Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences University of Oxford, Nuffield Orthopaedic Centre, Oxford; Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Southmead Hospital, Westbury-on-Trym, UK.
Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences University of Oxford, Nuffield Orthopaedic Centre, Oxford.
Acta Orthop. 2022 May 24;93:478-487. doi: 10.2340/17453674.2022.2743.
The main treatments for severe medial compartment knee arthritis are unicompartmental (UKR) and total knee replacement (TKR). UKRs have higher revision rates, particularly for aseptic loosening, therefore the cementless version was introduced. We compared the outcomes of matched cementless UKRs and TKRs.
The National Joint Registry was linked to the English Hospital Episode Statistics and Patient Reported Outcome Measures (PROMs) databases. 10,552 cementless UKRs and 10,552 TKRs were propensity matched and regression analysis used to compare revision/reoperation risks. 6-month PROMs were compared. UKR results were stratified by surgeon caseload into low- (< 10 UKRs/year), medium- (10 to < 30 UKRs/year), and high-volume (≥ 30 UKRs/year).
8-year cementless UKR revision survival for the 3 respective caseloads were 90% (95% CI 87-93), 93% (CI 91-95), and 96% (CI 94-97). 8-year reoperation survivals were 76% (CI 71-80), 81% (CI 78-85), and 84% (CI 82-86) respectively. For TKR the 8-year implant survivals for revision and reoperation were 96% (CI 95-97) and 81% (CI 80-83). The HRs for the 3 caseload groups compared with TKR for revision were 2.0 (CI 1.3-2.9), 2.0 (CI 1.6-2.7), and 1.0 (CI 0.8-1.3) and for reoperation were 1.2 (CI 1.0-1.4), 0.9 (CI 0.8-1.0), and 0.6 (CI 0.5-0.7). 6-month Oxford Knee Score (OKS) (39 vs. 37) and EQ-5D (0.80 vs. 0.77) were higher (p < 0.001) for the cementless UKR.
Cementless UKRs have higher revision and reoperation rates than TKR for low-volume UKR surgeons, similar reoperation but higher revision rates for mid-volume surgeons, and lower reoperation and similar revision rates for high-volume surgeons. Cementless UKR also had better PROMs.
治疗严重内侧间室膝关节炎的主要方法是单髁置换术（UKR）和全膝关节置换术（TKR）。UKR 的翻修率较高，尤其是无菌性松动，因此引入了非骨水泥固定版本。我们比较了匹配的非骨水泥 UKR 和 TKR 的结果。
国家关节登记处与英国住院患者事件统计和患者报告结局测量（PROMs）数据库相链接。对 10552 例非骨水泥 UKR 和 10552 例 TKR 进行了倾向匹配，并使用回归分析比较了翻修/再手术风险。比较了 6 个月的 PROMs。根据外科医生的手术量，将 UKR 结果分层为低量（<10 例/年）、中量（10-<30 例/年）和高量（≥30 例/年）。
在 3 个相应手术量组中，8 年非骨水泥 UKR 的翻修生存率分别为 90%（95%CI 87-93）、93%（CI 91-95）和 96%（CI 94-97）。8 年再手术生存率分别为 76%（CI 71-80）、81%（CI 78-85）和 84%（CI 82-86）。对于 TKR，8 年植入物的翻修和再手术生存率分别为 96%（CI 95-97）和 81%（CI 80-83）。与 TKR 相比，3 个手术量组的 HR 分别为 2.0（CI 1.3-2.9）、2.0（CI 1.6-2.7）和 1.0（CI 0.8-1.3），再手术的 HR 分别为 1.2（CI 1.0-1.4）、0.9（CI 0.8-1.0）和 0.6（CI 0.5-0.7）。6 个月的牛津膝关节评分（OKS）（39 分比 37 分）和 EQ-5D（0.80 分比 0.77 分）更高（p<0.001）。
对于低量 UKR 外科医生，非骨水泥 UKR 的翻修和再手术率高于 TKR；对于中量外科医生，再手术率相似，但翻修率更高；对于高量外科医生，再手术和翻修率相似。非骨水泥 UKR 的 PROMs 也更好。
