Hoorntje Alexander, van der Wilk Sten, Koenraadt-van Oost Iris, van Geenen Rutger C I
Department of Orthopaedic Surgery & Sports Medicine, Amsterdam Movement Sciences, Amsterdam UMC University of Amsterdam Amsterdam the Netherlands.
Amsterdam Movement Sciences, Program Musculoskeletal Health Amsterdam the Netherlands.
J Exp Orthop. 2025 Apr 1;12(2):e70205. doi: 10.1002/jeo2.70205. eCollection 2025 Apr.
Approximately 50% of knee osteoarthritis patients are eligible for unicompartmental knee arthroplasty (UKA), but only 10%-15% of knee replacements are UKAs. Higher UKA revision rates may prevent broader implementation. The hypothesis was that up to 40% of UKA revisions are potentially avoidable based on a radiographic analysis of indications, surgical technique and reasons for revision.
Consecutive UKA revisions between 2007 and 2022 from one high-volume UKA centre were analysed. Two independent reviewers systematically evaluated all preoperative, direct post-operative and prerevision radiographs (anteroposterior and lateral, stress radiographs if available). Using the Oxford group criteria, adequate use of UKA indications was assessed, as well as surgical technique errors and the presence of radiographic reasons for revision. Infections were excluded.
Ninety-eight revisions were included with a median time to revision of 2.2 years (interquartile range: 0.9-5.5). UKA indications were satisfied in 45%. Presence of medial bone-on-bone osteoarthritis was doubtful or not present in 37%. Other indications were possibly not satisfied in 18%. Post-operative, major technical errors were identified in 7% of cases. No radiographic reason for revision was identified in 34%. Common reasons for revision were progression of lateral/patellofemoral osteoarthritis in 41%, bearing dislocation in 13% and periprosthetic fractures in 9% of cases. Uncemented fixation was associated with revision ≤2 years ( < 0.01), due to more periprosthetic fractures. In 47% of UKAs without preoperative bone-on-bone osteoarthritis, no radiographic reason for revision was identified, compared to 26% of UKAs with preoperative bone-on-bone osteoarthritis ( = 0.03).
In conclusion, a substantial number (>40%) of UKA revisions are potentially avoidable based on the present radiographic analysis.
Level III.
约50%的膝关节骨关节炎患者适合单髁膝关节置换术（UKA），但仅10%-15%的膝关节置换手术采用UKA。UKA较高的翻修率可能会阻碍其更广泛的应用。本研究假设基于对UKA适应症、手术技术及翻修原因的影像学分析，高达40%的UKA翻修可能是可以避免的。
对一家大量开展UKA手术的中心在2007年至2022年间连续进行的UKA翻修病例进行分析。两名独立的评估人员系统地评估了所有术前、术后即刻及翻修前的X线片（前后位和侧位，如有应力位X线片也纳入评估）。采用牛津组标准，评估UKA适应症的合理应用情况、手术技术失误以及影像学上的翻修原因。排除感染病例。
共纳入98例翻修病例，翻修的中位时间为2.2年（四分位间距：0.9-5.5年）。45%的病例符合UKA适应症。37%的病例中内侧骨对骨的骨关节炎情况存疑或不存在。18%的病例其他适应症可能未得到满足。术后，7%的病例存在重大技术失误。34%的病例未发现影像学上的翻修原因。常见的翻修原因包括外侧/髌股关节骨关节炎进展（41%）、假体脱位（13%）以及假体周围骨折（9%）。非骨水泥固定与2年内翻修相关（<0.01），因为假体周围骨折更多见。在术前无骨对骨骨关节炎的UKA病例中，47%未发现影像学上的翻修原因，而术前有骨对骨骨关节炎的UKA病例中这一比例为26%（P=0.03）。
总之，基于目前的影像学分析，相当一部分（>40%）的UKA翻修可能是可以避免的。
III级。
