a Department of Orthopaedic Surgery, Clinical Orthopaedic Research Hvidovre (CORH) , Copenhagen University Hospital Hvidovre , Denmark ;
b Department of Clinical Epidemiology , Aarhus University Hospital , Denmark.
Acta Orthop. 2019 Aug;90(4):354-359. doi: 10.1080/17453674.2019.1601834. Epub 2019 Apr 11.
Background and purpose - Using contemporary indications, up to 50% of patients undergoing knee arthroplasty are eligible for unicompartmental knee arthroplasty (UKA), and lower UKA use likely reflects a restrictive approach to patient selection. Since broader indications have been successfully introduced, and low surgical volume and UKA percentage (usage) are associated with higher revision rates, it is of interest whether the actual use of UKA has changed accordingly. We explored this by assessing time trends in patient demographics and whether these are associated with center UKA volume and usage. Patients and methods - From the Danish Knee Arthroplasty Registry, we included 8,501 medial UKAs performed for primary osteoarthritis during 2002-2016. Using locally weighted regression, we examined changes-both overall and by center volume and usage (low vs high)-in sex distribution, age, weight, and preoperative American Knee Society Score (AKSS-O). Results - Over the last 20 years, UKA use in Denmark has been increasing steadily. Age, weight, and proportion of men all increased regardless of volume and usage. AKSS-O showed an initial increase followed by a decrease. In low-usage and low-volume centers, the proportion of women was higher, patients were younger, weighed less, and had higher AKSS-O scores; however, for age and AKSS-O, the groups were converging during the last part of the period. Interpretation - Characteristics of UKA patients have changed in the last 15 years irrespective of center volume and usage. We found between-group differences for both volume and usage, though with convergence for age and AKSS-O, which suggests an increasingly uniform approach to patient selection.
背景与目的-使用当代的适应证，多达 50%接受膝关节置换术的患者适合进行单髁膝关节置换术（UKA），而 UKA 使用率较低可能反映了对患者选择的限制。由于适应证已经得到了更广泛的应用，并且手术量和 UKA 使用率较低与更高的翻修率相关，因此，我们有兴趣了解 UKA 的实际使用是否相应地发生了变化。我们通过评估患者人口统计学特征的时间趋势以及这些特征是否与中心 UKA 手术量和使用率相关，来探讨这个问题。患者和方法-从丹麦膝关节置换登记处，我们纳入了 2002 年至 2016 年期间因原发性骨关节炎行内侧 UKA 的 8501 例患者。使用局部加权回归，我们检查了整体以及按中心手术量和使用率（低与高）变化的性别分布、年龄、体重和术前美国膝关节协会评分（AKSS-O）。结果-在过去的 20 年中，丹麦的 UKA 使用量一直在稳步增加。无论手术量和使用率如何，年龄、体重和男性比例均有所增加。AKSS-O 最初呈上升趋势，随后下降。在低使用率和低手术量中心，女性比例较高，患者年龄较轻，体重较轻，AKSS-O 评分较高；然而，对于年龄和 AKSS-O，在研究期间的最后一部分，两组之间的差异正在缩小。结论-无论中心手术量和使用率如何，过去 15 年来，UKA 患者的特征都发生了变化。我们发现手术量和使用率都存在组间差异，尽管年龄和 AKSS-O 有趋同趋势，这表明患者选择的方法越来越统一。
