Doğaç KARAGÜVEN, İlker ÇETİN, Alper KAYA, Berk GÜÇLÜ, Burak AKAN

Medial Kompartman Gonartrozunda Oxford Faz 3 Unikompartmantal Protezin Erken ve Orta Dönem Klinik ve Radyolojik Sonuçları

Giriş: Unikompartmantal diz protezi (UDP) medial kompartman gonartrozunda düşük morbidite, minimal kemik ve yumuşak doku rezeksiyonu ve fonksiyonel olarak yüksek hasta memnuniyeti gibi önemli avantajlara sahip bir cerrahi yöntemdir. Gereç ve Yöntem: Ufuk Üniversitesi Tıp Fakültesi Ortopedi ve Travmatoloji Kliniğinde Şubat 2008-Kasım 2009 tarihleri arasında çimentolu Oxford faz 3 unikompartmantal diz protezi ile cerrahi tedavi uygulanan ve en az 2 yıllık takipleri tamamlanmış 105 hastanın 124 dizi, erken-orta dönem radyolojik ve klinik sonuçları açısından değerlendirilmiştir. Hastalardan 102’sinde primer patoloji anteromedial osteoartrit, 3’ünde ise femur medial kondil osteonekrozu nedeniyle Oxford UDP yapılmıştır. Bulgular: Oxford Diz Skoru’na (min=12, max=60) göre yapılan değerlendirmede diz skoru, ameliyat öncesi dönemde ortalama 27.2(15-40) bulunmuştur. Ameliyat sonrası son kontrollerinde ise ortalama 51.5(26-60) olarak bulunmuştur. Eklem hareket açıklığı ameliyat öncesi dönemde ortalama 114.5° (80°-130°) bulunmuştur. Ameliyat sonrası dönemde ise ortalama 128.5° (115°-140°) olarak bulundu. 105 hastanın 124 dizi ameliyat sonrası 2 yıl sonunda değerlendirildiğinde 8 hastada (%6.5) başarısızlık söz konusu iken 95 hastada (%90.5) sonuçlar iyi ve mükemmel bulunmuştur. Başarısız sonuçlara sahip hastalardan ikisi nedeni açıklanamayan ağrı, biri insert çıkığı olmak üzere, en sık başarısızlık nedeni 5 hastayla lateral osteoartrit (%62.5) olarak görülmektedir. 8 hastanın 5’ine revizyon primer TDP uygulanmıştır. Radyolojik değerlendirmede en fazla hata femoral komponentin medial/lateral yerleştirilmesi sırasında ortaya çıkmıştır ancak hastalarda radyolojik gevşeme bulgusuna rastlanmamıştır. Radyografik hatalarla klinik sonuçlar arasında istatiksel olarak anlamlı bir ilişki saptanmamıştır. Sonuç: Çalışmamızda orta dönemde UDP’nin doğru hasta seçim kriterleri dikkatli uygulandığında gerek klinik skorlar, gerek radyolojik sonuçlar, gerekse de hasta memnuniyeti açısından yüksek başarı oranına (%90.5) sahip olduğu görülmektedir.

Anahtar Kelimeler:

Gonartroz, anteromedial osteoartrit, unikondiler diz artroplastisi

Early and Mid-term Clinical and Radiological Results of Oxford Phase 3 Unicompartmental Prosthesis in Medial Compartment Gonarthrosis

Introduction: Unicompartmental knee arthroplasty is a surgical technique which is applied in medial compartment gonarthrosis and has advantages like low morbidity, minimal bone and soft tissue resection and high functional patient satisfaction. Material and Method: Short and middle term radiologic and clinical data from 124 knees of 105 patients who underwent cemented Oxford phase 3 unicompartmental knee arthroplasty between February 2008–November 2009 in Ufuk University Medical Faculty Orthopedics and Traumatology Clinic with at least 2 years of follow-up were evaluated. The primary pathology for Oxford UKA was anteromedial osteoarthritis in 102 patients and osteonecrosis in the medial condyle of femur. Results: Knee scores in the preoperative period were average 27.2(15-40) according to Oxford Knee Score (min=12, max=60). The score was 51.5(26-60) in the postoperative controls. Range of motion was average 114.5°(80°-130°) in the preoperative period. The range of motion was average 128.5°(115°-140°) in the postoperative period. In the 2 year follow-up of 124 knees of 105 patients, 8 patients(6.5%) had unsuccessful results while 95(90.5%) patients had good and perfect results. Two patients had unexplainable pain, one patient had a dislocated insert while 5 patients(62.5%) had lateral osteoarthritis which was the most frequent cause for failure. 5 of 8 patients underwent revision primary TKA. The most frequent error was found to be during the medial/lateral placement of the femoral component but none of the patients had radiological findings of laxation. The relationship between radiographical errors and clinical results was not statistically significant. Conclusion: Our study shows that UKA has a high rate of middle term success(90.5%) in terms of radiologic results, clinical scores and patient satisfaction when right criteria for patient selection are applied carefully.

Keywords:

Gonarthrosis, anteromedial osteoarthritis, unicondylar knee arthroplasty,

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