BACKGROUND Unicompartmental knee replacement (UKR) is an effective treatment for end-stage medial compartment osteoarthritis, but there can be problems with fixation. The cementless UKR was introduced to address this issue. It is unknown how its functional outcomes compare with those of the cemented version on a national scale. We performed a matched comparison of the clinical and functional outcomes of cementless and cemented UKRs. METHODS Using the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man (NJR), 14,764 Oxford UKRs with linked data regarding patient-reported outcomes were identified. A total of 6,906 UKRs (3,453 cemented and 3,453 cementless) were propensity score matched on the basis of patient, surgical, and implant factors. RESULTS The 10-year cumulative implant survival rate was 93.0% (95% confidence interval [CI], 90.0% to 95.1%) for cementless UKRs and 91.3% (95% CI, 89.0% to 93.0%) for cemented UKRs. The cementless UKR group had a significantly lower revision risk (hazard ratio [HR], 0.74; p = 0.02). Subgroup analyses showed a stronger effect size (HR, 0.66) among UKRs performed by high-caseload surgeons (i.e., surgeons performing ≥30 UKRs/year). In the overall cohort, the postoperative Oxford Knee Score (OKS) in the cementless group (mean and standard deviation, 39.1 ± 8.7) was significantly higher (p = 0.001) than that in the cemented group (38.5 ± 8.6). The cementless group gained a mean of 17.6 ± 9.3 points in the OKS postoperatively and the cemented group gained 16.5 ± 9.6 points, with a difference of 1.1 points between the groups (p < 0.001). The difference in OKS points gained postoperatively was highest among UKRs performed by high-caseload surgeons, with the cementless group gaining 1.8 points more (p < 0.001) than the cemented group. CONCLUSIONS The cementless UKR demonstrated better 10-year implant survival and postoperative functional outcomes than the cemented UKR. The difference was largest among UKRs performed by high-caseload surgeons, with the cementless fixation group having an HR for revision of 0.66 and an approximately 2-point greater improvement in the OKS compared with the cemented fixation group. LEVEL OF EVIDENCE Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.

中文翻译：

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骨水泥和非骨水泥单间室膝关节置换术的植入物和功能结果的匹配比较：一项来自英格兰、威尔士、北爱尔兰和马恩岛国家联合登记处以及医院发作统计患者报告结果测量数据库的研究。


背景单间室膝关节置换术（UKR）是治疗终末期内侧间室骨关节炎的有效方法，但可能存在固定问题。无水泥 UKR 的推出就是为了解决这个问题。目前尚不清楚其功能结果与全国范围内的水泥版本相比如何。我们对非骨水泥和骨水泥 UKR 的临床和功能结果进行了匹配比较。方法 使用英格兰、威尔士、北爱尔兰和马恩岛国家联合登记系统 (NJR)，确定了 14,764 份牛津 UKR，其中包含有关患者报告结果的关联数据。根据患者、手术和种植体因素对总共 6,906 名 UKR（3,453 名骨水泥患者和 3,453 名非骨水泥患者）进行了倾向评分匹配。结果 非骨水泥 UKR 的 10 年累积种植体存活率为 93.0%（95% 置信区间 [CI]，90.0% 至 95.1%），骨水泥 UKR 的 10 年累积种植体存活率为 91.3%（95% CI，89.0% 至 93.0%）。无骨水泥 UKR 组的翻修风险显着较低（风险比 [HR]，0.74；p = 0.02）。亚组分析显示，高病例量外科医生（即每年执行 ≥30 UKR 的外科医生）执行的 UKR 效果更强（HR，0.66）。在整个队列中，无骨水泥组的术后牛津膝评分 (OKS)（平均值和标准差，39.1 ± 8.7）显着高于骨水泥组（38.5 ± 8.6）（p = 0.001）。无骨水泥组术后 OKS 平均得分为 17.6 ± 9.3 分，骨水泥组术后平均得分为 16.5 ± 9.6 分，组间差异为 1.1 分 (p < 0.001)。术后获得的 OKS 分数差异在高病例量外科医生进行的 UKR 中最高，非骨水泥组多获得 1.8 分 (p < 0.001）比胶结组。结论 无骨水泥 UKR 比骨水泥 UKR 具有更好的 10 年种植体存活率和术后功能结果。在高病例量外科医生进行的 UKR 中差异最大，与骨水泥固定组相比，无骨水泥固定组的修正 HR 为 0.66，OKS 提高约 2 个百分点。证据级别 预后 III 级。有关证据级别的完整描述，请参阅作者须知。