Koch Kevin-Arno, Thapa Michael, Weishorn Johannes, Hariri Mustafa, Lotz Benedict, Knappe Kevin, Reiner Tobias, Walker Tilman
Department of Orthopaedic Surgery, University Hospital of Heidelberg, Heidelberg, Germany.
Knee Surg Sports Traumatol Arthrosc. 2025 Sep;33(9):3324-3332. doi: 10.1002/ksa.12703. Epub 2025 May 26.
To evaluate long-term outcomes of cemented, mobile-bearing medial unicompartmental knee arthroplasty (UKA) in patients aged 60 or younger, focusing on implant survival, functional results, patient-reported outcome measures (PROMs), and radiographic findings over >10 years.
This retrospective single-centre study included 119 knees (102 patients). Implant survival was evaluated using Kaplan-Meier analysis. PROMs included the Oxford Knee Score (OKS), American Knee Society Score (AKSS), UCLA Activity Score and Visual Analogue Scale (VAS). Assessments were performed preoperatively, at mid-term (2-10 years), and at long-term follow-up (>10 years). OKS and AKSS were analysed in relation to Patient Acceptable Symptom State (PASS) thresholds. Radiographs were graded using the Kellgren-Lawrence classification to evaluate lateral osteoarthritis (LOA) progression.
The implant survival rate was 86.7% (95% CI: 78.5-91.9%) at 15 years, and 81.7% (95% CI: 71.4%-88.5%) at 17.5 years. Revision surgery was required in 18 knees (mean time to revision: 8.7 years), primarily due to progression of LOA. All PROMs improved significantly from baseline to the final follow-up (mean: 16 years; p < 0.0001). Although minor functional declines occurred between mid- and long-term follow-ups, these were not statistically significant (p > 0.05), except for functional AKSS. At the final assessment, 96% of patients exceeded the PASS threshold for OKS, 84% for AKSS objective, and 80% for AKSS functional scores. Radiographic LOA progression was frequent but did not significantly impair functional outcomes.
Cemented mobile-bearing medial UKA in patients aged ≤60 years demonstrated high long-term implant survival and sustained functional benefit. Even in the presence of radiographic LOA progression, clinical outcomes remained excellent. UKA represents a durable and effective treatment for younger patients with isolated medial compartment osteoarthritis.
Level IV.
评估骨水泥固定、活动平台内侧单髁膝关节置换术（UKA）在60岁及以下患者中的长期疗效，重点关注植入物生存率、功能结果、患者报告的结局指标（PROMs）以及超过10年的影像学表现。
这项回顾性单中心研究纳入了119个膝关节（102例患者）。采用Kaplan-Meier分析评估植入物生存率。PROMs包括牛津膝关节评分（OKS）、美国膝关节协会评分（AKSS）、加州大学洛杉矶分校活动评分和视觉模拟量表（VAS）。在术前、中期（2 - 10年）和长期随访（>10年）时进行评估。分析OKS和AKSS与患者可接受症状状态（PASS）阈值的关系。使用Kellgren-Lawrence分类对X线片进行分级，以评估外侧骨关节炎（LOA）的进展。
15年时植入物生存率为86.7%（95%可信区间：78.5 - 91.9%），17.5年时为81.7%（95%可信区间：71.4% - 88.5%）。18个膝关节需要翻修手术（翻修平均时间：8.7年），主要原因是LOA进展。从基线到最终随访（平均：16年；p < 0.0001），所有PROMs均有显著改善。虽然在中期和长期随访之间出现了轻微的功能下降，但除了AKSS功能评分外，这些下降在统计学上并不显著（p > 0.05）。在最终评估时，96%的患者OKS超过了PASS阈值，84%的患者AKSS客观评分超过阈值，80%的患者AKSS功能评分超过阈值。影像学上LOA进展频繁，但并未显著损害功能结果。
60岁及以下患者采用骨水泥固定活动平台内侧UKA显示出较高的长期植入物生存率和持续的功能益处。即使存在影像学上的LOA进展，临床结果仍然优异。UKA是年轻的单纯内侧间室骨关节炎患者的一种持久且有效的治疗方法。
IV级。
