Liddle A D, Pandit H, Judge A, Murray D W
Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK.
NDORMS, University of Oxford, Windmill Road, Oxford, OX3 7LD, UK.
Bone Joint J. 2015 Nov;97-B(11):1506-11. doi: 10.1302/0301-620X.97B11.35551.
Unicompartmental knee arthroplasty (UKA) has advantages over total knee arthroplasty but national joint registries report a significantly higher revision rate for UKA. As a result, most surgeons are highly selective, offering UKA only to a small proportion (up to 5%) of patients requiring arthroplasty of the knee, and consequently performing few each year. However, surgeons with large UKA practices have the lowest rates of revision. The overall size of the practice is often beyond the surgeon's control, therefore case volume may only be increased by broadening the indications for surgery, and offering UKA to a greater proportion of patients requiring arthroplasty of the knee. The aim of this study was to determine the optimal UKA usage (defined as the percentage of knee arthroplasty practice comprised by UKA) to minimise the rate of revision in a sample of 41 986 records from the for National Joint Registry for England and Wales (NJR). UKA usage has a complex, non-linear relationship with the rate of revision. Acceptable results are achieved with the use of 20% or more. Optimal results are achieved with usage between 40% and 60%. Surgeons with the lowest usage (up to 5%) have the highest rates of revision. With optimal usage, using the most commonly used implant, five-year survival is 96% (95% confidence interval (CI) 94.9 to 96.0), compared with 90% (95% CI 88.4 to 91.6) with low usage (5%) previously considered ideal. The rate of revision of UKA is highest with low usage, implying the use of narrow, and perhaps inappropriate, indications. The widespread use of broad indications, using appropriate implants, would give patients the advantages of UKA, without the high rate of revision.
单髁膝关节置换术（UKA）相较于全膝关节置换术具有优势，但国家关节登记处报告称UKA的翻修率显著更高。因此，大多数外科医生都非常有选择性，仅为一小部分（高达5%）需要膝关节置换术的患者提供UKA，结果每年实施的手术数量很少。然而，大量开展UKA手术的外科医生翻修率最低。手术量的总体规模往往超出外科医生的控制范围，因此，只有通过扩大手术适应症，为更大比例需要膝关节置换术的患者提供UKA，才能增加病例数量。本研究的目的是确定最佳的UKA使用率（定义为UKA在膝关节置换术病例中所占的百分比），以将来自英格兰和威尔士国家关节登记处（NJR）的41986份记录样本中的翻修率降至最低。UKA使用率与翻修率之间存在复杂的非线性关系。使用20%或更高的使用率可取得可接受的结果。使用率在40%至60%之间可取得最佳结果。使用率最低（高达5%）的外科医生翻修率最高。在最佳使用率下，使用最常用的植入物，五年生存率为96%（95%置信区间（CI）94.9至96.0），而之前认为理想的低使用率（5%）的五年生存率为90%（95%CI 88.4至91.6）。UKA的翻修率在低使用率时最高，这意味着使用的适应症范围狭窄，可能也不合适。广泛使用合适的植入物并扩大适应症，将使患者获得UKA的优势，而不会有高翻修率。
