可移动负重内侧单腔关节置换术的至少10年随访：术前髌骨关节炎的存在会影响患者的预后吗？

Q2 Medicine

Journal of Clinical Orthopaedics and Trauma Pub Date : 2025-04-05 DOI:10.1016/j.jcot.2025.103008

Todd E. Bertrand , Patricia R. Melvin , Jacob Alexander , David A. Crawford , Adolph V. Lombardi Jr. , Keith R. Berend

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引用次数: 0

摘要

背景：内侧单室膝关节置换术（UKA）已成为治疗终末期膝关节前内侧骨关节炎的公认方法。然而，术前x线片上髌股骨关节炎的存在已被证明是骨科医生在进行单腔关节置换术方面的困惑。本研究的目的是评估术前放射照相髌骨股骨关节（PFJ）关节炎的存在是否影响植入物的存活或至少10年随访的临床结果。方法对2004 ~ 2010年间502例内侧活动负重UKA患者的术前x线片进行评估，随访时间为10年（平均13.3年±2.0年），采用改良的Altman分级法进行髌骨股骨关节（PFJ）分级。在分析的队列中，0级膝关节310例（61.8%），1级膝关节135例（26.9%），2级膝关节51例（10.2%），3级膝关节6例（1.2%）。临床结果采用膝关节协会疼痛、临床和功能评分以及加州大学洛杉矶分校（UCLA）活动评分进行评估。结果66例（12.7%）膝关节修复，总生存率86.9%。最常见的翻修原因是关节炎进展，27例（40.9%）膝关节。基于术前髌股分级的Kaplan-Meier生存率无差异（p = 0.8047），两组间平均翻修时间相似（p = 0.6330）。当分析整个队列的结果时，从术前到术后活动范围（ROM）（p = 0.0002）和膝关节协会疼痛、临床和功能评分(均p <；0.0001)。结论：本研究表明，在长期随访中，基于术前放射照相PFJ关节炎状态的种植体总体存活率或患者报告的预后评分没有显著差异。因此，髌骨股骨关节的x线表现不应成为考虑患者内侧UKA的决定因素。

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Minimum 10-year follow-up of mobile bearing medial unicompartmental arthroplasty: Does the presence of preoperative radiographic patellofemoral arthritis influence patient outcomes?

Background

Medial unicompartmental knee arthroplasty (UKA) has become an accepted means of treating end stage anteromedial osteoarthritis of the knee. However, the presence of patellofemoral osteoarthritis on preoperative radiographs has proven to be confusing for orthopaedic surgeons in terms of candidacy for unicompartmental arthroplasty. The purpose of this study is to assess whether the presence of preoperative radiographic patellofemoral joint (PFJ) arthritis influences implant survivability or clinical outcomes at minimum 10-year follow-up.

Methods

Preoperative radiographs of 502 knees treated between 2004 and 2010 with medial mobile-bearing UKA and minimum 10-year follow-up (mean 13.3 years ± 2.0) were assessed by an observer blinded to the clinical outcome, and the patellofemoral joint (PFJ) was graded using the modified Altman classification. In the analyzed cohort there were 310 (61.8 %) grade 0, 135 (26.9 %) grade 1, 51 (10.2 %) grade 2, and 6 (1.2 %) grade 3 knees. Clinical outcomes were assessed using Knee Society pain, clinical and functional scores, and the University of California Los Angeles (UCLA) activity rating.

Results

There were 66 (12.7 %) knees revised for overall survival of 86.9 %. The most common reason for revision was arthritic progression, in 27 (40.9 %) knees. There was no difference in Kaplan-Meier survival based on preoperative patellofemoral grade (p = 0.8047) and mean time to revision was similar between groups (p = 0.6330). When analyzing outcomes for the entire cohort there was significant improvement from preoperative to postoperative range of motion (ROM) (p = 0.0002) and Knee Society pain, clinical, and functional scores (all p < 0.0001).

Conclusions

This study demonstrates that at long term follow-up there is not a significant difference in overall implant survival or patient reported outcome scores based upon preoperative radiographic PFJ arthritic state. Thus, the radiographic appearance of the patellofemoral joint alone should not be a deciding factor when considering patients as candidates for medial UKA.

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来源期刊

Journal of Clinical Orthopaedics and Trauma Medicine-Orthopedics and Sports Medicine

CiteScore

4.30

自引率

0.00%

发文量

181

审稿时长

92 days

期刊介绍： Journal of Clinical Orthopaedics and Trauma (JCOT) aims to provide its readers with the latest clinical and basic research, and informed opinions that shape today''s orthopedic practice, thereby providing an opportunity to practice evidence-based medicine. With contributions from leading clinicians and researchers around the world, we aim to be the premier journal providing an international perspective advancing knowledge of the musculoskeletal system. JCOT publishes content of value to both general orthopedic practitioners and specialists on all aspects of musculoskeletal research, diagnoses, and treatment. We accept following types of articles: • Original articles focusing on current clinical issues. • Review articles with learning value for professionals as well as students. • Research articles providing the latest in basic biological or engineering research on musculoskeletal diseases. • Regular columns by experts discussing issues affecting the field of orthopedics. • "Symposia" devoted to a single topic offering the general reader an overview of a field, but providing the specialist current in-depth information. • Video of any orthopedic surgery which is innovative and adds to present concepts. • Articles emphasizing or demonstrating a new clinical sign in the art of patient examination is also considered for publication. Contributions from anywhere in the world are welcome and considered on their merits.