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Fricka KB, Wilson EJ, Strait AV, Ho H, Hopper RH, Hamilton WG, Sershon RA. Outcomes of fixed versus mobile-bearing medial unicompartmental knee arthroplasty. Bone Joint J 2024; 106-B:916-923. [PMID: 39216863 DOI: 10.1302/0301-620x.106b9.bjj-2024-0075.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Aims The optimal bearing surface design for medial unicompartmental knee arthroplasty (UKA) remains controversial. The aim of this study was to compare outcomes of fixed-bearing (FB) and mobile-bearing (MB) UKAs from a single high-volume institution. Methods Prospectively collected data were reviewed for all primary cemented medial UKAs performed by seven surgeons from January 2006 to December 2022. A total of 2,999 UKAs were identified, including 2,315 FB and 684 MB cases. The primary outcome measure was implant survival. Secondary outcomes included 90-day and cumulative complications, reoperations, component revisions, conversion arthroplasties, range of motion, and patient-reported outcome measures. Overall mean age at surgery was 65.7 years (32.9 to 94.3), 53.1% (1,593/2,999) of UKAs were implanted in female patients, and demographics between groups were similar (p > 0.05). The mean follow-up for all UKAs was 3.7 years (0.0 to 15.6). Results Using revision for any reason as an endpoint, five-year survival for FB UKAs was 97.2% (95% CI 96.4 to 98.1) compared to 96.0% for MB (95% CI 94.1 to 97.9; p = 0.008). The FB group experienced fewer component revisions (14/2,315, 0.6% vs 12/684, 1.8%; p < 0.001) and conversion arthroplasties (38/2315, 1.6% vs 24/684, 3.5%; p < 0.001). A greater number of MB UKAs underwent revision due to osteoarthritis progression (FB = 21/2,315, 0.9% vs MB = 16/684, 2.3%; p = 0.003). In the MB group, 12 (1.8%) subjects experienced bearing dislocations which required revision surgery. There were 15 early periprosthetic tibia fractures (0.6%) in the FB group compared to 0 for MB (p = 0.035). Conclusion In similar patient populations, FB UKAs demonstrated slightly higher survival than a commonly used MB design. Adverse event profiles differed by bearing type, with an increased risk of bearing dislocation and OA progression with MB designs, and early periprosthetic tibia fractures for FB designs.
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Affiliation(s)
- Kevin B Fricka
- Anderson Orthopaedic Research Institute, Alexandria, Virginia, USA
| | - Eric J Wilson
- Anderson Orthopaedic Research Institute, Alexandria, Virginia, USA
| | | | - Henry Ho
- Anderson Orthopaedic Research Institute, Alexandria, Virginia, USA
| | - Robert H Hopper
- Anderson Orthopaedic Research Institute, Alexandria, Virginia, USA
| | | | - Robert A Sershon
- Anderson Orthopaedic Research Institute, Alexandria, Virginia, USA
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Karayiannis P, Cassidy R, Dobie I, Beverland D. Long term follow up of 257 consecutive cementless Oxford medial compartment knee arthroplasties at a non-designer centre. Knee 2024; 49:201-209. [PMID: 39043015 DOI: 10.1016/j.knee.2024.07.001] [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: 03/06/2024] [Revised: 06/04/2024] [Accepted: 07/02/2024] [Indexed: 07/25/2024]
Abstract
AIMS This study aimed to review the survivorship, indication for revision and patient reported outcomes for 257 consecutive Oxford cementless unicompartmental knee arthroplasties (OUKA's) in 238 patients at 12-14 years post-operatively. METHODS Patients underwent surgery between April 2008 and October 2010 by two non-design surgeons including their learning curve. The 5-year clinical and radiological outcomes have already been reported. Oxford knee scores (OKS) were recorded at 1, 5 and 12-14 years with delayed review a result of the COVID-19 pandemic. Revision indication and imaging were reviewed. RESULTS Revision was required in 28 OUKA's (10.9%) with a 10-year cumulative survival of 93.0%, reducing to 78.8% at 14 years. 59 patients had died prior to this review and 24 were not contactable. Those not contactable had electronic records reviewed to ensure they did not have a revision elsewhere. Half of the revisions were for progression of lateral compartment arthritis (14/28). Four of 6 cases with a full revision for polyethylene wear may have benefited from a bearing exchange instead. OKSs in non-revised patients were good (median score 38, IQR 30-44) with no significant deterioration noted from 5 to 12-14 years. CONCLUSIONS Cementless OUKA in this series had a long-term survival rate comparable to other OUKA's outside of the designer centre. OKSs remain good for those patients not revised. Progression of lateral compartment arthritis was the primary reason for revision with no revisions for component loosening or bearing spinout. Ideally UKA patients who experience problems should be under the care of revisions surgeons who perform UKA. Improving patient selection and understanding of the pathophysiology of lateral disease progression, remain crucial to improve the long-term survivorship of OUKA.
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Affiliation(s)
- Paul Karayiannis
- Musgrave Park Hospital, Stockman's Lane, Belfast BT9 7JB, Northern Ireland, United Kingdom.
| | - Roslyn Cassidy
- Musgrave Park Hospital, Stockman's Lane, Belfast BT9 7JB, Northern Ireland, United Kingdom.
| | - Ian Dobie
- Musgrave Park Hospital, Stockman's Lane, Belfast BT9 7JB, Northern Ireland, United Kingdom.
| | - David Beverland
- Primary Joint Unit, Musgrave Park Hospital, Stockman's Lane, Belfast BT97JB, Northern Ireland, United Kingdom.
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Nakano N, Tsubosaka M, Kamenaga T, Kuroda Y, Ishida K, Hayashi S, Kuroda R, Matsumoto T. What effect does preoperative flexion contracture have on the component angles in unicompartmental knee arthroplasty? EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:2185-2191. [PMID: 38573382 DOI: 10.1007/s00590-024-03929-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 03/20/2024] [Indexed: 04/05/2024]
Abstract
PURPOSE The indication for unicompartmental knee arthroplasty (UKA) has been extended to cases with some degree of preoperative knee flexion contracture recently. The purpose of this study was to clarify the effect of flexion contracture on component angles. MATERIALS AND METHODS Thirty-five fixed-bearing UKAs using the spacer block technique with preoperative flexion contracture (Group FC) and 35 UKAs using the same technique without preoperative flexion contracture (Group NC) were included. Using radiographs, the coronal femoral component angle, coronal tibial component angle, sagittal femoral component angle, and sagittal tibial component angle were determined. Also, extension and flexion angles of the knee as well as coronal Hip-Knee-Ankle (HKA) angles in long-leg standing radiographs were measured. The data about the thickness of the selected insert were also collected. The above results were compared between the two groups. RESULTS The femoral component tended to be placed in a more varus and flexed position in Group FC, while no significant difference was found about the tibial component angles. While there was no significant difference in pre- and postoperative knee flexion angles between the two groups, flexion contracture remained postoperatively in Group FC. Preoperative HKA angle was greater in Group FC while the difference was no longer significant postoperatively. Regarding the thickness of the selected insert, thicker inserts tended to be used in Group FC. CONCLUSIONS In fixed-bearing UKA with the spacer block technique, the femoral component tended to be placed in a flexed and varus position in the knees with preoperative flexion contracture.
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Affiliation(s)
- Naoki Nakano
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
| | - Masanori Tsubosaka
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Tomoyuki Kamenaga
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Yuichi Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Kazunari Ishida
- Department of Orthopaedic Surgery, Kobe Kaisei Hospital, 3-11-15, Shinoharakita-machi, Nada-ku, Kobe, Hyogo, 657-0068, Japan
| | - Shinya Hayashi
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
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Hung KT, Chen CC, Lin YC, Lee SH, Hu CC, Chang YH, Hsieh PH, Shih HN, Chang CH. Survivorship of the fixed-bearing medial unicompartmental knee arthroplasty: mean 14-year follow-up in a single medical center. BMC Musculoskelet Disord 2024; 25:283. [PMID: 38609884 PMCID: PMC11010285 DOI: 10.1186/s12891-024-07378-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND This study aimed to report the long-term survival of fixed-bearing medial unicompartmental knee arthroplasty (UKA) with a mean of 14-year follow-up, and to determine possible risk factors of failure. METHODS We retrospectively evaluated 337 fixed-bearing medial UKAs implanted between 2003 and 2014. Demographic and radiographic parameters were measured, including pre-operative and post-operative anatomical femorotibial angle (aFTA), posterior tibial slope (PTS), and anatomical medial proximal tibial angle (aMPTA). Multivariate logistic regression analysis was applied to figure out risk factors. RESULTS The mean follow-up time was 14.0 years. There were 32 failures categorized into implant loosening (n = 11), osteoarthritis progression (n = 7), insert wear (n = 7), infection (n = 4), and periprosthetic fracture (n = 3). Cumulative survival was 91.6% at 10 years and 90.0% at 15 years. No statistically significant parameters were found between the overall survival and failure groups. Age and hypertension were significant factors of implant loosening with odds ratio (OR) 0.909 (p = 0.02) and 0.179 (p = 0.04) respectively. In the insert wear group, post-operative aFTA and correction of PTS showed significance with OR 0.363 (p = 0.02) and 0.415 (p = 0.03) respectively. Post-operative aMPTA was a significant factor of periprosthetic fracture with OR 0.680 (p < 0.05). CONCLUSIONS The fixed-bearing medial UKA provides successful long-term survivorship. Tibial component loosening is the major cause of failure. Older age and hypertension were factors with decreased risk of implant loosening.
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Affiliation(s)
- Kung-Tseng Hung
- Department of Orthopaedic Surgery, Linkou Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist, Taoyuan, Taiwan
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Chieh Chen
- Department of Orthopaedic Surgery, Linkou Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist, Taoyuan, Taiwan
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Chih Lin
- Department of Orthopaedic Surgery, Linkou Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist, Taoyuan, Taiwan
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Sheng-Hsun Lee
- Department of Orthopaedic Surgery, Linkou Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist, Taoyuan, Taiwan
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Chien Hu
- Department of Orthopaedic Surgery, Linkou Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist, Taoyuan, Taiwan
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Han Chang
- Department of Orthopaedic Surgery, Linkou Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist, Taoyuan, Taiwan
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Pang-Hsin Hsieh
- Department of Orthopaedic Surgery, Linkou Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist, Taoyuan, Taiwan
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsin-Nung Shih
- Department of Orthopaedic Surgery, Linkou Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist, Taoyuan, Taiwan
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Hsiang Chang
- Department of Orthopaedic Surgery, Linkou Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist, Taoyuan, Taiwan.
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Wang Y, Xu C, Yang B, Yu F, Guo A. Finite Element Analysis of the Effect of Femoral Prosthesis Varus and Valgus Angle Installation on the Lateral Compartment in Unicompartmental Knee Arthroplasty. J NIPPON MED SCH 2024; 91:88-98. [PMID: 38462443 DOI: 10.1272/jnms.jnms.2024_91-110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
BACKGROUND This study used finite element analysis (FEA) to investigate the effect of varus and valgus angle on the lateral compartment in unicompartmental knee arthroplasty (UKA). METHODS One patient who underwent UKA was enrolled as the subject. Thirteen working conditions of the femoral prosthesis were simulated at varus and valgus angles of 0°, 2°, 4°, 6°, 8°, 10°, and 12°. A load of 1,000 N was applied downward along the mechanical axis of the femur, and the highest stress values on the surface of the polyethylene liner, cancellous bone under the tibial prosthesis, cartilage of femur lateral condyle, lateral meniscus, and tibial lateral plateau cartilage in each model were recorded. The six highest points were used to calculate the mean value. RESULTS The highest stress values on the surface of the polyethylene liner, cancellous bone under the tibial prosthesis, cartilage of femur lateral condyle, lateral meniscus, and tibial lateral plateau cartilage increased with an increase in the femoral prosthesis varus/valgus angle. As compared with the standard position of the femoral prosthesis, there was no significant difference in the surface stress values of the polyethylene liner, cancellous bone under the tibial prosthesis, cartilage of femur lateral condyle, lateral meniscus and tibial lateral plateau cartilage when the femoral prosthesis varus/valgus angle was less than 4° (p > 0.05). In addition, the stress magnitude on the polyethylene liner, cancellous bone under the tibial prosthesis, cartilage of femur lateral condyle, lateral meniscus, and tibial lateral plateau cartilage significantly increased when the femoral prosthesis varus/valgus angle was greater than 4° (p < 0.001). CONCLUSIONS The optimal femoral prosthesis varus/valgus angle in UKA was less than 4°.
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Affiliation(s)
- Yonggui Wang
- Department of Orthopedic Surgery, Beijing Friendship Hospital, Capital Medical University
- Department of Orthopedics, Xiangyang No. 1 People's Hospital, Hubei University of Medicine
| | - Chongyang Xu
- Department of Orthopedic Surgery, Beijing Friendship Hospital, Capital Medical University
| | - Bo Yang
- Department of Orthopedic Surgery, Beijing Friendship Hospital, Capital Medical University
| | - Fei Yu
- Department of Orthopedic Surgery, Beijing Friendship Hospital, Capital Medical University
| | - Ai Guo
- Department of Orthopedic Surgery, Beijing Friendship Hospital, Capital Medical University
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Ghazal AH, Fozo ZA, Matar SG, Kamal I, Gamal MH, Ragab KM. Robotic Versus Conventional Unicompartmental Knee Surgery: A Comprehensive Systematic Review and Meta-Analysis. Cureus 2023; 15:e46681. [PMID: 37869054 PMCID: PMC10589056 DOI: 10.7759/cureus.46681] [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: 10/08/2023] [Indexed: 10/24/2023] Open
Abstract
Robotic-assisted surgery is a computer-controlled technique that may improve the accuracy and outcomes of unicompartmental total knee arthroplasty (TKA), a partial knee replacement surgery. The purpose of a meta-analysis about robotic-assisted versus conventional surgery for unicompartmental TKA is to compare the effectiveness of these two methods based on the current evidence. Our meta-analysis can help inform clinical decisions and guidelines for surgeons and patients who are considering unicompartmental TKA as a treatment option. We searched four online databases for studies that compared the two methods until March 2023. We used RevMan software to combine the data from the studies. We calculated the mean difference (MD) and the 95% confidence interval (CI) for each outcome, which are statistical measures of the difference and the uncertainty between the two methods. We included 16 studies in our analysis. We found that robotic-assisted surgery had a better hip-knee-ankle angle, which is a measure of how well the knee is aligned, than conventional surgery (MD = 0.86, 95% CI = 0.16-1.56). We also found that robotic-assisted surgery had a better Oxford Knee score, which is a measure of how well the knee functions, than conventional surgery (MD = 3.03, 95% CI = 0.96-5.110). This study compared the results of conventional and robotic-assisted unicompartmental knee arthroplasty in 12 studies. We concluded that robotic-assisted surgery may have some benefits over conventional surgery in terms of alignment and function of the knee. However, we did not find any significant difference between the two methods in terms of other outcomes, such as pain, range of motion, health status, and joint awareness. Therefore, we suggest that more research is needed to confirm these results and evaluate the long-term effects and cost-effectiveness of robotic-assisted surgery.
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Affiliation(s)
- Ahmed Hussein Ghazal
- Orthopaedics, Northwick Park Hospital, London North West University Healthcare NHS Trust, Harrow, GBR
| | | | - Sajeda G Matar
- Pharmacology and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman, JOR
| | - Ibrahim Kamal
- General Medicine, Al-Azhar University, Alexandria, EGY
| | - Mohamed Hesham Gamal
- Pharmacology and Therapeutics, Faculty of Pharmacy, Tanta University, Tanta, EGY
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Chan-Waï-Nam J, Fernandez M, Josse A, Dubrana F. Medial unilateral knee arthroplasty after high tibial osteotomy: A retrospective study of 41 cases. Orthop Traumatol Surg Res 2023; 109:103514. [PMID: 36513325 DOI: 10.1016/j.otsr.2022.103514] [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: 11/15/2021] [Revised: 05/01/2022] [Accepted: 05/16/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION When medial knee osteoarthritis continues to get worse after a high tibial osteotomy (HTO) procedure, a subsequent total knee arthroplasty (TKA) is typically warranted. Medial unilateral knee arthroplasty (UKA) is not recommended. The aim of this study was to evaluate the outcomes of patients who underwent medial UKA after HTO. HYPOTHESIS Good results can be obtained with this procedure, as long as the postoperative valgus is not excessive. MATERIALS AND METHODS This was a retrospective, single-center study of patients operated between January 2005 and June 2019. The primary endpoint was the Oxford Knee Scale (OKS). The Knee injury and Osteoarthritis Outcome Score (KOOS) and the Western Ontario and McMaster Universities osteoarthritis index (WOMAC), range of motion and complications were the secondary endpoints. The average follow-up was 79 months. RESULTS Forty-one knees in 38 patients were analyzed. Four revisions with implant exchange (10%) were needed. Thirty-seven knees had a mean OKS of 20/60±8 (12-39). The mean flexion and extension amplitude were 123°±8° (110-140) and -1.5°±4 (-15-0), respectively. Eight patients had flexion and/or extension contractures. DISCUSSION Good functional and clinical outcomes in the medium term were achieved for the patients in this study who underwent UKA after HTO. These findings reinforce the good results reported in recent studies of UKA after HTO. LEVEL OF EVIDENCE IV, Retrospective study.
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Affiliation(s)
- Julie Chan-Waï-Nam
- Orthopedic Surgery Department, hôpital de la Cavale Blanche, boulevard Tanguy Prigent, 29200 Brest, France.
| | - Marie Fernandez
- Orthopedic Surgery Department, hôpital de la Cavale Blanche, boulevard Tanguy Prigent, 29200 Brest, France
| | - Antoine Josse
- Pediatric Surgery Department, Hospices civils de Lyon, hôpital mère-enfant, 3, quai des Célestins, 69002 Lyon, France
| | - Frédéric Dubrana
- Orthopedic Surgery Department, hôpital de la Cavale Blanche, boulevard Tanguy Prigent, 29200 Brest, France
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Bayoumi T, Kleeblad LJ, Borus TA, Coon TM, Dounchis J, Nguyen JT, Pearle AD. Ten-Year Survivorship and Patient Satisfaction Following Robotic-Arm-Assisted Medial Unicompartmental Knee Arthroplasty: A Prospective Multicenter Study. J Bone Joint Surg Am 2023:00004623-990000000-00793. [PMID: 37146125 DOI: 10.2106/jbjs.22.01104] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
BACKGROUND Robotic-arm-assisted unicompartmental knee arthroplasty (UKA) has been shown to result in high short- and mid-term survivorship. However, it is not known whether these outcomes are maintained at long-term follow-up. This study aimed to evaluate long-term implant survivorship, modes of failure, and patient satisfaction following robotic-arm-assisted medial UKA. METHODS A prospective multicenter study of 474 consecutive patients (531 knees) undergoing robotic-arm-assisted medial UKA was conducted. A cemented, fixed-bearing system with a metal-backed onlay tibial implant was used in all cases. Patients were contacted at 10-year follow-up to determine implant survivorship and satisfaction. Survival was analyzed using Kaplan-Meier models. RESULTS Data were analyzed for 366 patients (411 knees) with a mean follow-up of 10.2 ± 0.4 years. A total of 29 revisions were reported, corresponding to a 10-year survivorship of 91.7% (95% confidence interval, 88.8% to 94.6%). Of all revisions, 26 UKAs were revised to total knee arthroplasty. Unexplained pain and aseptic loosening were the most commonly reported modes of failure, accounting for 38% and 35% of revisions, respectively. Of patients without revision, 91% were either satisfied or very satisfied with their overall knee function. CONCLUSIONS This prospective multicenter study found high 10-year survivorship and patient satisfaction following robotic-arm-assisted medial UKA. Pain and fixation failure remained common causes for revision following cemented fixed-bearing medial UKA, despite the use of a robotic-arm-assisted technique. Prospective comparative studies are needed to assess the clinical value of robotic assistance over conventional techniques in UKA. LEVEL OF EVIDENCE Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Tarik Bayoumi
- Computer Assisted Surgery and Sports Medicine, Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY
| | - Laura J Kleeblad
- Department of Surgery, Northwest Clinics, Alkmaar, the Netherlands
| | - Todd A Borus
- Department of Orthopaedic Surgery, Rebound Orthopedics & Neurosurgery, Portland, Oregon
| | - Thomas M Coon
- Coon Joint Replacement Institute, Department of Orthopaedic Surgery, St. Helena, California
| | - Jon Dounchis
- Department of Orthopaedic Surgery, NCH Orthopedics, Naples, Florida
| | - Joseph T Nguyen
- Biostatistics Core, Healthcare Research Institute, Hospital for Special Surgery, New York, NY
| | - Andrew D Pearle
- Computer Assisted Surgery and Sports Medicine, Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY
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9
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Goodell PB, Johansen PM, Bartels DW, Sherman SL, Amanatullah DF. Comparing Unicompartmental Knee Arthroplasty and High Tibial Osteotomy for Isolated Medial Compartment Knee Osteoarthritis. JBJS Rev 2023; 11:01874474-202303000-00004. [PMID: 36930742 DOI: 10.2106/jbjs.rvw.22.00127] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
Abstract
» Both unicompartmental knee arthroplasty (UKA) and high tibial osteotomy (HTO) allow for compartment-specific intervention on an arthritic knee joint that preserves bone stock and native soft tissue compared to a total knee arthroplasty (TKA). Both operations give a more natural feeling with native proprioception compared with a TKA. » HTO is better suited in patients who are younger (<55 years-of-age), have a body mass index (BMI) <30 kg/m2, high activity requirements, mechanical malalignment, asymmetric varus, isolated anterior cruciate ligament insufficiency, need for multiplanar correction, and a preference for joint preserving interventions. Recent data suggest that age (>55 years-of-age) should not solely contraindicate a HTO. » UKA may be chosen in patients who are older (>55 years-of-age), low activity requirements, have a BMI <40 kg/m2, severe osteoarthritis with significant joint space narrowing, acceptable coronal alignment, symmetric varus, and patient preference for arthroplasty.
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Affiliation(s)
- Parker B Goodell
- Department of Orthopaedic Surgery, University of California San Francisco, Fresno, California
| | - Phillip M Johansen
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida
| | - Douglas W Bartels
- Department of Orthopaedic Surgery, Stanford University, Palo Alto, California
| | - Seth L Sherman
- Department of Orthopaedic Surgery, Stanford University, Palo Alto, California
| | - Derek F Amanatullah
- Department of Orthopaedic Surgery, Stanford University, Palo Alto, California
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10
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Safe and reliable clinical outcomes at 2 years of a fixed-bearing partial knee arthroplasty with a morphometric tibial tray in a large worldwide population. Knee Surg Sports Traumatol Arthrosc 2023; 31:814-821. [PMID: 34557949 DOI: 10.1007/s00167-021-06748-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 09/09/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The purpose of this study was to evaluate: (1) improvement of functional and quality of life scores, (2) adverse events, (3) short-term implants survivorship of a newly designed fixed-bearing partial knee replacement (PKR) with a morphometric tibial tray in a large and multicentric population at a minimum follow-up of 2 years. METHODS From 2017 to 2019, 479 medial PKR were implanted by 16 non-developing surgeons from United States, Europe, and Japan. Eight patients were lost to follow-up (1.8%). Standardized follow-up procedures included patient-reported outcomes (Oxford Knee Society score, Forgotten Joint Score, EQ VAS, EQ 5D), patient satisfaction, radiographic assessments, adverse event at 2 years. Comparisons between the preoperative and postoperative values were performed using Student t test. Kaplan-Meier survivorship analysis was performed with knee revision as the endpoint. RESULTS The mean age was 65.6 ± 9.6 years. Mean body mass index was 29.5 ± 5.1 kg/m2. Oxford Knee Society score and Forgotten Joint Score, respectively, improved from 23.7 ± 8 and 16 ± 15.8 preoperatively to 42.4 ± 6.5 and 74 ± 24.9 at 2 years (p < 0.0001). Satisfaction Score was 92.3 ± 13.4 at 2 years. Ten re-operations (2.1%) were reported including seven implant removals (1.5%). No other adverse event was reported. The causes of conversion to total knee arthroplasty were: nickel allergy (n = 2), patellofemoral osteoarthritis (n = 1), pain (n = 1), deep infection (n = 3). Two re-operations were performed due to infection, and one for internal fixation for a tibial plateau fracture. The 2-year Kaplan-Meier survival estimate was 98.4%, with implant removals as the endpoint. CONCLUSION This prospective multicentric study reported safe and reliable clinical outcomes of a morphometric PKR, which optimized tibial coverage and femoral fit, in a large population of patients worldwide at 2 years. LEVEL OF EVIDENCE Prospective cohort study-therapeutic study, Level II.
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Zanirato A, Cavagnaro L, Chiarlone F, Quarto E, Formica M. Periprosthetic joint infection in unicompartmental knee arthroplasty: treatment options and outcomes. What is the current evidence in literature? Arch Orthop Trauma Surg 2023; 143:1031-1039. [PMID: 35303146 PMCID: PMC9925597 DOI: 10.1007/s00402-022-04414-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 03/04/2022] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Periprosthetic joint infections (PJI) following unicompartmental knee arthroplasties (UKAs) will increase. The aim of this review is to evaluate current evidence regarding treatment options, complications, clinical and radiological outcomes of PJI management in UKAs. METHODS A systematic review of English literature was performed. Retrospective and prospective studies providing treatment options, complications, clinical and radiological outcomes of PJI following UKAs were included. PJI type, treatment, survival rate with no reoperation for infection and survival rate with no reoperation for any cause were evaluated. RESULTS Eleven articles were included. Three studies focusing on PJI following UKA (45 cases) report a survival rate with no reoperation for infection of 68.9% and a survival rate with no reoperation for any cause of 48.9%. Eight articles concerning UKA failure modes (28 cases) overestimate survival rate with no reoperation for infection (88.9%) and survival rate with no reoperation for any cause (88.9%) (p < 0.05). DAIR reports a rate of infection eradication failure ranging from 43.8 to 100%. 1SE allows for a survival rate with no reoperation for infection of 100%. 2SE reports a rate of infection eradication failure ranging from 0 to 12.5%. A high rate of early aseptic reoperation is reported, despite infection eradication (20% in DAIR; 28.5% in 2SE). CONCLUSIONS Treatment strategy is determined by symptom timing, PJI type (acute vs chronic), causative organism, patient's comorbidities. A longer duration of PJI or severe host and extremity status seems to require 2SE or 1SE. Patients who have a shorter duration of PJI could receive DAIR.
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Affiliation(s)
- Andrea Zanirato
- IRCCS Ospedale Policlinico San Martino-Clinica Ortopedica, Largo Rosanna Benzi 10, 16132, Genova, GE, Italy.
- DISC Dipartimento Di Scienze Chirurgiche e Diagnostiche Integrate, Viale Benedetto XV 6, 16132, Genova, GE, Italy.
| | - Luca Cavagnaro
- Joint Replacement Unit, Ortopedia e Traumatologia 2--Ospedale Santa Corona, Viale 25 Aprile, 38, 17027, Pietra Ligure, SV, Italy
| | - Francesco Chiarlone
- Joint Replacement Unit, Ortopedia e Traumatologia 2--Ospedale Santa Corona, Viale 25 Aprile, 38, 17027, Pietra Ligure, SV, Italy
| | - Emanuele Quarto
- IRCCS Ospedale Policlinico San Martino-Clinica Ortopedica, Largo Rosanna Benzi 10, 16132, Genova, GE, Italy
- DISC Dipartimento Di Scienze Chirurgiche e Diagnostiche Integrate, Viale Benedetto XV 6, 16132, Genova, GE, Italy
| | - Matteo Formica
- IRCCS Ospedale Policlinico San Martino-Clinica Ortopedica, Largo Rosanna Benzi 10, 16132, Genova, GE, Italy
- DISC Dipartimento Di Scienze Chirurgiche e Diagnostiche Integrate, Viale Benedetto XV 6, 16132, Genova, GE, Italy
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Miyake Y, Namba Y, Mitani S, Umehara N, Kawamoto T, Furuichi S. Comparison of tibial implant positioning between symmetrical and anatomical design implants in unicompartmental knee arthroplasty for Japanese patients. J Orthop Surg (Hong Kong) 2023; 31:10225536221149485. [PMID: 36594921 DOI: 10.1177/10225536221149485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
PURPOSE In unicompartmental knee arthroplasty (UKA) procedures, maximizing the bone coverage of the tibial implant and eliminating the medial and posterior overhang would be optimal. We commonly used Physica ZUK® (ZUK), which is a symmetrical design. Alternatively, since Persona Partial Knee® (PPK) was developed in 2017 with an anatomical design to improve bone coverage, we started PPK. We hypothesized that the PPK facilitated better bone coverage than the ZUK without obvious overhangs. This study evaluated the bone coverage and the medial and posterior overhang of these differently designed tibial implants. METHODS Seventy-nine knees from 68 patients who underwent UKA were evaluated. Cases were categorized into the ZUK (41 knees) and PPK (38 knees) groups. CT images were acquired before surgery and 1 week after surgery. We measured the tibial bone coverage, and the medial and posterior overhang by 3D software. RESULTS The bone coverages were 103.8 ± 4.8% and 102.0 ± 3.0%, the medial overhangs were 2.2 ± 1.2 mm and 1.4 ± 1.1 mm, and the posterior overhangs were 0.6 ± 1.3 mm and 0.4 ± 1.2 mm for the ZUK and PPK groups, respectively. The bone coverage and medial overhang were significantly different between the groups, with ZUK being larger. CONCLUSION Patients who received PPK had significantly smaller medial overhangs and better bone coverage. PPK is more likely to give better results than ZUK.
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Affiliation(s)
- Yoshiaki Miyake
- Department of Bone and Joint Surgery, 12864Kawasaki Medical School, Kurashiki, Japan
| | - Yoshifumi Namba
- Department of Bone and Joint Surgery, 12864Kawasaki Medical School, Kurashiki, Japan
| | - Shigeru Mitani
- Department of Bone and Joint Surgery, 12864Kawasaki Medical School, Kurashiki, Japan
| | - Norifumi Umehara
- Department of Bone and Joint Surgery, 12864Kawasaki Medical School, Kurashiki, Japan
| | - Toyohiro Kawamoto
- Department of Bone and Joint Surgery, 12864Kawasaki Medical School, Kurashiki, Japan
| | - Shuro Furuichi
- Department of Bone and Joint Surgery, 12864Kawasaki Medical School, Kurashiki, Japan
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Lee QJ, Chang WYE, Wong YC. Mid-term survivorship of fixed bearing unicondylar knee arthroplasty with no exclusion of early PFJ arthritis or ACL deficiency: Analysis of clinical and radiological predictors. J Orthop Surg (Hong Kong) 2022; 30:10225536221141782. [PMID: 36419402 DOI: 10.1177/10225536221141782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Fixed bearing (FB) UKA constituted 63.7% of unicondylar knee arthroplasties in 2020 Australian Registry with the longest UKA survivorship. The significance of patellofemoral joint (PFJ) arthritis, ACL deficiency, post-operative anteromedial pain, radiosclerosis or radiolucency on survivorship of FB UKA is not established. The aim of this study was to analyze the medium-term survivorship of fixed-bearing UKA with no exclusion of PFJ OA and ACL deficiency. Predictors for failure were analyzed. METHODS FB UKA performed in 2011-17 were reviewed. Cases with PFJ OA or ACL deficiency were not excluded. The effect on survivorship by ACL deficiency, PFJ arthritis, post-operative anteromedial pain and radiological abnormalities were analyzed. RESULTS There were 96 UKA with follow-up time of 66 ± 18 months (27-98). The mean age was 70 ± 9 years, BMI 25.8 ± 2.6 kg/m2. Alignment was varus 9° ± 4° pre-operatively and varus 3° ± 3° post-operatively. There were four revisions (4.2%) and 4 deaths (4.2%). Reasons for revisions were loosening (n = 1), persistent pain (n = 2) and lateral compartment disease (n = 1). Estimated survival at 8.3 years was 94.7% (95% CI 91.6-97.7). BMI ≥30 was found to be a significant predictor for failure. The incidence of radiographic abnormalities was 75% for PFJ arthritis, 39% for tibial tray overhang, 14% for radiolucency or radiosclerosis, 5% for ACL deficiency and 5% for edge loading respectively but they were not significantly associated with lower survivorship or anteromedial knee pain. The presence of anteromedial pain after surgery in 36.5% was also not significantly associated with survivorship. CONCLUSION FB UKA with no exclusion of early PFJ arthritis and ACL deficiency has satisfactory medium-term survivorship. BMI ≥30 could have higher risk of all-cause revision. Tibial tray overhang, non-progressive radiolucency or radiosclerosis do not seem to be associated with anteromedial knee pain or poorer medium term survivorship.
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Affiliation(s)
- Qunn Jid Lee
- Total Joint Replacement Center, 71210Yan Chai Hospital, Hong Kong, China
| | | | - Yiu Chung Wong
- Total Joint Replacement Center, 71210Yan Chai Hospital, Hong Kong, China
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Barbera JP, Xiao RC, Williams CS, Poeran J, Moucha CS, Chen DD, Hayden BL. Treatment patterns and failure rates associated with prosthetic joint infection in unicompartmental knee arthroplasty: A systematic review. J Orthop 2022; 34:288-294. [PMID: 36158037 PMCID: PMC9493286 DOI: 10.1016/j.jor.2022.09.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 09/10/2022] [Indexed: 10/31/2022] Open
Abstract
Background Prosthetic joint infection (PJI) following unicompartmental knee arthroplasty (UKA) is a rare but challenging complication. A paucity of literature exists regarding the management of PJI in UKA. This systematic review aims to assess current treatment patterns in UKA PJI and analyze the failure rates associated with treatment. Methods PubMed, Scopus, and EMBASE were systematically searched for studies that presented cases of PJI following UKA. Data regarding study design, country of publication, index procedure type, diagnosis of PJI, number and incidence of PJI, timing of PJI (acute versus chronic), treatment, and outcomes were recorded. Failure rates in acute and chronic PJI as well as total failure rates were analyzed. Results Sixteen articles were identified that met inclusion criteria. These included 97 PJI cases (37 acute, 58 chronic, 2 unknown timing); incidence across all studies of 0.80%. The most common treatment for all PJI cases was debridement, antibiotics, and implant retention (DAIR) (40.2%), followed by two-stage conversion to total knee arthroplasty (TKA) (33.0%), one-stage conversion to TKA (23.7%), and one-stage exchange UKA (3.1%). There were no significant differences in failure rates across procedures for acute, chronic or overall PJI management (p > 0.05 for all). Conclusion This systematic review found relatively few studies reporting on PJI after UKA compared to the available TKA evidence. Further research is warranted to better elucidate the most appropriate treatment of PJI after UKA in both the acute and chronic setting along with risk factors for failure.
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Affiliation(s)
- Joseph P. Barbera
- Department of Orthopaedic Surgery, Mount Sinai Health System, New York, NY, USA
| | - Ryan C. Xiao
- Department of Orthopaedic Surgery, Mount Sinai Health System, New York, NY, USA
| | | | - Jashvant Poeran
- Department of Orthopaedic Surgery, Mount Sinai Health System, New York, NY, USA
| | - Calin S. Moucha
- Department of Orthopaedic Surgery, Mount Sinai Health System, New York, NY, USA
| | - Darwin D. Chen
- Department of Orthopaedic Surgery, Mount Sinai Health System, New York, NY, USA
| | - Brett L. Hayden
- Department of Orthopaedic Surgery, Mount Sinai Health System, New York, NY, USA
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Armillotta N, Bori E, Innocenti B. Finite element analysis of malposition in bi-unicompartmental knee arthroplasty. Arch Orthop Trauma Surg 2022; 143:3447-3455. [PMID: 36264510 DOI: 10.1007/s00402-022-04656-2] [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: 04/19/2022] [Accepted: 10/09/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Bi-unicompartmental knee arthroplasty is a less invasive treatment than a total one, great advantage for the patient but more difficult for the surgeon because of the lower visibility during surgery; this can therefore lead to eventual small errors in cutting angles during the procedure. The aim of this study is to investigate the effects of these slight angle variations in terms of anterior-posterior slope for the lateral tibial tray. METHODS The geometries of the bones were acquired and uncemented fixed bearing metal-back UKAs virtually implanted in a finite elements environment. The lateral component was implanted in six different antero-posterior slope configurations (from - 5° to + 5° respect to medial component). Material properties for implant, bones and soft tissues were taken from the literature. A vertical compressive force of 2000 N was applied in full-extended configuration on the femur. Von Mises stress distribution in proximal tibia, load/pressure/contact area repartitions between the medial and lateral compartments was extracted as outputs. RESULTS Outcomes for 0° and - 3° configurations are acceptable, but the - 2° of slope configuration achieved the best ones in terms of stress on proximal tibia, load repartition, contact pressure distribution and shear component. Drastically different results are found for the ± 5° configurations, presenting a level of unbalancing often associated with weak stability and failure over time. CONCLUSIONS Slight errors can happen during the surgery: performing the cut aiming to slightly posterior slopes during the surgery helps to minimize the chances of obtaining positive slopes that could lead to an unstable implant.
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Affiliation(s)
- Nicola Armillotta
- BEAMS Department (Bio Electro and Mechanical Systems), Université Libre de Bruxelles, École Polytechnique de Bruxelles, Av. F. Roosevelt, 50 CP165/56, 1050, Brussels, Belgium
| | - Edoardo Bori
- BEAMS Department (Bio Electro and Mechanical Systems), Université Libre de Bruxelles, École Polytechnique de Bruxelles, Av. F. Roosevelt, 50 CP165/56, 1050, Brussels, Belgium.
| | - Bernardo Innocenti
- BEAMS Department (Bio Electro and Mechanical Systems), Université Libre de Bruxelles, École Polytechnique de Bruxelles, Av. F. Roosevelt, 50 CP165/56, 1050, Brussels, Belgium
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Bandi M, Benazzo F, Batailler C, Blatter I, Siggelkow E, Parratte S. A Morphometric Fixed-Bearing Unicompartmental Knee Arthroplasty Can Reproduce Normal Knee Kinematics. An In Vitro Robotic Evaluation. Arthroplast Today 2022; 16:151-157. [PMID: 35769767 PMCID: PMC9234006 DOI: 10.1016/j.artd.2022.02.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 02/15/2022] [Indexed: 11/26/2022] Open
Abstract
Background Methods Results Conclusion
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17
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Rossi SMP, Sangaletti R, Nesta F, Matascioli L, Terragnoli F, Benazzo F. A well performing medial fixed bearing UKA with promising survivorship at 15 years. Arch Orthop Trauma Surg 2022; 143:2693-2699. [PMID: 35908099 DOI: 10.1007/s00402-022-04562-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 07/18/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Unicompartmental knee arthroplasty (UKA) accounts for 10% of knee arthroplasty procedures in Europe. Fixed bearing UKA designs have shown favorable survivorship in registries when compared with mobile bearings. This study analyses long-term follow-up of patients with a medial fixed bearing metal backed tibial UKA and reports 15 years survivorship and clinical outcomes. METHODS Data were collected prospectively for 148 medial unicompartmental fixed bearing metal backed UKAs implanted in 148 patients in two high volumes knee arthroplasty centers between January 2005 and December 2007. The indication was osteoarthritis in all but 2 patients. Patients' reported outcome scores were documented at last follow up. The mean patient age at time of surgery was 65 years. RESULTS At final follow up, outcome and survivorship data were collected for 124 medial fixed bearing UKAs. Thirteen patients underwent revision; average time to revision was 77 months (SD 35.31). The Kaplan-Meier analysis demonstrated a survivorship of 97.65% at 69 months and of 89,52%. at 120 months and 173 months of follow-up. When revisions for infection were excluded, the survivorship of the implant was 90.3% at the last of follow up. The mean OKS was 43.02 (SD 5.1) at the last follow-up, and the mean FJS was 77.6 (SD 6.9). CONCLUSION This Medial fixed bearing metal backed UKA demonstrates promising long-term survivorship and patient outcomes. It appears to be a suitable and reasonably lasting option for the treatment of medial compartment OA.
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Affiliation(s)
- Stefano Marco Paolo Rossi
- Sezione di Chirurgia Protesica ad Indirizzo Robotico, Unità di Traumatologia dello Sport, U.O.C Ortopedia e Traumatologia, Fondazione Poliambulanza, Via Bissolati 57, 25124, Brescia, Italy.
| | - Rudy Sangaletti
- Sezione di Chirurgia Protesica ad Indirizzo Robotico, Unità di Traumatologia dello Sport, U.O.C Ortopedia e Traumatologia, Fondazione Poliambulanza, Via Bissolati 57, 25124, Brescia, Italy
| | - Fabio Nesta
- U.O.C Ortopedia e Traumatologia, Fondazione Poliambulanza, Via Bissolati 57, Brescia, Italy
| | - Luca Matascioli
- U.O.C Ortopedia e Traumatologia, Fondazione Poliambulanza, Via Bissolati 57, Brescia, Italy
| | - Flavio Terragnoli
- U.O.C Ortopedia e Traumatologia, Fondazione Poliambulanza, Via Bissolati 57, Brescia, Italy
| | - Francesco Benazzo
- Sezione di Chirurgia Protesica ad Indirizzo Robotico, Unità di Traumatologia dello Sport, U.O.C Ortopedia e Traumatologia, Fondazione Poliambulanza, Via Bissolati 57, 25124, Brescia, Italy
- IUSS Istituto Universitario di Studi Superiori, Pavia, Italy
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Retrospective comparison of rates of aseptic loosening in fixed-bearing unicompartmental knee arthroplasty (UKA) implants. CURRENT ORTHOPAEDIC PRACTICE 2022. [DOI: 10.1097/bco.0000000000001120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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5-Year Survivorship and Outcomes of Robotic-Arm-Assisted Medial Unicompartmental Knee Arthroplasty. Appl Bionics Biomech 2022; 2022:8995358. [PMID: 35572062 PMCID: PMC9106446 DOI: 10.1155/2022/8995358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 04/12/2022] [Indexed: 11/20/2022] Open
Abstract
Purpose While unicompartmental knee arthroplasty (UKA) has demonstrated benefits over total knee arthroplasty (TKA) in selected populations, component placement continues to be challenging with conventional surgical instruments, resulting in higher early failure rates. Robotic-arm-assisted UKA (RA-UKA) has shown to be successful in component positioning through preop planning and intraop adjustability. The purpose of this study is to assess the 5-year clinical outcomes of medial RA-UKA. Methods This study was a retrospective review of a single-center prospectively maintained cohort of 133 patients (146 knees) indicated for medial UKA from 2009 to 2013. Perioperative data and 2- and 5-year Knee injury Osteoarthritis Outcome Score (KOOS), Western Ontario and McMaster Universities Osteoarthritis Score (WOMAC), and Forgotten Joint Score (FJS) outcome measures were collected. Five-year follow-up was recorded in 119 patients (131 knees). Results Mean follow-up was 5.1 ± 0.2 years. Mean age and BMI were 68.0 ± 8.1 years and 29.3 ± 4.7 kg/m2, respectively. At 2-year follow-up, mean KOOS, WOMAC, and FJS were 71.5 ± 15.3, 14.3 ± 7.9, and 79.1 ± 25.8, respectively. At 5-year follow-up, mean KOOS, WOMAC, and FJS were 71.6 ± 15.2, 14.2 ± 7.9, and 80.9 ± 25.1, respectively. Mean change in KOOS and WOMAC was 34.6 ± 21.4 and 11.0 ± 13.6, respectively (p < 0.001 and p < 0.001). For patient satisfaction at last follow-up, 89% of patients were very satisfied/satisfied and 5% were dissatisfied. For patient activity expectations at last follow-up, 85% met activity expectations, 52% were more active than before, 25% have the same level of activity, 23% were less active than before, and 89% were walking without support. All patients returned to driving after surgery at a mean 15.2 ± 9.4 days. Survivorship was 95% (95% CI 0.91-0.98) at 5 years. One knee (1%) had a patellofemoral revision, two knees (1.3%) were revised to different partial knee replacements, and five knees (3.4%) were converted to TKA. Conclusion Overall, medial RA-UKA demonstrated improved patient-recorded outcomes, high patient satisfaction, met expectations, and excellent functional recovery. Midterm survivorship was excellent. Longitudinal follow-up is needed to evaluate long-term outcomes of robotic-arm-assisted UKA procedures.
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Outcomes of Bi-unicompartmental Versus Total Knee Arthroplasty for the Treatment of Medial and Lateral Knee Osteoarthritis: A Systematic Review and Meta-analysis of Comparative Studies. Indian J Orthop 2022; 56:963-972. [PMID: 35669030 PMCID: PMC9123098 DOI: 10.1007/s43465-022-00628-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 03/18/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE The aim of this meta-analysis was to evaluate differences in functional outcomes between simultaneous bi-unicompartmental knee arthroplasty (Bi-UKA) and total knee arthroplasty (TKA) for the treatment of medial and lateral knee osteoarthritis. MATERIAL AND METHODS According to the PRISMA statement, a comprehensive search was conducted to identify studies reporting comparative results of the Bi-UKA versus the TKA. Of 953 titles, 6 studies met the inclusion criteria. RESULTS A total of 286 patients were identified, of which 137 underwent Bi-UKA and 149 TKA. TKA reported a mean hip-knee-ankle (HKA) angle of 179.4 ± 2.4 compared to that in Bi-UKA measuring 177.2 ± 2.7 (p = 0.0001, 95% CI - 3.02 to - 1.38). No difference was found in the Western Ontario and McMaster Universities (WOMAC) pain (4 ± 1.6 and 4.2 ± 1.3 for Bi-UKA and TKA, respectively; p = 0.4996, 95% CI - 0.86 to 0.43). Bi-UKA was favorable in terms of WOMAC function (7.5 ± 1.9 and 9 ± 1.9 for Bi-UKA and TKA, respectively; p = 0.001, 95% CI - 2.29 to - 0.61) and WOMAC stiffness (1.6 ± 1 and 2.4 ± 0.7 for Bi-UKA and TKA, respectively; p = 0.0001, 95% CI - 1.18 to - 0.42). Bi-UKA showed a better Knee Society Score (KSS) in comparison to TKA (79.7 ± 7.8 and 75.4 ± 10.5 for Bi-UKA and TKA, respectively; p = 0.0021, 95% CI 1.58-7.02). The differences in postoperative outcomes scores between Bi-UKA and TKA were lower than their respective minimum clinically important differences. CONCLUSIONS When Bi-UKA and TKA are compared for the treatment of medial and lateral knee osteoarthritis, Bi-UKA are favorable in terms of WOMAC and KSS even though these values are lower than the minimum clinically important differences; moreover, similar postoperative hip-knee-ankle angle can be expected 3 years after Bi-UKA and TKA.
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Porteous AJ, Smith JRA, Bray R, Robinson JR, White P, Murray JRD. St Georg Sled medial unicompartmental arthroplasty: survivorship analysis and function at 20 years follow up. Knee Surg Sports Traumatol Arthrosc 2022; 30:800-808. [PMID: 33502571 DOI: 10.1007/s00167-021-06454-6] [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: 09/02/2020] [Accepted: 01/11/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE The peri-operative and short-term benefits of unicompartmental knee arthroplasty (UKA) are well supported in the literature. However, there remains concern regarding the higher revision rate when compared with total knee replacement. This manuscript reports the functional outcome and survivorship of a large series of fixed bearing, medial unicompartmental replacements (St Georg Sled), with a minimum of 20 years follow-up. METHODS Between 1974 and 1994, 399 patients (496 knees) underwent a medial fixed-bearing UKA. Prospective data were collected pre-operatively and at regular intervals post-operatively using the Bristol Knee Score (BKS), Oxford Knee (OKS) and Western Ontario MacMaster (WOMAC) scores. Kaplan-Meier survival analysis was used to determine survivorship, with revision or need for revision as end point, and differences assessed using Mantel-Cox log rank test. RESULTS Functional knee scores improved post-operatively, but demonstrated a slight decline from 10 years of follow-up onwards. Survivorship is estimated as 86% at 10 years, 80% at 15 years, and 78% at 20 years. Sixty knees were revised, with progression of disease in another compartment the commonest reason. Eighty eight percent were revised using a primary prosthesis. For patients over the age of 65 years at the time of index procedure, 93% died with a functioning prosthesis in situ. CONCLUSION Medial UKA demonstrates good long-term function and survivorship, and represents an excellent surgical option for patients aged over 65 years of age, where few patients will require a revision procedure. LEVEL OF EVIDENCE IV.
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Affiliation(s)
| | - James R A Smith
- Avon Orthopaedic Centre, Southmead Hospital, Bristol, BS10 5NB, UK.
| | - Rachel Bray
- Avon Orthopaedic Centre, Southmead Hospital, Bristol, BS10 5NB, UK
| | - James R Robinson
- Avon Orthopaedic Centre, Southmead Hospital, Bristol, BS10 5NB, UK
| | - Paul White
- University of the West of England, Bristol, BS16 1QL, UK
| | - James R D Murray
- Avon Orthopaedic Centre, Southmead Hospital, Bristol, BS10 5NB, UK
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Revision indications for medial unicompartmental knee arthroplasty: a systematic review. Arch Orthop Trauma Surg 2022; 142:301-314. [PMID: 33630155 DOI: 10.1007/s00402-021-03827-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 02/08/2021] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Unicompartmental knee arthroplasty (UKA) has advantages over total knee arthroplasty including fewer complications and faster recovery; however, UKAs also have higher revision rates. Understanding reasons for UKA failure may, therefore, allow for optimized clinical outcomes. We aimed to identify failure modes for medial UKAs, and to examine differences by implant bearing, cement use and time. MATERIALS AND METHODS A systematic review was conducted by searching MedLine, EMBASE, CINAHL and Cochrane databases from 2000 to 2020. Studies were selected if they included ≥ 250 participants, ≥ 10 failures and reported all failure modes of medial UKA performed for osteoarthritis (OA). RESULTS A total of 24 cohort and 2 registry-based studies (levels II and III) were selected. The most common failure modes were aseptic loosening (24%) and OA progression (30%). Earliest failures (< 6 months) were due to infection (40%), bearing dislocation (20%), and fracture (20%); mid-term failures (> 2 years to 5 years) were due to OA progression (33%), aseptic loosening (17%) and pain (21%); and late-term (> 10 years) failures were mostly due to OA progression (56%). Rates of failure from wear were higher with fixed-bearing prostheses (5% cf. 0.3%), whereas rates of bearing dislocations were higher with mobile-bearing prostheses (14% cf. 0%). With cemented components, there was a high rate of failure due to aseptic loosening (27%), which was reduced with uncemented components (4%). CONCLUSIONS UKA failure modes differ depending on implant design, cement use and time from surgery. There should be careful consideration of implant options and patient selection for UKA.
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Tensho K, Iwaasa T, Koyama S, Shimodaira H, Horiuchi H, Saito N, Takahashi J. Potential risk of medial cortex perforation due to peg position of morphometric tibial component in unicompartmental knee arthroplasty: a computer simulation study. Knee Surg Sports Traumatol Arthrosc 2022; 30:536-544. [PMID: 32865659 DOI: 10.1007/s00167-020-06242-8] [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: 05/29/2020] [Accepted: 08/14/2020] [Indexed: 02/14/2023]
Abstract
PURPOSE The purpose of this study is to evaluate the risk of medial tibial cortical perforation in unicompartmental knee arthroplasty (UKA) due to peg positions on the tibial tray of the Persona Partial Knee (PPK). METHODS Preoperative CT images of 60 patients and 60 osteoarthritic knees (30 male and 30 female patients) were used. A tibial multiplanar reconstruction (MPR) image was reconstructed in preoperative planning software, and the implant was placed in a virtual osteotomy plane. In addition to PPK, Zimmer Unicompartmental Knee (ZUK) and TRIBRID (TBD) were used for evaluation. The horizontal distances from the medial tibial cortex to the anterior and posterior pegs (APCD/PPCD, respectively) were measured under neutral, 3-degree varus, 3-degree valgus and 2 mm distal positions. The differences between implants under the same positions and between positions using the same implants were compared. The percentage of total cases with APCD/PPCD of less than 3 mm and the perforation risk rate were calculated. RESULTS The APCD of PPK was significantly shorter at all positions except for the varus position of TBD. The PPCD of PPK was significantly shorter at all positions compared to ZUK and TBD. There were no cases with an APCD of less than 3 mm. Except for varus positions, the perforation risk rate of PPCD was significantly higher for PPK than the other two implants. CONCLUSION The posterior pegs of the PPK are located more medially than the other two implants, which may result in perforation of the medial tibial cortex during implantation. Surgeons should consider the risk involved in the type of implant used.
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Affiliation(s)
- Keiji Tensho
- Department of Orthopedic Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, 390-8621, Japan.
| | - Tomoya Iwaasa
- Department of Orthopedic Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, 390-8621, Japan
| | - Suguru Koyama
- Department of Orthopedic Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, 390-8621, Japan
| | - Hiroki Shimodaira
- Department of Orthopedic Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, 390-8621, Japan
| | - Hiroshi Horiuchi
- Department of Orthopedic Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, 390-8621, Japan
| | - Naoto Saito
- Department of Orthopedic Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, 390-8621, Japan
| | - Jun Takahashi
- Department of Orthopedic Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, 390-8621, Japan
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24
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Wong KC, Lee M, Liow L, Lo NN, Yeo SJ, Chen J. Bone-on-Bone Contact on Radiograph is not a Prerequisite for Successful Outcome in Fixed-Bearing Medial Unicompartmental Knee Arthroplasty-A 10-Year Follow-Up Study. J Knee Surg 2021; 36:658-666. [PMID: 34952551 DOI: 10.1055/s-0041-1740932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Patients without bone-on-bone osteoarthritis are excluded from mobile-bearing unicompartmental knee arthroplasty due to higher revision rates and poorer outcomes. However, we do not know if the same indication applies to fixed-bearing unicompartmental knee arthroplasty implants. Our study aims to compare functional outcomes and revision rates in patients with and without bone-on-bone arthritis undergoing fixed-bearing medial unicompartmental knee arthroplasty. MATERIALS AND METHODS We reviewed 153 fixed-bearing medial unicompartmental knee arthroplasties in a single institution. Patients were divided into four groups based on joint space remaining measured on preoperative radiographs. Group 1 included knees with bone-on-bone contact; group 2 included knees with less than 2 mm joint space; group 3 included knees with 2 to 4 mm joint space; group 4 included knees with more than 4 mm joint space. Patients were followed up for 10 years postoperatively and assessed using the Oxford Knee Score, the Functional Score and Knee Score from the Knee Society Clinical Rating Score, and the Short Form 36 Health Survey. RESULTS There was no difference in terms of demographic data and preoperative scores. Postoperative Knee Society Functional Score was found to be lower in group 1 as compared with the other groups. There was no difference between the four groups of patients in terms of Knee Society Knee Score, Oxford Knee Score, and Physical Component Summary and Mental Component Summary Scores from the Short Form 36 Health Survey. There was no difference in terms of survivorship free from all-cause revision at a minimum of 10 years' follow-up. CONCLUSION Symptomatic patients with varying degrees of arthritis on preoperative radiographs had comparable clinical outcomes. We conclude that symptomatic patients with clinical and radiographic evidence of medial compartment osteoarthritis of any grade can benefit from a fixed-bearing medial unicompartmental knee arthroplasty.
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Affiliation(s)
- Khai Cheong Wong
- Department of Orthopedic Surgery, Singapore General Hospital, Singapore
| | - Merrill Lee
- Department of Orthopedic Surgery, Singapore General Hospital, Singapore
| | - Lincoln Liow
- Department of Orthopedic Surgery, Singapore General Hospital, Singapore
| | - Ngai-Nung Lo
- Department of Orthopedic Surgery, Singapore General Hospital, Singapore
| | - Seng-Jin Yeo
- Department of Orthopedic Surgery, Singapore General Hospital, Singapore
| | - Jerry Chen
- Department of Orthopedic Surgery, Singapore General Hospital, Singapore
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Mohammad HR, Bullock GS, Kennedy JA, Mellon SJ, Murray D, Judge A. Cementless unicompartmental knee replacement achieves better ten-year clinical outcomes than cemented: a systematic review. Knee Surg Sports Traumatol Arthrosc 2021; 29:3229-3245. [PMID: 32613336 DOI: 10.1007/s00167-020-06091-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 06/03/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE The aim of this study was to report and compare the long-term revision rate, revision indications and patient reported outcome measures of cemented and cementless unicompartmental knee replacements (UKR). METHODS Databases Medline, Embase and Cochrane Central of Controlled Trials were searched to identify all UKR studies reporting the ≥ 10 year clinical outcomes. Revision rates per 100 component years [% per annum (% pa)] were calculated by fixation type and then, subgroup analyses for fixed and mobile bearing UKRs were performed. Mechanisms of failure and patient reported outcome measures are reported. RESULTS 25 studies were eligible for inclusion with a total of 10,736 UKRs, in which there were 8790 cemented and 1946 cementless knee replacements. The revision rate was 0.73% pa (CI 0.66-0.80) and 0.45% pa (CI 0.34-0.58) per 100 component years, respectively, with the cementless having a significantly (p < 0.001) lower overall revision rate. Therefore, based on these studies, the expected 10-year survival of cementless UKR would be 95.5% and cemented 92.7%. Subgroup analysis revealed this difference remained significant for the Oxford UKR (0.37% pa vs 0.77% pa, p < 0.001), but for non-Oxford UKRs there were no significant differences in revision rates of cemented and cementless UKRs (0.57% pa vs 0.69% pa, p = 0.41). Mobile bearing UKRs had significantly lower revision rates than fixed bearing UKRs in cementless (p = 0.001), but not cemented groups (p = 0.13). Overall the revision rates for aseptic loosening and disease progression were significantly lower (p = 0.02 and p = 0.009 respectively) in the cementless group compared to the cemented group (0.06 vs 0.13% pa and 0.10 vs 0.21% pa respectively). CONCLUSIONS Cementless fixation had reduced long-term revision rates compared to cemented for the Oxford UKR. For the non-Oxford UKRs, the revision rates of cementless and cemented fixation types were equivalent. Therefore, cementless UKRs offer at least equivalent if not lower revision rates compared to cemented UKRs. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Hasan R Mohammad
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, OX3 7LD, UK. .,Musculoskeletal Research Unit, Bristol Medical School, Level 1 Learning and Research Building, Southmead Hospital, University of Bristol, Westbury-On-Trym, Bristol, BS10 5NB, UK.
| | - Garrett S Bullock
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, OX3 7LD, UK
| | - James A Kennedy
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, OX3 7LD, UK
| | - Stephen J Mellon
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, OX3 7LD, UK
| | - David Murray
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, OX3 7LD, UK
| | - Andrew Judge
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, OX3 7LD, UK.,Musculoskeletal Research Unit, Bristol Medical School, Level 1 Learning and Research Building, Southmead Hospital, University of Bristol, Westbury-On-Trym, Bristol, BS10 5NB, UK
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26
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Zambianchi F, Daffara V, Franceschi G, Banchelli F, Marcovigi A, Catani F. Robotic arm-assisted unicompartmental knee arthroplasty: high survivorship and good patient-related outcomes at a minimum five years of follow-up. Knee Surg Sports Traumatol Arthrosc 2021; 29:3316-3322. [PMID: 32737526 DOI: 10.1007/s00167-020-06198-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 07/27/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Robotic arm-assisted unicompartmental knee arthroplasty (RA-UKA) has been shown to improve component placement, reduce intraoperative variability, increase patient satisfaction and improve short-term survivorship results. The aim of this retrospective study was to determine the incidence of revision and the clinical performance at a minimum of 5-year follow-up for a cohort of patients who received a medial RA-UKA. METHODS Between April 2011 and July 2013, a total of 254 patients underwent medial RA-UKA at a single centre. Clinical performance was investigated using the Forgotten Joint Score-12 (FJS-12) and a 5-level Likert scale made of five items to assess joint perception and patient satisfaction. Kaplan-Meier implant survivorship was calculated and reasons for revision were collected. The effect of age, gender and body mass index (BMI) on the probability of reporting high FJS-12 and satisfaction were assessed. RESULTS After considering exclusion criteria and loss to follow-up, a total of 216 patients (224 medial RA-UKAs) were assessed at a mean 5.9 years of follow-up. Five RA-UKAs underwent implant revision, resulting in an overall Kaplan-Meier survivorship of 97.8%. Unexplained knee pain (0.9%) was the most common reason for RA-UKA revision. Good-to-excellent FJS-12 scores and high satisfaction levels were reported at mid-term follow-up. Male patients had higher probability of having FJS-12 > 90 (p < 0.05) and high satisfaction levels (p < 0.05). CONCLUSIONS RA-UKAs demonstrated high survivorship and good-to-excellent patient-reported outcome measures and satisfaction levels at minimum 5-year follow-up. Results for male patients had improved clinical performance when compared to female subjects. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Francesco Zambianchi
- Department of Orthopaedic Surgery, Azienda Ospedaliero Universitaria di Modena, University of Modena and Reggio-Emilia, Modena, Italy.
| | - Valerio Daffara
- Department of Orthopaedic Surgery, Azienda Ospedaliero Universitaria di Modena, University of Modena and Reggio-Emilia, Modena, Italy
| | - Giorgio Franceschi
- Department of Knee Surgery, Policlinico di Abano Terme, Abano Terme, PD, Italy
| | - Federico Banchelli
- Statistics Unit, Department of Diagnostics, Clinical and Public Health Medicine, University of Modena and Reggio-Emilia, Modena, Italy
| | - Andrea Marcovigi
- Department of Orthopaedic Surgery, Azienda Ospedaliero Universitaria di Modena, University of Modena and Reggio-Emilia, Modena, Italy
| | - Fabio Catani
- Department of Orthopaedic Surgery, Azienda Ospedaliero Universitaria di Modena, University of Modena and Reggio-Emilia, Modena, Italy
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Nie Y, Yu Q, Shen B. Impact of Tibial Component Coronal Alignment on Knee Joint Biomechanics Following Fixed-bearing Unicompartmental Knee Arthroplasty: A Finite Element Analysis. Orthop Surg 2021; 13:1423-1429. [PMID: 34018326 PMCID: PMC8274147 DOI: 10.1111/os.12927] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 12/11/2020] [Accepted: 12/20/2020] [Indexed: 02/05/2023] Open
Abstract
Objective Unicompartmental knee arthroplasty (UKA) has indicated a higher rate of revision than total knee arthroplasty (TKA). The success of UKA depends on UKA component alignment, fixation, and soft tissue integrity. The purpose of this study was to investigate the effects of different tibial component alignments in the coronal plane on the stress distribution in UKA. It was hypothesized that the stress distribution would approach native knee when the tibial component was neutrally positioned. Methods The left legs from two healthy volunteers were considered to represent the geometric native knee models. All bones within the knee joint were extracted from the three‐dimensional (3D) computed tomography (CT). MRI was used to generate cartilage, menisci, and four major ligaments. The UKA components were virtually implanted in the medial compartment of the knee model using MIMICS. A total of five different configurations of UKA tibial obliquity in the coronal plane (neutral, 3° varus, 6° varus, 3° valgus, and 6° valgus) were adopted and investigated. Subject‐specific inhomogeneous material properties of bones were used in the finite element analysis (FEA) model. The von Mises stress in the tibia platform and proximal tibia, and the load distribution between the medial and lateral compartments were extracted and compared among the five different configurations. Results The inhomogeneous material properties of the trabecular bone were closer to real physics than traditional homogeneous methods. Neutral and 3° varus alignments of the tibial component in the coronal plane have better stress distribution between medial and lateral compartment as healthy knee models, and less stress‐shielding effects than other UKA configurations. The stress pathway under the medial tibia platform in neutral and 3° varus UKA configurations was similar and more obvious than the other three UKA configurations. Notably, the stress of the medial tibia platform in the 3° varus UKA models was more homogenous than the neutral UKA configuration. The 6° varus, 3° valgus, and 6° valgus UKA models had higher stress at the location of anterolateral and posterolateral tibia platform than other UKA configurations. Conclusion Neutral or 3° varus positioned in the coronal plane for the tibial component could be the optimal alignment for UKA. Excessive varus or valgus obliquity in the coronal plane lead to significant differences in bone stress transfer and load distribution in the knee, and increase the risk of UKA failure.
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Affiliation(s)
- Yong Nie
- Department of Orthopaedic Surgery and Orthopaedic Research Institute and National Clinical Research Center for Geriatrics, West China Hospital, West China Medical School, Sichuan University, Chengdu, China
| | - Qiang Yu
- Department of Orthopaedic Surgery and Orthopaedic Research Institute and National Clinical Research Center for Geriatrics, West China Hospital, West China Medical School, Sichuan University, Chengdu, China.,Department of Orthopaedic Surgery, Chengdu 7th people's Hospital, Chengdu, China
| | - Bin Shen
- Department of Orthopaedic Surgery and Orthopaedic Research Institute and National Clinical Research Center for Geriatrics, West China Hospital, West China Medical School, Sichuan University, Chengdu, China
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28
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Gill JR, Vermuyten L, Wastnedge E, Nicolai P. The effect of component alignment on clinical outcomes in fixed bearing unicompartmental knee arthroplasty. Knee 2021; 29:126-133. [PMID: 33610119 DOI: 10.1016/j.knee.2021.01.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 11/29/2020] [Accepted: 01/08/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND The aim of this study is to report component alignment in a series of ZUK fixed bearing unicompartmental knee arthroplasty (UKA) implants and compare this to clinical outcomes. METHODS The radiographs, Knee Society Scores (KSS) and knee flexion of 223 medial UKAs were evaluated. The following alignment parameters were assessed; coronal and sagittalfemoral component angle (c-FCA and s-FCA), coronal and sagittal tibia component angle (c-TCA and s-TCA)and the coronal tibiofemoralangle (c-TFA). Each alignment parameter was grouped at consecutive 2.5° intervals, mean KSS and knee flexion was then compared between the interval groups. RESULTS 96.4% of femoral components were between 7.5° of varus and valgus and 95.1% between 7.5° extension and 5° flexion. 89.6% of tibial components were between 7.5° of varus and 2.5° valgus and 97.3% between 2.5° and 15° flexion. There was no significant difference between the KSS or knee flexion between any of the incremental groups of component alignment. Mean c-TFA was 0.2 ± 3.0°, 92.4% were between -5° (varus) and 5° (valgus). KSS were significantly greater for two of the increments with slightly more varus. Linear regression analysis showed there was very weak correlation (R2 = 0.1933) between c-TFA and c-TCA. CONCLUSIONS The results of this study show that fixed bearing UKA components are forgiving to accommodate some variation in tibial and femoral component position without effecting clinical outcome scores or knee flexion. Limb alignment matters more than component position and knees with slight varus tibiofemoral alignment have better clinical scores than those with valgus.
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Affiliation(s)
- James R Gill
- Department of Trauma and Orthopaedics, West Suffolk NHS Foundation Trust, Hardwick Lane, Bury St Edmunds, Suffolk IP33 2QZ, United Kingdom.
| | - Lieven Vermuyten
- Department of Trauma and Orthopaedics, West Suffolk NHS Foundation Trust, Hardwick Lane, Bury St Edmunds, Suffolk IP33 2QZ, United Kingdom
| | | | - Paul Nicolai
- Department of Trauma and Orthopaedics, West Suffolk NHS Foundation Trust, Hardwick Lane, Bury St Edmunds, Suffolk IP33 2QZ, United Kingdom
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29
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Calkins TE, Hannon CP, Fillingham YA, Culvern CC, Berger RA, Della Valle CJ. Fixed-Bearing Medial Unicompartmental Knee Arthroplasty in Patients Younger Than 55 Years of Age at 4-19 Years of Follow-Up: A Concise Follow-Up of a Previous Report. J Arthroplasty 2021; 36:917-921. [PMID: 33051122 DOI: 10.1016/j.arth.2020.09.042] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 09/18/2020] [Accepted: 09/23/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Unicompartmental knee arthroplasty (UKA) is an effective alternative to total knee arthroplasty (TKA) in isolated unicompartmental disease; however, mid-term to long-term results in young patients are unknown. The purpose of this study is to determine the mid-term outcomes of fixed-bearing medial UKA in patients less than 55 years of age. METHODS Seventy-seven fixed-bearing medial UKAs in patients less than 55 years of age (mean 49.9, range 38-55) from a previously published report were retrospectively reviewed at a mean follow-up of 11.2 years (range 4.1-19.2). RESULTS Eleven knees were converted to TKA (14.3%) at 0.7-13.8 years postoperatively. The indications for revision included 7 for unexplained pain (9.1%), 2 for grade 4 arthritic progression (1 isolated lateral and 1 lateral and patellofemoral compartments; 2.6%), 1 for polyethylene wear (1.3%), and 1 for femoral component loosening (1.3%). Predicted survivorship free from component revision was 90.4% (95% confidence interval 86.9-93.9) at 10 years and 75.1% (95% confidence interval 66.2-84.0) at 19 years. The mean Knee Society Score improved from a mean of 51.9-88.6 points (P < .001). Of the 52 knees with 4-year minimum radiographs, 3 (5.8%) developed isolated grade 4 patellofemoral arthritis that was asymptomatic, and no knees had evidence of component loosening or osteolysis. CONCLUSION Fixed-bearing medial UKA is a durable option for young patients with unicompartmental arthritis, with good clinical outcomes at mid-term follow-up. Unexplained pain was the most common reason for revision to TKA.
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Affiliation(s)
- Tyler E Calkins
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee - Campbell Clinic, Memphis, TN
| | - Charles P Hannon
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | - Yale A Fillingham
- Department of Orthopaedic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Chris C Culvern
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | - Richard A Berger
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | - Craig J Della Valle
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
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30
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Negrín R, Duboy J, Iñiguez M, Reyes NO, Barahona M, Ferrer G, Infante C, Jabes N. Robotic-assisted vs conventional surgery in medial unicompartmental knee arthroplasty: a clinical and radiological study. Knee Surg Relat Res 2021; 33:5. [PMID: 33579393 PMCID: PMC7879692 DOI: 10.1186/s43019-021-00087-2] [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: 08/03/2020] [Accepted: 01/12/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The use of unicompartmental knee arthroplasty (UKA) has increased and new technologies have been developed to improve patient survival and satisfaction, soft tissue balance, alignment, and component size. Robot-assisted systems offer an increase in surgical precision and accuracy. The purpose of this study is to evaluate the precision of component position using five radiological parameters in conventional and robotic-assisted medial UKA using the NAVIO system. METHODS A cohort study was designed for patients who underwent medial UKA between April 2017 and March 2019 in a single center. Patients were allocated in the conventional (UKA-C) or robotic-assisted (UKA-R) group. The variables analyzed were age, gender, affected knee side, length of hospital stay, surgical time, and radiological measurements such as anatomical medial distal femoral angle (aMDFA), anatomical medial proximal tibial angle (aMPTA), tibial slope, the sagittal femoral angle, and the component size. A target was defined for each measurement, and a successful UKA was defined if at least four radiological measures were on target after surgery. Also, patients' reported outcomes were evaluated using the Oxford Knee Score (OKS) and a numeric rating scale (NRS) for pain. RESULTS Thirty-four patients were included, 18 of them underwent UKA-R. The success rate for UKA in the UKA-R group was 87%; meanwhile, in the UKA-C group this was 28%, this difference was significant and powered (Fisher's exact test, p = 0.001; 1 - β = 0.95). Also, a 5-point difference in favor of the UKA-R group in the median OKS (p = 0.01), and a significantly lower median NRS for pain (p < 0.000) were found after surgery. CONCLUSIONS UKA-R achieved more precision in the radiological parameters' measure in this study. Also, UKA-R has a trend towards a better OKS and a lower NRS for pain at short-term follow-up.
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Affiliation(s)
- Roberto Negrín
- Department of Orthopedics and Traumatology, Clinica Las Condes, Estoril 450, Las Condes, Santiago, Chile
| | - Jaime Duboy
- Department of Orthopedics and Traumatology, Clinica Las Condes, Estoril 450, Las Condes, Santiago, Chile
| | - Magaly Iñiguez
- Department of Orthopedics and Traumatology, Clinica Las Condes, Estoril 450, Las Condes, Santiago, Chile
| | - Nicolás O Reyes
- Department of Orthopedics and Traumatology, Clinica Las Condes, Estoril 450, Las Condes, Santiago, Chile.
| | - Maximiliano Barahona
- Department of Orthopaedic Surgery, Hospital Clinico de la Universidad de Chile, Santiago, Chile
| | - Gonzalo Ferrer
- Department of Orthopedics and Traumatology, Clinica Las Condes, Estoril 450, Las Condes, Santiago, Chile
| | - Carlos Infante
- Department of Orthopedics and Traumatology, Clinica Las Condes, Estoril 450, Las Condes, Santiago, Chile.,Department of Orthopaedic Surgery, Hospital Clinico de la Universidad de Chile, Santiago, Chile
| | - Nicolás Jabes
- Department of Orthopedics and Traumatology, Clinica Las Condes, Estoril 450, Las Condes, Santiago, Chile
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31
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Kim TK, Mittal A, Meshram P, Kim WH, Choi SM. Evidence-based surgical technique for medial unicompartmental knee arthroplasty. Knee Surg Relat Res 2021; 33:2. [PMID: 33413698 PMCID: PMC7792201 DOI: 10.1186/s43019-020-00084-x] [Citation(s) in RCA: 15] [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: 09/11/2020] [Accepted: 11/26/2020] [Indexed: 01/04/2023] Open
Abstract
Unicompartmental knee arthroplasty (UKA) is a successful treatment modality in selected patients having advanced, single-compartment osteoarthritis of the knee. The bone and ligament preservation leading to shorter recovery periods, better functional outcomes, lower perioperative complication rates, and easier revision, if needed, are proposed as some of the advantages of UKA over total knee arthroplasty (TKA). Despite several advantages, UKA is reported to have higher failure rates as compared to TKA. The prosthesis failure of UKA is directly correlated to intraoperative technique-related factors like malpositioning of components and the inability to replicate the target-limb alignment as per preoperative planning. An evidence-based surgical technique for UKA may help surgeons to avoid the intraoperative technique-related errors. The purpose of this paper is to describe a stepwise surgical technique for the fixed-bearing medial UKA.
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Affiliation(s)
- Tae Kyun Kim
- TK Orthopedic Institution, 55 Dongpangyo-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13535, Republic of Korea.
| | - Anurag Mittal
- TK Orthopedic Institution, 55 Dongpangyo-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13535, Republic of Korea
| | - Prashant Meshram
- Department of Orthopaedics, Johns Hopkins Medical Institute, 2360 West Joppa Road, Suite 306, Baltimore, MD, 21093, USA
| | - Woo Hyun Kim
- TK Orthopedic Institution, 55 Dongpangyo-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13535, Republic of Korea
| | - Sang Min Choi
- TK Orthopedic Institution, 55 Dongpangyo-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13535, Republic of Korea
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Agarwal N, To K, Zhang B, Khan W. Obesity does not adversely impact the outcome of unicompartmental knee arthroplasty for osteoarthritis: a meta-analysis of 80,798 subjects. Int J Obes (Lond) 2020; 45:715-724. [PMID: 33214703 DOI: 10.1038/s41366-020-00718-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 10/13/2020] [Accepted: 11/02/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Patients with end-stage single compartment osteoarthritis benefit from the less invasive unicompartmental knee arthroplasty (UKA). With increasing financial restraints, some healthcare services have set specific BMI cut-offs when determining patient eligibility for knee arthroplasty due to perceived obesity-related complications. The aim of this systematic review is to determine the effect obesity has on outcomes following UKA, and thus elucidate whether obesity should be a contraindication for UKA. METHODS A PRISMA systematic review was conducted using five databases (MEDLINE, EMBASE, Cochrane, PubMed and Web of Science) to identify all clinical studies that examined the effect of obesity on outcomes following UKA. Quantitative meta-analysis was carried out using RevMan 5.3 software. Quality assessment was carried out using the Critical Appraisal Skills Programme (CASP) checklist. RESULTS Thirty studies, including a total of 80 798 patients were analysed. The mean follow- up duration was 5.42 years. Subgroup meta-analyses showed no statistically significant difference following UKA between patients cohorts with and without obesity in overall complication rates (95% CI, P = 0.52), infection rates (95% CI, P = 0.81), and revision surgeries (95% CI, P = 0.06). When further analysing complications, no differences were identified in minor (95% CI, P = 0.23) and major complications (95% CI, P = 0.68), or venous thromboembolism rates (95% CI, P = 0.06). When further analysing revision surgeries, no differences were identified for revisions specifically for infection (95% CI, P = 0.71) or aseptic loosening (95% CI, P = 0.75). CONCLUSIONS This meta-analysis shows that obesity does not result in poorer post-operative outcomes following UKA and should not be considered a contraindication for UKA. Future studies, including long-term follow-up RCTs and registry-level analyses, should examine factors associated with obesity and consider stratifying obesity to better delineate any potential differences in outcomes.
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Affiliation(s)
- Nikhil Agarwal
- Division of Trauma & Orthopaedic Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, CB2 0QQ, UK. .,MBChB Office, University of Aberdeen College of Life Sciences and Medicine, Foresterhill Rd, Aberdeen, AB25 2ZD, UK.
| | - Kendrick To
- Division of Trauma & Orthopaedic Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Bridget Zhang
- Division of Trauma & Orthopaedic Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Wasim Khan
- Division of Trauma & Orthopaedic Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, CB2 0QQ, UK
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Wada K, Price A, Gromov K, Lustig S, Troelsen A. Clinical outcome of bi-unicompartmental knee arthroplasty for both medial and lateral femorotibial arthritis: a systematic review-is there proof of concept? Arch Orthop Trauma Surg 2020; 140:1503-1513. [PMID: 32529388 DOI: 10.1007/s00402-020-03492-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 05/31/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Unicompartmental knee arthroplasty (UKA) is a well-accepted treatment for isolated unicompartmental osteoarthritis (OA) of the knee. In previous literature, it has been suggested that bi-unicompartmental knee arthroplasty (bi-UKA) which uses two UKA implants in both the medial and lateral compartments of the same knee is a feasible and viable option for the treatment of knee OA. Given the advantages of UKA treatment, it is warranted to review the literature of bi-UKA and discuss the evidence in terms of implant selection, indications, surgical techniques, and outcomes, respectively. MATERIALS AND METHODS Following the PRISMA guidelines, PubMed, Medline, Embase, CINAHL, Web of Science, and Cochrane Library were searched for studies presenting outcome of bi-UKA. Studies were included if they reported clinical outcomes using two unicompartmental prostheses for both medial and lateral femorotibial arthritis. Studies with the addition of patellofemoral arthroplasty or concomitant soft-tissue reconstruction and those not published in English were excluded. RESULTS In the early literature, the procedure of bi-UKA were performed for very severe OA and rheumatoid arthritis, but indications have evolved to reflect a more contemporary case-mix of knee OA patients. Both mobile and fixed bearing implants have been used, with the latter being the most frequent choice. A medial parapatellar approach for incision and arthrotomy has been the most frequently used technique. The present review found a promising clinical outcome of both simultaneous and staged bi-UKA although the number of long-term follow-up studies was limited. CONCLUSIONS Both simultaneous and staged bi-UKA has demonstrated good functional outcomes. However, the volume and level of evidence in general is low for studies captured in this review, and the data on long-term outcomes remain limited. The present review indicates that bi-UKA is a feasible and viable surgical option for bicompartmental femorotibial OA in carefully selected patients.
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Affiliation(s)
- Keizo Wada
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima, 770-8503, Japan. .,Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark.
| | - Andrew Price
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Kirill Gromov
- Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
| | - Sebastien Lustig
- Service de Chirurgie orthopédique, Centre Albert-Trillat, CHU de Lyon-Nord, Lyon, France
| | - Anders Troelsen
- Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
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Mittal A, Meshram P, Kim WH, Kim TK. Unicompartmental knee arthroplasty, an enigma, and the ten enigmas of medial UKA. J Orthop Traumatol 2020; 21:15. [PMID: 32876817 PMCID: PMC7468046 DOI: 10.1186/s10195-020-00551-x] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 07/22/2020] [Indexed: 12/17/2022] Open
Abstract
Unicompartmental knee arthroplasty (UKA) is a bone- and ligament-sparing alternative to total knee arthroplasty in the patients with end-stage single-compartment degeneration of the knee. Despite being a successful procedure, the multiple advantages of UKA do not correlate with its usage, most likely due to the concerns regarding prosthesis survivability, patient selection, ideal bearing design, and judicious use of advanced technology among many others. Therefore, the purpose of this study is to review and summarize the debated literature and discuss the controversies as “Ten Enigmas of UKA.”
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Affiliation(s)
- Anurag Mittal
- TK Orthopedic Surgery, 55 Dongpangyo-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13535, Republic of Korea
| | - Prashant Meshram
- Department of Orthopaedics, Johns Hopkins Medical Institute, 2360 West Joppa Road, Suite 306, Baltimore, MD, 21093, USA
| | - Woo Hyun Kim
- TK Orthopedic Surgery, 55 Dongpangyo-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13535, Republic of Korea
| | - Tae Kyun Kim
- TK Orthopedic Surgery, 55 Dongpangyo-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13535, Republic of Korea.
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Does the overhang of tibial component in fixed bearing medial unicondylar knee arthroplasty affect 1-year results? JOURNAL OF SURGERY AND MEDICINE 2020. [DOI: 10.28982/josam.759045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Burger JA, Kleeblad LJ, Sierevelt IN, Horstmann WG, van Geenen RCI, van Steenbergen LN, Nolte PA. A Comprehensive Evaluation of Lateral Unicompartmental Knee Arthroplasty Short to Mid-Term Survivorship, and the Effect of Patient and Implant Characteristics: An Analysis of Data From the Dutch Arthroplasty Register. J Arthroplasty 2020; 35:1813-1818. [PMID: 32192831 DOI: 10.1016/j.arth.2020.02.027] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 02/07/2020] [Accepted: 02/12/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The rarity of lateral unicompartmental knee arthroplasty (UKA) results in a lack of large cohort studies and understanding. The aim of this study is to comprehensively evaluate survivorship of lateral UKA with registry data and compare this to medial UKA. METHODS Lateral (n = 537) and medial UKAs (n = 19,295) in 2007-2017 were selected from the Dutch Arthroplasty Register. Survival analyses were performed with revision for any reason as primary endpoint. Adjustments were made for patient and implant characteristics. Stratified analyses according to patient and implant characteristics were performed. Reasons and type of revision were grouped according to laterality and bearing design. RESULTS The 5-year revision rate was 12.9% for lateral UKA and 9.3% for medial UKA. Multivariable regression analyses showed no significant increased risk for revision for lateral UKA (hazard ratio 0.87, 95% confidence interval 0.66-1.15). Stratified analyses showed that the effect of patient characteristics on revision was comparable between lateral and medial UKA; however, the use of mobile-bearing design for lateral UKA was associated with increased revision rate. Progression of osteoarthritis was the main reason for revision on both sides accompanied by tibia component loosening for medial UKA. Reasons and type of revision varied depending on bearing design. CONCLUSION Similar survivorship of lateral and medial UKA was reported. Specifically, there is a notable risk for revision when using mobile-bearing designs for lateral UKA. Failure modes and type of revision depends on laterality and bearing design. These findings emphasize that surgical challenges related to anatomy and kinematics of the lateral and medial knee compartment need to be considered.
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Affiliation(s)
- Joost A Burger
- Department of Orthopaedic Surgery, Computer Assisted Surgery Center, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY
| | - Laura J Kleeblad
- Department of Orthopaedic Surgery, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - Inger N Sierevelt
- Department of Orthopaedic Surgery, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - Wieger G Horstmann
- Department of Orthopaedic Surgery, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | | | | | - Peter A Nolte
- Department of Orthopaedic Surgery, Spaarne Gasthuis, Hoofddorp, The Netherlands
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Szarek A, Stradomski G, Łukomska-Szarek J, Rydz D, Wolański W, Joszko K. Wear Morphology on the Surfaces of CoCrMo Unicompartmental Knee Joint Endoprostheses as Elements of Metal-Metal Friction Nodes. MATERIALS (BASEL, SWITZERLAND) 2020; 13:E2689. [PMID: 32545611 PMCID: PMC7345842 DOI: 10.3390/ma13122689] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 06/05/2020] [Accepted: 06/09/2020] [Indexed: 01/17/2023]
Abstract
The article assesses the strength and structural parameters of load-bearing layers of metal biobearings made of CoCrMo alloy. The research material consisted of unicompartmental knee joint endoprostheses used in the human body, removed due to excessive wear. No patient participated in the examinations. The endoprostheses used as research material underwent the liquidation procedures in the hospital, which has all necessary permissions and certifications to perform endoprosthetic procedures. Endoprostheses selected for the examinations had been used for 6 to 12 years at similar load conditions as declared by the patients, i.e., body weight of F = 835 N, declared activity expressed as the number of load cycles up to 100 thousand/year, and no artificial joint infections. To assess the homogeneity of the research material, the analysis of chemical composition using a Joel scanning electron microscope with EDS (Energy-dispersive X-ray spectroscopy) was made to exclude endoprostheses with various alloying additives. Microscopic examinations were performed using the Phenom XL microscope, while the wear surface was examined using a Keyence VHX-900F microscope. Several experimental tests were also carried out on load-bearing surfaces to assess changes in strength parameters of the base material after a known life cycle and load conditions. Material hardness using the Vickers method, yield point, critical value of stress intensity coefficient, and the coefficient of friction µ were evaluated. The examinations allowed for the systematization of wear in the knee and femoral components of unicompartmental hip endoprostheses. The statistical evaluation of the number and costs of hip joint replacement surgeries in Poland was also made.
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Affiliation(s)
- Arkadiusz Szarek
- Faculty of Mechanical Engineering and Computer Science, Department of Technology and Automation, Czestochowa University of Technology, 21 Armii Krajowej Av., 42-201 Czestochowa, Poland;
| | - Grzegorz Stradomski
- Faculty of Production Engineering and Materials Technology, Czestochowa University of Technology, 19 Armii Krajowej Av., 42-201 Czestochowa, Poland; (G.S.); (D.R.)
| | - Justyna Łukomska-Szarek
- Faculty of Management, Czestochowa University of Technology, 19 B Armii Krajowej Av., 42-201 Czestochowa, Poland;
| | - Dariusz Rydz
- Faculty of Production Engineering and Materials Technology, Czestochowa University of Technology, 19 Armii Krajowej Av., 42-201 Czestochowa, Poland; (G.S.); (D.R.)
| | - Wojciech Wolański
- Faculty of Biomedical Engineering, Department of Biomechatronics, Silesian University of Technology, 40 Roosevelta Av., 41-800 Zabrze, Poland;
| | - Kamil Joszko
- Faculty of Biomedical Engineering, Department of Biomechatronics, Silesian University of Technology, 40 Roosevelta Av., 41-800 Zabrze, Poland;
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Kagan R, Anderson MB, Bailey T, Hofmann AA, Pelt CE. Ten-Year Survivorship, Patient-Reported Outcomes, and Satisfaction of a Fixed-Bearing Unicompartmental Knee Arthroplasty. Arthroplast Today 2020; 6:267-273. [PMID: 32577476 PMCID: PMC7303483 DOI: 10.1016/j.artd.2020.02.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 02/20/2020] [Accepted: 02/23/2020] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND We sought to determine the 10-year survivorship and reasons for revision for a fixed-bearing unicompartmental knee arthroplasty (UKA) design. In addition, we report on patient-reported outcomes and satisfaction and compare results of medial vs lateral compartment UKA and cemented vs cementless UKA with the same design. METHODS We performed a retrospective cohort study on a single-surgeon case series using a single fixed-bearing UKA design in 158 consecutive patients who underwent 177 UKA procedures between July 2000 and December 2010. Cases missing follow-up within the last year, clinically or via telephone, were excluded (n = 17, 10%). A cumulative incidence competing risk model was used to evaluate the cumulative incidence of failure. RESULTS Cumulative incidence of revision at a mean follow-up of 10 years was 13%. The majority of revisions (43%, 10/23) were for aseptic tibial component loosening, followed by progression of osteoarthritis (5/23, 22%). All Patient Reported Outcomes Measurement Information System measures demonstrated mean T-scores within one standard deviation from the US population norm. The mean Knee Injury and Osteoarthritis Outcome Score for Joint Replacement was 96.9 (range, 40-100). The mean pain score was 3.8 (range, 0-8). Eighty-six percent of patients were satisfied with the UKA. CONCLUSIONS At 10-year follow-up, the most common causes for revision were aseptic tibial loosening and adjacent compartment knee arthroplasty, and similar results were found for medial vs lateral compartment and for cemented vs cementless UKA. Surgeons should consider these findings for future UKA designs, and this represents the first study reporting on survivorship and outcomes of this specific UKA design.
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Affiliation(s)
- Ryland Kagan
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR, USA
| | - Mike B. Anderson
- Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Travis Bailey
- Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | | | - Christopher E. Pelt
- Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, UT, USA
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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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St Mart JP, de Steiger RN, Cuthbert A, Donnelly W. The three-year survivorship of robotically assisted versus non-robotically assisted unicompartmental knee arthroplasty. Bone Joint J 2020; 102-B:319-328. [PMID: 32114810 DOI: 10.1302/0301-620x.102b3.bjj-2019-0713.r1] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIM There has been a significant reduction in unicompartmental knee arthroplasty (UKA) procedures recorded in Australia. This follows several national joint registry studies documenting high UKA revision rates when compared to total knee arthroplasty (TKA). With the recent introduction of robotically assisted UKA procedures, it is hoped that outcomes improve. This study examines the cumulative revision rate of UKA procedures implanted with a newly introduced robotic system and compares the results to one of the best performing non-robotically assisted UKA prostheses, as well as all other non-robotically assisted UKA procedures. METHODS Data from the Australian Orthopaedic Association National Joint Arthroplasty Registry (AOANJRR) for all UKA procedures performed for osteoarthritis (OA) between 2015 and 2018 were analyzed. Procedures using the Restoris MCK UKA prosthesis implanted using the Mako Robotic-Arm Assisted System were compared to non-robotically assisted Zimmer Unicompartmental High Flex Knee System (ZUK) UKA, a commonly used UKA with previously reported good outcomes and to all other non-robotically assisted UKA procedures using Cox proportional hazard ratios (HRs) and Kaplan-Meier estimates of survivorship. RESULTS There was no difference in the rate of revision when the Mako-assisted Restoris UKA was compared to the ZUK UKA (zero to nine months: HR 1.14 (95% CI 0.71 to 1.83; p = 0.596) vs nine months and over: HR 0.66 (95% CI 0.42 to 1.02; p = 0.058)). The Mako-assisted Restoris had a significantly lower overall revision rate compared to the other types of non-robotically assisted procedures (HR 0.58 (95% confidence interval (CI) 0.42 to 0.79); p < 0.001) at three years. Revision for aseptic loosening was lower for the Mako-assisted Restoris compared to all other non-robotically assisted UKA (entire period: HR 0.34 (95% CI 0.17 to 0.65); p = 0.001), but not the ZUK prosthesis. However, revision for infection was significantly higher for the Mako-assisted Restoris compared to the two comparator groups (ZUK: entire period: HR 2.91 (95% CI 1.22 to 6.98; p = 0.016); other non-robotically assisted UKA: zero to three months: HR 5.57 (95% CI 2.17 to 14.31; p < 0.001)). CONCLUSION This study reports comparable short-term survivorship for the Mako robotically assisted UKA compared to the ZUK UKA and improved survivorship compared to all other non-robotic UKA. These results justify the continued use and investigation of this procedure. However, the higher rate of early revision for infection for robotically assisted UKA requires further investigation. Cite this article: Bone Joint J 2020;102-B(3):319-328.
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Affiliation(s)
- Jean-Pierre St Mart
- St Vincent's Hospital Northside, Brisbane, Queensland, Australia.,The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Richard N de Steiger
- Department of Surgery, Epworth HealthCare, University of Melbourne, Melbourne, Victoria, Australia.,Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), Adelaide, South Australia, Australia
| | - Alana Cuthbert
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - William Donnelly
- St Vincent's Hospital Northside, Brisbane, Queensland, Australia.,The Prince Charles Hospital, Brisbane, Queensland, Australia.,Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), Adelaide, South Australia, Australia.,Queensland University of Technology, Brisbane, Queensland, Australia
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Sano M, Oshima Y, Murase K, Sasatani K, Takai S. Finite-Element Analysis of Stress on the Proximal Tibia After Unicompartmental Knee Arthroplasty. J NIPPON MED SCH 2020; 87:260-267. [PMID: 32009074 DOI: 10.1272/jnms.jnms.2020_87-504] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Because the indications for unicompartmental knee arthroplasty (UKA) are limited, few patients have undergone the procedure. Therefore, it is difficult to decide the acceptable range of variation in the details of UKA on the basis of the available clinical data. The objective of this study was to identify factors that affect the distribution of stress on the proximal tibia after UKA. METHODS Two-dimensional finite-element analysis of the proximal tibia was used to assess four factors: 1) two types of implants-all ultra-high-molecular-weight polyethylene (UHMWPE) and metal-backed implants, 2) postoperative alignment, 3) coverage of tibial bone, 4) level of the tibial osteotomy. RESULTS In cases of varus alignment, high stress values and large areas of deformation were observed on and beneath the implant. In cases of valgus alignment, stress was concentrated at the lateral portion of tibial tray. In comparison with the standard model, stress concentration was greater at the medial edge of the medial condyle in a narrow-coverage model. Stress distribution for the low-osteotomy-level model did not differ markedly differ from that for the standard model. Stress distribution was better for metal-backed implants than for UHMWPE implants. CONCLUSIONS Proper postoperative alignment must be achieved in UKA. The osteotomy level should be set at the cancellous bone close to the joint line, and preservation of bone stock should be maximized.
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Affiliation(s)
- Mihoro Sano
- Department of Orthopaedic Surgery, Nippon Medical School
| | - Yasushi Oshima
- Department of Orthopaedic Surgery, Nippon Medical School
| | - Kohei Murase
- Center for Industry-University Collaboration, Graduate School of Engineering Science, Osaka University
| | | | - Shinro Takai
- Department of Orthopaedic Surgery, Nippon Medical School
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Greater activity, better range of motion and higher quality of life following unicompartmental knee arthroplasty: a comparative case-control study. Arch Orthop Trauma Surg 2020; 140:231-237. [PMID: 31686181 PMCID: PMC6989597 DOI: 10.1007/s00402-019-03296-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Indexed: 01/06/2023]
Abstract
PURPOSE The purpose of this study was to provide a matched cohort comparison of clinical and functional outcome scores, range of motion and quality of life following unicompartmental knee arthroplasty (UKA) or total knee arthroplasty (TKA). The hypothesis was that patients receiving UKA report better results than comparable patients who receive conventional TKA. METHODS Clinical and functional results of 35 patients with medial end-stage osteoarthritis who had received a fixed-bearing UKA were compared with the results of 35 matched patients who had received a TKA from the same manufacturer by the same surgeon. Outcome scores were measured before surgery and at final follow-up using Tegner Activity Scale (TAS), range of motion (ROM) and Short Form 36 Health Survey (SF-36). The Knee Society Score (KSS) was assessed at final follow-up. The mean observation period was 2.3 years in both groups. RESULTS The preoperative knee scores had no statistically significant differences between the two groups. Postoperatively, however, UKAs performed significantly better regarding TAS and ROM (4 vs. 3 and 118.4 vs. 103.7, respectively). The results of the SF-36 showed significantly better results for the UKA group in the mental component summary score and in the subscale of social function. CONCLUSIONS The present study suggests that UKA is associated with higher activity level, higher quality of life, and greater ROM when compared with TKA on comparable patients. Prolonged clinical follow-up in a larger patient cohort with a randomised-controlled study design would be beneficial to confirm these findings. LEVEL OF EVIDENCE III.
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Burger JA, Kleeblad LJ, Laas N, Pearle AD. Mid-term survivorship and patient-reported outcomes of robotic-arm assisted partial knee arthroplasty. Bone Joint J 2020; 102-B:108-116. [DOI: 10.1302/0301-620x.102b1.bjj-2019-0510.r1] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Aims Limited evidence is available on mid-term outcomes of robotic-arm assisted (RA) partial knee arthroplasty (PKA). Therefore, the purpose of this study was to evaluate mid-term survivorship, modes of failure, and patient-reported outcomes of RA PKA. Methods A retrospective review of patients who underwent RA PKA between June 2007 and August 2016 was performed. Patients received a fixed-bearing medial or lateral unicompartmental knee arthroplasty (UKA), patellofemoral arthroplasty (PFA), or bicompartmental knee arthroplasty (BiKA; PFA plus medial UKA). All patients completed a questionnaire regarding revision surgery, reoperations, and level of satisfaction. Knee Injury and Osteoarthritis Outcome Scores (KOOS) were assessed using the KOOS for Joint Replacement Junior survey. Results Mean follow-up was 4.7 years (2.0 to 10.8). Five-year survivorship of medial UKA (n = 802), lateral UKA (n = 171), and PFA/BiKA (n = 35/10) was 97.8%, 97.7%, and 93.3%, respectively. Component loosening and progression of osteoarthritis (OA) were the most common reasons for revision. Mean KOOS scores after medial UKA, lateral UKA, and PFA/BiKA were 84.3 (SD 15.9), 85.6 (SD 14.3), and 78.2 (SD 14.2), respectively. The vast majority of the patients reported high satisfaction levels after RA PKA. Subgroup analyses suggested tibial component design, body mass index (BMI), and age affects RA PKA outcomes. Five-year survivorship was 98.4% (95% confidence interval (CI) 97.2 to 99.5) for onlay medial UKA (n = 742) and 99.1% (95% CI 97.9 to 100) for onlay medial UKA in patients with a BMI < 30 kg/m2 (n = 479). Conclusion This large single-surgeon study showed high mid-term survivorship, satisfaction levels, and functional outcomes in RA UKA using metal-backed tibial onlay components. In addition, favourable results were reported in RA PFA and BiKA. Cite this article: Bone Joint J 2020;102-B(1):108–116
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Affiliation(s)
- Joost A. Burger
- Department of Orthopaedic Surgery and Computer Assisted Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Laura J. Kleeblad
- Department of Orthopaedic Surgery and Computer Assisted Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Niels Laas
- Department of Orthopaedic Surgery and Computer Assisted Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Andrew D. Pearle
- Department of Orthopaedic Surgery and Computer Assisted Surgery, Hospital for Special Surgery, New York, New York, USA
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Comparison of Fixed-Bearing and Mobile-Bearing Unicompartmental Knee Arthroplasty: A Systematic Review and Meta-Analysis. J Arthroplasty 2019; 34:3114-3123.e3. [PMID: 31474324 DOI: 10.1016/j.arth.2019.07.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 06/12/2019] [Accepted: 07/08/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Prior studies have compared fixed-bearing unicompartmental knee arthroplasty (FB-UKA) with mobile-bearing UKA (MB-UKA), suggesting that both procedures have good clinical outcomes. However, which treatment is more beneficial for patients is controversial. The purpose of our study is to evaluate the postoperative outcomes, including the revision rate, complications, functional results, range of motion, and femoral-tibial angle, between the 2 procedures. METHODS We searched the MEDLINE, EMBASE, Cochrane Library, and Web of Science databases starting from August 2017 to May 2018. The publication date of articles was not restricted. Before we submit our contribution, we have re-searched it again. Articles that directly compared the postoperative outcomes of the 2 prosthesis type were included. RESULTS A total of 15 comparative studies were included in our meta-analysis. The pooled data indicated no differences between the 2 operation modes in terms of revision rates, complications, and knee function, but earlier failure occurred more frequently with the MB design. CONCLUSION Both the arthroplasty types provided satisfactory clinical results for patients with classic indications. However, MB-UKA tended to fail in early postoperative years whereas fixed-bearing UKA in later postoperative years. Therefore treatment options should be carefully considered for each patient, and surgeons should still use their personal experience when deciding between these options.
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Sasatani K, Majima T, Murase K, Takeuchi N, Matsumoto T, Oshima Y, Takai S. Three-Dimensional Finite Analysis of the Optimal Alignment of the Tibial Implant in Unicompartmental Knee Arthroplasty. J NIPPON MED SCH 2019; 87:60-65. [PMID: 31611507 DOI: 10.1272/jnms.jnms.2020_87-202] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Although unicompartmental knee arthroplasty (UKA) has become more common because of its good outcomes, several complications have been reported. Tibial implant alignment, an important cause of such complications, has been investigated; however, the optimal alignment of the tibial implant has not been determined. This study used 3-dimensional finite element analysis to investigate changes in stress distribution in the proximal tibia after UKA at multiple tibial implant alignments. METHODS A 3-dimensional finite element model was created with CT digital imaging and communications in medicine (CT-DICOM) data from a medial osteoarthritic knee. Change in stress distribution of the tibial implant alignment on the coronal plane (middle position, varus 5°, valgus 5°) and sagittal plane (0°, 5°, 10°) under conditions of a loose boundary between implant and bone and no loosening was analyzed with 3-dimensional finite analysis. RESULTS In the absence of loosening, the stress distribution was high at the lateral rim of the subchondral bone in the varus alignment model, and the high stress distribution moved from the anterior to the posterior position with posterior tilting from 0° to 10°. With loosening, the stress distribution was high at the proximal tibial medial cortex in the valgus alignment model. CONCLUSIONS To reduce UKA complications, the present findings indicate that the optimal alignment of the tibial implant is at the middle position on the coronal plane, with a posterior inclination similar to the original inclination on the sagittal plane.
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Affiliation(s)
| | | | - Kohei Murase
- Center for Industry-University Collaboration, Graduate School of Engineering Science, Osaka University
| | - Naoki Takeuchi
- Department of Mechanical Science and Engineering, Graduate School of Engineering, Nagoya University
| | - Takeo Matsumoto
- Department of Mechanical Science and Engineering, Graduate School of Engineering, Nagoya University
| | - Yasushi Oshima
- Department of Orthopaedic Surgery, Nippon Medical School
| | - Shinro Takai
- Department of Orthopaedic Surgery, Nippon Medical School
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Burger JA, Kleeblad LJ, Laas N, Pearle AD. The Influence of Preoperative Radiographic Patellofemoral Degenerative Changes and Malalignment on Patellofemoral-Specific Outcome Scores Following Fixed-Bearing Medial Unicompartmental Knee Arthroplasty. J Bone Joint Surg Am 2019; 101:1662-1669. [PMID: 31567803 DOI: 10.2106/jbjs.18.01385] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND There is controversy as to whether the presence of degenerative changes and malalignment of the patellofemoral joint is a contraindication to medial unicompartmental knee arthroplasty. Therefore, the aim of the present study was to examine the influence of preoperative radiographic patellofemoral joint osteoarthritis and alignment on intermediate-term knee and patellofemoral joint-specific patient-reported outcomes following fixed-bearing medial unicompartmental knee arthroplasty. METHODS We performed a retrospective review of the records on a consecutive series of patients who had undergone robotic arm-assisted fixed-bearing onlay medial unicompartmental knee arthroplasty and had a minimum duration of follow-up of 2 years. All records were collected from a single surgeon's arthroplasty registry. Patients with severe bone loss or grooving of the lateral patellar facet were excluded. Radiographic assessment was performed with use of the Kellgren-Lawrence and Altman classification systems as well as with patellofemoral joint alignment measurements. The latest follow-up consisted of a patient-reported questionnaire, including the Kujala (Anterior Knee Pain Scale) score, the Knee Injury and Osteoarthritis Outcome Score (KOOS), Junior (JR), and satisfaction levels. RESULTS A total of 536 patients (639 knees) were included. After a mean duration of follow-up (and standard deviation) of 4.3 ± 1.6 years (range, 2.0 to 9.2 years), good-to-excellent Kujala scores were reported independent of the presence of patellofemoral joint osteoarthritis preoperatively (Kellgren-Lawrence grade 0 compared with ≥1, p = 0.82; grade ≤1 compared with ≥2, p = 0.84). Similar findings were found when osteoarthritis was present in either the medial or lateral side of the patellofemoral joint as defined by an Altman score of ≥2 (medial, p = 0.81; lateral, p = 0.90). KOOS scores and satisfaction also were not affected by degenerative patellofemoral joint changes. Furthermore, neither the patellar tilt angle nor the congruence angle influenced patient-reported outcomes. CONCLUSIONS Preoperative radiographic mild to moderate patellofemoral joint degeneration (Kellgren-Lawrence grades 1 through 3) and/or malalignment did not compromise intermediate-term knee and patellofemoral joint-specific patient-reported outcomes in patients managed with fixed-bearing medial unicompartmental knee arthroplasty. On the basis of the results of the present study, we believe that neither mild to moderate patellofemoral degeneration nor abnormal patellar tilt or congruence should be considered a contraindication to fixed-bearing medial unicompartmental knee arthroplasty. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Joost A Burger
- Department of Orthopaedic Surgery and Computer Assisted Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY
| | - Laura J Kleeblad
- Department of Orthopaedic Surgery and Computer Assisted Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY
| | - Niels Laas
- Department of Orthopaedic Surgery and Computer Assisted Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY
| | - Andrew D Pearle
- Department of Orthopaedic Surgery and Computer Assisted Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY
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Winnock de Grave P, Luyckx T, Ryckaert A, Noyez J, Gunst P, Van den Daelen L. Medial Unicompartmental Knee Arthroplasty with a Fixed Bearing Implant. JBJS Essent Surg Tech 2019; 9:e26. [PMID: 32021723 PMCID: PMC6948995 DOI: 10.2106/jbjs.st.18.00083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Unicompartmental knee arthroplasty (UKA) is an alternative to total knee arthroplasty in isolated medial arthritis. UKA restores native tibial and femoral joint surfaces and corrects pre-disease limb alignment, by which natural knee biomechanics are restored, ensuring effective functional recovery. Proper patient selection and accurate surgical technique contribute to good functional outcome and long-term survival. The key steps of the procedure (as well as multiple tips and tricks) are demonstrated in the video article: (1) preoperative assessment and planning; (2) patient positioning and setup; (3) exposure; (4) instrument options and surgical technique; (5) distal femoral resection; (6) proximal tibial resection; (7) assessment of alignment and gaps; (8) finishing the femur—sizing, position, and posterior resection; (9) finishing the tibia—sizing and position; (10) trialing the implant; (11) implanting final components—cementing technique; (12) closure; and (13) rehabilitation. Following these surgical steps and principles will lead to excellent functional long-term results with a low revision rate and a minimum of complications.
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Affiliation(s)
| | - Thomas Luyckx
- Orthopaedic Department, AZ Delta Hospital, Roeselare, Belgium
| | | | - Jan Noyez
- Orthopaedic Department, AZ Delta Hospital, Roeselare, Belgium
| | - Paul Gunst
- Orthopaedic Department, AZ Delta Hospital, Roeselare, Belgium
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Clinical results and 12-year survivorship of the Physica ZUK unicompartmental knee replacement. Knee 2019; 26:750-758. [PMID: 30885547 DOI: 10.1016/j.knee.2019.02.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 01/21/2019] [Accepted: 02/27/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND The Physica ZUK is a fixed bearing unicompartmental knee replacement. The purpose of this prospective cohort study was to determine the mid-term clinical outcomes and survivorship of the Physica ZUK. METHODS From 2005 to 2017 a total of 466 Physica ZUK prostheses were implanted in 398 patients by a single surgeon. The series consisted of 452 medial and 14 lateral unicompartmental knee arthroplasties (UKAs). Three hundred and sixty-seven medial UKAs with a minimum follow-up of two years (median 5.4 years) and 14 lateral UKAs with a minimum follow-up of 18 months (median 5.3 years) were analysed using the Knee Society Knee Score (KS-KS) and Function Score (KS-FS) at latest follow-up. Kaplan Meier survivorship analysis was performed with implant revision as the end point. RESULTS Mean age at the time of surgery was 67 (range 42-88) and 58 (47-69) years for patients undergoing medial and lateral UKA respectively. For medial UKAs the KS-KS and KS-FS improved significantly compared to the pre-operative values from 53.6 and 54.0 to 93.4 and 91.0 respectively (p = 0.0001). For lateral UKAs the KS-KS and KS-FS improved significantly from 46.4 and 48.7 to 91.3 and 93.1 respectively (p = 0.0001). Six cases of medial UKA were revised to total knee arthroplasty. Medial implant survivorship was 97.9% (95% confidence intervals, 95.6-99.0%) at both five and 10 years. No lateral implants were revised. CONCLUSION This prospective cohort study shows encouraging short to mid-term clinical results and survivorship for the Physica ZUK unicompartmental knee replacement.
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