Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
Knee Surg Sports Traumatol Arthrosc. 2023 Nov;31(11):5180-5189. doi: 10.1007/s00167-023-07589-4. Epub 2023 Sep 30.
To compare patient-reported pain scores and assess the influence of neuropathy and co-morbidity, on knee pain following cemented and cementless medial unicompartmental knee replacement (UKR) 5 years after surgery.
In this longitudinal study, 262 cemented and 262 cementless Oxford UKR performed for the same indications and with the same techniques were recruited. Patients were reviewed at five years, evaluating patient-reported pain and association with clinical outcomes. Intermittent and Constant Osteoarthritis Pain (ICOAP), PainDETECT (PD), Charnley score, Oxford Knee Score (OKS) and American Knee Society Score (AKSS) were compared.
In both cohorts, intermittent pain was more common than constant pain (47% vs 21%). Cementless knees reported significantly less pain than cemented (ICOAP-Total 5/100 vs 11/100, p < 0.0001). A greater proportion of cementless knees experienced no pain at all (ICOAP = 0/100, 61% vs 43%, p < 0.0001) and 75% fewer experienced severe or extreme pain. Pain sub-scores in PD, OKS and AKSS follow this trend. Pain was unlikely to be neuropathic (PD positive: 5.26%), but patients reporting high levels of 'strongest' pain were three times more likely to be neuropathic. Patients with co-morbidities (Charnley C) experienced greater pain than those without (Charnley A+B) across all knee-specific scores, despite scores being knee specific.
Both cemented and cementless UKR in this study had substantially less pain than that reported in literature following TKR. Cementless UKR had significantly less pain than cemented UKR in all scores. Two-thirds of patients with a cementless UKR had no pain at all at 5 years, and pain experienced was most likely to be mild and intermittent with no patients in severe or extreme pain. Patients with cementless UKR that had higher levels of pain were more likely to have co-morbidity or evidence or neuropathic pain. It is unclear why cementless UKR have less pain than cemented; further study is necessary.
比较术后 5 年水泥固定和非水泥固定内侧单髁膝关节置换（UKR）患者报告的疼痛评分，并评估神经病变和合并症对膝关节疼痛的影响。
本纵向研究共纳入了 262 例因相同适应证和相同技术接受水泥固定和非水泥固定牛津 UKR 的患者。在术后 5 年时对患者进行评估，评估患者报告的疼痛情况及其与临床结果的关系。比较间歇性和持续性骨关节炎疼痛（ICOAP）、疼痛 DETECT（PD）、Charnley 评分、牛津膝关节评分（OKS）和美国膝关节协会评分（AKSS）。
在两个队列中，间歇性疼痛均比持续性疼痛更常见（47% vs 21%）。非水泥固定膝关节报告的疼痛明显少于水泥固定膝关节（ICOAP 总分为 5/100 分 vs 11/100 分，p<0.0001）。非水泥固定膝关节无疼痛的比例更高（ICOAP=0/100 分，61% vs 43%，p<0.0001），且严重或极度疼痛的比例低 75%。PD、OKS 和 AKSS 的疼痛亚评分也呈现出这种趋势。疼痛不太可能是神经病理性的（PD 阳性：5.26%），但报告“最强”疼痛程度较高的患者出现神经病理性疼痛的可能性是前者的三倍。有合并症（Charnley C）的患者在所有膝关节特定评分中疼痛均大于无合并症（Charnley A+B）的患者，尽管评分是膝关节特异性的。
在这项研究中，与 TKR 后文献报道的疼痛相比，水泥固定和非水泥固定 UKR 的疼痛都明显减轻。在所有评分中，非水泥固定 UKR 的疼痛均明显轻于水泥固定 UKR。在术后 5 年时，有三分之二的非水泥固定 UKR 患者完全没有疼痛，而且疼痛大多为轻度间歇性，无患者出现严重或极度疼痛。有非水泥固定 UKR 患者疼痛程度较高的更可能有合并症或神经病理性疼痛的证据。目前尚不清楚为什么非水泥固定 UKR 的疼痛比水泥固定 UKR 轻；需要进一步研究。
