Schweizer Conradin, Pulatkan Anil, Krug Tatjana, Herre Joachim, Aldinger Peter R, Merle Christian, Waldstein Wenzel
Orthopaedic Clinic Paulinenhilfe, Diakonie-Klinikum, Stuttgart, Germany.
Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, Greifswald, Germany.
Knee Surg Sports Traumatol Arthrosc. 2025 Jul 18. doi: 10.1002/ksa.12779.
Limited evidence exists regarding the safety and efficacy of medial unicompartmental knee arthroplasty (UKA) in patients with end-stage medial arthritis following knee osteotomy. This study aims to evaluate survival, functional and radiological outcomes in patients undergoing medial UKA following knee osteotomy.
A retrospective analysis was conducted evaluating 63 knees (60 patients; 62% men, 38% women; mean age 61 ± 8 years; body mass index 28 ± 5 kg/m) who underwent medial UKA (n = 47 mobile-bearing, n = 16 fixed-bearing) following knee osteotomy. Patients were considered suitable for medial UKA if they met the Oxford criteria and had a preoperative hip-knee-ankle angle (HKAA) < 5° valgus and a medial proximal tibial angle (MPTA) < 95°. Primary outcomes were cumulative revision rates for (1) conversion to total knee arthroplasty (TKA) and (2) any reoperation. Functional outcomes were assessed using the Oxford Knee Score (OKS) and the UCLA Activity Score. HKAA was measured to determine overall limb alignment pre- and post-operatively.
The average time from osteotomy to UKA was 11 ± 8 years, and the mean follow-up after UKA was 5 ± 2 years. The cumulative 8-year implant survival rate was 96.3% (95% confidence interval [CI]: 0.912-1.0) for revision to TKA and 93.2% (95% CI: 0.899-0.965) for any reoperation. Two patients required revision to TKA due to overcorrection and infection. The mean OKS improved from 25.5 ± 5.9 preoperatively to 42.8 ± 6.0 post-operatively (p < 0.001). The mean preoperative HKAA of 2.4 ± 3.0° varus was corrected to 0.0 ± 3.1°.
Medial UKA after knee osteotomy represents a viable treatment option, but it requires a strict preoperative alignment assessment. In the absence of excessive mechanical valgus alignment (HKAA < 3° valgus) and severe valgus deformities (MPTA < 95°) of the proximal tibia, medial UKA provides favourable midterm implant survivorship and excellent functional outcomes. In borderline cases, fixed-bearing implants should be considered to avoid valgus overcorrection.
Level IV.
关于膝关节截骨术后终末期内侧关节炎患者行内侧单髁膝关节置换术（UKA）的安全性和有效性，现有证据有限。本研究旨在评估膝关节截骨术后行内侧UKA患者的假体生存率、功能及影像学结果。
进行一项回顾性分析，评估63例膝关节（60例患者；男性占62%，女性占38%；平均年龄61±8岁；体重指数28±5kg/m²），这些患者在膝关节截骨术后接受了内侧UKA（47例活动平台，16例固定平台）。如果患者符合牛津标准且术前髋-膝-踝角（HKAA）<5°外翻以及胫骨近端内侧角（MPTA）<95°，则被认为适合行内侧UKA。主要结局为（1）转换为全膝关节置换术（TKA）和（2）任何再次手术的累积翻修率。使用牛津膝关节评分（OKS）和加州大学洛杉矶分校活动评分评估功能结局。测量HKAA以确定术前和术后的整体肢体对线情况。
从截骨到UKA的平均时间为11±8年，UKA后的平均随访时间为5±2年。转换为TKA的8年累积假体生存率为96.3%（95%置信区间[CI]：0.912 - 1.0），任何再次手术的累积假体生存率为93.2%（95%CI：0.899 - 0.965）。两名患者因矫正过度和感染需要转换为TKA。平均OKS从术前的25.5±5.9提高到术后的42.8±6.0（p<0.001）。术前平均HKAA为2.4±3.0°内翻，矫正后为0.0±3.1°。
膝关节截骨术后行内侧UKA是一种可行的治疗选择，但需要严格的术前对线评估。在不存在过度机械性外翻对线（HKAA<3°外翻）和胫骨近端严重外翻畸形（MPTA<95°）的情况下，内侧UKA可提供良好的中期假体生存率和出色的功能结局。在临界病例中，应考虑使用固定平台假体以避免外翻矫正过度。
四级。
