変形性膝関節症の外科的治療の最近の話題

Cartilage/chondrocyte research and osteoarthritis. Recent Topics of surgical treatment for knee osteoarthritis.

　変形性膝関節症に対する外科的治療として人工膝関節手術が普及している。近年は高齢患者，術後の高い活動性を求める患者の増加に対応可能な手術として，人工膝関節単顆置換術（UKA）が脚光を浴びている。ただし，UKAの成功には，UKAのコンセプト，手術適応の理解や適切な手術手技が求めれられる。 　UKAの臨床的な成功から，膝前十字靭帯（ACL）の重要性が見直され，ACL（機能）を温存するコンポーネント等の開発が進んでいる。またナビゲーションやロボット手術などの最新テクノロジーも続々と人工関節分野に導入されている。今後の飛躍的な臨床成績向上が期待される。

　Unicompartmental knee arthroplasty（UKA）has been performed for the treatment of isolated unicompartmental knee disease. Satisfactory results have been achieved when used in the medial compartment and strict inclusion criteria are followed. UKA is one of the minimally invasive surgeries and suitable for elderly severe knee osteoarthritis（OA）patients with a lot of complication. 　Anterior cruciate ligament（ACL）preserving and stabilizing total knee arthroplasty have been thought to be effective surgical options to improve the clinical results and satisfaction of the OA patients whose arthritis is not limited to a single compartment. 　Computer-assisted surgery, including navigation assisted and robotic surgery, has been designed to increase the accuracy of implantation and has become much more accepted and prevalent in recent years. 　These kind of “next generation knee arthroplasty” will improve the clinical results and satisfaction of knee OA patinets dramatically, I believe.