术前膝关节屈曲挛缩并不影响内侧固定平台单髁膝关节置换术的结果和生存率。
Preoperative Flexion Contracture Does Not Compromise the Outcomes and Survivorship of Medial Fixed Bearing Unicompartmental Knee Arthroplasty.
机构信息
Department of Orthopaedic Surgery, Singapore General Hospital.
出版信息
J Arthroplasty. 2021 Oct;36(10):3406-3412. doi: 10.1016/j.arth.2021.05.019. Epub 2021 May 20.
BACKGROUND
Despite the expanding indications for unicompartmental knee arthroplasty (UKA), the classic indication that limits flexion contracture to <5° in fixed bearing UKA excludes most patients with arthritic knees and has not been challenged in modern literature. This study compared the clinical outcomes between patients with severe flexion contracture and controls undergoing UKA.
METHODS
Eighty seven medial fixed bearing UKAs performed in patients with severe (≥15°) flexion contracture were matched 1:1 with 87 controls without flexion or recurvatum deformity (-5°<extension<5°) using propensity scores to control for age, sex, BMI, Charlson comorbidity index, ASA class, and baseline patient-reported outcome measures (PROMs). Perioperative outcomes were recorded. Range of motion, Knee Society Score, Oxford Knee Score, SF-36, and patient satisfaction were assessed at 6 months and 2 years. Survivorship was recorded at mean 11.5 ± 3.2 years.
RESULTS
Preoperative knee extension in the control and contracture groups was 0.9° ± 1.9° and 18.0° ± 3.5° (P < .001), respectively, whereas flexion was 122.8° ± 27.9° and 120.6° ± 13.6° (P = .502). The contracture group had poorer Knee Society functional (P = .023) and SF-36 physical score (P = .010) at 6 months. However, there was no difference in PROMs at 2 years. A similar proportion achieved the minimal clinically important difference for each PROM and was satisfied with surgery. Range of motion remained poorer in the contracture group and a higher percentage had residual contractures (P < .001). Ten-year survivorship was 94% and 97% in the control and contracture groups, respectively (P = .145).
CONCLUSION
Although patients with severe flexion contractures had a poorer range of motion and postoperatively, these patients attained comparable PROMs, satisfaction rates, and mid-term survivorship after UKA.
LEVEL OF EVIDENCE
III, therapeutic study.
背景
尽管单髁膝关节置换术（UKA）的适应证不断扩大，但经典的适应证是将固定轴承 UKA 的屈曲挛缩限制在<5°，这排除了大多数患有膝关节关节炎的患者，并且在现代文献中也没有受到挑战。本研究比较了严重屈曲挛缩患者与接受 UKA 的对照者之间的临床结果。
方法
对 87 例患有严重（≥15°）屈曲挛缩的内侧固定轴承 UKA 患者进行了研究，通过倾向评分将其与 87 例无屈曲或反屈畸形（-5°<伸展<5°）的对照者进行 1:1 匹配，以控制年龄、性别、BMI、Charlson 合并症指数、ASA 分级和基线患者报告的结果测量（PROM）。记录围手术期结果。在 6 个月和 2 年时评估关节活动度、膝关节学会评分、牛津膝关节评分、SF-36 和患者满意度。记录平均 11.5±3.2 年的生存率。
结果
对照组和挛缩组的术前膝关节伸展度分别为 0.9°±1.9°和 18.0°±3.5°（P<.001），而屈曲度分别为 122.8°±27.9°和 120.6°±13.6°（P=.502）。挛缩组在术后 6 个月时膝关节学会功能（P=.023）和 SF-36 躯体评分（P=.010）较差。然而，在 2 年时，PROM 无差异。每个 PROM 都有相似比例的患者达到最小临床重要差异，并且对手术感到满意。在挛缩组中，关节活动度仍然较差，并且有更高比例的患者存在残余挛缩（P<.001）。在控制组和挛缩组中，10 年生存率分别为 94%和 97%（P=.145）。
结论
尽管严重屈曲挛缩患者的活动范围较差，但在 UKA 后，这些患者的 PROM、满意度和中期生存率相当。
证据等级
III 级，治疗性研究。
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