Prosthesis Position: UKA Prosthesis Overhang ejja kuleeta ebivaamu?

unicompartmental knee arthroplasty (UKA) ye nkola ey’okulongoosa okugulu okugulu okugulu (TKA) okujjanjaba obulwadde bw’amagumba obumu. Wabula, ebikwata ku muwendo gw’okulemererwa kwa UKA biraga nti emyaka 7 egy’okuwangaala gya bitundu 74%, nga kino kitono nnyo okusinga ekya TKA (92%). Wadde ng’ensonga z’abalwadde bennyini zongera obulabe bw’okulemererwa, gamba ng’abalwadde abato n’omuwendo gw’omubiri ogw’amaanyi (BMI) guyinza okwongera ku bulabe bw’okulemererwa kwa UKA, ensobi mu by’ekikugu mu kulongoosa zibadde zitwalibwa ng’ebintu ebikulu eby’obulabe eri okulemererwa amangu. Mu UKA, kizibu okutuuka ku kukwatagana kw’ebitundu by’omubiri (prosthetic alignment) n’okusukka (overhang). Ekitundu ky’omugongo (tibial prosthesis) kisaana okussibwamu sayizi n’okuteekebwa mu ngeri ekendeeza ku kunyiiga kw’ebitundu ebigonvu, n’okusukkuluma kw’omugongo ogw’omu makkati (medial tibial overhang) okusukka mm 3 kulagiddwa okuba ensonga enkulu ey’obulabe eri okukendeera kw’obubonero bw’okugulu kwa Oxford (OKS) n’obulumi obweyongedde. Ekigendererwa ekikulu eky’okunoonyereza kuno kyali kya kwekenneenya ebiva mu bujjanjabi n’okukuba ebifaananyi okutwalira awamu mu UKA. Ekigendererwa ekyokubiri kyali kya kwekenneenya ekikolwa kya prosthetic malalignment ne overhang ku implant okuwangaala.Unicompartmental knee arthroplasty (UKA) is a surgical alternative to total knee arthroplasty (TKA) for the treatment of unicompartmental osteoarthritis. Wabula, ebikwata ku muwendo gw’okulemererwa kwa UKA biraga nti emyaka 7 egy’okuwangaala gya bitundu 74%, nga kino kitono nnyo okusinga ekya TKA (92%). Wadde ng’ensonga z’abalwadde bennyini zongera obulabe bw’okulemererwa, gamba ng’abalwadde abato n’omuwendo gw’omubiri ogw’amaanyi (BMI) guyinza okwongera ku bulabe bw’okulemererwa kwa UKA, ensobi mu by’ekikugu mu kulongoosa zibadde zitwalibwa ng’ebintu ebikulu eby’obulabe eri okulemererwa amangu. Mu UKA, kizibu okutuuka ku kukwatagana kw’ebitundu by’omubiri (prosthetic alignment) n’okusukka (overhang). Ekitundu ky’omugongo (tibial prosthesis) kisaana okussibwamu sayizi n’okuteekebwa mu ngeri ekendeeza ku kunyiiga kw’ebitundu ebigonvu, n’okusukkuluma kw’omugongo ogw’omu makkati (medial tibial overhang) okusukka mm 3 kulagiddwa okuba ensonga enkulu ey’obulabe eri okukendeera kw’obubonero bw’okugulu kwa Oxford (OKS) n’obulumi obweyongedde. Ekigendererwa ekikulu eky’okunoonyereza kuno kyali kya kwekenneenya ebiva mu bujjanjabi n’okukuba ebifaananyi okutwalira awamu mu UKA. Ekigendererwa ekyokubiri kyali kya kwekenneenya ekikolwa kya prosthetic malalignment n’okusukkuluma ku bulamu bw’okuteekebwamu.

Enkola .

Okunoonyereza kuno kwali kunoonyereza kwa kifo kimu okwalimu abalwadde abasajja n’abakazi abaakozesebwa Medial UKA mu kitongole kyaffe okuva mu January 2008 okutuuka mu December 2017, era abalwadde bonna baakolebwako UKA nga bakozesa enkola ez’omutindo.Exclusion criteria for UKA included moderate to severe valgus deformity, patellemoral compartment arthritis, posterior tibial, and instlability. Ebyava mu bujjanjabi n’okukuba ebifaananyi byafunibwa okuva mu kwekenneenya okudda emabega kw’ebiwandiiko by’obujjanjabi n’ebiwandiiko by’ebitongole. Enkoona z’omu kifuba (femoral coronal and sagittal angles) (FCA ne FSA) n’enkoona z’omugongo (tibial coronal and sagittal angles) (TCA ne TSA) zaapimibwa ku radiographs ku UKA zonna ezitakyukakyuka n’ezitambula, nga bwe kiragibwa.

Alizaati

Okugoberera okwa wakati kwali kwa myaka 4.9 (0.03 okutuuka ku 10.2). Twazuula okulongoosebwa 36 okuddamu okutunula mu kunoonyereza nga kuli wakati w’emyaka 3.7 (0.03 okutuuka ku 8.7) oluvannyuma lw’okulongoosebwa n’omuwendo gw’okulemererwa okukuŋŋaanyizibwa ogwa 14.2%. Okuwangaala kw’emyaka 5 kwali 88.0% (95% confidence interval [CI]=82.0% okutuuka ku 91.0%) ate okuwangaala kw’emyaka 10 kwali 70.0% (95% CI=56.0% okutuuka ku 80.0%).

Ensonga ezisinga okuddamu okutunulwamu zaali poor/unstable prosthesis alignment (31%), okulemererwa mu byuma (22%), okukulaakulana kw’obulwadde bw’amagumba (14%), n’obulumi obutannyonnyolwa (8%).

11.9% zokka eza UKAS ze zaatuuka ku byonna ebyagala okukwatagana n’okubikka ebitundu by’omubiri. anterior overhang of the prosthesis teyali nsonga ya bulabe nnyo eri UKA okulemererwa (10.0% okulemererwa, p=0.090), era emabega w’okusukkuluma kw’ekitundu ky’omubiri (25.0%, p=0.006) ne medial overhang of the prosthesis (38.2%, p <0.0001) baali ba stagnificant.

Okwogerako

Mu kunoonyereza kuno, twekenneenya ebiva mu bujjanjabi n’okukuba ebifaananyi eby’omu makkati UKA n’enkosa y’okukwatagana kw’ebitundu by’omubiri (prosthetic alignment) ne overhang. Emiwendo gya 5- ne 10 egy’okuwangaala gyali 88% ne 70%, era nga gyali wansi nnyo okusinga egya TKA. Ebisinga okulaga okuddamu okutunulwamu byali kukwatagana kwa kiwangaafu okubi, okulemererwa kw’ebyuma, n’okukulaakulana kw’obulwadde bw’amagumba. Okukwatagana kw’ebitundu by’omubiri ebitali birungi n’okusalako eby’emabega n’eby’omu makkati bye bikulu ebiyinza okuleeta obulabe eri okuddamu okutunula mu UKA.

Mu biwandiiko ebifulumiziddwa, ebikulu ebibiri ebivaako okulemererwa kwa UKA kwe kusumulula aseptic n’okukulaakulana kw’amagumba, byombi birina ensaasaanya y’emigugu egitakwatagana, ekiraga nti ebivaako okulemererwa kwa UKA okwogeddwako waggulu biyinza okuba eby’ebyuma mu butonde. Obujulizi buno bulaga nti okukwatagana obubi kw’ekiwanga (prosthesis alignment) kye kiyinza okuvaako okulemererwa kwa UKA mu kusooka. N’olwekyo, tukkiriza nti kaweefube alina okukolebwa okulongoosa obukodyo bw’okulongoosa okulongoosa UKA prosthesis alignment n’okukendeeza ku kubeerawo kwa overhang.

Ebizuuliddwa mu kiseera kino biraga nti akakwate ak’amaanyi wakati w’okukwatagana kw’ekiwanga obubi/okusukka n’obulabe bw’okuddamu okutunula mu nsonga biraga enkola eyinza okubaawo ku muwendo gw’okulemererwa okungi ogwetegerezeddwa mu kunoonyereza kuno. Obusobozi bw’omusawo alongoosa okubeera omutuufu obutakyukakyuka mu kuteekebwa kw’ekiwanga nsonga nkulu mu kuyamba okulongoosa emiwendo gya UKA egy’okuwangaala.

Engeri y'okugulamu amagumba agateekebwamu amagumba n'ebikozesebwa mu kuzimba amagumba) .

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