Arthur Lachlan W, Jenkins Cathy, Dodd Christopher A F, Price Andrew J, Jackson William F M, Bottomley Nicholas, Alvand Abtin, Murray David W
Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
Bone Joint J. 2025 Apr 1;107-B(4):432-439. doi: 10.1302/0301-620X.107B4.BJJ-2024-0977.R1.
Mixed clinical results have been reported following the use of lateral unicompartmental knee arthroplasty (UKA) in patients with isolated lateral compartment osteoarthritis (OA) of the knee. Although this procedure may be appropriate for use in about 10% of knees needing arthroplasty, it is only used in about 1%. The aim of this study was to determine the medium-term results for the Fixed Lateral Oxford (FLO) UKA.
We report the clinical results and survival for 305 consecutive FLO UKAs implanted in 279 patients between July 2015 and August 2022. A total of 283 knees (93%) satisfied the recommended surgical indications. The mean age of the patients was 70.8 years (SD 11), their mean BMI was 28.4 kg/m (SD 5.4), and 219 (72%) were female. Isolated lateral compartment OA was the indication for 298 operations (98%). The mean follow-up was 4.3 years (1 to 8). The Oxford Knee Score (OKS) was recorded pre- and postoperatively. The revision status of all knees was known.
There were four revisions (1%): two were conversions to a total knee arthroplasty (TKA) for instability and progressive OA and two had the addition of a medial UKA for medial compartment OA. Three other UKAs required a reoperation. At the last follow-up, the mean OKS was 40.9 (SD 7.8), a mean increase of 20 points from the preoperative score. The cumulative rate of survival with any reoperation, including revision, as the endpoint, at seven years, was 96% (95% CI 91 to 100), with revision as the endpoint was 98% (95% CI 94 to 100) and with revision to a TKA as the endpoint was 99% (95% CI 96 to 100). No revisions required revision TKA components. When those who underwent surgery for indications which were outside the recommended indications were excluded, there were only two revisions, both with the addition of a medial UKA for progressive OA, resulting in a seven-year cumulative survival with revision as the endpoint of 99% (95% CI 93 to 100).
This study involved the largest published cohort of fixed-bearing lateral UKAs. The good clinical outcomes and medium-term survival of the FLO UKA, particularly in patients satisfying the recommended indications, suggest that it is an excellent alternative to TKA for the treatment of patients with isolated OA of the lateral compartment of the knee.
对于单纯膝关节外侧间室骨关节炎（OA）患者采用外侧单髁膝关节置换术（UKA）后，临床结果不一。尽管该手术可能适用于约10%需要进行关节置换的膝关节，但实际仅约1%的患者使用。本研究的目的是确定固定外侧牛津（FLO）UKA的中期结果。
我们报告了2015年7月至2022年8月期间为279例患者植入的305例连续FLO UKA的临床结果和生存率。共有283个膝关节（93%）符合推荐的手术指征。患者的平均年龄为70.8岁（标准差11），平均体重指数为28.4 kg/m（标准差5.4），219例（72%）为女性。298例手术（98%）的指征为单纯外侧间室OA。平均随访时间为4.3年（1至8年）。术前和术后记录牛津膝关节评分（OKS）。所有膝关节的翻修情况均已知。
有4例翻修（1%）：2例因不稳定和进行性OA转换为全膝关节置换术（TKA），2例因内侧间室OA增加了内侧UKA。另外3例UKA需要再次手术。在最后一次随访时，平均OKS为40.9（标准差7.8），比术前评分平均提高了20分。以任何再次手术（包括翻修）为终点的7年累积生存率为96%（95%可信区间91%至100%），以翻修为终点的累积生存率为98%（95%可信区间94%至100%），以翻修为TKA为终点的累积生存率为99%（95%可信区间96%至100%）。没有翻修需要更换TKA组件。当排除那些因超出推荐指征的适应证而接受手术的患者后，仅有2例翻修，均为因进行性OA增加了内侧UKA，以翻修为终点的7年累积生存率为99%（95%可信区间93%至100%）。
本研究纳入了已发表的最大队列的固定承重外侧UKA。FLO UKA良好临床结果和中期生存率，特别是在符合推荐指征的患者中，表明它是治疗单纯膝关节外侧间室OA患者的TKA的极佳替代方案。
