Scheele Christian B, Pietschmann Matthias F, Wagner Thomas C, Müller Peter E
Klink für Orthopädie und Unfallchirurgie, Muskuloskelettalen Universitätszentrum München (MUM), Ludwig-Maximilians-Universität, Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland.
Klinik und Poliklinik für Orthopädie und Sportorthopädie, Klinikum rechts an der Isar der Technischen Universität München, Ismaninger Str. 22, 81675, München, Deutschland.
Orthopadie (Heidelb). 2024 Mar;53(3):201-208. doi: 10.1007/s00132-024-04472-z. Epub 2024 Feb 13.
Unicompartmental knee arthroplasty (UKA), in addition to total knee arthroplasty (TKA), has been shown to be effective in the surgical treatment of knee osteoarthritis with appropriate patient selection. In clinical studies, it has demonstrated superior functional results with lower complication rates. In clinical practice, these advantages must be weighed against the disadvantage of an increased revision rate, especially in younger patients with sports and work activities.
The aim of this study was to compare the functional outcome as well as the time to return to daily activities, work, and sports after revision of UKA to TKA with those of primary UKA and primary TKA using a matched-pair analysis.
The study was based on a matched-pair analysis at two defined time points, always comparing 28 patients who underwent either revision of a UKA to a TKA, primary UKA, or primary TKA. Patients completed the Oxford Knee Score, UCLA score, Knee Society score, and WOMAC score during standardized follow-up. In addition, postoperative patient satisfaction and return to activities of daily living, work, and sports were recorded in a standardized manner, and a clinical examination was performed.
The four functional scores studied showed a common trend in favor of UKA, followed by primary TKA and revision TKA. The differences between converted UKA and primary TKA were not significant. However, at 3.2 years after the last surgery, the results of the converted UKA were significantly lower than those of the primary UKA. Return to work and sports tended to occur the earliest after UKA, followed by TKA and the revision group. All groups showed a tendency to engage in low-impact sports.
The functional results of revised UKA were significantly inferior to those of primary UKA based on a 3-year follow-up. Return to work, sports, and activities of daily living tended to take longer after revision than after primary implantation of either a UKA or a TKA.
除全膝关节置换术(TKA)外,单髁膝关节置换术(UKA)已被证明在对合适的患者进行选择后,对于膝关节骨关节炎的手术治疗是有效的。在临床研究中,它已显示出具有更好的功能结果以及更低的并发症发生率。在临床实践中,这些优势必须与翻修率增加的缺点相权衡,尤其是在从事体育活动和工作的年轻患者中。
本研究的目的是通过配对分析,比较UKA翻修为TKA后与初次UKA和初次TKA在功能结果以及恢复日常活动、工作和运动的时间方面的差异。
本研究基于在两个特定时间点的配对分析,始终比较28例接受UKA翻修为TKA、初次UKA或初次TKA的患者。患者在标准化随访期间完成牛津膝关节评分、加州大学洛杉矶分校(UCLA)评分、膝关节协会评分和西安大略和麦克马斯特大学骨关节炎指数(WOMAC)评分。此外,以标准化方式记录术后患者满意度以及恢复日常生活、工作和运动的情况,并进行临床检查。
所研究的四项功能评分显示出一个共同趋势,即有利于UKA,其次是初次TKA和翻修TKA。UKA翻修后与初次TKA之间的差异不显著。然而,在最后一次手术后3.2年,UKA翻修后的结果显著低于初次UKA。恢复工作和运动往往在UKA后最早出现,其次是TKA和翻修组。所有组都倾向于进行低强度运动。
基于3年的随访,UKA翻修后的功能结果明显低于初次UKA。翻修后恢复工作、运动和日常生活活动的时间往往比初次植入UKA或TKA后更长。