Ernstbrunner Lukas, Imam Mohamed A, Andronic Octavian, Perz Tabea, Wieser Karl, Fucentese Sandro F
Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008, Zurich, Switzerland.
Department of Orthopaedics and Traumatology, Paracelsus Medical University, Muellner Hauptstrasse 48, 5020, Salzburg, Austria.
Int Orthop. 2018 Aug;42(8):1827-1833. doi: 10.1007/s00264-017-3662-4. Epub 2017 Oct 13.
Currently, individual studies lack the power to successively illustrate different failure modes; therefore, we undertook a systematic review to examine lateral unicompartmental knee replacement (lat UKR) failure modes. Furthermore, we compared early with midterm and late failures and fixed-bearing with mobile-bearing implants.
A search using the databases of PubMed, EMBASE, Cochrane, and annual registries was performed to search for failed lat UKRs. Studies were included when they reported more than four failures, described failure modes and were minimum level IV studies. Data was analysed based on overall failure modes, fixed- vs. mobile bearing and early (<5 years) vs. midterm (5-10 years) vs. late failures (>10 years).
Fourteen cohort studies and two registry-based studies were included. A total of 336 overall failures, 87 time-dependent failures, and 175 implant-specific failures were identified. The main overall causes of failure were osteoarthritis (OA) progression (30%) and aseptic loosening (22%). These were followed by less common causes such as instability (7%), unexplained pain (5%), infection (5%), polyethylene wear (5%), and bearing dislocation (5%). Bearing dislocation was the most common early failure (29%) and also the most common failure among mobile-bearing implants (27%). In midterm and late failures, OA progression had the highest rates (59% and 78% respectively) and was also the most common type of failure in fixed-bearing implants (44%).
Progression of OA and aseptic loosening are the major overall failure modes in lat UKR. Bearing dislocation was the main failure mode in early years and in mobile-bearing implants, whereas OA progression caused most failures in late years and in fixed-bearing implants.
Systematic Review of minimum level IV studies.
目前，个别研究缺乏连续阐明不同失败模式的能力；因此，我们进行了一项系统评价，以研究外侧单髁膝关节置换术（lat UKR）的失败模式。此外，我们比较了早期、中期和晚期失败情况，以及固定平台与活动平台假体。
利用PubMed、EMBASE、Cochrane数据库和年度登记处进行检索，以查找失败的lat UKR病例。当研究报告超过4例失败、描述了失败模式且至少为IV级研究时纳入。根据总体失败模式、固定平台与活动平台以及早期（<5年）、中期（5 - 10年）和晚期失败（>10年）对数据进行分析。
纳入了14项队列研究和2项基于登记处的研究。共确定了336例总体失败、87例时间依赖性失败和175例假体特定失败。失败的主要总体原因是骨关节炎（OA）进展（30%）和无菌性松动（22%）。其次是不太常见的原因，如不稳定（7%）、不明原因疼痛（5%）、感染（5%）、聚乙烯磨损（5%）和衬垫脱位（5%）。衬垫脱位是最常见的早期失败原因（29%），也是活动平台假体中最常见的失败原因（27%）。在中期和晚期失败中，OA进展发生率最高（分别为59%和78%），也是固定平台假体中最常见的失败类型（44%）。
OA进展和无菌性松动是lat UKR主要的总体失败模式。衬垫脱位是早期以及活动平台假体的主要失败模式，而OA进展是晚期以及固定平台假体的主要失败原因。
IV级最低水平的系统评价。
