Department of Orthopaedic Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.
Center for Orthopaedics and Trauma Surgery, University of Linz, Krankenhausstr. 7a, 4020, Linz, Austria.
Arch Orthop Trauma Surg. 2023 Jun;143(6):3077-3084. doi: 10.1007/s00402-022-04539-6. Epub 2022 Jul 18.
The aim of the present study was to assess clinical outcome and mid-term survivorship of mobile-bearing unicompartmental knee arthroplasty in patients 50 years of age or younger.
This study reports the results of 119 patients (130 knees) following mobile-bearing medial UKA. Primary indication was advanced osteoarthritis or avascular necrosis of the femoral condyle. The anterior cruciate ligament (ACL) as well as the collateral ligaments were functionally intact, the varus deformity was manually correctable and there was no evidence of osteoarthritis in the lateral compartment. Survivorship analysis was performed with different endpoints and clinical outcome was measured using the Oxford Knee Score (OKS), American Knee Society Score and Functional Score (AKSS-O, AKSS-F), range of motion (ROM), Tegner activity score, University of California Los Angeles score (UCLA) and visual analogue scale for pain (VAS).
The survival rate was 96.6% at 6.5 years (95% CI 98.7-91.3%; number at risk: 56) and 91.7% (95% CI 96.7-80%; number at risk: 22) at 10 years for the endpoint device related revisions and 91.5% at 6.5 years (95% CI 95.4-84.5%; number at risk: 56) and 86.8% (95% CI 93-76.2%; number at risk: 22) at 10 years for the endpoint revision for any reason. Outcome scores, VAS and ROM showed significant improvements (p < 0.001). The mean OKS increased from 26.7 (standard deviation (sd): 7.2) preoperatively to 40.9 (sd: 7.6) at final follow-up, the mean AKSS-O from 48.3 (sd: 13.3) to 87.8 (sd: 14.4) and the mean ROM from 118° (sd: 16.7) to 125° (sd: 11.4). The radiological analysis revealed progression of degenerative changes in the lateral compartment in 39.6% of patients without affecting the functional outcome.
Medial mobile-bearing UKA is a viable surgical treatment option in young patients with significant improvements in knee function and pain. Further follow-up is necessary to evaluate the long-term efficacy.
Retrospective cohort study, Level III.
本研究旨在评估 50 岁及以下患者行单髁膝关节置换术中活动平台假体的临床结果和中期生存率。
本研究报告了 119 例（130 膝）行活动平台内侧 UKA 患者的结果。主要适应证为晚期骨关节炎或股骨髁缺血性坏死。前交叉韧带（ACL）和侧副韧带功能完整，内翻畸形可手法矫正，外侧间室无骨关节炎证据。采用不同的终点进行生存分析，使用牛津膝关节评分（OKS）、美国膝关节协会评分和功能评分（AKSS-O、AKSS-F）、关节活动度（ROM）、Tegner 活动评分、加利福尼亚大学洛杉矶分校评分（UCLA）和疼痛视觉模拟评分（VAS）来测量临床结果。
6.5 年时的生存率为 96.6%（95%CI 98.7-91.3%；风险人数：56），10 年时为 91.7%（95%CI 96.7-80%；风险人数：22），终点为与器械相关的翻修；6.5 年时的生存率为 91.5%（95%CI 95.4-84.5%；风险人数：56），10 年时为 86.8%（95%CI 93-76.2%；风险人数：22），终点为任何原因的翻修。VAS 和 ROM 评分以及 OKS 显著提高（p<0.001）。术前 OKS 平均为 26.7（标准差（sd）：7.2），末次随访时为 40.9（sd：7.6），术前 AKSS-O 平均为 48.3（sd：13.3），末次随访时为 87.8（sd：14.4），ROM 平均为 118°（sd：16.7），末次随访时为 125°（sd：11.4）。放射学分析显示 39.6%的患者外侧间室退行性改变进展，但不影响功能结果。
内侧活动平台 UKA 是年轻患者的一种可行的手术治疗选择，可显著改善膝关节功能和疼痛。需要进一步随访以评估长期疗效。
回顾性队列研究，III 级。
