内侧单髁膝关节置换术翻修术——并非如人们所想的那么简单？来自单一中心的生存率及再次翻修分析
Revision of medial unicompartmental knee arthroplasty-Not as uncomplicated as one thought? Analysis of survival and re-revisions from a single centre.
作者信息
Bockholt Sebastian, Gosheger Georg, Moellenbeck Burkhard, Schneider Kristian Nikolaus, Schwarze Jan, Theil Christoph
机构信息
Department of Orthopedics and Tumor Orthopedics Muenster University Hospital Muenster Germany.
出版信息
J Exp Orthop. 2025 Apr 18;12(2):e70250. doi: 10.1002/jeo2.70250. eCollection 2025 Apr.
PURPOSE
Medial unicompartmental knee arthroplasty (UKA) is a treatment option for medial knee osteoarthritis, with an increase in surgeries over the last few years. However, the results of revision total knee arthroplasty (TKA) after a UKA vary greatly. The purpose of the study was to examine the survival after revision TKA of a failed UKA.
METHODS
This is a retrospective single-centre analysis that includes 35 revision TKA procedures after the failed UKA performed from 2004 to 2019. The median follow-up after revision TKA was 39 months (interquartile range [IQR]: 32-52). The indication for revision of the UKA was aseptic loosening in 49% of patients (17/35). We evaluated demographic factors, reason for revision and revision implant used with descriptive statistics. Implant survival analysis with a focus on re-revision-free survival and potential re-revisions was performed using Kaplan-Meier survival curves. Differences in survival were analyzed using the log-rank test. Value was set at 0.05.
RESULTS
Forty per cent (14/35) of revision implants were posterior stabilized revision TKA, followed by 34% (12/35) of condylar constrained designs and 23% of rotating hinged TKA (8/35). Only one patient was revised to a cruciate retaining primary implant (3%). The re-revision-free survival after revision TKA amounted to 94% (95% confidence interval [CI]: 91%-100%) after 1 year, 80% (95% CI: 67%-93%) after 2 years and 74% (95% CI: 56%-90%) at 5 years. Twenty-three per cent of patients (8/35) underwent re-revision after the initial UKA revision after a median time period of 21 months (IQR: 12-24). The reasons for repeat revision were tibial aseptic loosening in 9% of patients (3/35), periprosthetic joint infection (PJI) in 9% of patients (3/35) and instability in 5% (2/35). Rotating hinge knee implants showed reduced survivorship.
CONCLUSIONS
Revision of medial UKA is associated with an increased use of more elaborate and complex revision implants. There is a substantial risk of repeat revision, with aseptic tibial loosening and PJI being the main reasons for the failure of this series.
LEVEL OF EVIDENCE
Level III.
目的
内侧单髁膝关节置换术（UKA）是治疗内侧膝关节骨关节炎的一种选择，在过去几年中手术量有所增加。然而，UKA术后翻修全膝关节置换术（TKA）的结果差异很大。本研究的目的是检查UKA失败后翻修TKA的生存率。
方法
这是一项回顾性单中心分析，包括2004年至2019年期间UKA失败后进行的35例翻修TKA手术。翻修TKA后的中位随访时间为39个月（四分位间距[IQR]：32 - 52）。UKA翻修的指征在49%的患者（17/35）中是无菌性松动。我们用描述性统计评估人口统计学因素、翻修原因和使用的翻修植入物。使用Kaplan-Meier生存曲线进行以无再次翻修生存率和潜在再次翻修为重点的植入物生存分析。使用对数秩检验分析生存率的差异。设定P值为0.05。
结果
40%（14/35）的翻修植入物是后稳定型翻修TKA，其次是34%（12/35）的髁限制型设计和23%的旋转铰链式TKA（8/35）。只有1例患者翻修为保留交叉韧带的初次植入物（3%）。翻修TKA后的无再次翻修生存率在1年后为94%（95%置信区间[CI]：91% - 100%），2年后为80%（95% CI：67% - 93%），5年后为74%（95% CI：56% - 90%）。23%的患者（8/35）在初次UKA翻修后中位21个月（IQR：12 - 24）进行了再次翻修。再次翻修的原因在9%的患者（3/35）中是胫骨无菌性松动，9%的患者（3/35）是假体周围关节感染（PJI），5%（2/35）是不稳定。旋转铰链膝关节植入物的生存率较低。
结论
内侧UKA的翻修与使用更精细复杂的翻修植入物增加有关。存在再次翻修的重大风险，无菌性胫骨松动和PJI是本系列失败的主要原因。
证据水平
III级。
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