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Janssen SJ, van Oost I, Breugem SJM, van Geenen RCI. A structured evaluation of the symptomatic medial Oxford unicompartmental knee arthroplasty (UKA). EFORT Open Rev 2021; 6:850-860. [PMID: 34760285 PMCID: PMC8559574 DOI: 10.1302/2058-5241.6.200105] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Unicompartmental knee arthroplasty (UKA) has several advantages over total knee arthroplasty; however, in many reports, the risk of revision remains higher after UKA.Many reasons for failure of UKA exist.Successful treatment starts with accurate assessment of the symptomatic UKA as a specific mode of failure requires a specific solution.A structured and comprehensive evaluation aids assessment of the symptomatic UKA.This review provides an overview of the causes for a symptomatic medial UKA, its risk factors, diagnostic modalities that can be used, and briefly discusses treatment options. Cite this article: EFORT Open Rev 2021;6:850-860. DOI: 10.1302/2058-5241.6.200105.
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Affiliation(s)
- Stein J Janssen
- Department of Orthopaedic Surgery, Academic Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Iris van Oost
- Department of Orthopaedic Surgery, FORCE (Foundation for Orthopaedic Research Care Education), Amphia Hospital, Breda, The Netherlands
| | - Stefan J M Breugem
- Department of Orthopaedic Surgery, Bergman Clinics, Naarden, The Netherlands
| | - Rutger C I van Geenen
- Department of Orthopaedic Surgery, FORCE (Foundation for Orthopaedic Research Care Education), Amphia Hospital, Breda, The Netherlands
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Afghanyar Y, Kutzner KP, Drees P, Schneider M. Secondary Osseous Integration of Cementless Unicompartmental Knee Arthroplasty After Internal Fixation of a Felix Type IIIB Fracture: A Case Report. JBJS Case Connect 2021; 11:01709767-202103000-00050. [PMID: 33705362 DOI: 10.2106/jbjs.cc.20.00885] [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: 11/14/2022]
Abstract
CASE A 76-year-old man presented with periprosthetic tibial plateau fracture (TPF), with a completely loosened tibial component 3 weeks after cementless unicompartmental knee arthroplasty (UKA). Internal fixation by buttress plating was performed, and the tibial component was retained and left in situ primarily as a spacer. Revision was planned after fracture consolidation, but at 3 months, the patient was able to walk without support, without pain, and with full range of motion. At 1 year, he is free of complaints. The initial loosened tibial component reintegrated. CONCLUSION Internal fixation combined with preserving the loosened tibial component may be a treatment option for TPF involving a cementless UKA.
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Affiliation(s)
- Yama Afghanyar
- Department of Orthopaedics and Traumatology, St. Josefs Hospital Wiesbaden, Wiesbaden, Germany
| | - Karl Philipp Kutzner
- Department of Orthopaedics and Traumatology, St. Josefs Hospital Wiesbaden, Wiesbaden, Germany
- Department of Orthopaedics and Traumatology, University Medical Centre of the Johannes Gutenberg-University of Mainz, Mainz, Germany
| | - Philipp Drees
- Department of Orthopaedics and Traumatology, University Medical Centre of the Johannes Gutenberg-University of Mainz, Mainz, Germany
| | - Michael Schneider
- Department of Orthopaedics and Traumatology, St. Josefs Hospital Wiesbaden, Wiesbaden, Germany
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Calvo R, Figueroa D, Anastasiadis Z, Espinoza G, Sarango D. Medial femoral condyle fracture during an Oxford unicompartmental knee replacement surgery: case report. J ISAKOS 2020; 6:182-184. [PMID: 34006582 DOI: 10.1136/jisakos-2019-000311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 10/21/2020] [Accepted: 11/01/2020] [Indexed: 11/04/2022]
Abstract
Oxford unicompartmental knee arthroplasty has been used as a good alternative for medial unicompartmental osteoarthritis due to its association with early rehabilitation and a low rate of intraoperative complications. This case describes a rare complication during the procedure of an intraoperative fracture of the medial condyle that was treated with osteosynthesis with 6.5 mm cannulated screws and a compression technique. The patient followed a non-weight-bearing protocol for 6 weeks and reached full range of motion at 3 months. Complete radiological fusion and good functional outcome were observed. Intraoperative fractures can benefit from stable osteosynthesis that allows free range of motion and does not jeopardise the final surgical result.
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Affiliation(s)
- Rafael Calvo
- Ortopedia y Traumatologia, Clinica Alemana de Santiago SA, Vitacura, Chile
| | - David Figueroa
- Ortopedia y Traumatologia, Clinica Alemana de Santiago SA, Vitacura, Chile
| | | | - Gonzalo Espinoza
- Clinica Alemana de Santiago SA, Vitacura, Metropolitan Region, Chile
| | - Daniel Sarango
- Knee Fellow, Clinica Alemana de Santiago SA, Vitacura, Metropolitan Region, Chile
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Kim KT, Lee S, Lee JI, Kim JW. Analysis and Treatment of Complications after Unicompartmental Knee Arthroplasty. Knee Surg Relat Res 2016; 28:46-54. [PMID: 26952551 PMCID: PMC4779805 DOI: 10.5792/ksrr.2016.28.1.46] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 10/20/2015] [Accepted: 11/03/2015] [Indexed: 11/13/2022] Open
Abstract
Purpose To analyze the causes and types of complications after unicompartmental knee arthroplasty (UKA) and determine proper prevention and treatment methods. Materials and Methods A total of 1,576 UKAs were performed for osteoarthritis of the knee from January 2002 to December 2014 at one institution. We analyzed complications after UKA retrospectively and investigated proper methods of treatment. Results A total of 89 complications (5.6%) occurred after UKA. Regarding the type of complications after UKA, there were 42 cases of dislocation of the mobile bearing, 23 cases of loosening of the prosthesis, 6 cases of periprosthetic fracture, 3 cases of polyethylene wear, 3 cases of progression of arthritis in the contralateral compartment, 2 cases of medial collateral ligament injury, 2 cases of impingement, 5 cases of infection, 1 case of arthrofibrosis, and 2 cases of failure due to unexplained pain. The most common complication after UKA was mobile bearing dislocation in the mobile-bearing knees and loosening of the prosthesis in the fixed-bearing knees, but polyethylene wear and progression of arthritis were relatively rare. The complications were treated with conversion to total knee arthroplasty in 58 cases and simple bearing change in 21 cases. Conclusions The most common complication after UKA was dislocation of the mobile bearing. When a complication occurs after UKA, appropriate treatment should be performed after accurate analysis of the cause of complication.
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Affiliation(s)
- Kyung Tae Kim
- Department of Orthopedic Surgery, Seoul Sacred Heart General Hospital, Seoul, Korea
| | - Song Lee
- Department of Orthopedic Surgery, Seoul Sacred Heart General Hospital, Seoul, Korea
| | - Jae Il Lee
- Department of Orthopedic Surgery, Seoul Sacred Heart General Hospital, Seoul, Korea
| | - Jin Woo Kim
- Department of Orthopedic Surgery, Seoul Sacred Heart General Hospital, Seoul, Korea
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Prospective randomised trial comparing unlinked, modular bicompartmental knee arthroplasty and total knee arthroplasty: a five years follow-up. Knee 2015; 22:321-7. [PMID: 25956739 DOI: 10.1016/j.knee.2015.04.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 02/17/2015] [Accepted: 04/06/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND A significant proportion of patients with knee osteoarthritis have articular degeneration that is limited to the medial and patellofemoral compartments. The objective of this study was to compare clinical outcomes of unlinked bicompartmental knee arthroplasty (BCA) and total knee arthroplasty (TKA) at 5years in this subset of patients. METHODS 48 patients were randomised into two groups: unlinked, modular bicompartmental arthroplasty and total knee arthroplasty. Data on demographics and clinical outcomes were collected (Bartlett Knee Score, Oxford Knee Score, Knee Society Score). Data on intra-operative blood loss in both groups were also recorded. RESULTS Out of the 48 patients, 26 underwent BCA and 22 had TKA. Both groups shared similar demographic profiles. At five years post surgery, there was significant improvement across all functional scores in both groups. However, there was no significant difference in outcome scores in the BCA group compared to the TKA group. The drop in serum haemoglobin levels postoperatively was 1.55 and 2.30g/dl for the BCA and TKA groups respectively (p<.001). The total amount of blood loss was 397 and 647ml respectively (p=.001). CONCLUSIONS Unlinked, modular BCA results in similar clinical and functional scores as TKA for medial and patellofemoral arthritis in the mid-term. Intra-operative blood loss was significantly lower in the BCA group compared to the TKA group. BCA is a viable option for a select group of young and active patients with the advantage of reduced intra-operative blood loss and equivalent functional outcomes as TKA.
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Argelo KDS, Burger MA, Hoozemans MJM, Temmerman OPP. Femoral component failure in the Oxford unicompartmental knee arthroplasty: a case report. J Med Case Rep 2014; 8:419. [PMID: 25495338 PMCID: PMC4308016 DOI: 10.1186/1752-1947-8-419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 10/06/2014] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION The present case report describes a patient who presented with an early complication after a unicompartmental knee arthroplasty. It is not the first case in this subject but the unique aspect of this case report rests on the timing in which the failure occurred. CASE PRESENTATION A 64-year-old Caucasian man received a medial unicompartmental knee arthroplasty (Oxford® Partial Knee) due to isolated anteromedial osteoarthritis of his right knee. His initial recovery was good, however, after 3 months he presented with acute pain and a locked knee. Radiographs showed a complete loosening and migration of the femoral component. During revision surgery no clear explanation was found for failure of the femoral component. CONCLUSIONS The most likely explanation for loosening is the combination of peak stresses on the posterior facet of the femoral components of a unicompartmental knee arthroplasty in a patient in a cross-legged knee position causing bone-cement or cement-implant interface failure. Further research is necessary in prosthetic designs and applications of the unicompartmental knee arthroplasty to determine the origin of this early complication.
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Affiliation(s)
| | | | | | - Olivier P P Temmerman
- CORAL - Centre for Orthopaedic Research Alkmaar, Department of Orthopaedic Surgery, Medical Center Alkmaar, P,O Box 501, 1800 AM Alkmaar, The Netherlands.
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Woo YL, Chin PL, Lo NN, Chia SL, Tay DKJ, Yeo SJ. Management of Periprosthetic Fracture in Unicompartmental Knee Arthroplasty Patients: A Case Series. PROCEEDINGS OF SINGAPORE HEALTHCARE 2013. [DOI: 10.1177/201010581302200406] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Unicompartmental knee arthroplasty (UKA) has been one of the treatment modality specifically for unicompartmental osteoarthritis of the knee. The advantages of UKA are faster recovery period, shorter length of hospital stay, reduced morbidity, and good functional outcome. However, one of the complications in UKA is periprosthetic fracture where most papers suggested a surgical intervention such as revision to total knee replacement. In our six years of experience with UKA surgery from 2005 to 2010, we encountered six periprosthetic fractures out of 966 knees that were operated on among 901 patients. Five patients were treated conservatively by casting and were advised not to bear weight on the affected side. One patient was revised to total knee replacement immediately. Each patient underwent a series of scoring system such as Knee Society Clinical Rating and Oxford Questionnaire to evaluate the outcome of treatment. The results were variable with only one patient showing reasonable improvement by conservative management alone. Another three patients did not show significant functional improvements despite the fractures healing. One patient developed non-union and had to undergo internal fixation to correct the deformity. The patient who underwent a revision to total knee replacement showed significant improvement. We conclude that surgical intervention produced better outcome. Revision to total knee replacement was the preferred treatment.
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Affiliation(s)
- Yew Lok Woo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Pak Lin Chin
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Ngai Nung Lo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Shi-Lu Chia
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | | | - Seng Jin Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
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Akan B, Yildirim T, Karaguven D. Medial femoral condyle fracture after cementless unicompartmental knee replacement: a rare complication. Knee 2013. [PMID: 23178111 DOI: 10.1016/j.knee.2012.10.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
This case report describes a rare complication of unicompartmental knee arthroplasty. Femoral fracture after TKR is a serious and relatively common problem, but to the best of our knowledge, only one case of femoral condylar fracture after UKA has been reported thus far.
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Affiliation(s)
- Burak Akan
- Department of Orthopedics and Traumatology, Ufuk University Faculty of Medicine, Ankara, Turkey.
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Abstract
Cementless fixation is an increasingly popular option in unicondylar knee arthroplasty (UKA). Early cementless UKAs suffered from unreliable fixation and uptake of cementless UKA was limited. However, modern designs of cementless UKA have demonstrated excellent results with improved radiographic appearances when compared with cemented implants. This is supported by early joint registry data, which demonstrate a survival advantage with cementless fixation in one design of UKA. This review explains the rationale for cementless UKA, summarizes the results from published trials, and highlights technical aspects points to be aware of when implanting cementless UKA.
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Ng VY, Arnott L, McShane M. Periprosthetic femoral condyle fracture after total knee arthroplasty and saline-coupled bipolar sealing technology. Orthopedics 2011; 34:53. [PMID: 21210617 DOI: 10.3928/01477447-20101123-22] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Saline-cooled bipolar radiofrequency technology has emerged as an effective method to reduce bleeding during total knee arthroplasty (TKA). No significant osseous complications have been previously reported, and animal studies have revealed no difference in bone healing, strength, or osteonecrosis compared to conventional monopolar electrocautery. This article presents 4 cases of early postoperative periprosthetic femoral condyle fractures after extensive use of saline-cooled bipolar radiofrequency requiring revision TKA. Preoperative, intraoperative, and postoperative details from 4 patients who underwent early TKA revision for periprosthetic femoral condyle fractures were retrospectively reviewed. The senior author (M.M.) had not experienced similar condyle fractures postoperatively in over 2,500 primary TKAs performed over 2 decades. The cases described here were performed between July 2009 and November 2009, shortly after increasing the usage of saline-cooled bipolar radiofrequency on the synovium overlying the femoral condyles for hemostasis. No other change in surgical technique or implant that occurred during this time was observed. The senior author has significantly decreased his use of saline-cooled bipolar radiofrequency and has seen no recurrence of these complications.
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Affiliation(s)
- Vincent Y Ng
- The Ohio State University Medical Center, Department of Orthopedics, 4110 Cramblett Hall, 456 W10th Ave, Columbus, Ohio 43210, USA.
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