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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >Knee OUTcome Study: A Comparison of the Patient Perceived Outcome between High Tibial Osteotomy, Unicompartmental and Total Knee Arthroplasty for Medial Compartment Osteoarthitis in Men under age 55.
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Knee OUTcome Study: A Comparison of the Patient Perceived Outcome between High Tibial Osteotomy, Unicompartmental and Total Knee Arthroplasty for Medial Compartment Osteoarthitis in Men under age 55.

机译：膝关节预后研究：比较55岁以下男性内侧胫骨关节炎的高胫骨截骨术，单室和全膝关节置换术患者的预期结果。

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Objectives: Managing medial compartment osteoarthritis (OA) in the younger male patient is challenging because these patients tend to be physically high demand. Traditionally, High Tibial Osteotomy (HTO) has been the favoured surgical option, but Total (TKA) and Unicompartmental (UKA) knee arthroplasty have been more recently utilized. Our aims were to compare patient reported outcome, revision and reoperation rates with these 3 procedures. Methods: Using our hospital data bases we retrieved the details of male patients under 55 who had one of the 3 procedures performed between 2005-2013, for medial compartment OA by 6 knee surgeons in our group. All 6 surgeons used the 3 procedures in this cohort. The TKA database was analysed to exclude patients who did not meet the criteria for HTO/UKA of isolated medial OA. The 3 groups had their satisfaction assessed retrospectively using the Forgotten Joint Score (FJS), information on occupation, reoperation and duration of satisfaction were also questioned. Hospital records were reviewed for the reoperation and revision rate on all of the patients identified. Results: We identified 117 TKA in patients under 55, 27 TKA which met our criteria, 75 HTO (medial opening wedge) and 95 UKA (Oxford cementless). The mean followup periods for HTO/UKA/TKA were 8.1, 6.1, 7.5 years respectively. Of the HTO group, 19 (25%) were revised to TKA at a mean 4.8 years, 8 underwent reoperation for malonunion, and 10 had reoperation for fixation issues. Overall a reoperation rate of 50% and projected 10 year survivorship of 58% for HTO. Of the UKA group, there was 1 revision to TKA at 1 year for tibial component loosening and 3 reoperations for bearing instability, retaining the primary implant. Reoperation rate 4% and projected 10 year survivorship 99%. Of the TKA group there were 2 revisions at 4 years for tibial component loosening, no non-revision reoperations, reoperation rate 7.5% with projected 10 year survivorship 92.5%. The Forgotten Joint Score results (0-100) were median 21 for HTO, 38 for TKA, 67 for UKA. All comparisons between the three groups were significant. TKA vs HTO p value 0.04 (CI 0.67-36.54), UKA vs TKA p value 0.02 (CI 2.26-35.58), UKA vs HTO p value 0.00001 (CI 25.36-49.68). Further analysis of the HTO cohort revealed that 75% of the unrevised cases considered the benefit of the index procedure had expired at a mean 3.1 years, yet they had not sought further surgery, despite a mean FJS of only 18 in this subgroup. Conclusion: In this retrospective cohort study with medium term followup of 3 procedures performed by 6 knee surgeons, patients were highly matched by virtue of gender (male), age (<55 years), activity level (Tegner scores), pathology (isolated medial compartment OA). Regarding survivorship of the index procedure, the outcome for Osteotomy was poor with 58% at 10 yrs and high reoperation/complication rate of 50% at mean 4.8 years. The best survivorship/reoperation rates were in the UKA group (99% and 4% respectively). Regarding patient reported outcome using Forgotten Joint Score, comparison between all groups favoured UKA. The comparison between UKA and Osteotomy was so powerful, as to render the p value almost unmeasureable (0.00001). Unrevised Osteotomy patients reported disappointing duration of benefit (mean 3.1 years), and low FJS (mean 18), but hadn’t sought further surgery. A further example that revision rates are not a good indicator of outcome, especially for Osteotomy. Our study demonstrates that at medium term followup, cementless Oxford UKA provides the best outcome with respect to patient satisfaction, function and survivorship compared to Osteotomy and TKA in men under 55 yrs with medial compartment osteoarthritis.
机译：目的：在年轻男性患者中管理内侧腔室骨关节炎（OA）具有挑战性，因为这些患者的身体素质往往较高。传统上，高胫骨截骨术（HTO）一直是首选的外科手术选择，但是Total（TKA）和Unicompartmental（UKA）膝关节置换术最近得到了广泛应用。我们的目的是比较这3种方法对患者报告的结果，修订和再次手术率。方法：使用我们的医院数据库，我们检索了55名年龄在55岁以下的男性患者的详细信息，这些患者在2005年至2013年之间进行了3组手术中的一项，由我们的6名膝关节外科医生进行。所有6位外科医生在该队列中均使用了3种程序。分析了TKA数据库，以排除不符合孤立内侧OA HTO / UKA标准的患者。使用“被遗忘的关节评分”（FJS）对这三组患者的满意度进行了回顾性评估，还询问了有关职业，再次手术和满意度持续时间的信息。复查了医院记录中所有确定的患者的再手术率和翻修率。结果：我们在55岁以下的患者中确定了117个TKA，27个符合我们标准的TKA，75个HTO（内侧开口楔形）和95个UKA（牛津无骨水泥）。 HTO / UKA / TKA的平均随访期分别为8.1、6.1、7.5年。在HTO组中，平均4.8年将19例（25％）改正为TKA，其中8例因畸形/不愈合而接受了再手术，而10例因固定问题进行了再手术。总体而言，HTO的再手术率为50％，预计10年生存率将为58％。在UKA组中，在1年时对TKA进行了1次翻修，以放松胫骨组件，并进行了3次再次手术，以保持关节不稳，保留了主要植入物。再次手术率4％，预计10年生存率99％。在TKA组中，胫骨组件松动在4年内进行了2次修订，无未修订的再次手术，再手术率为7.5％，预计10年生存率为92.5％。被遗忘的联合评分结果（0-100）为HTO中位数21，TKA为38，UKA为67。三组之间的所有比较都是有意义的。 TKA vs HTO p值0.04（CI 0.67-36.54），UKA vs TKA p值0.02（CI 2.26-35.58），UKA vs HTO p值0.00001（CI 25.36-49.68）。对HTO队列的进一步分析表明，认为该索引程序获益的未修订病例中，有75％的平均寿命为3.1年，但他们并未寻求进一步的手术，尽管该亚组的平均FJS只有18岁。结论：在这项回顾性队列研究中，由6名膝关节外科医生进行了3次手术的中期随访，患者在性别（男性），年龄（<55岁），活动水平（Tegner评分），病理学（孤立的内侧OA）。关于指数程序的生存率，截骨术的结果很差，在10年时为58％，在平均4.8年时的再手术/并发症发生率高达50％。存活率/再手术率最高的是UKA组（分别为99％和4％）。关于患者使用“遗忘关节评分”报告的结局，所有组之间的比较均支持UKA。 UKA和截骨术之间的比较是如此强大，以至于p值几乎无法测量（0.00001）。未经修订的截骨术患者报告受益期令人失望（平均3.1年），FJS偏低（平均18岁），但未寻求进一步手术。另一个例子是翻修率不是预后的良好指标，尤其是对于截骨术。我们的研究表明，相比于截骨术和TKA，在55岁以下患有内侧间隔性骨关节炎的男性中，在中期随访中，非骨水泥牛津UKA在患者满意度，功能和生存率方面提供了最佳结果。

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