Department of Trauma and Orthopaedics, Northern General Hospital, Sheffield Teaching Hospitals NHS Trust, Herries Road, Sheffield, S5 7AU, UK.
BMC Med. 2013 Jan 18;11:14. doi: 10.1186/1741-7015-11-14.
As a result of increasing life expectancies, continuing physical careers, lifestyles into later life and rising obesity levels, the number of younger patients presenting with osteoarthritis (OA) of the knee is increasing. When conservative management options have been exhausted, the challenge for the orthopedic surgeon is to offer a procedure that will relieve symptoms and allow a return to a high level of function but not compromise future surgery that may be required as disease progresses or prostheses fail and require revision. We discuss the options available to this group of patients and the relative benefits and potential negative points of each. Total knee replacement (TKR) in the young patient is associated with high risk of early failure and the need for future revision surgery. After TKR, most surgeons advise limitation of sporting activities. If osteoarthritis is limited to only one compartment in the knee there may be surgical options other than TKR. Osteotomy above or below the knee may be considered and works by redirecting the load passing through the joint into the relatively unaffected compartment. A unicompartmental knee replacement (UKR) or patella-femoral joint (PFJ) replacement only replaces the articular surfaces in the affected compartment, leaving the unaffected compartments untouched with better preservation of the soft tissues. Which of these options is best for a particular patient depends upon the patient's symptoms, precise pathology, lifestyle, and expectations.
随着预期寿命的延长、持续的体力职业、晚年生活方式和肥胖水平的上升，越来越多的年轻患者出现膝关节骨关节炎（OA）。当保守治疗选择已经用尽时，骨科医生的挑战是提供一种能够缓解症状并恢复高水平功能的手术，但又不会影响未来可能因疾病进展或假体失效而需要的手术，或者需要进行翻修。我们讨论了这群患者的可用选择，以及每种选择的相对益处和潜在缺点。年轻患者的全膝关节置换术（TKR）与早期失败的高风险和未来翻修手术的需要有关。TKR 后，大多数外科医生建议限制体育活动。如果膝关节的骨关节炎仅局限于一个间室，则可能有除 TKR 以外的手术选择。可以考虑膝关节以上或以下的截骨术，通过将通过关节传递的负荷重新引导到相对未受影响的间室来起作用。单髁膝关节置换术（UKR）或髌股关节（PFJ）置换术仅置换受影响间室的关节表面，而未受影响的间室保持不变，从而更好地保留软组织。对于特定患者，哪种选择最好取决于患者的症状、确切的病理学、生活方式和期望。
