Abstract：
OBJECTIVE: Treatment of end-stage anteromedial osteoarthritis (AMOA) of the knee is commonly approached using one of two surgical strategies: medial unicompartmental knee arthroplasty (UKA) or total knee arthroplasty (TKA). In this study we aim to investigate if there is any difference in outcome for patients undergoing UKA or TKA, when treated by high-volume surgeons, in high-volume centres, using two different clinical guidelines. The two strategies are \'UKA whenever possible\' vs TKA for all patients with AMOA.
METHODS: A total of 501 consecutive AMOA patients (301 UKA) operated on between 2013 to 2016 in two high-volume centres were included. Centre One employed clinical guidelines for the treatment of AMOA allowing either UKA or TKA, but encouraged UKA wherever possible. Centre Two used clinical guidelines that treated all patients with a TKA, regardless of wear pattern. TKA patients were included if they had isolated AMOA on preoperative radiographs. Data were collected from both centres\' local databases. The primary outcome measure was change in Oxford Knee Score (OKS), and the proportion of patients achieving the patient-acceptable symptom state (PASS) at one-year follow-up. The data were 1:1 propensity score matched before regression models were used to investigate potential differences.
RESULTS: The matched cohort included 400 patients (mean age 67 years (SD 9.55), 213 (53%) female, mean BMI 30.2 kg/m2, 337 (84%) American Society of Anesthesiologists grade ≤ 2). We found a mean adjusted difference in change score of 3.02 points (95% confidence interval (CI) 1.41 to 4.63; p < 0.001) and a significantly larger likeliness of achieving PASS (odds ratio 3.67 (95% CI 1.73 to 8.45); p = 0.001) both in favour of the UKA strategy.
CONCLUSIONS: UKA and TKA are both good strategies for treating end-stage AMOA. However, when compared as a strategy, UKA achieved larger improvements in OKS, and were more likely to reach the PASS value at one-year follow-up. Cite this article: Bone Jt Open 2022;3(5):441-447.
METHODS: A total of 501 consecutive AMOA patients (301 UKA) operated on between 2013 to 2016 in two high-volume centres were included. Centre One employed clinical guidelines for the treatment of AMOA allowing either UKA or TKA, but encouraged UKA wherever possible. Centre Two used clinical guidelines that treated all patients with a TKA, regardless of wear pattern. TKA patients were included if they had isolated AMOA on preoperative radiographs. Data were collected from both centres\' local databases. The primary outcome measure was change in Oxford Knee Score (OKS), and the proportion of patients achieving the patient-acceptable symptom state (PASS) at one-year follow-up. The data were 1:1 propensity score matched before regression models were used to investigate potential differences.
RESULTS: The matched cohort included 400 patients (mean age 67 years (SD 9.55), 213 (53%) female, mean BMI 30.2 kg/m2, 337 (84%) American Society of Anesthesiologists grade ≤ 2). We found a mean adjusted difference in change score of 3.02 points (95% confidence interval (CI) 1.41 to 4.63; p < 0.001) and a significantly larger likeliness of achieving PASS (odds ratio 3.67 (95% CI 1.73 to 8.45); p = 0.001) both in favour of the UKA strategy.
CONCLUSIONS: UKA and TKA are both good strategies for treating end-stage AMOA. However, when compared as a strategy, UKA achieved larger improvements in OKS, and were more likely to reach the PASS value at one-year follow-up. Cite this article: Bone Jt Open 2022;3(5):441-447.
摘要：
目的：终末期膝关节前内侧骨关节炎（AMOA）的治疗通常采用两种手术策略之一：内侧单室膝关节置换术（UKA）或全膝关节置换术（TKA）。在这项研究中，我们的目的是调查是否有任何差异的患者接受UKA或TKA，当接受大量外科医生治疗时，在高容量中心，使用两种不同的临床指南。对于所有AMOA患者，这两种策略是“尽可能UKA”与“TKA”。
方法：纳入了2013年至2016年在两个高容量中心进行手术的501例连续AMOA患者（301UKA）。中心1采用了AMOA治疗的临床指南，允许UKA或TKA，但尽可能鼓励UKA。中心二使用临床指南治疗所有TKA患者，不管磨损模式。如果TKA患者在术前X光片上有分离的AMOA，则将其包括在内。数据是从两个中心的本地数据库收集的。主要结果指标是牛津膝关节评分（OKS）的变化，以及一年随访时达到患者可接受症状状态（PASS）的患者比例。在使用回归模型调查潜在差异之前，数据为1：1倾向评分匹配。
结果：匹配的队列包括400名患者（平均年龄67岁（SD9.55），213（53%）女性，平均BMI30.2kg/m2，337（84％）美国麻醉医师协会等级≤2）。我们发现变化评分的平均调整差异为3.02分（95％置信区间（CI）1.41至4.63；p<0.001），并且达到PASS的可能性明显更大（比值比3.67（95％CI1.73至8.45；p=0.001），均支持UKA策略。
结论：UKA和TKA都是治疗终末期AMOA的良好策略。然而,当作为一种策略进行比较时，UKA在OKS中实现了更大的改进，在一年的随访中更有可能达到PASS值。引用这篇文章：BoneJtOpen2022；3（5）：441-447。
方法：纳入了2013年至2016年在两个高容量中心进行手术的501例连续AMOA患者（301UKA）。中心1采用了AMOA治疗的临床指南，允许UKA或TKA，但尽可能鼓励UKA。中心二使用临床指南治疗所有TKA患者，不管磨损模式。如果TKA患者在术前X光片上有分离的AMOA，则将其包括在内。数据是从两个中心的本地数据库收集的。主要结果指标是牛津膝关节评分（OKS）的变化，以及一年随访时达到患者可接受症状状态（PASS）的患者比例。在使用回归模型调查潜在差异之前，数据为1：1倾向评分匹配。
结果：匹配的队列包括400名患者（平均年龄67岁（SD9.55），213（53%）女性，平均BMI30.2kg/m2，337（84％）美国麻醉医师协会等级≤2）。我们发现变化评分的平均调整差异为3.02分（95％置信区间（CI）1.41至4.63；p<0.001），并且达到PASS的可能性明显更大（比值比3.67（95％CI1.73至8.45；p=0.001），均支持UKA策略。
结论：UKA和TKA都是治疗终末期AMOA的良好策略。然而,当作为一种策略进行比较时，UKA在OKS中实现了更大的改进，在一年的随访中更有可能达到PASS值。引用这篇文章：BoneJtOpen2022；3（5）：441-447。
