Medical and Surgical Orthopaedic Center, 2, rue du Pressoir, 71640 Dracy-le-Fort, France.
Orthop Traumatol Surg Res. 2011 Oct;97(6):648-61. doi: 10.1016/j.otsr.2011.08.003. Epub 2011 Sep 25.
Unicompartmental knee arthroplasty (UKA) is designed for patients presenting arthritic wear limited to a single medial or lateral tibiofemoral compartment. The indication is based on strict criteria. Wear must stem from degenerative osteoarthritis or be secondary to aseptic necrosis of the medial condyle. Inflammatory rheumatism is a contraindication. Age and activity level should be compatible with an indication for arthroplasty. The body mass index should be less than 30 kg/m(2). The ligament system must be intact, particularly both cruciate ligaments. Any pre-existing axis deformity should be moderate and the residual axis deformity, after correction of wear with a unicompartmental tibial augmentation spacer, should not exceed 7-10° varus or valgus. These highly restrictive conditions result in the ideal indications for UKA suitable for no more than 15-20% of knee arthroplasty candidates for most surgeons experienced in this procedure. Although the results of certain early series worried potential users, today it can be asserted that recent series whose indications and technique correspond to modern use criteria, have shown results that are as reliable as those of total knee arthroplasty (TKA) at a 10 years' follow-up. Beyond this time frame, the risk of polyethylene wear related to the technical restrictions of the UKA is another consideration. Indeed, to prevent the risk of rapid extension of osteoarthritis to the opposite compartment, the procedure should be limited to restoring the patient's constitutional axis before wear phenomena had set in. This makes UKA a surgical procedure at risk of failure due to wear phenomena. Much of this paper will describe the precise rules for UKA positioning, which are critical to observe to warrant these implants outcome and longevity.
单间膝关节置换术（UKA）适用于仅存在单一内侧或外侧胫股关节间室关节炎性磨损的患者。其适应证基于严格的标准。磨损必须源于退行性骨关节炎，或继发于内侧髁无菌性坏死。炎性风湿病是禁忌证。年龄和活动水平应与关节置换的适应证相匹配。体重指数应小于 30kg/m(2)。韧带系统必须完整，特别是两条交叉韧带。任何先前存在的轴性畸形应适度，在使用单间胫骨增强垫片矫正磨损后，残余轴性畸形不应超过 7-10°内翻或外翻。这些高度受限的条件导致了 UKA 的理想适应证，对于大多数经验丰富的外科医生来说，适合不超过 15-20%的膝关节置换候选者。尽管某些早期系列的结果令潜在使用者感到担忧，但如今可以断言，对于那些适应证和技术符合现代使用标准的近期系列，其结果与全膝关节置换术（TKA）在 10 年随访时一样可靠。在此时间范围之外，与 UKA 技术限制相关的聚乙烯磨损风险是另一个需要考虑的因素。实际上，为了防止由于磨损现象导致关节炎迅速扩展到对侧间室的风险，该手术应仅限于在磨损现象出现之前恢复患者的固有轴。这使得 UKA 成为一种有失败风险的手术，因为磨损现象会导致手术失败。本文的大部分内容将描述 UKA 定位的精确规则，这些规则对于保证这些植入物的效果和寿命至关重要。
