Jiang Y K, Zhang Q D, Huang C, Ding R, Liu Z H, Cheng L M, Wang W G, Guo W S
Department of Orthopedics, China-Japan Friendship Hospital, Beijing 100029, China.
Zhonghua Yi Xue Za Zhi. 2024 Jan 30;104(5):344-349. doi: 10.3760/cma.j.cn112137-20230910-00435.
To investigate the impact of changes in the posterior tibial slope (PTS) in Oxford unicompartmental knee arthroplasty (OUKA) on the mid-term clinical outcomes of postoperative patients. This study was a follow-up study. The data of 135 patients (150 knees) who underwent OUKA at the China-Japan Friendship Hospital from January 2012 to January 2013 were analyzed retrospectively. The patients were followed-up for at least ten years. According to the changes in PTS of the medial tibial plateau before and after surgery, patients were divided into three groups: group A (PTS decreased by more than 5°), group B (PTS changed by 5° or less), and group C (PTS increased by more than 5°). The Knee Society Clinical Score (KSS-C), Knee Society Functional Score (KSS-F), Oxford Knee Score (OKS), Forgotten Joint Score (FJS), and knee range of motion (ROM) among the three groups were compared at the last follow-up. Prior to the final follow-up assessment, six patients expired, and an additional nine patients were lost to follow-up. A total of 120 patients (135 knees) were enrolled in this study (30 males and 90 females). The mean age was (66.29±8.62) years, and the follow-up time was (10.54±0.72) years. Group A consisted of 32 patients (34 knees), group B comprised 77 patients (90 knees), and group C included 11 patients (11 knees). One knee in group A suffered prosthesis loosening, and two knees in group C experienced postoperative bearing dislocation, one knee encountered bearing fragmentation. The incidence of postoperative complications differed significantly among the three groups (<0.05). The preoperative OKS was (33.91±6.59) points, KSS-F was (43.46±8.99) points, KSS-C was (41.05±5.70) points and ROM was 115.23°±13.53°; after the surgery, they changed to (18.82±7.01) points, (81.51±7.34) points, (82.64±7.94) points, and 119.07°±8.62°, respectively, and all the differences were statistically significant (all <0.001). In terms of postoperative outcomes, group A had an OKS of (21.44±8.46) points and a FJS of (63.83±11.40) points, group B had an OKS of (17.07±5.81) points and a FJS of (70.49±12.45) points, group C had an OKS of (25.09±5.07) points and a FJS score of (59.48±10.09) points; the differences among the three groups were all statistically significant (all <0.05), but there were no significant differences in the postoperative KSS scores and ROM among the three groups (all >0.05). After OUKA, better mid-term clinical outcomes are achieved when ΔPTS is<5°. Although the recommended central value for PTS in OUKA is 7° according to Oxford, it should be individualized, and it is recommended to consider the preoperative angle, with a change of less than 5° before and after surgery.
探讨牛津单髁膝关节置换术（OUKA）中胫骨后倾坡度（PTS）的变化对术后患者中期临床疗效的影响。本研究为随访研究。回顾性分析2012年1月至2013年1月在中国-日本友好医院接受OUKA手术的135例患者（150膝）的数据。对患者进行至少十年的随访。根据手术前后内侧胫骨平台PTS的变化，将患者分为三组：A组（PTS下降超过5°）、B组（PTS变化5°或更小）和C组（PTS增加超过5°）。在末次随访时比较三组的膝关节协会临床评分（KSS-C）、膝关节协会功能评分（KSS-F）、牛津膝关节评分（OKS）、遗忘关节评分（FJS）和膝关节活动范围（ROM）。在最终随访评估前，6例患者死亡，另有9例患者失访。本研究共纳入120例患者（135膝）（男性30例，女性90例）。平均年龄为（66.29±8.62）岁，随访时间为（10.54±0.72）年。A组32例患者（34膝），B组77例患者（90膝），C组11例患者（11膝）。A组1膝发生假体松动，C组2膝发生术后假体脱位，1膝发生假体碎裂。三组术后并发症发生率差异有统计学意义（<0.05）。术前OKS为（33.91±6.59）分，KSS-F为（43.46±8.99）分，KSS-C为（41.05±5.70）分，ROM为115.23°±13.53°；术后分别变为（18.82±7.01）分、（81.51±7.34）分、（82.64±7.94）分和119.07°±8.62°，所有差异均有统计学意义（均<0.001）。术后A组OKS为（21.44±8.46）分，FJS为（63.83±11.40）分；B组OKS为（17.07±5.81）分，FJS为（70.49±12.45）分；C组OKS为（25.09±5.07）分，FJS评分为（59.48±10.09）分；三组间差异均有统计学意义（均<0.05），但三组术后KSS评分和ROM差异无统计学意义（均>0.05）。OUKA术后，当ΔPTS<5°时可获得更好的中期临床疗效。尽管根据牛津标准，OUKA中PTS的推荐中心值为7°，但应个体化，建议考虑术前角度，手术前后变化小于5°。
