单髁关节置换术治疗膝骨关节炎的研究进展
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摘要
单髁关节置换术(UKA)是治疗单间室骨关节炎(OA)的重要手段。UKA主要适用于60岁以上膝关节轻中度畸形、体重较轻的单间室病变患者。近年来,越来越多的研究发现肥胖、髌股关节退行性变、前后交叉韧带损伤等并非UKA绝对禁忌证,使得其临床适应证进一步扩大。虽然UKA存在操作复杂、翻修率高等问题,但与胫骨高位截骨术(HTO)相比,UKA的术后疗效显著且持久;而与全膝关节置换术(TKA)相比,UKA的发展更为迅速;UKA联合运动疗法及关节镜清理术亦受到广大骨科医师的重视。本文就UKA治疗单间室OA的最新研究进展作一综述。
Unicompartmental knee arthroplasty(UKA) is commonly used for the treatment of unicompartmental osteoarthritis of the knee. UKA is mainly performed in patients older than 60 years, with mild to moderate deformities of the knee and single compartment lesions with less body weight. Recently, more studies found that obesity, patellofemoral joint degeneration, and anterior cruciate ligament injury are not absolutely contraindicated in UKA, which makes its clinical indications expand larger.Although UKA has some problems as complicated operation and high revision rate, compared with high tibial osteotomy(HTO), UKA shows a significant and long-term effect; while compared with TKA, UKA has considerable advantages of less trauma, greater effect and quicker postoperative recovery. With the development of minimally invasive UKA and the application of computer-aided navigation technology, UKA rapidly develops; also, UKA combined with exercise therapy and arthroscopic debridement is highly evaluated by orthopedic surgeons. This article summarized the latest research progress of UKA in the treatment of unicompartmental osteoarthritis of the knee.
Unicompartmental knee arthroplasty(UKA) is commonly used for the treatment of unicompartmental osteoarthritis of the knee. UKA is mainly performed in patients older than 60 years, with mild to moderate deformities of the knee and single compartment lesions with less body weight. Recently, more studies found that obesity, patellofemoral joint degeneration, and anterior cruciate ligament injury are not absolutely contraindicated in UKA, which makes its clinical indications expand larger.Although UKA has some problems as complicated operation and high revision rate, compared with high tibial osteotomy(HTO), UKA shows a significant and long-term effect; while compared with TKA, UKA has considerable advantages of less trauma, greater effect and quicker postoperative recovery. With the development of minimally invasive UKA and the application of computer-aided navigation technology, UKA rapidly develops; also, UKA combined with exercise therapy and arthroscopic debridement is highly evaluated by orthopedic surgeons. This article summarized the latest research progress of UKA in the treatment of unicompartmental osteoarthritis of the knee.
引文
[1]Tang X,Wang S,Zhan S,et al.The prevalence of symptomatic knee osteoarthritis in China:results from the China health and retirement longitudinal study.Arthritis Rheumatol,2016,68(3):648-653.
[2]Kozinn SC,Scott R.Unicondylar knee arthroplasty.J Bone Joint Surg Am,1989,71(1):145-150.
[3]Borus T,Thornhill T.Unicompartmental knee arthroplasty.JAm Acad Orthop Surg,2008,16(1):9-18.
[4]Cao Z,Mai X,Wang J,et al.Unicompartmental knee arthroplasty vs high tibial osteotomy for knee osteoarthritis:a systematic review and meta-analysis.J Arthroplasty,2018,33(3):952-959.
[5]Pollock M,Somerville L,Firth A,et al.Outpatient total hip arthroplasty,total knee arthroplasty,and unicompartmental knee arthroplasty.JBJS Rev,2016,4(12):1.
[6]Kuipers BM,Kollen BJ,Kaijser Bots PC,et al.Factors associated with reduced early survival in the Oxford phase IIImedial unicompartment knee replacement.Knee,2010,17(1):48-52.
[7]Murray DW,Pandit H,Weston-Simons JS,et al.Does body mass index affect the outcome of unicompartmental knee replacement?Knee,2013,20(6):461-465.
[8]Boissonneault A,Pandit H,Pegg E,et al.No difference in survivorship after unicompartmental knee arthroplasty with or without an intact anterior cruciate ligament.Knee Surg Sports Traumatol Arthrosc,2013,21(11):2480-2486.
[9]Engh GA,Ammeen D.Is an intact anterior cruciate ligament needed in order to have a well-functioning unicondylar knee replacement?Clin Orthop Relat Res,2004,(428):170-173.
[10]Weston-Simons JS,Pandit H,Jenkins C,et al.Outcome of combined unicompartmental knee replacement and combined or sequential anterior cruciate ligament reconstruction:a study of 52 cases with mean follow-up of five years.JBone Joint Surg Br,2012,94(9):1216-1220.
[11]Mancuso F,Hamilton TW,Kumar V,et al.Clinical outcome after UKA and HTO in ACL deficiency:a systematic review.Knee Surg Sports Traumatol Arthrosc,2016,24(1):112-122.
[12]Munk S,Odgaard A,Madsen F,et al.Preoperative lateral subluxation of the patella is a predictor of poor early outcome of Oxford phase-III medial unicompartmental knee arthroplasty.Acta Orthop,2011,82(5):582-588.
[13]Jeer PJ,Keene GC,Gill P.Unicompartmental knee arthroplasty:an intermediate report of survivorship after the introduction of a new system with analysis of failures.Knee,2004,11(5):369-374.
[14]Ollivier M,Abdel MP,Parratte S,et al.Lateral unicondylar knee arthroplasty(UKA):contemporary indications,surgical technique,and results.Int Orthop,2014,38(2):449-455.
[15]Harrington IJ.Static and dynamic loading patterns in knee joints with deformities.J Bone Joint Surg Am,1983,65(2):247-259.
[16]邬晓勇,刘玉杰,李众利,等.人工单髁置换治疗膝关节骨关节炎的应用进展.现代生物医学进展,2016,16(20):3977-3981.
[17]Cross MB,Berger R.Feasibility and safety of performing outpatient unicompartmental knee arthroplasty.Int Orthop,2014,38(2):443-447.
[18]Thienpont E.Conversion of a unicompartmental knee arthroplasty to a total knee arthroplasty.Bone Joint J,2017,99-B:65-69.
[19]van der List JP,Zuiderbaan HA,Pearle AD.Why do medial unicompartmental knee arthroplasties fail today?J Arthroplasty,2016,31(5):1016-1021.
[20]Koskinen E,Eskelinen A,Paavolainen P,et al.Comparison of survival and cost-effectiveness between unicondylar arthroplasty and total knee arthroplasty in patients with primary osteoarthritis:a follow-up study of 50493 knee replacements from the Finnish Arthroplasty Register.Acta Orthop,2008,79(4):499-507.
[21]Koskinen E,Eskelinen A,Paavolainen P,et al.Comparative analysis of the results obtained after unicondylar knee arthroplasty and high tibial osteotomy in isolated gonarthrosis.Folia Med(Plovdiv),2014,56(1):11-19.
[22]Fu D,Li G,Chen K,et al.Comparison of high tibial osteotomy and unicompartmental knee arthroplasty in the treatment of unicompartmental osteoarthritis:a meta-analysis.J Arthroplasty,2013,28(5):759-765.
[23]Petersen W,Metzlaff S.Open wedge high tibial osteotomy(HTO)versus mobile bearing unicondylar medial joint replacement:five years results.Arch Orthop Trauma Surg,2016,136(7):983-989.
[24]Nwachukwu BU,Mccormick FM,Schairer WW,et al.Unicompartmental knee arthroplasty versus high tibial osteotomy:United States practice patterns for the surgical treat‐ment of unicompartmental arthritis.J Arthroplasty,2014,29(8):1586-1589.
[25]Jeon YS,Ahn CH,Kim M.Comparison of HTO with articular cartilage surgery and UKA in unicompartmental OA.JOrthop Surg(Hong Kong),2017,25(1):2309499016684092.
[26]Krych AJ,Reardon P,Sousa P,et al.Unicompartmental knee arthroplasty provides higher activity and durability than valgus-producing proximal tibial osteotomy at 5 to 7years.J Bone Joint Surg Am,2017,99(2):113-122.
[27]Konopka JF,Gomoll AH,Thornhill TS,et al.The cost-effectiveness of surgical treatment of medial unicompartmental knee osteoarthritis in younger patients:a computer modelbased evaluation.J Bone Joint Surg Am,2015,97(10):807-817.
[28]Oh K,Kim YC,Lee JS,et al.Open-wedge high tibial osteotomy versus unicompartmental knee arthroplasty:no difference in progression of patellofemoral joint arthritis.Knee Surg Sports Traumatol Arthrosc,2017,25(3):767-772.
[29]Yim J,Song E,Seo H,et al.Comparison of High Tibial Osteotomy and Unicompartmental Knee Arthroplasty at a Minimum Follow-Up of 3 Years.J Arthroplasty,2013,28(2):243-247.
[30]Siman H,Kamath AF,Carrillo N,et al.Unicompartmental knee arthroplasty vs total knee arthroplasty for medial compartment arthritis in patients older than 75 years:comparable reoperation,revision,and complication rates.J Arthroplasty,2017,32(6):1792-1797.
[31]Shankar S,Tetreault MW,Jegier BJ,et al.A cost comparison of unicompartmental and total knee arthroplasty.Knee,2016,23(6):1016-1019.
[32]Zuiderbaan HA,van der List JP,Khamaisy S,et al.Unicompartmental knee arthroplasty versus total knee arthroplasty:Which type of artificial joint do patients forget?Knee Surg Sports Traumatol Arthrosc,2017,25(3):681-686.
[33]Kim MS,Koh IJ,Choi YJ,et al.Differences in patient-reported outcomes between unicompartmental and total knee arthroplasties:a propensity score-matched analysis.J Arthroplasty,2017,32(5):1453-1459.
[34]Kleeblad LJ,van der List JP,Zuiderbaan HA,et al.Larger range of motion and increased return to activity,but higher revision rates following unicompartmental versus total knee arthroplasty in patients under 65:a systematic review.Knee Surg Sports Traumatol Arthrosc,2018,26(6):1811-1822.
[35]Schwab PE,Lavand'homme P,Yombi JC,et al.Lower blood loss after unicompartmental than total knee arthroplasty.Knee Surg Sports Traumatol Arthrosc,2015,23(12):3494-3500.
[36]Song EK,N M,Lee S,et al.Comparison of outcome and survival after unicompartmental knee arthroplasty between navigation and conventional techniques with an average 9-year follow-up.J Arthroplasty,2016,31(2):395-400.
[37]Bell SW,Anthony I,Jones B,et al.Improved accuracy of component positioning with robotic-assisted unicompartmental knee arthroplasty.J Bone Joint Surg Am,2016,98(8):627-635.
[38]Burn E,Sanchez-Santos MT,Pandit HG,et al.Ten-year patientreported outcomes following total and minimally invasive unicompartmental knee arthroplasty:a propensity scorematched cohort analysis.Knee Surg Sports Traumatol Arthrosc,2018,26(5):1455-1464.
[39]Fransen M,Mcconnell S,Harmer AR,et al.Exercise for osteoarthritis of knee:a cochrane systematic review.Br JSports Med,2015,49(24):1554-1557.
[40]Walton NP,Jahromi I,Lewis PL,et al.Patient-perceived outcomes and return to sport and work:TKA versus mini-incision unicompartmental knee arthroplasty.J Knee Surg,2006,19(2):112-116.
[41]Ho JC,Stitzlein RN,Green CJ,et al.Return to sports activity following UKA and TKA.J Knee Surg,2016,29(3):254-259.
[42]Boissonneault A,Pandit H,Pegg E,et al.No difference in survivorship after unicompartmental knee arthroplasty with or without an intact anterior cruciate ligament.Knee Surg Sports Traumatol Arthrosc,2013,21(11):2480-2486.
[43]Lloyd JM,Watts MC,Stokes AP,et al.Medium term results of per-operative knee arthroscopy in confirming suitability for unicompartmental arthroplasty.Knee,2012,19(6):908-912.
[44]Lim JW,Cousins GR,Clift BA,et al.Oxford unicompartmental knee arthroplasty versus age and gender matched total knee arthroplasty-functional outcome and survivorship analysis.J Arthroplasty,2014,29(9):1779-1783.
[45]Liddle AD,Pandit H,Judge A,et al.Patient-reported outcomes after total and unicompartmental knee arthroplasty:a study of 14076 matched patients from the National Joint Registry for England and Wales.Bone Joint J,2015,97-B(6):793-801.
[46]Liddle AD,Pandit H,Judge A,et al.Optimal usage of unicompartmental knee arthroplasty:a study of 41 986 cases from the National Joint Registry for England and Wales.Bone Joint J,2015,97-B(11):1506-1511.
[47]Borrego Paredes E,Barrena Sánchez P,Serrano Toledano D,et al.Total knee arthroplasty after failed unicompartmental knee arthroplasty.Clinical results,radiologic findings,and technical tips.J Arthroplasty,2017,32(1):193-196.
[48]Pandit H,Mancuso F,Jenkins C,et al.Lateral unicompartmental knee replacement for the treatment of arthritis progression after medial unicompartmental replacement.Knee Surg Sports Traumatol Arthrosc,2017,25(3):669-674.
[2]Kozinn SC,Scott R.Unicondylar knee arthroplasty.J Bone Joint Surg Am,1989,71(1):145-150.
[3]Borus T,Thornhill T.Unicompartmental knee arthroplasty.JAm Acad Orthop Surg,2008,16(1):9-18.
[4]Cao Z,Mai X,Wang J,et al.Unicompartmental knee arthroplasty vs high tibial osteotomy for knee osteoarthritis:a systematic review and meta-analysis.J Arthroplasty,2018,33(3):952-959.
[5]Pollock M,Somerville L,Firth A,et al.Outpatient total hip arthroplasty,total knee arthroplasty,and unicompartmental knee arthroplasty.JBJS Rev,2016,4(12):1.
[6]Kuipers BM,Kollen BJ,Kaijser Bots PC,et al.Factors associated with reduced early survival in the Oxford phase IIImedial unicompartment knee replacement.Knee,2010,17(1):48-52.
[7]Murray DW,Pandit H,Weston-Simons JS,et al.Does body mass index affect the outcome of unicompartmental knee replacement?Knee,2013,20(6):461-465.
[8]Boissonneault A,Pandit H,Pegg E,et al.No difference in survivorship after unicompartmental knee arthroplasty with or without an intact anterior cruciate ligament.Knee Surg Sports Traumatol Arthrosc,2013,21(11):2480-2486.
[9]Engh GA,Ammeen D.Is an intact anterior cruciate ligament needed in order to have a well-functioning unicondylar knee replacement?Clin Orthop Relat Res,2004,(428):170-173.
[10]Weston-Simons JS,Pandit H,Jenkins C,et al.Outcome of combined unicompartmental knee replacement and combined or sequential anterior cruciate ligament reconstruction:a study of 52 cases with mean follow-up of five years.JBone Joint Surg Br,2012,94(9):1216-1220.
[11]Mancuso F,Hamilton TW,Kumar V,et al.Clinical outcome after UKA and HTO in ACL deficiency:a systematic review.Knee Surg Sports Traumatol Arthrosc,2016,24(1):112-122.
[12]Munk S,Odgaard A,Madsen F,et al.Preoperative lateral subluxation of the patella is a predictor of poor early outcome of Oxford phase-III medial unicompartmental knee arthroplasty.Acta Orthop,2011,82(5):582-588.
[13]Jeer PJ,Keene GC,Gill P.Unicompartmental knee arthroplasty:an intermediate report of survivorship after the introduction of a new system with analysis of failures.Knee,2004,11(5):369-374.
[14]Ollivier M,Abdel MP,Parratte S,et al.Lateral unicondylar knee arthroplasty(UKA):contemporary indications,surgical technique,and results.Int Orthop,2014,38(2):449-455.
[15]Harrington IJ.Static and dynamic loading patterns in knee joints with deformities.J Bone Joint Surg Am,1983,65(2):247-259.
[16]邬晓勇,刘玉杰,李众利,等.人工单髁置换治疗膝关节骨关节炎的应用进展.现代生物医学进展,2016,16(20):3977-3981.
[17]Cross MB,Berger R.Feasibility and safety of performing outpatient unicompartmental knee arthroplasty.Int Orthop,2014,38(2):443-447.
[18]Thienpont E.Conversion of a unicompartmental knee arthroplasty to a total knee arthroplasty.Bone Joint J,2017,99-B:65-69.
[19]van der List JP,Zuiderbaan HA,Pearle AD.Why do medial unicompartmental knee arthroplasties fail today?J Arthroplasty,2016,31(5):1016-1021.
[20]Koskinen E,Eskelinen A,Paavolainen P,et al.Comparison of survival and cost-effectiveness between unicondylar arthroplasty and total knee arthroplasty in patients with primary osteoarthritis:a follow-up study of 50493 knee replacements from the Finnish Arthroplasty Register.Acta Orthop,2008,79(4):499-507.
[21]Koskinen E,Eskelinen A,Paavolainen P,et al.Comparative analysis of the results obtained after unicondylar knee arthroplasty and high tibial osteotomy in isolated gonarthrosis.Folia Med(Plovdiv),2014,56(1):11-19.
[22]Fu D,Li G,Chen K,et al.Comparison of high tibial osteotomy and unicompartmental knee arthroplasty in the treatment of unicompartmental osteoarthritis:a meta-analysis.J Arthroplasty,2013,28(5):759-765.
[23]Petersen W,Metzlaff S.Open wedge high tibial osteotomy(HTO)versus mobile bearing unicondylar medial joint replacement:five years results.Arch Orthop Trauma Surg,2016,136(7):983-989.
[24]Nwachukwu BU,Mccormick FM,Schairer WW,et al.Unicompartmental knee arthroplasty versus high tibial osteotomy:United States practice patterns for the surgical treat‐ment of unicompartmental arthritis.J Arthroplasty,2014,29(8):1586-1589.
[25]Jeon YS,Ahn CH,Kim M.Comparison of HTO with articular cartilage surgery and UKA in unicompartmental OA.JOrthop Surg(Hong Kong),2017,25(1):2309499016684092.
[26]Krych AJ,Reardon P,Sousa P,et al.Unicompartmental knee arthroplasty provides higher activity and durability than valgus-producing proximal tibial osteotomy at 5 to 7years.J Bone Joint Surg Am,2017,99(2):113-122.
[27]Konopka JF,Gomoll AH,Thornhill TS,et al.The cost-effectiveness of surgical treatment of medial unicompartmental knee osteoarthritis in younger patients:a computer modelbased evaluation.J Bone Joint Surg Am,2015,97(10):807-817.
[28]Oh K,Kim YC,Lee JS,et al.Open-wedge high tibial osteotomy versus unicompartmental knee arthroplasty:no difference in progression of patellofemoral joint arthritis.Knee Surg Sports Traumatol Arthrosc,2017,25(3):767-772.
[29]Yim J,Song E,Seo H,et al.Comparison of High Tibial Osteotomy and Unicompartmental Knee Arthroplasty at a Minimum Follow-Up of 3 Years.J Arthroplasty,2013,28(2):243-247.
[30]Siman H,Kamath AF,Carrillo N,et al.Unicompartmental knee arthroplasty vs total knee arthroplasty for medial compartment arthritis in patients older than 75 years:comparable reoperation,revision,and complication rates.J Arthroplasty,2017,32(6):1792-1797.
[31]Shankar S,Tetreault MW,Jegier BJ,et al.A cost comparison of unicompartmental and total knee arthroplasty.Knee,2016,23(6):1016-1019.
[32]Zuiderbaan HA,van der List JP,Khamaisy S,et al.Unicompartmental knee arthroplasty versus total knee arthroplasty:Which type of artificial joint do patients forget?Knee Surg Sports Traumatol Arthrosc,2017,25(3):681-686.
[33]Kim MS,Koh IJ,Choi YJ,et al.Differences in patient-reported outcomes between unicompartmental and total knee arthroplasties:a propensity score-matched analysis.J Arthroplasty,2017,32(5):1453-1459.
[34]Kleeblad LJ,van der List JP,Zuiderbaan HA,et al.Larger range of motion and increased return to activity,but higher revision rates following unicompartmental versus total knee arthroplasty in patients under 65:a systematic review.Knee Surg Sports Traumatol Arthrosc,2018,26(6):1811-1822.
[35]Schwab PE,Lavand'homme P,Yombi JC,et al.Lower blood loss after unicompartmental than total knee arthroplasty.Knee Surg Sports Traumatol Arthrosc,2015,23(12):3494-3500.
[36]Song EK,N M,Lee S,et al.Comparison of outcome and survival after unicompartmental knee arthroplasty between navigation and conventional techniques with an average 9-year follow-up.J Arthroplasty,2016,31(2):395-400.
[37]Bell SW,Anthony I,Jones B,et al.Improved accuracy of component positioning with robotic-assisted unicompartmental knee arthroplasty.J Bone Joint Surg Am,2016,98(8):627-635.
[38]Burn E,Sanchez-Santos MT,Pandit HG,et al.Ten-year patientreported outcomes following total and minimally invasive unicompartmental knee arthroplasty:a propensity scorematched cohort analysis.Knee Surg Sports Traumatol Arthrosc,2018,26(5):1455-1464.
[39]Fransen M,Mcconnell S,Harmer AR,et al.Exercise for osteoarthritis of knee:a cochrane systematic review.Br JSports Med,2015,49(24):1554-1557.
[40]Walton NP,Jahromi I,Lewis PL,et al.Patient-perceived outcomes and return to sport and work:TKA versus mini-incision unicompartmental knee arthroplasty.J Knee Surg,2006,19(2):112-116.
[41]Ho JC,Stitzlein RN,Green CJ,et al.Return to sports activity following UKA and TKA.J Knee Surg,2016,29(3):254-259.
[42]Boissonneault A,Pandit H,Pegg E,et al.No difference in survivorship after unicompartmental knee arthroplasty with or without an intact anterior cruciate ligament.Knee Surg Sports Traumatol Arthrosc,2013,21(11):2480-2486.
[43]Lloyd JM,Watts MC,Stokes AP,et al.Medium term results of per-operative knee arthroscopy in confirming suitability for unicompartmental arthroplasty.Knee,2012,19(6):908-912.
[44]Lim JW,Cousins GR,Clift BA,et al.Oxford unicompartmental knee arthroplasty versus age and gender matched total knee arthroplasty-functional outcome and survivorship analysis.J Arthroplasty,2014,29(9):1779-1783.
[45]Liddle AD,Pandit H,Judge A,et al.Patient-reported outcomes after total and unicompartmental knee arthroplasty:a study of 14076 matched patients from the National Joint Registry for England and Wales.Bone Joint J,2015,97-B(6):793-801.
[46]Liddle AD,Pandit H,Judge A,et al.Optimal usage of unicompartmental knee arthroplasty:a study of 41 986 cases from the National Joint Registry for England and Wales.Bone Joint J,2015,97-B(11):1506-1511.
[47]Borrego Paredes E,Barrena Sánchez P,Serrano Toledano D,et al.Total knee arthroplasty after failed unicompartmental knee arthroplasty.Clinical results,radiologic findings,and technical tips.J Arthroplasty,2017,32(1):193-196.
[48]Pandit H,Mancuso F,Jenkins C,et al.Lateral unicompartmental knee replacement for the treatment of arthritis progression after medial unicompartmental replacement.Knee Surg Sports Traumatol Arthrosc,2017,25(3):669-674.