PURPOSE The purpose of this study was to examine the predictive value concerning clinical outcome and implant survival, as well as the accuracy of individual tests of a recently published radiographic decision aid for unicondylar knee arthroplasty indication findings. METHODS In the retrospective part of the study, 98 consecutive patients who had undergone unicondylar knee arthroplasty (Phase 3 Oxford medial UKA) were included, using revision questionnaires, as well as the Forgotten Joint Score-12 (FJS-12) and Knee Osteoarthritis Outcome Score (KOOS) and analysed for suitability of the radiographic decision aid. Inappropriate and appropriate indications were then compared concerning the clinical outcome and implant survival. The prospective part of the study assessed the accuracy of the decision aid's radiographic tests (varus and valgus stress views, true lateral view and skyline view), and included 90 patients. Definition as appropriate for UKA procedure included medial bone-on-bone situation in varus stress views, full-thickness lateral cartilage and functional medial collateral ligament in valgus stress views, functional anterior cruciate ligament (ACL) in true lateral views and absence of lateral facet osteoarthritis with bone loss in skyline views. Pre-operative radiographic assessment with respect to the decision aid was then compared with intraoperative articular conditions. The clinical outcome was analysed using non-parametric tests (Mann-Whitney U), and revision rates were compared using the Fisher's exact test. Accuracy assessment included calculations of the sensitivity, specificity, negative predictive value and positive predictive value. A p value < 0.05 was considered statistically significant. RESULTS Appropriate unicondylar knee arthroplasty with respect to the decision aid showed a significantly lower revision rate compared to inappropriate unicondylar knee arthroplasty (7.3% vs. 50.0%, p < 0.0001), as well as higher clinical outcome scores (FJS-12: 53.13 vs. 31.25, p = 0.041 and KOOS-QDL: 68.75 vs. 50.0, p = 0.036). The overall sensitivity (70.1%) and specificity (76.2%) for the radiographic decision aid was comparably low, which was essentially based on false negative cases (22.7%) regarding medial bone-to-bone conditions. CONCLUSION The radiographic decision aid is a helpful tool to predict clinical outcome and implant survival of mobile-bearing unicondylar knee arthroplasty. Strict use of the radiographic decision aid may lead to increased exclusion of appropriate patients with unicondylar knee arthroplasty implantation.

中文翻译：

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中期随访中选择单icon膝关节置换术患者的放射学决策辅助工具的临床验证和准确性测试。

目的这项研究的目的是检查有关临床结局和植入物存活率的预测价值，以及最近发表的放射影像学决策辅助工具对icon突膝关节置换指征结果的个别测试的准确性。方法在研究的回顾性部分中，使用修订问卷，“遗忘关节评分12（FJS-12）”和“膝关节骨关节炎结果”，纳入了98例连续进行了icon突膝关节置换术（第3阶段牛津内侧UKA）的患者。得分（KOOS）并分析放射线决策辅助工具的适用性。然后比较关于临床结果和植入物存活的不适当和适当的适应症。该研究的前瞻性部分评估了决策辅助工具的准确性 的放射线检查（内翻和外翻应力图，真实侧面图和天际线图），包括90名患者。适用于UKA程序的定义包括内翻应力视野中的骨上内侧情况，外翻应力视野中的全层外侧软骨和内侧副韧带，真正的外侧视野中的功能性前交叉韧带（ACL）和无外侧小平面在天际线景观中出现骨丢失的骨关节炎。然后将就决策辅助工具进行的术前影像学评估与术中关节状况进行比较。使用非参数检验（Mann-Whitney U）分析临床结局，并使用Fisher精确检验比较修订率。准确性评估包括敏感性，特异性，阴性预测值和阳性预测值。p值<0.05被认为具有统计学意义。结果与不适当的单icon膝关节置换术相比，适当的单icon膝关节置换术的翻修率显着降低（7.3％vs. 50.0％，p <0.0001），以及更高的临床结果评分（FJS-12：53.13 vs 31.25，p ＝ 0.041，KOOS-QDL：68.75对50.0，p ＝ 0.036）。放射线照相辅助检查的总体敏感性（70.1％）和特异性（76.2％）相对较低，这主要是基于内侧骨到骨状况的假阴性病例（22.7％）。结论放射照相辅助决策是预测活动性单un窝膝关节置换术的临床结果和植入物存活的有用工具。