Newcastle Upon Tyne NHS Trust, Freeman Hospital, Freeman Road, Newcastle Upon Tyne, UK.
School of Medicine, Keele University, Newcastle-under-Lyme, UK.
Arch Orthop Trauma Surg. 2024 Jan;144(1):23-30. doi: 10.1007/s00402-023-05010-w. Epub 2023 Aug 10.
Unicompartmental knee replacement (UKR) is an effective surgical strategy in patients with isolated medial or lateral compartment osteoarthritis. Study aims were to (1) describe the epidemiology of patients undergoing revision of UKR to a hinge knee replacement (HKR); (2) identify factors influencing time to revision; (3) evaluate HKR survival.
An analysis of National Joint Registry data was undertaken, exploring revision of UKR to HKR between 2007 and April 2021. Descriptive analysis of eligible patients and Cox Regression to identify key determinants of time to revision were performed. Failure of HKR post-revision was assessed using survival analysis.
111 patients underwent revision of UKR to HKR. Median age at revision was 70 years and most common indications were instability (n = 42) and infection (n = 22). The most common implant was a rotating HKR. Significant independent factors associated with earlier revision were periprosthetic fracture (p = 0.03) and malalignment (p = 0.03). Progressive osteoarthritis (p = 0.01) and higher ASA grades (3: p = 0.01, 4: p < 0.01) delayed time to revision; patient sex and age were not significant factors. Ten patients required subsequent re-revision; median age at re-revision was 61 years. HKR revised from UKR had an 89.3% revision-free risk at 5 years. Male sex (p < 0.01) and younger age (p < 0.01) were associated with re-revision.
Factors associated with time to revision may be used to counsel patients prior to UKR. The survivorship of the HKR of 89.3% at 5 years is concerning and careful consideration should be given when using this level of constraint when revising UKR in younger or male patients.
单髁膝关节置换术（UKR）是治疗内侧或外侧间室骨关节炎的有效手术策略。本研究的目的是：（1）描述接受铰链膝关节置换术（HKR）翻修的 UKR 患者的流行病学特征；（2）确定影响翻修时间的因素；（3）评估 HKR 的生存率。
对国家关节登记处的数据进行了分析，研究了 2007 年至 2021 年 4 月间 UKR 翻修为 HKR 的情况。对符合条件的患者进行描述性分析，并采用 Cox 回归分析确定翻修时间的关键决定因素。通过生存分析评估 HKR 翻修后的失败情况。
111 例患者接受 UKR 翻修为 HKR。翻修时的中位年龄为 70 岁，最常见的适应证为不稳定（n=42）和感染（n=22）。最常见的植入物是旋转 HKR。与更早翻修相关的显著独立因素包括假体周围骨折（p=0.03）和对线不良（p=0.03）。进展性骨关节炎（p=0.01）和较高的 ASA 分级（3：p=0.01，4：p<0.01）延迟了翻修时间；患者性别和年龄不是显著因素。10 例患者需要再次翻修；再次翻修时的中位年龄为 61 岁。从 UKR 翻修为 HKR 的患者在 5 年内的无翻修风险为 89.3%。男性（p<0.01）和年龄较小（p<0.01）与再次翻修相关。
与翻修时间相关的因素可用于 UKR 前对患者进行咨询。5 年内 HKR 的生存率为 89.3%，令人担忧，在对年轻或男性患者的 UKR 进行翻修时，应慎重考虑使用这种程度的限制。
