Unicompartmental knee arthroplasty versus total knee arthroplasty in the same patient with bilateral unicompartment knee osteoarthritis

doi:10.3969/j.issn.2095-4344.0028

Abstract

Abstract:

BACKGROUND: In the treatment of unicompartmental knee osteoarthritis, unicompartmental knee arthroplasty (UKA) has the advantages of less blood loss, less trauma, quick recovery, maximum retention of bone mass, low cost, few complications and high patient satisfaction. However, it has not been extensively accepted by orthopedic surgeons.

OBJECTIVE: To investigate the clinical effect and imaging changes of UKA versus total knee arthroplasty (TKA) in the same patient with bilateral unicompartment knee osteoarthritis.

METHODS: A total of 38 patients with bilateral unicompartment knee osteoarthritis undergoing UKA and TKA were selected, and all the cases were performed by the same surgeon. Among them, 10 cases were replaced at the same time, and 28 cases were in staging surgery. The clinical data of the patients were collected, including the preoperative and postoperative Knee Society Score sores, the range of motion of the knee, and limb alignment, and postoperative complications. Comparison between bilateral knee joints was conducted by paired t test.

RESULTS AND CONCLUSION: (1) All patients were followed up for 3-36 months, and no aseptic prosthesis loosening, unexplained pain or other complications occurred. (2) The postoperative Knee Society Score sores in UKA and TKA were significantly higher than those before surgery, and the scores did not differ significantly between UKA and TKA at each time point (P > 0.05). (3) The range of motion of the knee in the UKA group was significantly larger than that in the TKA group at the last follow-up postoperatively (P < 0.05). (4) The limb alignment was improved in both groups, which showed no significant difference at different time points (P > 0.05). (5) Totally 20 patients felt preference for UKA, 18 patients preferred TKA, and most patients were satisfied with the surgical efficacy. (6)There were no significant differences in the Knee Society Score, range of motion of the knee, hip-knee-ankle angle and femorotibial angle at the last follow-up between staging and same time arthroplasties. (7)These findings imply that for patients with bilateral unicompartment knee osteoarthritis, both UKA and TKA can correct the lower limb force line, correct the limb alignment similarly, but UKA holds advantages in less trauma, high patient’s satisfaction, and good functional recovery, so it should be selected firstly. Notably, staging or same time surgery makes no effect on the clinical effectiveness.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Osteoartheitis, Arthroplasty, Replacement, Knee, Tissue Engineering

CLC Number:

R318

Lu Ming-feng, Li Ze-hui, Zhu Dong-ping, Cao Xue-wei, Niu Wei. Unicompartmental knee arthroplasty versus total knee arthroplasty in the same patient with bilateral unicompartment knee osteoarthritis [J]. Chinese Journal of Tissue Engineering Research, 2018, 22(3): 343-349.

Figures/Tables 3

2.1 参与者数量分析按意向性处理，纳入同一患者膝单间室关节炎单髁置换和全膝关节置换治疗的患者38例，术后全部获得随访，无脱落。试验流程图见图2。 2.2 随访时间及不良事件术后随访3-36个月，所有病例双膝均未发生无菌性假体松动、不明原因疼痛等并发症。 2.3 总体疗效比较单髁置换膝与全膝关节置换膝KSS临床评分均比术前明显升高(P < 0.05)；术前单髁置换膝和全膝关节置换膝KSS临床评分相比差异无显著性意义(t=1.905 1，P > 0.05)；单髁置换膝和全膝关节置换膝末次随访KSS临床评分相比，差异亦无显著性意义(t=0.931 5，P > 0.05)；单髁置换膝与全膝关节置换膝KSS功能评分均比术前明显升高(P < 0.05)；术前单髁置换膝和全膝关节置换膝KSS功能评分相比差异无显著性意义(t=0.339，P > 0.05)；单髁置换膝和全膝关节置换膝末次随访KSS功能评分相比，差异亦无显著性意义(t=0.939，P > 0.05)；单髁置换能获得比全膝关节置换膝更大的膝关节活动度，术后末次随访时单髁置换膝和全膝关节置换膝活动度差异有显著性意义(t=9.190，P < 0.05)，见表1。下肢力线均得到矫正，术前术后单髁置换膝和全膝关节置换膝胫股角和髋膝踝角比较，差异均无显著性意义 (P > 0.05)，见表2。 20例患者觉得偏爱单髁置换，18例患者偏爱全膝关节置换；大部分患者对于置换术后双膝感觉满意或者非常满意，见表3。 2.4 同一患者双膝同期及分期手术的疗效比较本组患者双膝同期置换10例，分期置换28例。根据统计(表4)，同期与分期行单髁和全膝置换的患者术后末次随访时KSS临床评分、KSS功能评分、膝关节活动度、髋膝踝角、胫股角相比较，差异均无显著性意义(P > 0.05)。 2.5 典型病例典型病例1：女性患者，54岁，双膝疼痛、活动受限10余年，加重3个月，左膝内侧单间室、髌骨关节疼痛明显，右膝以内侧疼痛为主，行同期右侧全膝关节置换术+左膝单髁置换术，双侧下肢力线矫正角度好，术后患者右膝关节伸直和屈曲较左膝差，患者对左膝单髁置换较满意，见图3。典型病例2：女性患者，54岁，双膝疼痛、活动受限5余年，加重1个月，左膝行全膝关节置换，右侧LINK单髁置换术，分期手术。双侧下肢力线矫正角度好，术后患者左膝关节伸直和屈曲较右膝差，患者对右膝单髁置换较满意，见图4。 "

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