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Hu H, Li P, Liu Z, Lv H, Yang X, Liu P. Comparative long-term outcomes of unicompartmental and total knee arthroplasty in knee osteoarthritis patients: a systematic review and meta-analysis. Front Surg 2024; 11:1405025. [PMID: 39233767 PMCID: PMC11371575 DOI: 10.3389/fsurg.2024.1405025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 08/06/2024] [Indexed: 09/06/2024] Open
Abstract
Background Long-term outcomes for knee osteoarthritis patients undergoing unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA) remain inconclusive. Objectives This study aims to evaluate the long-term outcomes over five years, including Knee Society Pain Scores (KSPS), Knee Society Scores (KSS), Knee Society Function Scores (KSFS), range of motion (ROM), and survival rates-of UKA vs. TKA in knee osteoarthritis patients. Design Systematic review using data from randomized controlled and cohort trials, and world databases. Data sources Researchers searched Medline, Embase, Cochrane Controlled Register of Trials, and ClinicalTrials.gov from January 1990 to March 2024. Eligibility criteria for selecting studies The researchers selected studies based on adult participants with knee osteoarthritis. Eligible studies compare UKA and TKA reports on clinical or surgical outcomes, including KSPS, KSS, KSFS, ROM and survival rates, over 5 years. The researchers excluded the studies fewer than five years, or if English text was unavailable. Results Researchers categorized twenty-nine eligible studies into three groups: five randomized controlled trials, 11 registries and database studies, and 13 cohort studies. The analysis revealed that neither TKA nor UKA definitively outperformed the other in terms of pain (SMD (95% CI): -0.06 [-0.41, 0.28], I 2 = 90%) and KSS scores (SMD (95% CI): -0.07 [-0.23, 0.008], I 2 = 81%) over a period of five years. However, KSFS (SMD (95% CI): -0.30 [-0.43, -0.17], I 2 = 74%) and ROM (SMD (95% CI): -0.78 [-1.11, -0.46], I 2 = 92%) tended to favor UKA, and survival rate favor TKA at 5 or over 5-year follow-up periods. Conclusions UKA shows a trend towards better outcomes in KSFS and ROM, alongside a more favorable survival rate in TKA at the five-year and beyond follow-up periods. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=517835, PROSPERO (CRD42024517835).
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Affiliation(s)
- Hai Hu
- Department of Bone Injuries, Hanan Branch of the Second Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine, Harbin, China
| | - Pengfei Li
- Department of Bone Injuries, Hanan Branch of the Second Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine, Harbin, China
| | - Zelin Liu
- Department of Medical Services Division, The Second Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine, Harbin, China
| | - Hang Lv
- Department of Bone Injuries, Hanan Branch of the Second Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine, Harbin, China
| | - Xiangjun Yang
- Department of Bone Injuries, Hanan Branch of the Second Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine, Harbin, China
| | - Peiran Liu
- Department of Bone Injuries, Hanan Branch of the Second Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine, Harbin, China
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Fuqua A, Heo K, Worden JA, Goel RK, Guild GN, Premkumar A. Outcomes of Unicompartmental Knee Arthroplasty in Patients Receiving Long-Term Anticoagulation Therapy: A Propensity-Matched Cohort Study. J Arthroplasty 2024; 39:1996-2002. [PMID: 38360285 DOI: 10.1016/j.arth.2024.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Although total knee arthroplasty has been considered the gold-standard treatment for severe osteoarthritis of the knee, unicompartmental knee arthroplasty (UKA) has become an increasingly favorable alternative for single-compartment osteoarthritis of the knee. Few studies have examined potential high-risk populations undergoing this procedure. The purpose of this study was to investigate the outcomes of UKA in patients receiving long-term anticoagulation therapy. METHODS In this study, a large administrative database was queried to identify patients undergoing UKA between 2009 and 2019, who were then divided into a cohort receiving long-term anticoagulation and a control cohort. Propensity scores were utilized to match these patients. Multivariable logistic regression was utilized to compare 90-day and 2-year complication rates between cohorts. RESULTS Patients who were on long-term anticoagulation had significantly increased odds of extended length of stay, surgical site infection, wound complication, transfusion, deep vein thrombosis, pulmonary embolism, and readmission at 90-day follow-up. The long-term anticoagulation cohort also experienced significantly higher odds of periprosthetic joint infection and mechanical complications at 2-year follow-up; however, odds of conversion to total knee arthroplasty were not increased. CONCLUSIONS This study demonstrated that long-term anticoagulation use was associated with poorer medical and surgical outcomes at both 90 days and 2 years postoperatively in patients undergoing UKA, even after rigorous adjustment for confounders.
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Affiliation(s)
- Andrew Fuqua
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Kevin Heo
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Jacob A Worden
- Department of Orthopaedic Surgery, Medical College of Georgia, Augusta, Georgia
| | - Rahul K Goel
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina
| | - George N Guild
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Ajay Premkumar
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia
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Xia K, Min L, Xie W, Yang G, Yon DK, Lee SW, Koyanagi A, Jacob L, Smith L, Shin JI, Rahmati M, Xiao W, Li Y. Is unicompartmental knee arthroplasty a better choice than total knee arthroplasty for unicompartmental osteoarthritis? A systematic review and meta-analysis of randomized controlled trials. Chin Med J (Engl) 2024:00029330-990000000-01143. [PMID: 38997246 DOI: 10.1097/cm9.0000000000003193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND The choice of unicompartmental knee arthroplasty (UKA) vs. total knee arthroplasty (TKA) in the surgical treatment of knee osteoarthritis (KOA) remains controversial. This study aimed to perform a systematic review and meta-analysis of randomized controlled trials (RCTs) to compare the clinical results of UKA and TKA for treating unicompartmental KOA. METHODS PubMed, Embase, and the Cochrane Library were systematically searched for articles published up to January 2, 2023. The literature was rigorously screened to include only RCTs comparing UKA and TKA for unicompartmental KOA. A systematic review and meta-analysis were performed to calculate the mean difference (MD), relative risk (RR), and 95% confidence interval (CI) according to the Cochrane standards. RESULTS Thirteen publications involving 683 UKAs and 683 TKAs were analyzed. Except for one study with a follow-up period of 15 years, all outcome measures reported were within 5 years of follow-up. Meta-analysis showed better knee recovery (MD: 1.23; 95% CI: 1.01-1.45; P <0.00001), greater knee function (MD: 1.78; 95% CI: 0.34-3.22; P = 0.02), less pain (MD: 0.75; 95% CI: 0.43-1.06; P <0.00001), and better health status (MD: 3.75; 95% CI: 0.81-6.69; P = 0.01) after UKA than TKA. However, considering the minimal clinically important difference values for these variables, the findings were not clinically relevant. Moreover, UKA patients had fewer complications (RR: 0.59; 95% CI: 0.45-0.78; P = 0.0002) and shorter hospital stays (MD: -0.89; 95% CI: -1.57 to -0.22; P = 0.009) than did TKA patients. There were no statistically significant differences in terms of postoperative range of movement, revision, failure, operation time, and patient satisfaction. CONCLUSIONS In terms of clinical efficacy, there was no obvious advantage of UKA over TKA in the surgical treatment of knee OA when considering the minimal clinically important difference. The main advantage of UKA over TKA is that it leads to fewer complications and a shorter length of hospital stay. It is ideal to perform prospective studies with longer follow-up periods to fully evaluate the long-term efficacy and safety of the two procedures in the future.
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Affiliation(s)
- Kuanyu Xia
- Deparment of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Lang Min
- Deparment of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Wenqing Xie
- Xiangya School of Medicine, Central South University, Changsha, Hunan 410083, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan 410083, China
| | - Guang Yang
- Xiangya School of Medicine, Central South University, Changsha, Hunan 410083, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan 410083, China
| | - Dong Keon Yon
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Republic of Korea
- Department of Pediatrics, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Seung Won Lee
- Department of Precision Medicine, Sungkyunkwan University College of Medicine, Suwon, Republic of Korea
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Dr. Antoni Pujadas, 08830 Barcelona, Spain
| | - Louis Jacob
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Dr. Antoni Pujadas, 08830 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), ISCIII, 28029 Madrid, Spain
- Department of Physical Medicine and Rehabilitation, Lariboisière-Fernand Widal Hospital, AP-HP, University Paris Cité, Paris, France
| | - Lee Smith
- Centre for Health, Performance, and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Masoud Rahmati
- Department of Physical Education and Sport Sciences, Faculty of Literature and Human Sciences, Lorestan University, Khorramabad, Iran
- Department of Physical Education and Sport Sciences, Faculty of Literature and Humanities, Vali-E-Asr University of Rafsanjan, Rafsanjan, Iran
| | - Wenfeng Xiao
- Xiangya School of Medicine, Central South University, Changsha, Hunan 410083, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan 410083, China
| | - Yusheng Li
- Xiangya School of Medicine, Central South University, Changsha, Hunan 410083, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan 410083, China
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Mancino F, Fontalis A, Grandhi TSP, Magan A, Plastow R, Kayani B, Haddad FS. Robotic arm-assisted conversion of unicompartmental knee arthroplasty to total knee arthroplasty. Bone Joint J 2024; 106-B:680-687. [PMID: 38945538 DOI: 10.1302/0301-620x.106b7.bjj-2023-0943.r2] [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: 07/02/2024]
Abstract
Aims Robotic arm-assisted surgery offers accurate and reproducible guidance in component positioning and assessment of soft-tissue tensioning during knee arthroplasty, but the feasibility and early outcomes when using this technology for revision surgery remain unknown. The objective of this study was to compare the outcomes of robotic arm-assisted revision of unicompartmental knee arthroplasty (UKA) to total knee arthroplasty (TKA) versus primary robotic arm-assisted TKA at short-term follow-up. Methods This prospective study included 16 patients undergoing robotic arm-assisted revision of UKA to TKA versus 35 matched patients receiving robotic arm-assisted primary TKA. In all study patients, the following data were recorded: operating time, polyethylene liner size, change in haemoglobin concentration (g/dl), length of inpatient stay, postoperative complications, and hip-knee-ankle (HKA) alignment. All procedures were performed using the principles of functional alignment. At most recent follow-up, range of motion (ROM), Forgotten Joint Score (FJS), and Oxford Knee Score (OKS) were collected. Mean follow-up time was 21 months (6 to 36). Results There were no differences between the two treatment groups with regard to mean change in haemoglobin concentration (p = 0.477), length of stay (LOS, p = 0.172), mean polyethylene thickness (p = 0.065), or postoperative complication rates (p = 0.295). At the most recent follow-up, the primary robotic arm-assisted TKA group had a statistically significantly improved OKS compared with the revision UKA to TKA group (44.6 (SD 2.7) vs 42.3 (SD 2.5); p = 0.004) but there was no difference in the overall ROM (p = 0.056) or FJS between the two treatment groups (86.1 (SD 9.6) vs 84.1 (4.9); p = 0.439). Conclusion Robotic arm-assisted revision of UKA to TKA was associated with comparable intraoperative blood loss, early postoperative rehabilitation, functional outcomes, and complications to primary robotic TKA at short-term follow-up. Robotic arm-assisted surgery offers a safe and reproducible technique for revising failed UKA to TKA.
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Affiliation(s)
- Fabio Mancino
- Department of Trauma and Orthopaedic Surgery, University College Hospitals, London, UK
- The Princess Grace Hospital, London, UK
| | - Andreas Fontalis
- Department of Trauma and Orthopaedic Surgery, University College Hospitals, London, UK
- The Princess Grace Hospital, London, UK
| | - Tarani S P Grandhi
- Department of Trauma and Orthopaedic Surgery, University College Hospitals, London, UK
- The Princess Grace Hospital, London, UK
| | - Ahmed Magan
- Department of Trauma and Orthopaedic Surgery, University College Hospitals, London, UK
| | - Ricci Plastow
- Department of Trauma and Orthopaedic Surgery, University College Hospitals, London, UK
| | - Babar Kayani
- Department of Trauma and Orthopaedic Surgery, University College Hospitals, London, UK
- The Princess Grace Hospital, London, UK
| | - Fares S Haddad
- Department of Trauma and Orthopaedic Surgery, University College Hospitals, London, UK
- The Princess Grace Hospital, London, UK
- The Bone & Joint Journal , London, UK
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Dal Fabbro G, Grassi A, Agostinone P, Lucidi GA, Fajury R, Ravindra A, Zaffagnini S. High survivorship rate and good clinical outcomes after high tibial osteotomy in patients with radiological advanced medial knee osteoarthritis: a systematic review. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05254-0. [PMID: 38430233 DOI: 10.1007/s00402-024-05254-0] [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] [Received: 09/01/2023] [Accepted: 02/17/2024] [Indexed: 03/03/2024]
Abstract
INTRODUCTION The role of valgus producing high tibial osteotomy (HTO) for the treatment of advanced knee osteoarthritis (OA) is still controversial. The aim of the current systematic review was to assess survivorship and patient-reported outcomes (PROMs) of high tibial osteotomy in patients with radiological advanced medial knee OA. METHODS A systematic search of PubMed, Cochrane and EMBASE database was performed in July 2023 in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines. Inclusion and exclusion criteria were applied to identify studies investigating the survivorship rate and PROMs of valgus-producing high tibial osteotomy in patients with advanced knee OA at x-ray assessment in the medial compartment at minimum-two-years follow up. Advanced radiological OA was defined as Kellgren Lawrence (K-L) ≥ 3 or Ahlbäch ≥ 2. Survivorship was defined as percentage of patients free of total knee arthroplasty (TKA) at follow-up. Clinical interpretation of provided PROMs were performed according to minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) target values reported in literature. Survivorship data and PROMs scores were extracted, and studies were stratified based on selected study features. The quality of included studies was assessed with modified Coleman score. RESULTS A total of 18 studies, totalling 1296 knees with a mean age between 46.9 and 67 years old, were included. Average survivorship was of 74.6% (range 60 - 98.1%) at 10-years follow up. The subjective scoring systems showed good results according to MCID and PASS, and postoperative improvements were partially maintained until final follow-up. CONCLUSION HTO is worth considering as treatment choice even in patients affected by radiological advanced medial knee osteoarthritis. Long term survivorship and good patient reported clinical outcomes could be expected in this population. LEVEL OF EVIDENCE IV; systematic review of level III-IV studies.
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Affiliation(s)
- Giacomo Dal Fabbro
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, Bologna, 40136, Italy.
- Università di Bologna, Dipartimento di Scienze Biomediche e Neuromotorie DIBINEM, Bologna, Italy.
| | - Alberto Grassi
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, Bologna, 40136, Italy
| | - Piero Agostinone
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, Bologna, 40136, Italy
| | - Gian Andrea Lucidi
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, Bologna, 40136, Italy
| | - Raschid Fajury
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, Bologna, 40136, Italy
| | - Abhijit Ravindra
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, Bologna, 40136, Italy
| | - Stefano Zaffagnini
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, Bologna, 40136, Italy
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Montilla FJ, Payo-Ollero J, Serrano-Toledano D, Del Río-Arteaga M, Ribera J, Muela R. Unicompartmental knee arthroplasties: does the type of tibial component selected influence implant survival? Arch Orthop Trauma Surg 2024; 144:347-355. [PMID: 37743356 DOI: 10.1007/s00402-023-05055-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 09/02/2023] [Indexed: 09/26/2023]
Abstract
INTRODUCTION Few information has been published on the survival of unicompartmental knee arthroplasty (UKA) and fixed-bearing tibial components. The aim of this study is to analyze if UKA survival varies according to UKA model used and to analyze the possible risk factors for UKA revision. MATERIALS AND METHODS A retrospective study analyzing 301 UKAs (ACCURIS, all-polyethylene tibial component, 152; Triathlon PKR, metal-backed tibial component, 149) was performed. Demographic parameters as well as implant survival and cause of prosthetic revision were analyzed. The Kaplan-Meier survival analysis, the log-rank test and the Cox multiple regression were used for the analysis. RESULTS Average follow-up was 8.1 ± 3.08-years. Average age was 68.1 ± 8.6-years; 70.4% of subjects were women. The ACCURIS UKA group had a UKA revision rate higher compared to the Triathlon PKR group (16/152, 10.6% vs 5/149, 3.4%, respectively; p < 0.001). The main cause of prosthetic revision was aseptic loosening (5/21, 23.8%). All aseptic loosening cases and tibial component collapse were reported with the ACCURIS UKA group. Overall UKA survival was 98.01% (95% CI 95.62-99.1) at 1-year, 94.27% (95% CI 90.95-96.4) at 5-years and 92.38% (95% CI 88.48-94.99) at 10-years' follow-up. There were no differences in the Kaplan-Meier survival curves regarding operated side or affected tibiofemoral compartment (log-rank test = 0.614 and 0.763, respectively). However, Kaplan-Meier survival curve according to UKA model used was different (log-rank test = 0.033). The metal-backed component appeared to be a protector factor for UKA revision when adjusted for age, sex, operated side, and affected tibiofemoral compartment (Hazard Ratio 0.32, p = 0.031). CONCLUSION Fixed-bearing UKAs showed excellent mid- and long-term survival rates. Aseptic loosening is the main cause of implant failure. PKR group (metal-backed component) seem to be a protector factor to UKA revision when it was compared with ACCURIS UKA group (all-polyethylene tibial component).
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Affiliation(s)
- Francisco Javier Montilla
- Clínica COT, C/ Juan Ramón Jiménez 29, 41011, Seville, Spain
- Orthopedics and Trauma Surgery Department, Viamed Santa Ángela de la Cruz Hospital, Av. de Jerez, 59, 41014, Seville, Spain
| | - Jesús Payo-Ollero
- Clínica COT, C/ Juan Ramón Jiménez 29, 41011, Seville, Spain.
- Orthopedics and Trauma Surgery Department, Viamed Santa Ángela de la Cruz Hospital, Av. de Jerez, 59, 41014, Seville, Spain.
| | - David Serrano-Toledano
- Clínica COT, C/ Juan Ramón Jiménez 29, 41011, Seville, Spain
- Orthopedics and Trauma Surgery Department, Viamed Santa Ángela de la Cruz Hospital, Av. de Jerez, 59, 41014, Seville, Spain
| | - Marta Del Río-Arteaga
- Clínica COT, C/ Juan Ramón Jiménez 29, 41011, Seville, Spain
- Orthopedics and Trauma Surgery Department, Viamed Santa Ángela de la Cruz Hospital, Av. de Jerez, 59, 41014, Seville, Spain
| | - Juan Ribera
- Clínica COT, C/ Juan Ramón Jiménez 29, 41011, Seville, Spain
- Orthopedics and Trauma Surgery Department, Viamed Santa Ángela de la Cruz Hospital, Av. de Jerez, 59, 41014, Seville, Spain
| | - Rafael Muela
- Clínica COT, C/ Juan Ramón Jiménez 29, 41011, Seville, Spain
- Orthopedics and Trauma Surgery Department, Viamed Santa Ángela de la Cruz Hospital, Av. de Jerez, 59, 41014, Seville, Spain
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Hayashi T, Hiranaka T, Fujishiro T, Okamoto K, Koide M. Restricted Kinematically Aligned Total Knee Arthroplasty Following Failed Oxford Unicompartmental Knee Arthroplasty. Cureus 2023; 15:e45104. [PMID: 37842438 PMCID: PMC10569232 DOI: 10.7759/cureus.45104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2023] [Indexed: 10/17/2023] Open
Abstract
In this report, we describe how to revise a failed Oxford unicompartmental knee arthroplasty to kinematically aligned total knee arthroplasty (TKA). Its benefits are the maintenance of the native joint line along with the avoidance of supplemental parts, such as metal augments and stems. This can be applied to patients whose medial tibial cortex is well preserved. The distal cutting plane and rotation alignment are decided before the removal of the femoral component. The tibial cutting plane is up to 12 mm below the lateral joint surface and the varus is up to 5° below the extramedullary rod. Eventually, the native joint line and alignment along with the soft tissue envelope can be well maintained, similar to the restricted kinematically aligned TKA.
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Affiliation(s)
- Takuma Hayashi
- Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Takatsuki, JPN
| | - Takafumi Hiranaka
- Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Takatsuki, JPN
| | - Takaaki Fujishiro
- Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Takatsuki, JPN
| | - Koji Okamoto
- Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Takatsuki, JPN
| | - Motoki Koide
- Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Takatsuki, JPN
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Anatone AJ, Uppstrom TJ, Fletcher C, Baral E, Gomoll AH, Strickland SM. Patellofemoral arthroplasty conversion to total knee arthroplasty: An updated retrieval analysis and clinical outcomes. Knee 2023; 43:28-33. [PMID: 37210859 DOI: 10.1016/j.knee.2023.04.019] [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] [Received: 11/30/2022] [Revised: 04/28/2023] [Accepted: 04/30/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND A prior retrieval analysis found high rates of infection after conversion of PFA to TKA, but was limited by a small sample size. The purpose of this study is to perform a retrieval analysis with clinical correlation on an expanded group of patients to better understand conversion of PFA to TKA. METHOD A retrospective review of an implant retrieval registry identified 62 conversions of PFA to TKA between 2004-2021. Implants were analyzed for wear pattern and cement fixation. Patient charts were reviewed for demographic information, perioperative data, prior and subsequent surgical procedures, complications and outcomes. Radiographs performed prior to index PFA and conversion procedures were assessed for KL grading. RESULTS Cement fixation was present on 86% of retrieved components and wear was more pronounced on the lateral side. The most common indication for conversion to TKA was progression of OA in 46.8% of patients, followed by unexplained pain in the absence of radiographic or clinical changes (37.1%), loosening (8.1%), mechanical symptoms (4.8%), traumatic (3.2%). Thirteen patient experienced complications requiring additional procedures including arthrofibrosis (n = 4, 7.3%), PJI (n = 3, 5.5%), instability (n = 3, 5.5%), hematoma (n = 2, 3.6%) and loosening (n = 1, 1.8%). Revision components were used in 1.8% of cases and average post-conversion arc of motion was 119 degrees. CONCLUSIONS The most common reason for PFA conversion to TKA was progression of osteoarthritis. PFA conversion to TKA is technically similar to primary TKA, but complication rates are more consistent with revision TKA in this study.
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Affiliation(s)
- Alex J Anatone
- Hospital for Special Surgery, 535 E 70th Street, New York, NY 10021, USA.
| | - Tyler J Uppstrom
- Hospital for Special Surgery, 535 E 70th Street, New York, NY 10021, USA
| | - Connor Fletcher
- Hospital for Special Surgery, 535 E 70th Street, New York, NY 10021, USA
| | - Elexis Baral
- Hospital for Special Surgery, 535 E 70th Street, New York, NY 10021, USA
| | - Andreas H Gomoll
- Hospital for Special Surgery, 535 E 70th Street, New York, NY 10021, USA
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Rodriguez M, Heida K, Rider DE, Goodman GP, Waterman BR, Belmont PJ. Occupational Outcomes and Revision Rates for Medial Unicondylar Knee Arthroplasty in U.S. Military Servicemembers. J Knee Surg 2022; 35:1393-1400. [PMID: 33607676 DOI: 10.1055/s-0041-1723968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This study evaluates return to work and revision rates for medial unicondylar knee arthroplasty (UKA) in a high-demand military cohort. Patient demographic and clinical variables were isolated from the medical records of active-duty military servicemembers with at least 2 years of postoperative follow-up and correlated with return to work, medial UKA survivorship, and perioperative complications. The medial UKA annual revision rate was calculated as the percentage of implants revised per observed component year. A total of 39 servicemembers underwent 46 primary medial UKAs (32 unilateral and 7 bilateral) with a mean follow-up of 3.9 (2.0-6.6) years. At a minimum of 2 years postoperatively, 33 (85%) servicemembers returned to military service or successfully completed their service obligation. Older servicemembers (odds ratio [OR] = 0.67; 95% confidence interval [CI]: 0.45, 0.99) had a significantly decreased OR for knee-related medical separation. Nine servicemembers (20%) had conversion to TKA at an average of 2.4 (range, 0.6-5.6) years with a medial UKA annual revision rate of 5%. When compared with Navy/Air Force, Army/Marine servicemembers had an increased TKA conversion rate (OR = 5.40; 95% CI: 1.13, 25.81). Older age decreased the likelihood of medical separation and Army/Marines service was the sole risk factor associated with conversion to TKA. The level of evidence is IV, therapeutic case series.
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Affiliation(s)
- Marina Rodriguez
- Department of Orthopaedic Surgery and Rehabilitation, William Beaumont Army Medical Center, El Paso, Texas
| | - Ken Heida
- Department of Orthopaedic Surgery and Rehabilitation, William Beaumont Army Medical Center, El Paso, Texas
| | | | - Gens P Goodman
- Department of Orthopaedic Surgery and Rehabilitation, William Beaumont Army Medical Center, El Paso, Texas
| | - Brian R Waterman
- Division of Sports Medicine, Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Philip J Belmont
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland
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10
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Shen G, Shen D, Fang Y, Li X, Cui L, Wei B, Wu L. Clinical Outcomes of Revision Total Knee Arthroplasty after High Tibial Osteotomy and Unicompartmental Knee Arthroplasty: A Systematic Review and Meta-Analysis. Orthop Surg 2022; 14:1549-1557. [PMID: 35611758 PMCID: PMC9363736 DOI: 10.1111/os.13311] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 04/09/2022] [Accepted: 04/19/2022] [Indexed: 12/01/2022] Open
Abstract
As more high tibial osteotomy (HTO) and unicompartmental knee arthroplasty (UKA) are performed, orthopaedic surgeons realize that more HTO and UKA failures will require revision to total knee arthroplasty (TKA) in the future. To systematically evaluate the clinical outcomes of TKA after HTO and TKA after UKA, the Embase, PubMed, Ovid, Web of Science, and Cochrane Library databases were searched for studies investigating revision TKA after HTO and UKA published up to June 2021. RevMan version 5.3 was used to perform the meta‐analysis. The revision TKA after HTO and revision TKA after UKA groups were compared in terms of operative time, range of motion (ROM), knee score, postoperative complications, postoperative infection, revision, and revision implants used. Nine studies were ultimately included in the meta‐analysis. Results revealed that the knee score for the revision TKA after HTO group was better than that of the revision TKA after UKA group (MD 4.50 [95% CI 0.80–8.20]; p = 0.02). The revision TKA after HTO group had a lower revision rate (OR 0.65 [95% CI 0.55–0.78]; p < 0.00001) and fewer revision implants used (OR 0.11 [95% CI 0.05–0.23]; p < 0.00001). There were no statistical differences in operation time (MD ‐2.00 [95% CI −11.22 to 7.21]; p = 0.67), ROM (MD ‐0.04 [95% CI ‐3.69–3.61]; p = 0.98), postoperative complications (OR 1.41 [95% CI 0.77–2.60]; p = 0.27), or postoperative infections (OR 0.89 [95% CI 0.61–1.29]; p = 0.53). To conclude, the revision rate of revision TKA after UKA was greater, and more revision implants were required. It is important for orthopaedic surgeons to preserve bone during primary UKA.
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Affiliation(s)
- Gaobo Shen
- The Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, China.,Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Danhong Shen
- Nanjing University of Science and Technology, Nanjing, China
| | - Yuan Fang
- The Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, China
| | - Xuefei Li
- The Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, China
| | - Longkang Cui
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Bing Wei
- The Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, China
| | - Lianguo Wu
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
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11
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Jeuken RM, van Hugten PPW, Roth AK, Timur UT, Boymans TAEJ, van Rhijn LW, Bugbee WD, Emans PJ. A Systematic Review of Focal Cartilage Defect Treatments in Middle-Aged Versus Younger Patients. Orthop J Sports Med 2021; 9:23259671211031244. [PMID: 34676269 PMCID: PMC8524698 DOI: 10.1177/23259671211031244] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 03/22/2021] [Indexed: 01/08/2023] Open
Abstract
Background: Focal cartilage defects are often debilitating, possess limited potential for
regeneration, are associated with increased risk of osteoarthritis, and are
predictive for total knee arthroplasty. Cartilage repair studies typically
focus on the outcome in younger patients, but a high proportion of treated
patients are 40 to 60 years of age (ie, middle-aged). The reality of current
clinical practice is that the ideal patient for cartilage repair is not the
typical patient. Specific attention to cartilage repair outcomes in
middle-aged patients is warranted. Purpose: To systematically review available literature on knee cartilage repair in
middle-aged patients and include studies comparing results across different
age groups. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic search was performed in EMBASE, MEDLINE, and the Cochrane
Library database. Articles were screened for relevance and appraised for
quality. Results: A total of 21 articles (mean Coleman Methodology Score, 64 points) were
included. Two out of 3 bone marrow stimulation (BMS) studies, including 1
using the microfracture technique, revealed inferior clinical outcomes in
middle-aged patients in comparison with younger patients. Nine cell-based
studies were included showing inconsistent comparisons of results across age
groups for autologous chondrocyte implantation (ACI). Bone marrow aspirate
concentrate showed age-independent results at up to 8 years of follow-up. A
negative effect of middle age was reported in 1 study for both ACI and BMS.
Four out of 5 studies on bone-based resurfacing therapies (allografting and
focal knee resurfacing implants [FKRIs]) showed age-independent results up
to 5 years. One study in only middle-aged patients reported better clinical
outcomes for FKRIs when compared with biological repairs. Conclusion: Included studies were heterogeneous and had low methodological quality. BMS
in middle-aged patients seems to only result in short-term improvements.
More research is warranted to elucidate the ameliorating effects of
cell-based therapies on the aging joint homeostasis. Bone-based therapies
seem to be relatively insensitive to aging and may potentially result in
effective joint preservation. Age subanalyses in cohort studies, randomized
clinical trials, and international registries should generate more evidence
for the large but underrepresented (in terms of cartilage repair)
middle-aged population in the literature.
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Affiliation(s)
- Ralph M Jeuken
- Maastricht University Medical Center, Maastricht, the Netherlands
| | | | - Alex K Roth
- Maastricht University Medical Center, Maastricht, the Netherlands
| | - Ufuk Tan Timur
- Maastricht University Medical Center, Maastricht, the Netherlands
| | | | | | - William D Bugbee
- Department of Orthopaedic Surgery, Scripps Clinic, La Jolla, California, USA
| | - Pieter J Emans
- Maastricht University Medical Center, Maastricht, the Netherlands
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12
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Huang Q, Zeng Y, Hu Q, Si H, Nie Y, Shen B. [Comparison of unicompartmental knee arthroplasty and total knee arthroplasty in the treatment of severe medial compartment osteoarthritis]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:1125-1132. [PMID: 34523277 DOI: 10.7507/1002-1892.202103181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Objective To compare the effectiveness of unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA) in the treatment of severe medial compartment osteoarthritis (OA). Methods A clinical data of 69 patients (69 knees), who underwent joint replacement due to severe medial compartment OA between February 2015 and September 2018 and met the selection criteria, was retrospectively analyzed. Among them, 38 cases were treated with UKA (UKA group) and 31 cases with TKA (TKA group). There was no significant difference in gender, age, body mass index, course of disease, lesion side, and preoperative visual analogue scale (VAS) score, Hospital for Special Surgery (HSS) score, Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score, Feller score, range of motion of knee, physiological and psychological scores of short-form 12 health survey scale (SF-12) between the two groups ( P>0.05). The femorotibial angle (FTA) of TKA group was bigger than that of UKA group, and hip-knee-ankle angle (HKA) was smaller, showing significant differences ( P<0.05). The operative time, incision length, blood loss, time for flexion 90°, ambulation time, hospital stay, and incidence of deep venous thrombosis of lower extremity were recorded and compared between the two groups. The VAS score, HSS score, WOMAC score, Feller score, range of motion, and physiological and psychological scores of SF-12 were used to evaluate patients' quality of life. FTA, HKA, and prosthesis looseness were observed by X-ray films. Kaplan-Merier survival analysis was used to evaluate the survival rate of prosthesis. Results All operations were successfully completed in both groups. Compared with TKA group, UKA group had shorter incision length, longer operative time, and less blood loss ( P<0.05). There was no significant difference in time for flexion 90°, ambulation time, hospital stay, and the incidence of deep venous thrombosis of lower extremity between the two groups ( P>0.05). The incisions in both groups healed by first intention. During follow-up, 3 patients in the UKA group and 1 patient in the TKA group developed mild anterior knee pain. Patients were followed up (30.7±9.6) months in the UKA group and (34.9±8.7) months in the TKA group, and the difference was not significant ( t=-1.832, P=0.071). At last follow-up, there were significant differences in the HSS score, Feller score, WOMAC score, range of motion, VAS score, and physiological and psychological scores of SF-12 between pre- and post-operation ( P<0.05). The range of motion in the UKA group was bigger than that in the TKA group ( Z=-2.666, P=0.008), and there was no significant difference in the other indexes between the two groups ( P>0.05). X-ray films showed that the alignment of the two groups recovered well, and the FTA and HKA of the two groups were improved at 1 week after operation ( P<0.05). No radiolucency was found around the prosthesis during follow-up, no prosthesis loosening and meniscal bearing dislocation occurred. The survival rates of the prostheses in the two groups were 100%. Conclusion For severe medial compartment OA, the early survival rates of the two prostheses are similar, but UKA has less traumatic, can preserve the normal structure of the knee, and the range of motion of the knee after operation is significantly better than TKA.
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Affiliation(s)
- Qiang Huang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China.,Department of Orthopedics, Chengdu Fifth People's Hospital, Chengdu Sichuan, 611130, P.R.China
| | - Yi Zeng
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Qinsheng Hu
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Haibo Si
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Yong Nie
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Bin Shen
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
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13
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Ramamurti P, Fassihi SC, Stake S, Stadecker M, Whiting Z, Thakkar SC. Conversion Total Knee Arthroplasty. JBJS Rev 2021; 9:01874474-202109000-00007. [PMID: 34812774 DOI: 10.2106/jbjs.rvw.20.00198] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Conversion total knee arthroplasty (TKA) represents a heterogeneous group of procedures and most commonly includes TKA performed after ligamentous reconstruction, periarticular open reduction and internal fixation (ORIF), high tibial osteotomy (HTO), and unicompartmental knee arthroplasty (UKA). » Relative to patients undergoing primary TKA, patients undergoing conversion TKA often have longer operative times and higher surgical complexity, which may translate into higher postoperative complication rates. » There is mixed evidence on implant survivorship and patient-reported outcome measures when comparing conversion TKA and primary TKA, with some studies noting no differences between the procedures and others finding decreased survivorship and outcome scores for conversion TKA. » By gaining an improved understanding of the unique challenges facing patients undergoing conversion TKA, clinicians may better set patient expectations, make intraoperative adjustments, and guide postoperative care.
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Affiliation(s)
- Pradip Ramamurti
- Department of Orthopaedic Surgery, George Washington University, Washington, DC
| | - Safa C Fassihi
- Department of Orthopaedic Surgery, George Washington University, Washington, DC
| | - Seth Stake
- Department of Orthopaedic Surgery, George Washington University, Washington, DC
| | - Monica Stadecker
- Department of Orthopaedic Surgery, George Washington University, Washington, DC
| | - Zachariah Whiting
- Department of Orthopaedic Surgery, George Washington University, Washington, DC
| | - Savyasachi C Thakkar
- Adult Reconstruction Division, Department of Orthopaedic Surgery, Johns Hopkins University, Columbia, Maryland
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14
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Shelton TJ, Gill M, Athwal G, Howell SM, Hull ML. Revision of a Medial UKA to a Kinematic Aligned TKA: Comparison of Operative Complexity, Postoperative Alignment, and Outcome Scores to a Primary TKA. J Knee Surg 2021; 34:406-414. [PMID: 31499569 DOI: 10.1055/s-0039-1696734] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Revision of a medial unicompartmental knee arthroplasty (UKA) to a mechanically aligned total knee arthroplasty (MA TKA) is inferior to a primary TKA; however, revision with kinematic alignment (KA) has not been well studied. The present study determined whether patients revised with KA had a higher use of revision components, different postoperative alignment, and different clinical outcome scores from patients with a primary KA TKA. From 2006 to 2017, all patients suitable for a revision of a failed medial UKA to a TKA and a primary TKA were treated with KA. Reasons for the revision performed in ten females and six males at a mean age 67 ± 8 years included progression of osteoarthritis in the lateral hemi-joint (n = 6), aseptic loosening (n = 4), unremitting medial pain without loosening (n = 4), and insert wear (n = 2). Patients with a revision were matched 1:3 with a control cohort treated with a primary KA TKA. Revisions were performed with primary components without augments, stem extensions, or bone grafts. Seven postoperative alignment parameters of the limb and components were comparable to the control cohort (p > 0.05). At a mean follow-up of 5 years (1-10), implant survival was 100%, and the revision/primary group clinical outcome scores were 39/43 points for the Oxford Knee Score (OKS), 2.2/1.0 cm for the Visual Analog Pain Score, and 12/7 points for the Western Ontario and McMaster Universities Osteoarthritis Index score. When compared with primary KA TKA, surgeons that revise a failed medial UKA to a TKA with use of KA can expect similar operative complexity, comparable postoperative alignments, and a mean OKS of 39 points, which is higher than the mean 27 to 30 point range reported for revision of a failed UKA to a TKA with the use of MA.
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Affiliation(s)
- Trevor J Shelton
- Department of Orthopaedic Surgery, University of California, Davis, Sacramento, California
| | - Manpreet Gill
- Adventist Health Lodi Memorial Hospital, Lodi, California
| | - Gurbir Athwal
- California Northstate University College of Medicine, Elk Grove, California
| | - Stephen M Howell
- Department of Biomedical Engineering, University of California, Davis, Davis, California
| | - Maury L Hull
- Department of Orthopaedic Surgery, University of California, Davis, Sacramento, California.,Department of Biomedical Engineering, University of California, Davis, Davis, California.,Department of Mechanical Engineering, University of California, Davis, Davis, California
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15
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Risk of a complete exchange or failure in total knee arthroplasty and unicompartmental knee arthroplasty: a nationwide population-based cohort study from South Korea. Arch Orthop Trauma Surg 2021; 141:477-488. [PMID: 33184700 DOI: 10.1007/s00402-020-03675-1] [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] [Received: 03/26/2020] [Accepted: 10/28/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Few large-scale studies using adjusted data from national registries have explored the risk factors of subsequent revision in patients with unicompartmental knee arthroplasty (UKA) compared to those with total knee arthroplasty (TKA). We investigated the incidence rate and risk factors of subsequent revision in patients with UKA and TKA. METHODS We enrolled all patients who had undergone TKA or UKA as the primary surgical procedure without histories of having undergone either procedure during the preceding 2 years. Matched Cox regression models were used to compare the risks of revision between groups after propensity score matching. Revision was defined as conversion to revision TKA after primary TKA and conversion to TKA after UKA. RESULTS The study enrolled 418,806 TKA patients and 446,009 UKA patients. The risk of revision during the entire study period was higher for patients with UKA than for patients with TKA (adjusted hazard ratio [HR] 1.22, 95% confidence interval [95% CI]: 1.10-1.36). The Kaplan-Meier 8-year survival was 98.7% in the TKA group and 96.7% in the UKA group. Patients with UKA were at an increased risk of revision in cases of advanced age (70-79 years, HR 1.40, 95% CI: 1.15-1.71), female sex (HR 1.32, 95% CI: 1.16-1.49), the presence of chronic obstructive pulmonary disease (COPD) (HR 1.27, 95% CI: 1.05-1.54), the presence of peptic ulcer disease (PUD) (HR 1.34, 95% CI: 1.11-1.61) compared to patients with TKA. In patients with hemiplegia, however, UKA were associated with a lower risk of subsequent revision (HR 0.25, 95% CI: 0.07-0.94). CONCLUSION The risk of a complete exchange or failure was higher for patients with UKA than for patients with TKA. The most significant independent risk factors for subsequent a complete exchange or failure in patients with UKA were advanced age (70-79 years), female sex, and the presence of comorbidities such as COPD and PUD.
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16
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Sabah SA, Lim CT, Middleton R, von Fritsch L, Bottomley N, Jackson WFM, Price AJ, Alvand A. Management of aseptic failure of the mobile-bearing Oxford unicompartmental knee arthroplasty. Knee 2020; 27:1721-1728. [PMID: 33197810 DOI: 10.1016/j.knee.2020.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 09/11/2020] [Accepted: 10/07/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Unicompartmental knee arthroplasty (UKA) accounts for 9.1% of primary knee arthroplasties (KAs) in the UK. However, wider uptake is limited by higher revision rates compared with total knee arthroplasties (TKA) and concerns over subsequent poor function. The aim of this study was to understand the revision strategies and clinical outcomes for aseptic, failed UKAs at a high-volume centre. METHODS This was a retrospective, single-centre cohort study of 48 patients (31 female, 17 male) with 52 revision UKAs from 2006 to 2018. Median time to revision was 67 (range 4-180) months. Indications for revision were progression of osteoarthritis (n = 31 knees, 59.6%), unexplained pain (n = 10 knees, 19.2%), aseptic loosening (n = 6 knees, 11.5%), medial collateral ligament incompetence (n = 3 knees, 5.8%) and recurrent bearing dislocation (n = 2 knees, 3.8%). Technical details of surgery, complications and functional outcome were recorded. RESULTS Failed UKAs were revised to primary TKAs (n = 29 knees, 55.8%), revision TKAs (n = 9 knees, 17.3%), bicompartmental KAs (n = 11 knees, 21.2%), or unicompartmental-to-unicompartmental KAs (n = 3 knees, 5.8%). Median follow up was 81 (range 24-164) months. Four patients (7.7%) died from unrelated causes. No re-revisions were identified. Surgical complications required re-operation in five knees (9.6%). Median Oxford Knee Score at latest follow up was 38 (range 9-48) points and median EQ5D3L index 0.707 (range -0.247 to 1.000). CONCLUSIONS Aseptic, revision UKA at a high-volume centre had good clinical outcomes. Bicompartmental KA demonstrated excellent function and should be considered an alternative to TKA for progression of osteoarthritis for appropriately trained surgeons.
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Affiliation(s)
- Shiraz A Sabah
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
| | | | - Robert Middleton
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Lennart von Fritsch
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | | | | | - Andrew J Price
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK; Nuffield Orthopaedic Centre, Oxford, UK
| | - Abtin Alvand
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK; Nuffield Orthopaedic Centre, Oxford, UK
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17
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Yun AG, Qutami M, Chen CHM, Pasko KBD. Management of failed UKA to TKA: conventional versus robotic-assisted conversion technique. Knee Surg Relat Res 2020; 32:38. [PMID: 32727605 PMCID: PMC7389376 DOI: 10.1186/s43019-020-00056-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/02/2020] [Indexed: 11/13/2022] Open
Abstract
Background Failure of unicompartmental knee arthroplasty (UKA) is a distressing and technically challenging complication. Conventional conversion techniques (CCT) with rods and jigs have produced varying results. A robotic-assisted conversion technique (RCT) is an unexplored, though possibly advantageous, alternative. We compare our reconstructive outcomes between conventional and robotic methods in the management of failed UKA. Methods Thirty-four patients with a failed UKA were retrospectively reviewed. Patients underwent conversion total knee arthroplasty (TKA) with either a CCT or RCT. Seventeen patients were included in each group. All procedures were done by a single surgeon at a single institution, with a mean time to follow-up of 3.6 years (range, 1 to 12). The primary outcome measures were the need for augments and polyethylene thickness. Secondary outcome measures were complications, need for revision, estimated blood loss (EBL), length of stay, and operative time. Results The mean polyethylene thickness was 12 mm (range, 9 to 15) in the CCT group and 10 mm (range, 9 to 14) in the RCT groups, with no statistical difference between the two groups (P = 0.07). A statistically significant difference, however, was present in the use of augments. In the CCT group, five out of 17 knees required augments, whereas none of the 17 knees in the RCT group required augments (P = 0.04). Procedurally, robotic-assisted surgery progressed uneventfully, even with metal artifact noted on the preoperative computerized tomography (CT) scans. Computer mapping of the residual bone surface after implant removal was a helpful guide in minimizing resection depth. No further revisions or reoperations were performed in either group. Conclusions Robotic-assisted conversion TKA is technically feasible and potentially advantageous. In the absence of normal anatomic landmarks to guide conventional methods, the preoperative CT scans were unexpectedly helpful in establishing mechanical alignment and resection depth. In this limited series, RCT does not seem to be inferior to CCT. Further investigation of outcomes is warranted.
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Affiliation(s)
- Andrew G Yun
- Orthopedic Surgery, Center for Hip and Knee Replacement, Providence Saint John's Health Center, 2121 Santa Monica Blvd, Santa Monica, CA, 90404, USA
| | - Marilena Qutami
- Orthopedic Surgery, Center for Hip and Knee Replacement, Providence Saint John's Health Center, 2121 Santa Monica Blvd, Santa Monica, CA, 90404, USA
| | - Chang-Hwa Mary Chen
- Department of Surgery, Providence Saint John's Health Center, 2121 Santa Monica Blvd, Santa Monica, CA, 90404, USA
| | - Kory B Dylan Pasko
- Orthopedic Surgery, Center for Hip and Knee Replacement, Providence Saint John's Health Center, 2121 Santa Monica Blvd, Santa Monica, CA, 90404, USA.
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18
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Lo Presti M, Costa GG, Grassi A, Agrò G, Cialdella S, Vasco C, Neri MP, Cucurnia I, Zaffagnini S. Bearing thickness of unicompartmental knee arthroplasty is a reliable predictor of tibial bone loss during revision to total knee arthroplasty. Orthop Traumatol Surg Res 2020; 106:429-434. [PMID: 32253136 DOI: 10.1016/j.otsr.2019.12.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 12/09/2019] [Accepted: 12/17/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND Bone defects during revision procedures for failed UKA represent a challenge even for the most experienced surgeons; therefore, an accurate preoperative planning remains essential to prevent dramatic scenarios in the surgical theatre. HYPOTHESIS Our hypothesis is that bearing thickness used in original UKA represents a reliable predictor of severe tibial bone loss, requiring a metallic augment or constrained implant, during revision to TKA. PATIENTS AND METHODS Forty-two patients who underwent a total knee arthroplasty from failed UKA were identified from our institutional database and evaluated clinically using the Knee Society Score (KSS). A multivariate logistic regression analysis was performed using the presence of tibial augments or the need of varus-valgus constrained (VVC) prosthesis as depend variables, and patients' gender, age at revision procedure, side (medial or lateral), UKA tibial tray (all-polyethylene or metal back), bearing thickness (composite thicknesses of the metal-backed tray and insert or all-polyethylene tibial component ≤8mm or more than 8mm) and cause of failed UKA as independent variables. RESULTS A posterior-stabilized prosthesis was used in 27 cases (64.3%). An augment was necessary in 12 patients (28.6%). Initial bearing thickness greater than 8mm was associated with greater likelihood of a VVC implant (OR=11.78, 95% CI, 1.6583 to 83.6484, p=0.0137) and a tibial augment (OR=9.59, 95% CI, 1.327 to 69.395, p=0.0251). Tibial tray design, patients' gender or age during revision surgery, side or cause of failure were not associated to increased risk of augmentation or constrained implants. DISCUSSION Surgeons should be aware of the particular challenges that the conversion of a UKA to a TKA presents and be prepared to address them intraoperatively, with particular care to proper bone loss manage. Satisfying results can be achieved at mid-to-long term follow-up, if these procedures are planned accurately, and a precise analysis of failed UKA components, in particular bearing thickness, represents a helpful support in this context. LEVEL OF EVIDENCE IV, retrospective case series.
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Affiliation(s)
- Mirco Lo Presti
- II Orthopaedic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano n. 1/10, 40136, Bologna, Italy
| | - Giuseppe Gianluca Costa
- II Orthopaedic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano n. 1/10, 40136, Bologna, Italy.
| | - Alberto Grassi
- II Orthopaedic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano n. 1/10, 40136, Bologna, Italy
| | - Giuseppe Agrò
- II Orthopaedic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano n. 1/10, 40136, Bologna, Italy
| | - Sergio Cialdella
- II Orthopaedic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano n. 1/10, 40136, Bologna, Italy
| | - Cosimo Vasco
- II Orthopaedic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano n. 1/10, 40136, Bologna, Italy
| | - Maria Pia Neri
- II Orthopaedic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano n. 1/10, 40136, Bologna, Italy
| | - Ilaria Cucurnia
- II Orthopaedic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano n. 1/10, 40136, Bologna, Italy
| | - Stefano Zaffagnini
- II Orthopaedic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano n. 1/10, 40136, Bologna, Italy
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19
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Crawford DA, Berend KR, Thienpont E. Unicompartmental Knee Arthroplasty: US and Global Perspectives. Orthop Clin North Am 2020; 51:147-159. [PMID: 32138853 DOI: 10.1016/j.ocl.2019.11.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Unicompartmental knee arthroplasty (UKA) is a treatment option for anteromedial osteoarthritis. Compared with total knee arthroplasty (TKA), UKA offers improved knee range of motion, functional recovery and decreased medical complications. Revision rates continue to be higher with UKA compared with TKA. With current UKA implants, there is no significant difference in mobile bearing or fixed bearing, or between cemented and cementless implants. Enabling technology, such as robotic-assisted surgery, has demonstrated improvements in component positioning, but no long-term difference in survival compared with traditional manual instruments.
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Affiliation(s)
- David A Crawford
- JIS Orthopedics, 7277 Smith's Mill Road, Suite 200, New Albany, OH 43054, USA.
| | - Keith R Berend
- JIS Orthopedics, 7277 Smith's Mill Road, Suite 200, New Albany, OH 43054, USA
| | - Emmanuel Thienpont
- Cliniques universitaires Saint Luc, Avenue Hippocrate 10, Brussels 1200, Belgium
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20
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Scheele CB, Pietschmann MF, Schröder C, Lenze F, Grupp TM, Müller PE. Effect of bone density and cement morphology on biomechanical stability of tibial unicompartmental knee arthroplasty. Knee 2020; 27:587-597. [PMID: 32024609 DOI: 10.1016/j.knee.2020.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 10/08/2019] [Accepted: 01/21/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Unicompartmental knee arthroplasty (UKA) offers good long-term survivorship and superior kinematics and function compared with total knee arthroplasty (TKA). However, revision rates are higher with aseptic loosening representing a major cause. Biomechanical stability depends on cement penetration. The goal of this study was to analyze the influence of cement morphology and bone density on primary stability of tibial UKA under physiological loading conditions in human tibiae. METHODS Thirty-six tibial trays were implanted in fresh-frozen human cadaver knees and tested for primary stability using dynamic compression-shear testing. Prior to implantation, bone density had been quantified for all 18 tibiae. Postoperatively, cement penetration has been assessed on frontal cuts based on eight predefined parameters. The influence of bone density and cement morphology on biomechanical stability was determined using correlation and linear regression analysis. RESULTS Mean failure load was 2691 ± 832.9 N, mean total cement thickness was 2.04 ± 0.37 mm, mean cement penetration was 1.54 ± 0.33 mm and mean trabecular bone mineral density (BMD) was 107.1 ± 29.3 mg/ml. There was no significant correlation between failure load and cement morphology (P > .05). Failure load was significantly positive correlated with trabecular BMD (r = 0.843; P < .0001) and cortical BMD (r = 0.432; P = .0136). CONCLUSIONS Simulating physiological loading conditions, the failure load of tibial UKA is linearly dependent on the trabecular BMD. The observed parameters of cementation morphology seem capable of preventing failure at the bone-cement interface before inherent bone stability is reached. Further research is required to assess the usefulness of a preoperative assessment of bone quality for patient selection in UKA.
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Affiliation(s)
- Christian B Scheele
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Munich, Germany; Technical University Munich, Klinikum rechts der Isar, Department of Orthopedics and Sports Orthopedics, Munich, Germany.
| | - Matthias F Pietschmann
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Munich, Germany
| | - Christian Schröder
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Munich, Germany
| | - Florian Lenze
- Technical University Munich, Klinikum rechts der Isar, Department of Orthopedics and Sports Orthopedics, Munich, Germany
| | - Thomas M Grupp
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Munich, Germany; Aesculap AG Research & Development, Tuttlingen, Germany
| | - Peter E Müller
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Munich, Germany
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21
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Lim JBT, Pang HN, Tay KJD, Chia SL, Lo NN, Yeo SJ. Clinical outcomes and patient satisfaction following revision of failed unicompartmental knee arthroplasty to total knee arthroplasty are as good as a primary total knee arthroplasty. Knee 2019; 26:847-852. [PMID: 31113700 DOI: 10.1016/j.knee.2019.04.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 04/01/2019] [Accepted: 04/18/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND With unicompartmental knee arthroplasty (UKA) being increasingly performed for medial compartment osteoarthritis (OA) of the knee, revision total knee arthroplasty (TKA) for failed UKA is expected to increase. Our primary aim is to evaluate patients in our tertiary institution who underwent revision of failed UKA to TKA to compare their pre-operative clinical scores (patient-reported outcome measures, PROMs) to those of primary TKA. METHODS Retrospective review of our institutional arthroplasty registry between 2001 and 2014 was performed. We identified 70 patients who underwent revision of UKA to TKA. The revision UKA to TKA patients was matched with 140 patients who underwent primary TKA for OA in terms of preoperative demographics, gender, age at time of surgery, body mass index (BMI), primary surgeon, and PROMs. Intra-operative data and postoperative complications or re-revision surgeries performed were reviewed. RESULTS In the revision UKA to TKA group, more stems, augments or constrained implants were used compared to primary TKA. A greater proportion of patients with metal-backed UKA revision to TKA required stems, augments or constrained implants as compared to all-polyethylene UKA revision to TKA, but not a significant proportion (P = 0.250). At two years postoperatively, there were no significant differences observed between the groups in terms of patient satisfaction and PROMs. CONCLUSIONS This study showed similar outcomes following revision of failed UKA to TKA and primary TKA. There were significant improvements in PROMs for revision UKA to TKA, which is comparable to that of primary TKA.
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Affiliation(s)
- Jason Beng Teck Lim
- Department of Orthopaedic Surgery, Singapore General Hospital, Republic of Singapore.
| | - Hee Nee Pang
- Department of Orthopaedic Surgery, Singapore General Hospital, Republic of Singapore
| | - Keng Jin Darren Tay
- Department of Orthopaedic Surgery, Singapore General Hospital, Republic of Singapore
| | - Shi-Lu Chia
- Department of Orthopaedic Surgery, Singapore General Hospital, Republic of Singapore
| | - Ngai Nung Lo
- Department of Orthopaedic Surgery, Singapore General Hospital, Republic of Singapore
| | - Seng Jin Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, Republic of Singapore
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22
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Jonas SC, Jermin P, Howells N, Porteous A, Murray J, Robinson J. Outcome of revision UKR to TKR when compared to a matched group of TKR of same total arthroplasty lifespan. Knee 2019; 26:400-404. [PMID: 30792107 DOI: 10.1016/j.knee.2018.12.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 11/04/2018] [Accepted: 12/14/2018] [Indexed: 02/02/2023]
Abstract
AIM To compare outcomes of revision uni-compartmental knee replacement (UKR) with a defined revision cause with a matched group of primary total knee replacements (TKR). BACKGROUND UKR accounts for 8.7% of knee arthroplasty in the UK each year. It has better functional outcome than total knee replacement for isolated single compartment arthritis but can result in complex surgery when revision is required. This is feared to result in poorer patient reported outcomes when compared to primary TKR. We aim to compare the clinical results of revised UKR with primary TKR, taking into account the survival length of the UKR. PATIENTS AND METHODS Forty-five patients (27 female) were retrospectively identified from our arthroplasty database that had undergone revision from UKR to TKR (1999-2014) and had a minimum of two years of follow-up post-revision. These patients were then matched with regards to age at primary procedure, sex, BMI and total arthroplasty life (UKR + Revision TKR) up to point of follow-up. RESULTS In the UKR revision group (mean arthroplasty life 8.6 years) the mean Oxford knee score (OKS) was 31.8. In the primary knee group (mean arthroplasty life 8.4 years) the mean OKS was 32.8. This difference was not statistically significant. Fifteen out of 45 patients undergoing revision surgery required stemmed components. CONCLUSION UKR provides comparable clinical outcome even after revision surgery to TKR as primary TKRs and should be considered in all patients meeting the selection criteria. Revision is complex and revision components should be available.
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Affiliation(s)
- Sam C Jonas
- Avon Orthopaedic Centre, United Kingdom of Great Britain and Northern Ireland.
| | - Paul Jermin
- Avon Orthopaedic Centre, United Kingdom of Great Britain and Northern Ireland
| | - Nick Howells
- Avon Orthopaedic Centre, United Kingdom of Great Britain and Northern Ireland
| | - Andrew Porteous
- Avon Orthopaedic Centre, United Kingdom of Great Britain and Northern Ireland
| | - James Murray
- Avon Orthopaedic Centre, United Kingdom of Great Britain and Northern Ireland
| | - James Robinson
- Avon Orthopaedic Centre, United Kingdom of Great Britain and Northern Ireland
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Wilson HA, Middleton R, Abram SGF, Smith S, Alvand A, Jackson WF, Bottomley N, Hopewell S, Price AJ. Patient relevant outcomes of unicompartmental versus total knee replacement: systematic review and meta-analysis. BMJ 2019; 364:l352. [PMID: 30792179 PMCID: PMC6383371 DOI: 10.1136/bmj.l352] [Citation(s) in RCA: 181] [Impact Index Per Article: 36.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To present a clear and comprehensive summary of the published data on unicompartmental knee replacement (UKA) or total knee replacement (TKA), comparing domains of outcome that have been shown to be important to patients and clinicians to allow informed decision making. DESIGN Systematic review using data from randomised controlled trials, nationwide databases or joint registries, and large cohort studies. DATA SOURCES Medline, Embase, Cochrane Controlled Register of Trials (CENTRAL), and Clinical Trials.gov, searched between 1 January 1997 and 31 December 2018. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Studies published in the past 20 years, comparing outcomes of primary UKA with TKA in adult patients. Studies were excluded if they involved fewer than 50 participants, or if translation into English was not available. RESULTS 60 eligible studies were separated into three methodological groups: seven publications from six randomised controlled trials, 17 national joint registries and national database studies, and 36 cohort studies. Results for each domain of outcome varied depending on the level of data, and findings were not always significant. Analysis of the three groups of studies showed significantly shorter hospital stays after UKA than after TKA (-1.20 days (95% confidence interval -1.67 to -0.73), -1.43 (-1.53 to -1.33), and -1.73 (-2.30 to -1.16), respectively). There was no significant difference in pain, based on patient reported outcome measures (PROMs), but significantly better functional PROM scores for UKA than for TKA in both non-trial groups (mean difference -0.58 (-0.88 to -0.27) and -0.32 (-0.48 to -0.15), respectively). Regarding major complications, trials and cohort studies had non-significant results, but mortality after TKA was significantly higher in registry and large database studies (risk ratio 0.27 (0.16 to 0.45)), as were venous thromboembolic events (0.39 (0.27 to 0.57)) and major cardiac events (0.22 (0.06 to 0.86)). Early reoperation for any reason was higher after TKA than after UKA, but revision rates at five years remained higher for UKA in all three study groups (risk ratio 5.95 (1.29 to 27.59), 2.50 (1.77 to 3.54), and 3.13 (1.89 to 5.17), respectively). CONCLUSIONS TKA and UKA are both viable options for the treatment of isolated unicompartmental osteoarthritis. By directly comparing the two treatments, this study demonstrates better results for UKA in several outcome domains. However, the risk of revision surgery was lower for TKA. This information should be available to patients as part of the shared decision making process in choosing treatment options. SYSTEMATIC REVIEW REGISTRATION PROSPERO number CRD42018089972.
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Affiliation(s)
- Hannah A Wilson
- University of Oxford, Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, BOTNAR Research Centre, Headington, Oxford OX3 7LD, UK
| | - Rob Middleton
- University of Oxford, Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, BOTNAR Research Centre, Headington, Oxford OX3 7LD, UK
| | - Simon G F Abram
- University of Oxford, Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, BOTNAR Research Centre, Headington, Oxford OX3 7LD, UK
| | - Stephanie Smith
- University of Oxford, Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, BOTNAR Research Centre, Headington, Oxford OX3 7LD, UK
| | - Abtin Alvand
- University of Oxford, Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, BOTNAR Research Centre, Headington, Oxford OX3 7LD, UK
| | - William F Jackson
- Oxford University Hospitals NHS Trust, Nuffield Orthopaedic Centre, Oxford, UK
| | - Nicholas Bottomley
- Oxford University Hospitals NHS Trust, Nuffield Orthopaedic Centre, Oxford, UK
| | - Sally Hopewell
- Centre for Statistics in Medicine, Oxford Clinical Trials Research Unit, Oxford, UK
| | - Andrew J Price
- University of Oxford, Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, BOTNAR Research Centre, Headington, Oxford OX3 7LD, UK
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Zuo W, Ma J, Guo W, Zhang Q, Wang W, Liu Z. Comparison of the clinical outcomes of revision of failed UKAs to TKAs with primary TKAs: A systematic review and meta-analysis. Medicine (Baltimore) 2018; 97:e13408. [PMID: 30557995 PMCID: PMC6319976 DOI: 10.1097/md.0000000000013408] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Accepted: 11/01/2018] [Indexed: 12/05/2022] Open
Abstract
Unicompartmental knee arthroplasty (UKA) is one of the effective surgical methods for the treatment of unicompartmental knee arthritis. When UKA fails, a revised surgery to total knee arthroplasty (TKA) is often necessary. The purpose of this study was to compare the clinical outcomes of revision of failed UKAs to TKAs with primary TKAs. The hypothesis was that the TKAs revised from UKAs had inferior clinical outcomes compared with primary TKAs.This meta-analysis was conducted in accordance with the Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines. Newcastle-Ottawa Scale (NOS) proposed by the Cochrane Collaboration was used for evaluating the methodological quality of the studies. PubMed, Medline, Embase, Web of Science, and the Cochrane Library were searched to identify studies that compared the revision of UKA to TKA with primary TKA. Primary outcomes included Range of motion (ROM); Knee society score (KSS); (re-)revision rate and complications. Secondary outcomes were blood loss and length of hospital stay.A total of 8 eligible retrospective comparative studies were identified from a keyword search. Results revealed that the primary TKAs group has a better ROM (MD = -7.29, 95% CI:-14.03-0.56, P < .05), higher Knee Society Knee scores (MD = -0.54, 95% CI:-1.12-0.04, P < .05), higher Knee Society function score (MD = -0.65,95% CI:-1.25-0.06, P < .05), lower (re-)revision rate (MD = 4.15, 95% CI:2.37-7.25, P < .05) than rUKAs. There was no significant difference in postoperative complications, blood loss and length of stay between the 2 groups.Our meta-analysis revealed that compared with primary TKAs, TKAs revised from UKAs had inferior clinical outcomes.
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Affiliation(s)
- Wei Zuo
- Peking University China-Japan Friendship School of Clinical Medicine, 2 Yinghuadong Road
| | - Jinhui Ma
- Center for Osteonecrosis and Joint Preserving & Reconstruction, Department of Orthopaedic Surgery, China-Japan Friendship Hospital, 2 Yinghuadong Road China
| | - Wanshou Guo
- Center for Osteonecrosis and Joint Preserving & Reconstruction, Department of Orthopaedic Surgery, China-Japan Friendship Hospital, 2 Yinghuadong Road China
| | - Qidong Zhang
- Center for Osteonecrosis and Joint Preserving & Reconstruction, Department of Orthopaedic Surgery, China-Japan Friendship Hospital, 2 Yinghuadong Road China
| | - Weiguo Wang
- Center for Osteonecrosis and Joint Preserving & Reconstruction, Department of Orthopaedic Surgery, China-Japan Friendship Hospital, 2 Yinghuadong Road China
| | - Zhaohui Liu
- Center for Osteonecrosis and Joint Preserving & Reconstruction, Department of Orthopaedic Surgery, China-Japan Friendship Hospital, 2 Yinghuadong Road China
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25
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Lee JK, Kim HJ, Park JO, Yang JH. Inferior outcome of revision of unicompartmental knee arthroplasty to total knee arthroplasty compared with primary total knee arthroplasty: systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2018; 26:3403-3418. [PMID: 29589049 DOI: 10.1007/s00167-018-4909-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 03/20/2018] [Indexed: 01/14/2023]
Abstract
PURPOSE The purpose of this study was to compare the revision of unicompartmental knee arthroplasty (UKA) to total knee arthroplasty (TKA) with primary TKA through a review of previously published studies. The hypothesis was that the revised UKA group would need additional operative procedures, including the use of stems and augments, resulting in poorer clinical outcomes than those of the primary TKA group. METHODS A literature search of online register databases was performed to identify clinical trials that compared revised UKA to TKA with primary TKA. An electronic literature search was performed using the Medline, Embase, Cochrane Library, Web of Science, and Scopus databases. No language or date restrictions were applied. RESULTS A total of 2034 articles were identified from a keyword search, of which 11 studies were determined as eligible. They were all retrospective comparative studies. The revised UKA to TKA group had longer operation times resulting from additional procedures such as bone grafting and use of stems and augments, higher reoperation rates, and worse postoperative clinical outcomes based on the Western Ontario and McMaster Universities Osteoarthritis Index and Oxford Knee Score than the primary TKA group, with the differences being statistically significant. CONCLUSION UKA should not be considered an alternative procedure to TKA. LEVEL OF EVIDENCE Therapeutic Level III.
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Affiliation(s)
- Jin Kyu Lee
- Department of Orthopaedic Surgery, Hanyang University Hospital, Seoul, South Korea
| | - Hyun Jung Kim
- Department of Preventive Medicine, College of Medicine, Korea University, Seoul, South Korea
| | - Jae Ok Park
- Medical Library, Veterans Health Service Medical Center, Seoul, South Korea
| | - Jae-Hyuk Yang
- Department of Orthopedic Surgery, Hanyang University Guri Hospital, 153, Gyeongchunro, Guri, Gyeonggi-Do, 11923, South Korea.
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Abstract
With recent design modifications, proper patient selection, and sound surgical technique, medial unicompartmental knee arthroplasty has demonstrated long-term success in the management of degenerative joint disease. Nevertheless, complications do occur, most often aseptic loosening, tibial fracture, polyethylene wear, bearing dislocation, disease progression, infection, and unexplained pain. Some failures can be managed with retention of the implant, whereas others require revision to total knee arthroplasty (TKA), possibly including augments and stems. Although outcomes of unicompartmental knee arthroplasty may not match those of a primary TKA, they tend to exceed results of revision of a previous TKA.
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Lombardi AV, Kolich MT, Berend KR, Morris MJ, Crawford DA, Adams JB. Revision of Unicompartmental Knee Arthroplasty to Total Knee Arthroplasty: Is It as Good as a Primary Result? J Arthroplasty 2018; 33:S105-S108. [PMID: 29691172 DOI: 10.1016/j.arth.2018.03.023] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 03/12/2018] [Accepted: 03/13/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Unicompartmental knee arthroplasty (UKA) is touted as a more conservative, bone- and tissue-sparing procedure than total knee arthroplasty (TKA). Similarly, revision of UKA to TKA is generally a simpler procedure than revision of TKA to TKA and can be accomplished with primary TKA components in most cases. The purpose of this study was to review a consecutive series of patients undergoing revision of failed UKA to TKA to determine if etiology is similar to that reported in recent literature and evaluate if the results align more with primary TKA vs revision of TKA to TKA. METHODS A query of our private practice registry from 1996 to 2015 revealed 184 patients (193 knees) who underwent revisions of failed UKA with minimum 2-year follow-up. The mean age was 63.5 (37-84) years, body mass index was 32.3 (19-57) kg/m2, and interval after UKA was 4.8 (0-35) years. The most prevalent indications for UKA revision were aseptic loosening (42%) arthritic progression (20%), and tibial collapse (14%). RESULTS At 6.1-year mean follow-up (2-20), 8 knees (4.1%) required re-revision, which is similar to what we reported at 5.5 years in a group of primary TKA patients (6 of 189; 3.2%) and much lower than what we observed at 6.0 years in a recent study of aseptic revision TKA patients (35 of 278; 12.6%). In the study group, Knee Society clinical and function scores improved from 50.8 and 52.1 preoperatively to 83.4 and 67.6 at the most recent evaluation. Re-revisions were for aseptic loosening (3), instability (2), arthrofibrosis (2), and infection (1). CONCLUSIONS Compared to published individual institution and national registry data, re-revision rates of failed UKA are equivalent to revision rates of primary TKA and substantially better than re-revision rates of revision TKA. These data should be used to counsel patients undergoing revision UKA to TKA.
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Affiliation(s)
- Adolph V Lombardi
- Joint Implant Surgeons, Inc., New Albany, Ohio; White Fence Surgical Suites, New Albany, Ohio; Mount Carmel Health System, New Albany, Ohio; Department of Orthopaedics, Ohio State University Wexner Medical Center, Columbus, Ohio
| | | | - Keith R Berend
- Joint Implant Surgeons, Inc., New Albany, Ohio; White Fence Surgical Suites, New Albany, Ohio; Mount Carmel Health System, New Albany, Ohio
| | - Michael J Morris
- Joint Implant Surgeons, Inc., New Albany, Ohio; White Fence Surgical Suites, New Albany, Ohio; Mount Carmel Health System, New Albany, Ohio
| | - David A Crawford
- Joint Implant Surgeons, Inc., New Albany, Ohio; White Fence Surgical Suites, New Albany, Ohio; Mount Carmel Health System, New Albany, Ohio
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28
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Scott CEH, Powell-Bowns MFR, MacDonald DJ, Simpson PM, Wade FA. Revision of Unicompartmental to Total Knee Arthroplasty: Does the Unicompartmental Implant (Metal-Backed vs All-Polyethylene) Impact the Total Knee Arthroplasty? J Arthroplasty 2018. [PMID: 29525342 DOI: 10.1016/j.arth.2018.02.003] [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] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The aim of this study is to investigate differences in implant requirement, outcomes, and re-revision when total knee arthroplasty (TKA) was performed following unicompartmental knee arthroplasties (UKAs) with metal-backed (MB) compared to all-polyethylene (AP) tibial components. METHODS Retrospective study of 60 UKAs converted to 60 TKAs at mean 7.3 years (0.1 to 17) after implantation in 55 patients (mean age, 64 [49-83]; 44% male): 44 MB and 16 AP. TKA implant requirement was investigated in addition to mode of failure, Oxford Knee Score, and TKA survival at mean 5.4 years (0.5 to 17). RESULTS Progression of osteoarthritis was the commonest mode of failure in MB UKAs (P = .03) and unexplained pain in AP (P = .011) where revisions were performed earlier (4.8 ± 3.2 vs 8.2 ± 4.5, P = .012). In 56 of 60 (93%) cases, unconstrained TKA implants were used. The use of standard cruciate-retaining TKAs without augments or stems was less likely following MB UKA compared to AP (12 of 38 [32%] vs 10/14 [71%], P = .013). Specifically MB UKA implants were associated with more tibial stem use (P = .04) and more use of cruciate-substituting polyethylene (P = .05). There was no difference in the use of constrained implants. Multivariate analysis showed tibial resection depth to predict stem requirement. Seven were re-revised giving 7-year TKA survival: from MB UKA 70.3 (95% CI, 47.0 to 93.6) and from AP UKA 87.5 (95% CI, 64.6 to 100; P = .191). CONCLUSION MB UKA implants increase the chances of a complex revision requiring tibial stems and cruciate substitution but reduce the chances of early revision compared to AP UKA which often fail early with pain.
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Affiliation(s)
- Chloe E H Scott
- Department of Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | | | - Deborah J MacDonald
- Department of Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Philip M Simpson
- Department of Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Frazer A Wade
- Department of Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
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29
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Sun X, Su Z. A meta-analysis of unicompartmental knee arthroplasty revised to total knee arthroplasty versus primary total knee arthroplasty. J Orthop Surg Res 2018; 13:158. [PMID: 29929543 PMCID: PMC6013960 DOI: 10.1186/s13018-018-0859-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 06/08/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study was performed to compare the clinical outcomes of unicompartmental knee arthroplasty (UKA) revised to total knee arthroplasty (TKA) versus primary TKA. METHODS Relevant trials were identified via a search of the Cochrane Central Register of Controlled Trials and PubMed from inception to 17 June 2017. A meta-analysis was performed to compare postoperative outcomes between revised UKA and primary TKA with respect to the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, Knee Society Score (KSS), mean polyethylene thickness, hospital stay, revision rate, range of motion (ROM), and complications. RESULTS Five of 233 studies involving 536 adult patients (revised UKA group, n = 209; primary TKA group, n = 327) were eligible for inclusion in the meta-analysis. The primary TKA group had better WOMAC scores, KSS, and ROM than the revised UKA group (P < 0.05). Compared with primary TKA, revision of UKA to TKA required more augments, stems, and bone grafts and a thicker polyethylene component (P < 0.05). There were no significant differences between the two groups in the revision rate, hospital stay, or complications (P > 0.05). CONCLUSION Conversion of UKA to TKA is associated with poorer clinical outcomes than primary TKA. Furthermore, we believe that conversion of UKA to TKA is more complicated than performing primary TKA. Revision UKA often requires more augments, stems, and bone grafts and thicker polyethylene components than primary TKA. However, patients who undergo conversion of UKA to TKA have similar hospital stay, complications, and revision rate as patients who undergo primary TKA.
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Affiliation(s)
- Xuedong Sun
- Department of Orthopaedics, Weifang People's Hospital, no. 151 Guangwen Road, Weifang, 260041, China
| | - Zheng Su
- Department of Medical Oncology, Weifang People's Hospital, no. 151 Guangwen Road, Weifang, 260041, China.
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Comparison of the outcomes of navigation-assisted revision of unicompartmental knee arthroplasty to total knee arthroplasty versus navigation-assisted primary TKA. INTERNATIONAL ORTHOPAEDICS 2018; 43:315-322. [PMID: 29916003 DOI: 10.1007/s00264-018-4028-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 06/11/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Revision of unicompartmental knee arthroplasty (UKA) to total knee arthroplasty (TKA) is technically demanding but can be performed with computer navigation system guidance. The purpose of this study was (1) to compare the outcomes of revision of UKA to TKA to those of primary TKA and (2) to describe a surgical technique for the revision of UKA to TKA using a navigation system. METHODS From May 2011 to April 2014, a total of 298 knees underwent primary navigation-assisted TKA (group 1), and navigation-assisted UKA revision to TKA was performed in 15 patients (group 2). One to three propensity score matching was performed to compare the two groups after a minimum of three years of follow-up. Radiographic and clinical outcomes in addition to radiolucent lines were evaluated during follow-up. RESULTS In group 1, there was one case that required metal block augmentation with the long stem under the tibial plate due to severe bone loss, while in other cases, short stems were used, and cement and autogenous bone grafts were used to fill bone defects due to minimal bone loss. Pre- and post-operative outcomes were significantly improved in both groups (p < 0.001). There were no statistical differences between groups in pre- and post-operative outcomes except post-operative Knee Society Function Score (KSFS) (p = 0.008). There were no radiolucent lines in the tibia or femur in either group during follow-up. CONCLUSIONS With the use of an appropriate surgical technique, navigation-assisted revision of UKA to TKA can yield clinical and radiologic outcomes comparable to those of primary navigation-assisted TKA. LEVEL OF EVIDENCE Level IV.
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Tadros BJ, Dabis J, Twyman R. Short-term outcome of unicompartmental knee arthroplasty in the octogenarian population. Knee Surg Sports Traumatol Arthrosc 2018; 26:1571-1576. [PMID: 28744756 DOI: 10.1007/s00167-017-4639-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 07/07/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Unicompartmental knee arthroplasty (UKA) provides significant benefits to patients with anteromedial osteoarthritis, with good long-term results. Morbidity and mortality rates are lower, and recovery is quicker. These benefits would be advantageous to the octogenarian population whom carry significant comorbidities. The primary aim was to compare the short-term functional outcome at 2 years of UKA in the octogenarian population against a stratified younger cohort of patients. We hypothesised that the octogenarian population would have equally significant improved patient-reported outcome measures. METHODS Prospective patient-reported outcome measures, including Oxford Knee Score (OKS), satisfaction rates and Euro-Quol (EQ-5D) scores at 1-year and 2-year post-operative data, were collected and analysed. Three hundred and ninety-five medial Oxford Phase 3 UKA implants were evaluated. Mean follow-up was 4.7 years (range 2.1-7.7). Secondary outcomes including revision rates, length of stay, complications and mortality were recorded. Our patient population was stratified into three cohort groups based on age: 60-69, 70-79 and 80-89 years. RESULTS The OKS and EQ-5D score improved significantly in all three groups at all post-operative time periods and maintained at 2 years. The OKS at 2 years post-operatively by age was 39.5 (SD 18.6), 39.2 (SD 17.7) and 39.3 (SD 15.9), respectively. No significant difference of implant survival was found between the groups. The overall revision rate was 28/395 (7%). The 90-day mortality in the present series was one patient. CONCLUSION The 2-year short-term functional outcome, revision rates and satisfaction of UKA in the octogenarian population did not differ statistically from other age groups. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Baha John Tadros
- Registrar in Trauma and Orthopaedics, St Richards Hospital, Western Sussex Hospitals, Spitalfield Lane, Chichester, PO19 6SE, UK
| | - John Dabis
- Specialist Registrar (ST8) in Trauma and Orthopaedics, South West London Elective Orthopaedic Centre, Epsom Hospital, Dorking Road, Epsom, KT18 7EG, UK.
| | - Roy Twyman
- Consultant Orthopaedic Surgeon, South West London Elective Orthopaedic Centre, Epsom Hospital, Dorking Road, Epsom, KT18 7EG, UK
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Unicompartmental Knee Arthroplasty Revision to TKA: Are Tibial Stems and Augments Associated With Improved Survivorship? Clin Orthop Relat Res 2018; 476:854-862. [PMID: 29481343 PMCID: PMC6260091 DOI: 10.1007/s11999.0000000000000179] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Some surgeons contend that unicompartmental knee arthroplasty (UKA) can easily be revised to a TKA when revision is called for, whereas others believe that this can be complex and technically demanding. There has been little research regarding the efficacy or rationale of using metal augmentation and tibial stem extensions when revising a UKA to a TKA. QUESTION/PURPOSES: (1) Is the use of stem extensions for the tibial component associated with increased survival when revising a UKA to a TKA? (2) Is the addition of modular augments associated with increased survival compared with stem extensions alone? (3) Is TKA design (minimally stabilized versus posterior-stabilized) or (4) tibial fixation (cemented versus cementless) associated with differences in survivorship? METHODS Data from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) were used to analyze implant survival after revision of a UKA to a TKA, comparing results in which tibial components were used with and without modular components. The groups analyzed were TKA without a stem extension, those in which a tibial stem extension was used, and those in which a tibial stem extension was used together with an augment. There were 4438 revisions of UKAs to TKAs available for analysis. The mean duration of followup of patients having the TKA revisions was 5 years (SD, 3.5 years). There were 2901 (65%) procedures in which a tibial stem extension was not used, 870 (20%) procedures with a tibial stem extension, and 667 (15%) with a tibial stem extension and metallic augment. Kaplan-Meier estimates of survivorship were calculated and hazard ratios (HRs) from Cox proportional hazard models, adjusting for age and sex, were used to compare the rate of revision among groups. The overall 10-year cumulative percent revision (CPR) for UKA revised to a TKA was 16%. RESULTS At 10 years, the CPR was increased when a stem extension was not used (19%; 95% confidence interval [CI],16.5-20.7 without a stem extension compared with 13%; 95% CI, 9.2-17.0 with a stem extension; entire period HR, 1.44; 95% CI, 1.10-1.89; p = 0.007). There was no difference in the 10-year CPR when an augment was used together with a stem extension compared with a stem extension alone (HR, 1.26; 95% CI, 0.85-1.86; p = 0.251). When minimally stabilized and posterior-stabilized TKAs were compared, there was no difference in survivorship. Minimally stabilized TKA designs without stem extensions showed higher CPR compared with when stem extensions were used (HR, 1.77; 95% CI, 1.16-2.70; p = 0.007), whereas posterior-stabilized designs without stem extensions showed higher CPR only when compared with when stem extensions and augments were both used (HR, 2.16; 95% CI, 1.24-3.77; p = 0.006). Cementless fixation of the tibial component resulted in a higher CPR than when cement was used (HR, 1.36; 95% CI 1.08-1.71; p = 0.008). CONCLUSIONS In this registry study, the risk of repeat revision after revision of a UKA to a TKA was lower when a tibial stem extension was used, but no such difference was found with respect to augments. Our study did not account for the degree of bone loss or surgeon preference when considering stems and augments. Further research to establish the degree of bone loss associated with UKA to TKA revision procedures will help clarify these findings. LEVEL OF EVIDENCE Level III, therapeutic study.
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Dyrhovden GS, Lygre SHL, Badawy M, Gøthesen Ø, Furnes O. Have the Causes of Revision for Total and Unicompartmental Knee Arthroplasties Changed During the Past Two Decades? Clin Orthop Relat Res 2017; 475:1874-1886. [PMID: 28299718 PMCID: PMC5449334 DOI: 10.1007/s11999-017-5316-7] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 03/07/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND Revisions after knee arthroplasty are expected to increase, and the epidemiology of failure mechanisms is changing as new implants, technology, and surgical techniques evolve. QUESTIONS/PURPOSES (1) Was there improvement in survival for TKA and unicompartmental knee arthroplasty (UKA) when comparing two consecutive 11-year periods with similar followups in a national registry? (2) Were there changes in the causes of revision during the two times? (3) Could the changes in revision causes be attributed to patient or implant characteristics? METHODS A total of 60,623 TKAs (2426 revisions) and 7648 UKAs (725 revisions) were selected from the Norwegian Arthroplasty Register and analyzed based on year of primary surgery: 1994 to 2004 (Period 1) and 2005 to 2015 (Period 2). TKAs had median followup of 3.5 years in Period 1 and 4.2 years in Period 2. Median followup for UKAs was 2.7 years in Period 1 and 4.6 years in Period 2. Of the patients included in the registry, 99.6% were accounted for at the time of analysis, whereas 0.4% had moved abroad. We used Kaplan-Meier analyses and log-rank test to investigate changes in survival. Relative risk of revision in Period 2 relative to Period 1 was calculated for each registered revision cause in a Cox regression model adjusted for age, sex, diagnosis, fixation, and patella resurfacing. RESULTS For TKAs, the 10-year Kaplan-Meier survival free from revision improved from Period 1 to Period 2 from 91% (95% CI, 90%-92%) to 94% (95% CI, 94%-95%; p < 0.001). Revisions resulting from aseptic loosening of the femoral component, polyethylene wear/breakage, patellar dislocation, and unexplained pain decreased, whereas revisions resulting from early infection increased. Patients in Period 2 were younger and more often men compared with patients in Period 1. A higher risk of revision was found for male sex (relative risk [RR], 1.1; 95% CI, 1.0-1.2; p = 0.048) and age younger than 65 years (RR, 1.7; 95% CI, 1.6-1.9; p < 0.001). With UKAs, the 10-year survival free from revision was 80% (95% CI, 76%-84%) in Period 1 and 81% (95% CI, 79%-83%; p = 0.261) in Period 2. Revisions resulting from tibial aseptic loosening, polyethylene wear/breakage, and periprosthetic fractures decreased, but there were more revisions resulting from progression of osteoarthritis. In Period 2, there were more men and the average age was younger than for patients in Period 1. For UKAs, age younger than 65 years had a higher risk of revision (RR, 1.7; 95% CI, 1.5-2.0; p < 0.001), whereas sex did not affect the risk of revision. CONCLUSIONS We found an improvement in survival free from revision for TKA in the last period, but no similar improvement for UKA, and the survivorship for UKAs remains rather dramatically lower than that observed for TKAs. The decision to perform a UKA should be made with the explicit awareness that its survivorship is substantially inferior to that of TKA; any perceived advantages of UKA should be balanced against this issue of its decreased durability. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Gro S Dyrhovden
- Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Møllendalsbakken 11, 5021, Bergen, Norway.
- Department of Clinical Medicine (K1), Faculty of Medicine and DentistryUniversity of Bergen, Bergen, Norway.
| | - Stein Håkon L Lygre
- Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Møllendalsbakken 11, 5021, Bergen, Norway
- Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway
| | - Mona Badawy
- Department of Clinical Medicine (K1), Faculty of Medicine and DentistryUniversity of Bergen, Bergen, Norway
- Coastal Hospital in Hagevik, Hagavik, Norway
| | - Øystein Gøthesen
- Department of Clinical Medicine (K1), Faculty of Medicine and DentistryUniversity of Bergen, Bergen, Norway
- Department of Orthopedic Surgery, Haugesund Hospital, Haugesund, Norway
| | - Ove Furnes
- Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Møllendalsbakken 11, 5021, Bergen, Norway
- Department of Clinical Medicine (K1), Faculty of Medicine and DentistryUniversity of Bergen, Bergen, Norway
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Fiocchi A, Condello V, Madonna V, Bonomo M, Zorzi C. Medial vs lateral unicompartmental knee arthrroplasty: clinical results. ACTA BIO-MEDICA : ATENEI PARMENSIS 2017; 88:38-44. [PMID: 28657563 DOI: 10.23750/abm.v88i2 -s.6510] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 06/01/2017] [Indexed: 11/23/2022]
Abstract
Unicompartmental Knee Arthroplasty (UKA) is a common procedure for the management of isolated osteoarthritis. UKA is considered less invasive compared to total knee arthroplasty, associated with less operative time, blood loss and faster recovery. Isolated lateral osteoarthritis is a relatively uncommon clinical problem, with an incidence about ten times lower than the medial compartment. In fact, lateral UKA are about 5-10% of the total amount of the UKAs. In addition, it's historically considered more challenging and with poorer results. The aim of this paper was to compare current indications, modes of failure, survivorship and clinical results of medial and lateral UKA by a narrative review of the latest literature.
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Vasso M, Corona K, D'Apolito R, Mazzitelli G, Panni AS. Unicompartmental Knee Arthroplasty: Modes of Failure and Conversion to Total Knee Arthroplasty. JOINTS 2017; 5:44-50. [PMID: 29114630 PMCID: PMC5672863 DOI: 10.1055/s-0037-1601414] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Despite the excellent success rates of the modern unicompartmental knee arthroplasty (UKA), results of knee replacement registries still shows a relatively high revision and failure rate for UKA, especially when compared with traditional total knee arthroplasty (TKA). Bearing dislocation continues to be advocated as the predominant mechanism of failure in mobile UKA, whereas polyethylene wear and aseptic loosening remains the main cause of failure of fixed UKA. Degeneration of the unreplaced compartments has been reported in both mobile and fixed designs. When the revision is required, most of failed UKAs are converted to TKAs. Surgical challenges of the UKA revision, and outcomes of UKA converted to TKA are still debated in literature.
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Affiliation(s)
- Michele Vasso
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
| | - Katia Corona
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
| | - Rocco D'Apolito
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
| | - Giuseppe Mazzitelli
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
| | - Alfredo Schiavone Panni
- Multidisciplinary Department of Medical, Surgical and Dental Sciences, University Campana Luigi Vanvitelli, Caserta, Italy
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Thienpont E. Conversion of a unicompartmental knee arthroplasty to a total knee arthroplasty: can we achieve a primary result? Bone Joint J 2017; 99-B:65-69. [PMID: 28042121 DOI: 10.1302/0301-620x.99b1.bjj-2016-0272] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 07/11/2016] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Unicompartmental knee arthroplasty (UKA) is a potential treatment for isolated bone on bone osteoarthritis when limited to a single compartment. The risk for revision of UKA is three times higher than for total knee arthroplasty (TKA). The aim of this review was to discuss the different revision options after UKA failure. MATERIALS AND METHODS A search was performed for English language articles published between 2006 and 2016. After reviewing titles and abstracts, 105 papers were selected for further analysis. Of these, 39 papers were deemed to contain clinically relevant data to be included in this review. RESULTS The most common reasons for failure are liner dislocation, aseptic loosening, disease progression of another compartment and unexplained pain. UKA can be revised to or with another UKA if the failure mode allows reconstruction of the joint with UKA components. In case of disease progression another UKA can be added, either at the patellofemoral joint or at the remaining tibiofemoral joint. Often the accompanying damage to the knee joint doesn't allow these two former techniques resulting in a primary TKA. In a third of cases, revision TKA components are necessary. This is usually on the tibial side where augments and stems might be required. CONCLUSIONS In case of failure of UKA, several less invasive revision techniques remain available to obtain primary results. Revision in a late stage of failure or because of surgical mistakes might ask for the use of revision components limiting the clinical outcome for the patients. Cite this article: Bone Joint J 2017;99-B(1 Supple A):65-9.
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Affiliation(s)
- E Thienpont
- University Hospital Saint Luc-UCL, Department of Orthopaedic surgery, Av. Hippocrate 10, 1200 Brussels, Belgium
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Pailhé R, Cognault J, Massfelder J, Sharma A, Rouchy RC, Rubens-Duval B, Saragaglia D. Comparative study of computer-assisted total knee arthroplasty after opening wedge osteotomy versus after unicompartmental arthroplasty. Bone Joint J 2016; 98-B:1620-1624. [DOI: 10.1302/0301-620x.98b12.38064] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 08/18/2016] [Indexed: 11/05/2022]
Abstract
Aims The role of high tibial osteotomy (HTO) is being questioned by the use of unicompartmental knee arthroplasty (UKA) in the treatment of medial compartment femorotibial osteoarthritis. Our aim was to compare the outcomes of revision HTO or UKA to a total knee arthroplasty (TKA) using computer-assisted surgery in matched groups of patients. Patients and Methods We conducted a retrospective study to compare the clinical and radiological outcome of patients who underwent revision of a HTO to a TKA (group 1) with those who underwent revision of a medial UKA to a TKA (group 2). All revision procedures were performed using computer-assisted surgery. We extracted these groups of patients from our database. They were matched by age, gender, body mass index, follow-up and pre-operative functional score. The outcomes included the Knee Society Scores (KSS), radiological outcomes and the rate of further revision. Results There were 20 knees in 20 patients in each group. The mean follow-up was 4.1 years (2 to 18.7). The mean total KSS at last follow-up was 185.7 (standard deviation (sd) 5) in group 1 compared with 176.5 (sd 11) for group 2 (p = 0.003). The mean hip-knee-ankle angle was 180.2° (sd 3.2°) in group 1 and 179.0° (sd 2.2°) in group 2. No revision was required. Conclusion We found that good functional and radiological outcomes followed revision of both HTO and UKA to TKA. Revision of HTO showed significantly better functional outcomes. These results need to be further investigated by a prospective randomised controlled trial involving a larger group of patients. Cite this article: Bone Joint J 2016;98-B:1620–4.
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Affiliation(s)
- R. Pailhé
- Grenoble South Teaching Hospital, Avenue
de Kimberley, BP 338, 38434, Échirolles, France
| | - J. Cognault
- Grenoble South Teaching Hospital, Avenue
de Kimberley, BP 338, 38434, Échirolles, France
| | - J. Massfelder
- Grenoble South Teaching Hospital, Avenue
de Kimberley, BP 338, 38434, Échirolles, France
| | - A. Sharma
- The Royal Orthopaedic Hospital, Birmingham, UK
| | - R-C. Rouchy
- Grenoble South Teaching Hospital, Avenue
de Kimberley, BP 338, 38434, Échirolles, France
| | - B. Rubens-Duval
- Grenoble South Teaching Hospital, Avenue
de Kimberley, BP 338, 38434, Échirolles, France
| | - D. Saragaglia
- Grenoble South Teaching Hospital, Avenue
de Kimberley, BP 338, 38434, Échirolles, France
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Somford MP, Brouwer RW, Haen PSWA, van Raay JJAM, van Raaij TM. Technical aspects of revision and functional outcome after revision of the Oxford unicompartmental knee arthroplasty. Knee 2016; 23:1020-1023. [PMID: 27624394 DOI: 10.1016/j.knee.2016.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 01/05/2016] [Accepted: 02/09/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND This study analysed the technical aspects of revision of the Oxford unicompartmental knee arthroplasty (OUKA) and functional results after revision. METHODS In a historic cohort study we analysed all revised OUKAs that were primarily implanted at our clinic over a 10-year period (1998-2009). The primary aim was to investigate surgical difficulties encountered during revision surgery of the OUKA. Outcomes were the knee society score (KSS), WOMAC (Western Ontario and McMaster Universities), SF-36, VAS pain and VAS satisfaction after revision. RESULTS During the study period, 331 OUKAs were inserted. With an average follow-up of six years and five months (range one month to nine years and eight months), there were 44 (13.3%) OUKAs that needed one or more revision surgery procedures. The average time to revision was three years and eight months (range one month to nine years and five months). The main reasons for revision surgery were bearing dislocation, malpositioning or loosening of a component and progression of osteoarthritis. Most revisions, mainly conversion to primary total knee arthroplasty (TKA), gave few surgical problems. Minor bone loss that needed no augmentation was seen most frequently. The functional outcomes after revision surgery were moderate. CONCLUSION A limited amount of surgical difficulty during revision of OUKA was found; in all total revision cases a primary TKA was implanted. However, in most patients there were moderate functional results as well as disappointing pain and satisfaction scores after revision.
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Affiliation(s)
- Matthijs P Somford
- Department of Orthopedic Surgery, Martini Hospital, Groningen, The Netherlands.
| | - Reinoud W Brouwer
- Department of Orthopedic Surgery, Martini Hospital, Groningen, The Netherlands
| | | | - Jos J A M van Raay
- Department of Orthopedic Surgery, Martini Hospital, Groningen, The Netherlands
| | - Tom M van Raaij
- Department of Orthopedic Surgery, Martini Hospital, Groningen, The Netherlands
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Xu T, Lao Y, Wang J, Liu F, Xiao L, Tong P. Mid-term results of Oxford phase-3 medial unicompartmental knee arthroplasty for medial arthritis in Chinese patients. ANZ J Surg 2016; 87:287-290. [PMID: 27677984 DOI: 10.1111/ans.13764] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 06/11/2016] [Accepted: 07/30/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate the mid-term results of an Oxford phase-3 unicompartmental knee arthroplasty (UKA) for medial arthritis in Chinese patients. METHODS The study included 64 patients who underwent a minimally invasive Oxford phase-3 UKA for medial knee arthritis. The patients were clinically evaluated preoperatively and at the final follow-up according to the clinical and functional components of the Knee Society Score (KSS), the Hospital for Special Surgery knee score and range of motion. A Kaplan-Meier survivorship analysis was performed with revision surgery as the end point. RESULTS The mean preoperative clinical KSSs increased from 63.2 to 91.4 post-operatively, and the mean functional KSSs increased from 54.9 to 86.5 post-operatively. In addition, the mean Hospital for Special Surgery scores increased from 59.5 to 86.4. The mean active knee flexion increased from 109.1° preoperatively to 123.6° post-operatively. A total of six patients (six knees) required revision surgery at the time of the maximum 10-year follow-up. Four conversions to total knee arthroplasty were performed because of arthritis progression in the lateral compartment. One revision to total knee arthroplasty was performed for aseptic loosening, and one liner exchange was performed for wear. The cumulative survival rates at the 6- and 8-year follow-ups were 97% and 93%, respectively. CONCLUSION Oxford phase-3 UKA was largely applicable for medial arthritis in Chinese patients. However, the Oxford phase-3 medial UKA selection criteria for young Chinese males need further exploration to obtain the best treatment effect.
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Affiliation(s)
- Taotao Xu
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.,Institute of Orthopaedics and Traumatology of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Yangjun Lao
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.,Institute of Orthopaedics and Traumatology of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Jitao Wang
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.,Institute of Orthopaedics and Traumatology of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Fucun Liu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Luwei Xiao
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Peijian Tong
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
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Cankaya D, Della Valle CJ. Blood Loss and Transfusion Rates in the Revision of Unicompartmental Knee Arthroplasty to Total Knee Arthroplasty Are Similar to Those of Primary Total Knee Arthroplasty But Are Lower Compared With the Revision Total Knee Arthroplasty. J Arthroplasty 2016; 31:339-41. [PMID: 26350261 DOI: 10.1016/j.arth.2015.08.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 07/28/2015] [Accepted: 08/12/2015] [Indexed: 02/01/2023] Open
Abstract
A total of 42 patients revised from unicompartmental knee arthroplasty (UKA) to total knee arthroplasty (TKA) were matched with 40 aseptic patients, including both component revision TKA and 88 primary TKA patients. The hemoglobin and hematocrit levels of each patient were screened preoperatively and postoperatively. There were no statistically significant differences in the postoperative hemoglobin or hematocrit levels, calculated blood loss, or blood transfusion rates between the revision UKA and primary TKA groups, whereas the hemoglobin (P = .010) and hematocrit (P = .015) levels were lower and the calculated blood loss (P = .034) and blood transfusion rates (P = .031) were higher in the revision TKA group. Revision of a failed UKA is more similar to primary TKA with respect to blood loss and transfusion rate.
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Affiliation(s)
- Deniz Cankaya
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Craig J Della Valle
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
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