Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, South Korea.
Department of Orthopaedic Surgery, Seoul Sacred Heart General Hospital, Seoul, South Korea.
Knee Surg Sports Traumatol Arthrosc. 2019 Apr;27(4):1310-1319. doi: 10.1007/s00167-019-05390-w. Epub 2019 Feb 4.
Long-term clinical and radiographic results and survival rates were compared between closed-wedge high tibial osteotomy (HTOs) and fixed-bearing unicompartmental knee arthroplasty (UKA) in patients with similar demographics.
Sixty HTOs and 50 UKAs completed between 1992 and 1998 were retrospectively reviewed. There were no significant differences in pre-operative demographics. The mean follow-up period was 10.7 ± 5.7 years for HTO and 12.0 ± 7.1 years for UKA (n.s.). The Knee Society knee and function scores, WOMAC, and range of motion (ROM) were investigated. The mechanical axis and femorotibial angle were evaluated. Kaplan-Meier survival analysis was performed (failure: revision to TKA) and the failure modes were investigated.
Most of the clinical and radiographic results were not different at the last follow-up, except ROM; ROM was 135.3° ± 12.3° in HTO and 126.8° ± 13.3° in UKA (p = 0.005). The 5-, 10-, 15-, and 20-year survival rates were 100%, 91.0%, 63.4%, and 48.3% for closed-wedge HTO, respectively, and 90.5%, 87.1%, 70.8%, and 66.4% for UKA (n.s.). The survival rate was higher than that for UKA until 12 years post-operatively but was higher in UKAs thereafter, following a remarkable decrease in HTO. The most common failure mode was degenerative osteoarthritic progression of medial compartment in HTO and femoral component loosening in UKA.
Long-term survival did not differ significantly between closed-wedge HTO and fixed-bearing UKA in patients with similar pre-operative demographics and knee conditions. The difference in post-operative ROM and failure mode should be considered when selecting a procedure.
III.
比较相似人口统计学特征的患者中，闭合楔形胫骨高位截骨术（HTO）与固定平台单髁膝关节置换术（UKA）的长期临床和影像学结果及生存率。
回顾性分析 1992 年至 1998 年间完成的 60 例 HTO 和 50 例 UKA。术前人口统计学无显著差异。HTO 的平均随访时间为 10.7±5.7 年，UKA 为 12.0±7.1 年（无统计学意义）。研究了膝关节学会膝关节和功能评分、WOMAC、活动范围（ROM）。评估了机械轴和股胫角。进行了 Kaplan-Meier 生存分析（失败：翻修为 TKA）并研究了失败模式。
除 ROM 外，大多数临床和影像学结果在末次随访时无差异，HTO 的 ROM 为 135.3°±12.3°，UKA 为 126.8°±13.3°（p=0.005）。闭合楔形 HTO 的 5、10、15 和 20 年生存率分别为 100%、91.0%、63.4%和 48.3%，UKA 分别为 90.5%、87.1%、70.8%和 66.4%（无统计学意义）。HTO 的生存率在术后 12 年内高于 UKA，但此后生存率高于 UKA，HTO 显著下降。最常见的失败模式是 HTO 内侧间室的退行性骨关节炎进展和 UKA 的股骨部件松动。
在术前人口统计学特征和膝关节状况相似的患者中，闭合楔形 HTO 与固定平台 UKA 的长期生存率无显著差异。在选择手术时，应考虑术后 ROM 和失败模式的差异。
III 级。
