Bristol Medical School, University of Bristol, 5 Tyndall Avenue, Bristol BS8 1UD, UK.
Musculoskeletal Research Unit, Bristol Medical School, Southmead Hospital, University of Bristol, Bristol, United Kingdom.
Knee. 2024 Jun;48:63-75. doi: 10.1016/j.knee.2024.02.013. Epub 2024 Mar 22.
In order to assess the published validity of focal resurfacing of the knee, a systematic review and meta-analysis were conducted to (i) evaluate revision rates and implant survival of focal resurfacing of the knee; (ii) explore surgical complications; and (iii) evaluate patient reported clinical outcome measures.
PubMED, Cochrane Library and Medline databases were searched by 2 independent reviewers in February 2022 for prospective and retrospective cohort studies evaluating any of the following implant types: HemiCAP®, UniCAP®, Episealer® or BioBoly®. Data on incidence of revision, complications and various patient reported outcome measures, such as Knee Society Score (KSS) or Knee Injury and Osteoarthritis Outcome Score (KOOS) was sourced.
A total of 24 published studies were identified with a total of 1465 enrolled patients. A revision rate of 12.97% over a 5.9 year weighted mean follow-up period was observed across all implant types. However, in one series a Kaplan-Meir survival as high as 92.6% at a 10-year follow-up period was noted. A statistically significant improvement was documented across multiple subjective clinical outcomes scores, for example a mean 4.56 point improvement of the VAS (0-10) pain score. The Kellgren-Lawrence score was used to evaluate the radiological progression of osteoarthritis and showed a small significant reduction in all anatomical locations, hence not supporting the hypothesis that focal femoral implants can lead to the progression of osteoarthritis in the affected compartment. There was a low reported incidence of post-operative complications such as aseptic loosening or deep wound infection.
Focal femoral resurfacing appears to be a viable treatment option for focal symptomatic chondral lesions in patients beyond biological reconstruction, with low revision rates and high patient satisfaction especially at short and medium length follow-up.
为了评估膝关节局灶性表面置换术的已发表有效性，进行了系统评价和荟萃分析，以：（i）评估膝关节局灶性表面置换术的翻修率和植入物生存率；（ii）探索手术并发症；和（iii）评估患者报告的临床结果测量。
由 2 名独立审查员于 2022 年 2 月在 Pubmed、Cochrane Library 和 Medline 数据库中搜索了评估以下任何植入物类型的前瞻性和回顾性队列研究：HemiCAP®、UniCAP®、Episealer®或 BioBoly®。获取了有关翻修、并发症和各种患者报告结果测量（如膝关节协会评分（KSS）或膝关节损伤和骨关节炎结果评分（KOOS））的发生率的数据。
共确定了 24 项已发表的研究，共纳入了 1465 名患者。在所有植入物类型中，5.9 年加权平均随访期间的翻修率为 12.97%。然而，在一个系列中，10 年随访期间的 Kaplan-Meier 生存率高达 92.6%。多个主观临床结果评分记录了统计学上显著的改善，例如 VAS（0-10）疼痛评分平均提高了 4.56 分。Kellgren-Lawrence 评分用于评估骨关节炎的放射学进展，显示所有解剖部位的骨关节炎均有轻微但显著的减少，因此不支持局灶性股骨植入物会导致受累部位骨关节炎进展的假说。术后并发症的报告发生率较低，如无菌性松动或深部伤口感染。
在生物重建之外的患者中，局灶性股骨表面置换似乎是治疗局灶性症状性软骨病变的可行选择，其翻修率低，患者满意度高，尤其是在短中和中长度随访中。
