University of Hawai'I, John A Burns School of Medicine, 651 Ilalo Street, Honolulu, HI, 96813, USA.
Straub Medical Center, Bone and Joint Center, 888 South King Street, Honolulu, HI, 96813, USA.
Arch Orthop Trauma Surg. 2023 Nov;143(11):6791-6797. doi: 10.1007/s00402-023-04978-9. Epub 2023 Jul 7.
The presence of significant patellofemoral arthritis (PFA) is still considered a contraindication for unicondylar knee arthroplasty (UKA) by many surgeons. The purpose of this study was to determine if the presence of severe PFA at the time of UKA compromised early (< 6 months) post-operative knee range of motion or functional outcomes.
This retrospective review evaluated unilateral and bilateral UKA (323 patients; 418 knees) between 2015 and 2019. Procedures were grouped by degree of PFA present at the time of surgery, including mild PFA (Group 1; N = 266), moderate to severe PFA (Group 2; N = 101), and severe PFA with lateral compartment bone-on-bone contact (Group 3; N = 51). Knee range of motion and Knee Society Knee (KSS-K) and Function (KSS-F) scores were collected both before and at 6 months following surgery. Group differences were evaluated with Kruskal-Wallis and Chi-square tests for continuous and categorical variables, respectively. Univariate and multivariable logistic regressions were performed to determine influential variables associated with post-operative knee flexion being ≤ 120° and presented as odds ratios (OR) and 95% confidence intervals (CI).
Pre-operative flexion was lowest in Group 3 (p = 0.010) with 17.6% of knees having flexion ≤ 120°. Post-operative flexion was lowest in Group 3 (119.1° ± 8.4°, p = 0.003) with 19.6% knees having flexion ≤ 120° compared to 9.8% and 8.9% in Groups 1 and 2, respectively. No significant difference in KSS-F following surgery was found; all three groups demonstrated similar clinical improvement. Increased age (OR 1.089, CI 1.036-1.144; p = 0.001) and body mass index (OR 1.082, CI 1.006-1.163; p = 0.034) were found to be associated with post-operative knee flexion ≤ 120°, while high pre-operative flexion (OR 0.949, CI 0.921-0.978; p = 0.001) was found to be inversely associated with poor knee flexion following surgery.
Patients with severe PFA demonstrate similar clinical improvement following UKA at 6 months as patients with less severe PFA.
许多外科医生认为，存在明显的髌股关节炎（PFA）仍然是单髁膝关节置换术（UKA）的禁忌症。本研究旨在确定 UKA 时存在严重的 PFA 是否会影响术后 6 个月内（<6 个月）膝关节活动范围或功能结果。
本回顾性研究评估了 2015 年至 2019 年间的单侧和双侧 UKA（323 例患者；418 膝）。根据手术时 PFA 的严重程度对手术进行分组，包括轻度 PFA（第 1 组；N=266）、中重度 PFA（第 2 组；N=101）和严重 PFA 合并外侧间室骨对骨接触（第 3 组；N=51）。收集术前和术后 6 个月的膝关节活动范围和膝关节学会膝关节（KSS-K）和功能（KSS-F）评分。分别采用 Kruskal-Wallis 和卡方检验评估组间差异，用于连续和分类变量。采用单变量和多变量逻辑回归分析确定与术后膝关节屈曲度≤120°相关的影响因素，并以比值比（OR）和 95%置信区间（CI）表示。
第 3 组术前膝关节屈曲度最低（p=0.010），17.6%的膝关节屈曲度≤120°。术后膝关节屈曲度最低的是第 3 组（119.1°±8.4°，p=0.003），与第 1 组和第 2 组相比，有 19.6%和 8.9%的膝关节屈曲度≤120°。术后 KSS-F 无显著差异；三组均表现出相似的临床改善。年龄增加（OR 1.089，CI 1.036-1.144；p=0.001）和体重指数（OR 1.082，CI 1.006-1.163；p=0.034）与术后膝关节屈曲度≤120°相关，而术前膝关节屈曲度较高（OR 0.949，CI 0.921-0.978；p=0.001）与术后膝关节屈曲度不良呈负相关。
与 PFA 程度较轻的患者相比，PFA 严重的患者在 UKA 后 6 个月时也能获得相似的临床改善。
