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Fricka KB, Wilson EJ, Strait AV, Ho H, Hopper RH, Hamilton WG, Sershon RA. Outcomes of fixed versus mobile-bearing medial unicompartmental knee arthroplasty. Bone Joint J 2024; 106-B:916-923. [PMID: 39216863 DOI: 10.1302/0301-620x.106b9.bjj-2024-0075.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Aims The optimal bearing surface design for medial unicompartmental knee arthroplasty (UKA) remains controversial. The aim of this study was to compare outcomes of fixed-bearing (FB) and mobile-bearing (MB) UKAs from a single high-volume institution. Methods Prospectively collected data were reviewed for all primary cemented medial UKAs performed by seven surgeons from January 2006 to December 2022. A total of 2,999 UKAs were identified, including 2,315 FB and 684 MB cases. The primary outcome measure was implant survival. Secondary outcomes included 90-day and cumulative complications, reoperations, component revisions, conversion arthroplasties, range of motion, and patient-reported outcome measures. Overall mean age at surgery was 65.7 years (32.9 to 94.3), 53.1% (1,593/2,999) of UKAs were implanted in female patients, and demographics between groups were similar (p > 0.05). The mean follow-up for all UKAs was 3.7 years (0.0 to 15.6). Results Using revision for any reason as an endpoint, five-year survival for FB UKAs was 97.2% (95% CI 96.4 to 98.1) compared to 96.0% for MB (95% CI 94.1 to 97.9; p = 0.008). The FB group experienced fewer component revisions (14/2,315, 0.6% vs 12/684, 1.8%; p < 0.001) and conversion arthroplasties (38/2315, 1.6% vs 24/684, 3.5%; p < 0.001). A greater number of MB UKAs underwent revision due to osteoarthritis progression (FB = 21/2,315, 0.9% vs MB = 16/684, 2.3%; p = 0.003). In the MB group, 12 (1.8%) subjects experienced bearing dislocations which required revision surgery. There were 15 early periprosthetic tibia fractures (0.6%) in the FB group compared to 0 for MB (p = 0.035). Conclusion In similar patient populations, FB UKAs demonstrated slightly higher survival than a commonly used MB design. Adverse event profiles differed by bearing type, with an increased risk of bearing dislocation and OA progression with MB designs, and early periprosthetic tibia fractures for FB designs.
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Affiliation(s)
- Kevin B Fricka
- Anderson Orthopaedic Research Institute, Alexandria, Virginia, USA
| | - Eric J Wilson
- Anderson Orthopaedic Research Institute, Alexandria, Virginia, USA
| | | | - Henry Ho
- Anderson Orthopaedic Research Institute, Alexandria, Virginia, USA
| | - Robert H Hopper
- Anderson Orthopaedic Research Institute, Alexandria, Virginia, USA
| | | | - Robert A Sershon
- Anderson Orthopaedic Research Institute, Alexandria, Virginia, USA
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Liu C, Chen H, Ge J, Huang C, Zhang Q, Guo W. Predicting valgus malalignment after mobile-bearing UKA using a new method: the arithmetic HKA of the arthritic knee. Arch Orthop Trauma Surg 2023; 143:6381-6391. [PMID: 37244889 DOI: 10.1007/s00402-023-04921-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 05/21/2023] [Indexed: 05/29/2023]
Abstract
BACKGROUND Valgus malalignment is one of the most common reasons for the progression of osteoarthritis in the lateral compartment of the knee after mobile-bearing unicompartmental knee arthroplasty (UKA). The arithmetic hip-knee-ankle angle (aHKA) of the Coronal Plane Alignment of the Knee (CPAK) classification could reflect the constitutional alignment of the arthritic knee. The purpose of this study was to observe the relationship between the aHKA and valgus malalignment after mobile-bearing UKA. METHODS This retrospective study was conducted using 200 knees undergoing UKA from January 1, 2019, to August 1, 2022. These radiographic signs, including preoperative hip-knee-ankle angle (HKA), mechanical proximal tibial angle (MPTA), mechanical lateral distal femoral angle (LDFA), and postoperative HKA, were measured using standardized weight-bearing long-leg radiographs. Patients with postoperative HKA > 180° and postoperative HKA ≤ 180° were classified as the valgus group and non-valgus group, respectively. The aHKA was calculated as 180° + MPTA - LDFA in this study, which had the same meaning as that (aHKA = MPTA - LDFA) in the CPAK classification. The Spearman correlation analysis, the Mann-Whitney U test, the chi-square test, the Fisher's exact test, and multiple logistic regression were used in the study. RESULTS Of the 200 knees included in our study, 28 knees were classified as the valgus group, while 172 knees were in the non-valgus group. The mean ± standard deviation (SD) of aHKA (all groups) was 177.04 ± 2.58°. In the valgus group, 11 knees (39.3%) had a value of aHKA > 180°, while 17 knees (60.7%) had a value of aHKA ≤ 180°. In the non-valgus group, 12 knees (7.0%) had a value of aHKA > 180°, while 160 knees (93.0%) had a value of aHKA ≤ 180°. In Spearman correlation analysis, aHKA was positively correlated with postoperative HKA (r = 0.693, p < 0.001). In univariate analysis, preoperative HKA (p < 0.001), LDFA (p = 0.02), MPTA (p < 0.001), and aHKA (p < 0.001) showed significant differences between the valgus and non-valgus groups. Variables with p < 0.1 in univariate analysis were further analyzed using multiple logistic regression analysis, and the variable-aHKA (> 180° vs ≤ 180°, odds ratio (OR) = 5.899, 95% confidence interval (CI) = 1.213 to 28.686, and p = 0.028) was expressed as the risk factor of postoperative valgus malalignment. CONCLUSION The aHKA is correlated with the postoperative alignment of mobile-bearing UKA and a high aHKA (> 180°) will increase the risk of postoperative valgus malalignment. Therefore, mobile-bearing UKA should be performed with caution in patients with preoperative aHKA > 180°.
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Affiliation(s)
- Changquan Liu
- China-Japan Friendship Hospital (Institute of Clinical Medical Sciences), Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Handong Chen
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, China
- Beijing University of Chinese Medicine, Beijing, China
| | - Juncheng Ge
- Department of Orthopaedic Surgery, Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
| | - Cheng Huang
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Qidong Zhang
- China-Japan Friendship Hospital (Institute of Clinical Medical Sciences), Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, China.
| | - Wanshou Guo
- China-Japan Friendship Hospital (Institute of Clinical Medical Sciences), Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, China.
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Hariri M, Zahn N, Mick P, Jaber A, Reiner T, Renkawitz T, Innmann M, Walker T. Fixed-bearing is superior to mobile-bearing in lateral unicompartmental knee replacement: a retrospective matched-pairs analysis. Knee Surg Sports Traumatol Arthrosc 2023; 31:3947-3955. [PMID: 37093235 PMCID: PMC10435651 DOI: 10.1007/s00167-023-07417-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 04/08/2023] [Indexed: 04/25/2023]
Abstract
PURPOSE Due to low incidence of isolated lateral osteoarthritis (OA), there are limited data on whether a fixed-bearing (FB) or a mobile-bearing (MB) design is superior for lateral unicompartmental knee replacement (UKR). The aim of this matched-pairs analysis was to compare both designs in terms of implant survival and clinical outcome. METHODS Patients who received MB-UKR (Group A) and FB-UKR (Group B) at a single centre were matched according to gender, age at time of surgery and body mass index (BMI). Survivorship analysis was performed with the endpoint set as "revision for any reason". Clinical outcome was assessed using the Oxford knee score (OKS), visual analogue scale for pain (VAS), patients' satisfaction, University of California Los Angeles activity scale (UCLA) and the Tegner activity score (TAS). RESULTS A total of 60 matched pairs were included with a mean follow-up (FU) of 3.4 ± 1.3 (range 1.2-5.0) years in Group A and 2.7 ± 1.2 (range 1.0-5.0) years in Group B. Survivorship between both groups differed significantly (Group A: 78.7%; Group B: 98.3%, p = 0.003) with bearing dislocation being the most common reason for revision in Group A (46.2%). The relative and absolute risk reduction were 92.2% and 20%, respectively, with 5 being the number needed to treat. There were no differences in OKS (Group A: 41.6 ± 6.5; Group B: 40.4 ± 7.7), VAS (Group A: 2.9 ± 3.2; Group B: 1.6 ± 2.2), UCLA (Group A: 5.7 ± 1.3; Group B: 5.9 ± 1.8) and TAS (Group A: 3.0 ± 1.0; Group B: 3.1 ± 1.2) between both groups on follow-up. CONCLUSION Despite modern prosthesis design and surgical technique, implant survival of lateral MB-UKR is lower than that of FB-UKR on the short- to mid-term due to bearing dislocation as the most common cause of failure. Since clinical results are equivalent in both groups, FB-UKR should be preferred in treatment of isolated lateral OA. LEVEL OF EVIDENCE Retrospective case-control study, Level III.
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Affiliation(s)
- Mustafa Hariri
- Department of Orthopaedics, University Hospital of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Niklas Zahn
- Department of Orthopaedics, University Hospital of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Paul Mick
- Department of Orthopaedics, University Hospital of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Ayham Jaber
- Department of Orthopaedics, University Hospital of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Tobias Reiner
- Department of Orthopaedics, University Hospital of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Tobias Renkawitz
- Department of Orthopaedics, University Hospital of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Moritz Innmann
- Department of Orthopaedics, University Hospital of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Tilman Walker
- Department of Orthopaedics, University Hospital of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.
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Koenraadt-van Oost I, Koenraadt KL, Hoorntje A, van Steenbergen LN, Bolder SB, van Geenen RC. Nationwide partial knee replacement uptake is influenced by volume and supplier--A Dutch arthroplasty register study. J Orthop Surg (Hong Kong) 2022; 30:10225536221144726. [PMID: 36508684 DOI: 10.1177/10225536221144726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Despite the established advantages of partial knee replacements (PKR), their usage remains limited. We investigated the effect of hospital knee arthroplasty (KA) volume and the availability of a frequently used PKR by the total KA supplier on the use of PKRs in a hospital. METHODS A total of 190,204 total knee replacements (TKR) and 18,134 PKRs were identified in the Dutch Arthroplasty Register (LROI) from 2007 to 2016. For each hospital we determined the annual absolute KA volume (TKR+PKR) into quartiles (<103, 103-197, 197-292, >292 knee replacements/year), and determined whether the TKR supplier provided a frequently used PKR. Hospitals were divided in routine PKR users (≥13 PKRs/year) or occasional/non PKR users (<13 PKRs/year). Based on these parameters, the effect of total KA volume and supplier on PKR usage was investigated, using chi-square tests. Logistic regression analysis was performed to evaluate the influence of the combination of these factors. RESULTS In the lowest volume group, around 15% of the hospitals used PKRs, compared to 75% in the highest volume group. Having a TKR supplier that also provides a frequently used PKR resulted in a higher likelihood of performing PKR, especially in low volume hospitals. CONCLUSIONS Hospitals' total KA volume and the availability of a frequently used PKR appear to influence the use of PKR.
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Affiliation(s)
- Iris Koenraadt-van Oost
- Foundation for Orthopedic Research, Care and Education, 89411Amphia Hospital, Breda, Netherlands
| | - Koen Lm Koenraadt
- Foundation for Orthopedic Research, Care and Education, 89411Amphia Hospital, Breda, Netherlands
| | - Alexander Hoorntje
- Department of Orthopaedic Surgery, Ringgold: 26066Amsterdam UMC Location AMC, Amsterdam, Netherlands
| | | | - Stefan Bt Bolder
- Department of Orthopedic Surgery, 89411Amphia Hospital, Breda, Netherlands
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Röttinger T, Lisitano L, Wiedl A, Mayr E, Röttinger H. The Anterior Impingement After Mobile-Bearing Unicomparimental Knee Arthroplasty—A Neglected Problem. A Clinical Report of 14 Cases. Arthroplast Today 2022; 17:94-100. [PMID: 36042942 PMCID: PMC9420323 DOI: 10.1016/j.artd.2022.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/20/2022] [Accepted: 06/23/2022] [Indexed: 11/15/2022] Open
Abstract
Background Methods Results Conclusions
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Affiliation(s)
- Timon Röttinger
- Department of Trauma Surgery, Orthopedics, Plastic and Hand Surgery, University Hospital of Augsburg, Augsburg, Germany
| | - Leonard Lisitano
- Department of Trauma Surgery, Orthopedics, Plastic and Hand Surgery, University Hospital of Augsburg, Augsburg, Germany
| | - Andreas Wiedl
- Department of Trauma Surgery, Orthopedics, Plastic and Hand Surgery, University Hospital of Augsburg, Augsburg, Germany
| | - Edgar Mayr
- Department of Trauma Surgery, Orthopedics, Plastic and Hand Surgery, University Hospital of Augsburg, Augsburg, Germany
| | - Heinz Röttinger
- Department of Athroplasty, München Klinik Neuperlach, Munich, Germany
- Faculty of Medical University of Pleven, Pleven, Bulgaria
- Corresponding author. Department of Athroplasty, München Klinik Neuperlach, Oskar-Maria-Graf-Ring 51, 81737 Munich, Germany. Tel.: +49 151 21083727.
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Revision indications for medial unicompartmental knee arthroplasty: a systematic review. Arch Orthop Trauma Surg 2022; 142:301-314. [PMID: 33630155 DOI: 10.1007/s00402-021-03827-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 02/08/2021] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Unicompartmental knee arthroplasty (UKA) has advantages over total knee arthroplasty including fewer complications and faster recovery; however, UKAs also have higher revision rates. Understanding reasons for UKA failure may, therefore, allow for optimized clinical outcomes. We aimed to identify failure modes for medial UKAs, and to examine differences by implant bearing, cement use and time. MATERIALS AND METHODS A systematic review was conducted by searching MedLine, EMBASE, CINAHL and Cochrane databases from 2000 to 2020. Studies were selected if they included ≥ 250 participants, ≥ 10 failures and reported all failure modes of medial UKA performed for osteoarthritis (OA). RESULTS A total of 24 cohort and 2 registry-based studies (levels II and III) were selected. The most common failure modes were aseptic loosening (24%) and OA progression (30%). Earliest failures (< 6 months) were due to infection (40%), bearing dislocation (20%), and fracture (20%); mid-term failures (> 2 years to 5 years) were due to OA progression (33%), aseptic loosening (17%) and pain (21%); and late-term (> 10 years) failures were mostly due to OA progression (56%). Rates of failure from wear were higher with fixed-bearing prostheses (5% cf. 0.3%), whereas rates of bearing dislocations were higher with mobile-bearing prostheses (14% cf. 0%). With cemented components, there was a high rate of failure due to aseptic loosening (27%), which was reduced with uncemented components (4%). CONCLUSIONS UKA failure modes differ depending on implant design, cement use and time from surgery. There should be careful consideration of implant options and patient selection for UKA.
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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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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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Li C, Li T, Zhang Z, Huang H, Chen T, Zhang H. Potential factors in postoperative dislocation of Oxford phase III mobile bearing UKA in Chinese patients: a single-center retrospective study. BMC Musculoskelet Disord 2021; 22:930. [PMID: 34749697 PMCID: PMC8576971 DOI: 10.1186/s12891-021-04828-y] [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] [Received: 05/10/2021] [Accepted: 10/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Bearing dislocation is the main complication after mobile bearing unicompartmental knee arthroplasty. The purpose of this study was to analyze the potential risk factors of bearing dislocation after Oxford phase III mobile bearing unicompartmental knee arthroplasty in Chinese patients. METHODS We retrospectively investigated 492 patients (578 knees) who underwent Oxford phase III mobile bearing unicompartmental knee arthroplasty in our institution between February 2009 and June 2019. The patients were divided into two groups based on surgeons' annual surgical volume. Those with/ without bearing dislocation were compared based on patient, surgeon and implant factors. RESULTS Among the 492 patients, 21 (4.3%, 4 men and 17 women) experienced bearing dislocation. Of these, 14 (4.0%) were in the high surgical volume group and 7 (5.1%) were in the low surgical volume group. Multivariate analysis revealed that trauma to the operated leg and daily life involving high knee flexion cumulatively predicted bearing dislocation (p < 0.05). CONCLUSIONS Trauma to the operated leg and daily life involving high knee flexion were risk factors for bearing dislocation after Oxford phase III mobile bearing unicompartmental knee arthroplasty.
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Affiliation(s)
- Chenkai Li
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China
| | - Tao Li
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China
| | - Zian Zhang
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China
| | - Hui Huang
- Department of Anesthesiology, The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China
| | - Tian Chen
- Zhongtai Securities Institute for Financial Studies, Shandong University, Jinan, 250100, China
| | - Haining Zhang
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China.
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10
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Morikawa LH, Combs DB, Andrews SN, Mathews K, Nakasone CK. Component positioning of the first 300 mobile bearing unicompartmental knee arthroplasties. J Orthop 2021; 27:9-12. [PMID: 34413583 DOI: 10.1016/j.jor.2021.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 08/08/2021] [Indexed: 10/20/2022] Open
Abstract
The Oxford® Partial Knee has excellent long-term survivorship but high surgical times indicate a learn curve. This retrospective review included a radiographic evaluation of component placement of the initial 300 procedures following conversion from fixed bearing implant use. The anteroposterior and sagittal femoral angles were considered inaccurate in 1.7% and 3.9% of cases, respectively. The anteroposterior and sagittal tibial angles were considered inaccurate in 18.7% and 6.0% of cases, respectively. Overall, a learning curve appears to be present regarding the anteroposterior tibial component angle, with the greatest percentage of inaccuracies occurring within the initial 20 cases.
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Affiliation(s)
- Landon H Morikawa
- John A Burns School of Medicine, 651 Ilalo Street, Honolulu, HI, 96813, USA.,Straub Medical Center, Bone and Joint Center, 888 South King Street, Honolulu, HI, USA
| | - Dylan B Combs
- John A Burns School of Medicine, 651 Ilalo Street, Honolulu, HI, 96813, USA
| | - Samantha N Andrews
- Straub Medical Center, Bone and Joint Center, 888 South King Street, Honolulu, HI, USA.,University of Hawai'i, John A Burns School of Medicine, Department of Surgery, 1356 Lusitana Street, Honolulu, HI, 96813, USA
| | - Kristin Mathews
- Straub Medical Center, Bone and Joint Center, 888 South King Street, Honolulu, HI, USA
| | - Cass K Nakasone
- Straub Medical Center, Bone and Joint Center, 888 South King Street, Honolulu, HI, USA.,University of Hawai'i, John A Burns School of Medicine, Department of Surgery, 1356 Lusitana Street, Honolulu, HI, 96813, USA
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11
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Xue H, Ma T, Wen T, Yang T, Xue L, Tu Y. Predictors of Satisfactory Outcomes With Fixed-Bearing Lateral Unicompartmental Knee Arthroplasty: Up to 7-year Follow-Up. J Arthroplasty 2021; 36:910-916. [PMID: 33168343 DOI: 10.1016/j.arth.2020.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 09/10/2020] [Accepted: 10/01/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND There is little literature available examining factors that may predict functional recovery after lateral unicompartmental knee arthroplasty (UKA). The purpose of this study was to report short to mid-term effectiveness and evaluate predictors of better outcome following lateral UKA. METHODS We retrospectively reviewed 248 patients (260 knees) who underwent lateral UKA from January 2013, with a mean 5-year follow-up. The primary outcome measures comprised the Hospital for Special Surgery (HSS) score and patient satisfaction. Multivariate regression analyses were implemented to investigate associations between these factors with a satisfactory outcome. Implant survival was estimated by Kaplan-Meier analysis. RESULTS Complete follow-up was available for 186 patients (198 knees). At last follow-up, the HSS scores were changed from 52.1 (range, 38-80) preoperatively to 85.6 (range, 61-98) (P < .001), The OKS improved from 22.8 (range, 16-32) preoperatively to 42.7 (range, 30-47) postoperatively (P < .01). The 5-year survival was 99.5%. The multivariate analysis showed that the following factors tended to obtain a satisfactory outcome: higher proportion of ASA class I (P < .001), diagnosis of primary OA (P = .007), postoperative limb alignment (P = .007), and higher preoperative HSS score (P = .019). Patients with valgus 9°-12° reported the highest HSS scores among different subgroups (P < .001). CONCLUSION Following lateral UKA, postoperative outcomes were satisfactory in patients with lower ASA scores, diagnosis with primary OA, higher preoperative HSS scores and those with postoperative valgus alignment. It is important to understand these correlations to help appropriate patient selection to obtain optimal function after lateral UKA.
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Affiliation(s)
- Huaming Xue
- Department of Orthopaedics, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China
| | - Tong Ma
- Department of Orthopaedics, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China
| | - Tao Wen
- Department of Orthopaedics, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China
| | - Tao Yang
- Department of Orthopaedics, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China
| | - Long Xue
- Department of Orthopaedics, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yihui Tu
- Department of Orthopaedics, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China
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Khow YZ, Liow MHL, Lee M, Chen JY, Lo NN, Yeo SJ. The effect of tibial and femoral component coronal alignment on clinical outcomes and survivorship in unicompartmental knee arthroplasty. Bone Joint J 2021; 103-B:338-346. [PMID: 33517724 DOI: 10.1302/0301-620x.103b2.bjj-2020-0959.r1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS This study aimed to identify the tibial component and femoral component coronal angles (TCCAs and FCCAs), which concomitantly are associated with the best outcomes and survivorship in a cohort of fixed-bearing, cemented, medial unicompartmental knee arthroplasties (UKAs). We also investigated the potential two-way interactions between the TCCA and FCCA. METHODS Prospectively collected registry data involving 264 UKAs from a single institution were analyzed. The TCCAs and FCCAs were measured on postoperative radiographs and absolute angles were analyzed. Clinical assessment at six months, two years, and ten years was undertaken using the Knee Society Knee score (KSKS) and Knee Society Function score (KSFS), the Oxford Knee Score (OKS), the 36-Item Short-Form Health Survey questionnaire (SF-36), and range of motion (ROM). Fulfilment of expectations and satisfaction was also recorded. Implant survivorship was reviewed at a mean follow-up of 14 years (12 to 16). Multivariate regression models included covariates, TCCA, FCCA, and two-way interactions between them. Partial residual graphs were generated to identify angles associated with the best outcomes. Kaplan-Meier analysis was used to compare implant survivorship between groups. RESULTS Significant two-way interaction effects between TCCA and FCCA were identified. Adjusted for each other and their interaction, a TCCA of between 2° and 4° and a FCCA of between 0° and 2° were found to be associated with the greatest improvements in knee scores and the probability of fulfilling expectations and satisfaction at ten years. Patients in the optimal group whose TCCA and FCCA were between 2° and 4°, and 0° and 2°, respectively, had a significant survival benefit at 15 years compared with the non-optimal group (optimal: survival = 100% vs non-optimal: survival = 92%, 95% confidence interval (CI) 88% to 96%). CONCLUSION Significant two-way interactions between the TCCA and FCCA demonstrate the importance of evaluating the alignment of the components concomitantly in future studies. By doing so, we found that patients who concomitantly had both a TCCA of between 2° and 4° and a FCCA of between 0° and 2° had the best patient-reported outcome measures at ten years and better survivorship at 15 years. Cite this article: Bone Joint J 2021;103-B(2):338-346.
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Affiliation(s)
- Yong Zhi Khow
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | | | - Merrill Lee
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Jerry Yongqiang Chen
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Ngai Nung Lo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Seng Jin Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
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Khow YZ, Liow MHL, Lee M, Chen JY, Lo NN, Yeo SJ. Coronal Alignment of Fixed-Bearing Unicompartmental Knee Arthroplasty Femoral Component May Affect Long-Term Clinical Outcomes. J Arthroplasty 2021; 36:478-487. [PMID: 32828619 DOI: 10.1016/j.arth.2020.07.070] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/13/2020] [Accepted: 07/27/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND This study aims to investigate the clinical effects of femoral component coronal alignment in a cohort of fixed-bearing unicompartmental knee arthroplasty with clinical and radiological follow-up of 10 years. METHODS Prospectively collected registry data of 264 consecutive, cemented, primary fixed-bearing medial unicompartmental knee arthroplasties performed at a single institution from 2004 to 2007 were reviewed. Femoral component coronal angle (FCCA), tibial component coronal angle, and hip-knee-ankle angle were measured on postoperative radiographs. Patients were grouped into acceptable (AG ≤ 3°) and outlier (OG > 3°) groups according to absolute FCCA. Clinical assessment at 6-month, 2-year, and 10-year follow-up was performed using Knee Society Knee and Function Scores, Oxford Knee Score (OKS), and Short Form-36. Fulfillment of expectations, satisfaction, and implant survivorship was recorded. RESULTS There was no significant difference in demographics, tibial component coronal angle, hip-knee-ankle angle, and sagittal parameters in both groups. The OG had poorer OKS at 10 years and a larger deterioration from 2 to 10 years compared to AG (P = .02). Increase in FCCA was associated with deterioration in 2-year OKS (adjusted ß = 0.23, P = .01), 10-year OKS (adjusted ß = 0.26, P = .03), and 2-year Short Form-36 physical component score (adjusted ß = -0.44, P = .01). Expectation fulfillment at 2 years was lower in the OG vs the AG (88% vs 100%, P = .03). Both groups had similar 10-year survivorship (99% vs 98%, P = .65). CONCLUSIONS FCCA may affect long-term clinical outcomes, but not short-term clinical outcomes nor 10-year survivorship. Given similar limb alignment, coronal and sagittal component positioning, a larger FCCA was associated with poorer outcomes at 10-year follow-up.
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Affiliation(s)
- Yong Zhi Khow
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | | | - Merrill Lee
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Jerry Yongqiang Chen
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Ngai Nung Lo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Seng Jin Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
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14
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Sun XW, Lu FF, Zou K, Hong M, Zhang QD, Guo WS. Does new instrument for Oxford unicompartmental knee arthroplasty improve short-term clinical outcome and component alignment? A meta-analysis. J Orthop Surg Res 2020; 15:386. [PMID: 32894147 PMCID: PMC7487934 DOI: 10.1186/s13018-020-01926-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 08/24/2020] [Indexed: 11/10/2022] Open
Abstract
Background The Microplasty (MP) instrumentation designed for the Phase III Oxford mobile-bearing unicompartmental knee arthroplasty (UKA) system is considered a better option to achieve more accurate component positioning and alignment. In the present study, we focused on short-term clinical and radiological outcomes to determine whether the MP instrumentation can reduce the short-term revision rate and occurrence of outliers of metallic components. Methods The literature in PubMed, Embase, the Cochrane Library, and Web of Science was searched up to May 2020. Studies were scrutinized by two independent authors, and the revision rate, complication spectrum, and radiological assessment with outlier rates were specifically analyzed. RevMan 5.3 was used for the statistical analysis. Results Seven studies were included in the meta-analysis. Four studies reported both clinical and radiological outcomes, two reported only radiological outcomes, and one reported only clinical outcomes. The pooled analysis showed that the revision rate in the MP instrumentation group was 0.866 per 100 component years, while that in the control group was 1.124 (odds ratio, 0.77; p < 0.05). The subgroup analysis of the bearing dislocation rate showed a significantly greater reduction in the Korean population than in the populations of other countries (p < 0.05). The radiological assessment showed that the alignment of the femoral component was significantly improved (p < 0.05), while that of the tibial component was not (p > 0.05). Conclusion The newly developed MP instrumentation for Oxford UKA significantly reduced the revision rate of this treatment. The positioning of the femoral component was also proven to be better by radiological assessments.
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Affiliation(s)
- Xiao Wei Sun
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.,Department of Orthopaedic Surgery, China-Japan Friendship Hospital, No. 2 Yinghuadong Road, Chaoyang District, Beijing, 100029, China
| | - Fei Fan Lu
- China-Japan Friendship School of Clinical Medicine, Peking University, Beijing, China
| | - Kun Zou
- Beijing University of Chinese Medicine, Beijing, China
| | - Mao Hong
- Beijing University of Chinese Medicine, Beijing, China
| | - Qi Dong Zhang
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, No. 2 Yinghuadong Road, Chaoyang District, Beijing, 100029, China
| | - Wan Shou Guo
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China. .,Department of Orthopaedic Surgery, China-Japan Friendship Hospital, No. 2 Yinghuadong Road, Chaoyang District, Beijing, 100029, China.
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15
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van Oost I, Koenraadt KLM, van Steenbergen LN, Bolder SBT, van Geenen RCI. Higher risk of revision for partial knee replacements in low absolute volume hospitals: data from 18,134 partial knee replacements in the Dutch Arthroplasty Register. Acta Orthop 2020; 91:426-432. [PMID: 32285723 PMCID: PMC8023870 DOI: 10.1080/17453674.2020.1752017] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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 - Partial knee replacement (PKR) survival rates vary a great deal among registries and cohort studies. These discrepancies can largely be attributed to inappropriate indications of the PKR and low thresholds for revision, but also to the PKR volume. This study used Dutch Arthroplasty Register data to analyze whether absolute PKR or proportional PKR hospital volume is associated with the risk of revision.Patients and methods - 18,134 PKRs were identified in the Dutch Arthroplasty Register from 2007 to 2016. For each year, hospitals were divided into 4 groups based on the quartiles for the absolute volume (< 22, 22-36, 36-58 and > 58 PKRs per year) and the proportional volume (< 8.5, 8.6-14.2, 14.3-25.8 and > 25.8% PKRs). Kaplan-Meier survival analysis was performed to determine survival rates. A multivariable Cox regression adjusted for age category, sex, ASA score, year of surgery, diagnosis, unicondylar side, and type of hospital was used to estimate hazard ratios (HR) for revision.Results and interpretation - Proportional PKR volume did not, but absolute PKR volume did influence the risk of revision. The adjusted HR for hospitals with an absolute volume of 22-36 PKRs per year was 1.04 (95% CI 0.91-1.20), 0.96 (CI 0.83-1.10) for the hospitals with 36-58 PKRs, and 0.74 (CI 0.62-0.89) for hospitals with more than 58 PKRs compared with hospitals that had fewer than 22 PKRs per year. So, patients treated with a PKR in a high absolute volume hospital have a lower risk of revision compared with those treated in a low absolute volume hospital.
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Affiliation(s)
- Iris van Oost
- Foundation for Orthopedic Research, Care & Education, Amphia Hospital, Breda; ,Correspondence:
| | - Koen L M Koenraadt
- Foundation for Orthopedic Research, Care & Education, Amphia Hospital, Breda;
| | | | - Stefan B T Bolder
- Department of Orthopedic Surgery, Amphia Hospital, Breda, the Netherlands
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16
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Heaps BM, Blevins JL, Chiu YF, Konopka JF, Patel SP, McLawhorn AS. Improving Estimates of Annual Survival Rates for Medial Unicompartmental Knee Arthroplasty, a Meta-Analysis. J Arthroplasty 2019; 34:1538-1545. [PMID: 30954408 DOI: 10.1016/j.arth.2019.02.061] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 02/20/2019] [Accepted: 02/27/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Medial unicompartmental knee arthroplasty (mUKA) is an increasingly popular treatment option for medial compartment knee osteoarthritis. Published mUKA survival rates have varied. The purpose of this meta-analysis was to provide pooled estimates of mUKA survival 5 and 10 years postoperatively. METHODS We included studies in English within the last 15 years with a clear description of mUKA failure. Random-effects models were used to pool complementary log-log transformed implant survival estimates at 5 and 10 years postoperatively. Between-study variance was estimated using the restricted maximum likelihood method. Between-study heterogeneity was tested using the χ2 test and quantified using the I2 statistic. I2 values <25%, 25%-75%, and >75% were considered low, moderate, and high, respectively. Multivariable meta-regression was used to assess the potential association of mean patient age and study start year with survival estimates at 5 and 10 years. All analyses were performed using the metafor and meta packages implemented in R software version 3.3.4 (R Foundation for Statistical Computing, Vienna, Austria). RESULTS Twenty-six studies met inclusion criteria, representing 42,791 knees. Study-level and pooled 5- and 10-year mUKA survival estimates were 95.3% (95% confidence interval, 93.6-96.6) and 91.3% (88.9-93.3), respectively. Between-study heterogeneity was high (>88%) for all years. Mean patient age and study start year explained only 12.3% and 30.7% of between-study heterogeneity at 5 and 10 years, respectively. CONCLUSION Five- and 10-year pooled mUKA survival estimates were 95.3% and 91.3%, respectively. These data establish better estimates of mUKA survivorship and can help when counseling patients considering mUKA.
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Affiliation(s)
- Braiden M Heaps
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Jason L Blevins
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Yu-Fen Chiu
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Joseph F Konopka
- Department of Orthopaedic Surgery, Wentworth-Douglass Hospital, Dover, NH
| | - Shaun P Patel
- Department of Orthopaedic Surgery, Southern California Permanente Medical Group, Irvine, CA
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17
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Harbourne AD, Sanchez-Santos MT, Arden NK, Filbay SR. Predictors of return to desired activity 12 months following unicompartmental and total knee arthroplasty. Acta Orthop 2019; 90:74-80. [PMID: 30451046 PMCID: PMC6366469 DOI: 10.1080/17453674.2018.1542214] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - 1 in 5 patients are dissatisfied following unicompartmental or total knee arthroplasty (UKA or TKA). This may be partly explained by failing to return to desired activity post-arthroplasty. To facilitate return to desired activity, a greater understanding of predictors of return to desired activity in UKA and TKA patients is needed. We compared rates of return to desired activity 12 months following UKA vs. TKA, and identified and compared predictors of return to desired activity 12 months following UKA vs. TKA. Patients and methods - Patients were prospectively recruited from 2 hospitals prior to undergoing UKA or primary TKA. Patients reported preoperatively the activity/activities that were limited due to their knee that they wished to return to after arthroplasty. At 12-months postoperatively, patients reported whether they had returned to these activities ('return to desired activity'). Preoperative predictors evaluated were age, sex, BMI, education, comorbidities, pain expectations, Oxford Knee Score (OKS), UCLA Activity Score, and EQ-5D. Generalized linear models assessed the relationship between potential predictors and return-to-desired-activity. Results - The response rate of all patients eligible for 12-month follow-up was 74%. TKA patients (n = 575) were older (mean (SD) 70 (9) vs. 67 (10)) with a greater BMI (31 (6) vs. 30 (5)) than patients undergoing UKA (n = 420). 75% of UKA and 59% of TKA patients returned to desired activity. TKA patients had a greater risk of non-return to desired activity than patients undergoing UKA (risk ratio (95% CI) 1.5 (1.2-1.8)). Predictors of non-return to desired activity following UKA were worse OKS (0.96 (0.93-0.99)), higher BMI (1.04 (1.01-1.08)), and worse expectations (1.9 (1.2-2.8)). Predictors of non-return to desired activity following TKA were worse EQ-5D (0.53 (0.33-0.85)) and worse OKS (0.98 (0.96-1.0)). Interpretation - UKA patients were more likely to return to desired activity than TKA patients. Predictors of return to desired activity differed following UKA and TKA. Optimizing selection of arthroplasty procedure based on patient characteristics and targeting predictors of poor outcome may facilitate return to desired activity with potential to enhance postoperative satisfaction.
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MESH Headings
- Activities of Daily Living/psychology
- Arthroplasty, Replacement, Knee/adverse effects
- Arthroplasty, Replacement, Knee/methods
- Arthroplasty, Replacement, Knee/psychology
- Arthroplasty, Replacement, Knee/rehabilitation
- Female
- Follow-Up Studies
- Humans
- Karnofsky Performance Status
- Knee Joint/physiopathology
- Knee Joint/surgery
- Male
- Middle Aged
- Osteoarthritis, Knee/surgery
- Pain, Postoperative/diagnosis
- Pain, Postoperative/psychology
- Patient Satisfaction
- Patient Selection
- Prognosis
- Quality of Life
- Recovery of Function
- Risk Assessment/methods
- Risk Factors
- United Kingdom
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Affiliation(s)
- Alexander D Harbourne
- Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Oxford, UK
| | - Maria T Sanchez-Santos
- Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Oxford, UK
| | - Nigel K Arden
- Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Oxford, UK
- MRC Lifecourse Epidemiology Unit, University of Southampton, UK
| | - Stephanie R Filbay
- Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Oxford, UK
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Kim SG, Kim HG, Lee SY, Lim HC, Bae JH. Redislocation after Bearing Exchange for the Treatment of Mobile Bearing Dislocation in Medial Unicompartmental Knee Arthroplasty. Knee Surg Relat Res 2018; 30:234-240. [PMID: 30157591 PMCID: PMC6122936 DOI: 10.5792/ksrr.17.085] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 05/02/2018] [Accepted: 05/04/2018] [Indexed: 11/02/2022] Open
Abstract
Purpose This study was conducted to investigate the outcomes of bearing exchange for the treatment of mobile bearing dislocation in medial unicompartmental knee arthroplasty (UKA). Materials and Methods We retrospectively reviewed 18 patients (15 females and 3 males, mean age of 65 years) treated with bearing exchange following mobile bearing dislocation in medial UKA. The occurrence of bearing redislocation, the Oxford Knee Score, and radiographic changes at the last follow-up were investigated. Results Bearing redislocation after bearing exchange occurred in 9 of 18 patients (50%). Of these 9 patients, 7 underwent conversion to total knee arthroplasty after bearing redislocation. The 9 patients without bearing redislocation showed good to excellent clinical outcomes at a mean follow-up of 55 months after bearing exchange. The non-redislocation group had a higher percentage of posterior dislocation of the bearing than the redislocation group (55.5% vs. 22.2%, p=0.040). Univariate logistic regression analysis showed no significant risk factors for bearing redislocation. Conclusions This study showed a high rate of bearing redislocation after isolated, mobile bearing exchange for bearing dislocation following medial UKA. Therefore, bearing exchange as a sole treatment should be carefully considered in selected patients with correctable causes of bearing dislocation.
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Affiliation(s)
- Sang-Gyun Kim
- Department of Orthopaedic Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Hyun-Gon Kim
- Department of Orthopaedic Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Seung-Yup Lee
- Department of Orthopaedic Surgery, Seoul Barunsesang Hospital, Seoul, Korea
| | - Hong-Chul Lim
- Department of Orthopaedic Surgery, Seoul Barunsesang Hospital, Seoul, Korea
| | - Ji-Hoon Bae
- Department of Orthopaedic Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
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19
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Eckert JA, Jaeger S, Klotz MC, Schwarze M, Bitsch RG. Can intraoperative measurement of bone quality help in decision making for cementless unicompartmental knee arthroplasty? Knee 2018; 25:609-616. [PMID: 29792279 DOI: 10.1016/j.knee.2018.03.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 01/14/2018] [Accepted: 03/12/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND In uncemented total hip arthroplasty (THA), low bone mineral density (BMD) is associated with aseptic loosening. BMD is usually assessed via dual-energy X-ray absorptiometry (DXA) or quantitative computed tomography, which takes time and exposes patients to radiation. Due to its low risk profile, intraoperative measurement of the trabecular stability might be a useful alternative to DXA. METHODS In 24 human femora, BMD was analysed using DXA at the femoral necks and the knees. Performing the standard Oxford Unicompartmental Knee Arthroplasty (OUKA) implantation procedure, a wingblade (DensiProbe) coupled to a torque probe was used to evaluate the trabecular peak torque. The standard procedure was modified: before the completion of the central peg drill hole, the DensiProbe was inserted into the pre-drilled hole and then turned until a loss of resistance was achieved. The obtained data was then correlated with BMD at the femoral neck as well as the knee. RESULTS In all tested regions, a higher peak torque was observed in correlation with a higher BMD. CONCLUSIONS As demonstrated, the DensiProbe can be a helpful tool to assess the bone quality intraoperatively in OUKA. It can be a valuable decision guidance when faced with choosing between a cemented and a cementless implant. Due to the fact that the central peg hole of the OUKA can be used for the procedure, no additional risk for the patient exists, while the additional work for the surgeon is minimal.
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Affiliation(s)
- Johannes A Eckert
- Laboratory of Biomechanics and Implant Research, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany
| | - Sebastian Jaeger
- Laboratory of Biomechanics and Implant Research, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany
| | - Matthias C Klotz
- Laboratory of Biomechanics and Implant Research, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany
| | - Martin Schwarze
- Laboratory of Biomechanics and Implant Research, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany
| | - Rudi G Bitsch
- Laboratory of Biomechanics and Implant Research, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany.
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20
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Middleton SWF, Schranz PJ, Mandalia VI, Toms AD. The largest survivorship and clinical outcomes study of the fixed bearing Stryker Triathlon Partial Knee Replacement - A multi-surgeon, single centre cohort study with a minimum of two years of follow-up. Knee 2018; 25:732-736. [PMID: 29731320 DOI: 10.1016/j.knee.2018.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 01/30/2018] [Accepted: 04/09/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND The surgical management of isolated medial compartment degenerative disease of the knee causes debate. Unicompartmental arthroplasty options include fixed and mobile bearing implant designs with fixed bearing becoming increasingly popular. We present the largest cohort of a fixed bearing single radius design, Stryker Triathlon Partial Knee Replacement (PKR). METHODS We prospectively collected demographic data and patient reported outcome measures (PROMs) on our cohort of PKR implants since its adoption in our unit, 2009 until March 2015. RESULTS A total of 129 implants in 115 patients with a mean follow-up of 5.5 years (2.5 to 8.5 years) were included. There were 11 revisions at an average of 1.7 years (0.6-4.1 years), two for infection, two for mal-alignment, five for progression of disease and two for loosening. The survivorship of the implants at five years is 90%. CONCLUSION The PKR provides good survivorship at five years and PROM scores that are equal to the largest and most popular comparable implants. There is an associated learning curve with this implant, as there is with all systems and this is reflected in our results.
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Affiliation(s)
- S W F Middleton
- Exeter Knee Reconstruction Unit (EKRU), Royal Devon and Exeter Hospital, Barrack Road, Exeter, Devon, United Kingdom.
| | - P J Schranz
- Exeter Knee Reconstruction Unit (EKRU), Royal Devon and Exeter Hospital, Barrack Road, Exeter, Devon, United Kingdom
| | - V I Mandalia
- Exeter Knee Reconstruction Unit (EKRU), Royal Devon and Exeter Hospital, Barrack Road, Exeter, Devon, United Kingdom
| | - A D Toms
- Exeter Knee Reconstruction Unit (EKRU), Royal Devon and Exeter Hospital, Barrack Road, Exeter, Devon, United Kingdom
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21
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Neufeld ME, Albers A, Greidanus NV, Garbuz DS, Masri BA. A Comparison of Mobile and Fixed-Bearing Unicompartmental Knee Arthroplasty at a Minimum 10-Year Follow-up. J Arthroplasty 2018; 33:1713-1718. [PMID: 29398257 DOI: 10.1016/j.arth.2018.01.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 12/23/2017] [Accepted: 01/04/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The long-term survivorship and functional outcomes of the mobile-bearing (MB) compared to the fixed-bearing (FB) unicompartmental knee arthroplasty (UKA) implant design remain a topic of debate. The aim of the current study was to compare the survivorship and functional outcomes of MB and FB UKA at a minimum 10-year follow-up. METHODS We retrospectively reviewed 106 consecutive medial UKAs (89 patients) from our institution with a minimum 10-year follow-up. The 38 MB and 68 FB knees had follow-up of 14.2 years (12.9-15.5) and 11.5 years (10.2-15.1), respectively. Validated patient-reported outcomes and radiographs were evaluated as were etiology, timing, and complexity of revision. Kaplan-Meier 10-year survival was calculated with revision to total knee arthroplasty as the end point. RESULTS The 10-year survival was 82.9% (95% confidence interval [CI] 65.8-91.9) for MB and 90.9% (95% CI 79.4-96.2) for FB UKA (P = .102), and 88.0% (95% CI 79.3-93.2) for the entire cohort. Patient outcomes were similar between groups, as were timing and etiologies for revision to total knee arthroplasty. One-third of revisions required either stems or tibial augments, and of these, all were of MB design. CONCLUSION Survival and functional outcomes were similar between MB and FB designs. One-third of revisions required either stems or augments, all were of MB design.
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Affiliation(s)
- Michael E Neufeld
- Department of Orthopaedics, Reconstructive Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anthony Albers
- Department of Orthopaedics, McGill University, St. Mary's Hospital, Montréal, Quebec, Canada
| | - Nelson V Greidanus
- Department of Orthopaedics, Reconstructive Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Donald S Garbuz
- Department of Orthopaedics, Reconstructive Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bassam A Masri
- Department of Orthopaedics, Reconstructive Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
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22
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Kleeblad LJ, Borus TA, Coon TM, Dounchis J, Nguyen JT, Pearle AD. Midterm Survivorship and Patient Satisfaction of Robotic-Arm-Assisted Medial Unicompartmental Knee Arthroplasty: A Multicenter Study. J Arthroplasty 2018; 33:1719-1726. [PMID: 29486909 DOI: 10.1016/j.arth.2018.01.036] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 01/02/2018] [Accepted: 01/22/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Studies have showed improved accuracy of lower leg alignment, precise component position, and soft-tissue balance with robotic-assisted unicompartmental knee arthroplasty (UKA). No studies, however, have assessed the effect on midterm survivorship. Therefore, the purpose of this prospective, multicenter study was to determine midtem survivorship, modes of failure, and satisfaction of robotic-assisted medial UKA. METHODS A total of 473 consecutive patients (528 knees) underwent robotic-arm-assisted medial UKA surgery at 4 separate institutions between March 2009 and December 2011. All patients received a fixed-bearing, metal-backed onlay tibial component. Each patient was contacted at minimum 5-year follow-up and asked a series of questions to determine survival and satisfaction. Kaplan-Meier method was used to determine survivorship. RESULTS Data were collected for 384 patients (432 knees) with a mean follow-up of 5.7 years (5.0-7.7). The follow-up rate was 81.2%. In total, 13 revisions were performed, of which 11 knees were converted to total knee arthroplasty and in 2 cases 1 UKA component was revised, resulting in 97% survivorship. The mean time to revision was 2.27 years. The most common failure mode was aseptic loosening (7/13). Fourteen reoperations were reported. Of all unrevised patients, 91% was either very satisfied or satisfied with their knee function. CONCLUSION Robotic-arm-assisted medial UKA showed high survivorship and satisfaction at midterm follow-up in this prospective, multicenter study. However, in spite of the robotic technique, early fixation failure remains the primary cause for revision with cemented implants. Comparative studies are necessary to confirm these findings and compare to conventional implanted UKA and total knee arthroplasty.
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Affiliation(s)
- Laura J Kleeblad
- Department of Orthopaedic Surgery and Computer Assisted Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY
| | - Todd A Borus
- Department of Orthopaedic Surgery, Rebound Orthopedics & Neurosurgery, Portland, OR
| | - Thomas M Coon
- Department of Orthopaedic Surgery, Coon Joint Replacement Institute, St. Helena, CA
| | - Jon Dounchis
- Department of Orthopaedic Surgery, NCH Orthopedics, Naples, FL
| | - Joseph T Nguyen
- Biostatistics Core, Healthcare Research Institute, Hospital for Special Surgery, New York, NY
| | - Andrew D Pearle
- Department of Orthopaedic Surgery and Computer Assisted Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY
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Ro KH, Heo JW, Lee DH. Bearing Dislocation and Progression of Osteoarthritis After Mobile-bearing Unicompartmental Knee Arthroplasty Vary Between Asian and Western Patients: A Meta-analysis. Clin Orthop Relat Res 2018; 476:946-960. [PMID: 29406457 PMCID: PMC5916611 DOI: 10.1007/s11999.0000000000000205] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Implant survivorship is reported to be lower and complications, particularly bearing dislocation, are reported to be more frequent in Asian than in Western patients with medial knee osteoarthritis (OA) undergoing Oxford® Phase III unicompartmental knee arthroplasty (UKA). To date, however, these complications have not been compared between these groups of patients. QUESTIONS/PURPOSES The purpose of this study was to perform a meta-analysis comparing the standardized incidence rates of (1) all-cause reoperation; (2) reoperation related to bearing dislocation; and (3) reoperation related to progression of lateral compartment arthritis in Asian and Western patients with medial knee OA who underwent Oxford Phase III UKA. METHODS We searched MEDLINE® (January 1, 1976, to May 31, 2017), EMBASE® (January 1, 1985, to May 31, 2017), and the Cochrane Library (January 1, 1987, to May 31, 2017) for studies that reported complications of Oxford Phase III UKAs. Studies were included if they reported reoperation rates attributable to bearing dislocation and/or progression of lateral knee OA after surgery with this implant. Twenty-seven studies were included in this systematic review and 16 studies with followups > 5 years were included in the meta-analysis. These rates were converted to standardized incidence rate (that is, reoperations per 100 observed component years) based on mean followup and number of involved knees in each study. After applying prespecified inclusion and exclusion criteria, the studies were categorized into two groups, Asian and Western, based on hospital location. Twenty-five studies, containing 3152 Asian patients and 5455 Western patients, were evaluated. Study quality was assessed by the modified Coleman Methodology score (MCMS). Although all studies were Level IV, their mean MCMS score was 66.92 (SD, 8.7; 95% confidence interval [CI], 63.5-70.3), indicating fair quality. Because the heterogeneity of all subgroup meta-analyses was high, a random-effects model was used with estimations using the restricted maximum likelihood method. RESULTS There was no difference in the proportion of Asian patients versus Western patients undergoing reoperation for any cause calculated as 100 component observed years (1.022 of 3152 Asian patients; 95% CI, 0.810-1.235 versus 1.300 of 5455 Western patients; 95% CI, 1.067-1.534; odds ratio, 0.7839; 95% CI, 0.5323-1.1545; p = 0.178). The mean reoperation rate attributable to bearing dislocation per 100 observed years was higher in Asian than in Western patients (0.525; 95% CI, 0.407-0.643 versus 0.141; 95% CI, 0.116-0.166; odds ratio, 3.7378; 95% CI, 1.694-8.248; p = 0.001) Conversely, the mean reoperation rate attributable to lateral knee OA per 100 observed years was lower in Asian than in Western patients (0.093; 95% CI, 0.070-0.115 versus 0.298; 95% CI, 0.217-0.379; odds ratio, 0.3114; 95% CI, 0.0986-0.9840; p < 0.001). CONCLUSIONS Although total reoperation rates did not differ in the two populations, reoperation for bearing dislocation was more likely to occur in Asian than in Western patients, whereas reoperation for lateral knee OA progression was more likely to occur in Western than in Asian patients after Oxford Phase III UKA. Although possible explanations for these findings may be hypothesized, additional randomized, prospective comparative studies are needed. However, better survival outcomes after UKA may require consideration of ethnicity and lifestyle choices in addition to traditional surgical technique and perioperative care. LEVEL OF EVIDENCE Level III, therapeutic study.
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Horsager K, Kaptein BL, Jørgensen PB, Jepsen CF, Stilling M. Oxford medial unicompartmental knees display contact-loss during step-cycle motion and bicycle motion: A dynamic radiostereometric study. J Orthop Res 2018; 36:357-364. [PMID: 28574622 DOI: 10.1002/jor.23625] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 05/28/2017] [Indexed: 02/04/2023]
Abstract
The Oxford medial unicompartmental knee is designed fully congruent, with the purpose of maintaining a large contact-area throughout motion and minimize wear. No other study has investigated this design feature in-vivo. We aimed to evaluate if contact-loss was introduced between the articulating surfaces of the Oxford medial unicompartmental knee during bicycle- and step-cycle motion, and whether this correlated with essential implant parameters, such as polyethylene (PE) wear, knee-loadings, and clinical outcome. To study contact-loss, 15 patients (12 males, mean age 69 years) with an Oxford medial unicompartmental knee (7 cemented, mean follow-up 4.4 years) were examined with use of dynamic radiostereometry (RSA) (10 frames/s). PE wear was measured from static RSA and clinical outcome was evaluated with American Knee Society Score (AKSS) and Oxford Knee Score (OKS). Data on knee-loadings were acquired from the literature. Contact-loss was deteced in all patients during both exercises, and the trend of contact-loss correlated with the knee-loadings. Median contact-loss was 0.8 mm (95%PI: 0.3; 1.5) for bicycle motion and 0.3 mm (95%PI: 0.24; 0.35) for step-cycle motion, and did not correlate with the PE wear rate of mean 0.06 mm/year. Possible in-congruency was seen in three patients. Clinical outcome scores correlated with contact-loss during step-cycle motion. In conclusion, contact-loss was seen in all patients indicating a clinical tolerance during load. Contact-loss followed the knee-loadings, which could explain why no correlation was seen with PE wear, as an increase in load was acommadated by an increase in contact-area (contact-loss reduction). The size of contact-loss may reflect clinical outcome. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:357-364, 2018.
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Affiliation(s)
- Kristian Horsager
- Department of Orthopedics, Aarhus University Hospital, Tage-Hansens Gade 2, 8000, Aarhus, Denmark
| | - Bart L Kaptein
- Biomechanics and Imaging Group, Department of Orthopedic Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, Netherlands
| | - Peter B Jørgensen
- Department of Orthopedics, Aarhus University Hospital, Tage-Hansens Gade 2, 8000, Aarhus, Denmark
| | - Claus F Jepsen
- Department of Orthopedics, Aarhus University Hospital, Tage-Hansens Gade 2, 8000, Aarhus, Denmark
| | - Maiken Stilling
- Department of Orthopedics, Aarhus University Hospital, Tage-Hansens Gade 2, 8000, Aarhus, Denmark
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Hamilton TW, Rizkalla JM, Kontochristos L, Marks BE, Mellon SJ, Dodd CAF, Pandit HG, Murray DW. The Interaction of Caseload and Usage in Determining Outcomes of Unicompartmental Knee Arthroplasty: A Meta-Analysis. J Arthroplasty 2017. [PMID: 28641970 DOI: 10.1016/j.arth.2017.04.063] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Outcomes after unicompartmental knee arthroplasty (UKA) are variable and influenced by caseload (UKA/y) and usage (percentage of knee arthroplasty that are UKA), which relates to indications. This meta-analysis assesses the relative importance of these factors. METHODS MEDLINE (Ovid), Embase (Ovid), and Web of Science (ISI) were searched for consecutive series of cemented Phase 3 Oxford medial UKA. The primary outcome was revision rate/100 observed component years (% pa) with subgroup analysis based on caseload and usage. RESULTS Forty-six studies (12,520 knees) with an annual revision-rate ranging from 0% to 4.35% pa, mean 1.21% pa (95% confidence interval [CI], 0.97-1.47), were identified. In series with mean follow-up of 10-years, the revision-rate was 0.63% pa (95% CI, 0.46-0.83), equating to a 94% (95% CI, 92%-95%) 10-year survival. Aseptic loosening, lateral arthritis, bearing dislocation, and unexplained pain were the predominant failure mechanisms with revision for patellofemoral problems and polyethylene wear exceedingly rare. The lowest revision-rates were achieved with caseload >24 UKA/y (0.88% pa; 95% CI, 0.63-1.61) and usage >30% (0.69% pa; 95% CI, 0.50-0.90). Usage was more important than caseload; with high usage (≥20%), the revision-rate was low, whether the caseload was high (>12 UKA/y) or low (≤12 UKA/y; (0.94% pa; 95% CI, 0.69-1.23 and 0.85% pa; 95% CI, 0.65-1.08), respectively); with low usage (<20%), the revision-rate was high, whether the caseload was high or low (1.58% pa; 95% CI, 0.57-3.05 and 1.76% pa; 95% CI, 1.21-2.41, respectively). CONCLUSION To achieve optimum results, surgeons, whether high or low caseload, should adhere to the recommended indications such that ≥20%, or ideally >30% of their knee arthroplasties are UKA. If they do this, then they can expect to achieve results similar to those of the long-term series, which all had high usage (>20%) and an average 10-year survival of 94%.
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Affiliation(s)
- Thomas W Hamilton
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - James M Rizkalla
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Leonidas Kontochristos
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Barbara E Marks
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Stephen J Mellon
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Christopher A F Dodd
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Hemant G Pandit
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom
| | - David W Murray
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom; Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
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Choy WS, Lee KW, Kim HY, Kim KJ, Chun YS, Yang DS. Mobile bearing medial unicompartmental knee arthroplasty in patients whose lifestyles involve high degrees of knee flexion: A 10-14year follow-up study. Knee 2017; 24:829-836. [PMID: 28571920 DOI: 10.1016/j.knee.2017.05.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 03/02/2017] [Accepted: 05/04/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Because Asian populations have different lifestyles, such as squatting and sitting on the floor, from those of Western populations, it is possible that the clinical results and survival rate of unicompartmental knee arthroplasty (UKA) for Asian patients may be different. This study described outcomes of mobile bearing medial UKA for Korean patients. METHODS A total of the 164 knees treated with mobile bearing UKAs in 147 patients (14 males and 133 females) were reviewed. The mean follow-up period was 12.1years (range 10.1-14). RESULTS The clinical outcomes, such as the Hospital for Special Surgery Knee score, the Oxford Knee Score and the Knee Society rating system, showed statistically significant improvement from pre-operative to final follow-up (P<0.05). A total of 26 UKAs (15.8%) required revision; the most common reason was bearing dislocation. The 95% confidence interval of survival rate at 12years was 84.1%, with revision for any reason as the end point. CONCLUSIONS Minimally invasive mobile bearing UKA in Asian patients who required high degrees of knee flexion showed rapid recovery and good clinical outcome. However, they also showed relatively high rates of bearing dislocation and aseptic loosening. Therefore, mobile bearing UKA should only be performed in patients whose lifestyle involves high flexions after carefully considering these risks and benefits.
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Affiliation(s)
- Won Sik Choy
- Department of Orthopedic Surgery, Eulji University Hospital, Daejeon, Republic of Korea
| | - Kwang Won Lee
- Department of Orthopedic Surgery, Eulji University Hospital, Daejeon, Republic of Korea
| | - Ha Yong Kim
- Department of Orthopedic Surgery, Eulji University Hospital, Daejeon, Republic of Korea
| | - Kap Jung Kim
- Department of Orthopedic Surgery, Eulji University Hospital, Daejeon, Republic of Korea
| | - Young Sub Chun
- Department of Orthopedic Surgery, Eulji University Hospital, Daejeon, Republic of Korea
| | - Dae Suk Yang
- Department of Orthopedic Surgery, Eulji University Hospital, Daejeon, Republic of Korea.
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Knifsund J, Hatakka J, Keemu H, Mäkelä K, Koivisto M, Niinimäki T. Unicompartmental Knee Arthroplasties are Performed on the Patients with Radiologically Too Mild Osteoarthritis. Scand J Surg 2017; 106:338-341. [DOI: 10.1177/1457496917701668] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Patient selection for either total knee arthroplasty or unicompartmental knee arthroplasty remains controversial. The latter has several reported advantages over total knee arthroplasty, but it also appears to have significant drawbacks in terms of revision rates. Aims: This study aimed to determine the influence of the preoperative degree of osteoarthritis on the risk of reoperation following unicompartmental knee arthroplasty. Methods: Surgery was carried out on 294 knees in 241 patients between 2001 and 2012 at a single institute, using cemented Oxford phase III unicompartmental knee arthroplasty. The mean age at the time of operation was 67 years, and the mean follow-up time was 8.7 years. Results and Conclusion: The knees with a preoperative Kellgren–Lawrence grade of 0–2 osteoarthritis had a higher risk of reoperation than those with a Kellgren–Lawrence grade of 3–4 (odds ratio = 1.89; 95% confidence interval, 1.03–3.45; p = 0.04). In addition, the knees with a medial joint space width of more than 1 mm or a high medial/lateral joint space width ratio had an increased risk of reoperation. In conclusion, we suggest that unicompartmental knee arthroplasty should only be performed in cases showing severe osteoarthritis in preoperative radiographs, with medial bone-on-bone contact, and a medial/lateral ratio of <20%.
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Affiliation(s)
- J. Knifsund
- The Operational Division of Diseases of the Musculoskeletal System, Turku University Hospital (Tyks), Surgical Hospital, Turku University, Turku, Finland
- Department of Orthopaedics and Traumatology, Turku University Hospital, Turku, Finland
| | - J. Hatakka
- The Operational Division of Diseases of the Musculoskeletal System, Turku University Hospital (Tyks), Surgical Hospital, Turku University, Turku, Finland
| | - H. Keemu
- The Operational Division of Diseases of the Musculoskeletal System, Turku University Hospital (Tyks), Surgical Hospital, Turku University, Turku, Finland
| | - K. Mäkelä
- The Operational Division of Diseases of the Musculoskeletal System, Turku University Hospital (Tyks), Surgical Hospital, Turku University, Turku, Finland
| | - M. Koivisto
- The Operational Division of Diseases of the Musculoskeletal System, Turku University Hospital (Tyks), Surgical Hospital, Turku University, Turku, Finland
| | - T. Niinimäki
- Department of surgery, Oulu University Hospital, Oulu, Finland
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Annual revision rates of partial versus total knee arthroplasty: A comparative meta-analysis. Knee 2017; 24:179-190. [PMID: 27916580 DOI: 10.1016/j.knee.2016.11.006] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Revised: 10/29/2016] [Accepted: 11/07/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Utilization of unicompartmental knee arthroplasty (UKA) and patellofemoral arthroplasty (PFA) as alternatives to total knee arthroplasty (TKA) for unicompartmental knee osteoarthritis (OA) has increased. However, no single resource consolidates survivorship data between TKA and partial resurfacing options for each variant of unicompartmental OA. This meta-analysis compared survivorship between TKA and medial UKA (MUKA), lateral UKA (LUKA) and PFA using annual revision rate as a standardized metric. METHODS A systematic literature search was performed for studies quantifying TKA, MUKA, LUKA and/or PFA implant survivorship. Studies were classified by evidence level and assessed for bias using the MINORS and PEDro instruments. Annual revision rates were calculated for each arthroplasty procedure as percentages/observed component-year, based on a Poisson-normal model with random effects using the R-statistical software package. RESULTS One hundred and twenty-four studies (113 cohort and 11 registry-based studies) met inclusion/exclusion criteria, providing data for 374,934 arthroplasties and 14,991 revisions. The overall evidence level was low, with 96.7% of studies classified as level III-IV. Annual revision rates were lowest for TKA (0.49%, CI 0.41 to 0.58), followed by MUKA (1.07%, CI 0.87 to 1.31), LUKA (1.13%, CI 0.69 to 1.83) and PFA (1.75%, CI 1.19 to 2.57). No difference was detected between revision rates for MUKA and LUKA (p=0.222). CONCLUSIONS Revisions of MUKA, LUKA and PFA occur at an annual rate of 2.18, 2.31 and 3.57-fold that of TKA, respectively. These estimates may be used to inform clinical decision-making, guide patient expectations and evaluate the cost-effectiveness of total versus partial knee replacement in the setting of unicompartmental OA.
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van der List JP, Chawla H, Joskowicz L, Pearle AD. Current state of computer navigation and robotics in unicompartmental and total knee arthroplasty: a systematic review with meta-analysis. Knee Surg Sports Traumatol Arthrosc 2016; 24:3482-3495. [PMID: 27600634 DOI: 10.1007/s00167-016-4305-9] [Citation(s) in RCA: 114] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 08/30/2016] [Indexed: 12/11/2022]
Abstract
Recently, there is a growing interest in surgical variables that are intraoperatively controlled by orthopaedic surgeons, including lower leg alignment, component positioning and soft tissues balancing. Since more tight control over these factors is associated with improved outcomes of unicompartmental knee arthroplasty and total knee arthroplasty (TKA), several computer navigation and robotic-assisted systems have been developed. Although mechanical axis accuracy and component positioning have been shown to improve with computer navigation, no superiority in functional outcomes has yet been shown. This could be explained by the fact that many differences exist between the number and type of surgical variables these systems control. Most systems control lower leg alignment and component positioning, while some in addition control soft tissue balancing. Finally, robotic-assisted systems have the additional advantage of improving surgical precision. A systematic search in PubMed, Embase and Cochrane Library resulted in 40 comparative studies and three registries on computer navigation reporting outcomes of 474,197 patients, and 21 basic science and clinical studies on robotic-assisted knee arthroplasty. Twenty-eight of these comparative computer navigation studies reported Knee Society Total scores in 3504 patients. Stratifying by type of surgical variables, no significant differences were noted in outcomes between surgery with computer-navigated TKA controlling for alignment and component positioning versus conventional TKA (p = 0.63). However, significantly better outcomes were noted following computer-navigated TKA that also controlled for soft tissue balancing versus conventional TKA (mean difference 4.84, 95 % Confidence Interval 1.61, 8.07, p = 0.003). A literature review of robotic systems showed that these systems can, similarly to computer navigation, reliably improve lower leg alignment, component positioning and soft tissues balancing. Furthermore, two studies comparing robotic-assisted with computer-navigated surgery reported superiority of robotic-assisted surgery in controlling these factors. Manually controlling all these surgical variables can be difficult for the orthopaedic surgeon. Findings in this study suggest that computer navigation or robotic assistance may help managing these multiple variables and could improve outcomes. Future studies assessing the role of soft tissue balancing in knee arthroplasty and long-term follow-up studies assessing the role of computer-navigated and robotic-assisted knee arthroplasty are needed.
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Affiliation(s)
- Jelle P van der List
- Department of Orthopaedic Surgery, Computer Assisted Surgery Center, Hospital for Special Surgery, Weill Medical College of Cornell University, 535 E. 70th Street, New York, NY, 10021, USA.
| | - Harshvardhan Chawla
- Department of Orthopaedic Surgery, Computer Assisted Surgery Center, Hospital for Special Surgery, Weill Medical College of Cornell University, 535 E. 70th Street, New York, NY, 10021, USA
| | - Leo Joskowicz
- Computer Assisted Surgery and Medical Image Processing Laboratory, School of Engineering and Computer Science, Hebrew University, Jerusalem, Israel
| | - Andrew D Pearle
- Department of Orthopaedic Surgery, Computer Assisted Surgery Center, Hospital for Special Surgery, Weill Medical College of Cornell University, 535 E. 70th Street, New York, NY, 10021, USA
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van der List JP, Zuiderbaan HA, Pearle AD. Why Do Medial Unicompartmental Knee Arthroplasties Fail Today? J Arthroplasty 2016; 31:1016-21. [PMID: 26725134 DOI: 10.1016/j.arth.2015.11.030] [Citation(s) in RCA: 148] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 11/05/2015] [Accepted: 11/25/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Failure rates are higher in medial unicompartmental knee arthroplasty (UKA) than total knee arthroplasty. To improve these failure rates, it is important to understand why medial UKA fail. Because individual studies lack power to show failure modes, a systematic review was performed to assess medial UKA failure modes. Furthermore, we compared cohort studies with registry-based studies, early with midterm and late failures and fixed-bearing with mobile-bearing implants. METHODS Databases of PubMed, EMBASE, and Cochrane and annual registries were searched for medial UKA failures. Studies were included when they reported >25 failures or when they reported early (<5 years), midterm (5-10 years), or late failures (>10 years). RESULTS Thirty-seven cohort studies (4 level II studies and 33 level III studies) and 2 registry-based studies were included. A total of 3967 overall failures, 388 time-dependent failures, and 1305 implant design failures were identified. Aseptic loosening (36%) and osteoarthritis (OA) progression (20%) were the most common failure modes. Aseptic loosening (26%) was most common early failure mode, whereas OA progression was more commonly seen in midterm and late failures (38% and 40%, respectively). Polyethylene wear (12%) and instability (12%) were more common in fixed-bearing implants, whereas pain (14%) and bearing dislocation (11%) were more common in mobile-bearing implants. CONCLUSION This level III systematic review identified aseptic loosening and OA progression as the major failure modes. Aseptic loosening was the main failure mode in early years and mobile-bearing implants, whereas OA progression caused most failures in late years and fixed-bearing implants.
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Affiliation(s)
- Jelle P van der List
- Department of Orthopaedic Surgery, Sports Medicine and Shoulder Service, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York
| | - Hendrik A Zuiderbaan
- Department of Orthopaedic Surgery, Sports Medicine and Shoulder Service, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York
| | - Andrew D Pearle
- Department of Orthopaedic Surgery, Sports Medicine and Shoulder Service, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York
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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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Risk factors of post-operative malalignment in fixed-bearing medial unicompartmental knee arthroplasty. INTERNATIONAL ORTHOPAEDICS 2015; 40:1455-63. [DOI: 10.1007/s00264-015-3014-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 09/28/2015] [Indexed: 10/23/2022]
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