Parratte S, Ollivier M, Opsomer G, Lunebourg A, Argenson J-N, Thienpont E
Institut du mouvement et de l'appareil locomoteur, UMR CNRS 787/AMU, hôpital Sainte-Marguerite, CHU Sud, 270, boulevard de Sainte-Marguerite, 13009 Marseille, France.
Institut du mouvement et de l'appareil locomoteur, UMR CNRS 787/AMU, hôpital Sainte-Marguerite, CHU Sud, 270, boulevard de Sainte-Marguerite, 13009 Marseille, France.
Orthop Traumatol Surg Res. 2015 Sep;101(5):547-52. doi: 10.1016/j.otsr.2015.03.019. Epub 2015 Jun 3.
Bicompartmental knee arthroplasty (BKA) was developed to treat medial tibiofemoral and patellofemoral osteoarthritis while preserving the anterior cruciate ligament to optimise knee kinematics. Our objective here was to compare the probability of achieving forgotten knee status and the functional outcomes at least two years after BKA versus total knee arthroplasty (TKA). We hypothesised that contemporary modular BKA produced better functional outcomes than TKA after at least two years, for patients with similar pre-operative osteoarthritic lesions.
We conducted a two-centre prospective controlled study of 34consecutive patients who underwent BKA between January 2008 and January 2011. Each patient was matched on age, gender, body mass index, preoperative range of knee flexion, centre, and surgeon to a patient treated with TKA. An independent observer evaluated all 68 patients after six and 12months then once a year. Forgotten knee status was defined as a 100/100 value of the Forgotten Joint Score (FJS-12) and each of the five KOOS subscales. We also compared the two groups for knee range of motion, Knee Society Scores (KSSs), Timed Up-and-Go test (TUG), and UCLA Activity Score.
At a mean follow-up of 3.8±1.7 years, the probability of forgotten knee status was significantly higher in the BKA group (odds ratio, 4.64; 95% confidence interval, 1.63-13.21; P=0.007, Chi(2) test). Mean post-operative extension was not significantly different between the groups, whereas mean range of knee flexion was significantly greater in the BKA group (130°±6° vs. 125°±8° after TKA; P=0.03). The BKA group had significantly higher mean values for the knee and function KSSs, TUG test, and UCLA score (P<0.04 for all four comparisons).
After at least two years, contemporary unlinked BKA was associated with greater comfort during everyday activities (forgotten knee) and better functional outcomes, compared to TKA. These short-term results require validation in randomised trials with longer follow-ups.
III, case-control study.
双间室膝关节置换术（BKA）旨在治疗胫股内侧和髌股关节炎，同时保留前交叉韧带以优化膝关节运动学。我们的目的是比较BKA与全膝关节置换术（TKA）后至少两年达到“遗忘膝”状态的概率和功能结果。我们假设，对于术前骨关节炎病变相似的患者，当代模块化BKA在至少两年后产生的功能结果优于TKA。
我们对2008年1月至2011年1月期间连续接受BKA的34例患者进行了一项双中心前瞻性对照研究。根据年龄、性别、体重指数、术前膝关节屈曲范围、中心和外科医生，将每位患者与接受TKA治疗的患者进行匹配。一名独立观察者在6个月和12个月后对所有68例患者进行评估，然后每年评估一次。“遗忘膝”状态定义为“遗忘关节评分”（FJS-12）及KOOS五个子量表中的每一个均达到100/100分。我们还比较了两组患者的膝关节活动范围、膝关节协会评分（KSS）、定时起立行走测试（TUG）和加州大学洛杉矶分校活动评分。
平均随访3.8±1.7年，BKA组达到“遗忘膝”状态的概率显著更高（优势比，4.64；95%置信区间，1.63 - 13.21；P = 0.007，卡方检验）。两组术后平均伸直度无显著差异，而BKA组膝关节平均屈曲范围显著更大（TKA后为125°±8°，BKA组为130°±6°；P = 0.03）。BKA组膝关节和功能KSS、TUG测试及加州大学洛杉矶分校评分的平均值显著更高（所有四项比较P < 0.04）。
至少两年后，与TKA相比，当代非铰链式BKA在日常活动中（“遗忘膝”）舒适度更高，功能结果更好。这些短期结果需要在随访时间更长的随机试验中进行验证。
III级，病例对照研究。
