单间室膝关节置换术进展

单间室膝关节置换术（UKA）是指单纯置换膝关节内侧或外侧胫股关节面的手术。针对单间室膝骨性关节炎它是有效治疗方法,同时也是全膝关节置换术（TKA）或高位胫股截骨术（HT0）的有效替代方法。随着手术指征的认识、假体设计的完善、手术技巧的改进．UKA取得满意的临床效果,中远期假体生存率与TKA相近。微创概念、计算机导航、机器人辅助等新技术的应用,使UKA的优越性得到明显体现,受到越来越多的关注。本文就目前UKA适应证、禁忌证、手术新进展及与TKA、HTO相比的优缺点进行综述。     

膝关节单髁置换术研究进展

目的总结膝关节单髁置换术(unicompartmental knee arthroplasty,UKA)的临床应用及研究进展。方法广泛查阅近年国内外UKA相关文献,从UKA新出现的手术指征、假体类型选择、与其他术式对比以及最新进展等方面进行总结分析。结果临床研究表明UKA具有创伤小、恢复快、术后并发症少等诸多优点。目前该手术适应证有所扩展,体质量指数>25 kg/m^2、年龄<60岁、髌股关节炎及前交叉韧带功能不良不再属于手术禁忌证。UKA术中假体类型的选择需要充分考虑患者情况。近年,临床逐渐开展的机器人辅助UKA可有效改善手术疗效,提高患者术后满意度,降低术后并发症。结论随着手术技术、假体材料及机器人技术的发展,UKA临床应用会更广泛,但目前大多为短、中期随访研究,需要进一步观察长期随访结果以指导临床实践。     

单髁与全膝关节置换术治疗膝单间室骨关节炎的早期疗效比较

目的 比较单髁膝关节置换术(UKA)与全膝关节置换术(TKA)治疗膝单间室骨关节炎的早期疗效。方法 将156例膝单间室骨关节炎患者根据手术方式不同分为UKA组(64例，采用UKA治疗)和TKA组(92例，采用TKA治疗)。记录两组围手术期相关指标，采用疼痛VAS评分、HSS评分评价膝关节疼痛和功能改善情况，术后3个月记录膝关节活动度和负重情况。结果 患者均获得随访，时间3～12个月。血红蛋白及红细胞比容：术后第1、3天TKA组均显著低于UKA组(P<0.05)。总失血量、住院时间、术后输血率、深静脉血栓形成发生率：UKA组均少(低)于TKA组(P<0.05)。疼痛VAS评分：术后3 d两组比较差异无统计学意义(P>0.05)。HSS评分：术后3个月UKA组高于TKA组(P<0.01)。术后3个月，膝关节屈曲活动度UKA组大于TKA组(P<0.05),伸直活动度两组比较差异无统计学意义(P>0.05);两组患者均可全负重站立、正常行走，无需助行器辅助。结论 UKA和TKA治疗膝单间室骨关节炎均可获得显著效果，但UKA手术创伤小、安全性高，更利于患者术后...     

TKA术后早期非感染性失败的原因分析

全膝关节置换术（total knee arthroplasty,TKA）能明显减轻患者疼痛,改善关节功能,目前许多研究报道TKA术后10～15年的患者满意度及假体生存率均高于90％。但是仍有部分患者术后早期效果不令人满意,术后2～5年内即出现失败,需要进行翻修手术。TKA术后早期失败原因中,     

单髁置换术与全膝关节置换术治疗膝单间室骨性关节炎的疗效比较

目的比较单髁置换术(UKA)与全膝关节置换术(TKA)治疗单间室膝关节骨性关节炎(KOA)的疗效。方法笔者自2010-01—2014-04诊治56例单间室重度KOA,将30例接受TKA治疗的患者纳入TKA组,26例接受UKA治疗的患者纳入UKA组,比较2组的临床疗效。结果 2组并发症发生率比较差异无统计学意义(χ~2=0.219,P=0.982);UKA组术中出血量明显少于TKA组,术后膝关节主动屈曲至90°时间短于TKA组,差异均有统计学意义(P0.05);术后1年,2组膝关节屈曲角度及HSS评分均较术前明显增高,组内比较差异均有统计学意义(P0.05),2组HSS评分比较差异无统计学意义(P0.05),但UKA组膝关节屈曲角度明显大于TKA组,差异有统计学意义(P0.05)。结论 UKA与TKA治疗膝关节单间室骨性关节炎均能够有效改善患者膝关节功能,但UKA术中创伤小,更有利于患者术后的恢复。     

机器人辅助全膝关节置换术的利弊

全膝关节置换术(TKA)可改善患者功能,提高患者生活质量。然而,仍有较多患者对手术效果不满意。与传统TKA相比,机器人辅助TKA可以提高骨切除的准确性,减少医源性骨和关节周围软组织损伤,提高患者术后满意度。但是,机器人辅助TKA也存在设备成本高昂、软件需要更新、额外辐射暴露、手术时间增加等问题。该文对机器人辅助TKA的利弊进行综述。     

机器人辅助单髁膝关节置换术安全吗? 一项病例对照研究

正作者分析了200膝(175例患者)机器人辅助单髁膝关节置换术和191膝(179例患者)传统单髁膝关节置换术患者资料。随访至少1年。翻修率机器人辅助组为4%,传统组为11%。不换假体的再手术率两组相仿(7.3%vs8.6%)。关节僵硬与感染率两组无差异。没有发现与机器人设备使用相关的并发症。KSS评分机器人辅助组优于传统组。两组患者满意率和对侧骨性关节炎发生率无差异。因此作者认为,机器人辅助单髁膝关节置换术的近期翻修率比较低。     

计算机导航及机器人技术辅助膝关节单髁置换术的研究进展

目的总结计算机导航及机器人技术在膝关节手术中的分类,以及辅助膝关节单髁置换术(unicompartmental knee arthroplasty,UKA)的发展、手术适应证和禁忌证、临床疗效及最新进展。方法广泛查阅计算机导航及机器人技术辅助UKA的相关文献,并进行研究和总结分析。结果近年来UKA在治疗单间室膝关节骨性关节炎方面取得了令人满意的效果,随着计算机导航及手术机器人技术的飞速发展并逐渐与临床相结合,计算机导航及机器人技术联合UKA大大提高了术中截骨的精度及假体植入准确率,术后功能恢复良好的同时明显提高了单髁假体的使用寿命。结论计算机导航及机器人技术辅助UKA较传统UKA提高了假体植入精确度,术后早期疗效满意,但长期疗效仍有待进一步观察。     

单髁关节置换治疗膝骨关节炎进展

正单髁置换术(unicondylar knee arthroplasty,UKA)是治疗单间室膝关节病变的一种方法,与全膝关节置换(total knee arthroplasty,TKA)同时始于20世纪70年代初期。TKA由于其良好的疗效,已经成为一种治疗晚期膝关节疾病的有效方法,而早期UKA由于外科技术不成熟、患者选择不当以及假体设计等因素发展较慢。目前,尽管有学者报道TKA生存率高于UKA[1],但是随着UKA被重新认识,正     

单髁置换术与全膝关节置换术治疗膝关节内侧间室骨性关节炎的疗效比较

目的比较分析单髁置换术与全膝关节置换术治疗膝关节内侧间室骨性关节炎的疗效。方法回顾性分析自2018-01—2019-03诊治的50例膝关节内侧间室骨性关节炎(Ahlback 3、4期)。25例采用单髁置换术治疗(UKA组),25例采用全膝关节置换术治疗(TKA组)。比较2组恢复直腿抬高时间、恢复屈膝90°时间,以及术后2周、3个月、12个月疼痛VAS评分、膝关节HSS评分、膝关节活动度。结果 50例均获得随访,随访时间平均18.6(12～24)个月。术后无感染、深静脉血栓形成、假体松动、假体周围骨折、内衬脱位等并发症发生。UKA组恢复直腿抬高时间、恢复屈膝90°时间短于TKA组,术后2周时膝关节HSS评分、膝关节活动度、疼痛VAS评分均优于TKA组,差异有统计学意义(P0.05);UKA组与TKA组术后3个月、12个月膝关节HSS评分、膝关节活动度、疼痛VAS评分差异无统计学意义(P0.05)。结论单髁置换术与全膝关节置换术治疗膝关节内侧间室骨性关节炎均可取得满意疗效,而单髁置换术创伤更小,患者术后康复更快,但适应证也更为严格。     

Bone Loss During Revision of Unicompartmental to Total Knee Arthroplasty : An Analysis of Implanted Polyethylene Thickness From the National Joint Registry Data

Using the National Joint Registry (UK) database, we compared the thickness of polyethylene (PE) and the level of constraint used during primary total knee arthroplasty (TKA) versus the revision of unicondylar knee arthroplasty (UKA) to TKA. A total of 251,803 TKA procedures and 374 revision UKA–TKA procedures between 2003 and 2009 were reviewed. The commonest PE size used in TKA was 10 mm, compared to 12.79 mm in the revision group. The use of constrained knee implant was required in 2.15% of primary TKA and 4.19% of UKA to TKA revisions. The revision of UKA to TKA is a more complex procedure compared to primary TKA, with a higher incidence of using constrained implants and thicker PE inserts. These findings may be useful for surgeons in their decision making.     

Disease Progression After Unicompartmental Arthroplasty: Add a Compartment or Revise to Total Knee Arthroplasty?

BackgroundFive percent to 7% of unicompartmental knee arthroplasties (UKA) require revision for disease progression in untreated compartment(s), most commonly to total knee arthroplasty (TKA). TKA requires removal of bone and usually the anterior cruciate ligament. Preserving the UKA and converting to a bicompartmental arthroplasty (BCA) by performing a second UKA is an alternative.MethodsThe results of 73 UKA-BCA patients were compared to 75 patients treated by UKA-TKA revision. Knee Society, Knee Osteoarthritis Outcome Score Joint Replacement, and patient satisfaction scores were collected by a blinded therapist. Patients were asked about their implant preference and recovery. Twenty-two UKA-BCA revision patients had a UKA (6) or TKA (16) in the contralateral knee; thus, a direct comparison of UKA-BCA to both UKA and TKA was possible.ResultsOf the UKA-BCA patients, 69 (94%) had excellent or good, 2 (3%) fair, and 2 (3%) poor outcomes with 1 patient requiring revision to TKA. Of patients with a TKA in the contralateral knee, 13 (81%) preferred the UKA-BCA replacement and 3 (19%) preferred the TKA. All patients said the UKA-BCA revision recovery was similar or easier than their initial UKA. Of UKA-TKA revisions, 59 (79%) had excellent or good, 9 (12%) fair, and 7 (9%) poor outcomes. There was 1 wound infection and 1 re-revision in the UKA-BCA group and 1 wound infection and 3 re-revisions in the UKA-TKA group. The Knee Osteoarthritis Outcome Score Joint Replacement and Knee Society Scores were better for UKA-BCA compared to UKA-TKA.ConclusionUKA-BCA is a successful treatment for disease progression following UKA.     

TKA is More Durable Than UKA for Morbidly Obese Patients: A Two-Year Minimum Follow-Up Study

BackgroundUnicompartmental knee arthroplasty (UKA) indications have expanded during the past two decades to include some morbidly obese patients (body mass index (BMI) > 40 kg/m²). Few published studies have compared UKA and total knee arthroplasty (TKA) in this unique patient subgroup with conflicting observations.MethodsWe retrospectively compared 89 mobile bearing UKA (71 patients) and 201 TKA (175 patients) performed at a single institution with a minimum 2-year follow-up (mean 3.4 years). Demographic characteristics were similar for both patient cohorts. A detailed medical record review was performed to assess the frequency of component revision, revision indications, minor secondary procedures (components retained), and infections.ResultsUKA was more frequently associated with clinical failure (29.2% vs 2.5%, P < .001) and component revision (15.7% vs 2.5%, P < .001), TKA was more frequently associated with extensor mechanism complications or knee manipulation (5.5% vs 0.0%, P = .02), and there was no difference in the infection rate (3.0% vs 2.2%, P = 1.0).ConclusionEarly complications were lower following UKA but were outweighed by higher component revision rates for arthritis progression and implant failure. The study findings suggest that TKA provides a more predictable mid-term outcome for morbidly obese patients considering knee arthroplasty surgery.     

Revision after total knee arthroplasty and unicompartmental knee arthroplasty in the medicare population

This study compares the relative risk of revision and associated risk factors after total or unicompartmental knee arthroplasty (TKA or UKA) in the Medicare population. A total of 61 767 TKA and 2848 UKA patients were identified. Reviewed data included type of treatment, gender, age, race, Charlson Index for comorbidity, length of stay, Medicare buy-in for socioeconomic status, region, and year. Unicompartmental knee arthroplasty patients were at increased risk for revision at 2 and 5 years. Those patients undergoing UKA were significantly more likely to require revision in the first 5 years as compared with those undergoing TKA. Risk factors contributing to TKA revision included younger male patients with higher comorbidities and lower socioeconomic status. About UKA, lower revision rates tend to favor those surgeons with higher volume.     

Pros and Cons: A Balanced View of Robotics in Knee Arthroplasty

In both unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA), compared with conventional techniques robotic technology has been shown to optimize the precision of bone preparation and component alignment, reducing outliers and increasing the percentage of components aligned within 2° or 3° of the target goal. In addition, soft tissue balance can be quantified through a range of motion in UKA and TKA using the various robotic technologies available. Although the presumption has been that the improved alignment associated with robotics will improve function and implant durability, there are limited data to support that notion. Based on recent and emerging data, it may be unreasonable to presume that robotics is necessary for both UKA and TKA. In fact, despite improvements in various proxy measures, the precision of robotics may be more important for UKA than TKA, although if system costs and surgical efficiencies continue to improve, streamlining perioperative processes, reducing instrument inventory, and achieving comparable outcomes in TKA may be a reasonable goal of robotic surgery.     

Unicompartmental knee arthroplasty for the treatment of unicompartmental osteoarthritis: a systematic study

Unicompartmental knee arthroplasty (UKA), total knee arthroplasty (TKA) and high tibial osteotomy (HTO) may all be used to treat unicompartmental osteoarthritis, but they are often used for different patient groups. However, there is considerable overlap in indications for all three options. The aim of this review was to assess the safety and efficacy of UKA compared with TKA and HTO in unicompartmental osteoarthritis. Studies that compared UKA with either TKA or HTO were identified and included for review. For knee function and postoperative pain, UKA appeared similar to TKA and HTO at 5 years follow up. Range of motion was better in UKA compared with TKA. Complication rates after UKA and TKA appeared similar, although deep vein thrombosis was reported more often after TKA. There were more complications after HTO than UKA. Survival of UKA prostheses was approximately 85-95%, compared with at least 90% for TKA at 10 years follow up. Survivorship for HTO appeared to be less than 85%. It was not clear whether there were more revisions after UKA than TKA, but there appeared to be fewer revisions in UKA compared with HTO. UKA is considered at least as safe as TKA and HTO. For function, UKA appears to be at least as efficacious as TKA and HTO. The survival of UKA compared with TKA and HTO cannot be determined based on the available evidence.     

Osteotomy and Unicompartmental Knee Arthroplasty Converted to Total Knee Arthroplasty : Data From the New Zealand Joint Registry

We reviewed the revision rate and functional outcome of all patients who had a total knee arthroplasty (TKA) after an osteotomy or unicompartmental knee arthroplasty (UKA) on the New Zealand Joint Registry. We used these data to compare the results with primary TKA scores, including comparison of age-matched subgroups. There were 711 patients who had undergone TKA as salvage for a failed osteotomy with a revision rate of 1.33 per 100 component years and a mean 6-month Oxford Knee Score (OKS) of 36.9. There were 205 patients who had a failed UKA converted to TKA with a revision rate of 1.97 per 100 component years and a mean OKS of 29.1. The revision rates of TKA for both failed osteotomy and failed UKA were significantly poorer than after primary TKA (0.48 per 100 component years). The mean OKS after revision of a UKA was significantly poorer than both primary TKA and TKA for a failed osteotomy. There was no significant difference in mean OKS between primary TKA and TKA for a failed osteotomy, even among patients younger than 65 years. Revision of a failed osteotomy to a TKA has improved functional results compared with revision of a failed UKA. However, both yield poorer survivorship rates compared with primary TKA.     

Long-Term Survival of Semi-Constrained Total Knee Arthroplasty for Revision Surgery

Semi-constrained implants provide stability in the setting of soft-tissue deficiency in revision total knee arthroplasty (TKA). This study evaluated our institution’s long-term survival results with a semi-constrained implant used in the revision TKA setting. 234 semi-constrained revision total knee arthroplasties were performed in 209 patients. The average follow-up was 9 years. Forty repeat revisions were performed. 5-year survival was 91% and 10-year survival was 81%. Male gender significantly increased the risk of revision. At 10 years the average range of motion, pain level, and Knee Society score improved significantly (P < 0.001). Ninety percent of patients reported an improvement in their knee. The semi-constrained implant used in revision knee arthroplasty has acceptable implant survival and functional outcomes in the long-term follow-up period.     

Unicompartmental Knee Arthroplasty vs Total Knee Arthroplasty for Medial Compartment Arthritis in Patients Older Than 75 Years: Comparable Reoperation,Revision, and Complication Rates

Background

Prior studies comparing unicompartmental knee arthroplasty (UKA) with total knee arthroplasty (TKA) in the elderly are limited by heterogeneity in arthritic disease patterns and patient selection. We report the results of UKA and TKA in patients 75 years and older with isolated medial compartmental arthritis, with special emphasis on immediate postoperative recovery, complications, reoperation rates, and implant survivorship at midterm follow-up.