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Eckert JA, Bitsch RG, Sonntag R, Reiner T, Schwarze M, Jaeger S. The primary stability of the femoral component in cemented single and twin peg Oxford unicompartmental knee arthroplasty under adverse conditions. Bone Joint Res 2022; 11:82-90. [PMID: 35124977 PMCID: PMC8882328 DOI: 10.1302/2046-3758.112.bjr-2020-0507.r2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Aims The cemented Oxford unicompartmental knee arthroplasty (OUKA) features two variants: single and twin peg OUKA. The purpose of this study was to assess the stability of both variants in a worst-case scenario of bone defects and suboptimal cementation. Methods Single and twin pegs were implanted randomly allocated in 12 pairs of human fresh-frozen femora. We generated 5° bone defects at the posterior condyle. Relative movement was simulated using a servohydraulic pulser, and analyzed at 70°/115° knee flexion. Relative movement was surveyed at seven points of measurement on implant and bone, using an optic system. Results At the main fixation zone, the twin peg shows less relative movement at 70°/115°. At the transition zone, relative movements are smaller for the single peg for both angles. The single peg shows higher compression at 70° flexion, whereas the twin peg design shows higher compression at 115°. X-displacement is significantly higher for the single peg at 115°. Conclusion Bony defects should be avoided in OUKA. The twin peg shows high resilience against push-out force and should be preferred over the single peg. Cite this article: Bone Joint Res 2022;11(2):82–90.
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Affiliation(s)
- Johannes Adrian Eckert
- Laboratory of Biomechanics and Implant Research, Centre for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany.,Orthopaedic University Hospital, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Robert Sonntag
- Laboratory of Biomechanics and Implant Research, Centre for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany
| | - Tobias Reiner
- Laboratory of Biomechanics and Implant Research, Centre for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany.,Orthopaedic University Hospital, Heidelberg University Hospital, Heidelberg, Germany
| | - Martin Schwarze
- Laboratory of Biomechanics and Implant Research, Centre for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany.,Orthopaedic University Hospital, Heidelberg University Hospital, Heidelberg, Germany
| | - Sebastian Jaeger
- Laboratory of Biomechanics and Implant Research, Centre for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany
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Sun X, Hernigou P, Zhang Q, Zhang N, Wang W, Chen Y, Guo W. Sensor and machine learning-based assessment of gap balancing in cadaveric unicompartmental knee arthroplasty surgical training. INTERNATIONAL ORTHOPAEDICS 2021; 45:2843-2849. [PMID: 34351461 DOI: 10.1007/s00264-021-05176-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 07/28/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE The aim of this study was to assess the difference between flexion and extension contact forces-gap balance-after Oxford mobile-bearing medial unicompartmental knee arthroplasty (UKA) performed by surgeons with varying levels of experience. METHODS Surgeons in a training programme performed UKAs on fresh frozen cadaveric specimens (n = 60). Contact force in the medial compartment of the knee was measured after UKA during extension and flexion using a force sensor, and values were clustered using an unsupervised machine learning (k-means algorithm). Univariate analysis was performed with general linear regression models to identify the explanatory variable. RESULTS The level of experience was predictive of gap balance; surgeons were clustered into beginner, mid-level and experienced groups. Experienced surgeons' mean difference between flexion and extension contact force was 83 N, which was significantly lower (p < 0.05) than that achieved by mid-level (215 N) or beginner (346 N) surgeons. CONCLUSION We found that the lowest mean difference between flexion and extension contact force after UKA was 83 N, which was achieved by surgeons with the most experience; this value can be considered the optimal value. Beginner and mid-level surgeons achieved values that were significantly lower. This study also demonstrates that machine learning can be used in combination with sensor technology for improving gap balancing judgement in UKA.
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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, Beijing, China
| | - Philippe Hernigou
- Department of Orthopaedic Surgery, University Paris East (UPEC), Hôpital Henri Mondor, Creteil, France
| | - Qidong Zhang
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Nianfei Zhang
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Weiguo Wang
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Yang Chen
- Department of Computer Science and Technology, Tsinghua University, Beijing, 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, Beijing, China.
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Refsum AM, Nguyen UV, Gjertsen JE, Espehaug B, Fenstad AM, Lein RK, Ellison P, Høl PJ, Furnes O. Cementing technique for primary knee arthroplasty: a scoping review. Acta Orthop 2019; 90:582-589. [PMID: 31452416 PMCID: PMC6844414 DOI: 10.1080/17453674.2019.1657333] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - The optimal cementing technique for primary total knee arthroplasty (TKA) remains unclear. We therefore performed a scoping review based on available studies regarding cementation technique in primary TKA and unicondylar knee arthroplasty (UKA).Patients and methods - A search in 3 databases identified 1,554 studies. The inclusion criteria were literature that studied cementing technique in primary TKA or UKA. This included cement application methods, full or surface cementing, applying cement to the bone and/or prosthesis, stabilization of the implant during curing phase, bone irrigation technique, drilling holes in the bone, use of suction, and the timing of cementation. 57 studies met the inclusion criteria.Results - The evidence was unanimously in favor of pulsatile lavage irrigation, drying the bone, and drilling holes into the tibia during a TKA. All studies concerning suction recommended it during TKA cementation. 7 out of 11 studies favored the use of a cement gun and no studies showed that finger packing was statistically significantly better than using a cement gun. There is evidence that full cementation should be used if metal-backed tibial components are used. Applying the cement to both implant and bone seems to give better cement penetration.Interpretation - There are still many knowledge gaps regarding cementing technique in primary TKA. There seems to be sufficient evidence to recommend pulsatile lavage irrigation of the bone, drilling multiple holes, and drying the bone before cementing and implant insertion, and applying cement to both implant and on the bone.
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Affiliation(s)
- Anders M Refsum
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen;
| | - Uy V Nguyen
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen;
| | - Jan-Erik Gjertsen
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen; ,Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen;
| | - Birgitte Espehaug
- Centre for Evidence-Based Practice, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen;
| | - Anne M Fenstad
- Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen;
| | - Regina K Lein
- Medical Library, University of Bergen, Bergen, Norway
| | - Peter Ellison
- Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen;
| | - Paul J Høl
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen; ,Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen;
| | - Ove Furnes
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen; ,Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen; ,Correspondence:
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Abstract
BACKGROUND Although many factors are known to influence the polymerization time of bone cement, it remains unclear which bone cement shape predicts the precise polymerization time. The purpose of this study was to investigate whether different cement shapes influenced polymerization time and to identify the relationship between cement shape and ambient operating theater temperature, relative humidity, and equilibration time. METHODS Samples were gathered prospectively from 237 patients undergoing primary total knee arthroplasty. The cement components were made into 2 different shapes: lump and pan. The time at which no macroscopic indentation of both cement models was possible was recorded as the polymerization time. RESULTS There was no significant difference between hand mixing (lump shape: 789.3 ± 128.4 seconds, P = .591; pan shape: 899.3 ± 152.2 seconds, P = .584) and vacuum mixing (lump shape: 780.2 ± 131.1 seconds, P = .591; pan shape: 909.9 ± 143.3 seconds, P = .584) in terms of polymerization time. Conversely, the polymerization time was significantly shorter for Antibiotic Simplex (lump shape: 757.4 ± 114.9 seconds, P = .001; pan shape: 879.5 ± 125.0 seconds, P < .001) when compared with Palacos R+G (lump shape: 829.0 ± 139.3 seconds, P = .001; pan shape: 942.9 ± 172.0 seconds, P < .001). Polymerization time was also significantly longer (P < .001) for the pan shape model (904 ± 148.0 seconds) when compared with the lump shape model (785.2 ± 129.4 seconds). In addition, the polymerization time decreased with increasing temperature (lump shape: R = 0.334, P < .001; pan shape: R = 0.375, P < .001), humidity (lump shape: R = 0.091, P < .001; pan shape: R = 0.106, P < .001), and equilibration time (lump shape: R = 0.073, P < .001; pan shape: R = 0.044, P < .001). CONCLUSIONS The polymerization time was equally affected by temperature, relative humidity, and equilibration time regardless of bone cement shape. Furthermore, the pan shape model better reflected the cement polymerization time between implant and bone compared with the lump shape model. The current findings suggest that, clinically, constant pressure with the knee in <45° of flexion needs to be applied until remaining pan shaped cement is completely polymerized.
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Baur J, Zwicky L, Hirschmann MT, Ilchmann T, Clauss M. Metal backed fixed-bearing unicondylar knee arthroplasties using minimal invasive surgery: a promising outcome analysis of 132 cases. BMC Musculoskelet Disord 2015; 16:177. [PMID: 26228779 PMCID: PMC4521357 DOI: 10.1186/s12891-015-0651-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 07/27/2015] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Unicondylar knee arthroplasty (UKA) is a well-established treatment for isolated osteoarthritis (OA) of the medial knee compartment. Aim of this retrospective study was to evaluate the early clinical and radiological outcomes of a consecutive series of patients treated with medial metal backed fixed-bearing UKA. Furthermore, the influence of the component orientation on the outcome was analyzed. METHODS From 09/2006 to 11/2010 106 patients (132 knees; 69 ± 9 years) were treated using a metal backed fixed-bearing UKA with a MIS approach. All patients underwent a standardized clinical and radiological follow-up at 6 weeks, 1, 2 and 5 years. Mean follow-up was 3.4 ± 1.0 years. Two patients (three UKAs) deceased and two patients (two UKAs) were lost to follow-up. Three different survival analyses were performed using three different endpoints defining failure: (a) revision with exchange of any UKA component (b) aseptic loosening and (c), a worst case scenario, where it was assumed that all progressive radiolucencies would lead to aseptic loosening and thus these were additionally counted. Clinical outcome was assessed using the American knee society score (AKS) and the Oxford knee score (OKS). Radiographic analysis was done according to the American Knee Society Evaluation and Scoring System adapted for UKA and correlated with the AKS and OKS. RESULTS Five UKAs (3.8 %) were revised to total knee arthroplasties (TKAs) after a median of 25 (10-33) months. Five year survival was 95.2, 97.5 and 87.7% for the aforementioned endpoints. At final follow-up the median AKS knee score was 99 (50-100) points and the median AKS function score was 100 (60-100) points. The median OKS was 43 (8-48) points. Clinical outcome was independent of the component orientation. CONCLUSION Fixed-bearing UKA showed excellent clinical and radiological results at up to 5 years follow-up. Outcome was independent of component orientation.
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Affiliation(s)
- Joel Baur
- Kantonsspital Baselland, Clinics for Orthopaedics and Trauma Surgery, Rheinstrasse 26, CH-4410, Liestal, Switzerland.
| | - Lukas Zwicky
- Kantonsspital Baselland, Clinics for Orthopaedics and Trauma Surgery, Rheinstrasse 26, CH-4410, Liestal, Switzerland.
| | - Michael Tobias Hirschmann
- Kantonsspital Baselland, Clinics for Orthopaedics and Trauma Surgery, Rheinstrasse 26, CH-4410, Liestal, Switzerland.
| | - Thomas Ilchmann
- Kantonsspital Baselland, Clinics for Orthopaedics and Trauma Surgery, Rheinstrasse 26, CH-4410, Liestal, Switzerland.
- Leonardo - Klinik Birshof, CH-4142, Muenchenstein, Switzerland.
| | - Martin Clauss
- Kantonsspital Baselland, Clinics for Orthopaedics and Trauma Surgery, Rheinstrasse 26, CH-4410, Liestal, Switzerland.
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Abstract
INTRODUCTION Function and kinematics following unicondylar knee arthroplasty (UKA) have been reported to be close to the native knee. Gait, stair climbing and activities of daily living expose the knee joint to a combination of varus and valgus moments. Replacement of the medial compartment via UKA is likely to change the physiologic knee stability and its ability to respond to varus and valgus moments. It was hypothesized that UKA implantation would stiffen the knee and decrease range of motion in the frontal plane. MATERIALS AND METHODS Six fresh frozen cadaver knees were prepared and mounted in a six-degrees-of-freedom robot. An axial load of 200 N was applied with the knee in 15°, 45° and 90° of flexion. Varus and valgus moments were added, respectively, before and after implantation of medial UKA. Tests were than redone with a thicker polyethylene inlay to simulate overstuffing of the medial compartment. Range of motion in the frontal plane and the tibial response to moments were recorded via the industrial robot. RESULTS The range of motion in the frontal plane was decreased with both, balanced and overstuffed UKA and shifted towards valgus. When exposed to valgus moments, knees following UKA were stiffer in comparison with the native knee. The effect was even more pronounced with medial overstuffing. CONCLUSION In UKA, the compressive anatomy is replaced by much stiffer components. This lack of medial compression and relative overstuffing leads to a tighter medial collateral ligament. This drives the trend towards a stiffer joint as documented by a decrease in frontal plane range of motion. Overstuffing should strictly be avoided when performing UKA.
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