Xu B Y, Ji B C, Guo W T, Mu W B, Cao L
Department of Orthopaedic Surgery, First Teaching Hospital of Xinjiang Medical University, Urumqi 830054, China.
Zhonghua Wai Ke Za Zhi. 2017 Jun 1;55(6):416-422. doi: 10.3760/cma.j.issn.0529-5815.2017.06.004.
To evaluate the influence of patellofemoral joint degeneration and pre-operative pain location on the outcome of medial Oxford unicompartmental knee arthroplasty (UKA). A total of 58 patients (58 knees) with medial Oxford UKA had been performed for medial osteoarthritis from March 2013 to July 2014 in Department of Orthopaedic Surgery at First Teaching Hospital of Xinjiang Medical University were retrospective reviewed. There were 24 males and 34 females, the age from 43 to 87 years with the mean age was 68.5 years. The mean body mass index was 25.2 kg/m(2) ranging from 19.7 to 31.5 kg/m(2). Patients were divided into anterior-medial pain group (35 knees), anterior knee pain group (17 knees) and general knee pain group (6 knees) according to pre-operative pain location. Pre-operative radiological statuses of the patellefemoral joint were defined by Ahlback system and divided into patellofemoral joint degeneration group (16 knees) and normal group (42 knees). Patients were also divided into medial patellofemoral degeneration group (20 knees), lateral patellofemoral degeneration group (12 knees) and normal group (26 knees) according to Altman scoring system. Outerbridge system was used intraoperatively and the patients were divided into patellofemoral joint degeneration group (21 knees) and normal group (37 knees). Pre- and post-operative outcomes were evaluated with Oxford Knee Score (OKS), Western Ontario and MacMaster (WOMAC) and patellofemoral score system of Lonner. test and ANOVA were used to analyze the data. The average duration of follow-up was 33 months (from 26 to 42 months). There were no patients had complications of infection, deep vein thrombosis, dislocation or loosing at the last follow-up. Compared to pre-operation, OKS (18.9±3.5 . 38.9±4.7, 19.3±4.2 . 39.6±4.6, 18.1±3.2 . 38.1±3.7)(=5.64 to 7.08, all <0.01) and WOMAC (10.9±2.3 .53.2±4.5, 10.4±2.1 .54.6±3.4, 11.7±1.8 .52.8±3.7)(=14.50 to 19.16, all <0.01) decreased, and the Lonner score (88.9±3.4 .38.6±2.8, 87.5±4.1 .38.2±2.3, 88.2±3.2 . 37.6±3.5)(=-19.78 to -18.16, all <0.01) increased significantly in anterior-medial pain group, anterior knee pain group and general knee pain group. According to Ahlback scoring system, compared to pre-operation, OKS (18.3±2.4 . 38.7±4.4, 19.6±1.8 . 38.4±3.1)(=7.05, 9.08, both <0.01) and WOMAC (10.6 ±2.6 .53.2±4.5, 12.1±1.4 .52.4±3.3)(=14.21, 19.52, both <0.01) decreased, the Lonner score (88.1±3.1 .38.3±3.3, 86.9±2.6 .39.1±2.4)(=-18.90, -23.40, both <0.01) increased significantly in patellofemoral joint degeneration group and normal group, the outcomes were the same according to Altman and Outerbridge scoring system. There was no significant difference between patellofemoral joint degeneration group and normal group based on Ahlback grading system. According to Altman classification, compared to normal group, there was no statistically differences in OKS, WOMAC and Lonner scoring system between patients with degeneration in the medial patellofemoral joint group, OKS and WOMAC increased (20.2±1.4 .18.2±2.7, 12.5±1.7 .10.5±2.5) (=-4.30, =0.03; =-4.80, =0.02), the Lonner score decreased (84.3±2.8 .87.4±3.2) (=-6.20, =0.01) in lateral patellofemoral degeneration group. According to Outerbridge scoring system, there were no statistically differences in patients in patellofemoral joint degeneration group and normal group. There is a good evidence that neither mild to moderate degree of patellofemoral joint degeneration nor pre-operative pain location will compromise the short-term outcome of medial Oxford UKA, and should not be considered as contraindications. The situation is less clear for lateral patellofemoral degeneration, and more cautious option is advised.
评估髌股关节退变及术前疼痛部位对内侧牛津单髁膝关节置换术(UKA)疗效的影响。回顾性分析2013年3月至2014年7月在新疆医科大学第一附属医院骨科行内侧牛津UKA治疗内侧骨关节炎的58例患者(58膝)。其中男性24例,女性34例,年龄43~87岁,平均年龄68.5岁。平均体重指数为25.2kg/m²,范围为19.7~31.5kg/m²。根据术前疼痛部位将患者分为前内侧疼痛组(35膝)、膝前疼痛组(17膝)和全膝关节疼痛组(6膝)。采用Ahlback系统定义术前髌股关节的影像学状态,分为髌股关节退变组(16膝)和正常组(42膝)。根据Altman评分系统,患者还分为内侧髌股关节退变组(20膝)、外侧髌股关节退变组(12膝)和正常组(26膝)。术中采用Outerbridge系统,将患者分为髌股关节退变组(21膝)和正常组(37膝)。采用牛津膝关节评分(OKS)、西安大略和麦克马斯特大学骨关节炎指数(WOMAC)及Lonner髌股评分系统评估手术前后疗效。采用t检验和方差分析进行数据分析。平均随访时间为33个月(26~42个月)。末次随访时无患者发生感染、深静脉血栓、脱位或假体松动等并发症。与术前相比,前内侧疼痛组、膝前疼痛组和全膝关节疼痛组的OKS(18.9±3.5. 38.9±4.7,19.3±4.2. 39.6±4.6,18.1±3.2. 38.1±3.7)(t=5.64至7.08,均P<0.01)和WOMAC(10.9±2.3.53.2±4.5,10.4±2.1.54.6±3.4,11.7±1.8.52.8±3.7)(t=14.50至19.16,均P<0.01)降低,Lonner评分(88.9±3.4.38.6±2.8,87.5±4.1.38.2±2.3,88.2±3.2. 37.6±3.5)(t=-19.78至-18.16,均P<0.01)显著升高。根据Ahlback评分系统,与术前相比,髌股关节退变组和正常组的OKS(18.3±2.4. 38.7±4.4,19.6±1.8. 38.4±3.1)(t=7.05,9.08,均P<0.01)和WOMAC(10.6 ±2.6.53.2±4.5,12.1±1.4.52.4±3.3)(t=14.21,19.52,均P<0.01)降低,Lonner评分(88.1±3.1.38.3±3.3,86.9±2.6.39.1±2.4)(t=-18.90,-23.40,均P<0.01)显著升高,根据Altman和Outerbridge评分系统结果相同。基于Ahlback分级系统,髌股关节退变组和正常组之间无显著差异。根据Altman分类,与正常组相比,内侧髌股关节退变组患者的OKS、WOMAC和Lonner评分系统无统计学差异,外侧髌股关节退变组患者的OKS和WOMAC升高(20.2±1.4.18.2±2.7,12.5±1.7.10.5±2.5)(t=-4.30,P=0.03;t=-4.80,P=0.02),Lonner评分降低(84.3±2.8.87.4±3.2)(t=-6.20,P=0.01)。根据Outerbridge评分系统,髌股关节退变组和正常组患者之间无统计学差异。有充分证据表明,轻至中度髌股关节退变及术前疼痛部位均不会影响内侧牛津UKA的短期疗效,不应视为禁忌证。外侧髌股关节退变的情况尚不清楚,建议更谨慎选择。