Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Oxford, United Kingdom; Barts Bone & Joint Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.
Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Oxford, United Kingdom; Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Southmead Hospital, Westbury-on-Trym, Bristol, United Kingdom.
J Arthroplasty. 2024 Aug;39(8):2007-2013. doi: 10.1016/j.arth.2024.02.019. Epub 2024 Feb 12.
Periprosthetic fractures are rare but serious complications of unicompartmental knee arthroplasty (UKA). Although cementless UKA has a lower risk of loosening than cemented, there are concerns that tibial fracture risk may be higher given the reliance on interference fit for primary stability. The risk of fracture and the effect of surgical fixation are currently unknown. We compared the periprosthetic fracture rate following cemented and cementless UKA surgery.
A total of 14,122 medial mobile-bearing UKAs (7,061 cemented and 7,061 cementless) from the National Joint Registry and Hospital Episodes Statistics database were propensity score-matched. Cumulative fracture rates were calculated and Cox regressions were used to compare fixation groups.
The three-month periprosthetic fracture rates were similar (P = .80), being 0.10% in the cemented group and 0.11% in the cementless group. The fracture rates were highest during the first three months postoperatively, but then decreased and remained constant between one and 10 years after surgery. The one-year cumulative fracture rates were 0.2% (confidence interval [CI]: 0.1 to 0.3) for cemented and 0.2% (CI: 0.1 to 0.3) for cementless cases. The 10-year cumulative fracture rates were 0.8% (CI: 0.2 to 1.3) and 0.8% (CI: 0.3 to 1.3), respectively. The hazard ratio during the whole study period was 1.06 (CI: 0.64 to 1.77; P = .79).
The periprosthetic fracture rate following mobile bearing UKA surgery is low, being about 1% at 10 years. There were no significant differences in fracture rates between cemented and cementless implants after matching. We surmise that surgeons are aware of the higher theoretical risk of early fracture with cementless components and take care with tibial preparation.
III.
假体周围骨折是单髁膝关节置换术（UKA）少见但严重的并发症。虽然非骨水泥 UKA 的松动风险低于骨水泥固定，但由于其主要稳定性依赖于干扰配合，有人担心胫骨骨折风险可能更高。骨折风险和手术固定效果目前尚不清楚。我们比较了骨水泥固定和非骨水泥固定 UKA 手术后的假体周围骨折发生率。
从国家关节登记处和医院发病统计数据库中，共纳入 14122 例内侧活动衬垫 UKA（骨水泥固定 7061 例，非骨水泥固定 7061 例），采用倾向评分匹配。计算累积骨折发生率，并采用 Cox 回归比较固定组。
术后 3 个月假体周围骨折发生率相似（P=0.80），骨水泥组为 0.10%，非骨水泥组为 0.11%。骨折发生率在术后 3 个月内最高，但随后下降，并在术后 1 至 10 年内保持稳定。骨水泥固定组和非骨水泥固定组的 1 年累积骨折发生率分别为 0.2%（置信区间[CI]：0.1 至 0.3）和 0.2%（CI：0.1 至 0.3）。10 年累积骨折发生率分别为 0.8%（CI：0.2 至 1.3）和 0.8%（CI：0.3 至 1.3）。整个研究期间的危险比为 1.06（CI：0.64 至 1.77；P=0.79）。
活动衬垫 UKA 手术后的假体周围骨折发生率较低，10 年时约为 1%。匹配后，骨水泥固定和非骨水泥固定假体的骨折发生率无显著差异。我们推测，外科医生意识到非骨水泥固定部件早期骨折的理论风险较高，因此在胫骨准备时会格外小心。
III 级。
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