Bertani A, Flecher X, Parratte S, Aubaniac J-M, Argenson J-N
Service de Chirurgie Orthopédique et Traumatologique, HIA Laveran, Marseille, France.
Rev Chir Orthop Reparatrice Appar Mot. 2008 Dec;94(8):763-70. doi: 10.1016/j.rco.2008.04.010. Epub 2008 Jul 11.
The appropriate treatment when joint degeneration is limited to the lateral compartment remains controversial. Total-knee arthroplasty and alignment osteotomy are well studied for genu valgum. Little is known about the results with lateral-unicompartmental prostheses. The purpose of this work was to evaluate the midterm results in a series of lateral unicompartmental-knee prostheses.
From 1985 through 2005, 35 lateral unicompartmental prostheses were implanted among a total of 703 unicompartmental arthroplasties. The indication for surgery was established on the findings of the plain X-rays and stress films to evaluate the medial compartment. Preoperatively, the overall misalignment was 6 valgus (range: 0 to 15). The mean preoperative IKS was 102 (range: 54 to 164). Implants used were: Miller-Galante (n=20), ZUK (n=4), Marmor (n=5) and Alpina (n=1). Mean polyethelene thickness was 9 mm (range: 6 to 17 mm). The IKS score was established preoperatively and at last follow-up. Outcome assessment searched for clinical, radiological and surgical criteria affecting survival. The Kaplan-Meier method was used to determine implant survival. Surgical revision for implant replacement or adjunction of a new implant was considered as the endpoint of implant survival.
Twenty-nine patients (30 knees) were reviewed at mean nine years (range: two to 22 years). Mean IKS at one year was 185. At last follow-up, mean IKS was 166 (range: 28 to 200). Overall misalignment without revision was 3 (range: -6 to +11). Five arthroplasties were revised, four for extension of the degenerative disease (two supplementary unicompartmental prostheses and two total-knee arthroplasties) and one for depression of the tibial plateau after manipulation for stiffness and revision by total-knee arthroplasty. Two associated procedures were performed: arthroscopy for pseudoblockage at two years and one patellar osteosynthesis for fracture at 10 years.
We have used unicompartmental lateral prostheses regularly since initiating our experience, but for rare indications (5% of all unicompartmental implantations). The lateral unicompartmental prosthesis is a surgical solution for isolated femorotibial degeneration. Results at mean nine years follow-up have been encouraging, that is, similar to those with a medial prosthesis.
当关节退变局限于外侧间室时，合适的治疗方法仍存在争议。全膝关节置换术和对线截骨术在膝外翻治疗方面已有充分研究。对于外侧单髁假体的效果了解甚少。本研究的目的是评估一系列外侧单髁膝关节假体的中期结果。
1985年至2005年期间，在总共703例单髁关节置换术中植入了35个外侧单髁假体。根据X线平片和应力位片的结果来确定手术指征，以评估内侧间室情况。术前，整体对线不良为6°外翻（范围：0至15°）。术前膝关节协会（IKS）评分平均为102分（范围：54至164分）。使用的植入物有：米勒-加兰特（n = 20）、祖克（n = 4）、马莫尔（n = 5）和阿尔皮纳（n = 1）。聚乙烯平均厚度为9毫米（范围：6至17毫米）。术前和最后一次随访时均进行IKS评分。结果评估探寻影响假体存活的临床、放射学和手术标准。采用Kaplan-Meier法确定假体存活率。将因假体置换或添加新假体而进行的手术翻修视为假体存活的终点。
对29例患者（30个膝关节）进行了平均9年（范围：2至22年）的随访。术后1年IKS评分平均为185分。最后一次随访时，IKS评分平均为166分（范围：28至200分）。未进行翻修时的整体对线不良为3°（范围：-6至+11°）。5例关节置换术进行了翻修，4例是因为退行性疾病进展（2例补充单髁假体和2例全膝关节置换术），1例是因为膝关节僵硬手法治疗后胫骨平台塌陷，随后进行全膝关节置换术翻修。还进行了2例相关手术：2年时因假性阻滞进行关节镜检查，10年时因骨折进行1例髌骨接骨术。
自开展相关经验以来，我们一直常规使用外侧单髁假体，但手术指征罕见（占所有单髁植入手术的5%）。外侧单髁假体是治疗单纯股胫关节退变的一种手术解决方案。平均9年随访结果令人鼓舞，即与内侧假体的结果相似。
