Callan Kylie T, Smith Eric, Karasavvidis Theofilos, Wang Dean
Department of Orthopaedic Surgery, University of California-Irvine Health, Orange, California, USA.
Orthop J Sports Med. 2024 Jul 31;12(7):23259671241257818. doi: 10.1177/23259671241257818. eCollection 2024 Jul.
While unicompartmental knee arthroplasty (UKA) and osteotomy procedures are commonly used to treat knee osteoarthritis, the differences in complication profiles between procedures are still poorly understood.
PURPOSE/HYPOTHESIS: The purpose of this study was to assess the trends and complication rates of UKA and periarticular knee osteotomy for knee osteoarthritis among newly trained surgeons by using the American Board of Orthopaedic Surgery (ABOS) Part II Oral Examination Case List database. It was hypothesized that more adult reconstruction fellowship-trained surgeons would perform UKA, while more sports medicine fellowship-trained surgeons would perform osteotomy, and that both procedures would have low rates of complications.
Cross-sectional study; Level of evidence, 3.
The ABOS database was queried for patients who underwent UKA, high tibial osteotomy, and distal femoral osteotomy procedures in examination years 2011 to 2021. Patient characteristics, surgeon fellowship training history, surgeon-reported postoperative complications, and readmission and reoperation rates were recorded. Comparisons between the UKA and osteotomy groups were performed using independent tests and chi-square tests.
There were 2524 patients in the UKA group and 270 patients in the osteotomy group. The majority of newly trained surgeons performing UKA (70.5%) had fellowship training in adult reconstruction, while the majority of those performing osteotomy (57.8%) had fellowship training in sports medicine ( < .001). The incidence of UKA and osteotomy increased during the study period (18.8 UKAs and 1.8 osteotomies performed per 10,000 cases in 2011 vs 39.5 UKAs and 4.2 osteotomies performed per 10,000 cases in 2021). Rates were significantly higher for osteotomy compared with UKA regarding anesthetic complications (2.2% vs 0.6%; = .015), surgical complications (23.7% vs 7.3%; < .001), reoperation (5.2% vs 1.9%; = .002), and infection (6.7% vs 1.4%; < .001). There were no significant differences in rates of medical complication, readmission, deep vein thrombosis, pulmonary embolism, or stiffness/arthrofibrosis.
Among newly trained surgeons taking the ABOS Part II Oral Examination, the incidence of UKA and periarticular knee osteotomy increased over the past decade. Compared with UKA, complication rates were higher after osteotomy, with an overall surgical complication rate of 23.7%.
虽然单髁膝关节置换术（UKA）和截骨术常用于治疗膝关节骨关节炎，但两种手术并发症情况的差异仍了解不足。
目的/假设：本研究的目的是通过使用美国骨科医师协会（ABOS）第二部分口试病例清单数据库，评估新培训外科医生中UKA和膝关节周围截骨术治疗膝关节骨关节炎的趋势和并发症发生率。假设接受成人重建专科培训的外科医生会更多地进行UKA手术，而接受运动医学专科培训的外科医生会更多地进行截骨术，并且两种手术的并发症发生率都较低。
横断面研究；证据等级，3级。
查询ABOS数据库中2011年至2021年检查年份接受UKA、高位胫骨截骨术和股骨远端截骨术的患者。记录患者特征、外科医生专科培训史、外科医生报告的术后并发症以及再入院和再次手术率。使用独立t检验和卡方检验对UKA组和截骨术组进行比较。
UKA组有2524例患者，截骨术组有270例患者。进行UKA手术的新培训外科医生大多数（70.5%）接受过成人重建专科培训，而进行截骨术的大多数（57.8%）接受过运动医学专科培训（P <.001）。在研究期间，UKA和截骨术的发生率均有所增加（2011年每10000例中有18.8例UKA和1.8例截骨术，2021年每10000例中有39.5例UKA和4.2例截骨术）。截骨术的麻醉并发症发生率（2.2%对0.6%；P =.015）、手术并发症发生率（23.7%对7.3%；P <.001）、再次手术率（5.2%对1.9%；P =.002）和感染率（6.7%对1.4%；P <.001）均显著高于UKA。在医疗并发症、再入院率、深静脉血栓形成、肺栓塞或僵硬/关节纤维性变发生率方面无显著差异。
在参加ABOS第二部分口试的新培训外科医生中，过去十年UKA和膝关节周围截骨术的发生率有所增加。与UKA相比，截骨术后并发症发生率更高，总体手术并发症发生率为23.7%。
