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Watrinet J, Blum P, Maier M, Klingbeil S, Regenbogen S, Augat P, Schipp R, Reng W. Undersizing of the tibial component in Oxford unicompartmental knee arthroplasty (UKA) increases the risk of periprosthetic fractures. Arch Orthop Trauma Surg 2024; 144:1353-1359. [PMID: 38214714 DOI: 10.1007/s00402-023-05142-z] [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: 03/30/2023] [Accepted: 11/11/2023] [Indexed: 01/13/2024]
Abstract
INTRODUCTION Tibial periprosthetic fractures (TPF) after unicompartmental knee arthroplasty (UKA) are a rare condition that affects about 1% of cases. Known risk factors include age, sex, body mass index (BMI), and bone density, as well as surgical technique and prosthesis design. The purpose of the study was to determine if undersizing of the tibial component in relation to the femoral component increases the risk of tibial periprosthetic fractures. MATERIAL AND METHODS Over a 6-year-period 1542 patients with cemented (n = 363) and uncemented (n = 1179) medial UKA were retrospectively evaluated. Tibial periprosthetic fractures were identified and classified, and epidemiologic data were documented at follow-up. Undersizing was defined as a smaller tibial component compared to the femoral implant. The association of potential risk factors for TPF with the incidence of TPF was investigated with binominal logistic regression. RESULTS Fourteen patients (0.9%) suffered from TPF at a median of 1 month after surgery. The mean follow-up period was 5.9 ± 1.7 years. Fractures were more common in cases with undersized tibial components [odds ratio (OR) 3.2, p < 0.05]. Furthermore, older age (OR 1.1, p < 0.05) and female sex (OR 6.5, p < 0.05) were identified as significant risk factors, while BMI (p = 0.8) and cemented implantation (p = 0.2) had no effect on fracture rate. Revision surgery included open reduction and internal fixation or conversion to total knee arthroplasty. CONCLUSIONS Undersizing of implant sizes in UKA increases the risk for TPF especially in patients with small tibial implants. Therefore, mismatched implants should be avoided for UKA particularly when risk factors like obesity, older age, or female gender are present. Tibial periprosthetic fractures were successfully treated by open reduction and internal fixation or conversion to total knee arthroplasty.
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Affiliation(s)
- Julius Watrinet
- Endogap Joint Replacement Institute, Auenstraße 7, 82467, Garmisch-Partenkirchen, Germany.
- Department Trauma Surgery, BG Unfallklinik Murnau, Prof. Küntscher Str. 8, 82418, Murnau, Germany.
| | - Philipp Blum
- Endogap Joint Replacement Institute, Auenstraße 7, 82467, Garmisch-Partenkirchen, Germany
- Department Trauma Surgery, BG Unfallklinik Murnau, Prof. Küntscher Str. 8, 82418, Murnau, Germany
| | - Michael Maier
- Endogap Joint Replacement Institute, Auenstraße 7, 82467, Garmisch-Partenkirchen, Germany
| | - Steffen Klingbeil
- Endogap Joint Replacement Institute, Auenstraße 7, 82467, Garmisch-Partenkirchen, Germany
| | - Stephan Regenbogen
- Endogap Joint Replacement Institute, Auenstraße 7, 82467, Garmisch-Partenkirchen, Germany
- Department Trauma Surgery, BG Unfallklinik Murnau, Prof. Küntscher Str. 8, 82418, Murnau, Germany
| | - Peter Augat
- Institute Institute for Biomechanics, BG Unfallklinik Murnau, Prof. Küntscher Str. 8, 82418, Murnau, Germany
- Institute for Biomechanics, Paracelsus Medical University, Strubergasse 21, 5020, Salzburg, Austria
| | - Rolf Schipp
- Endogap Joint Replacement Institute, Auenstraße 7, 82467, Garmisch-Partenkirchen, Germany
| | - Wolfgang Reng
- Endogap Joint Replacement Institute, Auenstraße 7, 82467, Garmisch-Partenkirchen, Germany
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Vivekanantha P, Diao YD, Cohen D, Abouali J, Hantouly A, de Sa D. Posterior tibial slope, notch width index and tibial tubercle to trochlear groove distance contribute to development of mucoid degeneration of the anterior cruciate ligament: a systematic review. Knee Surg Sports Traumatol Arthrosc 2023:10.1007/s00167-023-07435-7. [PMID: 37121934 DOI: 10.1007/s00167-023-07435-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 04/20/2023] [Indexed: 05/02/2023]
Abstract
PURPOSE To determine what knee morphological factors are associated with the development of mucoid degeneration of the anterior cruciate ligament (ACL). METHODS Three databases MEDLINE, PubMed and EMBASE were searched from inception to January 29th, 2023 for literature outlining knee morphological factors that potentially lead to the development of mucoid degeneration of the ACL. The authors adhered to the PRISMA and R-AMSTAR guidelines as well as the Cochrane Handbook for Systematic Reviews of Interventions. Data on receiver operating characteristic (ROC) curve parameters such as area under the curve (AUC), sensitivity and specificity, odds ratios, as well as p values for comparisons of values between mucoid degeneration of the ACL and control patients were recorded. The Methodological Index for Non-Randomized Studies (MINORS) score was used for all studies to perform a quality assessment of included studies. RESULTS A total of 7 studies comprising 1326 patients (1330 knees) were included in this review. Four studies reported a significant association between increasing posterior tibial slope angles and mucoid degeneration of the ACL presence, with one study specifying that posterolateral tibial slope had a greater association than posteromedial tibial slope. Two studies reported a significant association between lower notch width index values and mucoid degeneration of the ACL presence. One study found that the presence of trochlear dysplasia was correlated with mucoid degeneration of the ACL and two studies found that increased tibial tuberosity-trochlear groove distance (TT-TG) was associated with mucoid degeneration of the ACL. CONCLUSION Increased posterior tibial slope, decreased notch width index, and elevated TT-TG and trochlear dysplasia were associated with the presence of mucoid degeneration of the ACL. Information from this review can aid surgeons in understanding what morphological features predispose their patients to the development of mucoid degeneration of the ACL. Identifying what features predispose patients to mucoid degeneration of the ACL can help determine if regular screening or preventative strategies are necessary. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
| | - Yi David Diao
- Michael DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Dan Cohen
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Center, 1200 Main Street West, 4E14, Hamilton, ON, L8N 3Z5, Canada
| | - Jihad Abouali
- Department of Orthopaedic Surgery, University of Toronto, Toronto, ON, Canada
| | - Ashraf Hantouly
- Department of Orthopaedic Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Darren de Sa
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Center, 1200 Main Street West, 4E14, Hamilton, ON, L8N 3Z5, Canada.
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