Chou Daud T S, Swamy Girish N, Lewis James R, Badhe Nitin P
ST3 Trauma and Orthopaedics, Queens Medical Centre, Nottingham University Hospital, United Kingdom.
Knee. 2012 Aug;19(4):356-9. doi: 10.1016/j.knee.2011.05.002. Epub 2011 Jun 1.
Recent reports suggest good outcome results following unicompartmental knee replacement (UKR). However, a number of authors have commented on the problem of osseous defects requiring technically difficult revision surgery. We reviewed clinical outcomes following revision total knee replacement (TKR) for failed UKR and analysed the reasons for failure and the technical aspects of the revision surgery. Between 2001 and 2010 our institute performed 132 UKR's out of which 33 required revision to TKR during a period 6 years. Demographics, details and indications for primary and revision surgery, the revised prosthesis including augments, technical difficulties and complications were noted. Patient outcome assessment was based on the Oxford knee score (OKS). Survival analysis for the UKR prosthesis was calculated using Kaplan-Meier Survival curves. Reasons for revision included aseptic loosening, persistent pain, dislocated meniscus, mal-alignment and other compartment osteoarthritis. Median time to revision was 19 months (range 2-159). Using revision as the end-point the survival proportion at 5-years was 69%. 18 revisions required additional intra-operative constructs including stemmed implants, wedge augmentation or bone graft. The mean 1 year post-operative OKS was 29 compared to 39 for primary TKR during the same period (p<0.001). Aseptic loosening was the commonest mode of failure. UKR survivorship at a non-specialist institute is considerably lower than at originating centres. Two thirds of the revisions were technically difficult and required additional constructs. The clinical outcome after revision surgery was inferior to that of primary TKR. The role of UKR needs to be more clearly defined.
近期报告显示单髁膝关节置换术（UKR）术后效果良好。然而，许多作者对骨缺损问题发表了评论，这种骨缺损需要进行技术难度较大的翻修手术。我们回顾了因UKR失败而进行全膝关节置换术（TKR）翻修后的临床结果，分析了失败原因及翻修手术的技术要点。2001年至2010年期间，我院共进行了132例UKR手术，其中33例在6年内需要翻修为TKR。记录了患者的人口统计学资料、初次手术和翻修手术的详细情况及适应证、翻修假体（包括增强装置）、技术难点和并发症。患者预后评估基于牛津膝关节评分（OKS）。使用Kaplan-Meier生存曲线计算UKR假体的生存分析。翻修原因包括无菌性松动、持续疼痛、半月板脱位、对线不良和其他间室骨关节炎。翻修的中位时间为19个月（范围2 - 159个月）。以翻修为终点，5年时的生存比例为69%。18例翻修需要额外的术中植入物，包括带柄植入物、楔形增强装置或骨移植。术后1年的平均OKS为29分，而同期初次TKR为39分（p<0.001）。无菌性松动是最常见的失败模式。非专科医院UKR的生存率远低于原发中心。三分之二的翻修手术技术难度大，需要额外的植入物。翻修手术后的临床结果不如初次TKR。UKR的作用需要更明确地界定。
