Krych Aaron J, Reardon Patrick, Sousa Paul, Pareek Ayoosh, Stuart Michael, Pagnano Mark
1Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota.
J Bone Joint Surg Am. 2017 Jan 18;99(2):113-122. doi: 10.2106/JBJS.15.01031.
The cases of patients with medial compartment osteoarthritis who were ≤55 years old and had a proximal tibial osteotomy (PTO) or medial unicompartmental knee arthroplasty (UKA) were compared. Outcomes included postoperative activity level, function, and survivorship free of revision to total knee arthroplasty.
Between 1998 and 2013, data were available for 240 patients between 18 and 55 years old with medial compartment arthritis and varus malalignment who were treated either with PTO (57 patients) or with UKA (183 patients). The mean age was 42.7 years for the 57 patients (41 men and 16 women) in the PTO group versus 49.2 years for the 183 patients (82 men and 101 women) in the UKA group. The Tegner activity level and Lysholm knee scores were evaluated at 3 months and at 1, 2, and 5 years postoperatively as well as at the time of the final follow-up. The end point for survival was defined as revision to total knee arthroplasty. A Wilcoxon rank-sum test was used to evaluate the difference between the groups with respect to the Tegner and Lysholm scores at the respective follow-up intervals. Multivariate regression was used to assess potential confounders.
Preoperatively, the PTO and UKA groups had similar Tegner (3.0 ± 1.3 and 2.6 ± 0.09, respectively) and Lysholm scores (69.5 ± 7.3 and 71.6 ± 5.4). Postoperatively, the UKA group had significantly superior mean Tegner scores compared with the PTO group at 3 months (3.82 and 2.02, respectively), at 2 years (4.33 and 3.75), and at the time of the final follow-up (4.48 and 3.08), while the Lysholm scores were higher at 3 months (88.0 and 76.3) and at the final follow-up (90.0 and 80.2) (p < 0.01 for all). Multivariate analysis showed UKA to be an independent predictor of activity level at 3 months, 1 year, and 2 years, as well as at the final follow-up. The survivorship was 77% in the PTO group at an average of 7.2 years and 94% in the UKA group at an average of 5.8 years (p < 0.01). The average time to failure was 98 months (range, 38 to 169 months) in the PTO group and 42 months (range, 2 to 123 months) in the UKA group (p < 0.01).
In this comparative cohort study of young patients with isolated unicompartmental arthritis, those treated with UKA reached a higher level of activity early after surgery and it persisted at mid-term follow-up. The UKA group had earlier, but less frequent, revision to total knee arthroplasty.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
比较年龄≤55岁且接受胫骨近端截骨术（PTO）或内侧单髁膝关节置换术（UKA）的内侧间室骨关节炎患者的病例。结果包括术后活动水平、功能以及无需翻修为全膝关节置换术的生存率。
1998年至2013年期间，有240例年龄在18至55岁之间患有内侧间室关节炎和内翻畸形的患者的数据，这些患者接受了PTO治疗（57例）或UKA治疗（183例）。PTO组57例患者（41例男性和16例女性）的平均年龄为42.7岁，UKA组183例患者（82例男性和101例女性）的平均年龄为49.2岁。在术后3个月、1年、2年和5年以及最后一次随访时评估Tegner活动水平和Lysholm膝关节评分。生存终点定义为翻修为全膝关节置换术。采用Wilcoxon秩和检验评估各随访间隔时两组在Tegner和Lysholm评分方面的差异。采用多变量回归分析潜在混杂因素。
术前，PTO组和UKA组的Tegner评分（分别为3.0±1.3和2.6±0.09）和Lysholm评分（分别为69.5±7.3和71.6±5.4）相似。术后，UKA组在术后3个月（分别为3.82和2.02）、2年（分别为4.33和3.75）以及最后一次随访时（分别为4.48和3.08）的平均Tegner评分显著高于PTO组，而Lysholm评分在术后3个月（分别为88.0和76.3）和最后一次随访时（分别为90.0和80.2）更高（所有p<0.01）。多变量分析显示，UKA是术后3个月、1年、2年以及最后一次随访时活动水平的独立预测因素。PTO组平均7.2年的生存率为77%，UKA组平均5.8年的生存率为94%（p<0.01）。PTO组的平均失败时间为98个月（范围为38至169个月），UKA组为42个月（范围为2至123个月）（p<0.01）。
在这项针对年轻孤立性单髁关节炎患者的比较队列研究中，接受UKA治疗的患者术后早期达到了更高的活动水平，并且在中期随访时持续保持。UKA组翻修为全膝关节置换术的时间更早，但频率更低。
治疗性III级。有关证据水平的完整描述，请参阅作者指南。
