Unicompartmental Knee Arthroplasty Survivorship is Lower Than TKA Survivorship: A 27-year Finnish Registry Study
Unicompartmental Knee Arthroplasty Survivorship is Lower Than TKA Survivorship: A 27-year Finnish Registry Study
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DOI：
10.1007/s11999-013-3347-2
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发表时间：
2014-05-01
影响因子：
4.2
通讯作者：
Remes, Ville
中科院分区：
文献类型：
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作者：
Niinimaki, Tuukka;Eskelinen, Antti;Remes, Ville
比较单髁膝关节置换术（UKAs）与TKA的相对优缺点可能具有挑战性。生存率是一个重要的终点;关节置换术登记处反复报告中期生存率较低，但长期数据很少。由于接受UKA和TKA的患者在适应症、植入物设计和患者人口统计学方面存在差异，直接使用关节成形术登记生存报告来比较生存率也可能是不充分的。本研究的目的是评估UKA的生存率在一个大型的背景下，北方欧洲登记处，并将其生存率与同期27年内对原发性膝关节骨关节炎进行的骨水泥型TKA进行比较。我们获得了4713例因原发性骨关节炎接受UKA的患者的数据（平均年龄63.5岁;最短随访时间0年;平均6.0年;范围0-24年），这些患者在1985年至2011年期间接受了手术翻修。在该队列中，我们计算了因任何原因进行翻修的Kaplan-Meier生存率，并将其与同期接受TKA治疗原发性骨关节炎的83，511例患者（平均年龄69.5岁;最短随访时间0年;平均6.4年;范围0-27年）的生存率进行了比较。在比较分析中，根据年龄和性别调整数据，UKAs的Kaplan-Meier生存率在5年时为89.4%，10年时为80.6%，15年时为69.6%; TKA的相应生存率分别为96.3%，93.3%和88.7%。与骨水泥型TKA相比，UKA的长期生存率较低，即使调整了患者的年龄和性别后也是如此（风险比2.2，p < 0.001）。UKA与TKA相比具有诱人的优势;然而，在一项大型国家登记研究中，广泛使用的UKA的翻修频率低于TKA。在选择UKA和TKA时，应告知患者两种手术的优点，但也应告知患者UKA后翻修风险通常较高。III级，治疗研究。有关证据等级的完整描述，请参见作者说明。
Balancing the relative advantages and disadvantages of unicompartmental knee arthroplasties (UKAs) against those for TKAs can be challenging. Survivorship is one important end point; arthroplasty registers repeatedly report inferior midterm survival rates, but longer-term data are sparse. Comparing survival directly by using arthroplasty register survival reports also may be inadequate because of differences in indications, implant designs, and patient demographics in patients having UKAs and TKAs.The aims of this study were to assess the survivorship of UKA in the context of one large, northern European registry, and to compare the rates of survivorship with those of cemented TKAs performed for primary knee osteoarthritis during the same 27-year period.From the Finnish Arthroplasty Register, we obtained the data for 4713 patients undergoing UKAs for primary osteoarthritis (mean age, 63.5 years; minimum followup, 0 years; mean, 6.0 years; range, 0-24 years) who had surgical revision between 1985 and 2011. From this cohort, we calculated the Kaplan-Meier survivorship for revision performed for any reason and compared it with the survivorship of 83,511 patients (mean age, 69.5 years; minimum followup 0 years; mean, 6.4 years; range, 0-27 years) with TKAs treated for primary osteoarthritis during the same period. Data were adjusted for age and sex in a comparative analysis.Kaplan-Meier survivorship of UKAs was 89.4% at 5 years, 80.6% at 10 years, and 69.6% at 15 years; the corresponding rates for TKAs were 96.3%, 93.3%, and 88.7%, respectively. UKAs had inferior long-term survivorship compared with cemented TKAs, even after adjusting for the age and sex of the patients (hazard ratio 2.2, p < 0.001).A UKA offers tempting advantages compared with a TKA; however, the revision frequency for UKAs in widespread use, as measured in a large, national registry, was poorer than that of TKAs. When choosing between a UKA and a TKA, patients should be informed of advantages of both procedures, but they also should be advised about the generally higher revision risk after UKA.Level III, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.