Department for Orthopaedic Surgery, Medical University Innsbruck, Innsbruck, Austria.
Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany.
Arch Orthop Trauma Surg. 2023 Jul;143(7):4331-4337. doi: 10.1007/s00402-023-04829-7. Epub 2023 Mar 18.
To investigate the clinical outcome of patients that underwent conversion of a medial unicondylar knee arthroplasty (UKA) to a total knee arthroplasty (TKA) and to compare that outcome to patients that underwent primary TKA. It was hypothesized that those groups would significantly differ in terms of knee score outcome and implant survival.
A retrospective-comparative study was conducted utilizing data from the Federal state's arthroplasty registry. Included were patients from our department that undergone a conversion of a medial UKA to a TKA (UKA-TKA group). The Western Ontario and MacMaster Universities Osteoarthritis Index (WOMAC) from preoperative and 1-year postoperative was used. Moreover, the implant survival was analyzed.
In the UKA-TKA group, there were 51 cases (age 67 ± 10, 74% women), and in the TKA group, there were 2247 cases (age 69 ± 9, 66% women). The one-year postoperative WOMAC total score was 33 in the UKA-TKA group und 21 in the TKA group (p < 0.001). Similarly, the WOMAC pain, WOMAC stiffness, and WOMAC function scores were significantly worse in the UKA-TKA. After 5 years, the survival rates were 82% and 95% (p = 0.001). The 10-years prosthesis survival was 74% and 91% in the UKA-TKA and TKA groups, respectively (p < 0.001).
Based on our findings it is concluded that patients who received a TKA after UKA have inferior results than those that directly receive a TKA. This is true for both patient-reported knee outcome and prosthesis survival. Converting UKA to TKA should not be seen as an easy operation, but should rather be done by surgeons with considerable experience in both primary and revision knee arthroplasty.
研究内侧单髁膝关节置换术（UKA）转换为全膝关节置换术（TKA）的患者的临床结果，并将其与初次行 TKA 的患者进行比较。假设这两组在膝关节评分结果和假体生存率方面存在显著差异。
利用联邦州关节置换登记处的数据进行回顾性比较研究。包括我院行内侧 UKA 转换为 TKA 的患者（UKA-TKA 组）。使用术前和术后 1 年的西部安大略省和麦克马斯特大学骨关节炎指数（WOMAC）进行评估。此外，还分析了假体的生存率。
在 UKA-TKA 组中，有 51 例（年龄 67±10 岁，74%为女性），在 TKA 组中，有 2247 例（年龄 69±9 岁，66%为女性）。UKA-TKA 组术后 1 年 WOMAC 总评分 33 分，TKA 组 21 分（p<0.001）。同样，UKA-TKA 组 WOMAC 疼痛、WOMAC 僵硬和 WOMAC 功能评分也明显较差。5 年后，生存率分别为 82%和 95%（p=0.001）。UKA-TKA 和 TKA 组的 10 年假体生存率分别为 74%和 91%（p<0.001）。
根据我们的发现，可以得出结论，接受 UKA 后行 TKA 的患者的结果不如直接接受 TKA 的患者。这在患者报告的膝关节结果和假体生存率方面都是如此。将 UKA 转换为 TKA 不应被视为一种简单的手术，而应由在初次和翻修膝关节置换术方面均具有丰富经验的外科医生进行。
