Wang Zhaolun, Deng Wang, Zhou Yixin, Huang Yong, Guo Shaoyi, Zhang Yunfeng
Department of Orthopaedic Surgery, Beijing Jishuitan Hospital Capital Medical University Beijing China.
Fourth Clinical College of Peking University Beijing China.
J Exp Orthop. 2025 Aug 5;12(3):e70389. doi: 10.1002/jeo2.70389. eCollection 2025 Jul.
This study aims to investigate whether restoring prearthritic alignment improves joint perception in medial unicompartmental knee arthroplasty (UKA).
This retrospective cohort study analysed 244 patients who underwent nonrobotic-assisted medial fixed-bearing UKA between 2015 and 2018 with a minimum 2-year follow-up. Patients were categorised into prearthritic and nonprearthritic alignment groups based on the difference between their postoperative alignment and prearthritic hip-knee-ankle angle. Postoperative outcomes, including the Forgotten Joint Score (FJS-12), Oxford Knee Score (OKS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Injury and Osteoarthritis Outcome Score (KOOS), Oxford Knee Score (OKS) and University of California Los Angeles (UCLA) activity score were compared between the groups. Additional analysis was performed in a subgroup of patients with constitutional varus alignment (CPAK types I, IV and VII). Multivariable logistic regression was used to identify predictors of achieving a forgotten joint.
Patients with restored prearthritic alignment had significantly higher FJS-12 (71.9 vs. 63.4, = 0.005), OKS (40.7 vs. 38.1, = 0.003) and WOMAC (91.2 vs. 88.1, = 0.017) scores compared to those with nonprearthritic alignment. In the constitutional varus subgroup, prearthritic alignment was associated with higher FJS-12, UCLA, OKS and KOOS ADL scores. The prearthritic alignment group also had a higher likelihood of achieving the 'forgotten joint' state. A 1-degree deviation from prearthritic alignment was associated with a 21% decrease in the probability of achieving a forgotten joint.
Restoring prearthritic alignment in UKA is associated with improved postoperative joint perception and function, especially in patients with constitutional varus alignment. This personalised alignment approach may lead to better outcomes than the traditional goal of neutral alignment. Further research with a longer follow-up period is required to validate these findings and explore their impact on prosthesis survival.
Level II.
本研究旨在探讨恢复关节炎前的关节对线是否能改善内侧单髁膝关节置换术（UKA）中的关节感知。
这项回顾性队列研究分析了2015年至2018年间接受非机器人辅助内侧固定承重UKA且至少随访2年的244例患者。根据术后对线与关节炎前髋-膝-踝角的差异，将患者分为关节炎前对线组和非关节炎前对线组。比较两组术后的结果，包括遗忘关节评分（FJS-12）、牛津膝关节评分（OKS）、西安大略和麦克马斯特大学骨关节炎指数（WOMAC）、膝关节损伤和骨关节炎结果评分（KOOS）、牛津膝关节评分（OKS）以及加利福尼亚大学洛杉矶分校（UCLA）活动评分。对伴有先天性内翻对线（CPAK I型、IV型和VII型）的患者亚组进行了额外分析。采用多变量逻辑回归来确定达到遗忘关节状态的预测因素。
与非关节炎前对线的患者相比，恢复关节炎前对线的患者FJS-12评分显著更高（71.9对63.4，P = 0.005）、OKS评分（40.7对38.1，P = 0.003）以及WOMAC评分（91.2对88.1，P = 0.017）。在先天性内翻亚组中，关节炎前对线与更高的FJS-12、UCLA、OKS和KOOS日常生活活动评分相关。关节炎前对线组达到“遗忘关节”状态的可能性也更高。与关节炎前对线相差1度与达到遗忘关节的概率降低21%相关。
在UKA中恢复关节炎前对线与术后关节感知和功能改善相关，尤其是在伴有先天性内翻对线的患者中。这种个性化对线方法可能比传统的中立对线目标带来更好的结果。需要更长随访期的进一步研究来验证这些发现并探讨其对假体生存率的影响。
II级。
