Tay Mei Lin, McGlashan Sue R, Monk A Paul, Young Simon W
Department of Orthopaedic Surgery, North Shore Hospital, 124 Shakespeare Road, Takapuna, 0622, Auckland, New Zealand.
Department of Anatomy and Medical Imaging, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, 1023, Auckland, New Zealand.
Arch Orthop Trauma Surg. 2022 Feb;142(2):301-314. doi: 10.1007/s00402-021-03827-x. Epub 2021 Feb 25.
Unicompartmental knee arthroplasty (UKA) has advantages over total knee arthroplasty including fewer complications and faster recovery; however, UKAs also have higher revision rates. Understanding reasons for UKA failure may, therefore, allow for optimized clinical outcomes. We aimed to identify failure modes for medial UKAs, and to examine differences by implant bearing, cement use and time.
A systematic review was conducted by searching MedLine, EMBASE, CINAHL and Cochrane databases from 2000 to 2020. Studies were selected if they included ≥ 250 participants, ≥ 10 failures and reported all failure modes of medial UKA performed for osteoarthritis (OA).
A total of 24 cohort and 2 registry-based studies (levels II and III) were selected. The most common failure modes were aseptic loosening (24%) and OA progression (30%). Earliest failures (< 6 months) were due to infection (40%), bearing dislocation (20%), and fracture (20%); mid-term failures (> 2 years to 5 years) were due to OA progression (33%), aseptic loosening (17%) and pain (21%); and late-term (> 10 years) failures were mostly due to OA progression (56%). Rates of failure from wear were higher with fixed-bearing prostheses (5% cf. 0.3%), whereas rates of bearing dislocations were higher with mobile-bearing prostheses (14% cf. 0%). With cemented components, there was a high rate of failure due to aseptic loosening (27%), which was reduced with uncemented components (4%).
UKA failure modes differ depending on implant design, cement use and time from surgery. There should be careful consideration of implant options and patient selection for UKA.
单髁膝关节置换术（UKA）相较于全膝关节置换术具有优势，包括并发症更少、恢复更快；然而，UKA的翻修率也更高。因此，了解UKA失败的原因可能有助于优化临床结果。我们旨在确定内侧UKA的失败模式，并按植入物衬垫、骨水泥使用情况和时间来研究差异。
通过检索2000年至2020年的MedLine、EMBASE、CINAHL和Cochrane数据库进行系统评价。如果研究纳入≥250名参与者、≥10例失败病例且报告了因骨关节炎（OA）而行内侧UKA的所有失败模式，则将其纳入。
共选择了24项队列研究和2项基于注册登记的研究（II级和III级）。最常见的失败模式是无菌性松动（24%）和OA进展（30%）。早期失败（<6个月）是由于感染（40%）、衬垫脱位（20%）和骨折（20%）；中期失败（>2年至5年）是由于OA进展（33%）、无菌性松动（17%）和疼痛（21%）；晚期（>10年）失败主要是由于OA进展（56%）。固定衬垫假体的磨损失败率更高（5%对比0.3%），而活动衬垫假体的衬垫脱位率更高（14%对比0%）。对于使用骨水泥的组件，无菌性松动导致的失败率很高（27%），而使用非骨水泥组件时这一比例降低（4%）。
UKA的失败模式因植入物设计、骨水泥使用情况和手术时间而异。对于UKA，应仔细考虑植入物选择和患者选择。
