1
|
Karayiannis P, Cassidy R, Dobie I, Beverland D. Long term follow up of 257 consecutive cementless Oxford medial compartment knee arthroplasties at a non-designer centre. Knee 2024; 49:201-209. [PMID: 39043015 DOI: 10.1016/j.knee.2024.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 06/04/2024] [Accepted: 07/02/2024] [Indexed: 07/25/2024]
Abstract
AIMS This study aimed to review the survivorship, indication for revision and patient reported outcomes for 257 consecutive Oxford cementless unicompartmental knee arthroplasties (OUKA's) in 238 patients at 12-14 years post-operatively. METHODS Patients underwent surgery between April 2008 and October 2010 by two non-design surgeons including their learning curve. The 5-year clinical and radiological outcomes have already been reported. Oxford knee scores (OKS) were recorded at 1, 5 and 12-14 years with delayed review a result of the COVID-19 pandemic. Revision indication and imaging were reviewed. RESULTS Revision was required in 28 OUKA's (10.9%) with a 10-year cumulative survival of 93.0%, reducing to 78.8% at 14 years. 59 patients had died prior to this review and 24 were not contactable. Those not contactable had electronic records reviewed to ensure they did not have a revision elsewhere. Half of the revisions were for progression of lateral compartment arthritis (14/28). Four of 6 cases with a full revision for polyethylene wear may have benefited from a bearing exchange instead. OKSs in non-revised patients were good (median score 38, IQR 30-44) with no significant deterioration noted from 5 to 12-14 years. CONCLUSIONS Cementless OUKA in this series had a long-term survival rate comparable to other OUKA's outside of the designer centre. OKSs remain good for those patients not revised. Progression of lateral compartment arthritis was the primary reason for revision with no revisions for component loosening or bearing spinout. Ideally UKA patients who experience problems should be under the care of revisions surgeons who perform UKA. Improving patient selection and understanding of the pathophysiology of lateral disease progression, remain crucial to improve the long-term survivorship of OUKA.
Collapse
Affiliation(s)
- Paul Karayiannis
- Musgrave Park Hospital, Stockman's Lane, Belfast BT9 7JB, Northern Ireland, United Kingdom.
| | - Roslyn Cassidy
- Musgrave Park Hospital, Stockman's Lane, Belfast BT9 7JB, Northern Ireland, United Kingdom.
| | - Ian Dobie
- Musgrave Park Hospital, Stockman's Lane, Belfast BT9 7JB, Northern Ireland, United Kingdom.
| | - David Beverland
- Primary Joint Unit, Musgrave Park Hospital, Stockman's Lane, Belfast BT97JB, Northern Ireland, United Kingdom.
| |
Collapse
|
2
|
Impact of age on unicompartmental knee arthroplasty outcomes: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2023; 31:986-997. [PMID: 36063186 PMCID: PMC9957860 DOI: 10.1007/s00167-022-07132-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 08/19/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE Unicompartmental knee arthroplasty (UKA) is an effective treatment for late knee osteoarthritis (OA). Young age (< 60 years) has been associated with worse outcomes. The goal of this systematic review and meta-analysis is to study the effect of age on UKA outcomes. METHODS The primary objective was to compare the UKA revision rate in young patients with that of old patients, using the age thresholds of 60 and 55 years. Secondary objectives were patient-reported outcome measures (PROMs) and implant design. Five databases were searched in December 2021 for original comparative studies with a minimum of 1-year follow-up. No restrictions were placed on the type of UKA prosthesis. RESULTS A total of 11 observational studies with 6130 knees were included. A mean MINORS score of 19 was assigned to the review. The mean age of patients was 64 years, with average follow-up of 7.5 ± 2.98 years. There was no significant difference in revision rate, incident or PROMs between young and old patients in the analysis for each age threshold. Further sub-analysis adjusting for implant type in mobile- and fixed-bearing prostheses also showed similar results between those above and under 60 and 55 years. CONCLUSION Young age was not associated with a higher revision rate or lower functional scores. Thus, this review provides evidence that age alone is not a contraindication to UKA, but the surgical choice must be based on several elements, and this finding should be applied in context, given the binary division and heterogeneity of patients. LEVEL OF EVIDENCE III.
Collapse
|
3
|
Ruangsomboon P, Paugchawee J, Narkbunnam R, Chareancholvanich K, Pornrattanamaneewong C. The factors influencing the component sizes in Oxford Phase 3 unicompartmental knee arthroplasty. Jt Dis Relat Surg 2022; 33:505-512. [PMID: 36345177 PMCID: PMC9647690 DOI: 10.52312/jdrs.2022.786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 08/25/2022] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES This study aims to investigate the Thai population characteristics that may correlate the component sizes used in the Oxford Phase 3 unicompartmental knee arthroplasty (OUKA) and to examine common matching patterns and variables affecting matching and patient-specific factors while determining the femoral component (Fc) size for Thai patients. PATIENTS AND METHODS Between June 2003 and June 2019, a total of 773 knees of 773 patients (145 males, 628 females; median age: 64.0 years; range: 44 to 86 years) who underwent OUKA using Oxford Microplasty® Instrumentation were retrospectively analyzed. The femoral and tibial components (Tc) were matched based on the patient's age, sex, height, weight, and other characteristics. The Fc sizes were compared in terms of patient characteristics. Also, the area under the receiver operating characteristic (AuROC) was calculated. RESULTS A total of 6.5% of the Fcs were extra small (XS), 65.7% were small (S), 20.6% were medium (M), 7.2% were large (L), and 0% were extra-large (XL). For Tc sizes, the distribution was as follows: 20.2% AA; 31.6% A; 24.3% B; 16.3% C; 6.0% D; 1.7% E; and 0% F. Females had the most common Fc and Tc sizes of S and A, while males had the most common sizes of M and C. The S-A (32.3%) and M-C (27.5%) were the most often used matching patterns among females and males, respectively. Sex, body weight (BW), height, and body mass index (BMI) were independent predictors of Fc sizes. The AuROC for BW, height, and BMI was statistically significant. CONCLUSION The S and A for females and M and C for men were the most common sizes of Fc and Tc in Thai patients. Among females, the most prevalent pairing was S-A and, among men, it was M-C. The strongest determinants of Fc sizes were found to be male sex and height.
Collapse
Affiliation(s)
- Pakpoom Ruangsomboon
- Division of Adult Reconstructive Surgery, Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Jirayu Paugchawee
- Division of Adult Reconstructive Surgery, Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Rapeepat Narkbunnam
- Division of Adult Reconstructive Surgery, Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Keerati Chareancholvanich
- Division of Adult Reconstructive Surgery, Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chaturong Pornrattanamaneewong
- Division of Adult Reconstructive Surgery, Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| |
Collapse
|
4
|
The effect of age on the outcomes of cementless mobile bearing unicompartmental knee replacements. Knee Surg Sports Traumatol Arthrosc 2022; 30:928-938. [PMID: 33580344 PMCID: PMC8901511 DOI: 10.1007/s00167-020-06428-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 12/23/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE Unicompartmental Knee Replacements (UKR) are being performed in patients with increasing demands and life expectancies with surgical concerns that cemented fixation will not last. Cementless fixation may offer a solution, but the results in different age groups have not been assessed. The effect of age at surgery on the outcomes of cementless UKRs was investigated. METHODS A prospective cohort of 1000 medial cementless mobile bearing UKR were analysed. Patients were categorised into four age groups (< 55, 55 to < 65, 65 to < 75 and ≥ 75 years). Implant survival was assessed using endpoints reoperation, revision and major revision requiring revision knee replacement components. Functional outcomes were assessed. RESULTS 10 year cumulative revision rate for the < 55, 55 to < 65, 65 to < 75 and ≥ 75 groups were 2.1% (CI 0.6-6.1), 1.8% (CI 0.6-5.3), 3.2% (CI 1.5-6.5) and 4.1% (1.7-9.6) with no differences between groups (p = 0.52). Two of the 22 revisions were considered major. The 10 year cumulative reoperation rates were 4.5% (CI 2.0-10.0), 3.0% (CI 1.3-6.5), 3.8% (CI 2.0-7.1) and 4.1% (CI 1.7-9.6) with no differences between groups (p = 0.81). The 10 year median Oxford Knee Scores were 42.5, 46.5, 45 and 42.5, respectively. The 10 year median Objective American Knee Society Scores were 95 for all age groups. CONCLUSION The cementless mobile bearing UKR has low reoperation and revision rates and similar functional outcomes in all age groups. Cementless UKR should be used in all age groups and age should not be considered a contraindication. LEVEL OF EVIDENCE III.
Collapse
|
5
|
Klasan A, Parker DA, Lewis PL, Young SW. Low percentage of surgeons meet the minimum recommended unicompartmental knee arthroplasty usage thresholds: Analysis of 3037 Surgeons from Three National Joint Registries. Knee Surg Sports Traumatol Arthrosc 2022; 30:958-964. [PMID: 33595679 PMCID: PMC8901519 DOI: 10.1007/s00167-021-06437-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 01/05/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE The reported usage of UKA is around 10% in the UK, Australian and New Zealand joint registries. However, some authors recommend that a higher UKA usage of 20%, or a minimum 12 UKA cases per year, would reduce revision rates. The purpose of this study was to analyze the percentage of surgeons performing the recommended thresholds in these 3 registries. METHODS Data from the UK, Australian and New Zealand registry databases was utilized from the time period since their respective introduction until 2017. All primary TKA and UKA performed for the diagnosis of osteoarthritis by surgeons with more than 100 recorded knee arthroplasties in their respective registry were included. The results between the registries were compared and a pooled analysis was performed. The number of surgeons meeting the recommended caseload of > 20% UKA yearly or 12 UKA cases yearly was calculated. RESULTS We identified 3037 knee surgeons performing 1,556,440 knee arthroplasties, of which 131,575 were UKA (8.45%). Over 50% of knee surgeons in each registry had a proportion of less than 5% UKA of their knee replacement procedures. After pooling of data, median surgeon UKA usage was 2.0% (IQR 0-9.1%). The percentage of surgeons meeting the proposed caseload criteria was highest in New Zealand, 16.3%, followed by the UK at 12.4% and Australia 11.3% (p = 0.28). CONCLUSION More than 50% of knee surgeons in UK, Australian and New Zealand joint registries perform less than 5% of UKA yearly. The majority of experienced knee surgeons are not meeting the recommended minimum thresholds, which might indicate that the recommended thresholds are not feasible for the vast majority of knee surgeons. The reasons behind this require further research. LEVEL OF EVIDENCE Level III retrospective registry study.
Collapse
Affiliation(s)
- Antonio Klasan
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020, Linz, Austria.
- Johannes Kepler University Linz, Altenberger Strasse 69, 4040, Linz, Austria.
| | - David A Parker
- Sydney Orthopaedic Research Institute, Sydney, Australia
| | - Peter L Lewis
- Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, Australia
- Wakefield Orthopaedic Clinic, Adelaide, Australia
- Faculty of Medicine, Department of Orthopedics, Lund University, Clinical Sciences Lund, Lund, Sweden
| | | |
Collapse
|
6
|
Burger JA, Jager T, Dooley MS, Zuiderbaan HA, Kerkhoffs GMMJ, Pearle AD. Comparable incidence of periprosthetic tibial fractures in cementless and cemented unicompartmental knee arthroplasty: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2022; 30:852-874. [PMID: 33528591 PMCID: PMC8901491 DOI: 10.1007/s00167-021-06449-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 01/11/2021] [Indexed: 12/18/2022]
Abstract
PURPOSE (I) To determine the incidence of periprosthetic tibial fractures in cemented and cementless unicompartmental knee arthroplasty (UKA) and (II) to summarize the existing evidence on characteristics and risk factors of periprosthetic fractures in UKA. METHODS Pubmed, Cochrane and Embase databases were comprehensively searched. Any clinical, laboratory or case report study describing information on proportion, characteristics or risk factors of periprosthetic tibial fractures in UKA was included. Proportion meta-analysis was performed to estimate the incidence of fractures only using data from clinical studies. Information on characteristics and risk factors was evaluated and summarized. RESULTS A total of 81 studies were considered to be eligible for inclusion. Based on 41 clinical studies, incidences of fractures were 1.24% (95%CI 0.64-2.41) for cementless and 1.58% (95%CI 1.06-2.36) for cemented UKAs (9451 UKAs). The majority of fractures in the current literature occurred during surgery or presented within 3 months postoperatively (91 of 127; 72%) and were non-traumatic (95 of 113; 84%). Six different fracture types were observed in 21 available radiographs. Laboratory studies revealed that an excessive interference fit (press fit), excessive tibial bone resection, a sagittal cut too deep posteriorly and low bone mineral density (BMD) reduce the force required for a periprosthetic tibial fracture to occur. Clinical studies showed that periprosthetic tibial fractures were associated with increased body mass index and postoperative alignment angles, advanced age, decreased BMD, female gender, and a very overhanging medial tibial condyle. CONCLUSION Comparable low incidences of periprosthetic tibial fractures in cementless and cemented UKA can be achieved. However, surgeons should be aware that an excessive interference fit in cementless UKAs in combination with an impaction technique may introduce an additional risk, and could therefore be less forgiving to surgical errors and patients who are at higher risk of periprosthetic tibial fractures. LEVEL OF EVIDENCE V.
Collapse
Affiliation(s)
- Joost A Burger
- Department of Orthopaedic Surgery and Computer Assisted Surgery Center, Hospital for Special Surgery, Weill Medical College of Cornell University, 535 East 70th St, New York, NY, 10021, USA.
| | - Tjeerd Jager
- Department of Orthopaedic Surgery, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - Matthew S Dooley
- Department of Orthopaedic Surgery and Computer Assisted Surgery Center, Hospital for Special Surgery, Weill Medical College of Cornell University, 535 East 70th St, New York, NY, 10021, USA
| | - Hendrik A Zuiderbaan
- Department of Orthopaedic Surgery, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - Gino M M J Kerkhoffs
- Department of Orthopedic Surgery, Amsterdam Movement Sciences (AMS), Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Andrew D Pearle
- Department of Orthopaedic Surgery and Computer Assisted Surgery Center, Hospital for Special Surgery, Weill Medical College of Cornell University, 535 East 70th St, New York, NY, 10021, USA
| |
Collapse
|
7
|
Prosthesis size distribution in Oxford phase III unicompartmental knee arthroplasty - Based on more than 1900 Chinese patients. J Orthop 2021; 25:230-236. [PMID: 34099952 DOI: 10.1016/j.jor.2021.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 05/08/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction It is difficult to determine the optimal size of unicompartmental knee arthroplasty (UKA) prosthesis both pre-operatively and intra-operatively. Inappropriate femoral and tibial components are still the leading cause of failure. Several guidelines based on the Western population may not apply to the Chinese patients. We consequently try to investigate distributions of Oxford-UKA prosthesis in Chinese patients in order to provide a good reference for surgeons preoperatively. Methods From January 2010 to December 2019, 1909 patients (2307 knees) with primary anteromedial osteoarthritis accepted Oxford phase III UKA. Statistical analyses were performed on the distributions of the femoral, tibial, and matching of the femoral-tibial prosthesis. The possible factors affecting the sizes of femoral components, including gender, height based on gender were investigated. Results 1. The distributions of femoral size components include extra-large (XL) 0, large (L) 1.08%, medium (M) 26.09%, small (S) 59.64%, extra-small (XS) 13.18%; the tibial sizes components were F 0, E 0.69%, D 7.80%, C 19.59%, B 24.79%, A 34.16%, AA 12.96%. 2. The matching of femur-tibia components were L-E 0.52%,L-D 0.52%,M-E 0.17%, M-D 7.28%,M - C 16.60%,M - B 1.95%,M-A 0.13%, M-AA 0.04%, S-C 2.99%, S-B 22.67%, S-A 31.12%, S-AA 2.82%, XS-B 0.17%, XS-A 2.90% and XS-AA 10.10%. The optimal matches between femoral and tibial components were: XL with F; L with E; M with C and D; S with A and B. 3. The patient's gender and height based on gender are necessary considerations for selection of femoral components (P<0.01). Conclusion In Chinese patients, the size of femoral components is mainly small (S) for women, medium (M) for men. The tibial components of female patients are mainly A and B, whereas C is predominant for male patients. The more commonly used matching forms are S-A and S-B.
Collapse
|
8
|
Three-Dimensional-Printed Guiding Template for Unicompartmental Knee Arthroplasty. BIOMED RESEARCH INTERNATIONAL 2020; 2020:7019794. [PMID: 33381577 PMCID: PMC7765727 DOI: 10.1155/2020/7019794] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 12/04/2020] [Indexed: 11/17/2022]
Abstract
Background For unicompartmental knee arthroplasty (UKA), accurate alignment of the limb is crucial. This study is aimed at investigating the efficacy and safety of a three-dimensional printed patient-customized guiding template (3DGT) for UKA. Methods A total of 22 patients receiving UKA were randomly divided into the 3DGT-UKA group (n = 11) and traditional UKA group (T-UKA group; n = 11). In the 3DGT-UKA group, the line and angle of osteotomy were decided on a 3D image of the limb reconstructed from imaging data; a guiding template was then designed and printed out. The patients in the T-UKA group underwent conventional UKA. Prosthesis size, operation time, postoperative drainage, hip–knee angle (HKA), pain, and Hospital for Special Surgery (HSS) scores were recorded at day 1, week 1, month 1, and month 3 after surgery. Results There was no significant difference in the size of prostheses between the preoperatively designed and actually used in the 3DGT-UKA group (p > 0.05). HKA was comparable in 3DGT-UKA and T-UKA patients. Operation time was shorter (53.6 ± 6.4 minutes vs. 75.8 ± 7.1 minutes) and wound drainage was less (93.2 ± 3.9 mL vs. 85.2 ± 3.0 mL) in 3DGT-UKA than in T-UKA (p < 0.05). Hospital stay was shorter in the 3DGT-UKA group. The 3DGT-UKA group had a lower VAS score on day 1, week 1, and month 1 and a higher HSS score on week 1 and month 1 after surgery. No varus/valgus deformity or prosthesis loosening was observed in either group at the final follow-up. Conclusion The 3D-printed patient-customized guiding template may help decrease operation time, decrease blood loss, and improve short-term clinical outcomes in patients undergoing UKA surgery.
Collapse
|
9
|
Gupta V, Kejriwal R, Frampton C. Revision Following Cemented and Uncemented Oxford-III Primary Medial Unicompartmental Knee Replacements: A 19-Year Analysis from the New Zealand Joint Registry. J Bone Joint Surg Am 2020; 102:1777-1783. [PMID: 33086344 DOI: 10.2106/jbjs.19.01443] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Oxford-III unicompartmental knee replacements (UKRs) are among the most commonly used prostheses to treat isolated medial compartment osteoarthritis (OA). However, the best mode of implant fixation for primary UKRs remains a source of debate. The hypothesis of this study was that the biologically superior fixation of uncemented Oxford-III primary UKRs would translate into a lower revision rate when compared with cemented Oxford-III primary UKRs used to treat isolated medial compartment OA. METHODS Data on all Oxford-III primary UKRs (n = 8,733) completed for isolated medial compartment OA from January 2000 to December 2018 were obtained from the New Zealand Joint Registry (NZJR). Revision rates were documented for each fixation type and analyzed for associations with patient sex and age at surgery. A multivariate Cox proportional-hazards analysis was completed to determine if type of fixation was an independent risk factor for revision of Oxford-III UKRs. RESULTS Statistical analysis revealed a >1.8-fold greater revision risk for cemented Oxford-III UKRs compared with uncemented Oxford-III UKRs (p = 0.001) when considered independently of other risk factors. Furthermore, compared with uncemented fixation, cemented fixation was associated with a 2.9-fold (p < 0.001) increase in revision risk for women <65 years old and a 1.7-fold (p = 0.008) increase in revision risk for men 55 to 74 years old. There was no significant difference in the risk of revision between fixation methods for women ≥65 years old and men ≥75 years old. CONCLUSIONS We found that the type of fixation was an independent risk factor for revision of Oxford-III UKRs used in the treatment of isolated medial compartment OA. Uncemented Oxford-III primary UKRs had superior implant survivorship in women <65 years old and men 55 to 74 years old. Age and sex are important factors to consider when determining the type of fixation for Oxford-III primary UKRs used to treat isolated medial compartment OA. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Vikesh Gupta
- Department of Orthopaedic Surgery, Whangarei Base Hospital, Whangarei, New Zealand
| | - Ritwik Kejriwal
- Department of Orthopaedic Surgery, Taranaki Base Hospital, New Plymouth, New Zealand
| | - Chris Frampton
- Department of Medicine, The University of Otago, Christchurch, New Zealand
| |
Collapse
|
10
|
Unikondylärer Gelenkersatz medial und lateral. ARTHROSKOPIE 2020. [DOI: 10.1007/s00142-020-00380-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
11
|
Valgus Correctability and Meniscal Extrusion Were Associated With Alignment After Unicompartmental Knee Arthroplasty. Clin Orthop Relat Res 2020; 478:1636-1644. [PMID: 32324667 PMCID: PMC7310375 DOI: 10.1097/corr.0000000000001260] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Appropriate postoperative lower limb alignment is one important element of a successful unicompartmental knee arthroplasty (UKA). To predict postoperative alignment, it is important to investigate the association between preoperative imaging evaluations and lower limb alignment after medial UKA. QUESTIONS/PURPOSES (1) Do preoperative valgus stress radiographic and MRI measurements (% mechanical axis, hip-knee-ankle angle, medial meniscal extrusion distance, and osteophyte area at the medial femur and tibia) correlate with postoperative lower limb alignment after UKA; and (2) Can useful cutoffs be calculated in advance of surgery for those findings that were associated with coronal-plane overcorrection? METHODS We retrospectively analyzed 125 patients with medial knee pain who underwent UKA from January 2012 to October 2018. Valgus stress radiography and MRI were performed routinely to assess the knee. Valgus stress radiography was obtained with the patient supine with the knee in full extension and a firm manual valgus force applied to the knee. Full-length weightbearing radiography was performed 3 months after surgery. There were 12% (15) of patients who did not undergo MRI, and 4% (five) of patients who did not receive the postoperative full-length weightbearing radiograph and they were excluded, leaving 84% (105) of patients available for analysis. There were 27 men and 78 women with a mean (range) age of 77 years ± 6 years (60 to 87). The preoperative diagnosis was medial osteoarthritis in 99 patients and osteonecrosis of the medial femoral condyle in six. To investigate the associations, we routinely measured % mechanical axis using radiography, and also measured the medial meniscal extrusion distance and osteophyte area at the medial femur and tibia using MRI after surgery. Medial meniscus extrusion distance was defined as the distance from the outermost edge of the medial meniscus to a line connecting the femoral and tibial cortices. From these parameters, postoperative alignment was estimated using regression and receiver operating characteristic curve analyses. Variables with p < 0.05 were included. RESULTS The % mechanical axis on the valgus stress radiograph and medial meniscal extrusion distance were correlated with postoperative lower limb alignment after UKA (adjusted correlation coefficient 0.72; p < 0.001, adjusted correlation coefficient 0.2; p = 0.003, respectively). The estimated % mechanical axis on the postoperative weightbearing radiograph was equal to -0.27 + 0.86% (% mechanical axis on valgus stress radiograph) + 1.14 mm (medial meniscal extrusion distance). Using a cutoff point of 36%, the % mechanical axis on valgus stress radiograph was associated with overcorrection after UKA (area under the curve: 0.89; odds ratio 14 [95% CI 0.75 to 0.95]; p < 0.001, sensitivity 77.8%, specificity 80.9%). CONCLUSIONS The overcorrection of a varus knee on a valgus stress radiograph before UKA and the increased extrusion of the medial meniscus on preoperative MRI was associated with a greater likelihood of overcorrected alignment after UKA. Future studies should conduct long-term follow-up of malalignment patients to assess the possible complications. LEVEL OF EVIDENCE Level III, diagnostic study.
Collapse
|
12
|
Kennedy JA, Matharu GS, Hamilton TW, Mellon SJ, Murray DW. Age and Outcomes of Medial Meniscal-Bearing Unicompartmental Knee Arthroplasty. J Arthroplasty 2018; 33:3153-3159. [PMID: 30006108 DOI: 10.1016/j.arth.2018.06.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 06/06/2018] [Accepted: 06/11/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND National joint registries report increasing revision rates with decreasing patient age for all types of joint arthroplasty. This study aimed to explore the effect of age on function and revision risk in patients undergoing medial meniscal-bearing UKA. METHODS A prospectively followed cohort of 1000 consecutive medial meniscal-bearing UKAs at a designer center was analyzed. All knees were implanted for recommended indications and had mean 10-year follow-up. Patients were grouped by age at surgery (<55, 55 to <65, 65 to <75, 75+). Oxford Knee Scores (OKS) were assessed at 5 and 10 years. Component-time revision incidence rates and Kaplan-Meier implant survival were calculated. RESULTS Mean patient age at surgery was 66.6 years (range, 33-88). All age-groups had significant (P < .001) improvement in OKS over time, and at 5 years achieved a median OKS of 44. At 10 years, median OKS, from youngest group to eldest, were 44, 45, 42, and 39, with the eldest group having a significantly lower OKS (P < .01). Ten-year implant survival rates were 97%, 94%, 94%, and 93%, respectively, and was not significantly associated with age at UKA. CONCLUSION Medial meniscal-bearing UKA provides good functional outcomes in all age-groups; however, in older patients (75+), the functional outcome deteriorated at 10 years presumably due to deteriorating health. Contrary to registry observations, the revision rate was not higher in younger patients. These results suggest that, with correct indications, patient age should not be considered a contraindication to medial meniscal-bearing UKA.
Collapse
Affiliation(s)
- James A Kennedy
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, United Kingdom
| | - Gulraj S Matharu
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, United Kingdom
| | - Thomas W Hamilton
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, United Kingdom
| | - Stephen J Mellon
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, United Kingdom
| | - David W Murray
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, United Kingdom
| |
Collapse
|
13
|
Hutt JRB, Sur A, Sur H, Ringrose A, Rickman MS. Outcomes and early revision rate after medial unicompartmental knee arthroplasty: prospective results from a non-designer single surgeon. BMC Musculoskelet Disord 2018; 19:172. [PMID: 29843680 PMCID: PMC5975526 DOI: 10.1186/s12891-018-2099-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Accepted: 05/17/2018] [Indexed: 12/11/2022] Open
Abstract
Background This prospective study evaluates outcomes and reoperation rates for unicompartmental knee arthroplasty (UKA) from a single non-designer surgeon using relatively extended criteria of degenerative changes of grade 2 or above in either or both non-operated compartments. Methods 187 consecutive medial mobile bearing UKA implants were included after history, clinical assessment and radiological evaluation. 91 patients had extended clinical outcomes. Post-operative assessment included functional scoring with the Oxford Knee Score (OKS) and radiographic review. Survivorship curves were constructed using the life-table method, with 95% confidence intervals calculated using Rothman’s equation. Separate endpoints were examined: revision for any reason and revision for confirmed loosening. Results The mean follow-up was 3.5 years. The pre-operative OKS improved from a mean of 21.2 to 38.9 (Mann-Whitney U Test, p = < 0.001). Twelve Patients required further operations including 9 revisions. No patients developed deep infection and no surviving implants were loose radiographically. Survivorship at 7 years with endpoints of re-operation, revision and aseptic loosening at surgery or radiographically was 88.4% (95% CI 79.6–93.7), 93.1% (95% CI 85.5–96.9) and 97.3% (95% CI 91.2–99.2) respectively. The presence of pre-operative mild contralateral tibiofemoral or any extent of patellofemoral joint degeneration was of no consequence. Discussion The indications for UKA are being expanded to include patients with greater deformity, more advanced disease in the patellofemoral joint and even certain features in the lateral compartment indicative of an anteromedial pattern of osteoarthritis (OA). However, much of the supporting literature remains available only from designer centres. This study represents a group of patients with what we believe to be wider indications, along with decisions to treat made on clinical grounds and radiographs alone. Conclusion This study shows comparable clinical outcomes of UKA for extended indications from a high volume, high-usage non-designer unit. Electronic supplementary material The online version of this article (10.1186/s12891-018-2099-2) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Jonathan R B Hutt
- Department of Trauma and Orthopaedics, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Avtar Sur
- Department of Trauma and Orthopaedics, St George's University Hospitals NHS Foundation Trust, London, UK.
| | - Hartej Sur
- Department of Trauma and Orthopaedics, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Aine Ringrose
- Department of Trauma and Orthopaedics, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Mark S Rickman
- Department of Orthopaedics and Trauma, The University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| |
Collapse
|
14
|
Alnachoukati OK, Barrington JW, Berend KR, Kolczun MC, Emerson RH, Lombardi AV, Mauerhan DR. Eight Hundred Twenty-Five Medial Mobile-Bearing Unicompartmental Knee Arthroplasties: The First 10-Year US Multi-Center Survival Analysis. J Arthroplasty 2018; 33:677-683. [PMID: 29113757 DOI: 10.1016/j.arth.2017.10.015] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 10/03/2017] [Accepted: 10/09/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND FDA approval for the Oxford phase III device was approved for use in the United States in 2004. This study seeks to provide the first long-term, large patient sample size, Oxford phase III multi-site survivorship study in the United States, investigating patient reported outcomes of pain and function, while also providing an in-depth analysis of causes for revision, and finally addressing recent advancements that can help aid the unicompartmental knee arthroplasty (UKA) process and further improve partial knee survivorship. METHODS Between July 2004 and December 2006, 5 surgeons from around the United States performed medial UKA through the minimally invasive surgical approach, on 825 knees in 695 patients. This was a consecutive series of primary UKAs using the phase III mobile bearing; cemented Oxford Knee (Zimmer Biomet, Warsaw, IN), implanted utilizing phase III instrumentation. UKA survivorship considered all revisions as the end point. Implant survivorship eliminated revisions at which the original Oxford implant was determined to be well fixated and functional intra-operatively. RESULTS A total of 93 knees were revised in this study. Mean follow-up was 9.7 years (6-12). Implant survivorship at year 10 was 90% (confidence interval 2.7%). UKA survivorship at year 10 was 85% (confidence interval 3.8%). Average preoperative American Knee Society Score (knee score) was 49 and rose to 90 postoperatively (standard deviations 16 and 18, respectively). Average preoperative American Knee Society Score (function score) was 55 and rose to 77 postoperatively (standard deviations 15 and 28, respectively). CONCLUSION This was the first large-scale, 10-year, multi-site follow-up of the Oxford mobile-bearing medial UKA undertaken in the United States, displaying good survivorship and excellent patient outcomes.
Collapse
|
15
|
Scheele C, Pietschmann MF, Schröder C, Grupp T, Holderied M, Jansson V, Müller PE. Effect of minimally-invasive implantation of unicompartmental knee arthroplasty on cement penetration and biomechanical stability. An experimental study in human tibiae. Clin Biomech (Bristol, Avon) 2018; 51:34-39. [PMID: 29175672 DOI: 10.1016/j.clinbiomech.2017.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Revised: 11/12/2017] [Accepted: 11/14/2017] [Indexed: 02/07/2023]
Affiliation(s)
- C Scheele
- Ludwig Maximilians University Clinic for Orthopaedic Surgery, Campus Grosshadern, Marchioninistr. 15, 81377 Munich, Germany.
| | - M F Pietschmann
- Ludwig Maximilians University Clinic for Orthopaedic Surgery, Campus Grosshadern, Marchioninistr. 15, 81377 Munich, Germany
| | - C Schröder
- Ludwig Maximilians University Laboratory for Biomechanics and Experimental Orthopaedics, Campus Grosshadern, Feodor-Lynen-Straße 19, 81377 Munich, Germany
| | - T Grupp
- Aesculap AG Research & Development, Am Aesculap-Platz, 78532 Tuttlingen, Germany; Ludwig Maximilians University Clinic for Orthopaedic Surgery, Campus Grosshadern, Marchioninistr. 15, 81377 Munich, Germany
| | - M Holderied
- Aesculap AG Research & Development, Am Aesculap-Platz, 78532 Tuttlingen, Germany
| | - V Jansson
- Ludwig Maximilians University Clinic for Orthopaedic Surgery, Campus Grosshadern, Marchioninistr. 15, 81377 Munich, Germany
| | - P E Müller
- Ludwig Maximilians University Clinic for Orthopaedic Surgery, Campus Grosshadern, Marchioninistr. 15, 81377 Munich, Germany
| |
Collapse
|
16
|
Hamilton TW, Rizkalla JM, Kontochristos L, Marks BE, Mellon SJ, Dodd CAF, Pandit HG, Murray DW. The Interaction of Caseload and Usage in Determining Outcomes of Unicompartmental Knee Arthroplasty: A Meta-Analysis. J Arthroplasty 2017. [PMID: 28641970 DOI: 10.1016/j.arth.2017.04.063] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Outcomes after unicompartmental knee arthroplasty (UKA) are variable and influenced by caseload (UKA/y) and usage (percentage of knee arthroplasty that are UKA), which relates to indications. This meta-analysis assesses the relative importance of these factors. METHODS MEDLINE (Ovid), Embase (Ovid), and Web of Science (ISI) were searched for consecutive series of cemented Phase 3 Oxford medial UKA. The primary outcome was revision rate/100 observed component years (% pa) with subgroup analysis based on caseload and usage. RESULTS Forty-six studies (12,520 knees) with an annual revision-rate ranging from 0% to 4.35% pa, mean 1.21% pa (95% confidence interval [CI], 0.97-1.47), were identified. In series with mean follow-up of 10-years, the revision-rate was 0.63% pa (95% CI, 0.46-0.83), equating to a 94% (95% CI, 92%-95%) 10-year survival. Aseptic loosening, lateral arthritis, bearing dislocation, and unexplained pain were the predominant failure mechanisms with revision for patellofemoral problems and polyethylene wear exceedingly rare. The lowest revision-rates were achieved with caseload >24 UKA/y (0.88% pa; 95% CI, 0.63-1.61) and usage >30% (0.69% pa; 95% CI, 0.50-0.90). Usage was more important than caseload; with high usage (≥20%), the revision-rate was low, whether the caseload was high (>12 UKA/y) or low (≤12 UKA/y; (0.94% pa; 95% CI, 0.69-1.23 and 0.85% pa; 95% CI, 0.65-1.08), respectively); with low usage (<20%), the revision-rate was high, whether the caseload was high or low (1.58% pa; 95% CI, 0.57-3.05 and 1.76% pa; 95% CI, 1.21-2.41, respectively). CONCLUSION To achieve optimum results, surgeons, whether high or low caseload, should adhere to the recommended indications such that ≥20%, or ideally >30% of their knee arthroplasties are UKA. If they do this, then they can expect to achieve results similar to those of the long-term series, which all had high usage (>20%) and an average 10-year survival of 94%.
Collapse
Affiliation(s)
- Thomas W Hamilton
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - James M Rizkalla
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Leonidas Kontochristos
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Barbara E Marks
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Stephen J Mellon
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Christopher A F Dodd
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Hemant G Pandit
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom
| | - David W Murray
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom; Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| |
Collapse
|
17
|
Cao F, Si H, Zeng Y, Li C, Wu Y, Shen B. WITHDRAWN: The Congruence and Joint Space Width of the Lateral Compartment Can Be Restored After Medial Unicompartmental Knee Arthroplasty. J Arthroplasty 2017:S0883-5403(17)30374-1. [PMID: 28578846 DOI: 10.1016/j.arth.2017.04.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 03/30/2017] [Accepted: 04/18/2017] [Indexed: 02/05/2023] Open
Abstract
This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.
Collapse
Affiliation(s)
- Fei Cao
- Department of Orthopaedic Surgery, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Haibo Si
- Department of Orthopaedic Surgery, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Yi Zeng
- Department of Orthopaedic Surgery, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Canfeng Li
- Department of Orthopaedic Surgery, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Yuangang Wu
- Department of Orthopaedic Surgery, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Bin Shen
- Department of Orthopaedic Surgery, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, People's Republic of China
| |
Collapse
|
18
|
Tu Y, Xue H, Ma T, Wen T, Yang T, Zhang H, Cai M. Superior femoral component alignment can be achieved with Oxford microplasty instrumentation after minimally invasive unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2017; 25:729-735. [PMID: 27225890 DOI: 10.1007/s00167-016-4173-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 05/17/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE Oxford microplasty (MP) instrumentation has been developed to facilitate the reproducible and consistent performance of minimally invasive unicompartmental knee arthroplasty (MI-UKA) operation. The aim of this study was to compare the clinical and radiographic results of two groups of patients implanted using either a conventional instrumentation technique or an MP technique. METHODS A prospective cohort study of 108 knees in 108 patients who underwent an MI-UKA procedure using either conventionally instrumented UKA (CI-UKA) (52 knees of 52 patients) or MP-assisted UKA (MP-UKA) (56 knees of 56 patients). The clinical assessment included the Oxford Knee Score (OKS), the Knee Society Score (KSS), a visual analogue scale (VAS) for pain, and range of motion (ROM). Complications were also recorded. RESULTS No significant differences were observed between the two groups regarding OKS, KSS, VAS, and ROM. There were also no significant differences in terms of mechanical limb alignment and tibia implant alignment. However, the MP-UKA group showed significantly more accurate positioning of the femoral component than the CI-UKA group. Additionally, the MP-UKA group had more femoral prostheses implanted in the "satisfactory" range and fewer "outliers" than the CI-UKA group. No significant difference in complications was noted between the two groups. CONCLUSION This study suggested that compared with CI-UKA, MP-UKA provides significant improvements in increasing the accuracy of sagittal and coronal implantation of the femoral component and in reducing the numbers of outliers for femoral prosthetic alignment. It is advocated that the MP system should be considered when MI-UKA is performed. LEVEL OF EVIDENCE Therapeutic study, Level IV.
Collapse
Affiliation(s)
- Yihui Tu
- Department of Orthopaedics, Yangpu District Central Hospital Affiliated to Tongji University School of Medicine, 450 Tengyue Road, Shanghai, China
| | - Huaming Xue
- Department of Orthopaedics, Yangpu District Central Hospital Affiliated to Tongji University School of Medicine, 450 Tengyue Road, Shanghai, China.
| | - Tong Ma
- Department of Orthopaedics, Yangpu District Central Hospital Affiliated to Tongji University School of Medicine, 450 Tengyue Road, Shanghai, China
| | - Tao Wen
- Department of Orthopaedics, Yangpu District Central Hospital Affiliated to Tongji University School of Medicine, 450 Tengyue Road, Shanghai, China
| | - Tao Yang
- Department of Orthopaedics, Yangpu District Central Hospital Affiliated to Tongji University School of Medicine, 450 Tengyue Road, Shanghai, China
| | - Hui Zhang
- Department of Orthopaedics, Yangpu District Central Hospital Affiliated to Tongji University School of Medicine, 450 Tengyue Road, Shanghai, China
| | - Minwei Cai
- Department of Orthopaedics, Yangpu District Central Hospital Affiliated to Tongji University School of Medicine, 450 Tengyue Road, Shanghai, China
| |
Collapse
|
19
|
Emerson RH, Alnachoukati O, Barrington J, Ennin K. The results of Oxford unicompartmental knee arthroplasty in the United States: a mean ten-year survival analysis. Bone Joint J 2017; 98-B:34-40. [PMID: 27694514 PMCID: PMC5047138 DOI: 10.1302/0301-620x.98b10.bjj-2016-0480.r1] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 06/30/2016] [Indexed: 12/12/2022]
Abstract
Aims Approved by the Food and Drug Administration in 2004, the Phase
III Oxford Medial Partial Knee is used to treat anteromedial osteoarthritis
(AMOA) in patients with an intact anterior cruciate ligament. This
unicompartmental knee arthroplasty (UKA) is relatively new in the
United States, and therefore long-term American results are lacking. Patients and Methods This is a single surgeon, retrospective study based on prospectively
collected data, analysing a consecutive series of primary UKAs using
the Phase III mobile-bearing Oxford Knee and Phase III instrumentation. Between July 2004 and December 2006, the senior author (RHE)
carried out a medial UKA in 173 patients (213 knees) for anteromedial
osteoarthritis or avascular necrosis (AVN). A total of 95 patients were men and 78 were women. Their mean
age at surgery was 67 years (38 to 89) and mean body mass index
29.87 kg/m2 (17 to 62). The mean follow-up was ten years (4 to 11). Results Survivorship of the Oxford UKA at ten years was 88%, using life
table analysis. Implant survivorship at ten years was 95%. The most
common cause for revision was the progression of osteoarthritis
in the lateral compartment. The mean knee score element of the American
Knee Society Score (AKSS) was 50 pre-operatively and increased to 93
post-operatively. The mean AKSS function score was 56 pre-operatively
rising to 78 post-operatively Conclusion This ten-year follow-up study of the Oxford UKA undertaken in
the United States shows good survivorship and excellent function
in a wide selection of patients with AMOA and AVN. Cite this article: Bone Joint J 2016;98-B(10
Suppl B):34–40.
Collapse
Affiliation(s)
- R H Emerson
- Texas Center for Joint Replacement, 6020 W. Parker Road Suite 470 Plano, Texas 75093, USA
| | - O Alnachoukati
- Texas Center for Joint Replacement, 6020 W. Parker Road Suite 470 Plano, Texas 75093, USA
| | - J Barrington
- Plano Orthopedic Sports Medicine and Spine Center, 5228 W Plano Pkwy, Plano, TX 75093, USA
| | - K Ennin
- Texas Center for Joint Replacement, 6020 W. Parker Road Suite 470 Plano, Texas 75093, USA
| |
Collapse
|
20
|
Bottomley N, Jones LD, Rout R, Alvand A, Rombach I, Evans T, Jackson WFM, Beard DJ, Price AJ. A survival analysis of 1084 knees of the Oxford unicompartmental knee arthroplasty: a comparison between consultant and trainee surgeons. Bone Joint J 2017; 98-B:22-27. [PMID: 27694512 PMCID: PMC5047132 DOI: 10.1302/0301-620x.98b10.bjj-2016-0483.r1] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 08/02/2016] [Indexed: 01/30/2023]
Abstract
Aims The aim of this to study was to compare the previously unreported
long-term survival outcome of the Oxford medial unicompartmental
knee arthroplasty (UKA) performed by trainee surgeons and consultants. Patients and Methods We therefore identified a previously unreported cohort of 1084
knees in 947 patients who had a UKA inserted for anteromedial knee
arthritis by consultants and surgeons in training, at a tertiary
arthroplasty centre and performed survival analysis on the group
with revision as the endpoint. Results The ten-year cumulative survival rate for revision or exchange
of any part of the prosthetic components was 93.2% (95% confidence
interval (CI) 86.1 to 100, number at risk 45). Consultant surgeons
had a nine-year cumulative survival rate of 93.9% (95% CI 90.2 to
97.6, number at risk 16). Trainee surgeons had a cumulative nine-year
survival rate of 93.0% (95% CI 90.3 to 95.7, number at risk 35).
Although there was no differences in implant survival between consultants
and trainees (p = 0.30), there was a difference in failure pattern
whereby all re-operations performed for bearing dislocation (n =
7), occurred in the trainee group. This accounted for 0.6% of the
entire cohort and 15% of the re-operations. Conclusion This is the largest single series of the Oxford UKA ever reported
and demonstrates that good results can be achieved by a heterogeneous
group of surgeons, including trainees, if performed within a high-volume
centre with considerable experience with the procedure. Cite this article: Bone Joint J 2016;(10 Suppl
B):22–7.
Collapse
Affiliation(s)
- N Bottomley
- NDORMs, University of Oxford, Botnar Research Centre, Old Road, Oxford OX3 7LD, UK
| | - L D Jones
- NDORMs, University of Oxford, Botnar Research Centre, Old Road, Oxford OX3 7LD, UK
| | - R Rout
- NDORMs, University of Oxford, Botnar Research Centre, Old Road, Oxford OX3 7LD, UK
| | - A Alvand
- NDORMs, University of Oxford, Botnar Research Centre, Old Road, Oxford OX3 7LD, UK
| | - I Rombach
- NDORMs, University of Oxford, Botnar Research Centre, Old Road, Oxford OX3 7LD, UK
| | - T Evans
- NDORMs, University of Oxford, Botnar Research Centre, Old Road, Oxford OX3 7LD, UK
| | - W F M Jackson
- NDORMs, University of Oxford, Botnar Research Centre, Old Road, Oxford OX3 7LD, UK
| | - D J Beard
- NDORMs, University of Oxford, Botnar Research Centre, Old Road, Oxford OX3 7LD, UK
| | - A J Price
- NDORMs, University of Oxford, Botnar Research Centre, Old Road, Oxford OX3 7LD, UK
| |
Collapse
|
21
|
Panzram B, Bertlich I, Reiner T, Walker T, Hagmann S, Weber MA, Gotterbarm T. Results after Cementless Medial Oxford Unicompartmental Knee Replacement - Incidence of Radiolucent Lines. PLoS One 2017; 12:e0170324. [PMID: 28103308 PMCID: PMC5245886 DOI: 10.1371/journal.pone.0170324] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 01/03/2017] [Indexed: 11/19/2022] Open
Abstract
PURPOSE Tibial radiolucent lines (RL) are commonly seen in cemented unicompartmental knee replacement (UKR). In the postoperative course, they can be misinterpreted as signs of loosening, thus leading to unnecessary revision. Since 2004, a cementless OUKR is available. First studies and registry data have shown equally good clinical results of cementless OUKR compared to the cemented version and a significantly reduced incidence of RL in cementless implants. METHODS This single-centre retrospective cohort study includes the first 30 UKR (27 patients) implanted between 2007 and 2009 with a mean follow-up of 5 years. Clinical outcome was evaluated using the OKS, AKS, range of movement (ROM) and level of pain (VAS). Standard radiologic evaluation was performed at three months, one and five years after surgery. The results five years after implantation were compared to a group of 27 cemented Oxford UKR (OUKR) in a matched-pair-analysis. RESULTS Tibial RL were seen in 10 implants three months after operation, which significantly decreased to five after one year and to three after five years (p = 0.02). RL did not have a significant influence on revision (p = 1.0) or clinical outcome after five years. RL were always partial, never progressive and strictly limited to the tibia. There was no significant difference in the incidence of tibial RL five years after implantation between cemented and cementless implants (cemented: 4, cementless: 3, p = 1.0). CONCLUSIONS After cementless implantation RL were limited to the tibia, partial and never progressive. During short term follow-up the incidence of RL decreased significantly. RL seem to have no influence on clinical outcome and revision.
Collapse
Affiliation(s)
- Benjamin Panzram
- Clinic of Orthopedic and Trauma Surgery, University of Heidelberg, Heidelberg, Germany
| | - Ines Bertlich
- Clinic of Orthopedic and Trauma Surgery, University of Heidelberg, Heidelberg, Germany
| | - Tobias Reiner
- Clinic of Orthopedic and Trauma Surgery, University of Heidelberg, Heidelberg, Germany
| | - Tilman Walker
- Clinic of Orthopedic and Trauma Surgery, University of Heidelberg, Heidelberg, Germany
| | - Sébastien Hagmann
- Clinic of Orthopedic and Trauma Surgery, University of Heidelberg, Heidelberg, Germany
| | - Marc-André Weber
- Clinic of Diagnostic and Interventional Radiology, University of Heidelberg, Heidelberg, Germany
| | - Tobias Gotterbarm
- Clinic of Orthopedic and Trauma Surgery, University of Heidelberg, Heidelberg, Germany
- * E-mail:
| |
Collapse
|
22
|
Koh IJ, Kim JH, Jang SW, Kim MS, Kim C, In Y. Are the Oxford(®) medial unicompartmental knee arthroplasty new instruments reducing the bearing dislocation risk while improving components relationships? A case control study. Orthop Traumatol Surg Res 2016; 102:183-7. [PMID: 26830001 DOI: 10.1016/j.otsr.2015.11.015] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 10/28/2015] [Accepted: 11/23/2015] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The recently introduced Microplasty(®) system is an upgrade of conventional phase III instrumentation. However, little is known of its impact on the position of the implant following the Oxford(®) mobile-bearing unicompartmental knee arthroplasty (UKA). This study investigated whether the Microplasty(®) instrumentation system can improve the positioning of the implant and reduce the rate of early failure. HYPOTHESIS Microplasty(®) provides a better positioning and decreases the rate of dislocation. MATERIALS AND METHODS The medical records and radiographs of 82 consecutive Oxford(®) UKAs were reviewed retrospectively. The radiographic parameters and prevalence of early failure of 41 UKAs performed with the Microplasty(®) system and 41 UKAs using the conventional instrumentation system were compared. Both groups were comparable in terms of demographics and preoperative status. RESULTS The femoral components in the Microplasty(®) group were more contiguously placed and more convergent in relation to the tibial components compared to the conventional instrumentation system (P<0.01). The frequency of bearing dislocation was lower in the Microplasty(®) group (P=0.04). A wide gap and the angle between components were associated with an increased risk of bearing dislocation. CONCLUSION The Microplasty(®) instrumentation system consistently placed the femoral and tibial components in more contiguous and convergent positions. Such changes in position decreased the risk of bearing dislocations by reducing the space available for bearing rotation. LEVEL OF EVIDENCE Level III, case control study.
Collapse
Affiliation(s)
- I J Koh
- Department of Orthopaedics, Seoul St. Mary's Hospital, 137-701 Seoul, Korea; Department of Orthopaedics, The Catholic University of Korea College of Medicine, 137-701 Seoul, Korea
| | - J H Kim
- Department of Orthopaedics, Gangseo Himchan Hospital, 157-930 Seoul, Korea
| | - S W Jang
- Department of Orthopaedics, Seoul St. Mary's Hospital, 137-701 Seoul, Korea
| | - M S Kim
- Department of Orthopaedics, Seoul St. Mary's Hospital, 137-701 Seoul, Korea
| | - C Kim
- Department of Orthopaedics, Seoul St. Mary's Hospital, 137-701 Seoul, Korea
| | - Y In
- Department of Orthopaedics, Seoul St. Mary's Hospital, 137-701 Seoul, Korea; Department of Orthopaedics, The Catholic University of Korea College of Medicine, 137-701 Seoul, Korea.
| |
Collapse
|
23
|
Kim KT, Lee S, Kim JH, Hong SW, Jung WS, Shin WS. The Survivorship and Clinical Results of Minimally Invasive Unicompartmental Knee Arthroplasty at 10-Year Follow-up. Clin Orthop Surg 2015. [PMID: 26217466 PMCID: PMC4515460 DOI: 10.4055/cios.2015.7.2.199] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background In this study, we investigated the long-term clinical results and survival rate of minimally invasive unicompartmental knee arthroplasty (UKA) by collecting cases that had been implanted more than 10 years ago. Methods One hundred and twenty-eight patients (166 cases) who underwent Oxford phase 3 medial UKA using the minimally invasive surgery from January 2002 to December 2002 were selected. The mean age of the patients at the time of surgery was 61 years, and the duration of the follow-up was minimum 10 years. Clinical and radiographic assessments were performed using the Knee Society clinical rating system, and the survival analysis was done by the Kaplan-Meier method with 95% confidence interval (CI). Results The mean Knee Society knee and function scores improved significantly from 53.8 points (range, 25 to 70 points) and 56.1 points (range, 35 to 80 points) preoperatively to 85.4 points (range, 58 to 100 points) and 80.5 points (range, 50 to 100 points) at 10-year follow-up, respectively (p < 0.001). Failures following the UKA occurred in 16 cases (9.6%), and the mean time of the occurrence of the failure was 6.2 years after the surgery. The 10-year survival rate was 90.5% (95% CI, 85.9 to 95.0) when failure was defined as all the reoperations, whereas the 10-year survival rate was 93.4% (95% CI, 89.6 to 97.1) when the cases in which only revision total knee arthroplasty was defined as failure. Conclusions The results of this study show outstanding functions of the knee joint and satisfactory 10-year survival rate after minimally invasive UKA. Therefore, minimally invasive UKA could be a useful method in the treatment of osteoarthritis in one compartment of knee joint.
Collapse
Affiliation(s)
- Kyung Tae Kim
- Department of Orthopedic Surgery, Seoul Sacred Heart General Hospital, Seoul, Korea
| | - Song Lee
- Department of Orthopedic Surgery, Seoul Sacred Heart General Hospital, Seoul, Korea
| | - Jee Hyoung Kim
- Department of Orthopedic Surgery, Seoul Sacred Heart General Hospital, Seoul, Korea
| | - Sung Won Hong
- Department of Orthopedic Surgery, Seoul Sacred Heart General Hospital, Seoul, Korea
| | - Woo Shik Jung
- Department of Orthopedic Surgery, Seoul Sacred Heart General Hospital, Seoul, Korea
| | - Won Shik Shin
- Department of Orthopedic Surgery, Seoul Sacred Heart General Hospital, Seoul, Korea
| |
Collapse
|
24
|
Kerens B, Schotanus MGM, Boonen B, Kort NP. No radiographic difference between patient-specific guiding and conventional Oxford UKA surgery. Knee Surg Sports Traumatol Arthrosc 2015; 23:1324-1329. [PMID: 24464421 DOI: 10.1007/s00167-014-2849-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Accepted: 01/12/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Implant position is an important factor in unicompartmental knee arthroplasty (UKA) surgery. Results on conventional UKA alignment are commonly described in literature. Patient-specific guiding (PSG) is a new technique for positioning the Oxford UKA. Our hypothesis is that PSG improves component position without affecting the HKA angle. METHODS This prospective study compares the results of our first thirty cases of cementless Oxford UKA using PSG with thirty cases using conventional outlining. Baseline characteristics for both groups were identical. Details on handling of the guide, estimated blood loss and operation time were recorded. Postoperative screened radiographs and standing long-leg radiographs of both groups were compared. RESULTS Median AP position of the femoral component was 3 degrees varus (-5 to 9) using PSG versus 2 degrees varus (-10 to 8) for the conventional group. For the femoral flexion, this was 9 degrees flexion (0-16) using PSG versus 12 degrees flexion (0-20). The tibial median AP position was 1 degree varus (-3 to 7) using PSG versus 2 degrees varus (-5 to 10). The median tibial posterior slope was 5 degrees (1-10) using PSG versus 5 degrees (0-12). All guides aligned well. No conversion to conventional outlining was performed, and no significant changes had to be made to the original approved plan. Operation time, estimated blood loss and postoperative haemoglobin drop were not significantly different between both groups. DISCUSSION Implant position was not different between both groups, even in the early phase of the learning curve. Perioperative results were not different between both groups. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Bart Kerens
- Department of Orthopedic Surgery, AZ Monica, Deurne, Belgium.
| | | | - Bert Boonen
- Department of Surgery, VieCuri Medical Centre, Venlo, The Netherlands
| | - Nanne P Kort
- Department of Orthopedic Surgery, Orbis Medisch Centrum, Sittard, The Netherlands
| |
Collapse
|
25
|
Results of the Oxford Phase 3 mobile bearing medial unicompartmental knee arthroplasty from an independent center: 467 knees at a mean 6-year follow-up: analysis of predictors of failure. J Arthroplasty 2014; 29:193-200. [PMID: 25060560 DOI: 10.1016/j.arth.2014.01.035] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 01/08/2014] [Accepted: 01/13/2014] [Indexed: 02/01/2023] Open
Abstract
A retrospective review of 467 Oxford UKAs was performed in 387 patients. Thirty-eight knees (8.1%) were revised to TKA at a mean of 49 months, most commonly for lateral compartment OA (47%). The 5-year cumulative survival using revision to TKA was 98.5%. Revisions required short stems in 26% and augments in 21% of cases. The mobile bearing dislocation rate was 0.64%. Correction of ≥3-5° from the preoperative alignment in a valgus direction was predictive of revision to TKA (P<.0001). Multivariate analysis revealed female gender (P=.002) also was associated with an increased risk of revision. Careful attention to the degree of mechanical axis correction with an overall maintained varus alignment may reduce revision rates for mobile bearing UKA.
Collapse
|
26
|
Causes of revision following Oxford phase 3 unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2014; 22:1895-901. [PMID: 23996106 DOI: 10.1007/s00167-013-2644-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 08/21/2013] [Indexed: 01/29/2023]
Abstract
PURPOSE Revision of unicompartmental knee arthroplasty (UKA) is relatively rare, but there is concern that the minimally invasive approach might result in more complications and a higher rate of revision. Current data regarding the revision of UKA using the Oxford phase 3 prosthesis are confined to a few reviews of single-institution experience. The purpose of this study was to provide an evidence-based summarisation of the revision of UKA with a pooled analysis of the reported cases. METHODS A systematic review of published studies that evaluated the causes that required further surgical intervention after UKA using the Oxford phase 3 prosthesis was performed. A structured literature review of multiple databases referenced articles from 1998 to 2012. The revision rates between Asian population and western population were compared. RESULTS A total of 2,683 patients (3,138 knees) from 17 published studies were assessed. The median age of the patients was 62.5 (range 32-93) years. The median follow-up period was 5.6 (range 0.1-11) years. Postoperative revision was necessary in 146 knees with a pooled percentage of 4.6 %. Bearing dislocation was found to be the single most important predisposing cause of revision, with a pooled percentage of 1.5 % (47/3,138 knees). The rate of bearing dislocation was significantly higher in Asian population than that in western population (p < 0.001). CONCLUSIONS Mobile bearing UKA seems to be less appropriate for the Asian population as extreme knee flexion is required for cultural purposes.
Collapse
|
27
|
Tu Y, Xue H, Cai M, Ma T, Liu X, Xia Z. Improvement of femoral component size prediction using a C-arm intensifier guide and our established algorithm in unicompartmental knee arthroplasty: a report from a Chinese population. Knee 2014; 21:435-8. [PMID: 23890472 DOI: 10.1016/j.knee.2013.06.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2013] [Revised: 05/22/2013] [Accepted: 06/23/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND Unicompartmental knee arthroplasty (UKA) is becoming more widely used with the recent increase in popularity of the use of minimally invasive techniques. However, it is difficult to judge about the femoral component size in UKA using preoperative templating digitally or otherwise. Even when using navigation it is impossible to control the femoral component size. The aim of this study is to develop a better pre- or intra-operative measure that will predict femoral component size. METHODS Ninety-two UKA cases were studied from June 2007 to December 2011 with a mean 26-month follow-up. We developed an intra-operative C-arm intensifier guide (CAIG) method for determining femoral size instead of pre-operative templating. The accuracy of prediction of both methods was compared from a review of post-operative radiographs. In addition, we summarized all cases and developed a Chinese algorithm to determine the femoral component size pre-operatively. RESULTS There was a significant difference between templating (59%) and CAIG (92%) method (P=0.0001). In the Chinese algorithm, height based on gender and tibial size both have greater accuracy of prediction (88% and 70.7%) than the Oxford algorithm (51.1% and 59.8%). Component size distribution and optimal tibial/femoral pairing differed from those in the Oxford report. CONCLUSIONS We conclude that the Chinese algorithm can greatly improve the accuracy of prediction of femoral component size. In addition, CAIG-assisted implantation of a UKR is a reliable intra-operative tool and can aid size selection of the femoral component. LEVEL OF EVIDENCE Level III.
Collapse
Affiliation(s)
- Yihui Tu
- Department of Orthopedics, Yangpu District Central Hospital affiliated to Tongji University, 450 Teng Yue Road, Shanghai 200090, China
| | - Huaming Xue
- Department of Orthopedics, Yangpu District Central Hospital affiliated to Tongji University, 450 Teng Yue Road, Shanghai 200090, China.
| | - Minwei Cai
- Department of Orthopedics, Yangpu District Central Hospital affiliated to Tongji University, 450 Teng Yue Road, Shanghai 200090, China
| | - Tong Ma
- Department of Orthopedics, Yangpu District Central Hospital affiliated to Tongji University, 450 Teng Yue Road, Shanghai 200090, China
| | - Xiaodong Liu
- Department of Orthopedics, Yangpu District Central Hospital affiliated to Tongji University, 450 Teng Yue Road, Shanghai 200090, China
| | - Zhidao Xia
- Botnar Research Centre, Nuffield Department of Orthopedics, Rheumatology and Musculoskeletal Sciences, Oxford University, NOC, Headington, Oxford OX3 7LD, UK
| |
Collapse
|
28
|
Becker R, Mauer C, Stärke C, Brosz M, Zantop T, Lohmann CH, Schulze M. Anteroposterior and rotational stability in fixed and mobile bearing unicondylar knee arthroplasty: a cadaveric study using the robotic force sensor system. Knee Surg Sports Traumatol Arthrosc 2013; 21:2427-32. [PMID: 22868351 DOI: 10.1007/s00167-012-2157-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2012] [Accepted: 07/25/2012] [Indexed: 12/22/2022]
Abstract
PURPOSE Different bearing designs in unicondylar knee arthroplasty (UKA) have been developed in order to influence the rate of polyethylene wear. Increased anteroposterior translation and rotation after UKA has been hypothesized due to changes in joint surface geometry. The mobile bearing design was expected to show increased anteroposterior translation compared to the fixed bearing and biconcave bearing design. METHODS Six human cadaver knees were used for the tests. Anteroposterior and rotational knee stability was analysed in 0°, 30°, 60°, 90° and 120° of knee flexion using a robotic testing system (KR 125, KUKA Robots Augsburg, Germany). Three forces and moments were measured in a Cartesian coordinate system with a resolution of 1.0 N and 0.1 Nm. RESULTS There was no difference between the native knees and the knees after UKA in AP translation and rotation in all knee flexion angles. The factor knee flexion angle had a significant impact on the anterior translation when the type of bearing was neglected (p ≤ 0.015). CONCLUSION This study shows that the natural knee stability in AP translation and rotation can be preserved in UKA. The preserved knee stability in different planes after UKA underlines the advantage of UKA when surgery is required in osteoarthritic changes of the medial compartment.
Collapse
Affiliation(s)
- Roland Becker
- Department of Orthopaedic and Trauma Surgery, City Hospital Brandenburg, Hochstrasse 26, 14770, Brandenburg, Havel, Germany,
| | | | | | | | | | | | | |
Collapse
|
29
|
Hall MJ, Connell DA, Morris HG. Medium to long-term results of the UNIX uncemented unicompartmental knee replacement. Knee 2013; 20:328-31. [PMID: 23062658 DOI: 10.1016/j.knee.2012.09.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Revised: 09/11/2012] [Accepted: 09/14/2012] [Indexed: 02/02/2023]
Abstract
INTRODUCTION We report the first non-designer study of the Unix uncemented unicompartmental knee prosthesis. MATERIALS AND METHODS Eighty-five consecutive UKRs were carried out with sixty-five available for follow-up. Oxford Knee Scores, WOMAC questionnaire and radiological assessment were completed. RESULTS The mean Oxford Knee Score was thirty-eight and WOMAC Score was twenty. Overall Kaplan Meier survival estimate is 76% (95% confidence interval 60%-97%) at 12years and 88% (95% confidence interval 76-100%) with aseptic loosening as the endpoint. Radiographic assessment showed lysis in the tibia in 6% of patients with no lysis evident around the central fin. DISCUSSION Survivorship is comparable to other published series of UKRs. We suggest the central fin design is key to dissipating large forces throughout the proximal tibia, resulting in low levels of tibial loosening. Level of evidence IV.
Collapse
Affiliation(s)
- Matthew J Hall
- Dept. of Orthopaedics, Derriford Hospital, Derriford Road, Plymouth, Devon, PL 8 6DH, UK.
| | | | | |
Collapse
|
30
|
Petersen W, Metzlaff S, Forkel P, Achtnich A, Schmoranzer K, Hertel P. Unikompartimentelle Oxford-III-Prothese mit mobilem Gleitlager. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2013; 25:505-17. [DOI: 10.1007/s00064-011-0116-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
31
|
Kendrick BJL, James AR, Pandit H, Gill HS, Price AJ, Blunn GW, Murray DW. Histology of the bone-cement interface in retrieved Oxford unicompartmental knee replacements. Knee 2012; 19:918-22. [PMID: 22542361 DOI: 10.1016/j.knee.2012.03.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Revised: 03/15/2012] [Accepted: 03/19/2012] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Radiolucent lines (RLL) are commonly seen at the cement-bone interface of knee replacements, yet are poorly understood. Although thin RLL are not associated with implant loosening or poor patient outcome there is still concern that they indicate sub-optimal fixation. The primary study aim is to characterise the histology at the cement-tibia interface in Oxford unicompartmental knee replacement (UKR). The second aim is to assess whether a correlation exists between the presence of a RLL and the type of tissue that predominates at the interface. METHODS The radiology and histology of retrieved specimens of the interface from around firmly fixed tibial trays in ten patients undergoing revision between 1 and 19 years after Oxford UKR were studied. RESULTS Pre-revision radiographs showed the presence of both full and partial RLL. On contact radiographs of 5mm thick sections of the interface the total percentage of radiolucency ranged from 0 to 90% between patients. There was no consistent pattern for the distribution of radiolucency. Histological assessment demonstrated that under every tibial component there were areas where there was direct contact and interdigitation between bone and cement. The amount of direct bone-cement contact was between 19% and 95% of the tibial tray surface area. The remaining tissue was mainly fibrocartilage but there was also fibrous tissue. The presence of radiolucency was strongly inversely correlated with the percentage of cement-bone contact. CONCLUSION This study demonstrates that even with partial or complete RLL seen on radiographs there is still cement-bone contact, thus indicating that there is stable fixation.
Collapse
Affiliation(s)
- B J L Kendrick
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Windmill Road, Oxford, OX3 7LD, UK.
| | | | | | | | | | | | | |
Collapse
|
32
|
Matharu G, Robb C, Baloch K, Pynsent P. The Oxford medial unicompartmental knee replacement: survival and the affect of age and gender. Knee 2012; 19:913-7. [PMID: 22480781 DOI: 10.1016/j.knee.2012.03.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Revised: 03/09/2012] [Accepted: 03/09/2012] [Indexed: 02/02/2023]
Abstract
STUDY AIMS To determine the survival and functional outcome for the phase 3 Oxford unicompartmental knee replacement (UKR) performed at a single independent centre and to assess whether age and gender affect survival. PATIENTS AND METHODS Between 2000 and 2008, 459 consecutive Oxford UKRs were implanted in 392 patients using a minimally invasive technique. RESULTS Mean age of patients was 63.0 years and 53% were female. Mean follow-up was 4.4 years (range 0.5-11.2 years). No patient was lost to follow-up and 411 (90%) knees had a minimum follow-up of 2 years. Twenty knees (4.4%) have undergone revision to total knee replacement at a mean time of 3.2 years. Aseptic component loosening (n=11) accounted for most failures. Cumulative survival was 94.4% at 5 years (95% confidence interval 90.9-97.0) and 93.0% at 8 years (95% confidence interval 84.8-96.2). The median postoperative Oxford knee score was 31.2% (interquartile range 12.2%-52.1%) at latest follow-up. Age and gender had no statistically significant affect on UKR survival. CONCLUSIONS This large independent series demonstrates good medium-term survival and functional outcome can be achieved with the phase 3 Oxford UKR in appropriately selected patients. Age and gender should not be considered contraindications for performing Oxford UKR.
Collapse
Affiliation(s)
- Gulraj Matharu
- Royal Orthopaedic Hospital, Northfield, Birmingham, B31 2AP United Kingdom.
| | | | | | | |
Collapse
|
33
|
Hooper GJ, Maxwell AR, Wilkinson B, Mathew J, Woodfield TBF, Penny ID, Burn PJ, Frampton C. The early radiological results of the uncemented Oxford medial compartment knee replacement. ACTA ACUST UNITED AC 2012; 94:334-8. [DOI: 10.1302/0301-620x.94b3.27407] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We carried out a prospective investigation into the radiological outcomes of uncemented Oxford medial compartment unicondylar replacement in 220 consecutive patients (231 knees) performed in a single centre with a minimum two-year follow-up. The functional outcomes using the mean Oxford knee score and the mean high-activity arthroplasty score were significantly improved over the pre-operative scores (p < 0.001). There were 196 patients with a two-year radiological examination performed under fluoroscopic guidance, aiming to provide images acceptable for analysis of the bone–implant interface. Of the six tibial zones examined on each knee on the anteroposterior radiograph, only three had a partial radiolucent line. All were in the medial aspect of the tibial base plate (zone 1) and all measured < 1 mm. All of these patients were asymptomatic. There were no radiolucent lines seen around the femoral component or on the lateral view. There was one revision for loosening at one year due to initial inadequate seating of the tibial component. These results confirm that the early uncemented Oxford medial unicompartmental compartmental knee replacements were reliable and the incidence of radiolucent lines was significantly decreased compared with the reported results of cemented versions of this implant. These independent results confirm those of the designing centre.
Collapse
Affiliation(s)
- G. J. Hooper
- University of Otago, Department
of Orthopaedic Surgery and MSM, Christchurch Hospital, Private
Bag, Christchurch, 8042, New
Zealand
| | - A. R. Maxwell
- University of Otago, Department
of Orthopaedic Surgery and MSM, Christchurch Hospital, Private
Bag, Christchurch 8042, New
Zealand
| | - B. Wilkinson
- Christchurch Hospital, Department
of Radiology, Private Bag, Christchurch
8042, New Zealand
| | - J. Mathew
- University of Otago, Department
of Orthopaedic Surgery and MSM, Christchurch Hospital, Private
Bag, Christchurch, 8042, New
Zealand
| | - T. B. F. Woodfield
- University of Otago, Department
of Orthopaedic Surgery and MSM, Christchurch Hospital, Private
Bag, Christchurch 8042, New
Zealand
| | - I. D. Penny
- University of Otago, Department
of Orthopaedic Surgery and MSM, Christchurch Hospital, Private
Bag, Christchurch 8042, New
Zealand
| | - P. J. Burn
- University of Otago, Department
of Orthopaedic Surgery and MSM, Christchurch Hospital, Private
Bag, Christchurch 8042, New
Zealand
| | - C. Frampton
- University of Otago, Department
of Medicine, Christchurch Hospital, Private
Bag, Christchurch 8042, New
Zealand
| |
Collapse
|
34
|
Tinius M, Hepp P, Becker R. Combined unicompartmental knee arthroplasty and anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2012; 20:81-7. [PMID: 21559848 DOI: 10.1007/s00167-011-1528-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2011] [Accepted: 04/19/2011] [Indexed: 11/27/2022]
Abstract
PURPOSE Patients presenting anterior cruciate ligament (ACL) deficiency and isolated osteoarthritis of the medial compartment are treated either with biplanar osteotomy or with total knee arthroplasty (TKA). However, these patients between the forties and fifties are often very active in daily life and feel limited due to their knee. In order to follow the idea of preserving as much as possible from the joint, the concept of unicondylar joint replacement in conjunction with ACL reconstruction has been followed. There seems to be a limited experience with this concept. The purpose of the follow-up study was to evaluate the midterm clinical and functional outcome. METHODS Twenty-seven patients were followed up for 53 months. The mean age of the 11 men and 16 women was 44 years. All patients were treated by combined unicompartmental knee arthroplasty and anterior cruciate ligament reconstruction. RESULTS The Knee Society Score improved significantly from 77.1 ± 11.6 points to 166.0 ± 12.1 points (P ≤ 0.01). No revision surgery was required and no radiolucent lines were observed on the radiographs at the time of follow-up. The anterior translation showed less than 5 mm in 24 patients and 5 mm in the remaining 3 patients. CONCLUSIONS The midterm clinical data have shown that combined surgery of UKA and anterior cruciate ligament reconstruction has revealed promising results. The restored knee stability seems to prevent the failure of UKA. However, long-term follow-up studies are required in these patients who received partial joint replacement fairly early in their life. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Marco Tinius
- Center for Joint Surgery, Knee Group, Praxisklinik- Stollberg, Hohensteiner Strasse 56, 09366, Stollberg, Germany.
| | | | | |
Collapse
|
35
|
The management of mobile bearing dislocation in the Oxford lateral unicompartmental knee replacement. Knee Surg Sports Traumatol Arthrosc 2011; 19:2023-6. [PMID: 21369839 DOI: 10.1007/s00167-011-1446-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2010] [Accepted: 02/07/2011] [Indexed: 10/18/2022]
Abstract
This article describes a technique to manage dislocations of mobile bearing lateral unicompartmental knee replacements. When dislocations occur, the bearing usually subluxes medially over the medial wall of the tibial component into the intercondylar notch. By positioning small fragment screws with their heads above the vertical wall, thereby increasing the height of the wall, subsequent dislocations can be prevented. Seven cases treated in this manner are reported, of which one of the seven has redislocated. In the remaining six, their clinical outcomes are comparable to the outcomes of those without dislocations.
Collapse
|
36
|
Mullaji AB, Shetty GM, Kanna R. Postoperative limb alignment and its determinants after minimally invasive Oxford medial unicompartmental knee arthroplasty. J Arthroplasty 2011; 26:919-25. [PMID: 21498039 DOI: 10.1016/j.arth.2011.03.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2009] [Accepted: 03/03/2011] [Indexed: 02/01/2023] Open
Abstract
One hundred twenty-two consecutive minimally invasive Oxford phase 3 medial unicompartmental knee arthroplasties in 109 patients were evaluated for postoperative limb alignment and the influence of factors such as preoperative limb alignment, age, body mass index, sex, insert thickness, and surgeon's experience. The mean mechanical preoperative hip-knee-ankle (HKA) angle of 172.2° ± 3.1° improved to 177.1° ± 2.9° postoperatively. In 75% of the limbs, the HKA angle was restored to within an acceptable alignment of 177° ± 3°, 14% of the limbs were in excessive varus (<174°), and 11% were in valgus (>180°). Only preoperative HKA angle was predictive of postoperative HKA angle. Although most of the limbs had acceptable limb alignment after unicompartmental knee arthroplasty, limbs with more severe preoperative varus deformity had a tendency to remain in excessive varus, and limbs with lesser preoperative varus deformity had a greater tendency to go into valgus postoperatively.
Collapse
Affiliation(s)
- Arun B Mullaji
- Department of Orthopaedic Surgery, Breach Candy Hospital, 7Mumbai, India
| | | | | |
Collapse
|
37
|
Kerens B, Kort NP. Overstuffed medial compartment after mobile-bearing unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2011; 19:952-4. [PMID: 21153547 DOI: 10.1007/s00167-010-1304-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2009] [Accepted: 10/12/2010] [Indexed: 10/18/2022]
Abstract
Overstuffing of the medial compartment in medial compartmental knee arthroplasty is a known pitfall. Attention to the flexion-extension gap should be addressed. If, however, overstuffing is found it can be corrected by revising the femoral component only.
Collapse
Affiliation(s)
- B Kerens
- Department of Orthopedic Surgery, Orbis Medisch Centrum, Dr. H. vd Hoffplein 1, 6162 BG, Sittard-Geleen, The Netherlands.
| | | |
Collapse
|
38
|
Smith TO, Chester R, Glasgow MM, Donell ST. Accelerated rehabilitation following Oxford unicompartmental knee arthroplasty: five-year results from an independent centre. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2011. [DOI: 10.1007/s00590-011-0797-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
39
|
Labek G, Sekyra K, Pawelka W, Janda W, Stöckl B. Outcome and reproducibility of data concerning the Oxford unicompartmental knee arthroplasty: a structured literature review including arthroplasty registry data. Acta Orthop 2011; 82:131-5. [PMID: 21434760 PMCID: PMC3235280 DOI: 10.3109/17453674.2011.566134] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE The reproducibility of results and potential confounders in sample-based studies is important to consider in the assessment of studies. Comprehensive arthroplasty registers could serve as a reference dataset for comparative analyses. We analyzed an implant that is frequently used worldwide, the Oxford unicompartmental knee replacement, in order to identify potential confounders inherent in the datasets and to evaluate the outcome achieved with this implant. METHODS We performed a structured literature review of the data published on the revision rate of the Oxford medial unicompartmental arthroplasty. Both clinical follow-up studies and worldwide registry data were included. Confidence intervals were calculated to determine the statistical significance of differences. RESULTS A substantial proportion of the published data (52-68% depending on the method of calculation) is derived from studies involving participation of the institution that developed the implant. The results published by this group show a statistically significant deviation from the reference datasets from registers or independent studies. Data from the developing hospital show mean revision rates that are 4 times lower than those based on worldwide register data, and 3 times lower than the ones quoted in independent studies. On average, the data published in independent studies are reproducible in registry data. INTERPRETATION A conventional meta-analysis of clinical studies is substantially affected by the influence of the developing hospital, and is therefore subject to bias. For assessment of the outcome of implants, registry data are superior and, in terms of reference data for the detection of potential bias factors in the literature, could make an essential contribution to meta-analyses.
Collapse
Affiliation(s)
- Gerold Labek
- Department of Orthopaedics, Innsbruck Medical University, Innsbruck, Austria
| | - Kathrin Sekyra
- Department of Orthopaedics, Innsbruck Medical University, Innsbruck, Austria
| | - Wolfram Pawelka
- Department of Orthopaedics, Innsbruck Medical University, Innsbruck, Austria
| | - Wolfgang Janda
- Department of Orthopaedics, Innsbruck Medical University, Innsbruck, Austria
| | - Bernd Stöckl
- Department of Orthopaedics, Innsbruck Medical University, Innsbruck, Austria
| |
Collapse
|
40
|
Lisowski LA, van den Bekerom MPJ, Pilot P, van Dijk CN, Lisowski AE. Oxford Phase 3 unicompartmental knee arthroplasty: medium-term results of a minimally invasive surgical procedure. Knee Surg Sports Traumatol Arthrosc 2011; 19:277-84. [PMID: 20640402 PMCID: PMC3023856 DOI: 10.1007/s00167-010-1213-2] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2009] [Accepted: 06/29/2010] [Indexed: 02/03/2023]
Abstract
PURPOSE in the last decade, a major increase in the use of and interest in unicompartmental knee arthroplasty (UKA) has developed. The Oxford Phase 3 UKA is implanted with a minimally invasive technique using newly developed instruments. The objective of this prospective study was to evaluate the outcome of UKA in patients with medial osteoarthritis of the knee in a high-volume unit. METHODS two-hundred and forty-four UKAs were performed with a minimally invasive approach. The median age was 72 (43-91) years. The median follow-up was 4.2 years (range 1-10.4 years). Fourteen patients died, and nine were considered to be lost to follow-up, but all had a well-functioning prosthesis in situ until their last follow-up. Pain, function and health-related quality of life were evaluated pre- and postoperatively using patient- and assessor-based outcome scores, as well as radiographic evidence. RESULTS the mean Knee Society knee and function scores, WOMAC-scores, Oxford-score and VAS pain and satisfaction all improved. Nine knees required revision. Eleven patients required an additional arthroscopic procedure due to persisting pain secondary to intra-articular pathology, and four patients required manipulation under anaesthesia because of limited range of motion. The 7-year cumulative survival rate of the arthroplasty was 94.4%. A low incidence (21%) of a radiolucent line beneath the tibial component was observed at 5 years of follow-up. CONCLUSION this study showed a high survival rate of the Oxford Phase 3 UKA. Patient satisfaction and functional performance were also very high. Major complication rate was low; in addition, the incidence of radiolucency under the tibial component, when compared to present literature, was low. When strict indication criteria are followed, excellent, durable, and in our opinion reliable, results can be expected for this procedure.
Collapse
Affiliation(s)
- Lukas A. Lisowski
- Department of Orthopedic Surgery, Academic Medical Center Amsterdam, Amsterdam, The Netherlands ,Het Bergske 4, 6417 GN Heerlen, The Netherlands
| | | | - Peter Pilot
- Department of Orthopedic Surgery, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - C. Niek van Dijk
- Department of Orthopedic Surgery, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Andrzej E. Lisowski
- Department of Orthopedic Surgery, Atrium Medical Centre, Kerkrade/Heerlen/Brunssum, The Netherlands
| |
Collapse
|
41
|
Clarius M, Mohr G, Jaeger S, Seeger JB, Bitsch RG. Femoral fixation pattern in cemented Oxford unicompartmental knee arthroplasty--an experimental cadaver study. Knee 2010; 17:398-402. [PMID: 20006930 DOI: 10.1016/j.knee.2009.11.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2009] [Revised: 11/22/2009] [Accepted: 11/26/2009] [Indexed: 02/02/2023]
Abstract
Femoral component loosening is a rare but serious complication in cemented Oxford unicompartmental knee arthroplasty (OUKA). In a cadaver study, OUKA was performed in 24 knees to evaluate the femoral fixation pattern. Due to the geometry of bone and implant, three different zones were identified. Complete cement mantles and good interdigitation were found in the spherical part of the implant (zone 1) and around the peg (zone 3), which implies that these are most important for implant fixation. The posterior plane facet (zone 2) is the weak point of the interface due to incompleteness of the cement mantle and a lack of interdigitation. This study suggests that the cancellous bone in zone 2 and the drill holes in sclerotic bone areas should be filled with cement and pressurised prior to component seating.
Collapse
Affiliation(s)
- M Clarius
- Department of Orthopaedic Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany.
| | | | | | | | | |
Collapse
|
42
|
Maduekwe UI, Zywiel MG, Bonutti PM, Johnson AJ, Delanois RE, Mont MA. Scientific evidence for the use of modern unicompartmental knee arthroplasty. Expert Rev Med Devices 2010; 7:219-39. [PMID: 20214428 DOI: 10.1586/erd.09.65] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Unicompartmental knee arthroplasty as a surgical treatment for monocompartmental knee arthritis remains a controversial procedure with questions surrounding the benefits and survivorship of the procedure versus osteotomies or total knee arthroplasties. The authors, by examining the complete body of literature for scientific evidence concerning the procedure, will describe the history of usage of these prostheses, their rationale for usage, modern devices and their results, and why they may have advantages as a treatment modality for monocompartmental knee arthritis. Outcomes of current unicompartmental designs will be presented and evaluated to determine which aspects of the design and patient selection technique are associated with success or failure. Commonly asked questions regarding the use of these devices will be addressed. The authors will also describe some potential modifications that might affect the use of these components in the future, including minimally invasive procedures and robotics, and how these devices may change over the next 5 years.
Collapse
Affiliation(s)
- Uma I Maduekwe
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215, USA
| | | | | | | | | | | |
Collapse
|
43
|
Is recovery faster for mobile-bearing unicompartmental than total knee arthroplasty? Clin Orthop Relat Res 2009; 467:1450-7. [PMID: 19225852 PMCID: PMC2674171 DOI: 10.1007/s11999-009-0731-z] [Citation(s) in RCA: 195] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2008] [Accepted: 01/20/2009] [Indexed: 01/31/2023]
Abstract
UNLABELLED How does unicompartmental compare with total knee arthroplasty in durability, incidence of complications and manipulations, recovery, postoperative function, and return to sport and work? We matched 103 patients (115 knees) treated with a mobile-bearing unicompartmental device through July 2005 to a selected group of 103 patients (115 knees) treated with cruciate retaining total knee arthroplasty for bilaterality, age, gender and body mass index. Patients who underwent a unicompartmental surgery had better range of motion at discharge and shorter hospital stay than those who had a total knee arthroplasty (77 degrees versus 67 degrees and 1.4 versus 2.2 days). At 6 weeks, Knee Society functional scores and range of motion were higher for unicompartmental than total knees (63 versus 55 and 115 degrees versus 110 degrees). Patient-perceived Oxford scores were similar between groups (unicompartmental 5.4 versus total 4.1). Average times to return to work and sport were similar for both groups. Minimally invasive unicompartmental knee arthroplasty demonstrated better early ROM, shorter hospital stays, and improved functional scores. No advantage was seen in terms of return to work, return to sport, or Oxford scores. The data suggest minimally invasive unicompartmental arthroplasty using a rapid recovery protocol allows patients a faster return to a more functional level than total knee arthroplasty. LEVEL OF EVIDENCE Level III, therapeutic study. See the guidelines online for a complete description of level of evidence.
Collapse
|
44
|
Contemporary unicompartmental knee arthroplasty: fixed vs mobile bearing. J Arthroplasty 2008; 23:24-7. [PMID: 18922370 DOI: 10.1016/j.arth.2008.06.025] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2008] [Accepted: 06/18/2008] [Indexed: 02/01/2023] Open
Abstract
Contemporary unicompartmental knee arthroplasty has shown resurgence in use partly because of studies reporting excellent long-term survivorship. Both fixed-bearing as well as mobile-bearing designs have shown comparable results. Fixed-bearing designs, in particular, implants with metal-backed tibial components have shown more consistent long-term survival, whereas fixed bearings with an all-polyethylene tibial component have had mixed results. Similar to the all-polyethylene tibial component designs, mobile-bearing designs have demonstrated mixed results. One concern with mobile bearings is the high rate of complete tibial radiolucent lines. The keys to long-term survival of both fixed and mobile-bearing designs in unicompartmental knee arthroplasty are patient selection, surgical technique, and surgical experience.
Collapse
|