Lum Zachary C, Crawford David A, Lombardi Adolph V, Hurst Jason M, Morris Michael J, Adams Joanne B, Berend Keith R
Doctors Medical Center, Orthopaedic Surgery Department, 1441 Florida Avenue, Modesto, CA 95350, USA.
Joint Implant Surgeons, Inc., 7277 Smith's Mill Road, Suite 200, New Albany, OH 43054, USA; Mount Carmel Health System, 7333 Smith's Mill Road, New Albany, OH 43054, USA.
Knee. 2018 Jan;25(1):161-166. doi: 10.1016/j.knee.2017.10.006. Epub 2018 Jan 9.
Medial unicompartmental knee arthroplasty (UKA) may have advantages over total knee arthroplasty (TKA) in the setting of obesity. There has been no direct comparison between the two cohorts. This study compares outcomes and complications of severely obese patients undergoing medial UKA versus TKA.
Six hundred and fifty medial UKA and 1300 TKA were performed in patients with BMI >35kg/m (mean 41kg/m) between 2007 and 2012. Pre- and postoperative ROM, Knee Society scores, perioperative factors, complications and reoperations were compared.
UKA patients had higher preoperative ROM, and Knee Society pain (KSP), functional (KSF), and clinical (KSC) scores (p<0.001, p=0.0008, p=0.0003, p=0.051 respectively). Mean tourniquet times, operative times, and lengths of stay were lower after UKA. Four TKA patients required transfusion. Mean follow-up was 2.3years. The frequency of manipulation under anesthesia was higher in TKA patients (p<0.001), while the rate of component revision was similar between the two groups (1.2% vs. 1.7%, p=0.328). Frequency of deep infection was lower in the UKA group (p=0.016). Postoperative KSF, change in KSF, and ROM were higher (p<0.0001) after UKA, but KSP and KSC were equivalent.
Severely obese patients who underwent medial UKA demonstrated equal survivorship with substantially fewer reoperations, reduced deep infection, and less perioperative complications at short term follow-up. Severely obese patients had improved KSF scores and maintenance of ROM after UKA compared with TKA.
在肥胖患者中，内侧单髁膝关节置换术（UKA）可能比全膝关节置换术（TKA）更具优势。目前尚无这两组患者的直接对比研究。本研究比较了重度肥胖患者接受内侧UKA与TKA的疗效及并发症情况。
2007年至2012年间，对体重指数（BMI）>35kg/m²（平均41kg/m²）的患者进行了650例内侧UKA和1300例TKA手术。比较了术前和术后的关节活动度（ROM）、膝关节协会评分、围手术期因素、并发症及再次手术情况。
UKA患者术前ROM、膝关节协会疼痛（KSP）、功能（KSF）和临床（KSC）评分更高（分别为p<0.001、p=0.0008、p=0.0003、p=0.051）。UKA术后平均止血带使用时间、手术时间和住院时间更短。4例TKA患者需要输血。平均随访时间为2.3年。TKA患者麻醉下手法操作的频率更高（p<0.001），而两组间假体翻修率相似（1.2%对1.7%，p=0.328）。UKA组深部感染频率更低（p=0.016）。UKA术后KSF、KSF变化值和ROM更高（p<0.0001），但KSP和KSC相当。
接受内侧UKA的重度肥胖患者在短期随访中显示出相同的生存率，再次手术明显减少，深部感染减少，围手术期并发症更少。与TKA相比，重度肥胖患者接受UKA后KSF评分改善，ROM得以维持。
