Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan.
Department of Orthopaedic Surgery, Sapporo Maruyama Orthopaedic Hospital, North-7, West-27-1-3, Chuo-ku, Sapporo, Hokkaido, 060-0007, Japan.
Arch Orthop Trauma Surg. 2023 Oct;143(10):6339-6344. doi: 10.1007/s00402-023-04888-w. Epub 2023 Apr 27.
Many countries are faced with aging populations. However, few studies have directly compared the clinical outcomes of medial opening-wedge high tibial osteotomy (OWHTO) and mobile-bearing unicompartmental knee arthroplasty (MB-UKA) in early elderly patients. Thus, we aimed to investigate the clinical outcomes after OWHTO and MB-UKA in early elderly patients with similar demographics and osteoarthritis (OA) severity.
Three hundred and fifteen OWHTO and 142 MB-UKA were performed for medial compartment OA by a single surgeon between August 2009 and April 2020. Among them, patients aged 65-74 years with more than two years of follow-up were enrolled. The patient-reported outcome measures (PROMs), including visual analog scale (VAS) score and Japanese Knee Osteoarthritis Measure (JKOM) score, were compared between both procedures preoperatively and at the last follow-up. The PROMs were compared between the groups by Kellgren-Lawrence (K-L) OA grades.
Seventy-three OWHTO and 37 MB-UKA patients were enrolled. No significant differences were found in the distribution of age, gender, follow-up period, body mass index, and Tegner activity scale between the two procedures. The postoperative PROMs in patients with K-L grade 4 were better after MB-UKA than OWHTO at the mean follow-up of 5 years. No significant difference was found in PROMs in patients with K-L grades 2 and 3.
ThePROMs after MB-UKA were superior to that after OWHTO in early elderly patients with severe OA. In particular, pain relief was better after MB-UKA than OWHTO with severe OA. Meanwhile, no significant difference in PROMs was found with moderate OA patients.
Level IVprospective cohort study.
许多国家都面临着人口老龄化的问题。然而，很少有研究直接比较内侧开放楔形胫骨高位截骨术（OWHTO）和单髁膝关节置换术（MB-UKA）在早期老年患者中的临床疗效。因此，我们旨在研究内侧间室骨关节炎（OA）患者中，具有相似人口统计学和 OA 严重程度的早期老年患者接受 OWHTO 和 MB-UKA 治疗后的临床结果。
2009 年 8 月至 2020 年 4 月，一位医生为 315 例内侧间室 OA 患者行 OWHTO，为 142 例内侧间室 OA 患者行 MB-UKA。其中，纳入了年龄在 65-74 岁、随访时间超过 2 年的患者。比较了两种手术方式的术前和末次随访时的患者报告结局指标（PROMs），包括视觉模拟评分（VAS）和日本膝关节骨关节炎评分（JKOM）。通过 Kellgren-Lawrence（K-L）OA 分级比较两组间的 PROMs。
纳入了 73 例 OWHTO 和 37 例 MB-UKA 患者。两种手术方式的年龄、性别、随访时间、体重指数和 Tegner 活动量表分布无显著差异。在平均随访 5 年后，K-L 分级为 4 级的患者中，MB-UKA 术后的 PROMs 优于 OWHTO。K-L 分级为 2 级和 3 级的患者的 PROMs 无显著差异。
对于严重 OA 的早期老年患者，MB-UKA 的 PROMs 优于 OWHTO。特别是对于严重 OA 患者，MB-UKA 的疼痛缓解效果优于 OWHTO。同时，对于中度 OA 患者，两种手术方式的 PROMs 无显著差异。
IV 级前瞻性队列研究。
