采用活动轴承装置的外侧单髁膝关节置换失败后的翻修手术：一项回顾性非设计病例系列研究
Revision surgery after failure of lateral unicompartmental knee replacement with a mobile-bearing device: a retrospective non -designer case-series.
作者信息
Hariri Mustafa, Freytag Jakob, Koch Kevin-Arno, Mick Paul, Nees Timo, Knappe Kevin, Renkawitz Tobias, Walker Tilman
机构信息
Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.
出版信息
Arch Orthop Trauma Surg. 2025 Mar 21;145(1):204. doi: 10.1007/s00402-025-05822-y.
INTRODUCTION
Failure of lateral unicompartmental knee replacement (UKR) with a mobile-bearing (MB) device often occurs due to bearing dislocation. The effectiveness of various treatment options for revision surgery is not clear. Therefore, the purpose of this study was to report on the failure modes in lateral MB-UKR, as well as the results of different revision strategies.
MATERIALS AND METHODS
Patients who experienced failure of lateral MB-UKR and required revision surgery at a single-center between 2008 and 2020 were included in this retrospective study. The aim of the study was to report the reasons for failure and to document all treatment strategies employed. Survivorship analysis was conducted using the Kaplan-Meier estimator, with the endpoint defined as 're-revision for any reason'. Survival rates among various treatment strategies were compared using the log-rank test.
RESULTS
A total of 13 patients were included in the study, with a mean follow-up (FU) period of 94.7 ± 36.4 months. The reasons for failure included bearing dislocation in 69.2%, progression of osteoarthritis (OA) in 23.1%, and periprosthetic joint infection in 7.7%. Treatment options included replacement of the tibial component with a fixed-bearing (FB) device in 23.1% of cases, solitary exchange of the bearing in 53.8%, or conversion to an unconstrained total knee replacement (TKR) in 23.1%. The re-dislocation rate in patients who underwent a bearing exchange as a treatment for bearing dislocation was 100%, with a mean FU period of 8.4 ± 11 months. Therefore, survivorship for the treatment of bearing dislocation differed significantly in these patients compared to those who received an exchange to a FB device (0% vs. 100%, p = 0.014).
CONCLUSIONS
Addressing the recurring issue of bearing dislocation in lateral MB-UKR demands a more comprehensive approach than merely replacing the bearing. Effective solutions include replacing the tibial component with an FB design or converting to an unconstrained TKR.
LEVEL OF EVIDENCE
Retrospective cohort study, Level IV.
引言
采用活动平台（MB）装置的外侧单髁膝关节置换术（UKR）失败常因平台脱位所致。翻修手术的各种治疗方案的有效性尚不清楚。因此，本研究的目的是报告外侧MB-UKR的失败模式以及不同翻修策略的结果。
材料与方法
本回顾性研究纳入了2008年至2020年间在单中心经历外侧MB-UKR失败并需要翻修手术的患者。该研究的目的是报告失败原因并记录所采用的所有治疗策略。采用Kaplan-Meier估计器进行生存分析，终点定义为“因任何原因再次翻修”。使用对数秩检验比较各种治疗策略的生存率。
结果
本研究共纳入13例患者，平均随访（FU）时间为94.7±36.4个月。失败原因包括平台脱位（69.2%）、骨关节炎（OA）进展（23.1%）和假体周围关节感染（7.7%）。治疗方案包括23.1%的病例采用固定平台（FB）装置更换胫骨部件，53.8%的病例单独更换平台，或23.1%的病例转换为非限制性全膝关节置换术（TKR）。接受平台更换治疗平台脱位的患者再次脱位率为100%，平均FU时间为8.4±11个月。因此，与接受更换为FB装置的患者相比，这些患者治疗平台脱位的生存率差异显著（0%对100%，p=0.014）。
结论
解决外侧MB-UKR中反复出现的平台脱位问题需要比单纯更换平台更全面的方法。有效的解决方案包括采用FB设计更换胫骨部件或转换为非限制性TKR。
证据水平
回顾性队列研究，IV级。
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