英国膝关节外科协会(BASK)和欧洲膝关节协会(EKS)关于膝关节单髁置换术的专家共识解读

Interpretation of the expert consensus of the British Association for Surgery of the Knee(BASK)and the European Knee Society(EKS)on unicompartmental knee arthroplasty

膝关节单髁置换术(unicompartmental knee arthroplasty,UKA)虽然历史悠久,而且对于适应证适宜的患者,相较于人工全膝关节置换术(total knee arthroplasty,TKA)来说有不少优势,但在全球一些国家和地区UKA并未得到充分应用。因此,2019年12月,80名来自英国膝关节外科协会(BASK)和欧洲膝关节协会(EKS)的专家成员受邀参加在英国伦敦举行的联席会议,针对UKA创建基于循证的共识声明。会上采用实时德菲尔专家调查法,通过两轮投票,并对各轮之间达成的一致和分歧内容分别进行了小组讨论,最终发布了5项共识声明:(1)对于符合关节置换术适应证的患者,应为其提供UKA的选择,作为TKA的可行替代方案;(2)当同意患者行UKA时,应根据每位患者的个体情况,量身定制包括UKA特有益处和风险在内的信息,并与之讨论;(3)有证据表明,为了优化患者的治疗效果,外科医生应避免过少地使用UKA;(4)对于内侧间室UKA,外科医生应该遵循当代基于循证的适应证和禁忌证;(5)膝关节置换外科医生应接触UKA并接受UKA的培训。本文在充分研读该共识的基础上,结合2020《中国膝关节单髁置换术围手术期管理专家共识》,阐述最终基于循证的共识涵义,以供临床医生参考。

Unicompartmental knee arthroplasty(UKA)has a long history and has many advantages in some aspects over total knee arthroplasty(TKA)for patients with suitable indications,but it has not been established as a treatment at the same level with TKA.Therefore,80 members of the British Association for Surgery of the Knee(BASK)and the European Knee Society(EKS)were invited to attend a joint meeting with the aim of creating an evidence-based consensus statement on UKA,in London,UK(December 2019).A formal consensus process was undertaken at the meeting incorporating a multiple round Delphi exercise,with group discussion of areas of agreement and disagreement between rounds.Five consensus statements were issued:①UKA should be offered as a successful alternative to TKA in patients undergoing arthroplasty who meet agreed indications.②When consenting a patient for UKA,information including the benefits and risks that are specific to UKA,should be tailored to and discussed with the individual patient.③Evidence suggests that surgeons should avoid low-volume use of UKA to optimise outcomes for their patients.④Surgeons should use the contemporary evidence-based indications and contraindications for medial UKA.⑤Knee arthroplasty surgeons should have exposure to and training in UKA.On the basis of full study of the consensus,combined with the Expert Consensus on Perioperative Management of Unicompartmental Knee Arthroplasty in China in 2020,this paper elaborates the meaning of the final evidence-based consensus for clinicians’reference.