Farhan-Alanie Muhamed M, Miller James, Stephens Alastair, Kwan Tsun Yu, Boutefnouchet Tarek
Warwick Medical School, University of Warwick, Coventry, UK.
Department of Trauma & Orthopaedics, University Hospital Coventry & Warwickshire NHS Trust, University Hospital Coventry, Coventry, UK.
Arch Orthop Trauma Surg. 2025 Jul 3;145(1):362. doi: 10.1007/s00402-025-05973-y.
Unicompartmental knee replacement (UKR) is a technically challenging operation. Component alignment can influence implant longevity and knee function post-operatively. This study aimed to investigate implant alignment following UKR performed by consultants compared to trainees.
100 Oxford UKRs performed by trainees and consultants were analysed. Two blinded surgeons independently assessed post-operative knee radiographs on four parameters: flexion/extension of femoral component, posterior slope of tibial component, and varus/valgus of femoral and tibial components. Logistic regression was performed to predict the probability of implant malpositioning outside the optimal position range.
Median varus/valgus angles for femoral components did not differ significantly between trainees and consultants (p = 0.92), nor did the angles for tibial components (p = 0.43). Posterior tibial slope measurements showed a significant difference between trainees and consultants (7.08° [IQR 5.2-9.30], and 5.35° [IQR 2.65-7.05], respectively; p < 0.01). Median flexion/extension angles for femoral components also differed significantly between trainees and consultants (-14.45° [IQR -19.2 to -9.85] and -10.2°[IQR -13.55 to -6.95], respectively; p < 0.01). A greater proportion of implants positioned by trainees were classified as outliers for this parameter (46% versus 20%, p < 0.01; aOR 5.39, 95% CI 2.05-14.18, p < 0.01). However, no differences in the proportion of outliers was found when trainees were directly supervised by consultants (p = 0.73).
Trainees achieved adequate component alignment within optimal ranges for most parameters however were more prone to positioning the femoral component in excessive flexion. Greater emphasis on achieving optimal flexion/extension positioning of the femoral component during surgical training and direct supervision may improve the outcomes of patients undergoing an Oxford UKR by trainees.
单髁膝关节置换术（UKR）是一项技术要求较高的手术。假体的对线情况会影响植入物的使用寿命和术后膝关节功能。本研究旨在比较由顾问医生和实习医生进行UKR手术后的假体对线情况。
分析了实习医生和顾问医生进行的100例牛津UKR手术。两位不知情的外科医生独立评估术后膝关节X线片的四个参数：股骨假体的屈伸角度、胫骨假体的后倾角度以及股骨和胫骨假体的内翻/外翻角度。进行逻辑回归分析以预测假体位置超出最佳位置范围的概率。
实习医生和顾问医生所植入股骨假体的内翻/外翻角度中位数无显著差异（p = 0.92），胫骨假体的角度也无显著差异（p = 0.43）。胫骨后倾角度测量结果显示实习医生和顾问医生之间存在显著差异（分别为7.08°[四分位间距5.2 - 9.30]和5.35°[四分位间距2.65 - 7.05]；p < 0.01）。股骨假体的屈伸角度中位数在实习医生和顾问医生之间也存在显著差异（分别为-14.45°[四分位间距-19.2至-9.85]和-10.2°[四分位间距-13.55至-6.95]；p < 0.01）。在该参数方面，实习医生植入的假体被归类为异常值的比例更高（46%对20%，p < 0.01；调整后比值比5.39，95%置信区间2.05 - 14.18，p < 0.01）。然而，当实习医生在顾问医生的直接监督下进行手术时，异常值比例没有差异（p = 0.73）。
对于大多数参数，实习医生能在最佳范围内实现足够的假体对线，但更容易将股骨假体置于过度屈曲位置。在外科培训期间更加强调实现股骨假体的最佳屈伸位置并进行直接监督，可能会改善实习医生为患者进行牛津UKR手术的效果。
