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Hung KT, Hsu KY, Cheng CM, Chen YJ, Chiu CH, Chan YS, Chen ACY, Yang CP. Analysis of correlation between medial joint line change and lower limb coronal alignment after Oxford unicompartmental knee arthroplasty. Clinics (Sao Paulo) 2024; 79:100478. [PMID: 39226870 DOI: 10.1016/j.clinsp.2024.100478] [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: 04/23/2024] [Accepted: 07/23/2024] [Indexed: 09/05/2024] Open
Abstract
BACKGROUND Lower limb coronal alignment was thought to be a predictive factor for Unicompartmental Knee Arthroplasty (UKA) result. The tibial bony resection and implant position lead to joint line change postoperatively. Analysis was done to find out the correlation between these factors. METHODS From 2019 to 2021, 90 medial Oxford UKA were implanted by a single surgeon. Hip Knee Ankle Angle (HKAA), Lateral Distal Femoral Angle (LDFA), Medial Proximal Tibial Angle (MPTA), and intraoperative bony resection thickness were measured. The medial joint line change was calculated. The correlation between joint line change and alignment change was evaluated. RESULTS The mean tibial resection thickness was 4.3 mm. The mean tibial joint line was elevated by 2.3 mm, while the mean femoral joint line proximalized by 0.8 mm. HKAA changed from 8.4° varus preoperatively to 3.6° varus postoperatively. LDFA changed from 89.0° to 86.7°. MPTA changed from 85.6° to 86.6°. Preoperative HKAA showed a strong correlation with postoperative HKAA (p < 0.001), and preoperative MPTA showed a positive correlation with postoperative HKAA (p < 0.001). While preoperative LDFA had a negative correlation with postoperative HKAA (p < 0.001). The femoral joint line change and LDFA change had a significant correlation with HKAA change (p < 0.05). CONCLUSION The change of joint line had no correlation with postoperative HKAA in Oxford UKA. Preoperative HKAA strongly correlated with postoperative HKAA; while preoperative smaller LDFA and larger MPTA had a moderate correlation with postoperative HKAA. The femoral joint line change and LDFA change had a weak to moderate correlation with HKAA change.
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Affiliation(s)
- Kung-Tseng Hung
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan (ROC); Bone and Joint Research Center, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan (ROC)
| | - Kuo-Yao Hsu
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan (ROC); Bone and Joint Research Center, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan (ROC)
| | - Chieh-Ming Cheng
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan (ROC); Bone and Joint Research Center, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan (ROC)
| | - Yi-Jou Chen
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan (ROC); Bone and Joint Research Center, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan (ROC)
| | - Chih-Hao Chiu
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan (ROC); Bone and Joint Research Center, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan (ROC)
| | - Yi-Shen Chan
- Bone and Joint Research Center, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan (ROC); Department of Orthopedic Surgery, Keelung Chang Gung Memorial Hospital, Keelung City, Taiwan
| | - Alvin Chao-Yu Chen
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan (ROC); Bone and Joint Research Center, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan (ROC)
| | - Cheng Pang Yang
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan (ROC); Bone and Joint Research Center, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan (ROC).
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Md NN, Md TM, Md YK, Md KI, Md SH, Md YH, Md TM, Md RK, Md TM. Difference in the Extension Gap Between Osteoarthritis and Osteonecrosis in Medial Fixed-Bearing Unicompartmental Knee Arthroplasty with the Spacer Block Technique. J Knee Surg 2024; 37:718-723. [PMID: 38552643 DOI: 10.1055/s-0044-1785222] [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: 07/25/2024]
Abstract
The spacer block technique is widely used in medial fixed-bearing unicompartmental knee arthroplasty (UKA) for osteoarthritis (OA) and osteonecrosis (ON), while it is still unclear if there is any difference in the extension gap between UKAs for the two conditions. To clarify the question, the data from 87 consecutive patients (OA: 57 patients and ON: 30 patients) who underwent medial fixed-bearing UKA with the spacer block technique were retrospectively collected and analyzed. The component gap between the medial tibial osteotomy surface and the femoral trial prosthesis in extension was measured using a UKA tensor, and the preosteotomy gap was calculated in each condition. Also, pre- and postoperative coronal hip-knee-ankle (HKA) angles, the thickness of the insert, and the amount of distal femoral and proximal tibial osteotomy were measured and compared between the two groups. As a result, the mean preosteotomy gap in Group OA and Group ON was 5.4 and 3.7 mm, respectively (p < 0.001). The amount of change in HKA angle following UKA in Group OA and Group ON was 4.4and 3.8 degrees, respectively (p = 0.044), while no significant difference was found regarding pre- and postoperative HKA angle between them. Also, thinner inserts tended to be used in Group ON than in Group OA, while no significant difference in the amount of osteotomies was found between them. Since knees with OA and ON showed different biomechanical conditions at medial fixed-bearing UKA probably for the difference in the amount of remaining cartilage, the surgical technique should be carefully considered for each condition.
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Affiliation(s)
- Naoki Nakano Md
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Chuo-ku, Kobe, Japan
| | - Toshihisa Maeda Md
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Chuo-ku, Kobe, Japan
| | - Yuichi Kuroda Md
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Chuo-ku, Kobe, Japan
| | - Kazunari Ishida Md
- Department of Orthopaedic Surgery, Kobe Kaisei Hospital, Nada-ku, Kobe, Hyogo, Japan
| | - Shinya Hayashi Md
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Chuo-ku, Kobe, Japan
| | - Yuichi Hoshino Md
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Chuo-ku, Kobe, Japan
| | - Takehiko Matsushita Md
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Chuo-ku, Kobe, Japan
| | - Ryosuke Kuroda Md
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Chuo-ku, Kobe, Japan
| | - Tomoyuki Matsumoto Md
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Chuo-ku, Kobe, Japan
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Hiranaka T, Fukai Y, Tanaka S, Okajima T, Kanno T, Koide M, Fujishiro T, Okamoto K. Pre-milling technique improves the accuracy of posterior femoral condyle cut and reduces the tibial recut in Oxford unicompartmental knee arthroplasty. Arch Orthop Trauma Surg 2024; 144:2761-2766. [PMID: 38693288 DOI: 10.1007/s00402-024-05333-2] [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: 01/26/2024] [Accepted: 04/14/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Recuts are sometimes needed in UKA because of inadequate posterior tibial cut thickness. We investigated the efficacy of a pre-milling technique (the first milling is done prior to the posterior condylar cut) in Oxford unicompartmental knee arthroplasty to enhance bone cut thickness and to minimize tibial recuts. PATIENTS AND METHODS Between January 2021 and January 2023, a posterior condyle cut was made before milling in 213 knees in 152 patients (conventional group), while the pre-milling technique was used in 198 knees in 140 patients (pre-milling group). The thickness of the posterior condyle and the rate of tibial recuts were compared between the groups. RESULTS The bone cut thickness was thinner in the conventional group than in the pre-milling group in small-size (4.7 mm ± 0.6 mm and 5.0 mm ± 0.6 mm, P = 0.0001) and in medium-size (5.1 mm ± 0.5 mm and 5.4 mm ± 0.5 mm, 0.0001) femoral components, whereas there was no difference in large-size femoral components. However, the thickness was still less than the component thickness (5.17 mm for small, 5.57 mm for medium and 6.17 mm for large) in both groups. Tibial recuts were more prevalent in the conventional group than in the pre-milling group (14 knees, 7%, 3 knees 2%, P = 0.002). CONCLUSIONS The pre-milling technique was found to increase the bone cut thickness in small and medium femoral components, reducing the need for tibial recuts. Further research is warranted to optimize the pre-milling technique and to investigate its long-term impact on patient outcomes.
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Affiliation(s)
- Takafumi Hiranaka
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, 1-3-13, Kosobe- Cho, Takatsuki City, Osaka, 561-1115, Japan.
| | - Yasuhiro Fukai
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, 1-3-13, Kosobe- Cho, Takatsuki City, Osaka, 561-1115, Japan
| | - Sho Tanaka
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, 1-3-13, Kosobe- Cho, Takatsuki City, Osaka, 561-1115, Japan
| | - Takahiro Okajima
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, 1-3-13, Kosobe- Cho, Takatsuki City, Osaka, 561-1115, Japan
| | - Tatsuhiko Kanno
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, 1-3-13, Kosobe- Cho, Takatsuki City, Osaka, 561-1115, Japan
| | - Motoki Koide
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, 1-3-13, Kosobe- Cho, Takatsuki City, Osaka, 561-1115, Japan
| | - Takaaki Fujishiro
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, 1-3-13, Kosobe- Cho, Takatsuki City, Osaka, 561-1115, Japan
| | - Koji Okamoto
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, 1-3-13, Kosobe- Cho, Takatsuki City, Osaka, 561-1115, Japan
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Liu P, Li L, Yang J, Li H, Feng Y, Qin Z, Zhang M. Comparison of the efficacy of Oxford unicondylar replacement for the treatment of spontaneous osteonecrosis of the knee versus medial knee osteoarthritis: a meta-analysis. J Orthop Surg Res 2024; 19:86. [PMID: 38254108 PMCID: PMC10801981 DOI: 10.1186/s13018-023-04519-5] [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: 11/15/2023] [Accepted: 12/29/2023] [Indexed: 01/24/2024] Open
Abstract
OBJECTIVE Meta-analysis of the comparative efficacy of Oxford unicompartmental knee arthroplasty (OUKA) for the treatment of spontaneous osteonecrosis of the knee (SONK) and medial knee osteoarthritis (MKOA). METHODS A computerized search was conducted for literature related to OUKA treatments of SONK and MKOA across various databases, including the China National Knowledge Infrastructure, WAN FANG, VIP, SinoMed, Cochrane Library, PubMed, Embase, and Web of Science, covering the period from each database's inception to September 2023. Literature screening, quality assessment and data extraction were performed according to the inclusion and exclusion criteria. After extracting the literature data, RevMan 5.4 software was applied to analyse the postoperative knee function score, postoperative knee mobility, postoperative pain, bearing dislocation rate, aseptic loosening, postoperative progression of posterolateral arthritis, and revision rate. RESULT A total of 9 studies were included, including 6 cohort studies and 3 matched case‒control studies. A total of 1544 knees were included, including 183 in the SONK group and 1361 in the MKOA group. The meta-analysis results showed that the SONK and MKOA groups showed a significant difference in postoperative knee function scores [MD = 0.16, 95% CI (- 1.20, 1.51), P = 0.82], postoperative knee mobility [MD = - 0.05, 95% CI (- 1.99. 1.89), P = 0.96], postoperative pain [OR = 0.89, 95% CI (0.23, 3.45), P = 0.87], rate of bearing dislocation [OR = 1.28, 95% CI (0.34, 4.81), P = 0.71], aseptic loosening [OR = 2.22, 95% CI (0.56, 8.82), P = 0.26], postoperative posterolateral arthritis progression [OR = 2.14, 95% CI (0.47, 9.86), P = 0.33], and revision rate [OR = 1.28, 95% CI (0.53, 3.04), P = 0.58] were not statistically significant. CONCLUSION OUKA treatment with SONK and MKOA can achieve similar satisfactory clinical results.
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Affiliation(s)
- Pengyu Liu
- Second Hospital of Shanxi Medical University, Taiyuan, 030001, Shanxi, China
| | - Liangliang Li
- Second Hospital of Shanxi Medical University, Taiyuan, 030001, Shanxi, China
| | | | - Hao Li
- Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Yuhua Feng
- Second Hospital of Shanxi Medical University, Taiyuan, 030001, Shanxi, China
| | - Zhipeng Qin
- Second Hospital of Shanxi Medical University, Taiyuan, 030001, Shanxi, China
| | - Min Zhang
- Second Hospital of Shanxi Medical University, Taiyuan, 030001, Shanxi, China.
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Liu C, Chen H, Ge J, Huang C, Zhang Q, Guo W. Predicting valgus malalignment after mobile-bearing UKA using a new method: the arithmetic HKA of the arthritic knee. Arch Orthop Trauma Surg 2023; 143:6381-6391. [PMID: 37244889 DOI: 10.1007/s00402-023-04921-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 05/21/2023] [Indexed: 05/29/2023]
Abstract
BACKGROUND Valgus malalignment is one of the most common reasons for the progression of osteoarthritis in the lateral compartment of the knee after mobile-bearing unicompartmental knee arthroplasty (UKA). The arithmetic hip-knee-ankle angle (aHKA) of the Coronal Plane Alignment of the Knee (CPAK) classification could reflect the constitutional alignment of the arthritic knee. The purpose of this study was to observe the relationship between the aHKA and valgus malalignment after mobile-bearing UKA. METHODS This retrospective study was conducted using 200 knees undergoing UKA from January 1, 2019, to August 1, 2022. These radiographic signs, including preoperative hip-knee-ankle angle (HKA), mechanical proximal tibial angle (MPTA), mechanical lateral distal femoral angle (LDFA), and postoperative HKA, were measured using standardized weight-bearing long-leg radiographs. Patients with postoperative HKA > 180° and postoperative HKA ≤ 180° were classified as the valgus group and non-valgus group, respectively. The aHKA was calculated as 180° + MPTA - LDFA in this study, which had the same meaning as that (aHKA = MPTA - LDFA) in the CPAK classification. The Spearman correlation analysis, the Mann-Whitney U test, the chi-square test, the Fisher's exact test, and multiple logistic regression were used in the study. RESULTS Of the 200 knees included in our study, 28 knees were classified as the valgus group, while 172 knees were in the non-valgus group. The mean ± standard deviation (SD) of aHKA (all groups) was 177.04 ± 2.58°. In the valgus group, 11 knees (39.3%) had a value of aHKA > 180°, while 17 knees (60.7%) had a value of aHKA ≤ 180°. In the non-valgus group, 12 knees (7.0%) had a value of aHKA > 180°, while 160 knees (93.0%) had a value of aHKA ≤ 180°. In Spearman correlation analysis, aHKA was positively correlated with postoperative HKA (r = 0.693, p < 0.001). In univariate analysis, preoperative HKA (p < 0.001), LDFA (p = 0.02), MPTA (p < 0.001), and aHKA (p < 0.001) showed significant differences between the valgus and non-valgus groups. Variables with p < 0.1 in univariate analysis were further analyzed using multiple logistic regression analysis, and the variable-aHKA (> 180° vs ≤ 180°, odds ratio (OR) = 5.899, 95% confidence interval (CI) = 1.213 to 28.686, and p = 0.028) was expressed as the risk factor of postoperative valgus malalignment. CONCLUSION The aHKA is correlated with the postoperative alignment of mobile-bearing UKA and a high aHKA (> 180°) will increase the risk of postoperative valgus malalignment. Therefore, mobile-bearing UKA should be performed with caution in patients with preoperative aHKA > 180°.
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Affiliation(s)
- Changquan Liu
- China-Japan Friendship Hospital (Institute of Clinical Medical Sciences), Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Handong Chen
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, China
- Beijing University of Chinese Medicine, Beijing, China
| | - Juncheng Ge
- Department of Orthopaedic Surgery, Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
| | - Cheng Huang
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Qidong Zhang
- China-Japan Friendship Hospital (Institute of Clinical Medical Sciences), Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, China.
| | - Wanshou Guo
- China-Japan Friendship Hospital (Institute of Clinical Medical Sciences), Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, China.
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Kulshrestha V, Sood M, Kumar S, Kharat K, Padhi PP, Kumar P, Shrama S, Stanley A. Early Outcomes of Modified Technique of Mobile Bearing Unicondylar Knee Replacement. Indian J Orthop 2023; 57:1209-1218. [PMID: 37525741 PMCID: PMC10387039 DOI: 10.1007/s43465-023-00907-5] [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: 10/27/2022] [Accepted: 05/08/2023] [Indexed: 08/02/2023]
Abstract
Background Recent years have seen a resurgence in utilization of partial knee replacement. One such device frequently used is Oxford partial knee implant (OPK). Deeper tibial bone cut while performing OPK replacement may risk early failure. Methods We prospectively looked at early outcomes of a modified technique (MT) of OPK replacement adopted by our centre to save tibial bone stock at 24 months of follow up as compared to designer group described technique (DT) as a prospective cohort. Results At 2 years follow up New Knee Society Score showed patient satisfaction (38.25 in DT vs 39.02 in MT, p value 0.10), objective (92.77 in DT vs 91.07 in MT, p value 0.21), expectation scores (14.77 in DT vs 14.85 in MT, p value 0.81) and activity (60.72 in DT vs 68.17 in MT, p value 0.79 were similar in MT group as compared to DT. The stair climbing ability (22.46 in MT vs 29.96 in DT, p value < 0.001) and getting up from chair (13.16 in MT vs 19.80 in DT, p value < 0.001), was better with MT group but most other patient performance scores were similar as assessed by DOP (Delaware Osteoarthritis Profile). Both groups had failure rate of 5% at 24 months follow up. Conclusion MT resulted in similar early outcomes in terms of patient reported outcomes, satisfaction and performance as compared to DT group. The MT to save tibial bone stock did not compromise early outcomes and can be utilised in certain patients with higher risk of tibial failure.
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Affiliation(s)
- Vikas Kulshrestha
- Department of Orthopaedics, Command Hospital Air Force, Bangalore, India
| | - Munish Sood
- Department of Orthopaedics, Indian Naval Hospital Ship Asvini, Mumbai, India
| | - Santhosh Kumar
- Joint Replacement Center, Army Hospital Research and Referral, New Delhi, 110010 India
| | - Kiran Kharat
- Ruby Hall Clinic, Survey No 59/6, Azad Nagar, Wanowrie, Pune, 411040 India
| | - Prashanth P. Padhi
- Department of Orthopaedics and Joint Replacement Surgery, 7 Air Force Hospital Kanpur, Kanpur, India
| | - Pardeep Kumar
- Department of Orthopaedics, Command Hospital Air Force, Bangalore, India
| | - Saurabh Shrama
- Joint Replacement Center, Army Hospital Research and Referral, New Delhi, India
| | - Abin Stanley
- Department of Orthopaedics and Joint Replacement Surgery, 7 Air Force Hospital Kanpur, Kanpur, India
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Saccone L, Franceschetti E, Campi S, Za P, Zampogna B, Esposito C, Papalia GF, Papapietro N, Papalia R. Unicompartmental knee arthroplasty (UKA) for primary spontaneous osteonecrosis of the knee (SONK): a systematic review. Orthop Rev (Pavia) 2023; 15:73916. [PMID: 37405275 PMCID: PMC10317517 DOI: 10.52965/001c.73916] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/06/2023] Open
Abstract
Introduction The role of unicompartmental knee arthroplasty (UKA) in spontaneous osteonecrosis of the knee (SONK) is still controversial. Materials and methods We performed a systematic review to evaluate all available current literature on UKA in the setting of SONK. A comprehensive electronic research was performed using the PubMed, Embase, Web of Science, and Cochrane databases with keywords related to SONK and knee arthroplasty. Studies were selected with predetermined inclusion criteria: 1) studies that specifically assessed SONK treated with UKA; 2) studies reporting implant survival rate and global clinical outcomes; 3) studies with a minimum follow up of 1 year. We excluded articles not written in English, articles that did not differentiate between primary and secondary osteonecrosis and articles published before 2000. Results The overall research process produced 19 studies. We extrapolated data of a total of 717 unicompartimental knee arthroplasty procedures (1,39% lateral UKA, 98,61% medial UKA). Extracted data include years of follow-up, patient demographics, laterality of lesion, radiological findings, unicompartimental knee arthroplasty implants, reason of revision, revision rate, maximum knee flexion, knee clinical outcomes score, and Kaplan-Meier survival curves. The data collected show that UKA had acceptable survival rates as well as revision rates and good clinical outcomes both in the short- and long-term. Conclusion UKA is an optimal treatment choice for primary SONK when correctly indicated in a carefully selected subset of patients, with no significant difference compared to osteoarthritis. Attention must be paid to distinguish the primary from secondary SONK, as the latter could lead to worse outcomes.
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Affiliation(s)
- Luca Saccone
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Edoardo Franceschetti
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Stefano Campi
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Pierangelo Za
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Biagio Zampogna
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Carlo Esposito
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Giuseppe Francesco Papalia
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Nicola Papapietro
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Rocco Papalia
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
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Bayoumi T, Kleeblad LJ, Borus TA, Coon TM, Dounchis J, Nguyen JT, Pearle AD. Ten-Year Survivorship and Patient Satisfaction Following Robotic-Arm-Assisted Medial Unicompartmental Knee Arthroplasty: A Prospective Multicenter Study. J Bone Joint Surg Am 2023:00004623-990000000-00793. [PMID: 37146125 DOI: 10.2106/jbjs.22.01104] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
BACKGROUND Robotic-arm-assisted unicompartmental knee arthroplasty (UKA) has been shown to result in high short- and mid-term survivorship. However, it is not known whether these outcomes are maintained at long-term follow-up. This study aimed to evaluate long-term implant survivorship, modes of failure, and patient satisfaction following robotic-arm-assisted medial UKA. METHODS A prospective multicenter study of 474 consecutive patients (531 knees) undergoing robotic-arm-assisted medial UKA was conducted. A cemented, fixed-bearing system with a metal-backed onlay tibial implant was used in all cases. Patients were contacted at 10-year follow-up to determine implant survivorship and satisfaction. Survival was analyzed using Kaplan-Meier models. RESULTS Data were analyzed for 366 patients (411 knees) with a mean follow-up of 10.2 ± 0.4 years. A total of 29 revisions were reported, corresponding to a 10-year survivorship of 91.7% (95% confidence interval, 88.8% to 94.6%). Of all revisions, 26 UKAs were revised to total knee arthroplasty. Unexplained pain and aseptic loosening were the most commonly reported modes of failure, accounting for 38% and 35% of revisions, respectively. Of patients without revision, 91% were either satisfied or very satisfied with their overall knee function. CONCLUSIONS This prospective multicenter study found high 10-year survivorship and patient satisfaction following robotic-arm-assisted medial UKA. Pain and fixation failure remained common causes for revision following cemented fixed-bearing medial UKA, despite the use of a robotic-arm-assisted technique. Prospective comparative studies are needed to assess the clinical value of robotic assistance over conventional techniques in UKA. LEVEL OF EVIDENCE Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Tarik Bayoumi
- Computer Assisted Surgery and Sports Medicine, Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY
| | - Laura J Kleeblad
- Department of Surgery, Northwest Clinics, Alkmaar, the Netherlands
| | - Todd A Borus
- Department of Orthopaedic Surgery, Rebound Orthopedics & Neurosurgery, Portland, Oregon
| | - Thomas M Coon
- Coon Joint Replacement Institute, Department of Orthopaedic Surgery, St. Helena, California
| | - Jon Dounchis
- Department of Orthopaedic Surgery, NCH Orthopedics, Naples, Florida
| | - Joseph T Nguyen
- Biostatistics Core, Healthcare Research Institute, Hospital for Special Surgery, New York, NY
| | - Andrew D Pearle
- Computer Assisted Surgery and Sports Medicine, Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY
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Yue L, Lamontagne M, Xiong Z, Zhengfei Z, Run T, Zhe L, Ning K, Chunsheng W, Pei Y, Kunzheng W. Evaluation of Knee Kinematics and Moments during Active Deep Flexion Activity after Oxford Mobile-Bearing Medial UKA-A Two-Year Follow-Up Study. J Knee Surg 2022; 35:896-903. [PMID: 33401312 DOI: 10.1055/s-0040-1721033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Few studies have assessed knee range of motion (ROM) and moments of patients with mobile-bearing unicompartmental knee arthroplasty (MB UKA) during active deep flexion activities. We analyze knee kinematic and kinetic parameters during postoperative squatting-standing activity, aiming to evaluate the efficacy of MB UKA and postoperative rehabilitation progress. This was a clinical cohort study. We followed up with 37 patients diagnosed with medial knee osteoarthritis (OA) with primary UKA. After screening 31 patients were recruited to take gait tests. Squatting-standing activities were performed under the test of 10-camera motion analysis system and force plates preoperatively at different stages after UKA (12, 18, and 24 months). The average duration of follow-up was 24.4 months (from 22.8 to 26.7 months). Hip-knee-ankle angle improved significantly compared with pre-UKA as well as scores of American Knee Society Score, numeric rating scale, ORS, and Western Ontario and McMasters. University Osteoarthritis Index. About 83.6% (31/37) of follow-up patients completed squatting-standing activity independently. At 1-year follow-up, peak varus angle (20.6 ± 2.8 degrees), internal rotation angle (13.6 ± 1.8 degrees), extensor moment (1.44 ± 0.04N*m/kg), and internal rotator moment (0.02 ± 0.005N*m/kg) of UKA knees were inferior to contralateral knees. Peak adductor moment (0.76 ± 0.05N*m/kg) was superior to contralateral knees. At 2-year follow-up, peak flexion angle (125.0 ± 2.8 degrees) showed a growing trend meanwhile extensor (1.70 ± 0.03N*m/kg) and adductor (0.68 ± 0.06 N*m/kg) moment closely resembled those of the contralateral knee. MB UKA could alleviate the affected knee mainly in flexion-extension ROM and moment meanwhile did not affect the biomechanical indicators of healthy limbs. OA knees in the early postoperative period showed decreased extensor moment and increased adductor moment during active deep flexion activity. Better ROM and relatively more natural extensor and adductor moment of UKA knee with rehabilitation time increasing may predict ideal rehabilitation outcome in the medium or longer term.
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Affiliation(s)
- Li Yue
- Department of Orthopaedics, The Second Affiliated Hospital of Xi'an Jiaotong University, Shaanxi Province, P.R. China.,School of Human Kinetics, University of Ottawa, Ottawa Ontario, Canada
| | - Mario Lamontagne
- School of Human Kinetics, University of Ottawa, Ottawa Ontario, Canada
| | - Zhao Xiong
- School of Human Kinetics, University of Ottawa, Ottawa Ontario, Canada
| | - Zhu Zhengfei
- State Key Laboratory for Manufacturing Systems Engineering, School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an, China
| | - Tian Run
- Department of Orthopaedics, The Second Affiliated Hospital of Xi'an Jiaotong University, Shaanxi Province, P.R. China
| | - Li Zhe
- Department of Orthopaedics, The Second Affiliated Hospital of Xi'an Jiaotong University, Shaanxi Province, P.R. China
| | - Kong Ning
- Department of Orthopaedics, The Second Affiliated Hospital of Xi'an Jiaotong University, Shaanxi Province, P.R. China
| | - Wang Chunsheng
- Department of Orthopaedics, The Second Affiliated Hospital of Xi'an Jiaotong University, Shaanxi Province, P.R. China
| | - Yang Pei
- Department of Orthopaedics, The Second Affiliated Hospital of Xi'an Jiaotong University, Shaanxi Province, P.R. China
| | - Wang Kunzheng
- Department of Orthopaedics, The Second Affiliated Hospital of Xi'an Jiaotong University, Shaanxi Province, P.R. China
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Revision indications for medial unicompartmental knee arthroplasty: a systematic review. Arch Orthop Trauma Surg 2022; 142:301-314. [PMID: 33630155 DOI: 10.1007/s00402-021-03827-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 02/08/2021] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Unicompartmental knee arthroplasty (UKA) has advantages over total knee arthroplasty including fewer complications and faster recovery; however, UKAs also have higher revision rates. Understanding reasons for UKA failure may, therefore, allow for optimized clinical outcomes. We aimed to identify failure modes for medial UKAs, and to examine differences by implant bearing, cement use and time. MATERIALS AND METHODS A systematic review was conducted by searching MedLine, EMBASE, CINAHL and Cochrane databases from 2000 to 2020. Studies were selected if they included ≥ 250 participants, ≥ 10 failures and reported all failure modes of medial UKA performed for osteoarthritis (OA). RESULTS A total of 24 cohort and 2 registry-based studies (levels II and III) were selected. The most common failure modes were aseptic loosening (24%) and OA progression (30%). Earliest failures (< 6 months) were due to infection (40%), bearing dislocation (20%), and fracture (20%); mid-term failures (> 2 years to 5 years) were due to OA progression (33%), aseptic loosening (17%) and pain (21%); and late-term (> 10 years) failures were mostly due to OA progression (56%). Rates of failure from wear were higher with fixed-bearing prostheses (5% cf. 0.3%), whereas rates of bearing dislocations were higher with mobile-bearing prostheses (14% cf. 0%). With cemented components, there was a high rate of failure due to aseptic loosening (27%), which was reduced with uncemented components (4%). CONCLUSIONS UKA failure modes differ depending on implant design, cement use and time from surgery. There should be careful consideration of implant options and patient selection for UKA.
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Excellent outcomes with Oxford Uni-compartmental knee arthroplasty in anteromedial osteoarthritis patients (≤60 years) at mid-term follow-up. BMC Musculoskelet Disord 2021; 22:859. [PMID: 34625077 PMCID: PMC8501524 DOI: 10.1186/s12891-021-04747-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 09/28/2021] [Indexed: 11/10/2022] Open
Abstract
Background The use of Oxford uni-compartmental knee arthroplasty (UKA) has rapidly increased worldwide,however,the relevance of younger patients for postoperative function after Oxford UKA remains unclear. The main purpose of our study is to clarify the effectivemess of Oxford UKA in the younger Chinese patients with anteromedial osteoarthritis (AMOA). Methods We retrospectively enrolled 252 consecutive patients who underwent Oxford UKA for AMOA with a minimum follow-up of 5 years between March 2013 and December 2016. The patients were divided into the younger (≤60 years) and elderly (> 60 years) age groups. The demographic data and surgery variables were recorded and compared. Patient satisfaction grade, range of motion (ROM), Oxford knee score (OKS), Hospital for Special Surgery (HSS) score, Western Ontario and McMaster (WOMAC) Universities Osteoarthritis Index score and postoperative complications were recorded. The 5-year survival of the implants were also compared with TKA revision as the endpoint. Results A total of 252 consecutive patients were recruited, including 96 aged 60 years or less and 156 aged over 60 years. The mean follow-up duration in the younger and elderly groups were 73.6 months (SD,standard deviation, 4.1) and 74.7 months (SD 6.2) respectively. Patient satisfaction rate was high in both groups (P = 0.805). Furthermore, no significant differences were observed in postoperative ROM(P = 0.299), OKS(P = 0.117), HSS(P = 0.357) and WOMAC scores(P = 0.151) between the younger and elderly groups (P>0.05). However, the incidence of joint stiffness (P = 0.033) and delayed wound dehiscence (P = 0.026) were significantly different between both groups. Five-year implant survival without revision were also similar in both groups (96.9% vs 97.4%, P = 0.871), and that for the entire cohort was 97.2% (95% CI 95.4–99.6). Conclusion Oxford UKA for AMOA demonstrated favorable results in younger patients aged ≤60 years at a minimum 5-year follow-up in terms of patient satisfaction, functional outcomes, implant survival and postoperative complications. Therefore, younger patients might not be considered as an absolute contraindication to Oxford UKA.
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12
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Panzram B, Mandery M, Reiner T, Walker T, Merle C, Gotterbarm T. Fast Return to Sports and High Level of Activity after Cementless Oxford Unicompartmental Knee Arthroplasty. J Knee Surg 2021; 34:1212-1219. [PMID: 32268405 DOI: 10.1055/s-0040-1702184] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Physical activity is essential for overall health. For patients undergoing knee arthroplasty, questions about the implant's suitability for sports arise. The general recommendations for physical activity with knee replacements are often based upon experts' opinions, with a lack of scientific data. This study was performed at an independent high-volume center and aimed to investigate what level of activity patients can achieve and how they perform with a well-functioning cementless unicompartmental knee replacement (UKR). Possible differences in outcome in regards to patients' body mass index (BMI) were also examined. A total of 228 knees treated with cementless Oxford UKR (OUKR) were followed up after a mean of 37.1 months. Tegner's and UCLA (University of California, Los Angeles) scores were obtained to assess the level of physical activity. The Schulthess Clinical Activity Questionnaire was assessed for detailed information on practiced sports, and the SF-36 questionnaire was evaluated to analyze patients' quality of life. The return to activity rate was 92.9%. In total, 64% of the physically active patients had already taken up sports within 3 months after surgery. Mean Tegner's score was at 3.5, and mean UCLA score was at 6.3. High impact sports were not performed very often after surgery. Higher BMI showed a negative correlation with the numbers of sports (rsp = -0.289) as well as Tegner's (rsp = -0.222) and UCLA (rsp = -0.383) scores. The SF-36 scores were comparably good to those in an age-equivalent standard reference group. In conclusion, cementless OUKR allows a fast return to activity with a high level of physical exercise. Patients with increased BMI tend to practice less types of sports with decreased activity scores.
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Affiliation(s)
- Benjamin Panzram
- Clinic of Orthopaedic and Trauma Surgery, University of Heidelberg, Heidelberg, Germany
| | - Mira Mandery
- Clinic of Orthopaedic and Trauma Surgery, University of Heidelberg, Heidelberg, Germany
| | - Tobias Reiner
- Clinic of Orthopaedic and Trauma Surgery, University of Heidelberg, Heidelberg, Germany
| | - Tilman Walker
- Clinic of Orthopaedic and Trauma Surgery, University of Heidelberg, Heidelberg, Germany
| | - Christian Merle
- Clinic of Orthopaedic and Trauma Surgery, University of Heidelberg, Heidelberg, Germany
| | - Tobias Gotterbarm
- Clinic of Orthopaedic and Trauma Surgery, University of Heidelberg, Heidelberg, Germany.,Clinic of Orthopaedic and Trauma Surgery, Kepler University Clinic for Orthopaedic and Trauma Surgery, Linz, Austria
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Wang F, Xue H, Ma T, Wen T, Yang T, Xue L, Tu Y. Short-term effectiveness of medial unicompartmental knee arthroplasty in young patients aged less than or equal to 60 years. J Orthop Surg (Hong Kong) 2021; 28:2309499020945118. [PMID: 33034241 DOI: 10.1177/2309499020945118] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
PURPOSE The treatment for young patients with advanced knee arthritis by Oxford unicompartmental knee arthroplasty (Oxford-UKA) is still controversial. A relative few studies were published about Asian patients. We evaluated midterm results of Oxford-UKA in young patients aged less than or equal to 60 years. METHODS Between December 2009 and December 2018, 95 patients (109 knees) (mean age 57.48 years; range: 33-60 years) were included. The mean follow-up period was 3.0 years (range: 1.0-9.5 years). The functional outcomes and pain score of the knee before and after surgery were examined. RESULTS To the last follow-up, no patient died, six patients (nine knees) were lost and one patient underwent total knee revision in case of unexplained postoperative pain. The patients demonstrated significant improvement in range of knee motion (103.65 vs. 115.96, p < 0.05), Oxford Knee Score (40.0 vs. 14.4, p < 0.05), Hospital for Special Surgery Score (56.0 vs. 85.7, p < 0.05), and Visual Analogue Score (VAS) (5.23 vs. 1.08, p < 0.05) before and after surgery. CONCLUSION Our midterm results showed that the Oxford-UKA was a reliable and effective treatment option for young patients aged less than or equal to 60 years with anterior medial osteoarthritis. The knee pain can be effectively relieved and excellent functional activities of the knee joint can be obtained after surgery.
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Affiliation(s)
- Fangxing Wang
- Department of Joint Surgery, 74683Yangpu Hospital Affiliated to Tongji University, Shanghai, China
| | - Huaming Xue
- Department of Joint Surgery, 74683Yangpu Hospital Affiliated to Tongji University, Shanghai, China
| | - Tong Ma
- Department of Joint Surgery, 74683Yangpu Hospital Affiliated to Tongji University, Shanghai, China
| | - Tao Wen
- Department of Joint Surgery, 74683Yangpu Hospital Affiliated to Tongji University, Shanghai, China
| | - Tao Yang
- Department of Joint Surgery, 74683Yangpu Hospital Affiliated to Tongji University, Shanghai, China
| | - Long Xue
- Department of Joint Surgery, 74683Yangpu Hospital Affiliated to Tongji University, Shanghai, China
| | - Yihui Tu
- Department of Joint Surgery, 74683Yangpu Hospital Affiliated to Tongji University, Shanghai, China
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Lu F, Sun X, Wang W, Zhang Q, Guo W. Anthropometry of the medial femoral condyle in the Chinese population: the morphometric analysis to design unicomparmental knee component. BMC Musculoskelet Disord 2021; 22:95. [PMID: 33472632 PMCID: PMC7819177 DOI: 10.1186/s12891-021-03979-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 01/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aimed to assess the radii of the distal and posterior articular surfaces of the medial femoral condyle in a Chinese population and provide detailed parameters of the knee joint for the future design of UKA components. METHODS This study included 500 consecutive Chinese patients who underwent knee MRI from Jan 2019 to Jan 2020. The two most appropriate circles were used to reveal the distal and posterior joint surfaces in the sagittal plane of the MRI images. The radius of the circle representing the distal articular surface in the sagittal plane was measured as R1, and the radius of the posterior articular surface was measured as R2. The distance between the centers of the two rotation circles was recorded as d. An independent t test was used to compare the differences between men and women. The Pearson correlation coefficient was calculated to analyze the correlation between R1 and R2. SPSS v19.0 software was used for statistical analysis. RESULTS The average values of R1, R2, R1/R2 and d were calculated. Scatter plots were constructed to show the trend of changes in the radius of the distal and posterior articular surfaces of the femoral condyle. R1, R2 and d differed significantly between men and women (p < 0.05). Correlation analysis showed that R1 was positively correlated with R2 (r = 0.61, p < 0.05). CONCLUSIONS The data of the radii of the distal and posterior articular surfaces of the medial femoral condyle were provided. In the UKA design, the relationships between the radii of the distal and posterior articular surfaces should be taken into account.
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Affiliation(s)
- Feifan Lu
- China- Japan Friendship School of Clinical Medicine, Peking University, 100029, Beijing, China
| | - Xiaowei Sun
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, 100029, Beijing, China
| | - Weiguo Wang
- Department of Orthopedic Surgery, Beijing Key Lab Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, Peking Union Medical School, 100029, Beijing, China
| | - Qidong Zhang
- Department of Orthopedic Surgery, Beijing Key Lab Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, Peking Union Medical School, 100029, Beijing, China.
| | - Wanshou Guo
- Department of Orthopedic Surgery, Beijing Key Lab Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, Peking Union Medical School, 100029, Beijing, China.
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15
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Sun X, Liu P, Lu F, Wang W, Guo W, Zhang Q. Bearing dislocation of mobile bearing unicompartmental knee arthroplasty in East Asian countries: a systematic review with meta-analysis. J Orthop Surg Res 2021; 16:28. [PMID: 33413535 PMCID: PMC7791981 DOI: 10.1186/s13018-020-02190-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 12/28/2020] [Indexed: 11/25/2022] Open
Abstract
Background Bearing dislocation is a common postoperative complication of mobile-bearing unicompartmental knee arthroplasty, and East Asian patients tend to be at higher risk. However, whether this high dislocation rate is common in all East Asian populations remains unclear. This meta-analysis was performed to explore this issue and describe various features of dislocation in East Asians, including the onset time, dislocation direction, and re-dislocation rate. Methods The literature was searched in PubMed, Embase, Ovid, and Cochrane Library up to May 2020. Studies were scrutinized by two independent authors, and the bearing dislocation rate, onset time, direction, and re-dislocation rate were specifically analyzed. RevMan 5.3 was used for the statistical analysis. Results Seven case series from Korea, China, and Japan were included. The pooled analysis showed that the total dislocation rate was 2.37%, while the subgroup analysis showed that the dislocation rate in Korea and other countries was 4.50% and 0.74%, respectively (P < 0.01). Another subgroup analysis of the onset time showed a significant difference before and after the first 5 years postoperatively (P < 0.01). Anterior and posterior dislocations were more frequent than medial and lateral dislocations (P < 0.01). The average re-dislocation rate was 32.45%, which was approximately seven times higher than the primary dislocation rate (P < 0.01). Conclusion Our meta-analysis demonstrated that Korea had a higher bearing dislocation rate among East Asian countries, especially in the first 5 years after primary UKA. Anterior and posterior dislocations were common. The most important finding is that the re-dislocation rate can be much higher than the initial dislocation rate.
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Affiliation(s)
- Xiaowei Sun
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.,Department of Orthopaedic Surgery, China-Japan Friendship Hospital, No. 2, Yinghuadong Road, Chaoyang District, Beijing, 100029, China
| | - Pei Liu
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, No. 2, Yinghuadong Road, Chaoyang District, Beijing, 100029, China.,Beijing University of Chinese Medicine, Beijing, China
| | - Feifan Lu
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, No. 2, Yinghuadong Road, Chaoyang District, Beijing, 100029, China.,China-Japan Friendship School of Clinical Medicine, Peking University, Beijing, 100029, China
| | - Weiguo Wang
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, No. 2, Yinghuadong Road, Chaoyang District, Beijing, 100029, China
| | - Wanshou Guo
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.,Department of Orthopaedic Surgery, China-Japan Friendship Hospital, No. 2, Yinghuadong Road, Chaoyang District, Beijing, 100029, China
| | - Qidong Zhang
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, No. 2, Yinghuadong Road, Chaoyang District, Beijing, 100029, China.
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16
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Liu P, Zhang C, Lu Z, Feng J, Xu W, Yang Z. Global research status and trends of UKA for knee osteoarthritis: a bibliometric analysis. ARTHROPLASTY 2020; 2:20. [PMID: 35236446 PMCID: PMC8796558 DOI: 10.1186/s42836-020-00039-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 06/28/2020] [Indexed: 12/03/2022] Open
Abstract
Objective As an alternative of knee-protection surgery, unicompartmental knee arthroplasty has been widely used for the treatment of knee osteoarthritis and has achieved good clinical results. However, reports on its data and trend are scanty. This article reviewed current status and trend in the research of UKA, and compared different regions, organizations and authors in terms of their contributions to the field. Methods The literature on UKA ranging from 2009 to 2019 was searched in the “Web of Science” database, and the search results were visually presented by using Excel and VOS-viewer software packages, and the status quo and development trends of relevant studies were analyzed. Results A total of 1264 articles on UKA were identified, of which 330 were the larger studies conducted in the United States. The institution that published most papers was Oxford University, with a total of 109 papers published. MURRAY DW was the largest contributor in this field. The National Institutes of Health was the largest funding agencies of the UKA. Studies could be divided into six clusters in terms of prosthesis design, follow-up investigation, OA etiology, hip-knee association, joint replacement registration, and computer navigation. “Computer-aided navigation” and “gait analysis” promise to be future hot spots in the field of UKA research. Conclusion Global trend analysis suggests that UKA research is gradually deepening and the number of papers has been on the rise. The USA was the largest contributor to this field. More research effort should be directed to “Computer-aided navigation”and “gait analysis”, which might be the popular topics in the UKA field in not very distant future.
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Bae JH, Kim JG, Lee SY, Lim HC, In Y. Epidemiology of Bearing Dislocations After Mobile-Bearing Unicompartmental Knee Arthroplasty: Multicenter Analysis of 67 Bearing Dislocations. J Arthroplasty 2020; 35:265-271. [PMID: 31471182 DOI: 10.1016/j.arth.2019.08.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 07/21/2019] [Accepted: 08/01/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND This study investigated the epidemiology and causes of bearing dislocations following mobile-bearing unicompartmental knee arthroplasty (MUKA) and determined whether the incidence of primary bearing dislocations decreases as surgeon experience increases. METHODS We retrospectively reviewed the bearing dislocations following MUKAs performed by 14 surgeons with variable experience levels. Causes of bearing dislocations were determined based on the surgical records, radiographs, and operator's suggestion. Using a chi-squared test, the incidence of bearing dislocation was compared between the first 50, the second 50, and the next 100 unicompartmental knee arthroplasties (UKAs) of each surgeon's cohort. RESULTS There were 67 (3.6%) bearing dislocations from 1853 MUKAs. The mean time to bearing dislocations after index MUKAs was 33 months (range, 1-144 months); 55% of the bearing dislocations occurred within 2 years after the index MUKAs. Primary bearing dislocations (n = 58) were the most common, followed by secondary (n = 6) and traumatic dislocations (n = 3). There was no significant difference in the incidence of bearing dislocation between the first 50 and second 50 UKAs for each surgeon. Two surgeons showed a significant decrease in bearing dislocations in their second 100 UKAs, while the other surgeons did not show a difference between their first 100 and second 100 UKAs. CONCLUSION Most bearing dislocations after MUKAs were related to technical errors such as component malposition or gap imbalance. This study did not confirm that the incidence of bearing dislocations decreases as the number of cases increases. LEVEL OF EVIDENCE IV, Case series.
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Affiliation(s)
- Ji-Hoon Bae
- Department of Orthopedic Surgery, Korea University College of Medicine, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Jae Gyoon Kim
- Department of Orthopedic Surgery, Korea University College of Medicine, Korea University Ansan Hospital, Ansan, Gyeonggi-do, Republic of Korea
| | - Seung-Yup Lee
- Yonsei Namu Orthopedic Clinic, Seoul, Republic of Korea
| | - Hong Chul Lim
- Department of Orthopedic Surgery, Seoul Barunsesang Hospital, Seoul, Republic of Korea
| | - Yong In
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Seo SS, Kim CW, Lee CR, Kwon YU, Oh M, Kim OG, Kim CK. Long-term outcomes of unicompartmental knee arthroplasty in patients requiring high flexion: an average 10-year follow-up study. Arch Orthop Trauma Surg 2019; 139:1633-1639. [PMID: 31463687 DOI: 10.1007/s00402-019-03268-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION To evaluate the long-term survival of unicompartmental knee arthroplasty (UKA) in the Asian population and assess differences in clinical outcomes between mobile- and fixed-bearing UKA. MATERIALS AND METHODS Among 111 cases of UKA that were performed by 1 surgeon from January 2002 to December 2009, we retrospectively reviewed 96 cases (36 mobile-bearing, 62 fixed-bearing) for this study. We examined cause of revision or failure, type of reoperation/revision, and duration from the surgery date to the revision upon reviewing the medical record. Survival analysis was conducted using the Kaplan-Meier method. Functional outcomes were evaluated based on range of motion and patient-reported outcome (PRO) measures (Knee Injury and Osteoarthritis Outcome Score) for cases with at least 8 years of follow-up (average, 10.2 years). RESULTS Overall, the 10-year survival was 88% [95% confidence interval (CI) 0.81-0.95], and the estimated mean survival time was 13.4 years (95% CI 12.5-14.2). In a comparison of survival between the mobile- and fixed-bearing groups, the former had a 10-year survival of 85% (95% CI, 0.72-0.97) and an estimated mean survival time of 13.5 years (95% CI 12.2-14.7) and the latter had a 10-year survival of 90% (95% CI 0.82-0.99) and an estimated mean survival time of 13.4 years (95% CI 12.3-14.4). Thus, there was no significant difference in survival between the two groups (log-rank test, p = 0.718). In addition, no significant difference in functional outcomes was observed between the two groups (p > 0.05 for all). CONCLUSIONS UKA performed in the Asian population showed a relatively good functional outcome and survival rate at an average 10-year follow-up. No difference in survival and PROs was observed according to the bearing type. Although the present study demonstrated a good survival rate, similar to that in other Western studies, further studies investigating the impact of the Asian lifestyle on the long-term survival of UKA is necessary.
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Affiliation(s)
- Seung-Suk Seo
- Department of Orthopedic Surgery, Haeundae Bumin Hospital, 584, Haeundae-ro, Haeundae-gu, Busan, 48094, Republic of Korea
| | - Chang-Wan Kim
- Department of Orthopedic Surgery, Inje University Busan Paik Hospital, 75, Bokji-ro, Busanjin-gu, Busan, 47392, Republic of Korea
| | - Chang-Rack Lee
- Department of Orthopedic Surgery, Inje University Busan Paik Hospital, 75, Bokji-ro, Busanjin-gu, Busan, 47392, Republic of Korea.
| | - Yong-Uk Kwon
- Department of Orthopedic Surgery, Inje University Busan Paik Hospital, 75, Bokji-ro, Busanjin-gu, Busan, 47392, Republic of Korea
| | - Minkyung Oh
- Department of Pharmacology, Inje University College of Medicine, 75, Bokji-ro, Busanjin-gu, Busan, 47392, Republic of Korea
| | - Ok-Gul Kim
- Department of Orthopedic Surgery, Bumin Hospital, 59, Mandeok-daero, Buk-gu, Busan, 46555, Republic of Korea
| | - Chang-Kyu Kim
- Department of Orthopedic Surgery, Haeundae Bumin Hospital, 584, Haeundae-ro, Haeundae-gu, Busan, 48094, Republic of Korea
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Heaps BM, Blevins JL, Chiu YF, Konopka JF, Patel SP, McLawhorn AS. Improving Estimates of Annual Survival Rates for Medial Unicompartmental Knee Arthroplasty, a Meta-Analysis. J Arthroplasty 2019; 34:1538-1545. [PMID: 30954408 DOI: 10.1016/j.arth.2019.02.061] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 02/20/2019] [Accepted: 02/27/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Medial unicompartmental knee arthroplasty (mUKA) is an increasingly popular treatment option for medial compartment knee osteoarthritis. Published mUKA survival rates have varied. The purpose of this meta-analysis was to provide pooled estimates of mUKA survival 5 and 10 years postoperatively. METHODS We included studies in English within the last 15 years with a clear description of mUKA failure. Random-effects models were used to pool complementary log-log transformed implant survival estimates at 5 and 10 years postoperatively. Between-study variance was estimated using the restricted maximum likelihood method. Between-study heterogeneity was tested using the χ2 test and quantified using the I2 statistic. I2 values <25%, 25%-75%, and >75% were considered low, moderate, and high, respectively. Multivariable meta-regression was used to assess the potential association of mean patient age and study start year with survival estimates at 5 and 10 years. All analyses were performed using the metafor and meta packages implemented in R software version 3.3.4 (R Foundation for Statistical Computing, Vienna, Austria). RESULTS Twenty-six studies met inclusion criteria, representing 42,791 knees. Study-level and pooled 5- and 10-year mUKA survival estimates were 95.3% (95% confidence interval, 93.6-96.6) and 91.3% (88.9-93.3), respectively. Between-study heterogeneity was high (>88%) for all years. Mean patient age and study start year explained only 12.3% and 30.7% of between-study heterogeneity at 5 and 10 years, respectively. CONCLUSION Five- and 10-year pooled mUKA survival estimates were 95.3% and 91.3%, respectively. These data establish better estimates of mUKA survivorship and can help when counseling patients considering mUKA.
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Affiliation(s)
- Braiden M Heaps
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Jason L Blevins
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Yu-Fen Chiu
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Joseph F Konopka
- Department of Orthopaedic Surgery, Wentworth-Douglass Hospital, Dover, NH
| | - Shaun P Patel
- Department of Orthopaedic Surgery, Southern California Permanente Medical Group, Irvine, CA
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Does unicompartmental knee arthroplasty have worse outcomes in spontaneous osteonecrosis of the knee than in medial compartment osteoarthritis? A systematic review and meta-analysis. Arch Orthop Trauma Surg 2019; 139:393-403. [PMID: 30680456 DOI: 10.1007/s00402-019-03125-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION The role of unicompartmental knee arthroplasty (UKA) in spontaneous osteonecrosis of the knee (SONK) remains controversial, even though SONK involves only one compartment of the knee joint. We aimed to compare the survival rate and clinical outcomes of UKA in SONK and medial compartment osteoarthritis (MOA) via a meta-analysis of previous studies. MATERIALS AND METHODS MEDLINE, Embase, and Cochrane Library were searched up to January 2018 with keywords related to SONK and knee arthroplasty. Studies were selected with predetermined inclusion criteria: (1) medial UKA as the primary procedure, (2) reporting implant survival or clinical outcomes of osteonecrosis and osteoarthritis, and (3) follow-up period > 1 year. Quality assessment was performed using the risk of bias assessment tool for non-randomized studies. A random-effects model was used to estimate the pooled relative risk (RR) and standardized mean difference. RESULTS The incidence of UKA revision for any reason was significantly higher in SONK than in MOA group (pooled RR = 1.83, p = 0.009). However, the risk of revision due to aseptic loosening was not significantly different between the groups. Moreover, when stratified by the study quality, high-quality studies showed similar risk of overall revision in SONK and MOA (p = 0.71). Subgroup analysis revealed no significant difference in failure between SONK and MOA after cemented mobile and fixed bearing UKA. Results of uncemented UKA were reported only in one study, which showed higher failure of SONK compared to MOA. Clinical outcomes after UKA were similar between SONK and MOA (p = 0.66). CONCLUSIONS Cemented UKA has similar survival and clinical outcomes in SONK and MOA. Prospective studies designed specifically to compare the UKA outcomes in SONK and MOA are necessary.
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Yang WM, Zhao CQ, Lu ZY, Yang WY, Lin DK, Cao XW. Clinical Characteristics and Treatment of Spontaneous Osteonecrosis of Medial Tibial Plateau: A Retrospective Case Study. Chin Med J (Engl) 2019; 131:2544-2550. [PMID: 30381587 PMCID: PMC6213846 DOI: 10.4103/0366-6999.244113] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background: In a small proportion of cases, spontaneous osteonecrosis of the knee (SONK) involves the medial tibial plateau (MT). Here, we introduced the clinical characteristics of spontaneous osteonecrosis of the MT and unicompartmental knee arthroplasty (UKA) as the favorable treatment for this situation based on a retrospective case study. Methods: Patients with spontaneous osteonecrosis of the MT, confirmed by magnetic resonance imaging (MRI) at Guangdong Provincial Hospital of Chinese Medicine (China) from March 2015 to June 2016, were included as a case serial and analyzed retrospectively. All patients underwent Oxford Medial UKA. The characteristics of their lesions, corresponding treatment, and results of follow-up were presented. The lesion scores and grade were determined according to the criteria of Ficat and Arlet. Results: In total, 22 patients (5 men, 17 women; mean age, 64.1 years) with spontaneous osteonecrosis of the MT were analyzed. The lesion stages assessment showed that 3 (14%) were Stage II, 10 (45%) were Stage III, 7 (32%) were Stage IV, and 2 (9%) were Stage V. In the sagittal plane, 7 (32%) were in the anterior region (MTa) and 15 (68%) were central (MTc). The lesion volume averaged 2.24 ± 0.79 cm3 (range: 1.57–3.08 cm3). Seventeen patients (77%) had Level III posterior medial meniscus root tears (MMRTs). All the patients underwent UKA. Average follow-up was 30.0 ± 6.4 months with a range of 23.0–38.0 months. The visual analog scale score was 7.78 ± 0.67 before surgery while decreased to 2.22 ± 1.09 at the final follow-up (P < 0.001). The Hospital for Special Surgery scores of pre-/post-surgery were 65.67 ± 5.45 and 84.10 ± 4.20, respectively (P < 0.001). Conclusions: SONK often occurs in the anterior and central tibial plateau due to abnormal stresses. Most of the patients had Level III posterior medial meniscus root tears. MRI is recommended for suspected cases to identify SONK at an early stage. The use of the Oxford Medial UKA for SONK of the MT is reliable both immediately and at follow-up.
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Affiliation(s)
- Wei-Ming Yang
- Department of Orthopaedics, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510120, China
| | - Cai-Qiong Zhao
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong 510120, China
| | - Zhao-Yu Lu
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong 510120, China
| | - Wei-Yi Yang
- Department of Orthopaedics, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510120, China
| | - Ding-Kun Lin
- Department of Orthopaedics, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510120, China
| | - Xue-Wei Cao
- Department of Orthopaedics, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510120, China
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Stempin R, Stempin K, Kaczmarek W. Medium-term outcome of cementless, mobile-bearing, unicompartmental knee arthroplasty. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:41. [PMID: 30906745 DOI: 10.21037/atm.2018.12.50] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Cemented, mobile-bearing unicondylar knee arthroplasty (UKA) yields good functional results. However, radiolucent lines (RLL) are not uncommon, even in asymptomatic patients, and it has been debated whether these "physiological" RLLs are indicative of loosening. Cementless UKA may lead to fewer RLLs compared with cemented devices. The present study was designed to document mid-term outcome with an emphasis on clinical outcomes. Methods We included 153 knees of 150 consecutive patients in a retrospective study. All patients had received a cementless medial mobile-bearing UKA. Patients were evaluated with use of the Knee Society Score (KSS), which was obtained at baseline and at final follow-up. The WOMAC, Oxford Knee Score (OKS) and Forgotten Joint Scores (FJS-12) were administered at the final follow-up. Anteroposterior (AP) and lateral radiographs were taken at final follow-up. Results At a mean follow-up of 5 years (range, 3-7 years), implant survival was 97.1% (95% confidence interval, 91.1-99.1%). Excellent postoperative KSS, WOMAC, OKS and FJS scores were obtained. Postoperative radiography was available for 78 knees. RLL was observed in 10.3% of the cases, but no cases with complete RLLs were seen. Conclusions Favourable results were found for cementless, mobile-bearing UKA, with no aseptic loosening at an average follow-up of 5 years. Cementless UKA fixation may lead to a clinically "forgotten joint" and may decrease the rate of RLLs.
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Affiliation(s)
- Radosław Stempin
- Department of Orthopedic & Trauma Surgery, J. Strus Memorial (Multispecialistic City) Hospital, Poznan, Poland
| | - Kacper Stempin
- Department of Orthopedic & Trauma Surgery, Westallgäu Clinic, Wangen, Germany
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Zhang Q, Zhang Q, Guo W, Gao M, Ding R, Wang W. Risk factors of postoperative valgus malalignment in mobile-bearing medial unicompartmental knee arthroplasty. Arch Orthop Trauma Surg 2019; 139:241-248. [PMID: 30417208 DOI: 10.1007/s00402-018-3070-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of this observational study was to investigate the risk factors of postoperative valgus malalignment after mobile-bearing medial unicompartmental knee arthroplasty (UKA). METHODS We retrospectively evaluated radiographic and surgical characteristics in 122 consecutive Oxford phase 3 UKAs. According to postoperative hip-knee-ankle angle (HKAA), 24 knees were sorted into group valgus with HKAA > 180° and 98 knees were sorted into group non-valgus with HKAA ≤ 180°. Logistic regression was performed to analyze risk factors including age, gender, BMI, side, preoperative limb alignment HKAA, preoperative LDFA, MPTA, FTFA, thickness of polyethylene bearing insert, tibial prothesis size, femoral prothesis size, medial tibial cut thickness, thickness of distal femoral mill, prothesis angle of coronal, and sagittal plane. RESULTS The mean mechanical preoperative HKAA of 174.39°±4.23° was corrected to 178.18°±3.49° postoperatively (t = - 13.45, p = 0.000). The mean of postoperative HKAA in valgus group and non-valgus group was 183.45 ± 2.21° and 176.88 ± 2.35°, respectively (t = 12.44, p = 0.000). After statistical analysis with univariate analysis, eight risk factor variables among 16 independent variables were identified as potential predictors with p value ≤ 0.1. Multivariate logistic regression analysis for these eight potential predictors revealed that tibial cut (p = 0.046), LDFA (p = 0.003), MPTA (p = 0.011), and FTFA (p = 0.008) were significant risk factors predicting postoperative valgus malalignment after mobile-bearing UKA. CONCLUSIONS Preoperative smaller LDFA, FTFA, larger MPTA and less medial tibial cut thickness were significantly associated with postoperative valgus malalignment in mobile-bearing UKA.
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Affiliation(s)
- Qidong Zhang
- Department of Orthopaedic Surgery, Beijing Key Lab Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Qian Zhang
- Beijing University of Chinese Medicine, Yinghuadong Road, Chaoyang District, Beijing, 100029, China
| | - Wanshou Guo
- Department of Orthopaedic Surgery, Beijing Key Lab Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Man Gao
- Beijing University of Chinese Medicine, Yinghuadong Road, Chaoyang District, Beijing, 100029, China
| | - Ran Ding
- Department of Orthopaedic Surgery, Beijing Key Lab Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Weiguo Wang
- Department of Orthopaedic Surgery, Beijing Key Lab Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, Beijing, 100029, China.
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Pongcharoen B, Boontanapibul K. Outcomes of mobile bearing unicompartmental knee arthroplasty in medial osteoarthritis knee with and without preoperative genu recurvatum. World J Orthop 2018; 9:149-155. [PMID: 30254971 PMCID: PMC6153131 DOI: 10.5312/wjo.v9.i9.149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 07/03/2018] [Accepted: 07/15/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To compare clinical outcomes of patients with and without preoperative genu recurvatum (GR) following mobile bearing unicompartmental knee arthroplasty (UKA).
METHODS We prospectively followed 176 patients for at least 24 mo who had been treated by unilateral, minimally invasive, Oxford UKA. Patients with medial osteoarthritis (OA) knee and preoperative GR (Group I) accounted for 18% (n = 32) and patients without preoperative GR (Group II) accounted for the remaining 82% (n = 144). Knee score, pain scores, and functional scores were assessed for each patient and compared between the two groups. The incidence of postoperative GR and the postoperative hyperextension angles also were recorded and analyzed.
RESULTS The pain score, knee score and functional score were not significantly different between the two groups. Similarly, the incidence of postoperative GR and the measured hyperextension angles were not significantly different between the two groups. The incidence of postoperative GR was 1/32 (3.12%) in Group I and 1/144 (0.69%) in Group II (P = 0.34). The mean postoperative hyperextension angles were 2.40° ± 2.19° (range: 1°-7°) for Group I and 1.57° ± 3.51° (range: 1°-6°) for Group II (P = 0.65).
CONCLUSION Medial OA of the knee and concomitant GR is not a contraindication for the mobile bearing UKA.
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Rodríguez-Merchán EC, Gómez-Cardero P. Unicompartmental knee arthroplasty: Current indications, technical issues and results. EFORT Open Rev 2018; 3:363-373. [PMID: 30034817 PMCID: PMC6026888 DOI: 10.1302/2058-5241.3.170048] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
An age younger than 60 years, a body weight of 180 lb (82 kg) or more, performing heavy work, having chondrocalcinosis and having exposed bone in the patellofemoral (PF) joint are not contraindications for unicompartmental knee arthroplasty (UKA).Severe wear of the lateral facet of the PF joint with bone loss and grooving is a contraindication for UKA.Medial UKA should only be performed in cases of severe osteoarthritis (OA) as shown in pre-operative X-rays, with medial bone-on-bone contact and a medial/lateral ratio of < 20%.The post-operative results of UKA are generally good. Medium-term and long-term studies have reported acceptable results at 10 years, with implant survival greater than 95% for UKAs performed for medial OA or osteonecrosis and for lateral UKA, especially when fixed-bearing implants are used.When all implant-related re-operations are considered, the 10-year survival rate is 94%, and the 15-year survival rate is 91%.Aseptic loosening is the principal failure mechanism in the first few years in mobile-bearing implants, whereas OA progression causes most failures in later years in fixed-bearing implants.The overall complication rate and the comprehensive re-operation rate are comparable in both mobile bearings and fixed bearings.The survival likelihood of the all-polyethylene UKA implant is similar to that of metal-backed modular designs for UKA.Notable cost savings of approximately 50% can be achieved with an outpatient UKA surgery protocol. Outpatient surgery for UKA is efficacious and safe, with satisfactory clinical results thus far. Cite this article: EFORT Open Rev 2018;3:363-373. DOI: 10.1302/2058-5241.3.170048.
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Neufeld ME, Albers A, Greidanus NV, Garbuz DS, Masri BA. A Comparison of Mobile and Fixed-Bearing Unicompartmental Knee Arthroplasty at a Minimum 10-Year Follow-up. J Arthroplasty 2018; 33:1713-1718. [PMID: 29398257 DOI: 10.1016/j.arth.2018.01.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 12/23/2017] [Accepted: 01/04/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The long-term survivorship and functional outcomes of the mobile-bearing (MB) compared to the fixed-bearing (FB) unicompartmental knee arthroplasty (UKA) implant design remain a topic of debate. The aim of the current study was to compare the survivorship and functional outcomes of MB and FB UKA at a minimum 10-year follow-up. METHODS We retrospectively reviewed 106 consecutive medial UKAs (89 patients) from our institution with a minimum 10-year follow-up. The 38 MB and 68 FB knees had follow-up of 14.2 years (12.9-15.5) and 11.5 years (10.2-15.1), respectively. Validated patient-reported outcomes and radiographs were evaluated as were etiology, timing, and complexity of revision. Kaplan-Meier 10-year survival was calculated with revision to total knee arthroplasty as the end point. RESULTS The 10-year survival was 82.9% (95% confidence interval [CI] 65.8-91.9) for MB and 90.9% (95% CI 79.4-96.2) for FB UKA (P = .102), and 88.0% (95% CI 79.3-93.2) for the entire cohort. Patient outcomes were similar between groups, as were timing and etiologies for revision to total knee arthroplasty. One-third of revisions required either stems or tibial augments, and of these, all were of MB design. CONCLUSION Survival and functional outcomes were similar between MB and FB designs. One-third of revisions required either stems or augments, all were of MB design.
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Affiliation(s)
- Michael E Neufeld
- Department of Orthopaedics, Reconstructive Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anthony Albers
- Department of Orthopaedics, McGill University, St. Mary's Hospital, Montréal, Quebec, Canada
| | - Nelson V Greidanus
- Department of Orthopaedics, Reconstructive Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Donald S Garbuz
- Department of Orthopaedics, Reconstructive Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bassam A Masri
- Department of Orthopaedics, Reconstructive Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
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Ro KH, Heo JW, Lee DH. Bearing Dislocation and Progression of Osteoarthritis After Mobile-bearing Unicompartmental Knee Arthroplasty Vary Between Asian and Western Patients: A Meta-analysis. Clin Orthop Relat Res 2018; 476:946-960. [PMID: 29406457 PMCID: PMC5916611 DOI: 10.1007/s11999.0000000000000205] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Implant survivorship is reported to be lower and complications, particularly bearing dislocation, are reported to be more frequent in Asian than in Western patients with medial knee osteoarthritis (OA) undergoing Oxford® Phase III unicompartmental knee arthroplasty (UKA). To date, however, these complications have not been compared between these groups of patients. QUESTIONS/PURPOSES The purpose of this study was to perform a meta-analysis comparing the standardized incidence rates of (1) all-cause reoperation; (2) reoperation related to bearing dislocation; and (3) reoperation related to progression of lateral compartment arthritis in Asian and Western patients with medial knee OA who underwent Oxford Phase III UKA. METHODS We searched MEDLINE® (January 1, 1976, to May 31, 2017), EMBASE® (January 1, 1985, to May 31, 2017), and the Cochrane Library (January 1, 1987, to May 31, 2017) for studies that reported complications of Oxford Phase III UKAs. Studies were included if they reported reoperation rates attributable to bearing dislocation and/or progression of lateral knee OA after surgery with this implant. Twenty-seven studies were included in this systematic review and 16 studies with followups > 5 years were included in the meta-analysis. These rates were converted to standardized incidence rate (that is, reoperations per 100 observed component years) based on mean followup and number of involved knees in each study. After applying prespecified inclusion and exclusion criteria, the studies were categorized into two groups, Asian and Western, based on hospital location. Twenty-five studies, containing 3152 Asian patients and 5455 Western patients, were evaluated. Study quality was assessed by the modified Coleman Methodology score (MCMS). Although all studies were Level IV, their mean MCMS score was 66.92 (SD, 8.7; 95% confidence interval [CI], 63.5-70.3), indicating fair quality. Because the heterogeneity of all subgroup meta-analyses was high, a random-effects model was used with estimations using the restricted maximum likelihood method. RESULTS There was no difference in the proportion of Asian patients versus Western patients undergoing reoperation for any cause calculated as 100 component observed years (1.022 of 3152 Asian patients; 95% CI, 0.810-1.235 versus 1.300 of 5455 Western patients; 95% CI, 1.067-1.534; odds ratio, 0.7839; 95% CI, 0.5323-1.1545; p = 0.178). The mean reoperation rate attributable to bearing dislocation per 100 observed years was higher in Asian than in Western patients (0.525; 95% CI, 0.407-0.643 versus 0.141; 95% CI, 0.116-0.166; odds ratio, 3.7378; 95% CI, 1.694-8.248; p = 0.001) Conversely, the mean reoperation rate attributable to lateral knee OA per 100 observed years was lower in Asian than in Western patients (0.093; 95% CI, 0.070-0.115 versus 0.298; 95% CI, 0.217-0.379; odds ratio, 0.3114; 95% CI, 0.0986-0.9840; p < 0.001). CONCLUSIONS Although total reoperation rates did not differ in the two populations, reoperation for bearing dislocation was more likely to occur in Asian than in Western patients, whereas reoperation for lateral knee OA progression was more likely to occur in Western than in Asian patients after Oxford Phase III UKA. Although possible explanations for these findings may be hypothesized, additional randomized, prospective comparative studies are needed. However, better survival outcomes after UKA may require consideration of ethnicity and lifestyle choices in addition to traditional surgical technique and perioperative care. LEVEL OF EVIDENCE Level III, therapeutic study.
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