Journal of the Korean Orthopaedic Association (대한정형외과학회지)

Korean Orthopaedic Association (대한정형외과학회)
권호 표지
DOI QR코드

DOI QR Code

Clinical Results of Medial Unicompartmental Knee Arthroplasty in Elderly Patients Older than 70 Years of Age

70세 이상의 고령 환자에서 시행한 내측 슬관절 단일구획치환술의 임상 결과

  • Kim, Kyung Tae (Department of Orthopedic Surgery, Seoul Sacred Heart General Hospital) ;
  • Lee, Song (Department of Orthopedic Surgery, Seoul Sacred Heart General Hospital) ;
  • Kim, Jin Hak (Department of Orthopedic Surgery, Seoul Sacred Heart General Hospital) ;
  • Lee, Ho Young (Department of Orthopedic Surgery, Seoul Sacred Heart General Hospital) ;
  • Kim, Myung Jin (Department of Orthopedic Surgery, Seoul Sacred Heart General Hospital)
  • Received : 2020.01.02
  • Accepted : 2020.02.24
  • Published : 2021.02.28
⟨ Previous Next ⟩

Abstract

Purpose: To evaluate the long-term clinical results and survivorship of unicompartmental knee arthroplasty (UKA) in elderly patients older than 70 years by analyzing cases that have been implanted for >10 years ago. Materials and Methods: The long-term follow-up results were evaluated in 39 patients (46 cases) who underwent medial UKA from March 2002 to February 2004. The mean age of the patients at the time of surgery was 74.0 years, and the preoperative diagnosis was degenerative arthritis of the knee in all cases. Results: Of the 46 cases, reoperation occurred due to the complications in four cases. In 22 cases without 14 cases of death and six cases of follow-up loss, follow-up more than 10 years was possible. The mean Knee Society knee and function scores improved significantly from 53.0 and 52.5 points pre-operatively to 89.4 and 80.9 points at the last follow-up, respectively (p<0.001). The mean range of motion of the knee recovered to 132.5°, and the mean tibiofemoral angle changed to 5.9° of valgus at the last follow-up. Complications following the UKA occurred in four cases; the most prevalent complication was mobile bearing dislocation (n=2). One case of failure occurred due to aseptic loosening and degenerative arthritis of the lateral compartment, respectively. The cumulative survival rate of the implants was 95.0% at 10 years and 85.7% at 15 years. Of the 40 cases, excluding six cases of follow-up loss, 36 cases (90.0%) could be used without reoperation until death or at the last follow-up after surgery. Conclusion: These results showed the outstanding functions of the knee and satisfactory long-term survivorship after UKA. Therefore, UKA could be a useful method for the treatment of osteoarthritis of the knee in elderly patients older than 70 years of age.

목적: 70세 이상 고령의 환자에서 시행한 슬관절 단일구획치환술의 장기 임상 결과와 합병증 및 치환물의 장기 생존율 등을 알아보고자 했다. 대상 및 방법: 2002년 3월부터 2004년 2월까지 70세 이상의 고령 환자에서 가동형 치환물을 사용하여 내측 슬관절 단일구획치환술을 시행하고 10년 이상 경과한 39명, 46예를 대상으로 장기 추시 결과를 평가했다. 수술 시 환자의 평균 연령은 74.0세였으며 수술 전 진단은 모두 퇴행성 관절염이었다. 결과: 총 46예 중 치환물의 실패로 인한 재수술이 4예 발생했고, 사망 14예 및 추시 소실 6예를 제외한 22예에서 수술 후 10년 이상 추시가 가능했다. 평균 13.1년 추시상 슬관절 점수는 수술 전 평균 53.0점에서 최종 추시 시 89.4점으로 유의미하게 향상되었고(p<0.001), 슬관절 기능 점수도 수술 전 평균 52.5점에서 최종 추시 시 80.9점으로 유의미하게 향상되었다(p<0.001). 슬관절 운동 범위는 수술 전 평균 128.8°에서 최종 추시시 132.5°로 회복되었으며 대퇴경골각은 수술 전 외반 0.1°에서 외반 5.9°로 변화했다. 수술 후 합병증으로 인한 실패는 총 4예에서 발생했으며 그중 가장 많이 발생한 합병증은 가동성 삽입물의 탈구(2예)였고 외측 구획의 관절염 및 폴리에틸렌 삽입물의 마모로 인한 실패가 각각 1예였다. 치환물의 10년 누적 생존율은 95.0%, 15년 누적 생존율은 85.7%였으며 추시 소실된 6예를 제외한 40예중 36예(90.0%)에서 재수술 없이 사망할 때까지 사용했거나 최종 추시 때까지 사용하고 있었다. 결론: 70세 이상의 고령 환자에서 시행한 슬관절 단일구획치환술은 장기 추시상 우수한 슬관절의 기능과 만족할만한 치환물의 장기 생존율을 보여주었다. 따라서 슬관절 단일구획치환술은 70세 이상 고령 환자에서도 퇴행성 슬관절염의 치료에 유용한 방법이 될 수 있을 것이다.

Keywords

References

  1. Heaps BM, Blevins JL, Chiu YF, Konopka JF, Patel SP, McLawhorn AS. Improving estimates of annual survival rates for medial unicompartmental knee arthroplasty, a meta-analysis. J Arthroplasty. 2019;34:1538-45. https://doi.org/10.1016/j.arth.2019.02.061
  2. Kim KT, Lee S, Kim JH, Hong SW, Jung WS, Shin WS. The survivorship and clinical results of minimally invasive unicompartmental knee arthroplasty at 10-year follow-up. Clin Orthop Surg. 2015;7:199-206. https://doi.org/10.4055/cios.2015.7.2.199
  3. Hansen EN, Ong KL, Lau E, Kurtz SM, Lonner JH. Unicondylar knee arthroplasty has fewer complications but higher revision rates than total knee arthroplasty in a study of large United States databases. J Arthroplasty. 2019;34:1617-25. https://doi.org/10.1016/j.arth.2019.04.004
  4. Marya S, Thukral R. Unicompartmental knee arthroplasty for tricompartment osteoarthritis in octogenarians. Indian J Orthop. 2009;43:361-6. https://doi.org/10.4103/0019-5413.54970
  5. Chawla H, Ghomrawi HM, van der List JP, Eggman AA, Zuiderbaan HA, Pearle AD. Establishing age-specific cost-effective annual revision rates for unicompartmental knee arthroplasty: a meta-analysis. J Arthroplasty. 2017;32:326-35. https://doi.org/10.1016/j.arth.2016.08.019
  6. Iacono F, Raspugli GF, Akkawi I, et al. Unicompartmental knee arthroplasty in patients over 75 years: a definitive solution? Arch Orthop Trauma Surg. 2016;136:117-23. https://doi.org/10.1007/s00402-015-2323-6
  7. Ode Q, Gaillard R, Batailler C, et al. Fewer complications after UKA than TKA in patients over 85 years of age: a case-control study. Orthop Traumatol Surg Res. 2018;104:955-9. https://doi.org/10.1016/j.otsr.2018.02.015
  8. Berger RA, Della Valle CJ. Unicompartmental knee arthroplasty: indications, techniques, and results. Instr Course Lect. 2010;59:47-56.
  9. Niinimaki T, Eskelinen A, Makela K, Ohtonen P, Puhto AP, Remes V. Unicompartmental knee arthroplasty survivorship is lower than TKA survivorship: a 27-year Finnish registry study. Clin Orthop Relat Res. 2014;472:1496-501. https://doi.org/10.1007/s11999-013-3347-2
  10. Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res. 1989;248:13-4.
  11. Bauer GC, Insall J, Koshino T. Tibial osteotomy in gonarthrosis (osteo-arthritis of the knee). J Bone Joint Surg Am. 1969;51:1545-63. https://doi.org/10.2106/00004623-196951080-00005
  12. Rea P, Short A, Pandit H, et al. Radiolucency and migration after Oxford unicompartmental knee arthroplasty. Orthopedics. 2007;30(5 Suppl):24-7.
  13. Kohn MD, Sassoon AA, Fernando ND. Classifications in brief: Kellgren-Lawrence classification of osteoarthritis. Clin Orthop Relat Res. 2016;474:1886-93. https://doi.org/10.1007/s11999-016-4732-4
  14. Pennington DW, Swienckowski JJ, Lutes WB, Drake GN. Unicompartmental knee arthroplasty in patients sixty years of age or younger. J Bone Joint Surg Am. 2003;85:1968-73. https://doi.org/10.2106/00004623-200310000-00016
  15. Kozinn SC, Scott R. Unicondylar knee arthroplasty. J Bone Joint Surg Am. 1989;71:145-50. https://doi.org/10.2106/00004623-198971010-00023
  16. Kuipers BM, Kollen BJ, Bots PC, et al. Factors associated with reduced early survival in the Oxford phase III medial unicompartment knee replacement. Knee. 2010;17:48-52. https://doi.org/10.1016/j.knee.2009.07.005
  17. Kim KT. Unicompartmental knee arthroplasty. Knee Surg Relat Res. 2018;30:1-2. https://doi.org/10.5792/ksrr.18.014
  18. Murray DW. Mobile bearing unicompartmental knee replacement. Orthopedics. 2005;28:985-7. https://doi.org/10.3928/0147-7447-20050901-35
  19. Panni AS, Vasso M, Cerciello S, Felici A. Unicompartmental knee replacement provides early clinical and functional improvement stabilizing over time. Knee Surg Sports Traumatol Arthrosc. 2012;20:579-85. https://doi.org/10.1007/s00167-011-1613-y
  20. Fabre-Aubrespy M, Ollivier M, Pesenti S, Parratte S, Argenson JN. Unicompartmental knee arthroplasty in patients older than 75 results in better clinical outcomes and similar survivorship compared to total knee arthroplasty. A matched controlled study. J Arthroplasty. 2016;31:2668-71. https://doi.org/10.1016/j.arth.2016.06.034
  21. Sah AP, Springer BD, Scott RD. Unicompartmental knee arthroplasty in octogenarians: survival longer than the patient. Clin Orthop Relat Res. 2006;451:107-12. https://doi.org/10.1097/01.blo.0000223983.67325.61
  22. Kennedy JA, Matharu GS, Hamilton TW, Mellon SJ, Murray DW. Age and outcomes of medial meniscal-bearing unicompartmental knee arthroplasty. J Arthroplasty. 2018;33:3153-9. https://doi.org/10.1016/j.arth.2018.06.014
  23. Clark M, Campbell DG, Kiss G, Dobson PJ, Lewis PL. Reintervention after mobile-bearing Oxford unicompartmental knee arthroplasty. Clin Orthop Relat Res. 2010;468:576-80. https://doi.org/10.1007/s11999-009-1089-y
  24. Vardi G, Strover AE. Early complications of unicompartmental knee replacement: the Droitwich experience. Knee. 2004;11:389-94. https://doi.org/10.1016/j.knee.2004.02.005
  25. Kim SJ, Postigo R, Koo S, Kim JH. Causes of revision following Oxford phase 3 unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2014;22:1895-901. https://doi.org/10.1007/s00167-013-2644-3
  26. Kim KT, Lee S, Lee JI, Kim JW. Analysis and treatment of complications after unicompartmental knee arthroplasty. Knee Surg Relat Res. 2016;28:46-54. https://doi.org/10.5792/ksrr.2016.28.1.46
  27. Hernigou P, Deschamps G. Alignment influences wear in the knee after medial unicompartmental arthroplasty. Clin Orthop Relat Res. 2004;423:161-5. https://doi.org/10.1097/01.blo.0000128285.90459.12
  28. Berend KR, Lombardi AV Jr, Adams JB. Obesity, young age, patellofemoral disease, and anterior knee pain: identifying the unicondylar arthroplasty patient in the United States. Orthopedics. 2007;30(5 Suppl):19-23.
  29. Weale AE, Murray DW, Crawford R, et al. Does arthritis progress in the retained compartments after 'Oxford' medial unicompartmental arthroplasty? A clinical and radiological study with a minimum ten-year follow-up. J Bone Joint Surg Br. 1999;81:783-9.