Zhang Xi, Liu Yishu, Shengyuan Yu, Gao Ming, Han Chaozhe, Xue Bing, Liu Jingsong, Zhou Yong
The Fourth Affiliated Hospital of Harbin Medical University, 37 Yiyuan Street, Nangang District, Harbin, Heilongjiang, China.
The First Affiliated Hospital of Harbin Medical University, 2075 Qunli Seventh Avenue, Daoli District, Harbin, Heilongjiang, China.
Orthop Traumatol Surg Res. 2025 Jul 13:104333. doi: 10.1016/j.otsr.2025.104333.
This study re-evaluates the clinical outcomes and prosthesis survival of fixed-bearing UKA in patients with ACL degeneration, PFJ degeneration, or both, compared to standard indications of UKA by examining its clinical outcomes in patients with anterior cruciate ligament-degeneration or deficient (ACLD) and patellofemoral joint degeneration (PFJ). These findings suggest a paradigm shift in patient selection, offering a broader surgical option for knee OA management. The transition from traditional contraindications to potential indications for UKA in selected ACLD and PFJ cases may significantly impact clinical decision-making.
A retrospective analysis was conducted on 375 patients with knee osteoarthritis who underwent UKA from January 2014 to January 2019. Patients were divided into ACLD (n = 52), PFJ (n = 101), ACLD + PFJ (n = 16), and other (n = 206) groups. Postoperative complications, including polyethylene wear, infection, and revision procedures, were retrospectively recorded and analyzed across all patient groups. Postoperative outcomes, including the Knee Society Score (KSS), Western Ontario and McMaster University Arthritis Index (WOMAC), and prosthesis survival rates, were compared across groups.
Preoperatively, the ACLD + PFJ group had higher Kellgren-Lawrence (KL) grades and poorer knee function (p < 0.05). After a median follow-up of 7 years, all groups demonstrated significant improvements in KSS and WOMAC scores (p < 0.0001), with no significant differences between groups. During the follow-up period, a total of 4 patients required revision surgery, prosthesis survival rates also showed no significant differences (p = 0.16), with an overall survival rate of 98.93% (371/375).
Fixed-bearing UKA demonstrated promising clinical outcomes and high prosthesis survival rates in this study, including in patients with ACLD and PFJ degeneration. While ACL degeneration (excluding total deficiency) and medial PFJ osteoarthritis (excluding lateral condyle involvement) may be considered as possible indications for UKA, this approach requires careful patient selection and the surgeon's expertise. These findings highlight the potential for expanding UKA indications and call for further studies to validate its use in more complex knee pathologies.
III; Retrospective Cohort Study.
本研究通过检查前交叉韧带退变或缺失（ACLD）及髌股关节退变（PFJ）患者的临床结果，重新评估了固定平台单髁膝关节置换术（UKA）在ACL退变、PFJ退变或两者皆有的患者中的临床结果及假体生存率，并与UKA的标准适应证进行比较。这些发现提示了患者选择方面的范式转变，为膝关节骨关节炎的治疗提供了更广泛的手术选择。在选定的ACLD和PFJ病例中，从传统禁忌证到UKA潜在适应证的转变可能会显著影响临床决策。
对2014年1月至2019年1月期间接受UKA的375例膝关节骨关节炎患者进行回顾性分析。患者分为ACLD组（n = 52）、PFJ组（n = 101）、ACLD + PFJ组（n = 16）和其他组（n = 206）。对所有患者组回顾性记录并分析术后并发症，包括聚乙烯磨损、感染和翻修手术。比较各组的术后结果，包括膝关节协会评分（KSS）、西安大略和麦克马斯特大学骨关节炎指数（WOMAC）以及假体生存率。
术前，ACLD + PFJ组的Kellgren-Lawrence（KL）分级更高，膝关节功能更差（p < 0.05）。中位随访7年后，所有组的KSS和WOMAC评分均有显著改善（p < 0.0001），组间无显著差异。随访期间，共有4例患者需要翻修手术，假体生存率也无显著差异（p = 0.16），总体生存率为98.93%（371/375）。
本研究中，固定平台UKA显示出了良好的临床结果和较高的假体生存率，包括在ACLD和PFJ退变患者中。虽然ACL退变（不包括完全缺失）和内侧PFJ骨关节炎（不包括外侧髁受累）可被视为UKA的可能适应证，但这种方法需要仔细选择患者并具备外科医生的专业知识。这些发现突出了扩大UKA适应证的潜力，并呼吁进一步研究以验证其在更复杂膝关节病变中的应用。
III级；回顾性队列研究。
