Bertrand Todd E, Melvin Patricia R, Alexander Jacob, Crawford David A, Lombardi Adolph V, Berend Keith R
JIS Orthopedics Inc., New Albany, OH 7277 Smith's Mill Rd, Ste 200, New Albany, OH, 43054, USA.
The University of Toledo College of Medicine, Department of Orthopedic Surgery, 3000 Arlington Ave, Toledo, OH, 43614, USA.
J Clin Orthop Trauma. 2025 Apr 5;66:103008. doi: 10.1016/j.jcot.2025.103008. eCollection 2025 Jul.
Medial unicompartmental knee arthroplasty (UKA) has become an accepted means of treating end stage anteromedial osteoarthritis of the knee. However, the presence of patellofemoral osteoarthritis on preoperative radiographs has proven to be confusing for orthopaedic surgeons in terms of candidacy for unicompartmental arthroplasty. The purpose of this study is to assess whether the presence of preoperative radiographic patellofemoral joint (PFJ) arthritis influences implant survivability or clinical outcomes at minimum 10-year follow-up.
Preoperative radiographs of 502 knees treated between 2004 and 2010 with medial mobile-bearing UKA and minimum 10-year follow-up (mean 13.3 years ± 2.0) were assessed by an observer blinded to the clinical outcome, and the patellofemoral joint (PFJ) was graded using the modified Altman classification. In the analyzed cohort there were 310 (61.8 %) grade 0, 135 (26.9 %) grade 1, 51 (10.2 %) grade 2, and 6 (1.2 %) grade 3 knees. Clinical outcomes were assessed using Knee Society pain, clinical and functional scores, and the University of California Los Angeles (UCLA) activity rating.
There were 66 (12.7 %) knees revised for overall survival of 86.9 %. The most common reason for revision was arthritic progression, in 27 (40.9 %) knees. There was no difference in Kaplan-Meier survival based on preoperative patellofemoral grade (p = 0.8047) and mean time to revision was similar between groups (p = 0.6330). When analyzing outcomes for the entire cohort there was significant improvement from preoperative to postoperative range of motion (ROM) (p = 0.0002) and Knee Society pain, clinical, and functional scores (all p < 0.0001).
This study demonstrates that at long term follow-up there is not a significant difference in overall implant survival or patient reported outcome scores based upon preoperative radiographic PFJ arthritic state. Thus, the radiographic appearance of the patellofemoral joint alone should not be a deciding factor when considering patients as candidates for medial UKA.
膝关节内侧单髁置换术（UKA）已成为治疗膝关节终末期前内侧骨关节炎的一种公认方法。然而，术前X线片上存在髌股关节骨关节炎，在单髁置换术的候选资格方面，已被证明让骨科医生感到困惑。本研究的目的是评估术前X线片上髌股关节（PFJ）关节炎的存在是否会影响至少10年随访期的植入物生存率或临床结果。
对2004年至2010年间接受膝关节内侧活动平台UKA治疗且至少随访10年（平均13.3年±2.0年）的502例膝关节的术前X线片进行评估，由对临床结果不知情的观察者进行评估，并使用改良的阿尔特曼分类法对髌股关节（PFJ）进行分级。在分析的队列中，有310例（61.8%）为0级，135例（26.9%）为1级，51例（10.2%）为2级，6例（1.2%）为3级膝关节。使用膝关节协会疼痛、临床和功能评分以及加利福尼亚大学洛杉矶分校（UCLA）活动评分来评估临床结果。
共有66例（12.7%）膝关节进行了翻修，总体生存率为86.9%。最常见的翻修原因是关节炎进展，有27例（40.9%）膝关节。基于术前髌股分级的Kaplan-Meier生存率无差异（p = 0.8047），两组之间的平均翻修时间相似（p = 0.6330）。分析整个队列的结果时，术前至术后的活动范围（ROM）（p = 0.0002）以及膝关节协会疼痛、临床和功能评分（均p < 0.0001）均有显著改善。
本研究表明，在长期随访中，基于术前X线片PFJ关节炎状态，总体植入物生存率或患者报告的结果评分没有显著差异。因此，在考虑患者作为内侧UKA的候选者时，仅髌股关节的X线表现不应成为决定因素。
