Vaz Grégoire, Collignon Florian, Jeanbert Elodie, Galois Laurent, Sirveaux François, Roche Olivier, Fernandez Andrea
Centre Chirurgical Emile Gallé 49 rue Hermite, CHRU Nancy, 54000 Nancy, France.
Centre Chirurgical Emile Gallé 49 rue Hermite, CHRU Nancy, 54000 Nancy, France.
Orthop Traumatol Surg Res. 2025 Jun;111(4):104083. doi: 10.1016/j.otsr.2024.104083. Epub 2024 Dec 7.
In the literature, 80%-92% of patients are satisfied with their medial femorotibial unicompartmental knee arthroplasties (UKAs). These results are associated with a 10-year implant survival rates ranging from 94% to 98% in various studies. Such outcomes are generally reported after excluding patients with obesity, chronic anterior instability, frontal deformities, or preoperative knee flexion deformities exceeding 10 °. These contraindications remain controversial in the literature. The primary objective of this study was to compare the survival rates of implants used for medial femorotibial UKA performed under borderline indications with those of procedures performed under conventional indications and to identify the prognostic factors for revision surgery.
We hypothesized that the survival of medial femorotibial UKAs is not impacted by these contraindications.
This was a retrospective, single-center, observational, epidemiological study. All consenting patients who underwent medial femorotibial UKA between 2009 and 2015 were included. Patients who underwent other types of arthroplasties concurrently were excluded. The primary evaluation criterion was implant survival, which was characterized by no need for revision surgery. The borderline indications were defined as follows: obesity (Body Mass index BMI > 30), anterior cruciate ligament (ACL) deficiency, preoperative lower limb frontal deviation ≥10 °, or preoperative flexion deformity ≥10 °.
A total of 468 patients were included, and the average follow-up duration was 8.5 years [7.1; 10.3]. Among them, 270 (57.7%) underwent UKA under at least one borderline indication, whereas 198 (42.3%) underwent UKA under conventional indications. Forty revision surgeries were recorded, and the average time to revision surgery was 26 months. No statistically significant difference in survival was observed between patients with borderline indications and those with conventional indications. Multivariate analysis revealed that obesity (HR = 3.0 [1.5-5.7]) and ACL deficiency (HR = 3.5 [1.4-8.8]) significantly increased the risk of revision surgery.
This study revealed no significant difference in survival between UKAs performed under borderline versus conventional indications. Larger studies are needed to confirm these findings.
IV; retrospective observational study. Mots clés: genou, arthroplastie, obésité, ostéoarthrite, survie.
在文献中，80%-92%的患者对其内侧股骨胫骨单髁膝关节置换术（UKA）感到满意。在各项研究中，这些结果与10年植入物生存率在94%至98%之间相关。这些结果通常是在排除肥胖、慢性前交叉韧带不稳定、额状面畸形或术前膝关节屈曲畸形超过10°的患者后报告的。这些禁忌症在文献中仍存在争议。本研究的主要目的是比较在临界适应症下进行的内侧股骨胫骨UKA所用植入物的生存率与在传统适应症下进行的手术的生存率，并确定翻修手术的预后因素。
我们假设内侧股骨胫骨UKA的生存率不受这些禁忌症的影响。
这是一项回顾性、单中心、观察性、流行病学研究。纳入了2009年至2015年间所有接受内侧股骨胫骨UKA且同意参与的患者。同时接受其他类型关节置换术的患者被排除。主要评估标准是植入物生存率，其特征为无需翻修手术。临界适应症定义如下：肥胖（体重指数BMI>30）、前交叉韧带（ACL）缺陷、术前下肢额状面偏差≥10°或术前屈曲畸形≥10°。
共纳入468例患者，平均随访时间为8.5年[7.1；10.3]。其中，270例（57.7%）在至少一项临界适应症下接受了UKA，而198例（42.3%）在传统适应症下接受了UKA。记录了40例翻修手术，翻修手术的平均时间为26个月。在临界适应症患者和传统适应症患者之间未观察到生存率的统计学显著差异。多变量分析显示，肥胖（HR=3.0[1.5-5.7]）和ACL缺陷（HR=3.5[1.4-8.8]）显著增加了翻修手术的风险。
本研究显示，在临界适应症与传统适应症下进行的UKA之间，生存率无显著差异。需要更大规模的研究来证实这些发现。
IV级；回顾性观察研究。关键词：膝关节、关节置换术、肥胖、骨关节炎、生存率
