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D'Ambrosi R, Rubino F, Ursino C, Mariani I, Ursino N, Formica M, Prinz J, Migliorini F. Change in patellar height in medial and lateral unicompartmental knee arthroplasty: a clinical trial. Arch Orthop Trauma Surg 2024; 144:1345-1352. [PMID: 38108862 PMCID: PMC10896931 DOI: 10.1007/s00402-023-05139-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 11/13/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION Evidence on patellar height changes following unicompartmental knee arthroplasty (UKA) is lacking. Therefore, this study compared the patella height in patients who underwent medial versus lateral UKA. Moreover, a subgroup analysis was conducted to investigate whether sex, age, and BMI of the patients exert an influence on the postoperative patellar height. METHODS Radiographs and hospital records of patients undergoing UKA were prospectively collected. Surgeries were performed by one author with long experience in UKA in a highly standardised fashion. The implants were fixed-bearing medial PPK (Zimmer Biomet, Warsaw, Indiana, USA) and fixed-bearing lateral ZUK (Lima Corporate, Udine, Italy). The patellar height was measured using the Insall-Salvati and Caton-Deschamps indices. RESULTS A total of 203 patients were included: 119 patients were included in the medial and 84 in the lateral UKA. The mean age of the patients was 68.9 ± 6.7 years, and the mean BMI was 28.1 ± 4.1 kg/m2. 54% (110 of 203 patients) were women. On admission, between-group comparability was found in age, BMI, sex, and length of the follow-up. No between-group and within-group difference was detected pre- and post-operatively in the Insall-Salvati and Caton-Deschamps indices in patients who have undergone medial versus lateral UKA. Concerning the subgroup analyses, no between-group and within-group difference was detected pre- and post-operatively in all comparisons according to sex, age, and BMI. CONCLUSION No difference was found in patella height in patients who have undergone medial compared to lateral UKA. Furthermore, there was no evidence of an association between patient characteristics (sex, age, BMI) and patella height between medial and lateral UKA.
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Affiliation(s)
- Riccardo D'Ambrosi
- IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
| | - Francesco Rubino
- Orthopaedic Clinic, IRCCS Hospital Policlinico San Martino, Genoa, Italy
- DISC - Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - Chiara Ursino
- Orthopaedic Clinic, IRCCS Hospital Policlinico San Martino, Genoa, Italy
- DISC - Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - Ilaria Mariani
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | | | - Matteo Formica
- Orthopaedic Clinic, IRCCS Hospital Policlinico San Martino, Genoa, Italy
- DISC - Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - Julia Prinz
- Department of Ophthalmology, RWTH University Hospital, 52074, Aachen, Germany
| | - Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany.
- Department of Orthopaedics and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical University, 39100, Bolzano, Italy.
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Retrospective comparison of rates of aseptic loosening in fixed-bearing unicompartmental knee arthroplasty (UKA) implants. CURRENT ORTHOPAEDIC PRACTICE 2022. [DOI: 10.1097/bco.0000000000001120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Tensho K, Iwaasa T, Koyama S, Shimodaira H, Horiuchi H, Saito N, Takahashi J. Potential risk of medial cortex perforation due to peg position of morphometric tibial component in unicompartmental knee arthroplasty: a computer simulation study. Knee Surg Sports Traumatol Arthrosc 2022; 30:536-544. [PMID: 32865659 DOI: 10.1007/s00167-020-06242-8] [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: 05/29/2020] [Accepted: 08/14/2020] [Indexed: 02/14/2023]
Abstract
PURPOSE The purpose of this study is to evaluate the risk of medial tibial cortical perforation in unicompartmental knee arthroplasty (UKA) due to peg positions on the tibial tray of the Persona Partial Knee (PPK). METHODS Preoperative CT images of 60 patients and 60 osteoarthritic knees (30 male and 30 female patients) were used. A tibial multiplanar reconstruction (MPR) image was reconstructed in preoperative planning software, and the implant was placed in a virtual osteotomy plane. In addition to PPK, Zimmer Unicompartmental Knee (ZUK) and TRIBRID (TBD) were used for evaluation. The horizontal distances from the medial tibial cortex to the anterior and posterior pegs (APCD/PPCD, respectively) were measured under neutral, 3-degree varus, 3-degree valgus and 2 mm distal positions. The differences between implants under the same positions and between positions using the same implants were compared. The percentage of total cases with APCD/PPCD of less than 3 mm and the perforation risk rate were calculated. RESULTS The APCD of PPK was significantly shorter at all positions except for the varus position of TBD. The PPCD of PPK was significantly shorter at all positions compared to ZUK and TBD. There were no cases with an APCD of less than 3 mm. Except for varus positions, the perforation risk rate of PPCD was significantly higher for PPK than the other two implants. CONCLUSION The posterior pegs of the PPK are located more medially than the other two implants, which may result in perforation of the medial tibial cortex during implantation. Surgeons should consider the risk involved in the type of implant used.
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Affiliation(s)
- Keiji Tensho
- Department of Orthopedic Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, 390-8621, Japan.
| | - Tomoya Iwaasa
- Department of Orthopedic Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, 390-8621, Japan
| | - Suguru Koyama
- Department of Orthopedic Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, 390-8621, Japan
| | - Hiroki Shimodaira
- Department of Orthopedic Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, 390-8621, Japan
| | - Hiroshi Horiuchi
- Department of Orthopedic Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, 390-8621, Japan
| | - Naoto Saito
- Department of Orthopedic Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, 390-8621, Japan
| | - Jun Takahashi
- Department of Orthopedic Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, 390-8621, Japan
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Bonanzinga T, Tanzi P, Altomare D, Dorotei A, Iacono F, Marcacci M. High survivorship rate and good clinical outcomes at mid-term follow-up for lateral UKA: a systematic literature review. Knee Surg Sports Traumatol Arthrosc 2021; 29:3262-3271. [PMID: 32621040 DOI: 10.1007/s00167-020-06129-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 06/24/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of this paper is to systematically review the available literature to understand the effectiveness, the survivorship, the clinical outcomes and the complications of lateral UKA. METHODS A review of the current literature available about lateral UKA was performed in March 2020, according to the PRISMA guidelines. Selection was based on the following inclusion criteria: (1) clinical reports of any level of evidence, (2) written in English language, (3) published from 1996 to 2020, (4) dealing with clinical data on lateral UKA. A total of 47 articles, published between 1996 and 2020, were included in the review. Quality of every article was assessed using the Modified Coleman Methodology Score. RESULTS A total of 47 studies were included. Mean mCMS was 45.27 (range 30-62). Mean age at surgery was 64.5 years (range 34.1-88.0 years). In 1741 patients (65.5%) a metal back implant was used and in 421 patients (15.8%) an all poly design was used. Several scores were used to evaluate clinical results (OKS, AKSS, IKS, KOOS, WOMAC, VAS). Range of motion improved with an overall mean value of 120.3° (range: 105.9°-143.3°). The mean follow-up was 60.7 months (range, 7-204 months), mean survivorship (absence of a revision) with a minimum 60 months of follow-up was 88.6% (range 74.5-100) and mean satisfaction of patients was 78.5% (range 41.0-97.9). CONCLUSIONS Lateral UKA seems to be an effective solution to manage lateral osteoarthritis (OA), based on preliminary results, with survivorship and satisfaction rate comparable to medial UKA and total knee arthroplasty (TKA). Nonetheless, this review highlights that the quality of studies available in current literature is low. LEVEL OF EVIDENCE Systematic review of level IV studies.
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Affiliation(s)
- Tommaso Bonanzinga
- Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089, Rozzano, MI, Italy.,Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, MI, Italy
| | | | - Daniele Altomare
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, MI, Italy.
| | - Andrea Dorotei
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, MI, Italy
| | - Francesco Iacono
- Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089, Rozzano, MI, Italy
| | - Maurilio Marcacci
- Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089, Rozzano, MI, Italy.,Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, MI, Italy
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Murray JRD, Smith JRA, Bray R, Robinson JR, White P, Porteous AJ. Fixed bearing, all-polyethylene tibia, lateral unicompartmental arthroplasty - A final outcome study with up to 28 year follow-up of a single implant. Knee 2021; 29:101-109. [PMID: 33610116 DOI: 10.1016/j.knee.2020.12.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 12/15/2020] [Accepted: 12/26/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Lateral unicompartmental arthroplasty (UKA) constitutes only 5-10% of all unicompartmental replacements performed. Whilst the short and medium term benefits are well documented, there remains concern regarding the higher revision rate when compared with total knee replacement. We report the long term clinical outcome and survivorship of a large series of lateral UKA. PATIENTS AND METHODS Between 1974 and 1994, 71 patients (82 knees) underwent a lateral fixed-bearing St Georg Sled UKA. Prospective data was collected pre-operatively and at regular intervals post-operatively using the Bristol Knee Score (BKS), with later introduction of the Oxford Knee (OKS) and Western Ontario MacMaster (WOMAC) scores. Kaplan Meier survival analysis was used, with revision, or need for revision, as end point. 85% of the patients were female. No patients were lost to follow-up. RESULTS Functional knee scores improved post-operatively up to 10 years, at which point they demonstrated a steady decline. Survivorship was 72% at 15 years, and 68% at 20 and 25 years. Nineteen knees were revised, with progression of disease in another compartment the commonest reason. There were two revisions due to implant fracture. In patients aged over 70 years at time of index procedure, 81% died with a functioning prosthesis in situ. CONCLUSION This represents the longest follow-up of a large series of lateral UKA. Results of this early design of fixed bearing UKA demonstrate satisfactory long term survivorship. In elderly patients, further intervention is rarely required. More contemporary designs or techniques may show improved long term survivorship in time.
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Affiliation(s)
- James R D Murray
- Avon Orthopaedic Centre, Southmead Hospital, Bristol BS10 5NB, United Kingdom.
| | - James R A Smith
- Avon Orthopaedic Centre, Southmead Hospital, Bristol BS10 5NB, United Kingdom.
| | - Rachel Bray
- Avon Orthopaedic Centre, Southmead Hospital, Bristol BS10 5NB, United Kingdom.
| | - James R Robinson
- Avon Orthopaedic Centre, Southmead Hospital, Bristol BS10 5NB, United Kingdom.
| | - Paul White
- University of the West of England, Bristol BS16 1QL, United Kingdom.
| | - Andrew J Porteous
- Avon Orthopaedic Centre, Southmead Hospital, Bristol BS10 5NB, United Kingdom.
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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]
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Han SB, Lee SS, Kim KH, Im JT, Park PS, Shin YS. Survival of medial versus lateral unicompartmental knee arthroplasty: A meta-analysis. PLoS One 2020; 15:e0228150. [PMID: 31978110 PMCID: PMC6980580 DOI: 10.1371/journal.pone.0228150] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 01/09/2020] [Indexed: 12/16/2022] Open
Abstract
Many studies have found associations between unicompartmental knee arthroplasty (UKA) and implant survival, but controversy still exists regarding the relative survival of medial versus lateral UKA over mid-to long-term follow-up. The purpose of this study was to compare survival and clinical outcomes of medial and lateral UKAs. In this meta-analysis, we reviewed studies that assessed implant survival in patients who underwent medial or lateral UKA with short- to mid-term (<10years) or long-term (>10years) follow-up, and that used assessments, such as pain and function scores, to compare postoperative scores on knee outcome scales. A total of eight studies (33,999 knees with medial UKA and 2,853 with lateral UKA) met the inclusion criteria and was analyzed in detail. There were no significant differences between medial and lateral UKA in pain score (95% CI: -0.37 to 0.88; P = 0.42), function score (95% CI: -0.19 to 0.60; P = 0.31), short- to mid-term survival (medial, 32,083/33,483; lateral, 2,636/2,726; OR 0.98, 95% CI: 0.64 to 1.48;P = 0.91), or long-term survival (medial, 479/516; lateral, 110/127; OR 2.51, 95% CI:0.67 to 9.43; P = 0.17). In addition, both groups had substantial proportions of knees with short- to mid-term survival (95.6% by medial UKA and 94.6% by lateral UKA) and long-term survival (92.8% by medial UKA and 86.6% by lateral UKA). This meta-analysis found no significant differences in short- to mid-term and long-term survival of medial and lateral UKAs. Similarly, patients treated with medial UKA showed no difference in pain relief or functional improvement compared to patients treated with lateral UKA. These results suggest that both UKA techniques are viable treatment options for patients with unicompartmental knee osteoarthritis over long-term follow-up, although further high-quality studies are needed to address some remaining uncertainties regarding the clinical benefits of these procedures.
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Affiliation(s)
- Seung-Beom Han
- Department of Orthopedic Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Sang-Soo Lee
- Institute for Skeletal Aging & Orthopedic Surgery, Chuncheon Sacred Heart hospital, Hallym University School of Medicine, Chuncheon, Republic of Korea
| | - Kyoung-Ho Kim
- Department of Orthopedic surgery, Armed Forces Daejeon Hospital, Daejeon, Republic of Korea
| | - Jung-Taek Im
- Department of Orthopedic Surgery, Veterans Health Service Medical Center, Seoul, Republic of Korea
| | - Phil-Sun Park
- Department of Orthopedic Surgery, Veterans Health Service Medical Center, Seoul, Republic of Korea
| | - Young-Soo Shin
- Department of Orthopedic Surgery, Chuncheon Sacred Heart hospital, Hallym University School of Medicine, Chuncheon, Republic of Korea
- * E-mail:
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Clinical results and 12-year survivorship of the Physica ZUK unicompartmental knee replacement. Knee 2019; 26:750-758. [PMID: 30885547 DOI: 10.1016/j.knee.2019.02.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 01/21/2019] [Accepted: 02/27/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND The Physica ZUK is a fixed bearing unicompartmental knee replacement. The purpose of this prospective cohort study was to determine the mid-term clinical outcomes and survivorship of the Physica ZUK. METHODS From 2005 to 2017 a total of 466 Physica ZUK prostheses were implanted in 398 patients by a single surgeon. The series consisted of 452 medial and 14 lateral unicompartmental knee arthroplasties (UKAs). Three hundred and sixty-seven medial UKAs with a minimum follow-up of two years (median 5.4 years) and 14 lateral UKAs with a minimum follow-up of 18 months (median 5.3 years) were analysed using the Knee Society Knee Score (KS-KS) and Function Score (KS-FS) at latest follow-up. Kaplan Meier survivorship analysis was performed with implant revision as the end point. RESULTS Mean age at the time of surgery was 67 (range 42-88) and 58 (47-69) years for patients undergoing medial and lateral UKA respectively. For medial UKAs the KS-KS and KS-FS improved significantly compared to the pre-operative values from 53.6 and 54.0 to 93.4 and 91.0 respectively (p = 0.0001). For lateral UKAs the KS-KS and KS-FS improved significantly from 46.4 and 48.7 to 91.3 and 93.1 respectively (p = 0.0001). Six cases of medial UKA were revised to total knee arthroplasty. Medial implant survivorship was 97.9% (95% confidence intervals, 95.6-99.0%) at both five and 10 years. No lateral implants were revised. CONCLUSION This prospective cohort study shows encouraging short to mid-term clinical results and survivorship for the Physica ZUK unicompartmental knee replacement.
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Forster-Horváth C, Artz N, Hassaballa MA, Robinson JR, Porteous AJ, Murray JR, Newman JH. Survivorship and clinical outcome of the minimally invasive Uniglide medial fixed bearing, all-polyethylene tibia, unicompartmental knee arthroplasty at a mean follow-up of 7.3years. Knee 2016; 23:981-986. [PMID: 27506988 DOI: 10.1016/j.knee.2016.07.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 05/13/2016] [Accepted: 07/18/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Medial UKA performed in England and Wales represents seven to 11% of all knee arthroplasty procedures, and is most commonly performed using mobile-bearing designs. Fixed bearing eliminates the risk of bearing dislocation, however some studies have shown higher revision rates for all-polyethylene tibial components compared to those that utilize metal-backed implants. The aim of the study is to analyse survivorship and maximum eight-year clinical outcome of medial fixed bearing, Uniglide unicompartmental knee arthroplasty performed using an all-polyethylene tibial component with a minimal invasive approach. METHODS Between 2002 and 2009, 270 medial fixed UKAs were performed in our unit. Patients were reviewed pre-operatively, five and eight years post-operatively. Clinical and radiographic reviews were carried out. Patients' outcome scores (Oxford, WOMAC and American Knee Score) were documented in our database and analysed. RESULTS Survival and clinical outcome data of 236 knees with a mean of 7.3years follow-up are reported. Every patient with less than 4.93years of follow-up underwent a revision. The patients' average age at the time of surgery was 69.5years. The American Knee Society Pain and Function scores, the Oxford Knee Score and the WOMAC score all improved significantly. The five-year survival rate was 94.1% with implant revision surgery as an end point. The estimated 10years of survival rate is 91.3%. Fourteen patients were revised before the five-year follow-up. CONCLUSION Fixed bearing Uniglide UKA with an all-polyethylene tibial component is a valuable tool in the management of a medial compartment osteoarthritis, affording good short-term survivorship. Level of evidence IV.
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Affiliation(s)
- C Forster-Horváth
- The Bristol Knee Group, Avon Orthopaedic Centre, Southmead Hospital, Southmead Way, Avon, Bristol BS10 5NB, United Kingdom.
| | - N Artz
- The Bristol Knee Group, Avon Orthopaedic Centre, Southmead Hospital, Southmead Way, Avon, Bristol BS10 5NB, United Kingdom
| | - M A Hassaballa
- The Bristol Knee Group, Avon Orthopaedic Centre, Southmead Hospital, Southmead Way, Avon, Bristol BS10 5NB, United Kingdom
| | - J R Robinson
- The Bristol Knee Group, Avon Orthopaedic Centre, Southmead Hospital, Southmead Way, Avon, Bristol BS10 5NB, United Kingdom
| | - A J Porteous
- The Bristol Knee Group, Avon Orthopaedic Centre, Southmead Hospital, Southmead Way, Avon, Bristol BS10 5NB, United Kingdom
| | - J R Murray
- The Bristol Knee Group, Avon Orthopaedic Centre, Southmead Hospital, Southmead Way, Avon, Bristol BS10 5NB, United Kingdom
| | - J H Newman
- The Bristol Knee Group, Avon Orthopaedic Centre, Southmead Hospital, Southmead Way, Avon, Bristol BS10 5NB, United Kingdom
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van der List JP, McDonald LS, Pearle AD. Systematic review of medial versus lateral survivorship in unicompartmental knee arthroplasty. Knee 2015; 22:454-60. [PMID: 26507286 DOI: 10.1016/j.knee.2015.09.011] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 08/20/2015] [Accepted: 09/22/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Unicompartmental knee arthroplasty (UKA) has gained popularity in patients with isolated unicompartmental osteoarthritis. To our knowledge no systematic review has assessed and compared survivorship of medial and lateral UKA. We performed a systematic review assessing medial and lateral UKA survivorship and comparing survivorship in cohort studies and registry-based studies. METHODS A search was performed using PubMed, Embase and Cochrane systems. Ninety-six eligible studies reported survivorship, of which fifty-eight reported medial and sixteen reported lateral UKA survivorship. Nineteen cohort studies and seven registry-based studies reported combined medial and lateral survivorship. RESULTS The five-year, ten-year and fifteen-year medial UKA survivorship was 93.9%, 91.7% and 88.9%, respectively. Lateral UKA survivorship was 93.2%, 91.4% and 89.4% at five-year, ten-year and fifteen-year, respectively. No statistical difference between both compartments was found. At twenty years and twenty-five years survivorship of medial UKA was 84.7% and 80%, respectively, but no studies reported lateral UKA survivorship at these follow-up intervals. Survivorship of cohort studies was not significantly higher compared to registry-based studies at five years (94.3 vs. 91.7, respectively, p=0.133) but was significantly higher at ten years (90.5 vs. 84.1, p=0.015). CONCLUSION This is the first systematic review that shows no difference in the five-, ten- and fifteen-year survivorship of medial and lateral UKA. We found a lower survivorship in the registry-based studies compared to cohort studies.
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Affiliation(s)
- J P van der List
- Sports Medicine and Shoulder Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, 535 E. 70th Street, New York, NY 10021, United States.
| | - L S McDonald
- Sports Medicine and Shoulder Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, 535 E. 70th Street, New York, NY 10021, United States.
| | - A D Pearle
- Sports Medicine and Shoulder Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, 535 E. 70th Street, New York, NY 10021, United States.
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Peersman G, Stuyts B, Vandenlangenbergh T, Cartier P, Fennema P. Fixed- versus mobile-bearing UKA: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2015; 23:3296-305. [PMID: 24957911 DOI: 10.1007/s00167-014-3131-1] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 06/04/2014] [Indexed: 02/03/2023]
Abstract
PURPOSE Two design concepts are currently used for unicondylar knee arthroplasty (UKA) prostheses: fixed bearing (FB) and mobile bearing (MB). While MB prostheses have theoretical advantages over their FB counterparts, it is not clear whether they are associated with better outcomes. A systematic review was conducted to examine survivorship differences and differences in failure modes of between FB and MB designs. METHODS PubMed, Scirus and Cochrane library databases were searched for medial UKA outcome studies. A total of 44 papers, involving 9,463 knees, were eligible. Outcomes examined included knee function, survivorship and the reasons for, and incidence of, revision for FB and MB prostheses. Random effects meta-analysis was employed to obtain pooled revision rate estimates. Where available, cause-specific time to revision was extracted. RESULTS Mean follow-up was 8.7 years for FB and 5.9 years for MB prostheses. There were no other relevant baseline differences. The overall crude revision rate for FB and for MB prostheses was 0.90 (95 % confidence interval (CI) 0.65-1.21) and 1.51 (95 % CI 1.11-1.93) per 100 component years, respectively. After stratification on follow-up time and age, the revision rates were not substantially different, aside for younger patients in short term from studies with short-term follow-up. CONCLUSION No essential differences between the two designs were observed. MB and FB UKA designs have comparable revision rates. As our study is based on predominantly observational data, with large variations in reporting standards, inferences should be drawn with caution. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Geert Peersman
- Department of Orthopaedic Surgery, Ziekenhuis Netwerk Antwerp, Campus Stuivenberg, Antwerp, Belgium.
| | - Bart Stuyts
- Department of Orthopaedic Surgery, St Augustinus ziekenhuis, Antwerp, Belgium
| | - Tom Vandenlangenbergh
- Department of Orthopaedic Surgery, Ziekenhuis Netwerk Antwerp, Campus Stuivenberg, Antwerp, Belgium
| | - Philippe Cartier
- Institu du Genou, Clinique Hartmann, Neuilly sur Seine, Paris, France
| | - Peter Fennema
- AMR Advanced Medical Research, Hofenstrasse 89b, 8708, Männedorf, Switzerland
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Abstract
BACKGROUND Unicondylar knee replacement (UKA) is a viable alternative to high tibial osteotomy (HTO) and total knee replacement in the treatment of medial osteoarthritis of the knee. With the correct indication, the results of UKA and HTO are comparable. RESULTS In comparison with the results of total knee replacements, UKA leads to faster rehabilitation, superior postoperative range of motion, and higher postoperative activity levels. Despite the excellent long-term results, the survival rate is inferior to the results of total knee replacement. The major causes for failure are progression of osteoarthritis in the lateral and patellofemoral joint as well as the loosening of the tibial component. CONCLUSION The conversion to total knee replacement can mostly be performed without problems. However, the expected results are inferior to primary total knee replacement and the reported revision rates are higher.
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Berend KR, Turnbull NJ, Howell RE, Lombardi AV. The current trends for lateral unicondylar knee arthroplasty. Orthop Clin North Am 2015; 46:177-84. [PMID: 25771313 DOI: 10.1016/j.ocl.2014.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Unicompartmental osteoarthritis of the knee is a relatively common disease that is seen in 40% of the population. Although disease isolated to the medial compartment of the knee is more common, isolated lateral disease also frequently exists (25% vs 10%). However, surgeons perform medial unicondylar knee replacement at a ratio of 10:1 when compared with lateral unicondylar knee replacement. This may be attributed to lack of familiarity or the increased difficulty of the procedure. Recent literature suggests that with proper patient selection, surgical technique, and implant choice, early survivorship ranges from 95% to 99%.
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Affiliation(s)
- Keith R Berend
- Joint Implant Surgeons, Inc. 7277 Smith's Mill Road, Suite 200, New Albany, OH 43054, USA.
| | - Nathan J Turnbull
- Joint Implant Surgeons, Inc. 7277 Smith's Mill Road, Suite 200, New Albany, OH 43054, USA
| | - Robert E Howell
- Joint Implant Surgeons, Inc. 7277 Smith's Mill Road, Suite 200, New Albany, OH 43054, USA
| | - Adolph V Lombardi
- Joint Implant Surgeons, Inc. 7277 Smith's Mill Road, Suite 200, New Albany, OH 43054, USA
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15
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Weston-Simons JS, Pandit H, Kendrick BJL, Jenkins C, Barker K, Dodd CAF, Murray DW. The mid-term outcomes of the Oxford Domed Lateral unicompartmental knee replacement. Bone Joint J 2014; 96-B:59-64. [DOI: 10.1302/0301-620x.96b1.31630] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Mobile-bearing unicompartmental knee replacements (UKRs) with a flat tibial plateau have not performed well in the lateral compartment, owing to a high dislocation rate. This led to the development of the Domed Lateral Oxford UKR (Domed OUKR) with a biconcave bearing. The aim of this study was to assess the survival and clinical outcomes of the Domed OUKR in a large patient cohort in the medium term. We prospectively evaluated 265 consecutive knees with isolated disease of the lateral compartment and a mean age at surgery of 64 years (32 to 90). At a mean follow-up of four years (sd 2.2, (0.5 to 8.3)) the mean Oxford knee score was 40 out of 48 (sd 7.4). A total of 12 knees (4.5%) had re-operations, of which four (1.5%) were for dislocation. All dislocations occurred in the first two years. Two (0.8%) were secondary to significant trauma that resulted in ruptured ligaments, and two (0.8%) were spontaneous. In four patients (1.5%) the UKR was converted to a primary TKR. Survival at eight years, with failure defined as any revision, was 92.1% (95% confidence interval 81.3 to 100). The Domed Lateral OUKR gives good clinical outcomes, low re-operation and revision rates and a low dislocation rate in patients with isolated lateral compartmental disease, in the hands of the designer surgeons. Cite this article: Bone Joint J 2014;96-B:59–64.
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Affiliation(s)
- J. S. Weston-Simons
- Nuffield Department of Orthopaedics, Rheumatology
and Musculoskeletal Sciences,, Botnar Research
Centre, University of Oxford, Windmill
Road, Headington, Oxford, OX3
7LD, UK
| | - H. Pandit
- Nuffield Department of Orthopaedics, Rheumatology
and Musculoskeletal Sciences,, Botnar Research
Centre, University of Oxford, Windmill
Road, Headington, Oxford, OX3
7LD, UK
| | - B. J. L. Kendrick
- Nuffield Department of Orthopaedics, Rheumatology
and Musculoskeletal Sciences,, Botnar Research
Centre, University of Oxford, Windmill
Road, Headington, Oxford, OX3
7LD, UK
| | - C. Jenkins
- Nuffield Orthopaedic Centre, Oxford
University Hospitals Trust, Headington, Oxford, OX3 7LD, UK
| | - K. Barker
- Nuffield Orthopaedic Centre, Oxford
University Hospitals Trust, Headington, Oxford, OX3 7LD, UK
| | - C. A. F. Dodd
- Nuffield Orthopaedic Centre, Oxford
University Hospitals Trust, Headington, Oxford, OX3 7LD, UK
| | - D. W. Murray
- Nuffield Department of Orthopaedics, Rheumatology
and Musculoskeletal Sciences,, Botnar Research
Centre, University of Oxford, Windmill
Road, Headington, Oxford, OX3
7LD, UK
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16
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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.
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Affiliation(s)
- Matthew J Hall
- Dept. of Orthopaedics, Derriford Hospital, Derriford Road, Plymouth, Devon, PL 8 6DH, UK.
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17
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Liddle AD, Pandit H, Murray DW, Dodd CAF. Unicompartmental knee arthroplasty: state of the art and future developments. ACTA ACUST UNITED AC 2012. [DOI: 10.1007/s10261-012-0035-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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