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Wood MJ, Al-Jabri T, Maniar AR, Stelzhammer T, Lanting B, Giannoudis PV. Periprosthetic tibial fracture as a complication of unicompartmental knee arthroplasty: Current insights. Injury 2024; 55:111654. [PMID: 38878385 DOI: 10.1016/j.injury.2024.111654] [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] [Indexed: 07/26/2024]
Abstract
Periprosthetic fracture following knee arthroplasty is a rare but devastating complication associated with significant morbidity. With unicompartmental knee arthroplasty being performed far less frequently than total knee arthroplasty, periprosthetic fracture following unicompartmental knee arthroplasty presents a particular challenge to orthopaedic surgeons, due to clinical unfamiliarity and sparsity of literature. An up-to-date review of the epidemiology, risk factors, and management strategies for PPF after UKA is presented.
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Affiliation(s)
- Matthew J Wood
- Joint Reconstruction Unit, The Royal National Orthopaedic Hospital, Stanmore, London, HA7 4LP, United Kingdom
| | - Talal Al-Jabri
- Trauma and Orthopaedic Surgery, Department of Surgery and Cancer, Imperial College London, London, SW7 2AZ, United Kingdom; Rorabeck Bourne Joint Replacement Institute, Schulich School of Medicine and Dentistry, London Health Sciences Centre, Western University, London, Ontario, Canada.
| | - Adit R Maniar
- Rorabeck Bourne Joint Replacement Institute, Schulich School of Medicine and Dentistry, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Thomas Stelzhammer
- Trauma and Orthopaedics Department, Whittington Health NHS Trust, Magdala Avenue, London, N19 5NF, UK
| | - Brent Lanting
- Rorabeck Bourne Joint Replacement Institute, Schulich School of Medicine and Dentistry, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Peter V Giannoudis
- Academic Department of Trauma and Orthopaedic Surgery, School of Medicine, University of Leeds, Clarendon Wing, Floor D, Great George Street, Leeds General Infirmary, Leeds LS1 3EX, United Kingdom; NIHR Leeds Biomedical Research Centre, Chapel Allerton Hospital, Leeds, United Kingdom
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Hiranaka T. Advantages and limitations of mobile-bearing unicompartmental knee arthroplasty: an overview of the literature. Expert Rev Med Devices 2024; 21:587-600. [PMID: 38873929 DOI: 10.1080/17434440.2024.2367002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 06/07/2024] [Indexed: 06/15/2024]
Abstract
INTRODUCTION Interest in unicompartmental knee arthroplasty (UKA) has recently grown. Mobile bearing UKA, in which the bearing is not fixed but rather perfectly conforms with femoral and tibial components and moves completely passively between the femoral and tibial implant, has now been used for approximately half a century. AREAS COVERED Alongside the recognized advantages of UKA, the mobile-bearing variant benefits from an extremely low rate of polyethylene wear and tolerable minor malalignment. Revision rates for UKA have been reported to exceed those of total knee arthroplasty, but long-term survival rates and outcomes from mobile-bearing UKA have been found to be satisfactory. In addition to the lateral osteoarthritis and loosening, which are main complications of UKA, bearing dislocation is a specific complication of mobile bearing UKA. Fractures and valgus subsidence are more prevalent than in the cementless UKA. While these continue to be features to be addressed, they have been partially solved. EXPERT OPINION Given the manifold benefits of UKA, its application could be extended to a larger patient population. Successful outcomes rely on careful patient selection and the surgeon's extensive familiarity with the procedure. Looking ahead, the incorporation of robotic surgery, already a feature of some fixed-bearing UKAs, might shape the future trajectory of mobile-bearing UKA.
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Affiliation(s)
- Takafumi Hiranaka
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Takatsuki, Osaka, Japan
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3
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Bayoumi T, Burger JA, van der List JP, Sierevelt IN, Spekenbrink-Spooren A, Pearle AD, Kerkhoffs GMMJ, Zuiderbaan HA. Comparison of the early postoperative outcomes of cementless and cemented medial unicompartmental knee arthroplasty. Bone Jt Open 2024; 5:401-410. [PMID: 38767223 PMCID: PMC11103876 DOI: 10.1302/2633-1462.55.bjo-2024-0007.r1] [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] [Indexed: 05/22/2024] Open
Abstract
Aims The primary objective of this registry-based study was to compare patient-reported outcomes of cementless and cemented medial unicompartmental knee arthroplasty (UKA) during the first postoperative year. The secondary objective was to assess one- and three-year implant survival of both fixation techniques. Methods We analyzed 10,862 cementless and 7,917 cemented UKA cases enrolled in the Dutch Arthroplasty Registry, operated between 2017 and 2021. Pre- to postoperative change in outcomes at six and 12 months' follow-up were compared using mixed model analyses. Kaplan-Meier and Cox regression models were applied to quantify differences in implant survival. Adjustments were made for patient-specific variables and annual hospital volume. Results Change from baseline in the Oxford Knee Score (OKS) and activity-related pain was comparable between groups. Adjustment for covariates demonstrated a minimally greater decrease in rest-related pain in the cemented group (β = -0.09 (95% confidence interval (CI) -0.16 to -0.01)). Cementless fixation was associated with a higher probability of achieving an excellent OKS outcome (> 41 points) (adjusted odds ratio 1.2 (95% CI 1.1 to 1.3)). The likelihood of one-year implant survival was greater for cemented implants (adjusted hazard ratio (HR) 1.35 (95% CI 1.01 to 1.71)), with higher revision rates for periprosthetic fractures of cementless implants. During two to three years' follow-up, the likelihood of implant survival was non-significantly greater for cementless UKA (adjusted HR 0.64 (95% CI 0.40 to 1.04)), primarily due to increased revision rates for tibial loosening of cemented implants. Conclusion Cementless and cemented medial UKA led to comparable improvement in physical function and pain reduction during the initial postoperative year, albeit with a greater likelihood of achieving excellent OKS outcomes after cementless UKA. Anticipated differences in early physical function and pain should not be a decisive factor in the choice of fixation technique. However, surgeons should consider the differences in short- and long-term implant survival when deciding which implant to use.
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Affiliation(s)
- Tarik Bayoumi
- Hospital for Special Surgery, Sports Medicine Institute, Weill Medical College of Cornell University, New York, New York, USA
- Department of Orthopaedic Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Joost A. Burger
- Department of Orthopaedic Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Charité – Department of Orthopaedic Surgery, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität, Berlin, Germany
| | - Jelle P. van der List
- Department of Orthopaedic Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Inger N. Sierevelt
- Xpert Clinics, Amsterdam, The Netherlands
- Spaarne Gasthuis Academy, Hoofddorp, The Netherlands
| | | | - Andrew D. Pearle
- Hospital for Special Surgery, Sports Medicine Institute, Weill Medical College of Cornell University, New York, New York, USA
| | - Gino M. M. J. Kerkhoffs
- Department of Orthopaedic Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
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Albishi W, AbuDujain NM, Aldhahri M, Alzeer M. Unicompartmental knee replacement: controversies and technical considerations. ARTHROPLASTY 2024; 6:21. [PMID: 38693586 PMCID: PMC11064323 DOI: 10.1186/s42836-024-00242-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 02/20/2024] [Indexed: 05/03/2024] Open
Abstract
BACKGROUND Unicompartmental knee replacement (UKR) is one of the effective interventions for the treatment of symptomatic knee osteoarthritis. Moreover, it has multiple advantages over total knee arthroplasty (TKA), including reduced intraoperative blood loss, decreased risk of transfusion, and faster recovery. This study aimed to discuss critical technical considerations regarding UKR and some of the controversies and updates. METHODS We conducted a review to provide an overview of the controversies and technical considerations about UKR in several aspects. Only peer-reviewed articles were included, up to December 2023 using PubMed, Google Scholar, ERIC, and Cochrane database for systematic reviews databases. RESULT UKR is associated with superior patient-reported clinical and functional outcomes, as well as shorter hospital stays, fewer postoperative complications, and revealed favorable outcomes in patients' return to sport. The choice between mobile- and fixed-bearing prostheses depends, in part, on the surgeon's preference. The mobile-bearing UKR is a less constrained prosthesis and can potentially result in less wear, but it is more technically demanding. While no significant difference between mobile-bearing versus fixed-bearing prostheses, cementless is superior to cemented design. Furthermore, UKR can be a good alternative for high tibial osteotomy (HTO) and still can be considered after a failed HTO. Lastly, recent reviews have shown a revision rate comparable to that of TKA. This is probably influenced by Improved comprehension of the best indications, patient selection criteria, as well as of the design, materials, and technological advances. CONCLUSION UKR treatment for unicompartmental knee osteoarthritis is secure and effective. Based on clinical and functional outcomes, decreased morbidity and mortality, and cost-effectiveness, long-term studies suggest that UKR is superior to TKA. Further investigation in this area is warranted.
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Affiliation(s)
- Waleed Albishi
- Department of Orthopedic Surgery, College of Medicine, King Saud University, Riyadh, 11362, Saudi Arabia
| | - Nasser M AbuDujain
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, 2925, Saudi Arabia.
| | - Mohammed Aldhahri
- Department of Orthopedic Surgery, College of Medicine, King Saud University, Riyadh, 11362, Saudi Arabia
| | - Meshari Alzeer
- College of Medicine, King Saud University, Riyadh, 11362, Saudi Arabia
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5
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Waldstein W, Aldinger PR, Merle C. [Successful medial unicompartmental knee arthroplasty-What are the most important surgical tricks?]. ORTHOPADIE (HEIDELBERG, GERMANY) 2024; 53:265-274. [PMID: 38441567 DOI: 10.1007/s00132-024-04479-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/08/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Unicompartmental knee arthroplasty (UKA) is an established surgical treatment option for end-stage anteromedial osteoarthritis with excellent functional outcomes and implant survival. Routine preoperative varus and valgus stress views are crucial for the selection of patients for unicompartmental or total knee arthroplasty. THERAPY UKA is a soft-tissue based operation that aims to reconstruct the individual joint line and pre-arthritic alignment by restoring the physiological tension of the medial collateral and the cruciate ligaments. RESULTS Current data for medial UKA show excellent results for both mobile and fixed bearing implant designs with the correct indication and surgical technique. Cementless fixation offers potential advantages over cemented implants. Registry data demonstrate that institutions and surgeons specializing in partial knee replacement (> 30 cases/year per surgeon, > 100/year per institution) with a high percentage of UKA relative to the total number of knee implants (> 20%) have significantly lower revision rates.
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Affiliation(s)
- Wenzel Waldstein
- Orthopädische Klinik Paulinenhilfe, Diakonie-Klinikum Stuttgart, Rosenbergstr. 38, 70176, Stuttgart, Deutschland
| | - Peter R Aldinger
- Orthopädische Klinik Paulinenhilfe, Diakonie-Klinikum Stuttgart, Rosenbergstr. 38, 70176, Stuttgart, Deutschland
| | - Christian Merle
- Orthopädische Klinik Paulinenhilfe, Diakonie-Klinikum Stuttgart, Rosenbergstr. 38, 70176, Stuttgart, Deutschland.
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6
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Lobenhoffer P. [Implant-associated fracture of the tibial plateau in cementless medial unicondylar knee prosthesis : Locking plate osteosynthesis]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2023; 35:397-402. [PMID: 37857816 DOI: 10.1007/s00064-023-00829-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 06/06/2023] [Accepted: 06/08/2023] [Indexed: 10/21/2023]
Abstract
THE PROBLEM Cementless medial unicondylar knee prostheses with mobile inlays have proved to be successful and are increasingly being used worldwide; however, there is a risk of fracture of the medial tibial plateau in the postoperative healing phase. THE SOLUTION In most cases we observed split fractures starting from the keel of the implant. These can be treated with a small posteromedial locking plate, whereby the upper screws are inserted through the keel slot and then interlocked. This achieves an optimally strong bond between the implant and the screws and a stable construct. SURGICAL TECHNIQUE A longitudinal skin incision is made at the level of the keel slot. A radial T‑plate is placed subcutaneously. The plate is fixed with a lag screw in the middle section. The compression usually closes the fracture gap. Then three locking cortical bone screws are inserted through the keel slot in the transverse section of the plate. Distal fixation by locking or standard screws. POSTOPERATIVE MANAGEMENT Immediate pain-adapted partial weight bearing, unrestricted mobility. Healing of the fracture and full weight bearing mostly achieved after 4 weeks.
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Affiliation(s)
- Philipp Lobenhoffer
- go:h Gelenkchirurgie Orthopädie Hannover, Bertastr. 10, 30159, Hannover, Deutschland.
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7
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Rahman A, Martin B, Jenkins C, Mohammad H, Barker K, Dodd C, Jackson W, Price A, Mellon S, Murray DW. Less pain reported 5 years after cementless compared to cemented unicompartmental knee replacement: an analysis of pain, neuropathy, and co-morbidity scores. Knee Surg Sports Traumatol Arthrosc 2023; 31:5180-5189. [PMID: 37776359 PMCID: PMC10598111 DOI: 10.1007/s00167-023-07589-4] [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: 09/04/2022] [Accepted: 09/11/2023] [Indexed: 10/02/2023]
Abstract
PURPOSE To compare patient-reported pain scores and assess the influence of neuropathy and co-morbidity, on knee pain following cemented and cementless medial unicompartmental knee replacement (UKR) 5 years after surgery. METHOD In this longitudinal study, 262 cemented and 262 cementless Oxford UKR performed for the same indications and with the same techniques were recruited. Patients were reviewed at five years, evaluating patient-reported pain and association with clinical outcomes. Intermittent and Constant Osteoarthritis Pain (ICOAP), PainDETECT (PD), Charnley score, Oxford Knee Score (OKS) and American Knee Society Score (AKSS) were compared. RESULTS In both cohorts, intermittent pain was more common than constant pain (47% vs 21%). Cementless knees reported significantly less pain than cemented (ICOAP-Total 5/100 vs 11/100, p < 0.0001). A greater proportion of cementless knees experienced no pain at all (ICOAP = 0/100, 61% vs 43%, p < 0.0001) and 75% fewer experienced severe or extreme pain. Pain sub-scores in PD, OKS and AKSS follow this trend. Pain was unlikely to be neuropathic (PD positive: 5.26%), but patients reporting high levels of 'strongest' pain were three times more likely to be neuropathic. Patients with co-morbidities (Charnley C) experienced greater pain than those without (Charnley A+B) across all knee-specific scores, despite scores being knee specific. CONCLUSION Both cemented and cementless UKR in this study had substantially less pain than that reported in literature following TKR. Cementless UKR had significantly less pain than cemented UKR in all scores. Two-thirds of patients with a cementless UKR had no pain at all at 5 years, and pain experienced was most likely to be mild and intermittent with no patients in severe or extreme pain. Patients with cementless UKR that had higher levels of pain were more likely to have co-morbidity or evidence or neuropathic pain. It is unclear why cementless UKR have less pain than cemented; further study is necessary.
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Affiliation(s)
- Azmi Rahman
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
| | - Benjamin Martin
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Cathy Jenkins
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Hasan Mohammad
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Karen Barker
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Christopher Dodd
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - William Jackson
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Andrew Price
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Stephen Mellon
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - David W Murray
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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8
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Mancino F, Malahias MA, Loucas R, Ryan L, Kostretzis L, Tornberg H, Gu A, Nikolaou VS, Togninalli D, Alexiades MM. Cementless versus cemented unicompartmental knee arthroplasty: a systematic review of comparative studies. Musculoskelet Surg 2023; 107:255-267. [PMID: 36689086 DOI: 10.1007/s12306-023-00773-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 01/08/2023] [Indexed: 01/24/2023]
Abstract
There are still some controversies regarding the clinical use of cementless UKAs. The aim of this systematic review was to determine whether cementless medial UKA leads to similar outcomes compared to cemented medial UKA. This search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews guidelines (PRISMA). The random effects model with 95% confidence interval (CI) was applied to the analysis. The I2 statistic was used to assess study heterogeneity. Six studies were eligible for inclusion (4784 UKAs, 4776 patients): 2947 cemented UKAs (61.6%) and 1837 cementless UKAs (38.4%). The overall mean follow-up was 4.9 years. The all-cause reoperation rate was 11.3% (80 of 706) at mean 5.7-year follow-up for cemented UKA and 6.9% (57 of 824) at mean 4.1-year follow-up for the cementless. The overall revision rate was 10.2% (303 of 2947) for the cemented and 5.8% (108 of 1837) for the cementless. Aseptic loosening was the most frequent reason of revision (2.3% cemented vs 0.5% cementless). The overall rate of radiolucent lines (RLL) was 28.3% (63 of 223) in the cemented cohort and 11.1% in the cementless (26 of 234). All the studies reported improved functional outcomes. Cementless UKA provides at least equivalent if not better results compared to cemented UKA. Despite the use of cemented UKA outnumber cementless fixation, available data shows that cementless UKA had a reduced midterm revision rate, while providing similar functional outcomes.
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Affiliation(s)
- F Mancino
- Department of Orthopaedic, The Orthopaedic Research Foundation of Western Australia (ORFWA), Fiona Stanley Hospital, Perth, Australia.
| | - M A Malahias
- School of Medicine - Frankfurt, European University Cyprus, Im Vogelsgesang 3, Frankfurt am Main, 60488, Germany
- Department of Orthopedics and Traumatology, Clinica ARS Medica, Via Grumo 16, 6929, Gravesano, Ticino, Switzerland
| | - R Loucas
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - L Ryan
- Department of Orthopedic Surgery, George Washington School of Medicine and Health Sciences, 2300 M St NW, Washington DC, 20037, USA
| | - L Kostretzis
- Hôpital Maisonneuve-Rosemont, CanadaCooper, 5415 Boulevard de L'Assomption, Montréal, QC, H1T 2M4, Canada
| | - H Tornberg
- Medical School of Rowan University, 401 Broadway, Camden, NJ, 08103, USA
| | - A Gu
- Department of Orthopedic Surgery, George Washington School of Medicine and Health Sciences, 2300 M St NW, Washington DC, 20037, USA
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, 535 E 70Th St, New York, 10021, USA
| | - V S Nikolaou
- 2nd Orthopaedic Department, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - D Togninalli
- Department of Orthopedics and Traumatology, Clinica ARS Medica, Via Grumo 16, 6929, Gravesano, Ticino, Switzerland
| | - M M Alexiades
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, 535 E 70th St, New York, 10021, USA
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Tay ML, Bolam SM, Maxwell AR, Hooper GJ, Monk AP, Young SW. Similar Survivorship but Different Revision Reasons for Uncemented Mobile-Bearing and Cemented Fixed-Bearing Medial UKA: A Long-Term Population-Based Cohort Study of 2,015 Patients. J Bone Joint Surg Am 2023; 105:755-761. [PMID: 36812351 DOI: 10.2106/jbjs.22.00686] [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] [Indexed: 02/24/2023]
Abstract
BACKGROUND Long-term survivorship and accurate characterization of revision reasons in unicompartmental knee arthroplasty (UKA) are limited by a lack of long-term data and standardized definitions of revision. The aim of this study was to identify survivorship, risk factors, and reasons for revision in a large cohort of medial UKAs with long-term follow-up (up to 20 years). METHODS Patient, implant, and revision details for 2,015 primary medial UKAs (mean follow-up, 8 years) were recorded following systematic clinical and radiographic review. Survivorship and risk of revision were analyzed using Cox proportional hazards. Reasons for revision were analyzed using competing-risk analysis. RESULTS Implant survivorship at 15 years was 92% for cemented fixed-bearing (cemFB), 91% for uncemented mobile-bearing (uncemMB), and 80% for cemented mobile-bearing (cemMB) UKAs (p = 0.02). When compared with cemFB, the risk of revision was higher for cemMB implants (hazard ratio [HR] = 1.9, 95% confidence interval [CI] = 1.1 to 3.2; p = 0.03). At 15 years, cemented implants had a higher cumulative frequency of revision due to aseptic loosening (3% to 4%, versus 0.4% for uncemented; p < 0.01), cemMB implants had a higher cumulative frequency of revision due to osteoarthritis progression (9% versus 2% to 3% for cemFB/uncemMB; p < 0.05), and uncemMB implants had a higher cumulative frequency of revision due to bearing dislocation (4% versus 2% for cemMB; p = 0.02). Compared with the oldest patients (≥70 years), younger patients had a higher risk of revision (<60 years: HR = 1.9, 95% CI = 1.2 to 3.0; 60 to 69 years: HR = 1.6, 95% CI = 1.0 to 2.4; p < 0.05 for both). At 15 years, there was a higher cumulative frequency of revision for aseptic loosening in these younger groups (3.2% and 3.5% versus 2.7% for ≥70 years; p < 0.05). CONCLUSIONS Implant design and patient age were risk factors for revision of medial UKA. The findings from this study suggest that surgeons should consider using cemFB or uncemMB designs because of their superior long-term implant survivorship compared with cemMB designs. Additionally, for younger patients (<70 years), uncemMB designs had a lower risk of aseptic loosening than cemFB designs at the expense of a risk of bearing dislocation. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Mei Lin Tay
- Department of Surgery, Faculty of Medical and Health Sciences (FMHS), University of Auckland, Auckland, New Zealand.,Department of Orthopaedic Surgery, North Shore Hospital, Auckland, New Zealand
| | - Scott M Bolam
- Department of Surgery, Faculty of Medical and Health Sciences (FMHS), University of Auckland, Auckland, New Zealand.,Department of Orthopaedic Surgery, Auckland City Hospital, Auckland, New Zealand
| | - A Rod Maxwell
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand
| | - Gary J Hooper
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand
| | - A Paul Monk
- Department of Orthopaedic Surgery, Auckland City Hospital, Auckland, New Zealand.,Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Simon W Young
- Department of Surgery, Faculty of Medical and Health Sciences (FMHS), University of Auckland, Auckland, New Zealand.,Department of Orthopaedic Surgery, North Shore Hospital, Auckland, New Zealand
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10
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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.
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11
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Grabherr M, Dimitriou D, Schraknepper J, Helmy N, Flury A. Hybrid fixation of unicompartmental knee arthroplasty shows equivalent short-term implant survivorship and clinical scores compared to standard fixation techniques. Arch Orthop Trauma Surg 2022:10.1007/s00402-022-04710-z. [PMID: 36459235 DOI: 10.1007/s00402-022-04710-z] [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: 01/04/2022] [Accepted: 11/22/2022] [Indexed: 12/04/2022]
Abstract
INTRODUCTION There is a paucity of data regarding hybrid-fixated unicompartmental knee arthroplasty (UKA), and no study directly compared all three available fixation techniques (cementless, cemented, and hybrid). The hypothesis was that hybrid fixation might have a lower incidence of radiolucent lines (RLL) than cemented UKA, with equivalent outcomes to uncemented UKA. MATERIALS AND METHODS A total of 104 UKA with a minimal follow-up of 1 year were retrospectively included, of which 40 were cemented, 41 cementless, and 23 hybrid prostheses. The functional outcomes scores included the Oxford Knee (OKS), Subjective Knee (SKS), and Forgotten Joint scores (FJS). RLLs, subsidence, and component positioning were assessed on radiographs. RESULTS At a mean follow-up of 28 months, the survival rate was 95% for cemented UKA and 100% for the cementless and hybrid UKA (n.s.), respectively. Postoperative FJS (93 vs. 82 points, p = 0.007) and SKS (4.7 vs. 4.1 points, p = 0.001) were better in cementless than cemented UKA, with hybrid-fixated UKA in between the two (90 and 4.4 points, n.s.). Improvement of OKS preoperatively to postoperatively did not differ between the groups (n.s.). RLLs were more frequent in cemented (23%) compared to cementless (5%, p = 0.021) and hybrid UKA (9%, n.s.). With an incidence of 12%, subsidence occurred more commonly in cementless UKA compared to cemented (5%) and hybrid (0%) (n.s.) UKA. CONCLUSION Hybrid fixation achieves equivalent results to standard UKA fixation techniques regarding implant survival and functional and radiological outcomes. Therefore, the hybrid fixation technique seems to be a valuable alternative as it combines the advantages of cemented tibial components with those of uncemented femoral components. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Michael Grabherr
- Orthopaedic and Traumatology Department, Bürgerspital Solothurn, Schöngrünstrasse 38, 4500, Solothurn, Switzerland.
| | - Dimitris Dimitriou
- Orthopaedic and Traumatology Department, Bürgerspital Solothurn, Schöngrünstrasse 38, 4500, Solothurn, Switzerland.,Orthopaedic Department, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Johannes Schraknepper
- Orthopaedic and Traumatology Department, Bürgerspital Solothurn, Schöngrünstrasse 38, 4500, Solothurn, Switzerland
| | - Näder Helmy
- Orthopaedic and Traumatology Department, Bürgerspital Solothurn, Schöngrünstrasse 38, 4500, Solothurn, Switzerland
| | - Andreas Flury
- Orthopaedic and Traumatology Department, Bürgerspital Solothurn, Schöngrünstrasse 38, 4500, Solothurn, Switzerland.,Orthopaedic Department, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
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12
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Kamenaga T, Hiranaka T, Hida Y, Nakano N, Kuroda Y, Tsubosaka M, Hayashi S, Kuroda R, Matsumoto T. Lateral osteoarthritis progression is associated with a postoperative residual tibiofemoral subluxation in Oxford UKA. Knee Surg Sports Traumatol Arthrosc 2022; 30:3236-3243. [PMID: 34514512 DOI: 10.1007/s00167-021-06729-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 08/27/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Lateral compartment osteoarthritis progression (LOP) is a major complication after Oxford mobile-bearing unicompartmental knee arthroplasty (OUKA). This study aimed to identify the association between tibiofemoral subluxation (TFS) and LOP after OUKA. Patients whose TFS was uncorrectable according to preoperative stress radiographs were hypothesised to develop residual TFS even after surgery, and thought to be more likely to develop LOP. METHODS The study included 201 patients who underwent medial OUKA. Fifteen patients showed increases in LOP of at least two Kellgren-Lawrence grades after surgery [progression (P) group], while the others had no progression (N group, n = 186). TFS was measured on preoperative full leg weight-bearing radiographs, valgus stress radiographs and postoperative plain radiographs. Valgus stress radiographs were obtained using a firm manual valgus force with the knee flexed at 20°. Leg alignment, Oxford knee score (OKS), and revision rates were assessed. RESULTS The P group had significantly higher TFS values on preoperative valgus stress (6.8° ± 2.2° vs. 4.5° ± 2.0°; P < 0.001) and postoperative radiographs (6.6° ± 2.3° vs. 4.6° ± 2.9°; P < 0.001) than the N group. Patients with postoperative residual TFS and postoperative valgus alignment were more likely to have LOP, but 9 of the 15 LOP patients did not show postoperative valgus alignment. The P group had significantly poorer postoperative OKS (33.0 ± 10.2 vs. 37.4 ± 6.5, P = 0.017) and a higher rate of revision (6/15 vs 6/186; odds ratio = 19.16; 95% CI = 4.98-76.05, P < 0.001). CONCLUSION OA progression in the lateral compartment after medial OUKA might be associated with postoperative residual TFS, but does not always coexist with postoperative valgus alignment. Preoperative assessment of TFS with valgus stress could be a potential predictor of postoperative residual TFS and LOP. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Tomoyuki Kamenaga
- Department of Orthopedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, 1-3-13, Kosobe-cho, Takatsuki, Osaka, 569-1192, Japan
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Takafumi Hiranaka
- Department of Orthopedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, 1-3-13, Kosobe-cho, Takatsuki, Osaka, 569-1192, Japan.
| | - Yuichi Hida
- Department of Orthopedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, 1-3-13, Kosobe-cho, Takatsuki, Osaka, 569-1192, Japan
| | - Naoki Nakano
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Yuichi Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Masanori Tsubosaka
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Shinya Hayashi
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
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13
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Gifstad T, Nordskar JJ, Egeberg T, Wik TS, Winther SB. Cementless unicompartmental knee arthroplasty results in higher pain levels compared to the cemented technique: a prospective register study. Knee Surg Sports Traumatol Arthrosc 2022; 30:2738-2743. [PMID: 34036403 PMCID: PMC9309142 DOI: 10.1007/s00167-021-06617-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 05/18/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE In recent years, the preferred fixation method for unicompartmental knee arthroplasty (UKA) has changed from cemented to cementless. The aim of this study was to compare patient-reported outcome measures (PROMs) from the cemented versus cementless techniques two- and twelve-months post-operation. METHODS From 2015 to 2019, 187 cemented and 261 cementless UKAs were included based on an institutional registry. The Oxford Unicompartmental Knee System™ (Zimmer Biomet, Bridgend, United Kingdom) was used for all patients. Three experienced surgeons performed all procedures. Data were collected pre- and peroperatively, and at two- and twelve-months postoperatively. PROMs included pain (evaluated on a numeric rating scale [NRS] during activity and at rest), and knee function (evaluated with the disease-specific short form of the Knee injury and Osteoarthritis Outcome Score [KOOS-PS]). Patients also rated postoperative joint function (better, unchanged, uncertain or worse) and were asked, "based on your experience to date, would you go through the surgery again?". Duration of surgery was noted and revisions during the first post-operative year were evaluated. RESULTS The cemented group reported significantly lower activity-related pain at both two- and twelve-month follow-up. This was also the case for pain at rest at twelve-month follow-up, and KOOS-PS at two-month follow-up. Duration of surgery (adjusted for surgeon differences) was eight minutes less on average with the cementless technique. Eleven prosthetic joint infections (PJIs) were found following the cementless fixation technique compared to three using the cemented implant. CONCLUSION UKA cases with cemented implants had lower pain scores during activity two and twelve months after surgery compared with those who had cementless implants. Differences in favor of the cemented group were also found for pain at rest one year after surgery and for KOOS-PS two months after. Surgery was significantly shorter in duration in the cementless group, but a relatively high number of PJIs were found in that same group. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Tone Gifstad
- Department of Orthopaedics, Trondheim University Hospital, Postbox 3250, NO 7006, Torgarden, Trondheim, Norway.
- Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Jørgen Jebens Nordskar
- Department of Orthopaedics, Trondheim University Hospital, Postbox 3250, NO 7006, Torgarden, Trondheim, Norway
| | - Tarjei Egeberg
- Department of Orthopaedics, Trondheim University Hospital, Postbox 3250, NO 7006, Torgarden, Trondheim, Norway
| | - Tina Strømdal Wik
- Department of Orthopaedics, Trondheim University Hospital, Postbox 3250, NO 7006, Torgarden, Trondheim, Norway
- Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Siri Bjørgen Winther
- Department of Orthopaedics, Orthopaedic Research Center, Trondheim University Hospital, Trondheim, Norway
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14
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[Focal femoral resurfacing and unicompartmental knee replacement : Between osteotomy and total knee replacement]. DER ORTHOPADE 2021; 50:387-394. [PMID: 33847791 DOI: 10.1007/s00132-021-04105-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/12/2021] [Indexed: 10/21/2022]
Abstract
Unicompartmental knee arthroplasty, especially for both femorotibial compartments of the knee, is an established partly joint-saving treatment option for osteoarthritis of the knee if the disease is limited to one compartment. Even smaller implants or resurfacing of the patellofemoral joint have been shown-in smaller patient collectives-to have the potential to yield good clinical results.
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15
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Asokan A, Plastow R, Kayani B, Radhakrishnan GT, Magan AA, Haddad FS. Cementless knee arthroplasty: a review of recent performance. Bone Jt Open 2021; 2:48-57. [PMID: 33537676 PMCID: PMC7842161 DOI: 10.1302/2633-1462.21.bjo-2020-0172.r1] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Cementless knee arthroplasty has seen a recent resurgence in popularity due to conceptual advantages, including improved osseointegration providing biological fixation, increased surgical efficiency, and reduced systemic complications associated with cement impaction and wear from cement debris. Increasingly younger and higher demand patients are requiring knee arthroplasty, and as such, there is optimism cementless fixation may improve implant survivorship and functional outcomes. Compared to cemented implants, the National Joint Registry (NJR) currently reports higher revision rates in cementless total knee arthroplasty (TKA), but lower in unicompartmental knee arthroplasty (UKA). However, recent studies are beginning to show excellent outcomes with cementless implants, particularly with UKA which has shown superior performance to cemented varieties. Cementless TKA has yet to show long-term benefit, and currently performs equivalently to cemented in short- to medium-term cohort studies. However, with novel concepts including 3D-printed coatings, robotic-assisted surgery, radiostereometric analysis, and kinematic or functional knee alignment principles, it is hoped they may help improve the outcomes of cementless TKA in the long-term. In addition, though cementless implant costs remain higher due to novel implant coatings, it is speculated cost-effectiveness can be achieved through greater surgical efficiency and potential reduction in revision costs. There is paucity of level one data on long-term outcomes between fixation methods and the cost-effectiveness of modern cementless knee arthroplasty. This review explores recent literature on cementless knee arthroplasty, with regards to clinical outcomes, implant survivorship, complications, and cost-effectiveness; providing a concise update to assist clinicians on implant choice. Cite this article: Bone Jt Open 2021;2(1):48–57.
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Affiliation(s)
- Ajay Asokan
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK.,Department of Orthopaedic Surgery, The Princess Grace Hospital, London, UK
| | - Ricci Plastow
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK.,Department of Orthopaedic Surgery, The Princess Grace Hospital, London, UK
| | - Babar Kayani
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK.,Department of Orthopaedic Surgery, The Princess Grace Hospital, London, UK
| | - Ganan T Radhakrishnan
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK.,Department of Orthopaedic Surgery, The Princess Grace Hospital, London, UK
| | - Ahmed A Magan
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK.,Department of Orthopaedic Surgery, The Princess Grace Hospital, London, UK
| | - Fares S Haddad
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK.,Department of Orthopaedic Surgery, The Princess Grace Hospital, London, UK
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