Published online Dec 26, 2019. doi: 10.12998/wjcc.v7.i24.4196
Peer-review started: September 8, 2019
First decision: November 11, 2019
Revised: November 24, 2019
Accepted: November 27, 2019
Article in press: November 27, 2019
Published online: December 26, 2019
Knee osteoarthritis is the most prevalent form of osteoarthritis and is becoming the main reason for progressive pain in knee joints. Arthroscopy combined with unicondylar knee arthroplasty (UKA) is one of the effective methods for the treatment of severe unicompartmental knee arthritis. This surgical approach gives us the capacity to explore all the articular cavities and plays a vital role in UKA patient selection. However, some scholars think that this surgical procedure is traumatic and may increase the rate of surgical infection, and its clinical efficacy needs further study.
We aimed to compare the clinical effects of arthroscopy combined with UKA and UKA alone for patients suffering from unicompartmental knee osteoarthritis (OA).
To further clarify the clinical efficacy, postoperative infection rate, and trauma of arthroscopy combined with UKA in patients with unicompartmental OA.
A retrospective study was conducted after selecting patients who were diagnosed with unicompartmental OA and underwent UKA between October 2012 and November 2006. The condition of each compartment was evaluated under arthroscopy, and whether or not to perform the UKA was determined according to the situation of the knee compartments. Minimally invasive surgery was adapted for UKA surgery. Patients were followed at 3, 6, and 12 mo and every 2 years thereafter. During each follow-up, the radiographic materials, the range of motion (ROM) of knee, the hospital for special surgery (HSS) score, knee society score, and knee function score as recorded, and the modes and time of failure and revision details were collected as well.
Data of 104 patients (118 knees), including 54 patients (60 knees) in the arthroscopy combined with UKA group (group A) and 51 patients (58 knees) in the UKA alone group (group B) was collected at an average follow-up time of 7.25 years. There were no significant differences in the number, age, gender, side, body mass index, etiology, or follow-up between the two groups. At the final follow-up, 3 (5.0%) of 60 knees in group A compared with 4 (6.9%) of 58 knees in group B failed and converted to total knee arthroplasty (TKA), with no statistically significant difference between the two groups (P = 0.933). The percentage of patients receiving blood transfusion was 40% in group A, significantly lower than that in group B (67.2%; P = 0.003). Total volume of blood transfusion in group A was also significantly lower than that of group B (P = 0.001). Both groups improved significantly after operation in clinical symptoms and functions. HSS score, knee society score, and knee function score increased significantly at the latest follow-up compared to pre-operation in group A, from 59.6 ± 10.9 to 82.7 ± 9.3 (P = 0.000), 47.3 ± 6.3 to 76.2 ± 13.1 (P = 0.000) and 57.5 ± 6.3 to 75.1 ± 19.6 (P = 0.000); and in group B, from 59.3 ± 15.6 to 84.3 ± 10.1 (P = 0.000), 49.1 ± 9.2 to 75.1 ± 13.2 (P = 0.000), and 59.3 ± 9.0 to 77.4 ± 13.8 (P = 0.000). There were no significant differences in the scores or angles between the groups at the last follow-up. As to the force line, 84.2% of patients in group A were corrected to normal, which was higher than that in group B (77.8%), although there was no statistical difference between the two groups (P = 0.387).
Arthroscopy combined with UKA and UKA alone both provide benefits in clinical symptom improvement and alignment correction. Arthroscopy combined with UKA does not increase the infection probability and surgical complications, and has an advantage in reducing the total volume of blood transfusion and the percentage of patients receiving blood transfusion. Arthroscopic surgery has a unique advantage with regard to patient selection and a curative effect on cartilage degeneration in the lateral compartment.
This study is a clinical follow-up study limited to a single center. We will conduct a multi-center large-scale clinical follow-up study and expand the case number. Through arthroscopic surgery, the surgery plan for patients who do not meet the UKA indications changes to arthroscopic joint cavity cleaning or TKA. Next, we will also collect clinical data from these patients and follow them to further verify the advantages of arthroscopy combined with UKA with regard to patient selection.