Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020, Linz, Austria.
Johannes Kepler University Linz, Altenberger Strasse 69, 4040, Linz, Austria.
Knee Surg Sports Traumatol Arthrosc. 2022 Sep;30(9):3191-3198. doi: 10.1007/s00167-021-06632-6. Epub 2021 Jun 19.
Indications for unicompartmental knee arthroplasty (UKA) are controversial. Studies based solely on radiographic criteria suggest up to 49% of patients with knee osteoarthritis (OA) are suitable for UKA. In contrast, the 'Appropriate use criteria' (AUC), developed by the AAOS, apply clinical and radiographic criteria to guide surgical treatment of knee OA. The aim of this study was to analyze patient suitability for TKA, UKA and osteotomy using both radiographic criteria and AUC in a cohort of 300 consecutive knee OA patients.
Included were consecutive patients with clinical and radiographic signs of knee OA referred to a specialist clinic. Collected were demographic data, radiographic wear patterns and clinical findings that were analyzed using the AUC. A comparison of the radiographic wear patterns with the treatment suggested by the AUC as well as the Surgeon Treatment Decision was performed.
There were 397 knees in 300 patients available for analysis. Median age was 68 [IQR 15], BMI 30 [6] with 55% females. Excellent consistency for both the radiographic criteria and the AUC criteria was found. Based on radiological criteria, 41% of knees were suitable for UKA. However, when using the AUC criteria, UKA was the appropriate treatment in only 13.3% of knees. In 19.1% of knees, no surgical treatment was appropriate at the visit, based on the collected data.
Application of isolated radiologic criteria in patients with knee OA results in a UKA candidacy is misleadingly high. AUC that are based on both radiological and clinical criteria suggest UKA is appropriate in less than 15% of patients.
III retrospective study.
单髁膝关节置换术（UKA）的适应证存在争议。仅基于影像学标准的研究表明，多达 49%的膝关节骨关节炎（OA）患者适合行 UKA。相比之下，AAOS 制定的“适宜使用标准”（AUC）应用临床和影像学标准来指导膝关节 OA 的手术治疗。本研究旨在分析 300 例连续膝关节 OA 患者使用影像学标准和 AUC 分析行 TKA、UKA 和截骨术的患者适宜性。
纳入临床和影像学表现为膝关节 OA 并转诊至专科诊所的连续患者。收集患者的人口统计学数据、影像学磨损模式和临床发现，并用 AUC 进行分析。比较影像学磨损模式与 AUC 建议的治疗以及外科医生的治疗决策。
300 例患者的 397 个膝关节可用于分析。患者的中位年龄为 68[IQR 15]岁，BMI 为 30[6]，女性占 55%。影像学标准和 AUC 标准均具有极好的一致性。根据影像学标准，41%的膝关节适合行 UKA。然而，根据 AUC 标准，仅 13.3%的膝关节适合行 UKA。根据收集的数据，19.1%的膝关节在就诊时没有合适的手术治疗。
在膝关节 OA 患者中应用孤立的影像学标准会导致 UKA 候选者的比例高得令人误解。基于影像学和临床标准的 AUC 提示 UKA 仅适用于不到 15%的患者。
III 级回顾性研究。
