Knifsund J, Hatakka J, Keemu H, Mäkelä K, Koivisto M, Niinimäki T
1 The Operational Division of Diseases of the Musculoskeletal System, Turku University Hospital (Tyks), Surgical Hospital, Turku University, Turku, Finland.
2 Department of Orthopaedics and Traumatology, Turku University Hospital, Turku, Finland.
Scand J Surg. 2017 Dec;106(4):338-341. doi: 10.1177/1457496917701668. Epub 2017 Apr 12.
Patient selection for either total knee arthroplasty or unicompartmental knee arthroplasty remains controversial. The latter has several reported advantages over total knee arthroplasty, but it also appears to have significant drawbacks in terms of revision rates.
This study aimed to determine the influence of the preoperative degree of osteoarthritis on the risk of reoperation following unicompartmental knee arthroplasty.
Surgery was carried out on 294 knees in 241 patients between 2001 and 2012 at a single institute, using cemented Oxford phase III unicompartmental knee arthroplasty. The mean age at the time of operation was 67 years, and the mean follow-up time was 8.7 years.
The knees with a preoperative Kellgren-Lawrence grade of 0-2 osteoarthritis had a higher risk of reoperation than those with a Kellgren-Lawrence grade of 3-4 (odds ratio = 1.89; 95% confidence interval, 1.03-3.45; p = 0.04). In addition, the knees with a medial joint space width of more than 1 mm or a high medial/lateral joint space width ratio had an increased risk of reoperation. In conclusion, we suggest that unicompartmental knee arthroplasty should only be performed in cases showing severe osteoarthritis in preoperative radiographs, with medial bone-on-bone contact, and a medial/lateral ratio of <20%.
全膝关节置换术或单髁膝关节置换术的患者选择仍然存在争议。与全膝关节置换术相比，后者有一些已报道的优势，但在翻修率方面似乎也有显著缺点。
本研究旨在确定术前骨关节炎程度对单髁膝关节置换术后再次手术风险的影响。
2001年至2012年期间，在一家机构对241例患者的294个膝关节进行了手术，采用骨水泥型牛津三期单髁膝关节置换术。手术时的平均年龄为67岁，平均随访时间为8.7年。
术前Kellgren-Lawrence分级为0-2级骨关节炎的膝关节再次手术风险高于Kellgren-Lawrence分级为3-4级的膝关节（优势比=1.89；95%置信区间，1.03-3.45；p=0.04）。此外，内侧关节间隙宽度大于1mm或内侧/外侧关节间隙宽度比高的膝关节再次手术风险增加。总之，我们建议单髁膝关节置换术仅应在术前X线片显示严重骨关节炎、内侧骨对骨接触且内侧/外侧比<20%的病例中进行。
