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Huffman N, Pasqualini I, Surace P, Molloy RM, Piuzzi NS, Deren ME. Diagnosis, Treatment, and Outcomes of Crystalline Arthropathy in the Setting of Total Knee Arthroplasty: A Critical Analysis Review. JBJS Rev 2023; 11:01874474-202312000-00010. [PMID: 38134288 DOI: 10.2106/jbjs.rvw.23.00163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2023]
Abstract
» Emerging evidence suggests the prevalence of crystalline arthropathy (CA) in the setting of total knee arthroplasty (TKA) is increasing, and diagnosis of CA is often intricate because of symptom overlap with other common postoperative complications such as periprosthetic joint infection (PJI). Consequently, an accurate and timely diagnosis becomes pivotal in guiding the choice of treatment.» CA includes gout and calcium pyrophosphate deposition (CPPD) disease, and accurate diagnosis in patients with prior TKA requires a multifaceted approach. The diagnosis algorithm plays a critical role in determining the appropriate treatment approach.» Management of CA typically involves a conservative strategy, encompassing the administration of nonsteroidal anti-inflammatory drugs, colchicine, and steroids, regardless of whether patients have undergone prior TKA.» There is conflicting evidence on the effect CA has on the surgical outcomes in postoperative TKA patients. While these patients may expect excellent functional outcomes and pain relief, they may be at a higher risk of complications such as infections, medical complications, and revision procedures.» Additional research is required to fully comprehend the impact of CA on postoperative TKA outcomes and to establish effective strategies for enhancing patient care and optimizing long-term joint function.
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Affiliation(s)
- Nickelas Huffman
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | | | - Peter Surace
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Robert M Molloy
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Nicolas S Piuzzi
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio
- Department of Biomedical Engineering, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Matthew E Deren
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio
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Hernigou P, Karam S, Zhang N, Guo W, Ge J, Liu C, Zhang Q, Hernigou J. Lateral meniscus with tears or with histologic calcification does not increase the risk of lateral osteoarthritis after medial unicompartmental arthroplasty. INTERNATIONAL ORTHOPAEDICS 2023; 47:2477-2485. [PMID: 37500969 DOI: 10.1007/s00264-023-05907-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 07/19/2023] [Indexed: 07/29/2023]
Abstract
PURPOSE Meniscal tears or histological meniscal calcifications (in the absence of radiological chondrocalcinosis) are frequent in osteoarthritis. Whether lateral meniscal lesions influence clinical outcomes after medial unicompartmental knee arthroplasty (UKA) is unknown. METHODS We analyzed 130 patients (130 knees) with medial unicompartmental knee arthroplasties between 2005 and 2015. These 130 knees had full articular cartilage thickness in the lateral compartment and no radiological chondrocalcinosis on preoperative radiographs. The lateral meniscus was analyzed with preoperative MRI and a biopsy of the anterior horn at the time of surgery. Synovial fluid was collected and analyzed for calcium pyrophosphate dihydrate crystal deposition (CPPD crystals). Lateral meniscal tears were untreated when detected on MRI or during surgery, with the hypothesis that these tears on the opposite compartment would remain asymptomatic in medial UKA. At average 10-year follow-up, patients were evaluated with clinical and radiographic outcome, with a focus on the risk of joint space narrowing of the lateral femorotibial compartment. RESULTS CPPD crystals were present in the synovial fluid of 70 knees. Lateral meniscal tears were seen on MRI in 34 (49%) normal meniscuses of the 60 knees without CPPD crystals and in six other knees without histological meniscal calcification despite CPPD crystals. Histological calcification was present on 61 lateral meniscuses with 53 meniscal tears. The results showed no significant differences in the clinical outcomes between knees with lateral meniscal tears or lateral meniscal histological chondrocalcinosis or both lesions and those without these conditions. Additionally, radiographic progression of osteoarthritis in the opposite femorotibial compartment of the knee was not more frequent in patients with these meniscal issues. The ten year cumulative survival rates, measured by the need for total knee arthroplasty, were 91% for knees without meniscal lesions and 92% for knees with these lesions. CONCLUSION On this basis, treatment of meniscal tears of the lateral compartment and routine aspiration of the knee to assess for birefringent crystals in the planning of medial UKA do not appear necessary.
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MESH Headings
- Humans
- Menisci, Tibial/diagnostic imaging
- Menisci, Tibial/surgery
- Menisci, Tibial/pathology
- Chondrocalcinosis/complications
- Chondrocalcinosis/diagnostic imaging
- Chondrocalcinosis/surgery
- Knee Joint/diagnostic imaging
- Knee Joint/surgery
- Knee Joint/pathology
- Arthroplasty, Replacement, Knee/adverse effects
- Arthroplasty, Replacement, Knee/methods
- Osteoarthritis, Knee/diagnostic imaging
- Osteoarthritis, Knee/surgery
- Osteoarthritis, Knee/pathology
- Knee Injuries/surgery
- Cartilage Diseases/surgery
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Affiliation(s)
- Philippe Hernigou
- Department of Orthopaedic Surgery, University Paris East (UPEC), Créteil, France.
| | - Sami Karam
- Department of Orthopaedic Surgery, University Paris East (UPEC), Créteil, France
| | - Nianfei Zhang
- Department of Orthopaedic Surgery, Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Wanshou Guo
- Department of Orthopaedic Surgery, Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Juncheng Ge
- Department of Orthopaedic Surgery, Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Changquan Liu
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, China
- China-Japan Friendship Hospital (Institute of Clinical Medical Sciences), Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Qidong Zhang
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Jacques Hernigou
- Department of Orthopedic Surgery, EpiCURA Hospital, 7331, Baudour, Belgium
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Kamenaga T, Hiranaka T, Hida Y, Nakano N, Kuroda Y, Tsubosaka M, Hayashi S, Kuroda R, Matsumoto T. Lateral osteoarthritis progression is associated with a postoperative residual tibiofemoral subluxation in Oxford UKA. Knee Surg Sports Traumatol Arthrosc 2022; 30:3236-3243. [PMID: 34514512 DOI: 10.1007/s00167-021-06729-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 08/27/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Lateral compartment osteoarthritis progression (LOP) is a major complication after Oxford mobile-bearing unicompartmental knee arthroplasty (OUKA). This study aimed to identify the association between tibiofemoral subluxation (TFS) and LOP after OUKA. Patients whose TFS was uncorrectable according to preoperative stress radiographs were hypothesised to develop residual TFS even after surgery, and thought to be more likely to develop LOP. METHODS The study included 201 patients who underwent medial OUKA. Fifteen patients showed increases in LOP of at least two Kellgren-Lawrence grades after surgery [progression (P) group], while the others had no progression (N group, n = 186). TFS was measured on preoperative full leg weight-bearing radiographs, valgus stress radiographs and postoperative plain radiographs. Valgus stress radiographs were obtained using a firm manual valgus force with the knee flexed at 20°. Leg alignment, Oxford knee score (OKS), and revision rates were assessed. RESULTS The P group had significantly higher TFS values on preoperative valgus stress (6.8° ± 2.2° vs. 4.5° ± 2.0°; P < 0.001) and postoperative radiographs (6.6° ± 2.3° vs. 4.6° ± 2.9°; P < 0.001) than the N group. Patients with postoperative residual TFS and postoperative valgus alignment were more likely to have LOP, but 9 of the 15 LOP patients did not show postoperative valgus alignment. The P group had significantly poorer postoperative OKS (33.0 ± 10.2 vs. 37.4 ± 6.5, P = 0.017) and a higher rate of revision (6/15 vs 6/186; odds ratio = 19.16; 95% CI = 4.98-76.05, P < 0.001). CONCLUSION OA progression in the lateral compartment after medial OUKA might be associated with postoperative residual TFS, but does not always coexist with postoperative valgus alignment. Preoperative assessment of TFS with valgus stress could be a potential predictor of postoperative residual TFS and LOP. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Tomoyuki Kamenaga
- Department of Orthopedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, 1-3-13, Kosobe-cho, Takatsuki, Osaka, 569-1192, Japan
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Takafumi Hiranaka
- Department of Orthopedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, 1-3-13, Kosobe-cho, Takatsuki, Osaka, 569-1192, Japan.
| | - Yuichi Hida
- Department of Orthopedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, 1-3-13, Kosobe-cho, Takatsuki, Osaka, 569-1192, Japan
| | - Naoki Nakano
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Yuichi Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Masanori Tsubosaka
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Shinya Hayashi
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
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Chondrocalcinosis does not affect functional outcome and prosthesis survival in patients after total or unicompartmental knee arthroplasty: a systematic review. Knee Surg Sports Traumatol Arthrosc 2022; 30:1039-1049. [PMID: 33677614 PMCID: PMC8901495 DOI: 10.1007/s00167-021-06519-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 02/19/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE There are contentious data about the role calcium pyrophosphate (CPP) crystals and chondrocalcinosis (CC) play in the progression of osteoarthritis (OA), as well as in the outcomes after knee arthroplasty. Hence, the purpose of this systematic review was to analyse the clinical and functional outcome, progression of OA and prosthesis survivorship after unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA) in patients with CC compared to patients without CC. METHODS A systematic review of the literature in PubMed, Medline, Embase and Web of Science was performed using the "Preferred Reporting Items for Systematic Reviews and Meta-Analysis" (PRISMA) guidelines. Articles which reported the outcome and survival rates of prosthesis after TKA or UKA in patients with CC were included. RESULTS A total of 3718 patient knees were included in eight selected publications, with a median sample sizes of 234 knees (range 78-1000) and 954 knees (range 408-1500) for publications including UKA and TKA, respectively. At time of surgery, the mean age was 69 years and the prevalence for CC ranged from 12.6 to 36%. Chondrocalcinosis did not significantly influence the functional and clinical outcome, the implant survival as well as the radiologic progression of OA disease after UKA and TKA. CONCLUSION The presence of CPP crystals in tissue samples, synovial fluid or evidence of calcifications on preoperative radiographs did not significantly influence the postoperative functional and activity scores. It also had no significant influence on prosthesis survival rate, whether it was a UKA or a TKA. This study shows that the impact of a subclinical form of chondrocalcinosis may not be of clinical relevance in the context of arthroplasty. LEVEL OF EVIDENCE IV.
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Piast RW, Wieczorek RM, Marzec N, Garstka M, Misicka A. A Phage Display-Identified Short Peptide Capable of Hydrolyzing Calcium Pyrophosphate Crystals-The Etiological Factor of Chondrocalcinosis. Molecules 2021; 26:molecules26195777. [PMID: 34641321 PMCID: PMC8510196 DOI: 10.3390/molecules26195777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/10/2021] [Accepted: 09/20/2021] [Indexed: 11/22/2022] Open
Abstract
Chondrocalcinosis is a metabolic disease caused by the presence of calcium pyrophosphate dihydrate crystals in the synovial fluid. The goal of our endeavor was to find out whether short peptides could be used as a dissolving factor for such crystals. In order to identify peptides able to dissolve crystals of calcium pyrophosphate, we screened through a random library of peptides using a phage display. The first screening was designed to select phages able to bind the acidic part of alendronic acid (pyrophosphate analog). The second was a catalytic assay in the presence of crystals. The best-performing peptides were subsequently chemically synthesized and rechecked for catalytic properties. One peptide, named R25, turned out to possess some hydrolytic activity toward crystals. Its catalysis is Mg2+-dependent and also works against soluble species of pyrophosphate.
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Affiliation(s)
- Radosław W. Piast
- Faculty of Chemistry, University of Warsaw, Pasteura 1, 02-093 Warsaw, Poland;
- Correspondence: (R.W.P.); (A.M.)
| | - Rafał M. Wieczorek
- Faculty of Chemistry, University of Warsaw, Pasteura 1, 02-093 Warsaw, Poland;
| | - Nicola Marzec
- Inter-Faculty Individual Studies in Mathematics and Natural Sciences, University of Warsaw, Stefana Banacha 2C, 02-087 Warsaw, Poland;
| | - Maciej Garstka
- Department of Metabolic Regulation, Faculty of Biology, University of Warsaw, Miecznikowa 1, 02-096 Warsaw, Poland;
| | - Aleksandra Misicka
- Faculty of Chemistry, University of Warsaw, Pasteura 1, 02-093 Warsaw, Poland;
- Correspondence: (R.W.P.); (A.M.)
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Beckmann J, Hirschmann MT, Matziolis G, Holz J, V Eisenhart-Rothe R, Becher C. [Recommendations for unicondylar knee replacement in the course of time : A current inventory]. DER ORTHOPADE 2021; 50:104-111. [PMID: 33346867 DOI: 10.1007/s00132-020-04054-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND A higher patient satisfaction stands in contrast to higher revision rates of unicondylar knee joint endoprosthetics (UKE) compared to total knee joint endoprosthetics (TKE). Furthermore, old "dogmas" regarding indications and contraindications persist, which is still reflected in the significantly different case numbers. AIM The aim of this article is to provide an overview of the current literature regarding 1. indication and contraindication (BMI, age, sport, arthrosis of other compartments, ligament status) and 2. the "eternal rival" fixed or mobile bearing for UKE. RESULTS The choice of the right patient remains essential, even if all the old "dogmas" of contraindications have been relativized or even outdated. Arthroses of the contralateral (in medial UKE correspondingly lateral) compartment and advanced arthroses of the lateral patella facet remain the only persistent contraindications. In contrast, a high BMI, age, chondrocalcinosis, medial patella facet and a defective (but particularly functionally stable) ACL are not contraindications; however, severe obesity is responsible for a significantly higher complication rate and probably a higher rate of loosening. Rather, the experience and thus the number of UKEs of the individual surgeon is decisive for the outcome, to which the discussion about mobile or fixed inlays must also be completely subordinated. CONCLUSION The indications for UKE can, therefore, be extended with a clear conscience on the basis of literature, and the current 1:10 UKE:TKE ratio in Germany can be shifted significantly.
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Affiliation(s)
- J Beckmann
- Sportklinik Stuttgart, Taubenheimstr. 8, 70372, Stuttgart, Deutschland.
| | | | - G Matziolis
- Waldkliniken Eisenberg, Eisenberg, Deutschland
| | - J Holz
- OrthoCentrum Hamburg, Hamburg, Deutschland
| | - R V Eisenhart-Rothe
- Klinikum rechts der Isar der Technischen Universität München, München, Deutschland
| | - C Becher
- IZO - Internationales Zentrum für Orthopädie, ATOS Klinik Heidelberg, Heidelberg, Deutschland
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Kikuchi K, Hiranaka T, Kamenaga T, Hida Y, Fujishiro T, Okamoto K. Anterior Cruciate Ligament Deficiency is Not Always a Contraindication for Medial Unicompartmental Knee Arthroplasty: A Retrospective Study in Nondesigner's Japanese Hospital. J Arthroplasty 2021; 36:495-500. [PMID: 32912672 DOI: 10.1016/j.arth.2020.08.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/07/2020] [Accepted: 08/12/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND An intact anterior cruciate ligament (ACL) is thought to be prerequisite for successful unicompartmental knee arthroplasty (UKA), but recent studies reported successful midterm results of UKA in ACL-deficient (ACLD) knees. We hypothesized that ACLD is not always a contraindication for medial UKA when preoperative radiographs showed typical anteromedial knee patterns. METHODS From April 2012 to March 2016, 401 Oxford mobile-bearing UKAs in 282 patients were retrospectively identified from our database. Patients whose ACL was severely damaged, but preoperative X-rays showed typical anteromedial osteoarthritis patterns, were categorized into the ACLD group. From intraoperative data, those whose ACL was intact were categorized into the ACL functional (ACLF) group. There were 32 and 369 knees in the ACLD and ACLF groups, respectively, and mean follow-up periods were 66.1 and 63.8 months for the ACLD and ACLF groups, respectively. We compared the postoperative clinical outcome and component survivorship, with an endpoint of component revision, between ACLD groups and ACLF groups. RESULTS In both groups, the Oxford knee score, Knee Society score, Tegner activity score, and knee range of motion in extension were improved after surgery. The UKA component survival rate at five years was 100% in the ACLD group and 98.9% in the ACLF group. There were no significant differences between the groups. CONCLUSION Mid-term clinical outcomes of Oxford mobile-bearing UKA in ACLD knees were similar to those in ACLF knees. ACL deficiency is not always a contraindication for medial unicompartmental knee arthroplasty in patients with typical anteromedial osteoarthritis radiographs.
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Affiliation(s)
- Kenichi Kikuchi
- Department of Orthopedic Surgery and Joint Surgery Center, Takatsuki General Hospital, Takatsuki-city, Osaka, Japan
| | - Takafumi Hiranaka
- Department of Orthopedic Surgery and Joint Surgery Center, Takatsuki General Hospital, Takatsuki-city, Osaka, Japan
| | - Tomoyuki Kamenaga
- Department of Orthopedic Surgery and Joint Surgery Center, Takatsuki General Hospital, Takatsuki-city, Osaka, Japan
| | - Yuichi Hida
- Department of Orthopedic Surgery and Joint Surgery Center, Takatsuki General Hospital, Takatsuki-city, Osaka, Japan
| | - Takaaki Fujishiro
- Department of Orthopedic Surgery and Joint Surgery Center, Takatsuki General Hospital, Takatsuki-city, Osaka, Japan
| | - Koji Okamoto
- Department of Orthopedic Surgery and Joint Surgery Center, Takatsuki General Hospital, Takatsuki-city, Osaka, Japan
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Mittal A, Meshram P, Kim WH, Kim TK. Unicompartmental knee arthroplasty, an enigma, and the ten enigmas of medial UKA. J Orthop Traumatol 2020; 21:15. [PMID: 32876817 PMCID: PMC7468046 DOI: 10.1186/s10195-020-00551-x] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 07/22/2020] [Indexed: 12/17/2022] Open
Abstract
Unicompartmental knee arthroplasty (UKA) is a bone- and ligament-sparing alternative to total knee arthroplasty in the patients with end-stage single-compartment degeneration of the knee. Despite being a successful procedure, the multiple advantages of UKA do not correlate with its usage, most likely due to the concerns regarding prosthesis survivability, patient selection, ideal bearing design, and judicious use of advanced technology among many others. Therefore, the purpose of this study is to review and summarize the debated literature and discuss the controversies as “Ten Enigmas of UKA.”
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Affiliation(s)
- Anurag Mittal
- TK Orthopedic Surgery, 55 Dongpangyo-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13535, Republic of Korea
| | - Prashant Meshram
- Department of Orthopaedics, Johns Hopkins Medical Institute, 2360 West Joppa Road, Suite 306, Baltimore, MD, 21093, USA
| | - Woo Hyun Kim
- TK Orthopedic Surgery, 55 Dongpangyo-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13535, Republic of Korea
| | - Tae Kyun Kim
- TK Orthopedic Surgery, 55 Dongpangyo-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13535, Republic of Korea.
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Lateral and patellofemoral compartment osteoarthritis progression after medial unicompartmental knee arthroplasty: A five- to 10-year follow-up study. Knee 2020; 27:1135-1142. [PMID: 32711874 DOI: 10.1016/j.knee.2020.05.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/23/2020] [Accepted: 05/29/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The purpose of the study was to evaluate lateral and patellofemoral osteoarthritis (OA) progression after medial unicompartmental knee arthroplasty (UKA) and identify factors affecting the progression that were not identified previously. METHODS We evaluated 146 patients who underwent medial UKA between 2009 and 2014. Kellgren-Lawrence grading of lateral and patellofemoral OA was performed on preoperative and final follow-up knee radiographs. Radiographic and clinical characteristics, SF-36, and Oxford knee scores were compared between the OA progressed and non-progressed groups. Risk factors for lateral and patellofemoral OA progression were evaluated. RESULTS The lateral OA progressed and non-progressed groups significantly differed in side, preoperative flexion contracture, preoperative joint line convergence angle, postoperative tibiofemoral angle, insert size, revision status (P < 0.05), and the patellofemoral OA progressed and non-progressed groups significantly differed in age, pre- and postoperative flexion contracture, postoperative tibiofemoral angle and pre- and postoperative patellofemoral OA grade (P < 0.05). At the final follow-up, Visual Analogue Scale, Oxford Knee Scores, and SF-36 sub-scores were significantly better in the lateral OA non-progressed group (P < 0.001). Dominant leg (odds ratio (OR): 2.759), insert size (>4, OR: 2.219), revision status (+, OR: 6.692), and postoperative tibiofemoral angle (>5.5°, OR: 1.177) were independent risk factors for lateral OA progression, whereas age (>60 years, OR: 3.222), preoperative patellofemoral OA grade (>1, OR: 2.085), and postoperative flexion contracture (>10°, OR: 1.919) were those for patellofemoral OA progression. CONCLUSIONS Mild radiographic progression of 1 KL grade is frequently seen five to 10 years after medial UKA. Postoperative outcomes are significantly affected by lateral compartment OA progression but not by patellofemoral OA progression.
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11
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Kleeblad LJ, Zuiderbaan HA, Hooper GJ, Pearle AD. Unicompartmental knee arthroplasty: state of the art. J ISAKOS 2017. [DOI: 10.1136/jisakos-2016-000102] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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12
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Kumar V, Pandit HG, Liddle AD, Borror W, Jenkins C, Mellon SJ, Hamilton TW, Athanasou N, Dodd CAF, Murray DW. Comparison of outcomes after UKA in patients with and without chondrocalcinosis: a matched cohort study. Knee Surg Sports Traumatol Arthrosc 2017; 25:319-324. [PMID: 25786825 DOI: 10.1007/s00167-015-3578-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 03/06/2015] [Indexed: 02/06/2023]
Abstract
PURPOSE Chondrocalcinosis can be associated with an inflammatory arthritis and aggressive joint destruction. There is uncertainty as to whether chondrocalcinosis represents a contraindication to unicompartmental knee arthroplasty (UKA). This study reports the outcome of a consecutive series of patients with chondrocalcinosis and medial compartment osteoarthritis treated with UKA matched to controls. METHODS Between 1998 and 2008, 88 patients with radiological chondrocalcinosis (R-CCK) and 67 patients with histological chondrocalcinosis (H-CCK) were treated for end-stage medial compartment arthritis with Oxford UKA. One-to-two matching was performed to controls, treated with UKA, but without evidence of chondrocalcinosis. Functional outcome and implant survival were assessed in each group. RESULTS The mean follow-up was 10 years. The mean Oxford Knee Score (OKS) at final follow-up was 43, 41 and 41 in H-CCK, R-CCK and control groups (change from baseline OKS was 21, 18 and 15, respectively). The change was significantly higher in H-CCK than in control but was not significantly different in R-CCK. Ten-year survival was 96 % in R-CCK, 86 % in H-CCK and 98 % in controls. Although the survival in H-CCK was significantly worse than in control, only one failure was due to disease progression. CONCLUSION The presence of R-CCK does not influence functional outcome or survival following UKA. Pre-operative radiological evidence of CCK should not be considered to be a contraindication to UKA. H-CCK is associated with significantly improved clinical outcomes but also a higher revision rate compared with controls. LEVEL OF EVIDENCE Case control study, Level III.
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Affiliation(s)
- V Kumar
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Nuffield Orthopaedic Centre, Windmill Road, Oxford, OX3 7LD, UK
| | - H G Pandit
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Nuffield Orthopaedic Centre, Windmill Road, Oxford, OX3 7LD, UK.
| | - A D Liddle
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Nuffield Orthopaedic Centre, Windmill Road, Oxford, OX3 7LD, UK
| | - W Borror
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Nuffield Orthopaedic Centre, Windmill Road, Oxford, OX3 7LD, UK
| | - C Jenkins
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Nuffield Orthopaedic Centre, Windmill Road, Oxford, OX3 7LD, UK
| | - S J Mellon
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Nuffield Orthopaedic Centre, Windmill Road, Oxford, OX3 7LD, UK
| | - T W Hamilton
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Nuffield Orthopaedic Centre, Windmill Road, Oxford, OX3 7LD, UK
| | - N Athanasou
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Nuffield Orthopaedic Centre, Windmill Road, Oxford, OX3 7LD, UK
| | - C A F Dodd
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Nuffield Orthopaedic Centre, Windmill Road, Oxford, OX3 7LD, UK
| | - D W Murray
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Nuffield Orthopaedic Centre, Windmill Road, Oxford, OX3 7LD, UK
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Aetiology of lateral progression of arthritis following Oxford medial unicompartmental knee replacement: a case-control study. Musculoskelet Surg 2016; 100:97-102. [PMID: 26810974 PMCID: PMC4971035 DOI: 10.1007/s12306-015-0394-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 12/07/2015] [Indexed: 12/28/2022]
Abstract
Purpose
The aim of this case–control study is to assess for predictive factors that may determine development of lateral compartment progression after Oxford medial unicompartmental knee replacement. Methods Twenty-eight patients who were revised as a result of lateral osteoarthritis progression were matched to 52 alive and unrevised patients. Body mass index, intra-operative findings, postoperative leg alignment, meniscal bearing size and histological findings have been analysed. Radiological analysis was carried out on the immediate postoperative radiographs by two blinded observers to assess the severity of arthritis in the lateral compartment. The measurements of the components positions were converted into binary figures as to whether they were inside or outside the recommended limits for analysis. Conditional logistic regression was used to identify important predictors of progression, taking into account the case–control grouping. Results The results shows that the condition of the lateral compartment is a significant predictor for developing subsequent lateral compartment arthrosis (OR 2.627, p = 0.019). The study showed no relationship between progression of arthritis and component position (OR [0.5–1.18], p [0.21–1]). Nor have it demonstrated that BMI (OR 1.06, p = 0.61), postoperative leg alignment (OR 1.26, p = 0.636), meniscal bearing size (1.32, p = 0.307) or presence of chondrocalcinosis (OR 0.35, p = 0.36) have any association with lateral osteoarthritis progression. Conclusions This study showed the importance of excluding radiographic evidence of lateral compartment osteoarthritis on the preoperative radiograph prior to medial unicompartmental knee replacement. We have not been able to show any relationship between progression of arthritis and component position. Level of proof Case–control study, level III.
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van der List JP, McDonald LS, Pearle AD. Systematic review of medial versus lateral survivorship in unicompartmental knee arthroplasty. Knee 2015; 22:454-60. [PMID: 26507286 DOI: 10.1016/j.knee.2015.09.011] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 08/20/2015] [Accepted: 09/22/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Unicompartmental knee arthroplasty (UKA) has gained popularity in patients with isolated unicompartmental osteoarthritis. To our knowledge no systematic review has assessed and compared survivorship of medial and lateral UKA. We performed a systematic review assessing medial and lateral UKA survivorship and comparing survivorship in cohort studies and registry-based studies. METHODS A search was performed using PubMed, Embase and Cochrane systems. Ninety-six eligible studies reported survivorship, of which fifty-eight reported medial and sixteen reported lateral UKA survivorship. Nineteen cohort studies and seven registry-based studies reported combined medial and lateral survivorship. RESULTS The five-year, ten-year and fifteen-year medial UKA survivorship was 93.9%, 91.7% and 88.9%, respectively. Lateral UKA survivorship was 93.2%, 91.4% and 89.4% at five-year, ten-year and fifteen-year, respectively. No statistical difference between both compartments was found. At twenty years and twenty-five years survivorship of medial UKA was 84.7% and 80%, respectively, but no studies reported lateral UKA survivorship at these follow-up intervals. Survivorship of cohort studies was not significantly higher compared to registry-based studies at five years (94.3 vs. 91.7, respectively, p=0.133) but was significantly higher at ten years (90.5 vs. 84.1, p=0.015). CONCLUSION This is the first systematic review that shows no difference in the five-, ten- and fifteen-year survivorship of medial and lateral UKA. We found a lower survivorship in the registry-based studies compared to cohort studies.
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Affiliation(s)
- J P van der List
- Sports Medicine and Shoulder Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, 535 E. 70th Street, New York, NY 10021, United States.
| | - L S McDonald
- Sports Medicine and Shoulder Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, 535 E. 70th Street, New York, NY 10021, United States.
| | - A D Pearle
- Sports Medicine and Shoulder Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, 535 E. 70th Street, New York, NY 10021, United States.
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15
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Lee GC, Lotke PA. Does chondrocalcinosis affect Knee Society scores and range of motion after TKA? Clin Orthop Relat Res 2014; 472:1512-7. [PMID: 24385044 PMCID: PMC3971233 DOI: 10.1007/s11999-013-3447-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 12/20/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND Chondrocalcinosis is manifested by crystalline deposits of calcium commonly found during primary TKA for osteoarthritis. Its frequency among patients undergoing TKA is poorly defined, as is its influence on pain or function after TKA. QUESTIONS/PURPOSES The purposes of this study are to (1) determine the prevalence of chondrocalcinosis in patients undergoing TKA for osteoarthritis; (2) evaluate the effect of chondrocalcinosis on ROM and The Knee Society scores; (3) determine if patients with chondrocalcinosis and severe synovitis who underwent synovectomy are at risk for lower postoperative Knee Society scores and less ROM; and (4) assess if chondrocalcinosis is associated with increased rates of revision surgery. METHODS We retrospectively reviewed the medical records of 1500 primary TKAs performed by one surgeon. The minimum followup for patients was 24 months (average, 57 months; range, 24-120 months). There were 511 men and 934 women with an average age of 70 years. Fifty-five patients underwent bilateral knee replacements. Crystal deposition was graded prospectively during surgery using a subjective visual scale. A thorough synovectomy was performed on patients with severe synovitis and apparent crystalline deposition suggestive of calcium pyrophosphate dihydrate (CPPD) deposition (n = 50). The Knee Society scores, ROM, and revision rates were compared between patients with visible chondrocalcinosis with those without and between patients with mild chondrocalcinosis with those with severe chondrocalcinosis. RESULTS Chondrocalcinosis was found in 173 male patients (34%) undergoing TKAs during this period compared with 224 female patients (24%) (p < 0.001). The Knee Society scores for knee rating and function were similar in patients with or without chondrocalcinosis undergoing TKA. However, patients with visible CPPD deposition who underwent synovectomy for proliferative synovitis had diminished final ROM and Knee Society knee rating scores (107(o) versus 115(o) knee flexion, p < 0.001 and 87 versus 94 points, p = 0.001). We cannot determine whether this result is because of the synovectomy or severity of the disease, and therefore we cannot recommend a synovectomy at this time. Revision rates were no different among patients with chondrocalcinosis compared with those without it (3.6% versus 2.2%, p = 0.2). CONCLUSIONS Chondrocalcinosis is common among patients undergoing TKA for osteoarthritis. The presence of CPPD deposition does not appear to affect the ROM and Knee Society scores of patients with CPPD but without severe synovitis. However, patients with severe synovitis and visible CPPD who underwent thorough synovectomy may be at risk for having decreased postoperative ROM and pain develop. LEVEL OF EVIDENCE Level III, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Gwo-Chin Lee
- Department of Orthopedic Surgery, University of Pennsylvania, 1 Cupp Pavilion, 39th and Market Streets, Philadelphia, PA, 19104, USA,
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Rosenthal AK, Ryan LM. Nonpharmacologic and pharmacologic management of CPP crystal arthritis and BCP arthropathy and periarticular syndromes. Rheum Dis Clin North Am 2014; 40:343-56. [PMID: 24703351 DOI: 10.1016/j.rdc.2014.01.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Calcium crystal arthritis is often unrecognized, poorly managed, and few effective therapies are available. The most common types of calcium crystals causing musculoskeletal syndromes are calcium pyrophosphate (CPP) and basic calcium phosphate (BCP). Associated syndromes have different clinical presentations and divergent management strategies. Acute CPP arthritis is treated similarly to acute gouty arthritis, whereas chronic CPP and BCP arthropathy may respond to strategies used for osteoarthritis. Calcific tendonitis is treated with a variety of interventions designed to dissolve BCP crystals. A better understanding of the causes and larger well-planned trials of current therapies will lead to improved care.
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Affiliation(s)
- Ann K Rosenthal
- Division of Rheumatology, Department of Medicine, Zablocki VA Medical Center and The Medical College of Wisconsin, FEOB 4th Floor, 9200 West Wisconsin Avenue, Milwaukee, WI 53226, USA.
| | - Lawrence M Ryan
- Division of Rheumatology, Department of Medicine, Zablocki VA Medical Center and The Medical College of Wisconsin, FEOB 4th Floor, 9200 West Wisconsin Avenue, Milwaukee, WI 53226, USA
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Liddle AD, Pandit H, Murray DW, Dodd CAF. Unicompartmental knee arthroplasty: state of the art and future developments. ACTA ACUST UNITED AC 2012. [DOI: 10.1007/s10261-012-0035-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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