Bunyoz Kristine Ifigenia, Lindberg-Larsen Martin, Gromov Kirill, Troelsen Anders
Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.
Department of Health and Medical Science, Copenhagen University, Copenhagen, Denmark.
Knee Surg Sports Traumatol Arthrosc. 2025 Jul 13. doi: 10.1002/ksa.12785.
Limited data and experience surround lateral unicompartmental knee arthroplasty (UKA), contributing to uncertainty regarding its broader application in clinical practice. To understand how to optimise lateral UKA outcomes, this study aimed to evaluate the implant survival of lateral UKA and compare it to total knee arthroplasty (TKA) using registry data.
Data were obtained from the Danish Knee Arthroplasty Registry, the Danish National Patient Registry and the Danish Civil Registration System. Between 1997 and 2022, all primary lateral UKAs (n = 538) and primary TKAs performed on valgus-aligned knees were included. Propensity score matching (1:4) matched patients by age, sex, weight, Charlson comorbidity index, year of surgery and hospital type. Survival analysis used the Fine-Gray subdistribution hazards model to account for competing risks.
The 5-year cumulative revision risk was 10.1% for lateral UKA and 5.0% for TKA (1997-2022). For lateral UKA, this decreased from 25.0% (1997-2006) to 7.3% (2017-2022); TKA decreased from 4.6% to 3.7%. Surgery after 2011 and use of the fixed lateral Oxford (FLO) implant significantly reduced the risk of revision. Compared to TKA, the subdistribution hazard ratio for revision was 0.7 (95% confidence interval [CI] = 0.2-2.2) for the FLO implant and 3.4 (95% CI = 1.9-6.1) for other lateral UKAs in the period 2017-2022. No differences were found in 90-day readmissions or complications between lateral UKA and TKA, but the 2-year reoperation rate was significantly lower for lateral UKA in both periods.
Lateral UKA survival has evolved with improved understanding of knee compartment biomechanics, indications, surgical techniques and implant designs. Lateral UKA with the FLO implant showed lower or similar revision rates compared with TKA.
Level III.
关于外侧单髁膝关节置换术（UKA）的数据和经验有限，这导致其在临床实践中更广泛应用的不确定性。为了解如何优化外侧UKA的手术效果，本研究旨在利用登记数据评估外侧UKA的植入物生存率，并将其与全膝关节置换术（TKA）进行比较。
数据来自丹麦膝关节置换登记处、丹麦国家患者登记处和丹麦民事登记系统。纳入1997年至2022年间所有在膝外翻对齐的膝关节上进行的初次外侧UKA（n = 538）和初次TKA。倾向评分匹配（1:4）根据年龄、性别、体重、Charlson合并症指数、手术年份和医院类型对患者进行匹配。生存分析使用Fine-Gray子分布风险模型来考虑竞争风险。
1997年至2022年期间，外侧UKA的5年累积翻修风险为10.1%，TKA为5.0%。对于外侧UKA，这一比例从1997年至2006年的25.0%降至2017年至2022年的7.3%；TKA从4.6%降至3.7%。2011年后手术以及使用固定外侧牛津（FLO）植入物显著降低了翻修风险。与TKA相比，2017年至2022年期间，FLO植入物的翻修子分布风险比为0.
