Department of Orthopedics and Traumatology, Bezmialem Vakıf University, İstanbul, Turkey.
Acta Orthop Traumatol Turc. 2021 Dec;55(6):513-517. doi: 10.5152/j.aott.2021.21093.
The main indication for medial Unicondylar Knee Arthroplasty (UKA) is Full-Thickness Cartilage Loss (FTCL) in the isolated medial compartment of the knee. However, controversial outcomes were reported in patients with Partial-Thickness Cartilage Loss (PTCL). The aim of this study is to compare PTCL and FTCL based on intraoperative findings in medial UKA in terms of functional outcomes and complication rates requiring reoperation and revision.
Two hundred and fifteen knees of 174 patients who underwent mobile-bearing UKA between October 2014 and February 2018 for the diagnosis of symptomatic anteromedial osteoarthritis were evaluated retrospectively. A single senior surgeon evaluated the type of cartilage loss in the medial compartment intraoperatively according to the International Cartilage Repair Society classification system. Clinical outcomes were evaluated using Oxford Knee Score (OKS) and International Knee Documentation Committee (IKDC) score pre- and post-operatively at the last follow-up. Patients with PTCL and FTCL were compared in terms of their pre- and post-operative OKS and IKDC scores, and their improvements, as well as complication rates requiring reoperation and revision.
The mean follow-up time was 33.1 ± 5.3 months. The PTCL (n = 80) and FTCL (n = 135) groups were statistically similar in terms of age (P = 0.41), gender (P = 0.921), body mass index (P = 0.165), bilaterality (P = 0.111), American Society of Anesthesiologists physical status (P = 0.218), Charlson Comorbidity Index (P = 0.74), and post-operative follow-up (P = 0.167). The mean pre-operative OKS and IKDC scores were improved from 24.5 ± 4.1 and 39.9 ± 5 to 40.3 ± 3.6 and 73.9 ± 7.7 at the last follow-up, respectively (P < 0.001). Pre-operative OKS and IKDC scores were superior in favor of the PTCL group. However, no significant difference was found between the groups in terms of post-operative OKS (P = 0.53) and IKDC (P = 0.975) scores, and their improvements (OKS, P = 0.953; IKDC, P = 0.536). The complication rates requiring reoperation was 5% (n = 11) in all patients. Of these, 9% (n = 7) from the PTCL group and 3% (n = 4) from the FTCL group were reoperated. Nevertheless, no significant difference was found between the groups (P = 0.105).
In PTCL, medial UKA is a reliable surgery in terms of functional outcomes, the same as in FTCL; however, its complication rates requiring reoperation is higher without statistical significance.
Level III, Therapeutic Study.
内侧单髁膝关节置换术（UKA）的主要适应证是膝关节内侧间室全层软骨缺损（FTCL）。然而，对于存在部分厚度软骨缺损（PTCL）的患者，其结果存在争议。本研究旨在根据术中内侧 UKA 发现，比较 PTCL 和 FTCL 患者在功能结果和需要再次手术和翻修的并发症发生率方面的差异。
回顾性分析了 2014 年 10 月至 2018 年 2 月期间因症状性前内侧骨关节炎接受活动衬垫 UKA 的 174 例患者的 215 个膝关节。一名资深外科医生根据国际软骨修复学会（ICRS）分类系统，对内侧间室的软骨缺损类型进行术中评估。使用牛津膝关节评分（OKS）和国际膝关节文献委员会（IKDC）评分，在术前和末次随访时评估临床结果。比较了存在 PTCL 和 FTCL 的患者的术前和术后 OKS 和 IKDC 评分及其改善情况，以及需要再次手术和翻修的并发症发生率。
平均随访时间为 33.1 ± 5.3 个月。PTCL（n = 80）和 FTCL（n = 135）组在年龄（P = 0.41）、性别（P = 0.921）、体重指数（P = 0.165）、双侧性（P = 0.111）、美国麻醉医师协会身体状况（P = 0.218）、Charlson 合并症指数（P = 0.74）和术后随访时间（P = 0.167）方面差异无统计学意义。术前 OKS 和 IKDC 评分分别从 24.5 ± 4.1 和 39.9 ± 5 改善至末次随访时的 40.3 ± 3.6 和 73.9 ± 7.7（P < 0.001）。PTCL 组的术前 OKS 和 IKDC 评分更优。然而，两组患者的术后 OKS（P = 0.53）和 IKDC（P = 0.975）评分及其改善情况（OKS，P = 0.953；IKDC，P = 0.536）差异无统计学意义。所有患者中有 5%（n = 11）需要再次手术。其中，PTCL 组有 9%（n = 7）和 FTCL 组有 3%（n = 4）需要再次手术。然而，两组之间差异无统计学意义（P = 0.105）。
在 PTCL 中，内侧 UKA 在功能结果方面与 FTCL 一样可靠，但再次手术的并发症发生率较高，但无统计学意义。
三级，治疗性研究。
