Service d'orthopédie, centre hospitalo-universitaire de Rennes, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France.
Institut national de la santé et de la recherche médicale, Inserm, laboratoire de traitement de l'information médicale (LATIM), UMR1101, 22, avenue Camille-Desmoulins, 29200 Brest, France.
Orthop Traumatol Surg Res. 2023 Jun;109(4):103581. doi: 10.1016/j.otsr.2023.103581. Epub 2023 Feb 14.
Unicompartmental knee arthroplasty (UKA) is a reliable and reproducible procedure. While some surgeons have incorporated it into their therapeutic armamentarium, others do not use it routinely, leading to a large disparity in practice. The objective of this study was to investigate in France the epidemiology of UKA from 2009 to 2019 to identify: (1) the evolution of growth trends by sex and age, (2) the evolution of the state of comorbidity of patients during the operation, (3) the evolution of trends according to the regions, (4) the projection best suited to the observations at 2050.
Our hypothesis was that in France, an increase would be observed over the period studied, differing according to the characteristics of the population.
The study was conducted in France over the 2009-2019 period for each gender and age group. The data was taken from the NHDS (National Health Data System) database, which includes all the procedures carried out in France. Based on the collection of procedures performed, the incidence rates (per 100,000 inhabitants) and their evolution were deduced, as well as the indirect assessment of the patient's comorbidity status. Using linear, Poisson, and logistic projection models, incidence rates were projected to the years 2030, 2040, and 2050.
Between 2009 and 2019, the incidence rate of UKA increased sharply (from 12.76 to 19.57; +53%), the growth was different in men (from 10.78 to 20.34; +89%) and women (from 14.61 to 18.85; +29%). The male/female sex ratio increased from 0.69 in 2009 to 1.0 in 2019. The increase was greatest among men under 65 (from 4.9 to 9.9; +100%) and lowest among women over 75 (from 41.2 to 40.5; -2%). Over the period studied, the proportion of patients with mild comorbidities (HPG1) increased (from 71.7% to 81.1%) at the expense of the other classes with more severe comorbidities. This dynamic was observed for all age groups: 0-64 years (from 83.3% to 90%), 65-74 years (from 81.4% to 88.4%), 75 years and over (38 .2% to 52.6%) regardless of sex. There was a strong disparity between the regions with a change in the incidence rate ranging from -22% (from 29.8 to 23.1) for Corsica to +251% (from 13.9 to 48.7) for Brittany. The proposed projection models suggested an increase in the incidence rate of +18% in logistic regression, +103% in linear regression by 2050.
Our study showed strong growth in the number of UKAs in France over the period studied, being highest in young men. The proportion of patients with fewer comorbidities increased for all age groups. A disparity in inter-regional practice was identified, with indications that remain ambiguous and differ according to the practitioner. We can expect continued growth in the years to come, adding to the care burden.
IV; Descriptive epidemiological study.
单髁膝关节置换术（UKA）是一种可靠且可重复的手术。虽然有些外科医生将其纳入了他们的治疗手段，但其他外科医生并不常规使用，导致手术实践存在很大差异。本研究的目的是调查法国从 2009 年到 2019 年 UKA 的流行病学情况，以确定：（1）按性别和年龄划分的增长趋势演变，（2）手术期间患者合并症状态的演变，（3）按地区划分的趋势演变，（4）到 2050 年最适合观察的预测。
我们的假设是，在法国，在研究期间观察到的增长率将有所不同，这取决于人口的特点。
该研究在法国进行，研究期间为 2009 年至 2019 年，针对每个性别和年龄组。数据来自 NHDS（国家健康数据系统）数据库，其中包含法国所有开展的手术。根据手术数量的收集，推断出发病率（每 10 万人）及其演变，以及对患者合并症状态的间接评估。使用线性、泊松和逻辑预测模型，将发病率预测到 2030 年、2040 年和 2050 年。
在 2009 年至 2019 年间，UKA 的发病率急剧上升（从 12.76 上升到 19.57；增长 53%），男性（从 10.78 上升到 20.34；增长 89%）和女性（从 14.61 上升到 18.85；增长 29%）的增长率不同。男性/女性性别比例从 2009 年的 0.69 上升到 2019 年的 1.0。65 岁以下男性（从 4.9 增加到 9.9；增长 100%）和 75 岁以上女性（从 41.2 增加到 40.5；下降 2%）的增长率最大。在研究期间，轻度合并症（HPG1）患者的比例增加（从 71.7%增加到 81.1%），而其他更严重合并症的患者比例下降。这种动态在所有年龄组中都有观察到：0-64 岁（从 83.3%增加到 90%）、65-74 岁（从 81.4%增加到 88.4%）、75 岁及以上（从 38.2%增加到 52.6%），无论性别如何。各地区之间存在明显差异，发病率变化范围从科西嘉岛的-22%（从 29.8 下降到 23.1）到布列塔尼的+251%（从 13.9 上升到 48.7）。提出的预测模型表明，逻辑回归的发病率增加 18%，线性回归增加 103%，到 2050 年。
我们的研究表明，法国 UKA 的数量在研究期间呈强劲增长，在年轻男性中增长最高。所有年龄组的合并症较少患者比例都有所增加。在各地区之间存在手术实践的差异，这表明手术指征仍然存在争议，并且因医生而异。我们可以预计未来几年还会继续增长，这将增加护理负担。
IV；描述性流行病学研究。
