecrosis and unicompartmental knee arthroplasty performed as treatment for spontaneous osteonecrosis were associated with improved outcomes in cohorts with more recent operative dates. The evidence suggests that the use of contemporary cemented implants in total knee arthroplasty and the selective use of stems and augments in patients who have development of secondary osteonecrosis after total knee arthroplasty are producing outcomes that are comparable to those seen after total knee arthroplasty for osteoarthritis. Although the outcomes of patients who have total knee arthroplasty for the treatment of spontaneous osteonecrosis of the knee have historically been favorable, such outcomes have also shown particular improvement in the studies from more recent operative periods. Although poor outcomes were seen after unicompartmental knee arthroplasty in earlier studies of patients with spontaneous osteonecrosis of the knee, it is possible that those results were secondary to inappropriate patient selection, as the authors of the most recent and, to our knowledge, the only study to follow established operative indications regarding the use of unicompartmental knee arthroplasty reported excellent results.
Therapeutic Level IV. See Instructions to Authors on jbjs.org for a complete description of levels of evidence.
关于因膝关节继发性和自发性骨坏死而接受全膝关节置换术或单髁膝关节置换术患者的报道结果，往往来自缺乏得出有意义结论所需样本量的研究。我们系统回顾了现有文献，以明确膝关节继发性骨坏死患者接受全膝关节置换术后以及膝关节自发性骨坏死患者接受全膝关节置换术或单髁膝关节置换术后的结果。
文献回顾纳入了20个队列，这些队列包含了因膝关节继发性或自发性骨坏死接受膝关节置换治疗患者的人口统计学信息和结果评分（膝关节整体评分、影像学结果及翻修率）。列出并报告了每种基础疾病患者膝关节术前和术后的平均整体评分、平均翻修率，以及膝关节“差”和“好”结果的均值分类。人口统计学数据和报道的平均膝关节整体评分根据每项研究中膝关节的数量进行加权。
150例继发性骨坏死膝关节和148例自发性骨坏死膝关节接受了全膝关节置换术，64例自发性骨坏死膝关节接受了单髁膝关节置换术。膝关节自发性骨坏死接受全膝关节置换术的结果最佳（与其他两组相比，“好”的比例更高、术后膝关节整体评分更高，翻修率[3%]和“差”结果比例[6%]更低）。1985年及以后接受手术的队列中，继发性骨坏死膝关节和自发性骨坏死膝关节接受全膝关节置换术后的结果，优于1985年以前接受手术的队列。同样，1985年及以后接受手术的队列中，膝关节自发性骨坏死接受单髁膝关节置换术后的结果，也优于1985年以前接受手术的队列。
在手术日期较近的队列中，用于治疗继发性骨坏死或自发性骨坏死的全膝关节置换术以及用于治疗自发性骨坏死的单髁膝关节置换术，结果有所改善。有证据表明，在全膝关节置换术中使用当代骨水泥型植入物，以及在全膝关节置换术后发生继发性骨坏死的患者中选择性使用柄和增强装置，所产生的结果与骨关节炎患者接受全膝关节置换术后的结果相当。虽然历史上膝关节自发性骨坏死患者接受全膝关节置换术的结果一直较好，但在更近手术时期的研究中，这些结果也有了特别的改善。尽管在早期膝关节自发性骨坏死患者单髁膝关节置换术的研究中结果较差，但有可能这些结果是由于患者选择不当所致，因为据我们所知，最近且唯一一项遵循单髁膝关节置换术既定手术指征的研究的作者报告了出色的结果。
治疗性IV级。有关证据水平的完整描述，请参阅jbjs.org上的作者须知。
