无骨水泥与有骨水泥内侧单室膝关节置换术术后早期疗效比较

IF 2.8 Q1 ORTHOPEDICS
Tarik Bayoumi, Joost A Burger, Jelle P van der List, Inger N Sierevelt, Anneke Spekenbrink-Spooren, Andrew D Pearle, Gino M M J Kerkhoffs, Hendrik A Zuiderbaan
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引用次数: 0

摘要

目的:这项以登记为基础的研究的主要目的是比较无骨水泥和有骨水泥内侧单室膝关节置换术(UKA)术后第一年的患者报告结果。次要目标是评估两种固定技术的一年和三年植入存活率:我们分析了荷兰关节置换登记处登记的 10,862 例无骨水泥和 7,917 例有骨水泥的 UKA 病例,手术时间为 2017 年至 2021 年。使用混合模型分析比较了术前到术后随访6个月和12个月的结果变化。采用 Kaplan-Meier 和 Cox 回归模型量化植入物存活率的差异。对患者特异性变量和年住院量进行了调整:结果:两组患者的牛津膝关节评分(OKS)和活动相关疼痛与基线值的变化相当。对协变量进行调整后发现,有骨水泥组休息相关疼痛的减少幅度较小(β = -0.09(95% 置信区间 (CI) -0.16--0.01))。无骨水泥固定与更高的 OKS 优良结果(> 41 分)概率相关(调整后的几率比 1.2(95% 置信区间 1.1 至 1.3))。有骨水泥植入物的一年存活率更高(调整后危险比 (HR) 1.35 (95% CI 1.01 to 1.71)),无骨水泥植入物假体周围骨折的翻修率更高。在两到三年的随访期间,无骨水泥UKA植入物存活的可能性无显著性差异(调整后的HR为0.64(95% CI为0.40至1.04)),主要原因是有骨水泥植入物的胫骨松动翻修率增加:结论:无骨水泥和有骨水泥内侧UKA在术后最初一年的身体功能改善和疼痛减轻方面具有可比性,尽管无骨水泥UKA更有可能获得最佳的OKS结果。早期身体功能和疼痛方面的预期差异不应成为选择固定技术的决定性因素。不过,外科医生在决定使用哪种植入物时,应考虑短期和长期植入物存活率的差异。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Comparison of the early postoperative outcomes of cementless and cemented medial unicompartmental knee arthroplasty.

Aims: The primary objective of this registry-based study was to compare patient-reported outcomes of cementless and cemented medial unicompartmental knee arthroplasty (UKA) during the first postoperative year. The secondary objective was to assess one- and three-year implant survival of both fixation techniques.

Methods: We analyzed 10,862 cementless and 7,917 cemented UKA cases enrolled in the Dutch Arthroplasty Registry, operated between 2017 and 2021. Pre- to postoperative change in outcomes at six and 12 months' follow-up were compared using mixed model analyses. Kaplan-Meier and Cox regression models were applied to quantify differences in implant survival. Adjustments were made for patient-specific variables and annual hospital volume.

Results: Change from baseline in the Oxford Knee Score (OKS) and activity-related pain was comparable between groups. Adjustment for covariates demonstrated a minimally greater decrease in rest-related pain in the cemented group (β = -0.09 (95% confidence interval (CI) -0.16 to -0.01)). Cementless fixation was associated with a higher probability of achieving an excellent OKS outcome (> 41 points) (adjusted odds ratio 1.2 (95% CI 1.1 to 1.3)). The likelihood of one-year implant survival was greater for cemented implants (adjusted hazard ratio (HR) 1.35 (95% CI 1.01 to 1.71)), with higher revision rates for periprosthetic fractures of cementless implants. During two to three years' follow-up, the likelihood of implant survival was non-significantly greater for cementless UKA (adjusted HR 0.64 (95% CI 0.40 to 1.04)), primarily due to increased revision rates for tibial loosening of cemented implants.

Conclusion: Cementless and cemented medial UKA led to comparable improvement in physical function and pain reduction during the initial postoperative year, albeit with a greater likelihood of achieving excellent OKS outcomes after cementless UKA. Anticipated differences in early physical function and pain should not be a decisive factor in the choice of fixation technique. However, surgeons should consider the differences in short- and long-term implant survival when deciding which implant to use.

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来源期刊
Bone & Joint Open
Bone & Joint Open ORTHOPEDICS-
CiteScore
5.10
自引率
0.00%
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审稿时长
8 weeks
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