Laoruengthana Artit, Reosanguanwong Kongpob, Rattanaprichavej Piti, Sahasoonthorn Kamonnop, Santisathaporn Nopparat, Pongpirul Krit
Department of Orthopaedics, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand.
Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Orthop Res Rev. 2024 Apr 10;16:103-110. doi: 10.2147/ORR.S444547. eCollection 2024.
Cruciate-retaining (CR) total knee arthroplasty (TKA) may provide better physiological knee kinematics, proprioception, and quadricep recovery than posterior-stabilized (PS) TKA. Therefore, we hypothesized that CR TKA with multimodal pain control may provide comparable postoperative pain and recovery as unicompartmental knee arthroplasty (UKA).
This study included patients with isolated medial compartment knee osteoarthritis who underwent CR TKA and UKA. TKA and UKA patients were propensity score-matched with age and body mass index (BMI) and compared using visual analog scales (VAS) for pain scores, total amount of morphine use (TMU), knee flexion angle, straight leg raise (SLR), independent ambulation, length of hospital stay (LOS), and costs during hospitalization.
After propensity score matching, 46 patients were included in the TKA and UKA groups, respectively, with no differences in demographic data. VAS at 6-72 h and TMU at 48 h after surgery were comparable between the groups. The knee flexion angle in the UKA group was significantly higher at 24 h (60.0° vs 46.6°; p<0.001) and 48 h (76.9° vs 69.1°; p = 0.021) than that in the TKA group. The SLR in the UKA group was significantly higher than that in the TKA group at 24-72 h. The UKA group ambulated significantly earlier (1.56 vs 2.13 days; p<0.001), had shorter LOS (3.68 vs 4.28 days; p<0.004) and incurred 12.43% lower costs when compared to the TKA group.
Patients who underwent CR TKA with multimodal pain management did not experience more postoperative pain or morphine use than those who underwent UKA. However, UKA patients seem to experienced faster recovery and shorter LOS than CR-TKA patients during the early postoperative course. Accordingly, UKA may be considered instead of TKA for patients who are good candidates for UKA and require expedited recovery.
保留交叉韧带（CR）的全膝关节置换术（TKA）可能比后稳定型（PS）TKA提供更好的膝关节生理运动学、本体感觉和股四头肌恢复。因此，我们假设采用多模式疼痛控制的CR TKA可能提供与单髁膝关节置换术（UKA）相当的术后疼痛和恢复情况。
本研究纳入了接受CR TKA和UKA的孤立性内侧间室膝关节骨关节炎患者。TKA和UKA患者根据年龄和体重指数（BMI）进行倾向评分匹配，并使用视觉模拟量表（VAS）评估疼痛评分、吗啡使用总量（TMU）、膝关节屈曲角度、直腿抬高（SLR）、独立行走能力、住院时间（LOS）以及住院费用，并进行比较。
倾向评分匹配后，TKA组和UKA组分别纳入46例患者，人口统计学数据无差异。两组术后6 - 72小时的VAS评分和术后48小时的TMU相当。UKA组在术后24小时（60.0°对46.6°；p<0.001）和48小时（76.9°对69.1°；p = 0.021）的膝关节屈曲角度显著高于TKA组。UKA组在术后24 - 72小时的SLR显著高于TKA组。与TKA组相比，UKA组患者行走明显更早（1.56天对2.13天；p<0.001），住院时间更短（3.68天对4.28天；p<0.004），住院费用降低12.43%。
采用多模式疼痛管理的CR TKA患者术后疼痛或吗啡使用量并不比UKA患者多。然而，在术后早期，UKA患者似乎比CR - TKA患者恢复更快，住院时间更短。因此，对于适合UKA且需要快速恢复的患者，可考虑采用UKA而非TKA。
