Siman Homayoun, Kamath Atul F, Carrillo Nazly, Harmsen William S, Pagnano Mark W, Sierra Rafael J
Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.
J Arthroplasty. 2017 Jun;32(6):1792-1797. doi: 10.1016/j.arth.2017.01.020. Epub 2017 Jan 24.
Prior studies comparing unicompartmental knee arthroplasty (UKA) with total knee arthroplasty (TKA) in the elderly are limited by heterogeneity in arthritic disease patterns and patient selection. We report the results of UKA and TKA in patients 75 years and older with isolated medial compartmental arthritis, with special emphasis on immediate postoperative recovery, complications, reoperation rates, and implant survivorship at midterm follow-up.
A retrospective review was performed of all patients 75 years and older who underwent UKA or TKA at our institution between 2002 and 2012. All TKA preoperative X-rays were reviewed by a blind observer to identify knees with isolated medial compartmental arthritis considered acceptable candidates for UKA. Patients with less than 2 years of follow-up, flexion contracture greater than 10°, and rheumatoid arthritis were excluded. The final sample included 120 UKA (106 patients) and 188 TKA (170 patients) procedures. Patient records were reviewed to determine early postoperative recovery, complications, reoperations for any reason, and implant survivorship.
UKA patients experienced significantly shorter operative time, shorter hospital stay, lower intraoperative estimated blood loss, lower postoperative transfusions, greater postoperative range of motion, and higher level of activity at time of discharge. Two UKA and 2 TKA patients required revision surgery. There was no statistically significant difference in postoperative Knee Society Scores. There were no differences in 5-year survivorship estimates.
Due to its less invasive nature, patients older than 75 undergoing UKA demonstrated faster initial recovery when compared to TKA, while maintaining comparable complications and midterm survivorship. UKA should be offered as an option in the elderly patient who fits the selection criteria for UKA.
先前比较老年患者单髁膝关节置换术（UKA）和全膝关节置换术（TKA）的研究受到关节炎疾病模式和患者选择异质性的限制。我们报告了75岁及以上孤立性内侧间室关节炎患者UKA和TKA的结果，特别强调术后即刻恢复、并发症、再次手术率和中期随访时的植入物生存率。
对2002年至2012年间在我们机构接受UKA或TKA的所有75岁及以上患者进行回顾性研究。所有TKA术前X线片由一名盲法观察者进行评估，以确定被认为适合UKA的孤立性内侧间室关节炎膝关节。随访时间少于2年、屈曲挛缩大于10°和类风湿关节炎患者被排除。最终样本包括120例UKA手术（106例患者）和188例TKA手术（170例患者）。审查患者记录以确定术后早期恢复情况、并发症、因任何原因进行的再次手术以及植入物生存率。
UKA患者的手术时间明显更短、住院时间更短、术中估计失血量更低、术后输血更少、术后活动范围更大且出院时活动水平更高。2例UKA患者和2例TKA患者需要翻修手术。术后膝关节协会评分无统计学显著差异。5年生存率估计无差异。
由于其侵入性较小，75岁以上接受UKA的患者与TKA相比，初始恢复更快，同时并发症和中期生存率相当。对于符合UKA选择标准的老年患者，应将UKA作为一种选择。
