Schweizer Conradin, Krug Tatjana, Herre Joachim, Aldinger Peter R, Merle Christian, Waldstein Wenzel
Orthopaedic Clinic Paulinenhilfe, Diakonie-Klinikum, Stuttgart, Germany.
Orthopaedic Clinic Paulinenhilfe, Diakonie-Klinikum, Stuttgart, Germany; Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, Greifswald, Germany.
J Arthroplasty. 2025 Aug 11. doi: 10.1016/j.arth.2025.08.008.
Osteonecrosis (ON) of the knee commonly affects the medial femoral condyle, leading to secondary unicompartmental arthritis. While most studies on unicompartmental knee arthroplasty (UKA) in patients who have ON focus on cemented fixation, the outcomes of cementless UKA remain unknown. This study evaluated survival, functional and radiological outcomes, and assessed potential differences for cemented and cementless medial mobile-bearing UKA in patients who had ON.
This retrospective, single-center study analyzed 119 patients who underwent medial UKA for ON between 2020 and 2022, with a minimum follow-up of two years. Patients were stratified into cemented (n = 63, women/men 71/29%, mean age 70 ± 9 years, BMI 29 ± 4) and cementless (n = 56, women/men 34/66%, mean age 72 ± 8 years, BMI 28 ± 4) groups. Demographics were similar between groups, except for sex, with more men in the cementless UKA group (P < 0.001). Kaplan-Meier survival analysis compared survival rates for aseptic loosening, implant revision (exchange of the femoral or tibial component), and any reoperation. Functional outcomes were assessed using the Oxford Knee Score (OKS) and the UCLA (University of California, Los Angeles) Activity Score.
At 50 months, cumulative survival rates showed no significant differences between cemented and cementless UKA for aseptic loosening (100 versus 97.7%; P = 0.35), implant revision (97.5 versus 93.3%; P = 0.36), or any reoperation (92.1 versus 87.0%; P = 0.35). There was one case of aseptic tibial subsidence that occurred in the cementless group in a patient who had femoral ON. Functional outcomes were excellent in both groups, with no significant differences in OKS (cemented/cementless: 42.6 ± 5.4 versus 43.5 ± 6.3; P = 0.12) or UCLA Activity Scores (6.1 ± 1.0 versus 6.1 ± 1.2; P = 0.57).
Cementless medial mobile-bearing UKA is a safe treatment option for ON in the medial compartment, offering stable primary fixation and implant survival comparable to cemented fixation. However, future research with sex-balanced cohorts and extended follow-up is needed to confirm these findings.
膝关节骨坏死（ON）通常影响股骨内侧髁，导致继发性单髁关节炎。虽然大多数关于骨坏死患者单髁膝关节置换术（UKA）的研究集中在骨水泥固定方面，但非骨水泥UKA的结果仍不清楚。本研究评估了生存率、功能和影像学结果，并评估了骨坏死患者中骨水泥型和非骨水泥型内侧活动平台UKA的潜在差异。
这项回顾性单中心研究分析了2020年至2022年间接受内侧UKA治疗骨坏死的119例患者，最短随访两年。患者被分为骨水泥组（n = 63，女性/男性71/29%，平均年龄70±9岁，BMI 29±4）和非骨水泥组（n = 56，女性/男性34/66%，平均年龄72±8岁，BMI 28±4）。除性别外，两组的人口统计学特征相似，非骨水泥UKA组男性更多（P < 0.001）。采用Kaplan-Meier生存分析比较无菌性松动、植入物翻修（股骨或胫骨部件置换）和任何再次手术的生存率。使用牛津膝关节评分（OKS）和加州大学洛杉矶分校（UCLA）活动评分评估功能结果。
在50个月时，骨水泥型和非骨水泥型UKA在无菌性松动（100%对97.7%；P = 0.35）、植入物翻修（97.5%对93.3%；P = 0.36）或任何再次手术（92.1%对87.0%；P = 0.35）方面的累积生存率无显著差异。非骨水泥组有一例无菌性胫骨下沉发生在一名股骨骨坏死患者中。两组的功能结果均极佳，OKS（骨水泥型/非骨水泥型：42.6±5.4对43.5±6.3；P = 0.12）或UCLA活动评分（6.1±1.0对6.1±1.2；P = 0.57）无显著差异。
非骨水泥型内侧活动平台UKA是治疗内侧间室骨坏死的一种安全治疗选择，提供与骨水泥固定相当的稳定初次固定和植入物生存率。然而，需要未来进行性别均衡队列研究和延长随访来证实这些发现。
