Adult Reconstruction Service, Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, Singapore, 169865, Singapore.
Knee Surg Sports Traumatol Arthrosc. 2019 Jun;27(6):2030-2036. doi: 10.1007/s00167-018-5169-y. Epub 2018 Oct 4.
The purpose of this study was to assess 10-year functional outcome and survivorship analysis of patients with significant radiographic evidence of patellofemoral joint arthritis treated with fixed bearing unicompartmental knee arthroplasty.
Two hundred and sixteen patients (263 knees) that underwent UKA from 2003 to 2005 for a mean of 10.5 ± 2.1 years were prospectively followed up. Preoperative radiological assessment of the patellofemoral joint state was assessed according to the Ahlback classification by an independent assessor and radiographically significant patellofemoral disease was defined as grade 2 or more. Patients with significant bone-on-bone contact in the patellofemoral joint were excluded.
Of the 263 knees, 222 (84.4%) had normal patellofemoral joint state and 41 (15.6%) radiologically significant patellofemoral disease. At 10 years' follow-up, the normal and patellofemoral groups had similar OKS (20 ± 7 vs 20 ± 8, n.s.) and KSS scores (79 ± 20 vs 81 ± 20, n.s.), respectively. There were 12 revision surgeries in the normal group and the most common indication for revision was progression of contralateral compartment osteoarthritis (6 of 12 cases). There was only one revision in the patellofemoral group and it was due to progression of contralateral compartment osteoarthritis (n.s.). When all secondary surgeries to the operated knee were considered as failures, the 10-year survival rate was 95.1% (CI 95%: 92.2-97.7%).
The presence of significant preoperative radiological patellofemoral disease does not affect long-term implant survival and patients have excellent functional outcomes 10 years postoperatively. These patients should not be contraindicated from undergoing unicompartmental knee arthroplasty.
III.
本研究旨在评估 2003 年至 2005 年间因髌股关节炎行固定平台单髁膝关节置换术且影像学显示有明显髌股关节炎的患者 10 年的功能结果和生存率分析。
前瞻性随访 2003 年至 2005 年接受 UKA 治疗的 216 例（263 膝）患者，平均随访 10.5±2.1 年。由一位独立评估者根据 Ahlback 分类对髌股关节的术前影像学评估，并将影像学上明显的髌股关节疾病定义为 2 级或更高级别。排除髌股关节有明显骨对骨接触的患者。
在 263 个膝关节中，222 个（84.4%）髌股关节状态正常，41 个（15.6%）存在影像学上明显的髌股关节疾病。10 年随访时，正常组和髌股组的 OKS（20±7 分比 20±8 分，n.s.）和 KSS 评分（79±20 分比 81±20 分，n.s.）相似。正常组有 12 例翻修手术，最常见的翻修指征是对侧间室骨关节炎进展（12 例中有 6 例）。髌股组仅翻修 1 例，原因是对侧间室骨关节炎进展（n.s.）。当考虑所有对手术膝关节的二次手术为失败时，10 年生存率为 95.1%（95%CI：92.2-97.7%）。
术前影像学显示有明显的髌股关节疾病并不影响长期植入物的生存率，患者在术后 10 年有极好的功能结果。这些患者不应被排除在单髁膝关节置换术之外。
III 级。
