Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, United Kingdom.
Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, United Kingdom.
Knee. 2020 Oct;27(5):1332-1342. doi: 10.1016/j.knee.2020.06.004. Epub 2020 Jul 27.
Unicompartmental knee replacement (UKR) tends to provide better function but has a higher revision rate than total knee replacement (TKR). The aim was to determine if this occurred in all age groups.
Two large, non-registry, prospective cohorts with median 10-year follow-up (2252 TKR, 1000 medial UKR) were identified. All UKR met recommended indications. TKR with an inappropriate disease pattern for medial UKR were excluded. Knees were propensity score-matched within age-strata (<60 years at operation, 60 to <75, 75+) and compared using Oxford Knee Score (OKS), Kaplan-Meier revision rates and a composite failure, defined as any of revision, reoperation or no improvement in OKS.
One thousand five hundred and eighty-two TKR and UKR were matched. Results are reported TKR vs UKR for ages <60, 60 to <75 and 75+. Median 10-year OKS were 33 vs 45 (p < 0.001), 36 vs 42 (p < 0.001) and 36 vs 38 (p = 0.25). Ten-year revision rates were 11% vs 7%, 5% vs 5%, and 5% vs 10%, (none significant). The composite failures occurred 8%, 5% and 5% more frequently with TKR than UKR (none significant).
In this matched study UKR provided better functional outcomes in all age groups, particularly the young, and provided substantially more excellent outcomes. Although in older groups TKR tended to have a lower revision rate, in the young UKR had a lower revision rate. This was surprising and was perhaps because in this study UKR was, as recommended, only used for bone-on-bone arthritis, whereas in young patients it is widely used for early arthritis, which is associated with a high failure rate. This study supports the use of UKR with recommended indications, in all age groups.
单髁膝关节置换术（UKR）在提供更好的功能方面优于全膝关节置换术（TKR），但其翻修率更高。本研究旨在确定这种情况是否发生在所有年龄段。
确定了两个大型、非注册的前瞻性队列，中位随访时间为 10 年（2252 例 TKR，1000 例内侧 UKR）。所有 UKR 均符合推荐的适应证。排除了不适合内侧 UKR 适应证的 TKR。在年龄分层内（手术时<60 岁、60 至<75 岁、75+岁），使用牛津膝关节评分（OKS）、Kaplan-Meier 翻修率和复合失败率（任何翻修、再次手术或 OKS 无改善）对 UKR 和 TKR 进行匹配，并进行比较。
匹配了 1582 例 TKR 和 UKR。报告了<60 岁、60 至<75 岁和 75+岁时 TKR 与 UKR 的结果。中位 10 年 OKS 分别为 33 分和 45 分（p<0.001）、36 分和 42 分（p<0.001）和 36 分和 38 分（p=0.25）。10 年翻修率分别为 11%和 7%、5%和 5%以及 5%和 10%（均无统计学意义）。TKR 的复合失败发生率比 UKR 高 8%、5%和 5%（均无统计学意义）。
在这项匹配研究中，UKR 在所有年龄段（特别是年轻人）都提供了更好的功能结果，并且提供了更多的优秀结果。尽管在年龄较大的组中，TKR 的翻修率较低，但在年轻患者中，UKR 的翻修率较低。这令人惊讶，可能是因为在这项研究中，UKR 仅按建议用于骨对骨关节炎，而在年轻患者中，它广泛用于早期关节炎，其失败率较高。这项研究支持在所有年龄段使用 UKR，并遵循建议的适应证。
