Walter Reed National Military Medical Center, Bethesda, MD.
School of Medicine, Uniformed Services University, Bethesda, MD.
J Arthroplasty. 2021 Dec;36(12):3878-3882. doi: 10.1016/j.arth.2021.08.001. Epub 2021 Aug 8.
Patients with isolated medial compartment osteoarthritis requiring surgical intervention generally have two surgical options: unicompartmental knee arthroplasty (UKA) and proximal tibial osteotomy (PTO). Outcomes of reoperation rates and survivorship are important for counseling patients on treatment options.
A retrospective, comparative cohort study was performed for a consecutive series of patients in the Military Health System who underwent either UKA or PTO between 2003 and 2018. All patients were between 18 and 55 years old and diagnosed with isolated medial compartmental arthritis. Cases with concurrent meniscal or cartilage procedures were included, while cases with concurrent ligament reconstruction were excluded. A minimum 2-year follow-up was required. The primary outcome was conversion to total knee arthroplasty, and the secondary outcome was reoperation for any reason.
A total of 383 procedures were performed for isolated medial compartment arthritis in 303 patients (UKA 270, PTO 113). A multivariate analysis showed that PTO was associated with decreased risk of conversion to TKA compared to UKA (P = .0364). However, the reoperation due to complications was significantly higher in the PTO group (21.2% vs 2.2%; P ≤ .01). The 5-year conversion rate was 13.7% for UKA and 3.5% for PTO (P = .0033) with an average time to conversion of 3.1 years for UKA and 2.9 years for PTO (P = .7805).
In young patients with isolated medial compartment arthritis, conversion rates to TKA are higher with UKA compared to PTO. However, overall reoperation rate is higher with PTO, secondary to complications and revision procedures. Overall survivorship is acceptable for both procedures.
需要手术干预的孤立性内侧间室骨关节炎患者通常有两种手术选择：单髁膝关节置换术（UKA）和胫骨近端截骨术（PTO）。再手术率和生存率的结果对于为患者提供治疗方案的咨询非常重要。
对 2003 年至 2018 年间在军事卫生系统中接受 UKA 或 PTO 的连续患者系列进行回顾性、比较队列研究。所有患者年龄在 18 至 55 岁之间，诊断为孤立性内侧间室关节炎。包括同时进行半月板或软骨手术的病例，排除同时进行韧带重建的病例。需要至少 2 年的随访。主要结局是转为全膝关节置换术，次要结局是因任何原因再次手术。
共有 303 名患者的 383 个程序因孤立性内侧间室关节炎而进行（UKA 270，PTO 113）。多变量分析显示，与 UKA 相比，PTO 降低了转为 TKA 的风险（P =.0364）。然而，PTO 组因并发症导致的再手术率明显更高（21.2%对 2.2%；P ≤.01）。UKA 的 5 年转化率为 13.7%，PTO 为 3.5%（P =.0033），UKA 的平均转换时间为 3.1 年，PTO 为 2.9 年（P =.7805）。
在患有孤立性内侧间室关节炎的年轻患者中，与 PTO 相比，UKA 转为 TKA 的转化率更高。然而，由于并发症和翻修手术，PTO 的总再手术率更高。两种手术的总体生存率都可以接受。
