Pandit H, Jenkins C, Gill H S, Barker K, Dodd C A F, Murray D W
Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK.
J Bone Joint Surg Br. 2011 Feb;93(2):198-204. doi: 10.1302/0301-620X.93B2.25767.
This prospective study describes the outcome of the first 1000 phase 3 Oxford medial unicompartmental knee replacements (UKRs) implanted using a minimally invasive surgical approach for the recommended indications by two surgeons and followed up independently. The mean follow-up was 5.6 years (1 to 11) with 547 knees having a minimum follow-up of five years. At five years their mean Oxford knee score was 41.3 (sd 7.2), the mean American Knee Society Objective Score 86.4 (sd 13.4), mean American Knee Society Functional Score 86.1 (sd 16.6), mean Tegner activity score 2.8 (sd 1.1). For the entire cohort, the mean maximum flexion was 130° at the time of final review. The incidence of implant-related re-operations was 2.9%; of these 29 re-operations two were revisions requiring revision knee replacement components with stems and wedges, 17 were conversions to a primary total knee replacement, six were open reductions for dislocation of the bearing, three were secondary lateral UKRs and one was revision of a tibial component. The most common reason for further surgical intervention was progression of arthritis in the lateral compartment (0.9%), followed by dislocation of the bearing (0.6%) and revision for unexplained pain (0.6%). If all implant-related re-operations are considered failures, the ten-year survival rate was 96% (95% confidence interval, 92.5 to 99.5). If only revisions requiring revision components are considered failures the ten-year survival rate is 99.8% (confidence interval 99 to 100). This is the largest published series of UKRs implanted through a minimally invasive surgical approach and with ten-year survival data. The survival rates are similar to those obtained with a standard open approach whereas the function is better. This demonstrates the effectiveness and safety of a minimally invasive surgical approach for implanting the Oxford UKR.
这项前瞻性研究描述了首批1000例采用微创外科手术方法植入的牛津内侧单髁膝关节置换术（UKR）的结果，手术由两名外科医生进行，针对推荐适应症，并进行独立随访。平均随访时间为5.6年（1至11年），其中547例膝关节的最短随访时间为5年。5年时，他们的平均牛津膝关节评分为41.3（标准差7.2），平均美国膝关节协会客观评分为86.4（标准差13.4），平均美国膝关节协会功能评分为86.1（标准差16.6），平均特格纳活动评分为2.8（标准差1.1）。在末次复查时，整个队列的平均最大屈曲度为130°。与植入物相关的再次手术发生率为2.9%；在这29例再次手术中，2例为翻修手术，需要更换带柄和楔形的膝关节置换组件，17例转换为初次全膝关节置换术，6例为因关节面脱位进行的切开复位，3例为二次外侧UKR，1例为胫骨组件翻修。进一步手术干预的最常见原因是外侧间室关节炎进展（0.9%），其次是关节面脱位（0.6%）和因不明原因疼痛进行翻修（0.6%）。如果将所有与植入物相关的再次手术都视为失败，则十年生存率为96%（95%置信区间，92.5至99.5）。如果仅将需要更换组件的翻修视为失败，则十年生存率为99.8%（置信区间99至100）。这是已发表的通过微创外科手术方法植入UKR且有十年生存数据的最大系列研究。生存率与标准开放手术方法相似，而功能更好。这证明了微创外科手术方法植入牛津UKR的有效性和安全性。
