Møller Julie Kristine Steen, Bunyoz Kristine Ifigenia, Henkel Cecilie, Bredgaard Jensen Christian, Gromov Kirill, Troelsen Anders
Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Clinical Orthopaedic Research Hvidovre (CORH), Hvidovre, Denmark.
Clinical Academic Group: Research OsteoArthritis Denmark (CAG ROAD), Greater Copenhagen Health Science Partners, Copenhagen, Denmark.
Knee Surg Sports Traumatol Arthrosc. 2025 Apr;33(4):1345-1357. doi: 10.1002/ksa.12501. Epub 2024 Oct 23.
To investigate the impact of orthopaedic surgeons' arthroplasty distributions on patient-reported outcome measures (PROMs) following knee arthroplasty, thus addressing the gap in knowledge regarding the optimal distribution of arthroplasties.
2256 knee arthroplasties were included (total knee arthroplasty [TKA] or unicompartmental knee arthroplasty [UKA]). All were conducted at a single centre between August 2016 and August 2022 with a minimum of 1-year follow-up. The Oxford Knee Score (OKS), the Forgotten Joint Score (FJS) and the Activity and Participation Questionnaire (APQ) were assessed preoperatively, and at 3 and 12 months postoperatively. Patients were categorized based on the surgeons' yearly surgeries: (1) TKA only, (2) TKA+ <20% medial UKA, (3) TKA+ ≥20% medial UKA and (4) TKA+ ≥20% medial UKA + lateral UKA + patellofemoral UKA. Linear regression models adjusted for demographic variables and preoperative PROM scores were used to estimate changes in mean PROM scores.
Group 4 showed significantly higher improvements in PROM scores at 3 and 12 months compared to Group 1. In the 12-month adjusted analysis, Group 4 had 1.9 points (95% confidence interval [CI]: 1.0-2.8) higher OKS-, 7.0 points (95% CI: 3.9-10.2) higher FJS- and 8.3 points (95% CI: 4.8-11.8) higher APQ-change than Group 1. There were no significant differences between Groups 1 and 2, nor any clinically relevant differences between Groups 3 and 4. Additionally, the percentage of patients who achieved excellent OKS (>41) was significantly higher in Groups 3 + 4 compared to Groups 1 + 2 (p < 0.001).
Despite limitations, the findings of this study suggest that utilizing ≥20% medial UKA leads to greater postoperative improvements in PROM across all treated knee arthroplasty patients.
Level III.
探讨骨科医生的关节置换手术分布对膝关节置换术后患者报告结局指标（PROMs）的影响，从而填补关于关节置换最佳分布的知识空白。
纳入2256例膝关节置换手术（全膝关节置换术[TKA]或单髁膝关节置换术[UKA]）。所有手术均于2016年8月至2022年8月在单一中心进行，且至少随访1年。术前、术后3个月和12个月评估牛津膝关节评分（OKS）、遗忘关节评分（FJS）和活动与参与问卷（APQ）。患者根据外科医生每年的手术量进行分类：（1）仅行TKA，（2）TKA+内侧UKA占比<20%，（3）TKA+内侧UKA占比≥20%，（4）TKA+内侧UKA占比≥20%+外侧UKA+髌股关节UKA。采用针对人口统计学变量和术前PROM评分进行调整的线性回归模型来估计平均PROM评分的变化。
与第1组相比，第4组在术后3个月和12个月时PROM评分的改善显著更高。在12个月的调整分析中，第4组的OKS变化比第1组高1.9分（95%置信区间[CI]：1.0 - 2.8），FJS变化高7.0分（95%CI：3.9 - 10.2），APQ变化高8.3分（95%CI：4.8 - 11.8）。第1组和第2组之间无显著差异，第3组和第4组之间也无任何临床相关差异。此外，第3 + 4组中OKS评分达到优秀（>41）的患者百分比显著高于第1 + 2组（p < 0.001）。
尽管存在局限性，但本研究结果表明，对于所有接受治疗的膝关节置换患者，采用≥20%的内侧UKA可使术后PROM有更大改善。
三级。
