Walker T, Zahn N, Bruckner T, Streit M R, Mohr G, Aldinger P R, Clarius M, Gotterbarm T
University of Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany.
University of Heidelberg, Im Neuenheimer Feld 305, 69120 Heidelberg, Germany.
Bone Joint J. 2018 Jan;100-B(1):42-49. doi: 10.1302/0301-620X.100B1.BJJ-2017-0600.R1.
The aim of this independent multicentre study was to assess the mid-term results of mobile bearing unicondylar knee arthroplasty (UKA) for isolated lateral osteoarthritis of the knee joint.
We retrospectively evaluated 363 consecutive, lateral UKAs (346 patients) performed using the Oxford domed lateral prosthesis undertaken in three high-volume knee arthroplasty centres between 2006 and 2014. Mean age of the patients at surgery was 65 years (36 to 88) with a mean final follow-up of 37 months (12 to 93) RESULTS: A total of 36 (10.5%) patients underwent revision surgery, giving a survival rate of 90.1% at three years (95% confidence intervals (CI) 86.1 to 93.1; number at risk: 155) and 85.0% at five years (95% CI 77.9 to 89.9; number at risk: 43). Dislocation of the mobile bearing occurred in 18 patients (5.6%) at three years (95% CI 1.0 to 16.4; number at risk: 154) and in 20 patients (8.5%) at five years (95% CI 1.0 to 27.0; number at risk: 42). There were no significant differences in the dislocation rate between the participating centres or the surgeons. We were not able to identify an effect of each surgeon's learning curve on the dislocation rate of the mobile bearing. The clinical outcome in patients without revision surgery at final follow-up was good to excellent, with a mean Oxford knee score of 40.3 (95% CI 39.4 to 41.2), a mean Tegner activity score of 3.2 (95% CI 3.1 to 3.3) and a mean University of California, Los Angeles score of 5.7 (95% CI 5.5 to 5.9).
Our data, which consists of a high number of patients treated with mobile bearing UKA in the lateral compartment, indicates a high revision rate of 15% at five years with dislocation of the mobile bearing being the main reason for implant failure. Despite the good functional and clinical results and the high patient satisfaction in our study group, we therefore discontinued using mobile-bearing lateral UKA in favour of a fixed-bearing component. Cite this article: 2018;100-B:42-9.
本项独立多中心研究旨在评估活动平台单髁膝关节置换术（UKA）治疗单纯膝关节外侧骨关节炎的中期结果。
我们回顾性评估了2006年至2014年间在三个高容量膝关节置换中心使用牛津圆顶外侧假体进行的363例连续外侧UKA手术（346例患者）。患者手术时的平均年龄为65岁（36至88岁），平均最终随访时间为37个月（12至93个月）。结果：共有36例（10.5%）患者接受了翻修手术，三年生存率为90.1%（95%置信区间（CI）86.1至93.1；风险例数：155），五年生存率为85.0%（95%CI 77.9至89.9；风险例数：43）。活动平台脱位在三年时发生于18例患者（5.6%）（95%CI 1.0至16.4；风险例数：154），五年时发生于20例患者（8.5%）（95%CI 1.0至27.0；风险例数：42）。参与中心或外科医生之间的脱位率无显著差异。我们未能确定每位外科医生的学习曲线对活动平台脱位率的影响。最终随访时未接受翻修手术的患者临床结果良好至优秀，牛津膝关节平均评分为40.3（95%CI 39.4至41.2），平均Tegner活动评分为3.2（95%CI 3.1至3.3），加利福尼亚大学洛杉矶分校平均评分为5.7（95%CI 5.5至5.9）。
我们的数据包括大量接受外侧间室活动平台UKA治疗的患者，显示五年翻修率高达15%，活动平台脱位是植入物失败的主要原因。尽管我们研究组的功能和临床结果良好且患者满意度高，但我们因此停止使用活动平台外侧UKA，转而采用固定平台组件。引用本文：2018；100-B：42-9。
