Department of Orthopaedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark.
J Arthroplasty. 2025 Jan;40(1):22-27.e1. doi: 10.1016/j.arth.2024.07.005. Epub 2024 Jul 11.
In the past, the utilization of lateral unicompartmental knee arthroplasty (UKA) has been limited at national levels, despite the fact that an estimated 10% of patients who have an indication for arthroplasty, present with isolated lateral compartment osteoarthritis (OA). Units dedicated to UKA have reported good outcomes. Identifying patients for the procedure has been less clear, and the procedure has been perceived to be technically more demanding than medial UKA. This may result in a reluctance to start a lateral UKA practice and challenge the early phase. Therefore, this paper aimed to present the outcomes and learning curve when starting up a lateral UKA practice, as this theme remains unelucidated.
There were 85 primary fixed-bearing lateral UKAs, with a minimum of 1-year follow-up, performed between 2016 and 2022 by 2 arthroplasty surgeons with existing UKA practices. The indications were primary (n = 79) or post-traumatic (n = 6) OA. Patient-reported outcome measures (PROMs) were assessed at 3, 12, and 24 months. A cumulative sum (CUSUM) analysis was used to evaluate surgical duration and the 12-month Oxford Knee Score (OKS).
Median (interquartile range) 12-month OKS, activity and participation questionnaire, and Forgotten Joint Score (FJS) were 43 (37.5 to 46), 78 (42.5 to 98.5), and 72 (55 to 90), respectively. The OKS outcomes did not reveal adverse effects from the learning curve. A performance shift in surgical duration was observed around case 33. Kaplan-Meier implant survival reached 95.4% at 7 years for the endpoint "implant revision" and 93.5% for "implant revision or implant addition."
Starting up a lateral UKA practice is safe and efficient for surgeons who have prior medial UKA experience, provided strict adherence to indications. While surgical duration indicated a learning curve over approximately 33 cases, PROMs remained stable, suggesting proficient outcomes irrespective of the learning curve.
尽管有研究估计，10%需要接受关节置换术的患者存在孤立的外侧间室骨关节炎（OA），但在过去，外侧单髁膝关节置换术（UKA）的应用在全国范围内受到限制。专门开展 UKA 的单位报告了良好的结果。然而，对于哪些患者适合进行该手术，目前还不是很明确，而且人们普遍认为外侧 UKA 的技术要求比内侧 UKA 更高。这可能导致一些医生不愿意开展外侧 UKA 手术，也可能对早期阶段构成挑战。因此，本文旨在介绍开展外侧 UKA 手术的经验和学习曲线，因为这一主题尚未得到充分阐述。
2016 年至 2022 年间，由 2 名具有 UKA 手术经验的关节置换外科医生对 85 例初次固定衬垫外侧 UKA 患者进行了手术治疗，所有患者均获得了至少 1 年的随访。适应证为原发性（n=79）或创伤后（n=6）OA。在术后 3、12 和 24 个月时，采用患者报告的结局测量（PROMs）进行评估。采用累积和（CUSUM）分析评估手术时间和 12 个月时的牛津膝关节评分（OKS）。
中位（四分位距）12 个月时的 OKS、活动和参与问卷评分和遗忘关节评分（FJS）分别为 43（37.5 至 46）、78（42.5 至 98.5）和 72（55 至 90）。OKS 评分结果未显示学习曲线带来的不良影响。手术时间的变化发生在第 33 例左右。Kaplan-Meier 植入物生存率在 7 年时达到“植入物翻修”终点为 95.4%，达到“植入物翻修或添加”终点为 93.5%。
对于具有内侧 UKA 经验的外科医生来说，开展外侧 UKA 手术是安全且高效的，前提是严格遵守适应证。虽然手术时间表明存在大约 33 例左右的学习曲线，但 PROMs 保持稳定，这表明无论是否存在学习曲线，手术效果都很出色。
