Ma Jun, Si Haibo, Zeng Yi, Huang Qiang, Shen Bin
Department of Orthopedic Surgery/Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2024 Sep 15;38(9):1029-1034. doi: 10.7507/1002-1892.202405056.
Unicompartmental knee arthroplasty (UKA) has a long history and has many advantages in some aspects over total knee arthroplasty (TKA) for patients with suitable indications, but it has not been established as a treatment at the same level with TKA. Therefore, 80 members of the British Association for Surgery of the Knee (BASK) and the European Knee Society (EKS) were invited to attend a joint meeting with the aim of creating an evidence-based consensus statement on UKA, in London, UK (December 2019). A formal consensus process was undertaken at the meeting incorporating a multiple round Delphi exercise, with group discussion of areas of agreement and disagreement between rounds. Five consensus statements were issued: ① UKA should be offered as a successful alternative to TKA in patients undergoing arthroplasty who meet agreed indications. ② When consenting a patient for UKA, information including the benefits and risks that are specific to UKA, should be tailored to and discussed with the individual patient. ③ Evidence suggests that surgeons should avoid low-volume use of UKA to optimise outcomes for their patients. ④ Surgeons should use the contemporary evidence-based indications and contraindications for medial UKA. ⑤ Knee arthroplasty surgeons should have exposure to and training in UKA. On the basis of full study of the consensus, combined with the Expert Consensus on Perioperative Management of Unicompartmental Knee Arthroplasty in China in 2020, this paper elaborates the meaning of the final evidence-based consensus for clinicians' reference.
单髁膝关节置换术(UKA)历史悠久,对于有合适适应症的患者,在某些方面比全膝关节置换术(TKA)有诸多优势,但尚未被确立为与TKA处于同一水平的治疗方法。因此,英国膝关节外科学会(BASK)和欧洲膝关节学会(EKS)的80名成员受邀参加了一次联合会议,目的是就UKA制定一份基于证据的共识声明,会议于2019年12月在英国伦敦举行。会议采用了正式的共识达成过程,包括多轮德尔菲法,并在各轮之间对达成一致和存在分歧的领域进行小组讨论。发布了五项共识声明:①对于符合商定适应症的接受关节置换术的患者,UKA应作为TKA的一种成功替代方案提供。②在为患者进行UKA手术同意时,应根据个体患者情况定制并讨论包括UKA特有的益处和风险在内的信息。③有证据表明,外科医生应避免低手术量地使用UKA,以优化患者的治疗效果。④外科医生应使用当代基于证据的内侧UKA适应症和禁忌症。⑤膝关节置换外科医生应接触并接受UKA方面的培训。在充分研究该共识的基础上,结合2020年中国单髁膝关节置换术围手术期管理专家共识,本文阐述了最终基于证据的共识对临床医生的参考意义。