From Colorado Joint Replacement (Dr. Jennings), Denver, CO, and the Department of Orthopaedic Surgery (Dr. Kleeman-Forsthuber and Dr. Bolognesi), Duke University Medical Center, Durham, NC.
J Am Acad Orthop Surg. 2019 Mar 1;27(5):166-176. doi: 10.5435/JAAOS-D-17-00690.
Indications for medial unicompartmental knee arthroplasty (UKA) have expanded over the past two decades. Proposed advantages include faster recovery, improved kinematics, and better functional outcomes compared with total knee arthroplasty (TKA) in age-matched control subjects. A focused preoperative examination and imaging is essential to identify appropriate surgical candidates. No difference has been demonstrated between fixed- and mobile-bearing implants for implant survivorship or patient-reported outcomes. The most common reasons for conversion to a TKA are aseptic loosening and progression of osteoarthritis. Ten-year survival for UKA in cohort studies has shown to be >90% with outcomes after conversion to TKA being similar to outcomes for revision TKA. Registries have consistently shown lower implant survival for UKA compared with that for TKA, which is likely secondary to use of several different implants by surgeons of varying levels of experience. UKA has the potential to be a cost-effective alternative to TKA in certain patient populations when performed at high-volume centers with advanced surgical techniques.
过去二十年来，内侧单髁膝关节置换术（UKA）的适应证不断扩大。与年龄匹配的对照组全膝关节置换术（TKA）相比，UKA 具有更快的恢复、更好的运动学和更优的功能结果，这些都是其优势。术前进行针对性检查和影像学检查对于识别合适的手术候选者至关重要。固定和活动衬垫植入物在植入物存活率或患者报告的结果方面没有差异。需要转为 TKA 的最常见原因是无菌性松动和骨关节炎进展。队列研究中 UKA 的 10 年生存率>90%，转为 TKA 后的结果与翻修 TKA 的结果相似。登记处的数据一致表明，UKA 的植入物存活率低于 TKA，这可能是由于外科医生的经验水平不同，使用了几种不同的植入物。在高容量中心采用先进的手术技术进行 UKA 时，对于某些患者人群，其可能是一种比 TKA 更具成本效益的替代方法。
