Orthopedics and Traumatology Center Santa Fe & Rafaela, Argentina; Orthopedic Surgery Service Sanatorio Mayo, Santa Fe, Argentina.
Orthopedics and Traumatology Center Santa Fe & Rafaela, Argentina; Orthopedic Surgery Service Sanatorio Mayo, Santa Fe, Argentina.
J ISAKOS. 2024 Aug;9(4):549-556. doi: 10.1016/j.jisako.2024.04.003. Epub 2024 Apr 6.
Associated patellofemoral joint osteoarthritis (APFJ-OA) has typically been considered a contraindication for unicompartmental knee arthroplasty (UKA) in the treatment of femorotibial joint osteoarthritis. However, this contraindication is being challenged. The aim of this study was to assess clinical and functional outcomes, complications, and implant survival in medial or lateral UKA, regardless of clinical symptoms or radiographic signs of APFJ-OA.
This retrospective, comparative study included patients treated with medial or lateral UKA regardless of preoperative symptoms or signs of APFJ-OA, with a minimum 2-year follow-up. Intraoperatively, knees were subdivided based on APFJ-OA grade, according to the Outerbridge classification. Clinical and functional outcomes were analyzed using the 2011 Knee Society Score (KSS) at the last follow-up control. APFJ-OA was treated systematically, in a tailored, stepwise fashion according to its severity. Complications and implant survival rates were evaluated. Two-sided paired T-test, ANOVA, and Kruskal-Wallis tests were used with a significance level of 5%.
Finally, 110 UKAs were assessed 81 (73.6%) medial and 29 (26.4%) laterals. The average follow-up was 6 years (2-19.5). According to Outerbridge, 22 knees (20%) were in grade 2, 59 (53.6%) were in grade 3, and 29 (26.4%) were in grade 4. All three groups showed a statistically significant increase in KSS scores and range of motion. There were no significant differences in clinical KSS improvement and flexion contracture between Outerbridge groups (average 35.7 and -4.9, respectively). Group 3 showed statistically significant improvement in functional KSS when compared to group 2 (68.8 vs 61.2). In maximum flexion, groups 3 and 4 did significantly better than group 2 (20° vs 15°). Three prostheses (2.7%) needed revision after 7, 8.6, and 12 years due to aseptic tibial loosening. Implant survival was 100% at 5 (64 of 64), 97% at 7 (30 of 31), 93% at 9 (14 of 15), and 89% at 12 years, respectively (8 of 9).
Clinical and functional results, complications, and survival of medial or lateral UKA were not negatively affected by APFJ-OA assessed intraoperatively using the Outerbridge classification after an average follow-up of 6 years. We consider that APFJ-OA is not a contraindication for UKA when treated systematically according to its severity.
IV.
髌股关节骨关节炎（APFJ-OA）通常被认为是治疗股胫关节骨关节炎时行单髁膝关节置换术（UKA）的禁忌症。然而，这种禁忌症正受到挑战。本研究的目的是评估内侧或外侧 UKA 的临床和功能结果、并发症和假体生存率，无论髌股关节的临床症状或放射学迹象如何。
本回顾性、对照研究纳入了无论术前是否存在髌股关节症状或体征，且至少随访 2 年的行内侧或外侧 UKA 的患者。术中根据Outerbridge 分级对髌股关节 OA 进行分级。末次随访时采用 2011 年膝关节协会评分（KSS）评估临床和功能结果。APFJ-OA 根据其严重程度进行系统、逐步的治疗。评估并发症和假体生存率。采用双侧配对 T 检验、方差分析和 Kruskal-Wallis 检验，显著性水平为 5%。
最终，110 例 UKA 被评估，其中 81 例（73.6%）为内侧，29 例（26.4%）为外侧。平均随访时间为 6 年（2-19.5 年）。根据 Outerbridge，22 例（20%）为 2 级，59 例（53.6%）为 3 级，29 例（26.4%）为 4 级。三组 KSS 评分和活动范围均有显著增加。Outerbridge 组之间的临床 KSS 改善和屈曲挛缩无显著差异（平均分别为 35.7 和-4.9）。与组 2 相比，组 3 的功能 KSS 有统计学显著改善（68.8 比 61.2）。最大屈曲度方面，组 3 和组 4 明显优于组 2（分别为 20°和 15°）。3 例（2.7%）假体在 7、8.6 和 12 年后因胫骨无菌性松动而需要翻修。5 年（64/64）、7 年（30/31）、9 年（14/15）和 12 年（8/9）的假体生存率分别为 100%、97%、93%和 89%。
在平均随访 6 年后，使用 Outerbridge 分级评估髌股关节的情况下，内侧或外侧 UKA 的临床和功能结果、并发症和生存率不受髌股关节 OA 的影响。我们认为，根据髌股关节 OA 的严重程度进行系统治疗后，髌股关节 OA 不是 UKA 的禁忌症。
IV。
