Distinct age-related modes of failure in cemented and cementless Oxford medial unicompartmental knee arthroplasty : results from 25,762 patients in the Dutch Arthroplasty Register.
Gaby V Ten Noever de Brauw, Roderick J M Vossen, Tarik Bayoumi, Inger N Sierevelt, Joost A Burger, Andrew D Pearle, Gino M M J Kerkhoffs, Anneke Spekenbrink-Spooren, Hendrik A Zuiderbaan
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引用次数: 0
Abstract
Aims: The primary objective of this study was to compare short-term implant survival between cemented and cementless fixation for the mobile-bearing Oxford medial unicompartmental knee arthroplasty (UKA) across various age groups. The secondary objectives were to compare modes of failure and to evaluate patient-reported outcomes.
Methods: A total of 25,762 patients, comprising 8,022 cemented (31.1%) and 17,740 cementless (68.9%) medial UKA cases, were included from the Dutch Arthroplasty Register. Patient stratification was performed based on age: < 50 years, 50 to 59 years, 60 to 69 years, and ≥ 70 years. Survival rates and hazard ratios were calculated. Modes of failure were described and postoperative change in baseline for the Oxford Knee Score and numerical rating scale for pain at six and 12 months' follow-up were compared.
Results: The 2.5-year implant survival rate of cementless UKA was significantly higher compared to cemented UKA in patients aged younger than 60 years (age < 50 years: 95.9% (95% CI 93.8 to 97.3) vs 90.9% (95% CI 87.0 to 93.7); p = 0.007; and 50 to 59 years: 95.6% (95% CI 94.9 to 96.3) vs 94.0% (95% CI 92.8 to 95.0); p = 0.009). Cemented UKA exhibited significantly higher revision rates for tibial loosening (age < 50 and 60 to 69 years), while cementless UKA was associated with higher revision rates for periprosthetic fractures (age ≥ 60 years). Patient-reported outcomes were similar between both fixation techniques, irrespective of age.
Conclusion: Cementless fixation resulted in superior short-term implant survival compared to cemented fixation among younger patients undergoing Oxford mobile-bearing medial UKA. Distinct failure patterns between fixation techniques emerged across various age groups, with revisions for tibial loosening being associated with cemented UKA in younger patients, while revisions for periprosthetic fractures were specifically identified among elderly patients undergoing cementless UKA.
目的：本研究的主要目的是比较不同年龄组的移动式牛津内侧单室膝关节置换术（UKA）有骨水泥固定和无骨水泥固定的短期植入存活率。次要目标是比较失败模式并评估患者报告的结果：荷兰关节成形术登记处共纳入25762例患者，包括8022例骨水泥固定（31.1%）和17740例无骨水泥固定（68.9%）内侧UKA病例。根据年龄对患者进行了分层：< 小于50岁、50至59岁、60至69岁、≥70岁。计算了生存率和危险比。对失败方式进行了描述，并比较了术后6个月和12个月随访时牛津膝关节评分和疼痛数字评分表的基线变化：结果：在年龄小于60岁的患者中，无骨水泥UKA的2.5年植入存活率明显高于有骨水泥UKA（年龄小于50岁：95.9% (95% C)；年龄大于50岁：95.9% (95% C)）：95.9% (95% CI 93.8 to 97.3) vs 90.9% (95% CI 87.0 to 93.7)；p = 0.007；50-59岁：95.6% (95% CI 93.8 to 97.3) vs 90.9% (95% CI 87.0 to 93.7)；p = 0.007：95.6% (95% CI 94.9 to 96.3) vs 94.0% (95% CI 92.8 to 95.0); p = 0.009)。有骨UKA的胫骨松动翻修率明显更高（年龄小于50岁和60至69岁），而无骨UKA的假体周围骨折翻修率更高（年龄≥60岁）。两种固定技术的患者报告结果相似，与年龄无关：结论：在接受牛津移动支座内侧UKA手术的年轻患者中，无骨水泥固定的短期植入存活率优于有骨水泥固定。在不同年龄组中，两种固定技术出现了不同的失败模式，年轻患者因胫骨松动而进行的翻修与有骨水泥UKA有关，而在接受无骨水泥UKA的老年患者中，特别发现了因假体周围骨折而进行的翻修。
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