Outcomes of lateral unicompartmental knee arthroplasty in post-traumatic osteoarthritis, a retrospective comparative study

Lateral Unicompartmental Knee Arthroplasty for Osteoarthritis Secondary to Lateral Meniscectomy: High Functional Results and Survivorship and Low Osteoarthritis Progression at a Mean 10 Years of Follow-up

BACKGROUND

Meniscectomy, whether partial or total, is a common knee surgery, but it considerably increases the risk of knee osteoarthritis (OA). Lateral meniscectomy has more severe consequences than medial meniscectomy, leading to faster OA progression and worse clinical outcomes. Unicompartmental knee arthroplasty (UKA) is a suitable treatment option for lateral OA and has demonstrated better outcomes than total knee arthroplasty (TKA). The aims of this study were to evaluate the clinical and functional results, OA progression in the medial compartment, and implant survivorship following lateral UKA in patients with OA secondary to lateral meniscectomy and to compare these outcomes with those of patients who underwent lateral UKA for primary lateral OA.

METHODS

Between 2001 and 2017, 214 lateral UKAs were performed. Of these, 42 were performed for OA secondary to lateral meniscectomy. The control group was composed of patients who underwent lateral UKA for primary lateral OA and was formed through a 1:1 case-control matching process based on sex, age, body mass index, and operation date. The outcomes that were studied included range of motion, Knee Society Score, University of California Los Angeles (UCLA) Activity Score, Tegner Activity Scale, Forgotten Joint Score, visual analog scale for pain, OA progression in the medial compartment, and implant survivorship.

RESULTS

At a mean follow-up of 10.2 years, both groups demonstrated significant improvements (p < 0.01) after lateral UKA in all clinical and functional scores except the UCLA Activity Score and Tegner Activity Scale. No significant differences in clinical and functional scores were found between the groups. However, patients with OA secondary to meniscectomy exhibited significantly less OA progression in the medial compartment (p = 0.035) and higher 10-year implant survival (97.6% versus 83.3%).

CONCLUSIONS

Lateral UKA is an effective treatment option for OA secondary to lateral meniscectomy, providing excellent functional outcomes and survivorship. Patients with post-meniscectomy OA exhibited less OA progression in the medial compartment than patients with primary OA and, consequently, had better 10-year implant survivorship.

LEVEL OF EVIDENCE

Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.

Lateral UKA can be a safe solution in a young patients' population: a 10-year follow-up report

BACKGROUND

This study aimed to assess the long-term survivorship and functional outcomes of fixed-bearing lateral unicompartmental knee arthroplasty (UKA) in a young patients' population with osteoarthritis limited to the lateral compartment.

METHODS

The study included a cohort of consecutive patients who underwent lateral UKA between January 2008 and December 2014 at a single high-volume surgical center. The surgical procedures were performed by experienced surgeons using a lateral parapatellar approach and fixed-bearing implants. Patient follow-up included a retrospective re-evaluation, clinical assessments, patient-reported outcome measures (PROMs), and X-ray analysis.

RESULTS

A total of 40 lateral UKAs were analyzed, with 19 performed on the left and 21 on the right knee. The mean age of the patients at the time of surgery was 57.6 years, and the mean BMI was 24.8. At the final follow-up, 80% of patients achieved excellent outcomes (OKS > 41), and 20% had good outcomes (OKS: 34-41). No patients exhibited fair or poor outcomes. The mean FJS at the final follow-up was 82.8. The mean WOMAC was 10.5. Kaplan-Meier survival analysis revealed a survivorship rate of 93.1% at 10 years, considering revision for any reason as endpoint.

CONCLUSIONS

Lateral UKA proved to be an effective treatment option for osteoarthritis affecting the lateral compartment of the knee. The study demonstrated a high survivorship rate and favorable functional outcomes at a mean follow-up of 132.7 months. These findings highlight the potential benefits of fixed-bearing lateral UKA in selected patients with lateral compartment knee pathology.

Radiographic Evidence of Early Posttraumatic Osteoarthritis following Tibial Plateau Fracture Is Associated with Poorer Function

To determine if radiographic evidence of posttraumatic osteoarthritis (PTOA) following tibial plateau fracture correlates with poorer clinical and functional outcomes, patients with tibial plateau fractures were followed at 3, 6, and 12 months. All patients had baseline radiographs and computed tomography scan. Radiographs obtained at each follow-up were reviewed for healing, articular incongruence, hardware positional changes, and the development of postinjury arthritic change. Cohorts were determined based on the presence (PTOA) or absence (NPTOA) of radiographic evidence of PTOA. Demographics, fracture classification, complications, additional procedures, and functional status were compared between cohorts. Sixty patients had radiographic evidence of PTOA on follow-up radiographs at a mean final follow-up of 24.2 months. The NPTOA cohort was composed of 210 patients who were matched to the PTOA cohort based on age and Charlson comorbidity index. Mean time to fracture union for the overall cohort was 4.86 months. Cohorts did not differ in Schatzker classification, time to healing, injury mechanism, or baseline Short Musculoskeletal Function Assessment (SMFA). Patients with PTOA had a greater degree of initial depression and postoperative step-off, higher incidence of initial external fixator usage, higher rates of reoperation for any reason, and higher rates of wound complications. Associated soft tissue injury and meniscal repair did not coincide with the development of PTOA. Range of motion and SMFA scores were significantly worse at all time points in patients with PTOA. Although fracture patterns are similar, patients who required an initial external fixator, had a greater degree of initial depression or residual articular incongruity, underwent more procedures, and developed an infection were found to have increased incidence of PTOA. Radiographic evidence of osteoarthritis correlated with worse functional status in patients. The goal of surgery should be restoration of articular congruity and stability to mitigate the risk of PTOA, although this alone may not prevent degenerative changes. Patients with early loss of range of motion should be aggressively treated as this may precede the development of PTOA.

How do patients sleep after orthopaedic surgery? Changes in objective sleep parameters and pain in hospitalized patients undergoing hip and knee arthroplasty

PURPOSE

The aim of this observational cohort study was to assess actigraphy-based sleep characteristics and pain scores in patients undergoing knee or hip joint replacement and hospitalized for ten days after surgery.

METHODS

N=20 subjects (mean age: 64.0±10.39 years old) wore the Actiwatch 2 actigraph (Philips Respironics, USA) to record sleep parameters for 11 consecutive days. Subjective scores of pain, by a visual analog scale (VAS), were constantly monitored and the following evaluation time points were considered for the analysis: pre-surgery (PRE), the first (POST1), the fourth (POST4), and the tenth day (POST10) after surgery.

RESULTS

Sleep quantity and timing parameters did not differ from PRE to POST10, during the hospitalization whereas sleep efficiency and immobility time significantly decreased at POST1 compared to PRE by 10.8% (p=0.003; ES: 0.9, moderate) and 9.4% (p=0.005; ES: 0.86, moderate) respectively, and sleep latency increased by 18.7 min (+320%) at POST1 compared to PRE (p=0.046; ES: 0.70, moderate). Overall, all sleep quality parameters showed a trend of constant improvement from POST1 to POST10. VAS scores were higher in the first day post-surgery (4.58 ± 2.46; p=0.0011 and ES: 1.40, large) compared to POST10 (1.68 ± 1.58). During the time, mean VAS showed significant negative correlations with mean sleep efficiency (r = -0.71; p=0.021).

CONCLUSION

Sleep quantity and timing parameters were stable during the entire hospitalization whereas sleep quality parameters significantly worsened the first night after surgery compared to the pre-surgery night. High scores of pain were associated with lower overall sleep quality.

Survival of lateral unicompartmental knee arthroplasty at short-, mid-, and long-term follow-up: a systematic review and meta-analysis

BACKGROUND

The infrequency of lateral unicompartmental knee arthroplasty (UKA) has led to a lack of understanding of its survival. This study aimed to systematically evaluate the survivorship results of lateral UKA at different follow-ups based on available literature.

METHODS

Five databases were searched for eligible studies. Pooled survivorships with 95% confidence intervals (CIs) at 3, 5, 10, 15, and 20 years after lateral UKA were estimated using a random-effect model. Subgroup and sensitivity analyses were performed.

RESULTS

A total of 26 studies involving 5470 lateral UKAs were included. Survivorships of lateral UKA at 3-, 5-, 10-, 15-, and 20-year follow-ups were 96% (95% CI: 95-98%, I2 : 77.5%), 94% (95% CI: 93-96%, I2 : 70.8%), 88% (95% CI: 84-91%, I2 : 70.8%), 85% (95% CI: 79-91%, I2 : 70.8%), and 78% (95% CI: 71-85%, I2 : 54.2%), respectively. Subgroup analyses found that bearing type, the number of surgeons, and year of publication might be associated with implant survival outcomes.

CONCLUSION

Lateral UKA is an effective procedure with excellent survivorships at short-, mid-, and long-term follow-ups. Results suggest a single-surgeon lateral UKA using fixed-bearing. Additional well-designed studies are needed to elucidate the current findings.

Mild Valgus Alignment After Lateral Unicompartmental Knee Arthroplasty Led to Lower Functional Results and Survivorship at Mean 8-Year Follow-Up

BACKGROUND

In medial unicompartmental knee arthroplasty (UKA), the best results and the highest survivorship are found by mild undercorrection of varus deformities. In lateral UKA, the desirable amount of valgus undercorrection has not yet been determined. The purposes of this study were to present the results of a consecutive series of lateral UKAs and to investigate the effect of postoperative limb alignment on them.

METHODS

A total of 161 lateral UKA were reviewed. Outcomes studied included range of motion (ROM), Knee Society Score (KSS), University of California Los Angeles Activity Score, Tegner Activity Scale, Forgotten Joint Score, visual analogue scale (VAS) for pain, and survivorship. Patients were divided into two groups according to postoperative alignment: group A (hip-knee-ankle ≥184°, 79 UKA) and group B (hip-knee-ankle <184°, 82 UKA).

RESULTS

At a mean follow-up of 8 years (range, 2-18), ROM (P < .01); KSS-C (P < .01); KSS-F (P < .01); VAS (P < .01) improved from baseline. No differences were noted in postoperative ROM, VAS, University of California Los Angeles, Tegner Activity Scale, and Forgotten Joint Score between groups. Group A showed higher postoperative clinical and functional KSS (P < .01) and higher survivorship (96.2 versus 91.5%, P = .01) than group B.

CONCLUSION

Mild valgus alignment (3° or less) after lateral UKA is linked to lower clinical and functional scores and lower survivorship compared to moderate valgus (over 4°) at mean 8-year follow-up. More undercorrection of the coronal deformity in lateral UKA compared to medial UKA is desirable to get the best results.

Safety and Efficacy of Single Condylar Knee Prosthesis When Treating Knee Single Compartment Osteoarthritis: A Prospective, Case-Randomized Controlled Study

Objective. The aim of this study is to explore the safety and efficacy of single condylar knee prosthesis when treating knee single compartment osteoarthritis by measuring the decrease of hemoglobin, total postoperative blood loss, maximum reduction of HCT, and knee joint activity. Methods. A total of 80 patients with knee joint single compartment osteoarthritis treated in our hospital from January 2020 to December 2021 were studied. They were randomly assigned to a study group (n = 40) and a control group (n = 40). The study group was treated with total knee prosthesis, while the control group was treated with simple knee prosthesis. The decrease rate of hemoglobin, the amount of bleeding, and the maximum decrease of hematocrit were compared after treatment. The range of motion of knee joint was evaluated by the Fugl-Meyer motor function scale (FM-B) and Berg balance scale (BBS). Results. The decrease of hemoglobin in the study group at 24 hours, 36 hours, and 48 hours after treatment was remarkably lower ( $P$  < 0.05). The total blood loss and the maximum reduction of hematocrit(HCT) in the study group were lower ( $P$  < 0.05). The range of motion (ROM) of the knee joint in the study group at 6 and 12 months after treatment was remarkably higher than that before treatment and remarkably higher compared to the control group ( $P$  < 0.05). The FM-B scale and BBS scale of the studied cohort at 6 and 12 months after treatment were remarkably higher than those before treatment and were remarkably higher compared to the control’s ( $P$  < 0.05). Conclusion. The unicondylar knee prosthesis is safer and more effective in the treatment of noncompartmental osteoarthritis of the knee, facilitating less trauma and perioperative blood loss and enhancing the patient’s motion and balance.

Effects of Surgical Treatment Guided by the Three-Column Classification Method on Knee Joint Function and Postoperative Complications in Patients with Tibial Plateau Fractures

Many patients with tibial plateau fractures present with various degrees of soft tissue contusion and severely damaged articular surface, ligament, and vascular nerves, and thus how to treat this kind of patient has become one of the great difficulties in clinical practice. Therefore, we aim to investigate the effects of surgical treatment guided by the three-column classification method on knee joint function and postoperative complications in patients with tibial plateau fractures. A total of 120 patients with three-column tibial plateau fractures admitted to our hospital from January 2018 to January 2019 were selected and divided into group A (n = 60) and group B (n = 60). Among them, the group A patients were treated with an anterior lateral approach in floating positions combined with reduction plate internal fixation with an L-shaped approach in the posteromedial joint, while the patients in group B received reduction plate internal fixation with a knee midline incision in supine positions. After that, the perioperative indexes, knee function scores, the MOS item short-from health survey (SF-36) scores, complication rate (CR), and overall treatment efficacy of the patients were compared between the two groups. The perioperative indexes in group A were significantly better than those in group B (P < 0.001); the knee function scores and SF-36 scores in group A were significantly higher than those in group B (P < 0.001); the CR in group A was significantly lower than that in group B (P < 0.001); the treatment efficacy in group A was significantly better than that in group B (P < 0.05). The three-column classification method, with highly instructive significance in tibial plateau fracture surgery, can improve treatment efficacy and reduce the incidence of complications, which is worthy of application and promotion in clinical practice.