Scheele Christian B, Pietschmann Matthias F, Wagner Thomas C, Müller Peter E
Department of Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, Großhadern Campus, Ludwig Maximilians University, Marchioninistr. 15, Munich, 81377, Germany.
Department of Orthopedics and Sports Orthopedics, Klinikum Rechts Der Isar, Technical University Munich, Ismaninger Str. 22, Munich, 81675, Germany.
Arthroplasty. 2024 Sep 3;6(1):48. doi: 10.1186/s42836-024-00267-x.
UKA is a well-established treatment option for anteromedial osteoarthritis of the knee, resulting in superior functional outcomes but also higher revision rates than TKA. This study aimed to compare the outcomes of UKA, TKA, UKA converted to TKA using identical standard implants and revised TKA to support clinical decision-making.
In this study, we retrospectively examined 116 patients who underwent UKA, 77 patients who received TKA, 28 patients whose UKA was converted to TKA using identical standard implants, and 21 patients who had a one-stage revision of TKA. The mean age at operation was 66.5 years (39-90 years), with a mean BMI of 28.8 kg/m (17.4-58.8) and a mean follow-up period of four years (0.9-9.9 years). We assessed various PROMs, including Oxford Knee Score, UCLA score, KSS score, and a modified WOMAC-Score as well as patient satisfaction and ability to resume daily activities, work, and sports.
The highest patient satisfaction was seen in the UKA. All scores were significantly higher for UKA than for TKA, converted UKA, and revised TKA. None of the scores showed a significant inferiority of converted UKA to TKA. In the case of revision, two scores showed significantly better results for converted UKA than for revised TKA.
Our results indicated that patients initially treated with UKA did not have significantly worse functional outcomes after conversion to TKA, given the use of identical standard implants. This highlights the effectiveness of UKA as a therapeutic option with outcomes superior to those of primary TKA and the importance of a bone-sparing procedure. Conversely, revision TKA is linked to poorer functional outcomes compared to both primary arthroplasties.
单髁膝关节置换术（UKA）是治疗膝关节前内侧骨关节炎的一种成熟治疗选择，其功能预后良好，但翻修率高于全膝关节置换术（TKA）。本研究旨在比较UKA、TKA、使用相同标准植入物转为TKA的UKA以及翻修TKA的疗效，以支持临床决策。
在本研究中，我们回顾性分析了116例行UKA的患者、77例行TKA的患者、28例使用相同标准植入物由UKA转为TKA的患者以及21例行一期TKA翻修的患者。手术时的平均年龄为66.5岁（39 - 90岁），平均体重指数为28.8 kg/m²（17.4 - 58.8），平均随访期为4年（0.9 - 9.9年）。我们评估了各种患者报告结局指标（PROMs），包括牛津膝关节评分、加州大学洛杉矶分校（UCLA）评分、膝关节协会（KSS）评分以及改良的Western Ontario和McMaster大学骨关节炎指数（WOMAC）评分，以及患者满意度和恢复日常活动、工作及运动的能力。
UKA组患者满意度最高。UKA的所有评分均显著高于TKA、转为TKA的UKA以及翻修TKA。没有评分显示转为TKA的UKA明显劣于TKA。在翻修的情况下，有两个评分显示转为TKA的UKA比翻修TKA的结果明显更好。
我们的结果表明，在使用相同标准植入物的情况下，最初接受UKA治疗的患者转为TKA后，功能预后并没有显著变差。这突出了UKA作为一种治疗选择的有效性，其疗效优于初次TKA，也凸显了保留骨组织手术的重要性。相反，与两种初次关节置换术相比，翻修TKA的功能预后较差。
