1
|
Favroul C, Batailler C, Thouvenin C, Shatrov J, Neyret P, Servien E, Lustig S. Long-term functional success and robust implant survival in lateral unicompartmental knee arthroplasty: A case series with a mean follow-up of twenty two and a half years. INTERNATIONAL ORTHOPAEDICS 2024; 48:1761-1769. [PMID: 38743298 DOI: 10.1007/s00264-024-06215-3] [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: 04/18/2024] [Accepted: 05/07/2024] [Indexed: 05/16/2024]
Abstract
PURPOSE Lateral unicompartmental knee arthroplasty (UKA) is an accepted treatment option in cases of end-stage lateral osteoarthritis. While lateral UKA has many proposed advantages compared to total knee arthroplasty, its technical challenges and relatively small number of cases make this an uncommon procedure. The aim of this study was to report the survivorship and functional outcomes beyond 20 years of follow-up of isolated UKA. METHODS Between January 1988 and October 2003, 54 lateral UKAs were performed in a single center. The fitted prosthesis was a fixed plate and cemented polyethylene (PE). All patients had isolated lateral tibiofemoral osteoarthritis, including five open meniscectomies, three arthroscopies, and three open reductions of lateral tibial plateau fractures. Patients with a minimum of 20 years of follow-up were included in the final analysis. RESULTS Of the 54 UKA, 22 died before reaching the minimum follow-up period and four were lost to follow-up. Twenty-eight were included in the final analysis. Among them, 21 patients remained alive and an additional seven were deceased after 20 years. The mean age at the last follow-up was 84.8 ± 11.9 years with a mean follow-up duration of 22.5 ± 2.1 years. Of the 28 knees, eight underwent revision surgery (5 for the progression of osteoarthritis; 2 for aseptic loosening; 1 for PE wear). Kaplan-Meier survival analysis revealed a survival rate at 20 and 25 years of 72.3% (CI 59.1; 88.6). The average time to revision was 14.9 ± 4.9 years. At the last follow-up, the mean function Knee Society Score (KSS) was 41.5 ± 32.9 and the mean objective KSS score was 79.4 ± 9.7. In the unrevised population, 94.7% of patients (n = 18) reported being satisfied or very satisfied with the surgery. CONCLUSION Lateral UKA remains a viable treatment option for patients with isolated lateral tibiofemoral osteoarthritis, providing satisfactory 20-year implant survivorship and high patient satisfaction.
Collapse
Affiliation(s)
- Clément Favroul
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon North University Hospital, 103 Grande Rue de La Croix-Rousse, 69004, Lyon, France.
| | - Cécile Batailler
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon North University Hospital, 103 Grande Rue de La Croix-Rousse, 69004, Lyon, France
- Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406, 69622, Lyon, France
| | - Clara Thouvenin
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon North University Hospital, 103 Grande Rue de La Croix-Rousse, 69004, Lyon, France
| | - Jobe Shatrov
- Sydney Orthopedic Research Institute, University of Notre Dame Australia, Hornsby and Ku-Ring Hospital, Sydney, Australia
| | | | - Elvire Servien
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon North University Hospital, 103 Grande Rue de La Croix-Rousse, 69004, Lyon, France
- LIBM-EA 7424, Interuniversity Laboratory of Biology of Mobility, Claude Bernard Lyon 1 University, Lyon, France
| | - Sébastien Lustig
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon North University Hospital, 103 Grande Rue de La Croix-Rousse, 69004, Lyon, France
- Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406, 69622, Lyon, France
| |
Collapse
|
2
|
Marullo M, Russo A, Spreafico A, Romagnoli S. Lateral Unicompartmental Knee Arthroplasty for Osteoarthritis Secondary to Lateral Meniscectomy: High Functional Results and Survivorship and Low Osteoarthritis Progression at a Mean 10 Years of Follow-up. J Bone Joint Surg Am 2024; 106:992-999. [PMID: 38512989 DOI: 10.2106/jbjs.23.00764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
BACKGROUND Meniscectomy, whether partial or total, is a common knee surgery, but it considerably increases the risk of knee osteoarthritis (OA). Lateral meniscectomy has more severe consequences than medial meniscectomy, leading to faster OA progression and worse clinical outcomes. Unicompartmental knee arthroplasty (UKA) is a suitable treatment option for lateral OA and has demonstrated better outcomes than total knee arthroplasty (TKA). The aims of this study were to evaluate the clinical and functional results, OA progression in the medial compartment, and implant survivorship following lateral UKA in patients with OA secondary to lateral meniscectomy and to compare these outcomes with those of patients who underwent lateral UKA for primary lateral OA. METHODS Between 2001 and 2017, 214 lateral UKAs were performed. Of these, 42 were performed for OA secondary to lateral meniscectomy. The control group was composed of patients who underwent lateral UKA for primary lateral OA and was formed through a 1:1 case-control matching process based on sex, age, body mass index, and operation date. The outcomes that were studied included range of motion, Knee Society Score, University of California Los Angeles (UCLA) Activity Score, Tegner Activity Scale, Forgotten Joint Score, visual analog scale for pain, OA progression in the medial compartment, and implant survivorship. RESULTS At a mean follow-up of 10.2 years, both groups demonstrated significant improvements (p < 0.01) after lateral UKA in all clinical and functional scores except the UCLA Activity Score and Tegner Activity Scale. No significant differences in clinical and functional scores were found between the groups. However, patients with OA secondary to meniscectomy exhibited significantly less OA progression in the medial compartment (p = 0.035) and higher 10-year implant survival (97.6% versus 83.3%). CONCLUSIONS Lateral UKA is an effective treatment option for OA secondary to lateral meniscectomy, providing excellent functional outcomes and survivorship. Patients with post-meniscectomy OA exhibited less OA progression in the medial compartment than patients with primary OA and, consequently, had better 10-year implant survivorship. LEVEL OF EVIDENCE Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Matteo Marullo
- Department of Joint Replacement, IRCCS Galeazzi Orthopedic Institute, Milano, Italy
| | - Antonio Russo
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Andrea Spreafico
- Department of Joint Replacement, IRCCS Galeazzi Orthopedic Institute, Milano, Italy
| | - Sergio Romagnoli
- Department of Joint Replacement, IRCCS Galeazzi Orthopedic Institute, Milano, Italy
| |
Collapse
|
3
|
Sangaletti R, Andriollo L, Montagna A, Are L, Benazzo F, Rossi SMP. Lateral UKA can be a safe solution in a young patients' population: a 10-year follow-up report. Arch Orthop Trauma Surg 2024:10.1007/s00402-023-05189-y. [PMID: 38231208 DOI: 10.1007/s00402-023-05189-y] [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: 06/20/2023] [Accepted: 12/21/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND This study aimed to assess the long-term survivorship and functional outcomes of fixed-bearing lateral unicompartmental knee arthroplasty (UKA) in a young patients' population with osteoarthritis limited to the lateral compartment. METHODS The study included a cohort of consecutive patients who underwent lateral UKA between January 2008 and December 2014 at a single high-volume surgical center. The surgical procedures were performed by experienced surgeons using a lateral parapatellar approach and fixed-bearing implants. Patient follow-up included a retrospective re-evaluation, clinical assessments, patient-reported outcome measures (PROMs), and X-ray analysis. RESULTS A total of 40 lateral UKAs were analyzed, with 19 performed on the left and 21 on the right knee. The mean age of the patients at the time of surgery was 57.6 years, and the mean BMI was 24.8. At the final follow-up, 80% of patients achieved excellent outcomes (OKS > 41), and 20% had good outcomes (OKS: 34-41). No patients exhibited fair or poor outcomes. The mean FJS at the final follow-up was 82.8. The mean WOMAC was 10.5. Kaplan-Meier survival analysis revealed a survivorship rate of 93.1% at 10 years, considering revision for any reason as endpoint. CONCLUSIONS Lateral UKA proved to be an effective treatment option for osteoarthritis affecting the lateral compartment of the knee. The study demonstrated a high survivorship rate and favorable functional outcomes at a mean follow-up of 132.7 months. These findings highlight the potential benefits of fixed-bearing lateral UKA in selected patients with lateral compartment knee pathology.
Collapse
Affiliation(s)
- Rudy Sangaletti
- Sezione di Chirurgia Protesica ad Indirizzo Robotico, Unità di Traumatologia dello Sport, UOC Ortopedia e Traumatologia, Fondazione Poliambulanza, Via Bissolati, 57, 25124, Brescia, Italy
| | - Luca Andriollo
- Sezione di Chirurgia Protesica ad Indirizzo Robotico, Unità di Traumatologia dello Sport, UOC Ortopedia e Traumatologia, Fondazione Poliambulanza, Via Bissolati, 57, 25124, Brescia, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alice Montagna
- Sezione di Chirurgia Protesica ad Indirizzo Robotico, Unità di Traumatologia dello Sport, UOC Ortopedia e Traumatologia, Fondazione Poliambulanza, Via Bissolati, 57, 25124, Brescia, Italy
- Clinica Ortopedica e Traumatologica, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Lorenzo Are
- Sezione di Chirurgia Protesica ad Indirizzo Robotico, Unità di Traumatologia dello Sport, UOC Ortopedia e Traumatologia, Fondazione Poliambulanza, Via Bissolati, 57, 25124, Brescia, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Benazzo
- Sezione di Chirurgia Protesica ad Indirizzo Robotico, Unità di Traumatologia dello Sport, UOC Ortopedia e Traumatologia, Fondazione Poliambulanza, Via Bissolati, 57, 25124, Brescia, Italy
- IUSS Pavia, Pavia, Italy
| | - Stefano Marco Paolo Rossi
- Sezione di Chirurgia Protesica ad Indirizzo Robotico, Unità di Traumatologia dello Sport, UOC Ortopedia e Traumatologia, Fondazione Poliambulanza, Via Bissolati, 57, 25124, Brescia, Italy.
| |
Collapse
|
4
|
Plancher KD, Briggs KK, Tucker EE, Zuccaro P, Petterson SC. The Role of Severe Lateral Facet Patellar Osteoarthritis in Patient Selection for Success of a Medial Unicompartmental Knee Arthroplasty: Mean Follow-Up of 10 Years. J Arthroplasty 2023; 38:S145-S149. [PMID: 37230228 DOI: 10.1016/j.arth.2023.05.024] [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: 12/01/2022] [Revised: 05/11/2023] [Accepted: 05/15/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Lateral facet patellar osteoarthritis (LFPOA) has been reported as a contraindication for medial unicompartmental (UKA). The purpose of this paper was to determine if severe LFPOA was related to lower survivorship and patient-reported outcomes following medial UKA. METHODS A total of 170 medial UKAs were performed. Severe LFPOA was defined as Outerbridge grade 3 to 4 damage on the lateral facet cartilage surfaces of the patella as noted intraoperatively. There were 122 of 170 patients (72%) who had noLFPOA and 48 of 170 patients (28%) who had had severe LFPOA. A routine patelloplasty was performed in all patients. Patients completed the Veterans RAND 12-Item Health Survey (VR-12) Mental Component Score (MCS) and Physical Component Score (PCS), Knee Injury and Osteoarthritis Outcome Score (KOOS), and Knee Society Score. RESULTS There were 4 patients in the noLFPOA group who required total knee arthroplasty and 2 in the LFPOA group. There was no significant difference in mean survival time: noLFPOA = 17.2 years [95% confidence interval (CI): 17 to 18] and LFPOA = 18.0 years [95% CI: 17 to 19] (P = .94). At mean follow-up of 10 years, there were no significant differences in knee flexion or extension. Patello-femoral crepitus without pain was noted in 7 patients who had LFPOA and 21 patients who had noLFPOA. There were no significant differences in VR-12 MCS, PCS, KOOS subscales, or Knee Society Score between groups. Patient acceptable symptom state (PASS) was achieved in 80% (90 of 112) for KOOS ADL in the noLFPOA group and 82% (36 of 44) in the LFPOA group (P = .68). PASS was achieved in 82% (92 of 112) for KOOS Sport in the noLFPOA group and 82% (36/44) in the LFPOA group (P = .87). CONCLUSION At a mean of 10 years, patients who had LFPOA had equivalent survivorship and functional outcomes to patients who did not have LFPOA. These long-term results suggest that asymptomatic grade 3 or 4 LFPOA is not a contraindication to medial UKA.
Collapse
Affiliation(s)
- Kevin D Plancher
- Department of Orthopaedic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, New York; Department of Orthopaedic Surgery, Weil Cornell Medical College, New York, New York; Plancher Orthopaedics & Sports Medicine, New York, New York; Orthopaedic Foundation, Stamford, Connecticut
| | | | - Erin E Tucker
- Plancher Orthopaedics & Sports Medicine, New York, New York
| | - Philip Zuccaro
- Plancher Orthopaedics & Sports Medicine, New York, New York
| | | |
Collapse
|
5
|
Weber P, Beck M, Klug M, Klug A, Klug A, Glowalla C, Gollwitzer H. Survival of Patient-Specific Unicondylar Knee Replacement. J Pers Med 2023; 13:jpm13040665. [PMID: 37109051 PMCID: PMC10144963 DOI: 10.3390/jpm13040665] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/26/2023] [Accepted: 04/02/2023] [Indexed: 04/29/2023] Open
Abstract
Unicompartmental knee arthroplasty (UKA) in isolated medial or lateral osteoarthritis leads to good clinical results. However, revision rates are higher in comparison to total knee arthroplasty (TKA). One reason is suboptimal fitting of conventional off-the-shelf prostheses, and major overhang of the tibial component over the bone has been reported in up to 20% of cases. In this retrospective study, a total of 537 patient-specific UKAs (507 medial prostheses and 30 lateral prostheses) that had been implanted in 3 centers over a period of 10 years were analyzed for survival, with a minimal follow-up of 1 year (range 12 to 129 months). Furthermore, fitting of the UKAs was analyzed on postoperative X-rays, and tibial overhang was quantified. A total of 512 prostheses were available for follow-up (95.3%). Overall survival rate (medial and lateral) of the prostheses after 5 years was 96%. The 30 lateral UKAs showed a survival rate of 100% at 5 years. The tibial overhang of the prosthesis was smaller than 1 mm in 99% of cases. In comparison to the reported results in the literature, our data suggest that the patient-specific implant design used in this study is associated with an excellent midterm survival rate, particularly in the lateral knee compartment, and confirms excellent fitting.
Collapse
Affiliation(s)
- Patrick Weber
- ECOM, Arabellastraße 17, 81925 München, Germany
- ATOS Klinik München, Effnerstraße 38, 81925 München, Germany
- Dr. Lubos Kliniken München-Bogenhausen, Denninger Straße 44, 81925 München, Germany
| | - Melina Beck
- ECOM, Arabellastraße 17, 81925 München, Germany
| | - Michael Klug
- Knee Centre, Schweinfurter Straße 7, 97080 Würzburg, Germany
- Praxisklinik Werneck, Balthasar-Neumann-Platz 11-15, 97440 Werneck, Germany
| | - Andreas Klug
- Knee Centre, Schweinfurter Straße 7, 97080 Würzburg, Germany
- König Ludwig Haus, Brettreichstraße 11, 97074 Würzburg, Germany
| | - Alexander Klug
- Knee Centre, Schweinfurter Straße 7, 97080 Würzburg, Germany
- BG Unfallklinik, Friedberger Landstraße 430, 60389 Frankfurt, Germany
| | - Claudio Glowalla
- Klinik und Poliklinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675 München, Germany
| | - Hans Gollwitzer
- ECOM, Arabellastraße 17, 81925 München, Germany
- ATOS Klinik München, Effnerstraße 38, 81925 München, Germany
- Dr. Lubos Kliniken München-Bogenhausen, Denninger Straße 44, 81925 München, Germany
- Klinik und Poliklinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675 München, Germany
| |
Collapse
|
6
|
Wang Z, Ni J, Mao Z, Yu M, Li H, Chen G, Wang Y, Yao Q. Survival of lateral unicompartmental knee arthroplasty at short-, mid-, and long-term follow-up: a systematic review and meta-analysis. ANZ J Surg 2023; 93:980-988. [PMID: 36757833 DOI: 10.1111/ans.18244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 11/20/2022] [Accepted: 12/21/2022] [Indexed: 02/10/2023]
Abstract
BACKGROUND The infrequency of lateral unicompartmental knee arthroplasty (UKA) has led to a lack of understanding of its survival. This study aimed to systematically evaluate the survivorship results of lateral UKA at different follow-ups based on available literature. METHODS Five databases were searched for eligible studies. Pooled survivorships with 95% confidence intervals (CIs) at 3, 5, 10, 15, and 20 years after lateral UKA were estimated using a random-effect model. Subgroup and sensitivity analyses were performed. RESULTS A total of 26 studies involving 5470 lateral UKAs were included. Survivorships of lateral UKA at 3-, 5-, 10-, 15-, and 20-year follow-ups were 96% (95% CI: 95-98%, I2 : 77.5%), 94% (95% CI: 93-96%, I2 : 70.8%), 88% (95% CI: 84-91%, I2 : 70.8%), 85% (95% CI: 79-91%, I2 : 70.8%), and 78% (95% CI: 71-85%, I2 : 54.2%), respectively. Subgroup analyses found that bearing type, the number of surgeons, and year of publication might be associated with implant survival outcomes. CONCLUSION Lateral UKA is an effective procedure with excellent survivorships at short-, mid-, and long-term follow-ups. Results suggest a single-surgeon lateral UKA using fixed-bearing. Additional well-designed studies are needed to elucidate the current findings.
Collapse
Affiliation(s)
- Zhenwei Wang
- Department of Orthopedics, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Jie Ni
- Department of Orthopedics, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Zimu Mao
- Department of Orthopedics, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Meng Yu
- Department of Orthopedics, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Hongchuan Li
- Department of Orthopedics, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Guoqiang Chen
- Department of Orthopedics, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Yang Wang
- Department of Orthopedics, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Qi Yao
- Department of Orthopedics, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
7
|
Gaudiani MA, Samuel LT, Diana JN, DeBattista JL, Coon TM, Moore RE, Kamath AF. Robotic-arm assisted lateral unicompartmental knee arthroplasty: 5-Year outcomes & survivorship. J Orthop Surg (Hong Kong) 2023; 31:10225536221138986. [PMID: 36775979 DOI: 10.1177/10225536221138986] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/14/2023] Open
Abstract
INTRODUCTION Robotic-arm assisted unicompartmental knee arthroplasty (RA-UKA) has demonstrated accurate component positioning and excellent outcomes for medial components. However, there is a paucity of literature on lateral compartment RA-UKA. The purpose of our study was to assess the midterm clinical outcomes and survivorship of lateral RA-UKA. METHODS This study was a retrospective review of a single-center prospectively maintained cohort of 33 patients (36 knees) indicated for lateral UKA. Perioperative, and postoperative two- and five-year Knee injury Osteoarthritis Outcome Score (KOOS), Western Ontario and McMaster Universities Osteoarthritis Score (WOMAC), and Forgotten Joint Score (FJS) patient reported outcome measures were collected. Five-year follow-up was recorded in 29 patients (32 knees). RESULTS Mean follow up was 5.1 ± 0.1 years. Mean age and BMI was 70.9 ± 7.2 years and 29.0 ± 4.2 kg/m2, respectively. At discharge, mean distance walked was 273.4 ± 70.4 feet, and mean pain score was 2.0 ± 2.5. At 2-year follow up, mean KOOS, WOMAC, and FJS were 75.1 ± 13.5, 15.0 ± 7.2, and 81.0 ± 23.3, respectively. At 5-year follow up, mean KOOS, WOMAC, and FJS were 75.3 ± 14.6, 14.9 ± 5.0, and 75.8 ± 27.4, respectively. Mean change in KOOS and WOMAC were 35.6 ± 27.1 and 11.7 ± 13.4 (p< .001 and p< .001). 94% of patients were very satisfied/satisfied, 3% neutral, and 3% dissatisfied. 91% met activity expectations, and 59% were more active than before. Survivorship was 100% at 5 years. DISCUSSION In this study, lateral RA-UKA demonstrated significantly improved clinical outcomes, high patient satisfaction, met expectations, and excellent functional recovery at midterm follow up. Comparative studies are needed to determine differences between robotic-assisted and conventional lateral UKA, as well as TKA.
Collapse
Affiliation(s)
- Michael A Gaudiani
- Department of Orthopaedic Surgery, 2569Cleveland Clinic Foundation, Cleveland, OH, USA.,Department of Orthopaedic Surgery, Henry Ford Health, Detroit, MI, USA
| | - Linsen T Samuel
- Department of Orthopaedic Surgery, 2569Cleveland Clinic Foundation, Cleveland, OH, USA
| | - John N Diana
- Coon Joint Replacement Institute, St. Helena, CA, USA
| | | | - Thomas M Coon
- Coon Joint Replacement Institute, St. Helena, CA, USA
| | - Ryan E Moore
- Coon Joint Replacement Institute, St. Helena, CA, USA
| | - Atul F Kamath
- Department of Orthopaedic Surgery, 2569Cleveland Clinic Foundation, Cleveland, OH, USA
| |
Collapse
|
8
|
Marullo M, Russo A, Spreafico A, Romagnoli S. Mild Valgus Alignment After Lateral Unicompartmental Knee Arthroplasty Led to Lower Functional Results and Survivorship at Mean 8-Year Follow-Up. J Arthroplasty 2023; 38:37-42. [PMID: 35850420 DOI: 10.1016/j.arth.2022.07.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 07/09/2022] [Accepted: 07/11/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND In medial unicompartmental knee arthroplasty (UKA), the best results and the highest survivorship are found by mild undercorrection of varus deformities. In lateral UKA, the desirable amount of valgus undercorrection has not yet been determined. The purposes of this study were to present the results of a consecutive series of lateral UKAs and to investigate the effect of postoperative limb alignment on them. METHODS A total of 161 lateral UKA were reviewed. Outcomes studied included range of motion (ROM), Knee Society Score (KSS), University of California Los Angeles Activity Score, Tegner Activity Scale, Forgotten Joint Score, visual analogue scale (VAS) for pain, and survivorship. Patients were divided into two groups according to postoperative alignment: group A (hip-knee-ankle ≥184°, 79 UKA) and group B (hip-knee-ankle <184°, 82 UKA). RESULTS At a mean follow-up of 8 years (range, 2-18), ROM (P < .01); KSS-C (P < .01); KSS-F (P < .01); VAS (P < .01) improved from baseline. No differences were noted in postoperative ROM, VAS, University of California Los Angeles, Tegner Activity Scale, and Forgotten Joint Score between groups. Group A showed higher postoperative clinical and functional KSS (P < .01) and higher survivorship (96.2 versus 91.5%, P = .01) than group B. CONCLUSION Mild valgus alignment (3° or less) after lateral UKA is linked to lower clinical and functional scores and lower survivorship compared to moderate valgus (over 4°) at mean 8-year follow-up. More undercorrection of the coronal deformity in lateral UKA compared to medial UKA is desirable to get the best results.
Collapse
Affiliation(s)
- Matteo Marullo
- Department of Joint Replacement, IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
| | - Antonio Russo
- Orthopaedic Clinic, San Martino Hospital, Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostic (DISC), University of Genova, Genoa, Italy
| | - Andrea Spreafico
- Department of Joint Replacement, IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
| | - Sergio Romagnoli
- Department of Joint Replacement, IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
| |
Collapse
|
9
|
Tay ML, Matthews BG, Monk AP, Young SW. Disease progression, aseptic loosening and bearing dislocations are the main revision indications after lateral unicompartmental knee arthroplasty: a systematic review. J ISAKOS 2022; 7:132-141. [PMID: 35777698 DOI: 10.1016/j.jisako.2022.06.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/03/2022] [Accepted: 06/12/2022] [Indexed: 10/17/2022]
Abstract
IMPORTANCE Lateral unicompartmental knee arthroplasty (UKA) is a surgical option for patients with isolated lateral osteoarthritis however, the procedure has higher revision rates than medial UKA. The reason for this remains unclear; therefore, a better understanding of the indications for lateral UKA revision is needed. AIM The primary aim of this systematic review was to identify revision indications for lateral UKA. Secondary aims were to further investigate if revision indications were influenced by implant design and time from surgery. EVIDENCE REVIEW A systematic literature review was performed according to the PRISMA 2020 guidelines. Search was performed in January 2022 in MedLine, EMBASE, CINAHL and the Cochrane Library using the keywords "knee arthroplasty", "unicompartmental", "reoperation", synonyms and abbreviations. Articles published in 2000-2021 that were at least level III retrospective cohort studies with at least 10 lateral UKAs and reported all failure modes were included. Risk of bias was assessed using the ROBINS-I tool. Revision indications, patient characteristics, study design, implant types and time to failure were extracted from the selected studies. Collated data were tabulated and differences were tested using Chi-square or Fisher's exact test. FINDINGS A total of 29 cohort and 4 registry studies that included 7,668 UKAs met the inclusion criteria. Studies were judged as having moderate or severe risk of bias; this was associated with the retrospective nature of studies required to investigate long-term outcomes of knee arthroplasty. The main indications for lateral UKA revision were OA progression (35%), aseptic loosening (17%) and bearing dislocation (14%). The incidence of revision was similar for mobile-bearing implants (7.6%) and fixed-bearing (6.4%). For mobile-bearing implants, there was introduction of bearing dislocations as an additional mode of failure (24% cf. 0%, p < 0.001). For fixed-bearing implants, the incidence of revision was higher for all-poly-ethylene (13.9%) than metal-backed (1.8%) tibial components. Early lateral UKA failures were associated with bearing dislocations (sequential decrease from 69% under 6 months to 0% 10+ years, p < 0.001), whereas late failures were associated with OA progression (sequential increase from 0% under 6 months to 100% > 10+ years, p < 0.01). Compared with medial UKA, OA progression (41% cf. 30%, p = 0.004), malalignment (2.7% cf. 0.8%, p = 0.02), instability (4% cf. 1%, p = 0.02) and bearing dislocations (20% cf. 10%, p < 0.001) were more common for lateral UKA. CONCLUSIONS AND RELEVANCE OA progression, aseptic loosening and bearing dislocation were the three main revision indications for lateral UKA. Compared to medial UKA, OA progression, malalignment, instability and bearing dislocations were more common revision indications for lateral UKA. Higher survivorship of metal-backed fixed-bearing implants was found. The findings suggest that the outcomes of lateral UKA may be improved with more optimal alignment, gap balancing and patient selection. LEVEL OF EVIDENCE Level III systematic review.
Collapse
Affiliation(s)
- Mei Lin Tay
- Department of Surgery, University of Auckland, 85 Park Road, Grafton, Auckland, New Zealand; Department of Orthopaedic Surgery, North Shore Hospital, 124 Shakespeare Road, Takapuna, Auckland, New Zealand.
| | - Brya G Matthews
- Department of Molecular Medicine and Pathology, University of Auckland, 85 Park Road, Grafton, Auckland, New Zealand
| | - A Paul Monk
- Department of Orthopaedic Surgery, Auckland City Hospital, 2 Park Road, Grafton 1023, Auckland, New Zealand; Auckland Bioengineering Institute, University of Auckland, 70 Symonds Street, Auckland 1010, New Zealand
| | - Simon W Young
- Department of Surgery, University of Auckland, 85 Park Road, Grafton, Auckland, New Zealand; Department of Orthopaedic Surgery, North Shore Hospital, 124 Shakespeare Road, Takapuna, Auckland, New Zealand
| |
Collapse
|
10
|
Plancher KD, Briggs KK, Chinnakkannu K, Dotterweich KA, Commaroto SA, Wang KH, Petterson SC. Isolated Lateral Tibiofemoral Compartment Osteoarthritis: Survivorship and Patient Acceptable Symptom State After Lateral Fixed-Bearing Unicompartmental Knee Arthroplasty at Mean 10-Year Follow-up. J Bone Joint Surg Am 2022; 104:1621-1628. [PMID: 35766399 DOI: 10.2106/jbjs.21.01523] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Lateral unicompartmental knee arthroplasty (UKA) is an excellent option to alleviate disability and restore function in patients with lateral compartment knee osteoarthritis (OA). The purpose of the present study was to determine the survivorship and long-term outcomes in both younger/middle-aged and older patients with lateral compartment OA following non-robotically-assisted, fixed-bearing lateral UKA and to determine if an acceptable symptom state can be achieved. METHODS All patients were managed with fixed-bearing lateral UKA by a single surgeon utilizing a lateral parapatellar approach without robotic assistance. The primary outcome variables were the Knee injury and Osteoarthritis Outcome Score (KOOS) Activities of Daily Living (ADL) and Sport subscale scores. In addition, the other KOOS subscores, the Lysholm score, the achievement of the Patient Acceptable Symptom State (PASS), and the Veterans RAND (VR-12) Physical Component Summary score (PCS) and Mental Component Summary score (MCS) were collected. Failure was defined as conversion to total knee arthroplasty (TKA). Patients were divided into 2 cohorts: younger/middle-aged patients (<60 years of age) and older patients (≥60 years of age). RESULTS A cohort of 256 patients underwent medial (n = 193) or lateral (n = 63) UKA. Sixty-one patients met the inclusion criteria. At mean of 10 years (range, 4 to 17 years) of follow-up, there were no significant differences between the groups in terms of any patient-reported outcome measures (p > 0.05). The percentage of patients in whom PASS was achieved on the KOOS ADL and Sport subscores was 82% and 88%, respectively, in the younger cohort and 80% and 80%, respectively, in the older cohort. The mean survival estimate of the prothesis was 15.3 years (95% confidence interval [CI], 14.5 to 16.2 years) for the entire cohort. The estimated rate of implant survival in the younger cohort was 100% at 5 and 10 years, and the estimated rate of implant survival in the older cohort was 98% at 5 years and 96% at 10 years. CONCLUSIONS Lateral fixed-bearing, non-robotic UKA for the treatment of isolated lateral compartment OA resulted in >80% of patients reaching an acceptable symptom state in terms of both activities of daily living and sporting activities. UKA provides an excellent option that provides longevity with high PASS rates and return to activities with a low risk of complications and failure. LEVEL OF EVIDENCE Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Kevin D Plancher
- Department of Orthopaedic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY.,Department of Orthopaedic Surgery, Weill Cornell Medical College, New York, NY.,Plancher Orthopaedics & Sports Medicine, New York, NY.,Orthopaedic Foundation, Stamford, Connecticut
| | | | | | | | | | | | | |
Collapse
|
11
|
Plancher KD, Briggs KK, Brite JE, Petterson SC. The Lawrence D. Dorr Surgical Techniques & Technologies Award: Patient Acceptable Symptom State (PASS) in Medial and Lateral Unicompartmental Knee Arthroplasty: Does the Status of the ACL Impact Outcomes? J Arthroplasty 2022; 37:S710-S715. [PMID: 35122945 DOI: 10.1016/j.arth.2022.01.081] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/18/2021] [Accepted: 01/25/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The aim of this study is to determine if there is a difference in the percentage of patients who reach Patient Acceptable Symptom State (PASS) when comparing anterior cruciate ligament (ACL)-deficient and ACL-intact knees following fixed-bearing medial and lateral unicompartmental knee arthroplasty (UKA). METHODS A consecutive series of 215 knees that underwent UKA (medial = 158, lateral = 57) were included in the study. The Knee Osteoarthritis Outcome Score functional score [KOOS activities of daily living (ADL)] and KOOS Sport were used as the primary outcome variables. A KOOS ADL PASS of 87.5 and KOOS Sport PASS of 43.8 were previously described for total knee arthroplasty (TKA). Failure was defined as conversion to TKA. RESULTS There were 157 in the ACL-intact group and 58 in the ACL-deficient group. Conversion to TKA was 3.7%. The failure rate in the ACL-deficient group was 5% (3/58) and 3% (5/157) in the ACL-intact group (P = .447). The mean survival for the entire group was 18.1 years (95% confidence interval 17.6-18.6). At 10 years, the survival was 94.3% (standard error = 0.028) in the ACL-deficient group and 97.6% (standard error = 0.014) in the ACL-intact group. At a mean 10 ± 3.5 years, with 93% follow-up, 83% in the ACL-deficient group and 80% in the ACL-intact group reached PASS for KOOS ADL (P = .218). For KOOS Sport, 85% of the ACL-deficient group compared to 81% in the ACL-intact group (P = .374) reached PASS. CONCLUSION The ACL-deficient cohort results were not significantly different compared to ACL-intact knees in both medial and lateral compartment UKA. Fixed-bearing medial and lateral UKA resulted in low failure rate and excellent long-term outcomes.
Collapse
Affiliation(s)
- Kevin D Plancher
- Montefiore Medical Center, Department of Orthopaedic Surgery, Albert Einstein College of Medicine, New York, NY; Department of Orthopaedic Surgery, Weil Cornell Medical College, New York, NY; Plancher Orthopaedics & Sports Medicine, New York, NY; Orthopaedic Foundation, Stamford, CT
| | | | | | | |
Collapse
|
12
|
Robot-assisted knee arthroplasty improves component positioning and alignment, but results are inconclusive on whether it improves clinical scores or reduces complications and revisions: a systematic overview of meta-analyses. Knee Surg Sports Traumatol Arthrosc 2022; 30:2639-2653. [PMID: 33666686 DOI: 10.1007/s00167-021-06472-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 01/21/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE The purpose of this systematic overview was to identify, synthesise and critically appraise findings of meta-analyses on robot-assisted versus conventional unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA). The hypothesis was that robotic assistance would reduce complications and revision rates, yield better clinical scores, and improve component positioning and alignment. METHODS Two researchers independently conducted a literature search using Embase®, MEDLINE®, Web of Science, Allied and Complementary Medicine™ and Cochrane Database of Systematic Reviews on 2 November 2020 for meta-analyses (Level I-IV) on robotic assistance in UKA and/or TKA. Outcomes were tabulated and reported as weighted mean difference (WMD), risk ratio (RR) or weighted odds ratio (WOR), and were considered statistically significant when p < 0.05. RESULTS A total of ten meta-analyses were identified; four on robot-assisted UKA (n, 1880 robot-assisted vs. 2352 conventional UKA; follow-up, 0 to 60 months), seven on robot-assisted TKA (n, 4567 robot-assisted vs. 5966 conventional TKA; follow-up, 0 to 132 months). Of the meta-analyses on UKA, one found that robotic assistance reduced complication rates (relative risk (RR), 0.62), one found that it improved clinical scores (weighted mean difference (WMD), 19.67), three found that it extended operation times (WMD, 15.7 to 17.1 min), and three found that it improved component positioning and alignment (WMD, - 1.30 to - 3.02 degrees). Of the meta-analyses on TKA, two found that robotic assistance improved clinical scores (WMD, 1.62-1.71), two found that that it extended surgery times (WMD, 21.5-24.26 min), and five found that it improved component positioning and alignment (WMD, - 0.50 to - 10.07 degrees). None of the meta-analyses reported differences in survivorship between robot-assisted versus conventional knee arthroplasty. CONCLUSION Robot-assisted knee arthroplasty enabled more accurate component positioning and placement within target zones, but extended operation time considerably. Although robotic assistance improved component positioning, its benefits regarding clinical scores, patient satisfaction and implant survivorship remains to be confirmed. Finally, this overview revealed that six of the ten meta-analyses were of 'critically low quality', calling for caution when interpreting results. LEVEL OF EVIDENCE IV.
Collapse
|
13
|
Benignus C, Meier MK, Hirschmann MT, Tibesku CO, Beckmann J. Patientenspezifische Instrumentierung und Teilprothesen am Knie. ARTHROSKOPIE 2021. [DOI: 10.1007/s00142-021-00463-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
14
|
Chen L, Tiwari SR, Zhang Y, Zhang J, Sun Y. Facile Synthesis of Hollow MnO 2 Nanoparticles for Reactive Oxygen Species Scavenging in Osteoarthritis. ACS Biomater Sci Eng 2021; 7:1686-1692. [PMID: 33787210 DOI: 10.1021/acsbiomaterials.1c00005] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Osteoarthritis (OA) is a progressive degenerative joint disease whose molecular mechanism has not been revealed clearly, and there is still no effective approach to cure OA completely. Recently, reactive oxygen species (ROS) are exposed as an important mediator of OA's inflammatory response, and it has been regarded as a therapeutic target for OA treatment. MnO2 nanoparticles possess good biocompatibility and can act as an artificial nanoenzyme to scavenge ROS in various diseases effectively. In this study, the modified Stöber method was applied to synthesize hollow MnO2 (H-MnO2) and H-MnO2 was modified with NH2-PEG-NH2, which possesses excellent biological stability and biocompatibility. It induced a change in the articular cartilage structure changes in vivo, with the knee tissue staining and micro-CT scanning of the whole knee suggesting that H-MnO2 nanoparticles could effectively remove ROS and significantly relieve the inflammatory response of OA without obvious side effects. This study reveals the therapeutic effects of MnO2-based nanomedicine toward OA, which provides potential alternative therapeutic options for patients with inflammation tissue.
Collapse
Affiliation(s)
- Lei Chen
- Department of Orthopedics, Tongji Hospital, School of Medicine, Tongji University, 389 Xincun Road, Shanghai 200065, P. R. China
| | - Shashi Ranjan Tiwari
- Department of Orthopedics, Tongji Hospital, School of Medicine, Tongji University, 389 Xincun Road, Shanghai 200065, P. R. China
| | - Yingqi Zhang
- Department of Orthopedics, Tongji Hospital, School of Medicine, Tongji University, 389 Xincun Road, Shanghai 200065, P. R. China
| | - Jincheng Zhang
- Department of Orthopedics, Tongji Hospital, School of Medicine, Tongji University, 389 Xincun Road, Shanghai 200065, P. R. China
| | - Yeqing Sun
- Department of Orthopedics, Tongji Hospital, School of Medicine, Tongji University, 389 Xincun Road, Shanghai 200065, P. R. China
| |
Collapse
|