Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences University of Oxford, Nuffield Orthopaedic Centre, Oxford, United Kingdom; Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Southmead Hospital, Westbury-on-Trym, Bristol, United Kingdom.
MSk Lab, Imperial College London, London, United Kingdom.
J Arthroplasty. 2022 Feb;37(2):243-251. doi: 10.1016/j.arth.2021.09.018. Epub 2021 Oct 5.
The 2 main treatment options for end-stage single compartment knee arthritis are unicompartmental (UKR) or total knee replacement (TKR). We compared the long-term outcomes in different age groups.
In total, 54,215 UKRs and 54,215 TKRs from the National Joint Registry and Hospital Episode Statistics database were propensity score matched and Kaplan-Meier and regression analysis used to compare revision, reoperation, mortality, and 3-month complications.
UKR had higher 10-year revision rates (12% vs 5%, hazard ratio [HR] 2.31, P < .001) and 10-year reoperation rates (25% vs 21%, HR 1.12, P < .001). UKR had lower 10-year mortality rates (13.6% vs 15.5%, HR 0.86, P < .001). UKR had lower rates of medical (P < .001) and procedure related (P < .001) complications and deaths (HR 0.61, P = .02). If 100 patients had a UKR instead of a TKR then over 10 years, if they were <55 years old there would be 7 more reoperations and 1 less death; if they were 55-64 years old there would be 6 more reoperations and 2 more deaths; if they were 65-74 years old there would be 4 more reoperations and 2 less deaths; and if they were ≥75 years old there would be 3 more reoperations and 4 less deaths.
UKR has higher revision and slightly higher reoperation rates but lower mortality rates than matched TKR. The decision to do a UKR should, in part, be based on the balance of these risks, which are influenced by patient age. In the elderly group (>75 years) the data suggests that UKR compared to TKR has a greater absolute reduction in mortality than the increase in reoperation rate.
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单室膝关节关节炎终末期的 2 种主要治疗选择是单髁膝关节置换术（UKR）或全膝关节置换术（TKR）。我们比较了不同年龄组的长期结果。
共从国家关节登记处和医院病例统计数据库中匹配了 54215 例 UKR 和 54215 例 TKR，使用 Kaplan-Meier 和回归分析比较了翻修、再手术、死亡率和 3 个月并发症。
UKR 的 10 年翻修率（12%比 5%，危险比[HR]2.31，P<0.001）和 10 年再手术率（25%比 21%，HR 1.12，P<0.001）较高。UKR 的 10 年死亡率（13.6%比 15.5%，HR 0.86，P<0.001）较低。UKR 的医疗（P<0.001）和手术相关（P<0.001）并发症和死亡（HR 0.61，P=0.02）发生率较低。如果 100 例患者接受 UKR 而不是 TKR，那么在 10 年内，如果他们<55 岁，则会有 7 例以上的再手术和 1 例死亡减少；如果他们是 55-64 岁，则会有 6 例以上的再手术和 2 例死亡增加；如果他们是 65-74 岁，则会有 4 例以上的再手术和 2 例死亡减少；如果他们是≥75 岁，则会有 3 例以上的再手术和 4 例死亡减少。
UKR 的翻修率和略高的再手术率较高，但死亡率低于匹配的 TKR。选择进行 UKR 的决定部分应基于这些风险的平衡，这些风险受患者年龄的影响。在老年组（>75 岁），数据表明，与 TKR 相比，UKR 在降低死亡率方面具有更大的绝对优势，而在增加再手术率方面则相对较小。
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