Service de chirurgie orthopédique, CHU Lyon Croix-Rousse, hospices civils de Lyon, 69004 Lyon, France.
Service de chirurgie orthopédique, CHU Lyon Croix-Rousse, hospices civils de Lyon, 69004 Lyon, France; Laboratoire de biomécanique et mécanique des chocs, université Claude-Bernard Lyon 1, IFSTTAR, 69622 Villeurbanne, France.
Orthop Traumatol Surg Res. 2018 Nov;104(7):955-959. doi: 10.1016/j.otsr.2018.02.015. Epub 2018 Apr 21.
Implanting a knee prosthesis in patients aged over 85 years is not without risk. Unicompartmental knee arthroplasty (UKA) is reputed to show lower morbidity and mortality than total knee arthroplasty (TKA). Elderly patients with isolated unicompartmental osteoarthritis without specific contraindications are thus good candidates for this procedure. The present retrospective case-control study compared complications rates in elderly patients receiving UKA versus TKA. The study hypothesis was that UKA incurs fewer complications, with equivalent functional results.
Five hundred and forty-four UKAs were performed between 1987 and 2015; all patients aged 85 years or over (n=30) were included, and age-matched at a rate of 1 UKA for 3 TKAs in our database of 4,216 TKA procedures. Mean age was 87.5 years (range, 85-92 years). The main endpoint was complications rate; secondary endpoints comprised satisfaction, IKS function and knee scores, and implant survival.
Mean follow-up was 32 months (range, 12-118 months) for UKA and 34 months (range, 12-100 months) for TKA. The medical complications rate was significantly lower with UKA (6.7% versus 25.6%; P=0.02), with no early mortality. IKS scores were identical between UKA and TKA groups at last follow-up: knee, 93.8 (95% CI [89.7-98.0]) versus 89.5 (95% CI [85.6-93.4]), P=0.06; function, 63.8 (95% CI [53.1-74.5]) versus 67.0 (95% CI [61.3-72.7]), P=0.62. Satisfaction rates were likewise identical: 96% and 97%, respectively (P=0.77); and implant survivorship was identical (P=0.54).
Early medical complications were fewer after UKA than TKA in a population aged ≥85 years, with comparable clinical outcome. These results argue in favor of UKA in elderly patients with comorbidities.
III, case-control study.
为 85 岁以上的患者植入膝关节假体并非没有风险。单髁膝关节置换术（UKA）被认为比全膝关节置换术（TKA）具有更低的发病率和死亡率。因此，对于没有特殊禁忌的孤立性单间室骨关节炎的老年患者，UKA 是一种很好的治疗方法。本回顾性病例对照研究比较了接受 UKA 与 TKA 的老年患者的并发症发生率。研究假设是 UKA 可减少并发症，同时具有等效的功能结果。
1987 年至 2015 年间共进行了 544 例 UKA；我们的数据库中共有 4216 例 TKA 手术，包含了所有年龄在 85 岁及以上（n=30）的患者，并按 1 例 UKA 匹配 3 例 TKA 的比例进行年龄匹配。平均年龄为 87.5 岁（范围，85-92 岁）。主要终点是并发症发生率；次要终点包括满意度、IKA 功能和膝关节评分以及植入物存活率。
UKA 的平均随访时间为 32 个月（范围，12-118 个月），TKA 的平均随访时间为 34 个月（范围，12-100 个月）。UKA 的医疗并发症发生率明显低于 TKA（6.7%比 25.6%；P=0.02），且无早期死亡率。在最后一次随访时，IKA 评分在 UKA 和 TKA 组之间无差异：膝关节，93.8（95%CI[89.7-98.0]）比 89.5（95%CI[85.6-93.4]），P=0.06；功能，63.8（95%CI[53.1-74.5]）比 67.0（95%CI[61.3-72.7]），P=0.62。满意度也相同：分别为 96%和 97%（P=0.77）；植入物存活率也相同（P=0.54）。
在≥85 岁的人群中，与 TKA 相比，UKA 术后早期的医疗并发症更少，临床结果相似。这些结果支持在患有合并症的老年患者中使用 UKA。
III 级，病例对照研究。
