Hamilton T W, Pandit H G, Lombardi A V, Adams J B, Oosthuizen C R, Clavé A, Dodd C A F, Berend K R, Murray D W
University of Oxford, Oxford, UK.
Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, Oxford University NHS Foundation Trust, Oxford, UK.
Bone Joint J. 2016 Oct;98-B(10 Supple B):3-10. doi: 10.1302/0301-620X.98B10.BJJ-2016-0432.R1.
An evidence-based radiographic Decision Aid for meniscal-bearing unicompartmental knee arthroplasty (UKA) has been developed and this study investigates its performance at an independent centre.
Pre-operative radiographs, including stress views, from a consecutive cohort of 550 knees undergoing arthroplasty (UKA or total knee arthroplasty; TKA) by a single-surgeon were assessed. Suitability for UKA was determined using the Decision Aid, with the assessor blinded to treatment received, and compared with actual treatment received, which was determined by an experienced UKA surgeon based on history, examination, radiographic assessment including stress radiographs, and intra-operative assessment in line with the recommended indications as described in the literature.
The sensitivity and specificity of the Decision Aid was 92% and 88%, respectively. Excluding knees where a clear pre-operative plan was made to perform TKA, i.e. patient request, the sensitivity was 93% and specificity 96%. The false-positive rate was low (2.4%) with all affected patients readily identifiable during joint inspection at surgery. In patients meeting Decision Aid criteria and receiving UKA, the five-year survival was 99% (95% confidence intervals (CI) 97 to 100). The false negatives (3.5%), who received UKA but did not meet the criteria, had significantly worse functional outcomes (flexion p < 0.001, American Knee Society Score - Functional p < 0.001, University of California Los Angeles score p = 0.04), and lower implant survival of 93.1% (95% CI 77.6 to 100).
The radiographic Decision Aid safely and reliably identifies appropriate patients for meniscal-bearing UKA and achieves good results in this population. The widespread use of the Decision Aid should improve the results of UKA. Cite this article: Bone Joint J 2016;98-B(10 Suppl B):3-10.
已开发出一种基于证据的用于半月板支撑单髁膝关节置换术（UKA）的放射学决策辅助工具，本研究在一个独立中心对其性能进行调查。
对由一名外科医生连续进行关节置换术（UKA或全膝关节置换术；TKA）的550例膝关节的术前X线片（包括应力位片）进行评估。使用决策辅助工具确定UKA的适用性，评估者对所接受的治疗不知情，并与实际接受的治疗进行比较，实际治疗由一名经验丰富的UKA外科医生根据病史、检查、包括应力X线片在内的放射学评估以及术中评估，按照文献中所述的推荐指征来确定。
决策辅助工具的敏感性和特异性分别为92%和88%。排除术前明确计划行TKA的膝关节，即患者要求的情况，敏感性为93%，特异性为96%。假阳性率较低（2.4%），所有受影响患者在手术关节检查时都很容易识别。在符合决策辅助工具标准并接受UKA的患者中，五年生存率为99%（95%置信区间（CI）97至100）。接受UKA但不符合标准的假阴性患者（3.5%），其功能结局明显更差（屈曲度p<0.001，美国膝关节协会评分 - 功能p<0.001，加利福尼亚大学洛杉矶分校评分p = 0.04），植入物生存率较低，为93.1%（95%CI 77.6至100）。
放射学决策辅助工具能安全可靠地识别适合半月板支撑UKA的患者，并在该人群中取得良好效果。决策辅助工具的广泛应用应能改善UKA的治疗效果。引用本文：《骨与关节杂志》2016年；98 - B（10增刊B）：3 - 10。
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