Berend Keith R, Lombardi Adolph V, Morris Michael J, Hurst Jason M, Kavolus Joseph J
Joint Implant Surgeons, Inc, 7277 Smith's Mill Rd, Ste 200, New Albany, OH 43054, USA.
Orthopedics. 2011 Sep 9;34(9):e494-6. doi: 10.3928/01477447-20110714-39.
One contested contraindication to medial unicompartmental knee arthroplasty (UKA) has been status of the patellofemoral joint. Surgeons have avoided UKA when the patellofemoral joint has radiographic evidence of arthritic changes. However, recent studies advocate ignoring patellofemoral joint status when considering UKA. The purpose of this study was to compare the failure rate of mobile-bearing, medial UKA in patients with and without preoperative radiographic evidence of patellofemoral joint degeneration. Preoperative radiographs from a random selection of 503 patients (638 knees) treated with UKA for anteromedial osteoarthritis were assessed by an observer blinded to clinical outcome. The patellofemoral joint was graded using the modified Altman classification from 0 to 3 with 0 being no evidence of changes and 3 being severe, and identified 396 grade 0, 168 grade 1, 65 grade 2, and 9 grade 3 knees. At 1- to 7-year follow-up, there have been 17 revisions for overall survivorship of 97.3%. Kaplan-Meier analysis predicted 97.9% survival in knees with patellofemoral joint disease and 93.8% survival in knees without patellofemoral joint disease at 70 months (P=.1). Failure requiring revision occurred in 3.5% (14/396) of grade 0 knees, 1.2% (2/168) of grade 1, 1.5% (1/65) of grade 2, and 0% (0/9) of grade 3. No survival difference was noted between knees with medial or lateral patellofemoral joint disease (P=.1). No knees were revised for progression of disease in the patellofemoral joint or anterior knee pain. In light of this investigation and the work of others, preoperative radiographic changes in the patellofemoral joint can be safely ignored when considering patients for medial UKA without compromising survivorship.
对于内侧单髁膝关节置换术（UKA），一个存在争议的禁忌证是髌股关节的状况。当髌股关节有影像学证据显示存在关节炎改变时，外科医生会避免进行UKA。然而，最近的研究主张在考虑UKA时忽略髌股关节状况。本研究的目的是比较有无术前髌股关节退变影像学证据的患者中，活动平台内侧UKA的失败率。由一位对临床结果不知情的观察者对随机选取的503例因前内侧骨关节炎接受UKA治疗的患者（638个膝关节）的术前X线片进行评估。髌股关节采用改良的阿尔特曼分类法从0到3级进行分级，0级表示无改变迹象，3级表示严重改变，结果确定有396个0级膝关节、168个1级、65个2级和9个3级膝关节。在1至7年的随访中，共进行了17次翻修，总体生存率为97.3%。Kaplan-Meier分析预测，在70个月时，有髌股关节疾病的膝关节生存率为97.9%，无髌股关节疾病的膝关节生存率为93.8%（P = 0.1）。需要翻修的失败情况在0级膝关节中占3.5%（14/396），1级中占1.2%（2/168），2级中占1.5%（1/65），3级中占0%（0/9）。内侧或外侧髌股关节疾病的膝关节之间未观察到生存率差异（P = 0.1）。没有膝关节因髌股关节疾病进展或前膝疼痛而进行翻修。鉴于这项研究及其他研究成果，在考虑为患者进行内侧UKA时，可以安全地忽略髌股关节的术前影像学改变，而不会影响生存率。
