Abstract
Objective:To compare the impact of intramedullary-referencing(IMr)versus extramedullary-referencing(EMr)in tibial os-teotomy on efficacy and safety of unicompartmental knee arthroplasty(UKA)for treatment of medial compartment knee osteoarthritis(KOA).Methods:The medical records of 60 patients who underwent primary UKA for medial compartment KOA were retrospectively ana-lyzed.According to the tibial osteotomy technique employed in the UKA,the patients were divided into EMr group and IMr group,30 cases in each group.The outcome measures,including operative time,intraoperative blood loss,drainage volume,incision length,hospital stays,Hospital for Special Surgery(HSS)knee score,Lysholm knee score,hip-knee-ankle angle(HKA),lateral distal tibial angle(LDTA),coronal tibia component angle(c-TCA),absolute deviation of c-TCA from 90°,the excellent/good rate of coronal alignment of the tibial component and complication rates,were compared between the 2 groups.Results:①General outcomes.No significant differences were observed in operative time,intraoperative blood loss,drainage volume,incision length,and hospital stays between the 2 groups(120.59±20.31 vs 118.61±19.82 minutes,t=0.417,P=0.651;157.32±30.51 vs 158.59±29.72 mL,t=0.214,P=0.835;251.37±40.62 vs 249.85±39.48 mL,t=0.201,P=0.841;10.21±1.52 vs 10.09±1.41 cm,t=0.597,P=0.573;7.58±1.24 vs 7.35±1.12 days,t=0.709,P=0.462).②Efficacy outcomes.At postoperative month 6,both groups showed significantly higher HSS and Lysholm knee scores compared to preoperative values(HSS knee score:61.73±14.09 vs 80.45±2.36 points,t=7.177,P=0.000;61.92±13.87 vs 82.11±1.98 points,t=7.893,P=0.000;Lysholm knee score:65.27±15.14 vs 81.03±3.02 points,t=4.323,P=0.000;65.48±14.96 vs 83.75±2.54 points,t=6.595,P=0.000),with higher HSS and Lysholm knee scores observed in the IMr group(t=2.951,P=0.005;t=3.775,P=0.000).Moreover,the HKA was greater in the 2 groups at postoperative month 6 compared to preoperation(169.73±13.26 vs 178.45±13.21 degrees,t=2.552,P=0.013;169.28±11.95 vs 179.12±12.98 degrees,t=3.055,P=0.003),with no significant difference observed between the 2 groups(t=0.112,P=0.911).However,the LDTA showed no significant changes within or between the 2 groups at postoperative month 6.Besides,the IMr group showed larger c-TCA,smaller absolute deviation of c-TCA from 90°,and higher excellent/good rate of coronal alignment of the tibial component compared to the EMr group(88.01±3.12 vs 89.64±2.82 degrees,t=2.123,P=0.038;1.33±0.36 vs 0.34±0.10 degrees,t=14.513,P=0.000;x2=4.043,P=0.044).③Safety outcomes.No significant difference was observed in complication rates between the 2 groups(x2=0.111,P=0.739).Conclusion:In UKA for treatment of medial compartment KOA,the IMr for tibial osteotomy demonstrates superiority over EMr in restoring knee function and maintaining optimal tibial component alignment,while,the both are comparable in the safety profile.关键词
骨关节炎,膝/关节成形术,置换,膝/截骨术/胫骨/髓内定位/髓外定位Key words
osteoarthritis,knee/arthroplasty,replacement,knee/osteotomy/tibia/intramedullary referencing/extramedullary referencing
