Beard D J, Holt M D, Mullins M M, Malek S, Massa E, Price A J
Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, NIHR Biomedical Research Unit, University of Oxford, Oxford, OX3 7LD, UK.
Knee. 2012 Dec;19(6):886-9. doi: 10.1016/j.knee.2012.05.005. Epub 2012 Jun 7.
Patients with medial unicompartmental osteoarthritic disease of the knee requiring arthroplasty can be treated with either Total or Unicompartmental Knee Replacement (TKR or UKR). Currently, the decision to choose one operation over another is not well defined and may depend on the profile of the surgeon consulted. We tested the hypothesis that different surgeons will select different treatment for identical patients requiring knee replacement.
Four different surgeons, representing four different levels of expertise, made a forced choice decision of whether they would perform TKR or UKR based on radiographs alone and subsequent additional clinical information including gender and age, in 140 patients. Individual surgeon repeatability was tested by repeat assessment 3 months later.
The knee surgeon from the UKR design centre would have performed a UKR in up to 88% of the patients. The remaining surgeons would have performed UKR in 29-48% of patients; a variation in decision making of up to 59%. Additional clinical information had little effect on decision making with surgeons maintaining their radiographic based choice in 80 to 87% of cases. The repeatability study showed high within surgeon consistency for treatment choice.
Surgeons, given identical information, do not concur on treatment for patients with the same pathology. The decision making process appears heavily influenced by radiographic findings but individual surgeons are consistent with their own treatment choice. The study shows that consensus treatment for medial osteoarthritis of the knee remains in question.
需要进行关节置换术的膝关节内侧单髁骨关节炎患者可采用全膝关节置换术（TKR）或单髁膝关节置换术（UKR）进行治疗。目前，选择一种手术而非另一种手术的决定尚不明确，可能取决于咨询的外科医生的个人情况。我们检验了这样一个假设，即不同的外科医生会为需要膝关节置换的相同患者选择不同的治疗方法。
四位代表不同专业水平的外科医生，仅根据X线片以及随后包括性别和年龄在内的额外临床信息，对140例患者做出进行TKR还是UKR的强制选择决定。3个月后通过重复评估来测试每位外科医生的可重复性。
来自UKR设计中心的膝关节外科医生会为高达88%的患者进行UKR。其余外科医生会为29%至48%的患者进行UKR；决策差异高达59%。额外的临床信息对决策影响不大，80%至87%的病例中外科医生维持基于X线片的选择。重复性研究表明外科医生在治疗选择上具有较高的内部一致性。
在获得相同信息的情况下外科医生对于患有相同病症的患者的治疗意见并不一致。决策过程似乎受到X线片检查结果的严重影响，但每位外科医生对于自己的治疗选择是一致的。该研究表明膝关节内侧骨关节炎的共识性治疗仍存在疑问。
