Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, Singapore, 169865, Singapore.
Arch Orthop Trauma Surg. 2020 Jul;140(7):949-956. doi: 10.1007/s00402-020-03440-4. Epub 2020 Apr 18.
With increasing life expectancies worldwide, more elderly patients with isolated medial compartment osteoarthritis may become suitable UKA candidates. However, there is a paucity of literature comparing outcomes between older patients (≥ 75 years) and younger patients undergoing UKA. The aim of this study was to determine if there were differences in functional and HRQoL measures between older patients (≥ 75 years) and younger controls (< 75 years) undergoing primary UKA.
Prospectively collected registry data of 1041 patients who underwent primary, cemented, fixed-bearing medial UKA at a single institution from 2002-2013 were reviewed. Propensity scores generated using logistic regression was used to match older patients (≥ 75 years, n = 94) to controls (< 75 years, n = 188) in a 1:2 ratio. Knee Society Scores, Oxford Knee Score, Short Form-36, satisfaction/expectation scores, proportion of patients attaining OKS/SF-36 PCS MCID and survivorship were analysed.
Patients ≥ 75 years had significantly lower KSFS (67.1 ± 17.9 vs 79.4 ± 18.2, p < 0.001) and SF-36 PCS (47.3 ± 10.1 vs 50.4 ± 9.1, p = 0.01) as compared to the control group. In addition, a significantly lower proportion of patients ≥ 75 years attained MCID for SF-36 PCS when compared to the controls (50.0% vs 63.8%, p = 0.04). Survival rates at mean 8.3 ± 3.0 years were 98.9% (95% CI, 96.7-100) in the older group versus 92.8% (95% CI, 86.8-98.8) in the younger group (p = 0.31).
Our findings highlight the need to counsel older patients regarding potentially reduced improvements in functional outcomes, despite advantages of lower revision. However, UKA in older patients continues to be a viable option for isolated medial compartment osteoarthritis LEVEL OF EVIDENCE: Level III Propensity score matched study.
随着全球预期寿命的延长，更多患有孤立性内侧间室骨关节炎的老年患者可能成为接受 UKA 的合适人选。然而，关于接受 UKA 的老年患者（≥75 岁）和年轻患者之间的结局比较，文献相对较少。本研究旨在确定在接受初次 UKA 的老年患者（≥75 岁）和年轻对照组（<75 岁）之间，功能和 HRQoL 测量指标是否存在差异。
对 2002 年至 2013 年期间在一家机构接受初次、骨水泥固定、内侧 UKA 的 1041 例患者的前瞻性收集登记数据进行了回顾性分析。使用逻辑回归生成倾向评分，将 94 例老年患者（≥75 岁）与 188 例年轻对照组（<75 岁）按 1:2 比例匹配。分析了膝关节协会评分、牛津膝关节评分、36 项简短健康调查、满意度/期望评分、达到 OKS/SF-36 PCS MCID 的患者比例以及生存率。
与对照组相比，年龄≥75 岁的患者的 KSFS（67.1±17.9 比 79.4±18.2，p<0.001）和 SF-36 PCS（47.3±10.1 比 50.4±9.1，p=0.01）明显较低。此外，与对照组相比，年龄≥75 岁的患者达到 SF-36 PCS MCID 的比例显著较低（50.0%比 63.8%，p=0.04）。在平均 8.3±3.0 年的随访中，老年组的生存率为 98.9%（95%可信区间，96.7-100），而年轻组为 92.8%（95%可信区间，86.8-98.8）（p=0.31）。
我们的研究结果强调了需要对老年患者进行咨询，告知他们尽管翻修率较低存在优势，但功能结局的改善可能会降低。然而，UKA 在老年患者中仍然是治疗孤立性内侧间室骨关节炎的可行选择。
III 级倾向评分匹配研究。
