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Xu K, Wang T, Yu T, Zhao X, Zhang Y, Zhang L. Effect of body mass index on 30-day complication rate and implant survival rate after simultaneous bilateral unicompartmental knee arthroplasty: a multicentre retrospective study. BMC Musculoskelet Disord 2024; 25:518. [PMID: 38970062 PMCID: PMC11229017 DOI: 10.1186/s12891-024-07639-z] [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: 11/09/2023] [Accepted: 06/28/2024] [Indexed: 07/07/2024] Open
Abstract
OBJECTIVE The practice of simultaneous bilateral unicompartmental knee arthroplasty (SBUKA) remains a topic of debate, particularly in patients with obesity. Thus, the purpose of this study was to assess the impact of body mass index (BMI) on the 30-day complication rate and the survival rate of the implant following SBUKA. METHODS We retrospectively examined the clinical records of 245 patients (490 knees) who underwent SBUKA at the Affiliated Hospital of Qingdao University and the Third Hospital of Hebei Medical University between January 2010 and December 2020. Patients were categorised based on their BMI at the time of surgery into four groups: normal weight (BMI 18.5 to 22.9 kg/m2), overweight (BMI 23.0 to 24.9 kg/m2), obese (BMI 25.0 to 29.9 kg/m2), and severely obese (BMI ≥30 kg/m2). Variables such as length of hospital stay, duration of surgery, and costs of hospitalisation were compared across all groups. Additionally, we recorded the 30-day postoperative complication rate and the time from surgery to any required revision. The Kaplan-Meier survival analysis was employed to evaluate and compare the implant survival rates. RESULTS The follow-up period for the 245 patients ranged from 39 to 114 months, with an average of 77.05±18.71 months. The incidence of complications within 30 days post-surgery did not significantly differ across the groups (χ2 = 1.102, p = 0.777). The implant survival rates from the lowest to the highest BMI groups were 97.14%, 93.9%, 94.44%, and 96.43%, respectively. Both the rate of implant revision (χ2 =1.612, p = 0.657) and the survival curves of the implants (p = 0.639) showed no statistically significant differences among the groups. CONCLUSIONS BMI did not influence the 30-day complication rate nor the survival rate of implants following SBUKA, suggesting that SBUKA should not be contraindicated based on BMI alone.
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Affiliation(s)
- Kuishuai Xu
- Department of Sports Medicine, the Affiliated Hospital of Qingdao University, Shandong Qingdao, 266000, China
| | - Tianrui Wang
- Department of Traumatology, the Affiliated Hospital of Qingdao University, Shandong Qingdao, 266000, China
| | - Tengbo Yu
- Department of Orthopedic Surgery, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), Shandong Qingdao, 266000, China
| | - Xia Zhao
- Department of Sports Medicine, the Affiliated Hospital of Qingdao University, Shandong Qingdao, 266000, China
| | - Yingze Zhang
- Department of Sports Medicine, the Affiliated Hospital of Qingdao University, Shandong Qingdao, 266000, China.
| | - Liang Zhang
- Department of Abdominal ultrasound, the Affiliated Hospital of Qingdao University, Shandong Qingdao, 266000, China.
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Hiranaka T. Advantages and limitations of mobile-bearing unicompartmental knee arthroplasty: an overview of the literature. Expert Rev Med Devices 2024; 21:587-600. [PMID: 38873929 DOI: 10.1080/17434440.2024.2367002] [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] [Received: 08/20/2023] [Accepted: 06/07/2024] [Indexed: 06/15/2024]
Abstract
INTRODUCTION Interest in unicompartmental knee arthroplasty (UKA) has recently grown. Mobile bearing UKA, in which the bearing is not fixed but rather perfectly conforms with femoral and tibial components and moves completely passively between the femoral and tibial implant, has now been used for approximately half a century. AREAS COVERED Alongside the recognized advantages of UKA, the mobile-bearing variant benefits from an extremely low rate of polyethylene wear and tolerable minor malalignment. Revision rates for UKA have been reported to exceed those of total knee arthroplasty, but long-term survival rates and outcomes from mobile-bearing UKA have been found to be satisfactory. In addition to the lateral osteoarthritis and loosening, which are main complications of UKA, bearing dislocation is a specific complication of mobile bearing UKA. Fractures and valgus subsidence are more prevalent than in the cementless UKA. While these continue to be features to be addressed, they have been partially solved. EXPERT OPINION Given the manifold benefits of UKA, its application could be extended to a larger patient population. Successful outcomes rely on careful patient selection and the surgeon's extensive familiarity with the procedure. Looking ahead, the incorporation of robotic surgery, already a feature of some fixed-bearing UKAs, might shape the future trajectory of mobile-bearing UKA.
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Affiliation(s)
- Takafumi Hiranaka
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Takatsuki, Osaka, Japan
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Zheng N, Dai H, Zou D, Wang Q, Tsai TY. Safe bearing region for avoiding meniscal bearing impingement and overhang in mobile-bearing unicompartmental knee arthroplasty. J Orthop Res 2024; 42:1200-1209. [PMID: 38084771 DOI: 10.1002/jor.25767] [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: 07/13/2023] [Revised: 10/30/2023] [Accepted: 11/14/2023] [Indexed: 01/17/2024]
Abstract
The purposes of this study were to propose a quantitative method of bearing overhang to minimize the effect of bearing spinning on mobile-bearing unicompartmental knee arthroplasty (MB UKA), suggest and apply safe bearing regions in daily activities. The overhang distance and area were calculated for neutral and spinning positions. The safe bearing regions were based on the relationship between bearing overhang and linear wear rate. Eleven patients were included in an in-vivo experiment under dual fluoroscopic imaging following medial MB UKA. The bearing position was tracked by minimal joint space width, and the bearing overhang was calculated accordingly. Due to an equal contribution of 1 mm increase in medial overhang and 30 mm2 overhang areato wear rate, the maximum effect of potential bearing spinning on medial overhang distance was approximately three times as large as the overhang area. The safe bearing distance and area regions were rectangles and arches with different scales for different size combinations of bearing, femoral and tibial components. The maximum bearing overhang area during lunge (R = 0.76, p = 0.006) and open-chain exercise (R = 0.68, p = 0.02) significantly correlated with the overhang area in standing. The overhang area can be an appropriate parameter for evaluating dislocation degree less affected by potential bearing spinning than the overhang distance in clinical practice. The corresponding safe overhang area regions were proposed for surgical planning and postoperative dislocation degree evaluation. The bearing overhang area in static standing posture can be a valuable reference to estimate the dynamic overhang area and dislocation degree during motion.
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Affiliation(s)
- Nan Zheng
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
- Engineering Research Center for Digital Medicine of the Ministry of Education, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Orthopaedic Implants & Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huiyong Dai
- Department of Orthopedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Diyang Zou
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
- Engineering Research Center for Digital Medicine of the Ministry of Education, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Orthopaedic Implants & Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qi Wang
- Department of Orthopedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tsung-Yuan Tsai
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
- Engineering Research Center for Digital Medicine of the Ministry of Education, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Orthopaedic Implants & Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Hiranaka T, Kamachi M, Hayashi T, Inoue R, Ogino S, Koide M, Fujishiro T, Okamoto K. Propensity of the tight mid-flexion and loose flexion gap despite the adjustment of extension and flexion gaps in Oxford unicompartmental knee arthroplasty: retrospective study. Arch Orthop Trauma Surg 2024; 144:2783-2788. [PMID: 38761236 DOI: 10.1007/s00402-024-05377-4] [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: 03/29/2023] [Accepted: 05/07/2024] [Indexed: 05/20/2024]
Abstract
PURPOSE A well-balanced joint gap is necessary in Oxford unicompartmental knee arthroplasty (OUKA) to prevent mobile-bearing dislocation. While the gaps between 20° (extension) and 100° (flexion) are precisely adjusted using the incremental mill system, there has been insufficient evaluation of gaps in other angles. We hypothesized that the gap is not always the same in other angles. This retrospective study aimed to evaluate the gap in full-extension (0°), mid-flexion (60°) and deep flexion (130°) for comparison with those in extension and flexion gaps. METHODS We evaluated 119 knees in 83 patients (51 females, 31 males, aged 71.9 years). The full-extension and mid-flexion gaps were compared with the extension gap, and the deep flexion gap was contrasted with the flexion gap. Each gap was classified into isometric, tight or loose, for evaluation of contributing factors. RESULTS Although the full-extension gap tended to be isometric (45%), the mid-flexion tended to be tight (48%), whereas the deep-flexion was loose in most knees (84%) (P = 0.002). The tight mid-flexion and loose deep flexion gap pattern accounted for 44% of the total knees, especially so with smaller femoral components (P = 0.004). CONCLUSION Our results highlight the propensity of tight mid-flexion and loose flexion gap despite the adjustment of extension and flexion gaps in OUKA. Although the effect of such a minor gap imbalance is still unknown, the pattern was more prevalent in patients with smaller-sized femoral components. Use of a larger femoral component may equalize the gap throughout the motion arc.
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Affiliation(s)
- Takafumi Hiranaka
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, 1-3-13, Kosobe- cho, Takatsuki, Osaka, 569-1192, Japan.
| | - Masamune Kamachi
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, 1-3-13, Kosobe- cho, Takatsuki, Osaka, 569-1192, Japan
| | - Takuma Hayashi
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, 1-3-13, Kosobe- cho, Takatsuki, Osaka, 569-1192, Japan
| | - Ryoma Inoue
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, 1-3-13, Kosobe- cho, Takatsuki, Osaka, 569-1192, Japan
| | - Sota Ogino
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, 1-3-13, Kosobe- cho, Takatsuki, Osaka, 569-1192, Japan
| | - Motoki Koide
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, 1-3-13, Kosobe- cho, Takatsuki, Osaka, 569-1192, Japan
| | - Takaaki Fujishiro
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, 1-3-13, Kosobe- cho, Takatsuki, Osaka, 569-1192, Japan
| | - Koji Okamoto
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, 1-3-13, Kosobe- cho, Takatsuki, Osaka, 569-1192, Japan
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Nakano N, Tsubosaka M, Kamenaga T, Kuroda Y, Ishida K, Hayashi S, Kuroda R, Matsumoto T. Predicting postoperative coronal alignment after fixed-bearing unicompartmental knee arthroplasty using a new morphological assessment method: the arithmetic hip-knee-ankle angle. INTERNATIONAL ORTHOPAEDICS 2024; 48:889-897. [PMID: 38150005 PMCID: PMC10933208 DOI: 10.1007/s00264-023-06072-6] [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: 11/27/2023] [Accepted: 12/10/2023] [Indexed: 12/28/2023]
Abstract
PURPOSE Only a few reports have been published so far on factors that predict postoperative coronal alignment after unicompartmental knee arthroplasty (UKA). The purpose of this study is to clarify the relationship between the arithmetic hip-knee-ankle angle (aHKA) and postoperative coronal alignment after medial fixed-bearing UKA. METHODS One hundred and one consecutive patients (125 knees) who underwent medial fixed-bearing UKA were assessed. Pre- and postoperative coronal HKA angles, lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), and the thickness of the tibial and femoral bone cut were measured. aHKA was calculated as 180° - LDFA + MPTA. Correlations between postoperative HKA angle and aHKA, LDFA, and MPTA were investigated by single regression analysis. After the patients were divided into three groups according to the postoperative HKA angle, i.e., HKA angle > 180°, 175° < HKA angle ≤ 180°, and HKA angle ≤ 175°, aHKA, LDFA, MPTA, preoperative HKA angle, and the thickness of the distal femoral as well as tibial bone cut were compared among the three groups. RESULTS aHKA and MPTA were positively correlated with postoperative HKA angle, while no correlation was found between postoperative HKA angle and LDFA. Among the three groups classified by postoperative HKA angle, significant differences were found in aHKA, MPTA, and preoperative HKA angle, while no significant difference was found in LDFA and the amount of distal femoral and tibial osteotomies. CONCLUSIONS aHKA was correlated with postoperative HKA angle after medial fixed-bearing UKA, which was probably due to the influence of MPTA.
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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, Hyogo, 650-0017, Japan.
| | - Masanori Tsubosaka
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo, 650-0017, Japan
| | - Tomoyuki Kamenaga
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo, 650-0017, Japan
| | - Yuichi Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo, 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, Hyogo, 650-0017, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo, 650-0017, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo, 650-0017, Japan
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Hiranaka T, Suda Y, Kamenaga T, Fujishiro T, Koide M, Okamoto K. Bearings can dislocate with smaller femoral components and thicker bearings in Oxford™ medial unicompartmental knee arthroplasty. Orthop Traumatol Surg Res 2023; 109:103598. [PMID: 36933617 DOI: 10.1016/j.otsr.2023.103598] [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: 07/20/2022] [Revised: 02/04/2023] [Accepted: 02/20/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND A mobile bearing can dislocate when joint laxity is larger than jumping height, the height difference between the bottom and the peak of the bearing (the highest point of the upper bearing surface on each side). Significant laxity due to improper gap balancing should therefore be avoided. However, once the bearing rotates vertically on the tibial component, the bearing can dislocate with smaller laxity than the jumping height. We mathematically calculated the required laxity for dislocation (RLD) and the required rotation of the bearing for dislocation (RRD). The current study addressed the question: 1) could the femoral component size and the bearing thickness affect the RLD and RRD? HYPOTHESIS The femoral component size and the bearing thickness could affect the MLD and MRD. METHODS The RLD and RRD were calculated using the bearing dimensions provided by the manufacturer with femoral component size, bearing thickness, and directions (anterior, posterior, and medial/lateral) as the variables on a two-dimensional basis. RESULTS The RLD was 3.4 to 5.5mm in the anterior, 2.3 to 3.8mm in the posterior, and 1.4 to 2.4mm in the medial or lateral directions. The RLD decreased with a smaller femoral size or a thicker bearing. Similarly, the RRD decreased with a smaller femoral size or a thicker bearing thickness in all directions. CONCLUSIONS Increased bearing thickness and decreased femoral component size deceased the RLD and RRD, which would relate to an increased risk of dislocation. Selecting the femoral component as large as possible and the bearing as thin as possible would therefore be helpful in the prevention of dislocation. LEVEL OF EVIDENCE III; comparative computer simulation study.
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Affiliation(s)
- Takafumi Hiranaka
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Osaka, Japan.
| | - Yoshihito Suda
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Osaka, Japan; Department of Orthopaedic Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Tomoyuki Kamenaga
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Osaka, Japan; Department of Orthopaedic Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Takaaki Fujishiro
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Osaka, Japan
| | - Motoki Koide
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Osaka, Japan
| | - Koji Okamoto
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Osaka, Japan
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Long X, Ren J, Liu Q, Zhu S, Chen X, Zhang W, Liang T, Wang Z, Li Y, Hou J, Wang K, He R. The footprint of the anterior horn of medial meniscus: A novel and reliable landmark for the tibial vertical cut in Oxford mobile-bearing medial unicompartmental knee arthroplasty. Knee 2023; 44:236-244. [PMID: 37677874 DOI: 10.1016/j.knee.2023.08.010] [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: 04/07/2023] [Revised: 06/07/2023] [Accepted: 08/07/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Tibial vertical cut is crucial for rotational position and bony coverage in Oxford mobile-bearing medial unicompartmental knee arthroplasty (UKA). This study aimed to determine whether the footprint of the anterior horn of medial meniscus (FAM) is a reliable landmark for tibial vertical cut. METHODS The FAM and the line through FAM and the edge of anterior cruciate ligament insertion (FAMA line) were identified by dissection five knee joint specimens. The angle between FAMA line and standard Akagi's line was measured. From 2022 to 2023, 64 patients (74 knees) diagnosed as anteromedial osteoarthritis were included to undergo primary Oxford medial UKA by two surgeons (Group 1 and 2), using FAMA line as a landmark for tibial vertical cut. The anteroposterior (AP) length, mediolateral (ML) length of tibial cut and tibial prothesis were measured by vernier caliper. ML/AP ratio was also calculated, and data were compared intragroup and intergroup. Mediolateral position and external rotation of tibial components were assessed postoperatively. RESULTS FAMA line was parallel to standard Akagi's line. No significant differences were found in AP and ML lengths between tibial cut and tibial component (AP different value = 0.007 ± 0.154 cm, P = 0.674, ML different value = 0.020 ± 0.195 cm, P = 0.155). The ML/AP ratio was similar between the two groups (P = 0.141, 0.646, 0.255, 0.607, 0.384, size AA ∼ D). No significant difference was found in mediolateral position (0.87 ± 0.03 vs. 0.86 ± 0.03, P = 0.156) and external rotation (6.88 ± 2.08 vs. 6.68 ± 2.22, P = 0.746) of the tibial component between the two groups. CONCLUSION The FAM is a reliable landmark for tibial vertical cut in Oxford UKA.
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Affiliation(s)
- Xiangyu Long
- Department of Joint and Trauma Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jianhua Ren
- Department of Joint and Trauma Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Qian Liu
- Department of Joint and Trauma Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Shaoshen Zhu
- Department of Joint and Trauma Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xi Chen
- Department of Joint and Trauma Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Wenhui Zhang
- Department of Joint and Trauma Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Tangzhao Liang
- Department of Joint and Trauma Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhe Wang
- Department of Joint and Trauma Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yuhang Li
- Department of Joint and Trauma Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jianfeng Hou
- Department of Joint and Trauma Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Kun Wang
- Department of Joint and Trauma Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
| | - Ronghan He
- Department of Joint and Trauma Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
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Tsai YL, Tsai SHL, Lin CH, Lin CR, Hu CC. The Effect of Congruent Tibial Inserts in Total Knee Arthroplasty: A Network Meta-Analysis of Randomized Controlled Trials. Life (Basel) 2023; 13:1942. [PMID: 37763345 PMCID: PMC10532924 DOI: 10.3390/life13091942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/07/2023] [Accepted: 09/18/2023] [Indexed: 09/29/2023] Open
Abstract
Objective: The aim of this study was to determine whether modern congruent tibial inserts are associated with superior outcomes in total knee arthroplasty (TKA). Background: Ultracongruent fixed-bearing (UCFB) and medial congruent fixed-bearing (MCFB) inserts have been known to be effective in total knee arthroplasty with patient satisfaction. Nonetheless, no supporting evidence to date exists to rank the clinical outcomes of these various congruent inserts in TKA compared with other important considerations in TKA including cruciate-retaining fixed-bearing (CRFB) and posterior-stabilized fixed-bearing (PSFB) inserts. Methods: We searched PubMed, Embase, the Cochrane Central Register of Controlled Trials, Web of Science, and Scopus up to 15 May 2022. We selected studies involving an active comparison of UCFB or MCFB in TKAs. We performed a network meta-analysis (NMA) of randomized controlled trials (RCTs) and compared different congruent inserts. We ranked the clinical outcomes by SUCRA score with the estimate of the best treatment probability. Our primary outcomes were revision rates and radiolucent lines. Secondary outcomes were functional scores, including the range of motion (ROM), the Knee Society Score (KSS), the Oxford Knee Score (OKS), and WOMAC. Results: Eighteen RCTs with 1793 participants were analyzed. Our NMA ranked MCFB, CRFB, and UCFB with the lowest revision rates. CRFB and UCFB had the fewest radiolucent lines. UCFB had overall the best ROM. UCFB and MCFB had the best OKS score overall. Conclusions: The ranking probability for better clinical outcomes in congruent inserts demonstrated the superiority of congruent tibial inserts, including UCFB and MCFB. UCFB may be associated with better ROM and postoperative functional outcomes. However, integrating future RCTs for high-level evidence is necessary to confirm these findings.
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Affiliation(s)
- Yen-Lin Tsai
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, No. 5, Fu-Hsin St. Kweishan County, Taoyuan 333, Taiwan
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou Medical Center, No. 5, Fu-Hsin St. Kweishan County, Taoyuan 333, Taiwan
| | - Sung Huang Laurent Tsai
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou Medical Center, No. 5, Fu-Hsin St. Kweishan County, Taoyuan 333, Taiwan
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Keelung Branch, Keelung 204, Taiwan
| | - Chia-Han Lin
- Department of Medicine, MacKay Medical College, New Taipei City 252, Taiwan
| | - Chun-Ru Lin
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, No. 5, Fu-Hsin St. Kweishan County, Taoyuan 333, Taiwan
| | - Chih-Chien Hu
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, No. 5, Fu-Hsin St. Kweishan County, Taoyuan 333, Taiwan
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou Medical Center, No. 5, Fu-Hsin St. Kweishan County, Taoyuan 333, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
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Sun X, Lu F, Guo W, Cheng L, Wang W, Zhang Q. Trajectory of bearing movement during Oxford mobile-bearing unicompartmental knee arthroplasty using a kinematic alignment technique. Chin Med J (Engl) 2023; 136:613-615. [PMID: 36806284 PMCID: PMC10106227 DOI: 10.1097/cm9.0000000000002052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Indexed: 02/22/2023] Open
Affiliation(s)
- Xiaowei Sun
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing 100029, China
| | - Feifan Lu
- Department of Orthopedic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Wanshou Guo
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing 100029, China
| | - Liming Cheng
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing 100029, China
| | - Weiguo Wang
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing 100029, China
| | - Qidong Zhang
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing 100029, China
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Ji S, Huang Y, Zhou Y, Wang C, Wang X, Ma C, Jiang X. Pre-operative predictive factors of residual varus on the mechanical axis after Oxford unicompartmental knee arthroplasty. Front Surg 2023; 9:1054351. [PMID: 36700020 PMCID: PMC9869032 DOI: 10.3389/fsurg.2022.1054351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 12/08/2022] [Indexed: 01/12/2023] Open
Abstract
Background Residual varus after Oxford unicompartmental knee arthroplasty (UKA) happens frequently. This study aims to evaluate the pre-operative contributing factors of residual varus. Methods A total of 1,002 knees (880 patients, 201 patients were male, and 679 were female) underwent Oxford UKA in the Orthopedic Surgery Department of the Beijing Jishuitan Hospital from March 2018 to April 2021. The mean age of the patient was 64.7 ± 7.7 years. To assess residual varus, the full-length lower extremity is placed upright for EOS imaging, with the knee fully extended. The angle of post-operative residual varus was measured as described by Noyes et al. Of the knees studied, they were either categorized into an under-corrected group (post-operative Noyes angle >5°) or a corrected group (post-operative Noyes angle ≤5°). Age, gender, body mass index (BMI), range of motion (ROM), Clinical American Knee Society Score (Clinical AKSS), and Function American Knee Society Score (Function AKSS) were compared. The following additional parameters were measured: pre-operative Noyes angle, lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), the posterior slope of the proximal tibia angle (PPTA), joint line converge angle (JLCA), and fixed flexion deformity (FFD). Results There was no statistically significant difference between the two groups in regards to gender (p = 0.428), surgical leg (p = 0.937), age (p = 0.851), BMI (p = 0.064), pre-operative Clinical AKSS (p = 0.206) and Function AKSS (p = 0.100). However, pre-operative ROM statistically differed between the two groups (p < 0.001). The contributing factors of post-operative residual varus were determined to be the following parameters: pre-operative MPTA (p < 0.001, OR = 4.522, 95% CI: 2.927-6.984), pre-operative Noyes (p < 0.001, OR = 3.262, 95% CI: 1.802-5.907) and pre-operative FFD (p = 0.007, OR = 1.862, 95% CI: 1.182-2.934). The effects of pre-operative LDFA (p = 0.146), JLCA (p = 0.942), and pre-operative PPTA (p = 0.899) on the post-operative mechanical axis did not show statistical significance. Conclusions Patients with severe pre-operative varus, particularly varus deformity mainly from the tibial side or pre-operative FFD, are more prone to get extremity mechanical axis residual varus after UKA with Oxford.
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Affiliation(s)
- Songjie Ji
- Department of Orthopedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China,Correspondence: Songjie Ji Xu Jiang
| | - Ye Huang
- Department of Orthopedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China
| | - Yixin Zhou
- Department of Orthopedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China
| | - Chao Wang
- Department of Statistics, Beijing Research Institute of Traumatology and Orthopedics, Beijing, China
| | - Xiaokai Wang
- Department of Radiology, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China
| | - Chaoyi Ma
- Department of Radiology, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China
| | - Xu Jiang
- Department of Orthopedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China,Correspondence: Songjie Ji Xu Jiang
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11
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Approximately 41% of knees have a looser gap in full extension than in 20° flexion after Oxford unicompartmental arthroplasty. Arch Orthop Trauma Surg 2023; 143:495-500. [PMID: 35041083 DOI: 10.1007/s00402-022-04350-3] [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: 08/16/2021] [Accepted: 01/06/2022] [Indexed: 02/04/2023]
Abstract
INTRODUCTION In Oxford unicompartmental knee arthroplasty (OUKA), the flexion and extension gaps should be adjusted to prevent mobile-bearing dislocation. The extension gap is recommended to be evaluated in the 20° flexion position to avoid underestimation due to tension of the posterior capsule. However, we have become aware of a looser gap in full extension than in 20° flexion in some instances. MATERIALS AND METHODS We retrospectively investigated 83 knees in 60 patients who underwent OUKA between January and June 2020. During surgery, the extension gaps were measured in both full extension and 20° flexion. The knees were classified into two groups: the gap was looser in full extension (0° group), and the gap was equal or looser in 20° flexion than in full extension (20° group). The hip-knee-ankle angle (HKAA), the lateral distal femoral angle (LDFA), the medial proximal tibia angle (MPTA), the posterior tibial slope angle (PTSA), and the last spigot size were also measured and compared between the groups. RESULTS There was looseness in approximately 41% of knees (34 out of 83 knees) in full extension. In the knees in the 0° group, the last spigot size was significantly smaller (median 1 and 2, P < 0.01). However, there were no significant differences in the HKAA, MPTA, LDFA or PTSA between the groups. CONCLUSIONS Approximately 41% of knees have a looser gap in full extension than in 20° flexion after OUKA. Further investigation is needed to better understand which extension gap should be used in such cases, and to find the contributing factors in loose full extension gap other than the size of the last spigot.
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12
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Abdelhameed MA, Khalifa YE, Bakr HM, Abdelnasser MK. Debridement, Antibiotics, and Implant Retention for an Early Periprosthetic Infection After Unicompartmental Knee Arthroplasty: A Technical Note. Arthroplast Today 2022; 17:16-19. [PMID: 35942108 PMCID: PMC9355908 DOI: 10.1016/j.artd.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/16/2022] [Accepted: 06/20/2022] [Indexed: 12/01/2022] Open
Abstract
Early periprosthetic joint infection in unicompartmental knee arthroplasty (UKA) is shown to have a detrimental effect on the success of UKA surgery not only because of the sequences of the infection but also due to the other healthy lateral compartment. It is well known that Oxford meniscal bearing UKA is a very precise procedure that the use of any excessive force may have an injurious effect on the future prosthesis stability with a higher risk of bearing dislocation. This technical note aims at describing how to deal with a case of early periprosthetic joint infection in a female patient who underwent debridement, wash, implant retention and change of the mobile bearing insert including the demonstration of a difficult step during this procedure.
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13
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Tay ML, Matthews BG, Monk AP, Young SW. Disease progression, aseptic loosening and bearing dislocations are the main revision indications after lateral unicompartmental knee arthroplasty: a systematic review. J ISAKOS 2022; 7:132-141. [PMID: 35777698 DOI: 10.1016/j.jisako.2022.06.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/03/2022] [Accepted: 06/12/2022] [Indexed: 10/17/2022]
Abstract
IMPORTANCE Lateral unicompartmental knee arthroplasty (UKA) is a surgical option for patients with isolated lateral osteoarthritis however, the procedure has higher revision rates than medial UKA. The reason for this remains unclear; therefore, a better understanding of the indications for lateral UKA revision is needed. AIM The primary aim of this systematic review was to identify revision indications for lateral UKA. Secondary aims were to further investigate if revision indications were influenced by implant design and time from surgery. EVIDENCE REVIEW A systematic literature review was performed according to the PRISMA 2020 guidelines. Search was performed in January 2022 in MedLine, EMBASE, CINAHL and the Cochrane Library using the keywords "knee arthroplasty", "unicompartmental", "reoperation", synonyms and abbreviations. Articles published in 2000-2021 that were at least level III retrospective cohort studies with at least 10 lateral UKAs and reported all failure modes were included. Risk of bias was assessed using the ROBINS-I tool. Revision indications, patient characteristics, study design, implant types and time to failure were extracted from the selected studies. Collated data were tabulated and differences were tested using Chi-square or Fisher's exact test. FINDINGS A total of 29 cohort and 4 registry studies that included 7,668 UKAs met the inclusion criteria. Studies were judged as having moderate or severe risk of bias; this was associated with the retrospective nature of studies required to investigate long-term outcomes of knee arthroplasty. The main indications for lateral UKA revision were OA progression (35%), aseptic loosening (17%) and bearing dislocation (14%). The incidence of revision was similar for mobile-bearing implants (7.6%) and fixed-bearing (6.4%). For mobile-bearing implants, there was introduction of bearing dislocations as an additional mode of failure (24% cf. 0%, p < 0.001). For fixed-bearing implants, the incidence of revision was higher for all-poly-ethylene (13.9%) than metal-backed (1.8%) tibial components. Early lateral UKA failures were associated with bearing dislocations (sequential decrease from 69% under 6 months to 0% 10+ years, p < 0.001), whereas late failures were associated with OA progression (sequential increase from 0% under 6 months to 100% > 10+ years, p < 0.01). Compared with medial UKA, OA progression (41% cf. 30%, p = 0.004), malalignment (2.7% cf. 0.8%, p = 0.02), instability (4% cf. 1%, p = 0.02) and bearing dislocations (20% cf. 10%, p < 0.001) were more common for lateral UKA. CONCLUSIONS AND RELEVANCE OA progression, aseptic loosening and bearing dislocation were the three main revision indications for lateral UKA. Compared to medial UKA, OA progression, malalignment, instability and bearing dislocations were more common revision indications for lateral UKA. Higher survivorship of metal-backed fixed-bearing implants was found. The findings suggest that the outcomes of lateral UKA may be improved with more optimal alignment, gap balancing and patient selection. LEVEL OF EVIDENCE Level III systematic review.
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Affiliation(s)
- Mei Lin Tay
- Department of Surgery, University of Auckland, 85 Park Road, Grafton, Auckland, New Zealand; Department of Orthopaedic Surgery, North Shore Hospital, 124 Shakespeare Road, Takapuna, Auckland, New Zealand.
| | - Brya G Matthews
- Department of Molecular Medicine and Pathology, University of Auckland, 85 Park Road, Grafton, Auckland, New Zealand
| | - A Paul Monk
- Department of Orthopaedic Surgery, Auckland City Hospital, 2 Park Road, Grafton 1023, Auckland, New Zealand; Auckland Bioengineering Institute, University of Auckland, 70 Symonds Street, Auckland 1010, New Zealand
| | - Simon W Young
- Department of Surgery, University of Auckland, 85 Park Road, Grafton, Auckland, New Zealand; Department of Orthopaedic Surgery, North Shore Hospital, 124 Shakespeare Road, Takapuna, Auckland, New Zealand
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Wen P, Zhang Q, Sun X, Zhang B, Ma T, Zhang Y. Exploring the relationship between bearing extrusion and postoperative persistent pain in Oxford unicompartmental knee arthroplasty: A trajectory measurement study. Front Bioeng Biotechnol 2022; 10:965009. [PMID: 36246383 PMCID: PMC9557290 DOI: 10.3389/fbioe.2022.965009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 09/08/2022] [Indexed: 11/16/2022] Open
Abstract
Objective: The aim of the study is to explore the relationship between the extrusion of the meniscus bearing and postoperative persistent pain of Oxford unicompartmental knee arthroplasty. Methods: Patients undertaking Oxford UKA from January 2019 to June 2020 were retrospectively analyzed. Intraoperatively, the displacement and movement trajectory of the meniscus bearing was recorded by the specially designed gridding mold of the tibial component. The k-means clustering analysis was applied based on the incidence of postoperative persistent knee pain and the bearing extrusion distance. The intraoperative meniscus bearing movement trajectories were analyzed between the two groups and the patients’ clinical outcomes and radiographic assessments. Results: The k-means clustering analysis indicated that the extrusion of the bearing of 5 mm was the grouping standard. There were 27 patients with 30 knees in the extrusion group and 58 patients with 68 knees in the non-extrusion group. The proportion of optimal bearing movement trajectories in the extrusion group was significantly lower than that in the non-extrusion group (p < 0.05). Postoperative persistent knee pain occurred in six cases (6.1%), with four and two cases in the extrusion and non-extrusion groups, respectively. The incidence of postoperative persistent knee pain in the extrusion group was higher than that of the non-extrusion group (p < 0.05). Radiographic assessment showed that the continuity of the femoral and tibial components in the extrusion group was greater than that in the non-extrusion group (p < 0.05). However, there were no differences in pre- and postoperative HKAA, the varus/valgus degree of both femoral and tibial components, and the flexion/extension angles of the femoral component, and the tibial slope also showed no statistical difference (p > 0.05). Conclusion: For Oxford mobile-bearing UKA, the extrusion of meniscus bearing over 5 mm may increase the incidence of postoperative persistent knee pain, while the improvement of the bearing movement trajectory can effectively reduce this complication.
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Affiliation(s)
- Pengfei Wen
- Department of Joint Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
| | - Qidong Zhang
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Xiaowei Sun
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Binfei Zhang
- Department of Joint Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
| | - Tao Ma
- Department of Joint Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
| | - Yumin Zhang
- Department of Joint Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
- *Correspondence: Yumin Zhang,
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Legnani C, Parente A, Parente F, Ventura A. Medial unicompartmental knee replacement is a viable treatment option after failed high tibial osteotomy: a systematic review. EFORT Open Rev 2022; 7:569-575. [PMID: 35924648 PMCID: PMC9458945 DOI: 10.1530/eor-21-0133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Purpose Methods Results Conclusions
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Affiliation(s)
- Claudio Legnani
- IRCCS Istituto Ortopedico Galeazzi, Sports Traumatology and Minimally Invasive Articular Surgery Center, Milan Italy
| | - Andrea Parente
- IRCCS Istituto Ortopedico Galeazzi, Hip and Knee Arthroplasty Surgery Center, Milan, Italy
| | - Franco Parente
- IRCCS Istituto Ortopedico Galeazzi, Hip and Knee Arthroplasty Surgery Center, Milan, Italy
| | - Alberto Ventura
- IRCCS Istituto Ortopedico Galeazzi, Sports Traumatology and Minimally Invasive Articular Surgery Center, Milan Italy
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16
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Wu K, Lv G, Yin P, Dong S, Dai Z, Li L, Liu G. Effect of tibial component overhang on survivorship in medial mobile-bearing unicompartmental knee arthroplasty. Knee 2022; 37:188-195. [PMID: 35820266 DOI: 10.1016/j.knee.2022.06.011] [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: 03/29/2022] [Revised: 05/28/2022] [Accepted: 06/28/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Some studies have shown that the position of the tibial component in Oxford unicompartmental knee arthroplasty with a mobile bearing will affect the clinical outcome of patients. Hence, our study aimed to investigate the relationship between the overhang distance of the tibial component and the survival of the implant. METHODS A retrospective analysis of patients who underwent unicompartmental knee arthroplasty at the same institution from 2014 to 2018 was presented. The study was divided into three groups: minor underhang group (underhang between -3 and 0 mm); minor overhang group (overhang 0-3 mm); and major overhang group (overhang ≥ 3 mm). Demographic and clinical profile characteristics of each group were compared, and survival curves of each group were also compared using Kaplan-Meier and modeled using multivariate Cox regression. RESULTS A total of 351 knees were included in this study with a minimum follow up of three years and a mean follow up of 4.8 ± 1.5 years. The revision rates in each group were 3.6% (minor underhang group), 2.7% (minor overhang group), and 20.9% (major overhang group) (P < 0.001). From the three groups' cumulative survival rates, the major overhang group was significantly lower than the other two groups (log rank P < 0.001). Multivariate Cox regression showed an association between the major overhang group and implant survival rate (hazard ratio = 7.515, 95% confidence interval = 2.500-22.593, P < 0.001) CONCLUSION: The risk of revision will increase if the tibial component overhangs more than 3 mm medially. Moreover, the reasons for revision are generally bearing dislocation and aseptic loosening.
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Affiliation(s)
- Kanglong Wu
- Department of Joint Surgery, the Second Hospital of Dalian Medical University, Dalian, China; Dalian Medical University, Dalian, China
| | - Guoqi Lv
- Dalian Medical University, Dalian, China; Dalian Municipal Central Hospital, Dalian, China
| | - Peng Yin
- Department of Joint Surgery, the Second Hospital of Dalian Medical University, Dalian, China; Dalian Medical University, Dalian, China
| | - Shenton Dong
- Department of Joint Surgery, the Second Hospital of Dalian Medical University, Dalian, China; Dalian Medical University, Dalian, China
| | - Zhong Dai
- Department of Joint Surgery, the Second Hospital of Dalian Medical University, Dalian, China; Dalian Medical University, Dalian, China
| | - Linken Li
- Department of Joint Surgery, the Second Hospital of Dalian Medical University, Dalian, China; Dalian Medical University, Dalian, China
| | - Gang Liu
- Department of Joint Surgery, the Second Hospital of Dalian Medical University, Dalian, China.
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17
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Bonano JC, Barrett AA, Aggarwal VK, Chen F, Schirmers J, Finlay AK, Arora P, Amanatullah DF. Supine Knee Positioning Does Not Interfere with Mobile-Bearing Unicompartmental Knee Arthroplasty Performance. J Knee Surg 2022. [PMID: 35688441 DOI: 10.1055/s-0042-1748822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The Food and Drug Administration has only approved mobile-bearing unicompartmental knee arthroplasty (MB-UKA) to be performed with a hanging leg holder. The purpose of this study is to evaluate the impact of a supine knee position on MB-UKA performance.In total, 16 cadavers were randomized so that either the right or left knee was placed in the flexed or supine positions. One board-certified orthopaedic surgeon and three adult reconstruction fellows that attended the required Oxford partial knee instructional course performed four operations in each position. The primary outcome was final knee balance. Secondary outcomes included procedure duration, timing of individual surgical steps, implant sizes, range of motion, implant alignment, and fracture. A Students t-test was used to examine differences between positions with significance set at p < 0.05. Secondary analyses using two one-sided tests were conducted to explore equivalence between the two positions.There was no significant difference in mean final balance between supine (1.7 mm ± standard deviation [SD] = 1.5 mm) and flexed (1.3 ± 1.3 mm) positions (p = 0.390). There were also no significant differences between positions for procedure time (p = 0.497), tibia coronal alignment (p = 0.614), tibial slope (p = 0.194), femoral component sagittal alignment (p = 0.091), and fractures (n = 0). Exploratory equivalence analyses indicated that the positions were equivalent for final balance (p = 0.002).MB-UKA performed in the supine position is not significantly different from the flexed position in terms of ligament balance, overall procedure time, and radiographic appearance. These initial safety data warrant further clinical investigations and support the expansion of the surgical technique to include performing MB-UKAs in the supine position.
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Affiliation(s)
- John C Bonano
- Department of Orthopaedic Surgery, Stanford Hospital and Clinics, Redwood City, California
| | - Andrew A Barrett
- Department of Orthopaedic Surgery, Stanford Hospital and Clinics, Redwood City, California
| | - Vinay K Aggarwal
- Department of Orthopaedic Surgery, Stanford Hospital and Clinics, Redwood City, California
| | - Foster Chen
- Department of Orthopaedic Surgery, Stanford Hospital and Clinics, Redwood City, California
| | - Joseph Schirmers
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California
| | - Andrea K Finlay
- Department of Orthopaedic Surgery, Stanford Hospital and Clinics, Redwood City, California
| | - Prerna Arora
- Department of Orthopaedic Surgery, Stanford Hospital and Clinics, Redwood City, California
| | - Derek F Amanatullah
- Department of Orthopaedic Surgery, Stanford Hospital and Clinics, Redwood City, California
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Hiranaka T, Suda Y, Kamenaga T, Fujishiro T, Koide M, Saitoh A, Tanaka A, Arimoto A, Okamoto K. Bearing Separation From the Lateral Wall of the Tibial Component Is a Risk of Anterior Dislocation of the Mobile Bearing in Oxford Unicompartmental Knee Arthroplasty. J Arthroplasty 2022; 37:942-947. [PMID: 35074447 DOI: 10.1016/j.arth.2022.01.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 01/07/2022] [Accepted: 01/11/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Bearing dislocation is a serious complication after Oxford unicompartmental knee arthroplasty. Bearing separation from the lateral wall can cause it to spin (90° horizontal rotation) and eventually dislocate because there is just a 2 mm difference in height in both the lateral and medial sides from the bottom of the bearing, compared with the anterior (5 mm) and posterior (3 mm) sides. The details of this problem have not been previously examined. METHODS Twenty-one dislocations in 12 patients were retrospectively analyzed. Bearing separation was defined as the bearing position being sufficiently distant from the lateral wall of the tibial component to allow spinning. We analyzed the incidence of separation, the direction and the recurrence of the dislocations, and their causes and treatments. RESULTS Five of the 12 patients had separation. Of the total of 21 dislocations, 11 occurred in cases of separation (52%). Seven of 11 anterior dislocations were found to have separation, whereas nine of 13 posterior dislocations occurred without separation (P = .0237). Three of 5 patients with separation had recurrence of dislocation, and eventually 2 underwent revision to fixed-bearing unicompartmental knee arthroplasty. CONCLUSION Bearing separation from the lateral wall of the tibial component can cause bearing dislocation, especially in an anterior direction. To prevent separation, the wall-bearing distance should be evaluated before the keel slot preparation, with manipulation as necessary. Conversely, posterior dislocation was predominant in our nonseparation cases.
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Affiliation(s)
- Takafumi Hiranaka
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Osaka, Japan
| | - Yoshihito Suda
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Osaka, Japan
| | - Tomoyuki Kamenaga
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Osaka, Japan; Department of Orthopaedic Surgery, Graduate School of Medicine, Kobe University, Kobe, Hyogo Prefecture, Japan
| | - Takaaki Fujishiro
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Osaka, Japan
| | - Motoki Koide
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Osaka, Japan
| | - Akira Saitoh
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Osaka, Japan
| | - Atsuki Tanaka
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Osaka, Japan
| | - Akihiko Arimoto
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Osaka, Japan
| | - Koji Okamoto
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Osaka, Japan
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Kawaguchi K, Inui H, Taketomi S, Yamagami R, Kono K, Sameshima S, Kage T, Tanaka S. Effects of a 1-mm difference in bearing thickness on intraoperative bearing movement and kinematics in Oxford unicompartmental knee arthroplasty. BMC Musculoskelet Disord 2022; 23:341. [PMID: 35397577 PMCID: PMC8994313 DOI: 10.1186/s12891-022-05203-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 03/01/2022] [Indexed: 11/29/2022] Open
Abstract
Background The choice of mobile bearing (MB) thickness is essential for obtaining successful results after mobile-bearing Oxford unicompartmental knee arthroplasty (UKA). This study aimed to investigate the effects of a 1-mm difference in bearing thickness on intraoperative MB movement and intraoperative knee kinematics in Oxford UKAs. Methods We prospectively investigated the effects of a 1-mm difference in bearing thickness on intraoperative MB movement and knee kinematics in 25 patients who underwent Oxford UKAs when surgeons didn’t know which bearing thickness to choose with 1-mm difference. A trial tibial component that was scaled every 2 mm was used to measure the intraoperative MB movement, and the tibial internal rotation relative to the femur and the knee varus angle was simultaneously evaluated using the navigation system as the knee kinematics. We separately evaluated sets of two MB thicknesses with 1-mm differences, and we compared the intraoperative parameters at maximum extension; 30º, 45º, 60º, and 90º flexion; and maximum flexion between the thicker MB (thick group) and the thinner MB (thin group). Results The MB in the thin group was located significantly posteriorly at 90º flexion compared with that in the thick group; however, there were no differences at the other flexion angles. There was significantly less tibial internal rotation in the thin group at 90º flexion than that in the thick group; however, there were no differences at the other flexion angles. The knee varus angles in the thick group were significantly smaller than those in the thin group by approximately one degree at all angles other than at 30º and 45º flexion. Conclusion The thicker MB could bring the less posterior MB movement and the more tibial internal rotation at 90º flexion, additionally the valgus correction angle in the thicker MB should be paid attention. These results could help surgeons to decide the thickness of MBs when they wonder the thickness of MB.
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Prior high tibial osteotomy is not a contraindication for medial unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2021; 29:3279-3286. [PMID: 32671434 DOI: 10.1007/s00167-020-06149-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 07/10/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE To report on the outcome and complications of minimal invasive medial unicondylar knee arthroplasty (UKA) after failed prior high tibial osteotomy (HTO) as treatment for medial osteoarthritis in the knee. The hypothesis was that good results can be achieved, if no excessive postoperative valgus alignment and abnormal proximal tibial geometry is present. METHODS All medial UKAs after failed prior HTO (n = 30), performed between 2010 and 2018 were retrospectively reviewed. The patients were followed for revision surgery and survival of the UKA (defined as revision to TKA). Clinical examination using the Knee Society Score (KSS), Oxford Knee Score (OKS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), as well as radiological examination was performed. Radiographs were studied and the influence of the demographic factors and the radiographic measurements on the survival and the clinical outcome was analysed. RESULTS After a follow-up of 4.3 ± 2.6 years (2.1-9.9) 27 UKAs were available. The survival rate was 93.0%. Two UKAs were revised to TKA (excessive valgus alignment and tibial loosening with femoropatellar degeneration). Two further patients had revision surgery (hematoma and lateral meniscus tear). Follow-up clinical and radiological examination was performed in 21 cases: KSS 82.9 ± 10.1 (54.0-100.0), KSS (function) 93.3 ± 9.7 (70.0-100.0); OKS 42.7 ± 6.0 (25.0-48.0); WOMAC 7.9 ± 15.6 (0.0-67.1). No significant influence of demographic factors or radiological measurements on the clinical outcome was present. CONCLUSION Prior HTO is not a contraindication for medial UKA, because good-to-excellent results can be achieved in selected patients with medial osteoarthritis and previous HTO, treated with medial UKA, in a midterm follow-up. Excessive mechanical valgus axis should be avoided; therefore, patient selection and accurate evaluation of medial laxity, preoperative mechanical axis, joint line convergence and proximal tibial geometry are important. LEVEL OF EVIDENCE III.
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Kiran M, Kho J, Hepburn E, Chakraverty J, Davies H. Chronic Wear-Induced Bearing Dislocation in a Fixed-Bearing Unicompartmental Knee Arthroplasty: A Case Report. JBJS Case Connect 2021; 11:01709767-202109000-00066. [PMID: 34491688 DOI: 10.2106/jbjs.cc.21.00364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Case We present a case of late onset, bearing wear-induced failure of locking mechanism, resulting in bearing dislocation and rapidly progressive severe metallosis in a medial fixed-bearing (FB) unicompartmental knee arthroplasty (UKA). Conclusion Bearing dislocation is a rare complication of chronic wear in FB UKA, and early recognition is essential to prevent metallic component articulation-induced metallosis and catastrophic failure.
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Affiliation(s)
- Manish Kiran
- Department of Trauma and Orthopaedics, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, England
| | - James Kho
- Department of Trauma and Orthopaedics, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, England
| | - Elizabeth Hepburn
- Department of Trauma and Orthopaedics, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, England
| | - Julian Chakraverty
- Department of Trauma and Orthopaedics, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, England
| | - Hywel Davies
- Department of Trauma and Orthopaedics, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, England
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22
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Sun X, Hernigou P, Zhang Q, Zhang N, Wang W, Chen Y, Guo W. Sensor and machine learning-based assessment of gap balancing in cadaveric unicompartmental knee arthroplasty surgical training. INTERNATIONAL ORTHOPAEDICS 2021; 45:2843-2849. [PMID: 34351461 DOI: 10.1007/s00264-021-05176-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 07/28/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE The aim of this study was to assess the difference between flexion and extension contact forces-gap balance-after Oxford mobile-bearing medial unicompartmental knee arthroplasty (UKA) performed by surgeons with varying levels of experience. METHODS Surgeons in a training programme performed UKAs on fresh frozen cadaveric specimens (n = 60). Contact force in the medial compartment of the knee was measured after UKA during extension and flexion using a force sensor, and values were clustered using an unsupervised machine learning (k-means algorithm). Univariate analysis was performed with general linear regression models to identify the explanatory variable. RESULTS The level of experience was predictive of gap balance; surgeons were clustered into beginner, mid-level and experienced groups. Experienced surgeons' mean difference between flexion and extension contact force was 83 N, which was significantly lower (p < 0.05) than that achieved by mid-level (215 N) or beginner (346 N) surgeons. CONCLUSION We found that the lowest mean difference between flexion and extension contact force after UKA was 83 N, which was achieved by surgeons with the most experience; this value can be considered the optimal value. Beginner and mid-level surgeons achieved values that were significantly lower. This study also demonstrates that machine learning can be used in combination with sensor technology for improving gap balancing judgement in UKA.
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Affiliation(s)
- Xiaowei Sun
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Philippe Hernigou
- Department of Orthopaedic Surgery, University Paris East (UPEC), Hôpital Henri Mondor, Creteil, France
| | - Qidong Zhang
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Nianfei Zhang
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Weiguo Wang
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Yang Chen
- Department of Computer Science and Technology, Tsinghua University, Beijing, China
| | - Wanshou Guo
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, China.
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23
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Ellis RT, Nettrour JF, Keeney JA. TKA is More Durable Than UKA for Morbidly Obese Patients: A Two-Year Minimum Follow-Up Study. J Arthroplasty 2021; 36:1933-1941. [PMID: 33483247 DOI: 10.1016/j.arth.2020.12.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 12/19/2020] [Accepted: 12/22/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Unicompartmental knee arthroplasty (UKA) indications have expanded during the past two decades to include some morbidly obese patients (body mass index (BMI) > 40 kg/m2). Few published studies have compared UKA and total knee arthroplasty (TKA) in this unique patient subgroup with conflicting observations. METHODS We retrospectively compared 89 mobile bearing UKA (71 patients) and 201 TKA (175 patients) performed at a single institution with a minimum 2-year follow-up (mean 3.4 years). Demographic characteristics were similar for both patient cohorts. A detailed medical record review was performed to assess the frequency of component revision, revision indications, minor secondary procedures (components retained), and infections. RESULTS UKA was more frequently associated with clinical failure (29.2% vs 2.5%, P < .001) and component revision (15.7% vs 2.5%, P < .001), TKA was more frequently associated with extensor mechanism complications or knee manipulation (5.5% vs 0.0%, P = .02), and there was no difference in the infection rate (3.0% vs 2.2%, P = 1.0). CONCLUSION Early complications were lower following UKA but were outweighed by higher component revision rates for arthritis progression and implant failure. The study findings suggest that TKA provides a more predictable mid-term outcome for morbidly obese patients considering knee arthroplasty surgery.
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Affiliation(s)
- R Tyler Ellis
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO
| | - John F Nettrour
- Department of Orthopaedic Surgery, University of Pittsburgh, VA Pittsburgh Healthcare System, Pittsburgh, PA
| | - James A Keeney
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO
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24
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Hantouly AT, Ahmed AF, Alzobi O, Toubasi A, Salameh M, Elmhiregh A, Hameed S, Ahmed GO, Alvand A, Al Dosari MAA. Mobile-bearing versus fixed-bearing total knee arthroplasty: a meta-analysis of randomized controlled trials. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:481-495. [PMID: 34021791 PMCID: PMC8924090 DOI: 10.1007/s00590-021-02999-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 04/09/2021] [Indexed: 11/24/2022]
Abstract
Objective The purpose of this study was to perform a meta-analysis comparing mobile-bearing with fixed-bearing total knee arthroplasty (TKA) in terms of all-cause revision rates, aspetic loosening, knee functional scores, range of motion and radiographic lucent lines and osteolysis. Methods PubMed, Cochrane Library, Google Scholar and Web of Science were searched up to January 2020. Randomized controlled trials that compared primary mobile-bearing with fixed-bearing TKA, reporting at least one of the outcomes of interest, at a minimum follow-up of 12 months were included. All outcomes of interest were pooled at short-term (< 5 years), mid-term (5 to 9 years) and long-term (> = 10 years) follow-up intervals. Results A total of 70 eligible articles were included in the qualitative and statistical analyses. There was no difference between mobile-bearing or fixed-bearing TKA at short-term, mid-term and long-term follow-ups in all outcome measures including all-cause revision rate, aseptic loosening, oxford knee score, knee society score, Hospital for Special Surgery score, maximum knee flexion, radiographic lucent lines and radiographic osteolysis. Conclusion The current level of evidence demonstrated that both mobile-bearing and fixed-bearing designs achieved excellent outcomes, yet it does not prove the theoretical advantages of the mobile-bearing insert over its fixed-bearing counterpart. The use of either design could therefore be supported based on the outcomes assessed in this study. Level of Evidence: Level II, Therapeutic Supplementary information The online version contains supplementary material available at (10.1007/s00590-021-02999-x).
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Affiliation(s)
- Ashraf T Hantouly
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Abdulaziz F Ahmed
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar.
| | - Osama Alzobi
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Ammar Toubasi
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Motasem Salameh
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Aissam Elmhiregh
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Shamsi Hameed
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Ghalib O Ahmed
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Abtin Alvand
- Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Pontoh LA, Dilogo IH, Hartono F, Rhatomy S, Fiolin J. Meniscal bearing dislocation following minimally invasive Oxford medial unicompartmental knee arthroplasty treated with simple open reduction: Case report. Int J Surg Case Rep 2021; 79:371-374. [PMID: 33516053 PMCID: PMC7847823 DOI: 10.1016/j.ijscr.2021.01.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 01/12/2021] [Accepted: 01/13/2021] [Indexed: 10/28/2022] Open
Abstract
INTRODUCTION Dislocation of polyethylene insert is one of the most common complications of mobile bearing-medial unicompartmental knee arthroplasty (MUKA). Bearing dislocation was diagnosed by radiograph examination in these cases upon trivial injury. CASE PRESENTATION We reported one case of meniscal bearing dislocation after an Oxford MUKA treated with a simple open reduction technique. CLINICAL DISCUSSION Simple open reduction surgery without change of the bearing and the use of knee brace for 6 months was effective in preventing re-dislocation. CONCLUSION Mobile bearing dislocation is one of the most common complications in mobile-bearing MUKA. Besides the prevention of technical errors, usage of UKA with a frequency of 10-15 per year is recommended to increase the surgeon's learning curve.
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Affiliation(s)
- Ludwig Andre Pontoh
- Department of Orthopaedic and Traumatology, Fatmawati General Hospital, Faculty of Medicine Universitas Indonesia, Jl. RS Fatmawati no. 4, Jakarta Selatan, 12430, Indonesia.
| | - Ismail Hadisoebroto Dilogo
- Department of Orthopaedic and Traumatology, Dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia, Jl. Diponegoro no. 71, Jakarta Pusat, 10430, Indonesia.
| | - Franky Hartono
- Orthopaedic Center Pantai Indah Kapuk Hospital, Jl. Pantai Indah Utara 3, Jakarta Utara, 14460, Jakarta, Indonesia.
| | - Sholahuddin Rhatomy
- Orthopaedic Department, Soeradji Tirtonegoro Hospital, Klaten, Faculty of Medicine, Public Health of Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
| | - Jessica Fiolin
- Jakarta Knee, Shoulder and Orthopaedic Sport Clinic, Pondok Indah Hospital, Jl. Metro Duta Kav UE, Jakarta, 12310, Indonesia.
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26
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Sun X, Liu P, Lu F, Wang W, Guo W, Zhang Q. Bearing dislocation of mobile bearing unicompartmental knee arthroplasty in East Asian countries: a systematic review with meta-analysis. J Orthop Surg Res 2021; 16:28. [PMID: 33413535 PMCID: PMC7791981 DOI: 10.1186/s13018-020-02190-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 12/28/2020] [Indexed: 11/25/2022] Open
Abstract
Background Bearing dislocation is a common postoperative complication of mobile-bearing unicompartmental knee arthroplasty, and East Asian patients tend to be at higher risk. However, whether this high dislocation rate is common in all East Asian populations remains unclear. This meta-analysis was performed to explore this issue and describe various features of dislocation in East Asians, including the onset time, dislocation direction, and re-dislocation rate. Methods The literature was searched in PubMed, Embase, Ovid, and Cochrane Library up to May 2020. Studies were scrutinized by two independent authors, and the bearing dislocation rate, onset time, direction, and re-dislocation rate were specifically analyzed. RevMan 5.3 was used for the statistical analysis. Results Seven case series from Korea, China, and Japan were included. The pooled analysis showed that the total dislocation rate was 2.37%, while the subgroup analysis showed that the dislocation rate in Korea and other countries was 4.50% and 0.74%, respectively (P < 0.01). Another subgroup analysis of the onset time showed a significant difference before and after the first 5 years postoperatively (P < 0.01). Anterior and posterior dislocations were more frequent than medial and lateral dislocations (P < 0.01). The average re-dislocation rate was 32.45%, which was approximately seven times higher than the primary dislocation rate (P < 0.01). Conclusion Our meta-analysis demonstrated that Korea had a higher bearing dislocation rate among East Asian countries, especially in the first 5 years after primary UKA. Anterior and posterior dislocations were common. The most important finding is that the re-dislocation rate can be much higher than the initial dislocation rate.
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Affiliation(s)
- Xiaowei Sun
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.,Department of Orthopaedic Surgery, China-Japan Friendship Hospital, No. 2, Yinghuadong Road, Chaoyang District, Beijing, 100029, China
| | - Pei Liu
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, No. 2, Yinghuadong Road, Chaoyang District, Beijing, 100029, China.,Beijing University of Chinese Medicine, Beijing, China
| | - Feifan Lu
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, No. 2, Yinghuadong Road, Chaoyang District, Beijing, 100029, China.,China-Japan Friendship School of Clinical Medicine, Peking University, Beijing, 100029, China
| | - Weiguo Wang
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, No. 2, Yinghuadong Road, Chaoyang District, Beijing, 100029, China
| | - Wanshou Guo
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.,Department of Orthopaedic Surgery, China-Japan Friendship Hospital, No. 2, Yinghuadong Road, Chaoyang District, Beijing, 100029, China
| | - Qidong Zhang
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, No. 2, Yinghuadong Road, Chaoyang District, Beijing, 100029, China.
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27
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Rare Asymptomatic Posterior Dislocation of Mobile Bearing Insert in Unicondylar Knee Arthroplasty: A Case Report. Indian J Orthop 2020; 54:909-912. [PMID: 33133415 PMCID: PMC7573025 DOI: 10.1007/s43465-020-00245-w] [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: 03/10/2020] [Accepted: 08/21/2020] [Indexed: 02/04/2023]
Abstract
Dislocation of polyethylene insert is a common complication of mobile bearing uniconylar knee arthroplasty (UKA). Dislocation, when occurs is common in anterior, lateral or medial direction. The authors report a case of posterior dislocation in which patient remained asymptomatic and the dislocation was detected in a routine follow-up radiograph done at 18 months after surgery. UKA was subsequently converted into total knee arthroplasty and patient had a stable knee at two years follow-up with no signs of loosening or instability. Posterior meniscal bearing dislocation may remain asymptomatic and continued examination with high index of suspicion is needed to disclose such complications in the absence of symptoms.
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28
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Sun XW, Lu FF, Zou K, Hong M, Zhang QD, Guo WS. Does new instrument for Oxford unicompartmental knee arthroplasty improve short-term clinical outcome and component alignment? A meta-analysis. J Orthop Surg Res 2020; 15:386. [PMID: 32894147 PMCID: PMC7487934 DOI: 10.1186/s13018-020-01926-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 08/24/2020] [Indexed: 11/10/2022] Open
Abstract
Background The Microplasty (MP) instrumentation designed for the Phase III Oxford mobile-bearing unicompartmental knee arthroplasty (UKA) system is considered a better option to achieve more accurate component positioning and alignment. In the present study, we focused on short-term clinical and radiological outcomes to determine whether the MP instrumentation can reduce the short-term revision rate and occurrence of outliers of metallic components. Methods The literature in PubMed, Embase, the Cochrane Library, and Web of Science was searched up to May 2020. Studies were scrutinized by two independent authors, and the revision rate, complication spectrum, and radiological assessment with outlier rates were specifically analyzed. RevMan 5.3 was used for the statistical analysis. Results Seven studies were included in the meta-analysis. Four studies reported both clinical and radiological outcomes, two reported only radiological outcomes, and one reported only clinical outcomes. The pooled analysis showed that the revision rate in the MP instrumentation group was 0.866 per 100 component years, while that in the control group was 1.124 (odds ratio, 0.77; p < 0.05). The subgroup analysis of the bearing dislocation rate showed a significantly greater reduction in the Korean population than in the populations of other countries (p < 0.05). The radiological assessment showed that the alignment of the femoral component was significantly improved (p < 0.05), while that of the tibial component was not (p > 0.05). Conclusion The newly developed MP instrumentation for Oxford UKA significantly reduced the revision rate of this treatment. The positioning of the femoral component was also proven to be better by radiological assessments.
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Affiliation(s)
- Xiao Wei Sun
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.,Department of Orthopaedic Surgery, China-Japan Friendship Hospital, No. 2 Yinghuadong Road, Chaoyang District, Beijing, 100029, China
| | - Fei Fan Lu
- China-Japan Friendship School of Clinical Medicine, Peking University, Beijing, China
| | - Kun Zou
- Beijing University of Chinese Medicine, Beijing, China
| | - Mao Hong
- Beijing University of Chinese Medicine, Beijing, China
| | - Qi Dong Zhang
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, No. 2 Yinghuadong Road, Chaoyang District, Beijing, 100029, China
| | - Wan Shou Guo
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China. .,Department of Orthopaedic Surgery, China-Japan Friendship Hospital, No. 2 Yinghuadong Road, Chaoyang District, Beijing, 100029, China.
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