No Major Functional Benefit After Bicompartmental Knee Arthroplasty Compared to Total Knee Arthroplasty at 5-Year Follow-Up

Functional outcome after bicompartmental knee replacement for medial and patellofemoral osteoarthritis

INTRODUCTION

Total knee arthroplasty (TKA) is used for tricompartmental knee osteoarthritis, while unicompartmental knee arthroplasty (UKA) is preferred for unicompartmental knee osteoarthritis. Bicompartmental knee arthroplasty (BKA) aims to address 2 knee compartments by combining 2 UKA's or 1 UKA with a patellofemoral replacement. This study examines the clinical outcomes of BKA, focusing on pain alleviation and knee function. The aim of this study is to report the functional outcome of BKA and see if this aligns with BKA outcomes from literature in terms of patient reported outcome measurements (PROMs) and range of motion (ROM) after a 2-year follow-up. Additionally, radiographic alignment, implant survivorship, adverse events and length of stay are secondary outcomes.

METHODS

This is a cohort study of 21 patients who underwent BKA for medial and patellofemoral osteoarthritis. The patients had follow-up for at least 2 years postoperatively. PROMs were assessed using the Knee injury and Osteoarthritis Outcome Score (KOOS), Knee Society Score (KSS), Oxford Knee Score, Western Ontario and McMaster University Osteoarthritis index (WOMAC) and the Visual Analogue Scale (VAS). ROM was measured using a goniometer. Pre- and postoperative radiographic coronal alignment was measured using standard full leg radiographs. Patient demographics, implant survivorship, length of stay and adverse events were recorded.

RESULT

Twenty-one patients (23 knees) were included, with a mean follow-up of 41 months (standard deviation [SD] 12 months; range 24-59 months). Patient-reported outcome measures (PROMs) demonstrated significant improvements, with 80% achieving good to excellent OKS and KSS scores. KOOS scores were similar to scores found in literature. The WOMAC score was higher in our results compared to other authors. Which indicates worse outcome. The mean preoperative hip-knee-ankle angle (HKAA) was 2.4 degrees varus (SD 1.9 degrees; range 1.2 degrees valgus - 6.1 degrees varus), while the mean postoperative HKAA was 0.3 degrees valgus (SD 2.8 degrees; range 4.6 degrees valgus - 5.6 degrees varus) (p < 0.001). Postoperative range of motion averaged 117 degrees (SD 10 degrees; range 98-132).

CONCLUSIONS

BKA shows promise in alleviating pain and improving knee function in patients with medial and patellofemoral osteoarthritis. Challenges include the risk of revision and technical difficulties during surgery. Comparative studies suggest similar outcomes between BKA and TKA, with potential advantages for younger, more active patients. Further research, particularly randomized trials with larger cohorts, is necessary to elucidate the long-term benefits and drawbacks of BKA compared to other knee arthroplasty options.

Surgical interventions for symptomatic knee osteoarthritis: a network meta-analysis of randomized control trials

BACKGROUND

Multiple surgical interventions exist for the treatment of symptomatic knee osteoarthritis, but the surgeon and patient may often have difficulty deciding which interventions are the best option.

METHODS

We conducted a systematic review to identify randomized clinical trials (RCTs) that compared complications, revisions, reoperations, and functional outcomes among TKA (total knee arthroplasty), UKA (unicompartmental knee arthroplasty), HTO (high tibial osteotomy), BCA (bicompartmental knee arthroplasty), BIU (bi-unicompartmental knee arthroplasty), and KJD (knee joint distraction). The PubMed, Embase, and Cochrane databases were reviewed for all studies comparing two or more surgical interventions. Direct-comparison meta-analysis and network meta-analysis (NMA) were performed to combine direct and indirect evidence. The risk of bias was assessed using the revised Cochrane risk of bias tool for RCTs.

RESULTS

This NMA and systematic review included 21 studies (17 RCTs), with a total of 1749 patients. The overall risk-of-bias assessment of the RCTs revealed that 7 studies had low risk, 5 had some concerns, and 9 had high risk. SUCRA (the surface under the cumulative ranking curve) rankings revealed that KJD had the greatest risk of appearing postoperative complications, revisions, and reoperations, and UKA or TKA had the lowest risk. The majority of comparisons among various treatments showed no difference for functional outcomes.

CONCLUSION

Each surgical intervention is noninferior to other treatments in functional outcomes, but UKA and TKA are better options to treat OA according to SUCRA rankings by comparing complications, revisions, and reoperations. KJD is an imperfect option for treating OA. Other treatments should be carefully considered for each patient in accordance with their actual conditions. However, this conclusion is limited by the selection of reviewed publications and individual variation of surgical indications for patients.

TRIAL REGISTRATION

This study was registered with Research Registry (reviewregistry1395).

Image-based robot assisted bicompartmental knee arthroplasty versus total knee arthroplasty

OBJECTIVE

To evaluate the short-term clinical outcomes of image-based robot-assisted bicruciate retaining bicompartmental knee arthroplasty and compare it to robot-assisted total knee arthroplasty in the Indian population.

METHODS

Between December 2018 and November 2019, five patients (six knees) underwent robot-assisted bicompartmental knee arthroplasty (BCKA). These patients were demographically matched with five patients (six knees) who underwent robot-assisted total knee arthroplasty (TKA) during the same period. Clinical outcomes of these twelve knees were assessed in the form of knee society score (KSS) score, Oxford knee score (OKS), and forgotten joint score (FJS) after a minimum follow-up period of 25 months. The data between the two cohorts were compared and analyzed.

RESULTS

Scores obtained from both cohorts were subjected to statistical analysis. SPSS software was utilized and the Mann Whitney U-test was utilized to compare the two groups. There was no statistically significant difference found between the two groups in terms of functional outcome.

CONCLUSION

Image-based robot-assisted BCKA is a bone stock preserving and more physiological procedure which can be a promising alternative to patients presenting with isolated arthritis of only two compartments of the knee. Although long-term, larger trials are warranted to establish it as an alternative, our pilot study shows an equally favorable outcome as TKA, making it an exciting new avenue in the field of arthroplasty.

Better PROMs and higher return-to-sport rate after modular bicompartmental knee arthroplasty than after total knee arthroplasty for medial and patellofemoral compartment osteoarthritis

Background

Theoretical advantages of bicompartmental knee arthroplasty (BKA) over total knee arthroplasty (TKA) for bicompartmental (medial combined with patellofemoral) osteoarthritis (OA) are still unclear. This study aimed to compare patient-reported outcome measures (PROMs) and return-to-sport (RTS) rate between modular BKA and TKA in early follow-up.

Methods

Twenty-five consecutive modular BKA cases with a minimum 2-year follow-up were matched with 50 TKA cases at 1:2 ratio. Demographic data and preoperative functional scores, including the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Knee Society Scores (KSSs), were analyzed to ensure comparability. Postoperative WOMAC score, KSS, range of motion (ROM), Forgotten Joint Score-12 (FJS-12), and RTS rates were compared. Operative time and blood loss were also analyzed.

Results

Significant differences in the WOMAC-function (median 97.1 vs. 89.7, p < 0.001) and KSS-function (median 90.0 vs. 80.0, p = 0.003) scores were identified between the BKA and TKA groups. ROM was significantly greater in the BKA group than in the TKA group (median 125.0° vs. 120.0°, p = 0.004), in addition to the FJS-12 (median 89.6 vs. 53.1, p < 0.001). The overall RTS rate was significantly higher in the BKA group than in the TKA group (71.6% vs. 56.5%, p = 0.039). Operative time was significantly longer in the BKA group than in the TKA group (median 105.0 vs. 67.5 min, p < 0.001), but blood loss was similar (median 557.6 vs. 450.7 ml, p = 0.334).

Conclusion

Modular BKA demonstrated better functional recovery, better joint perception, and higher RTS rate than TKA; thus, modular BKA can be a good alternative for bicompartmental OA.

Staged BiCompartmental Knee Arthroplasty has Greater Functional Improvement, but Equivalent Midterm Survivorship, as Revision TKA for Progressive Osteoarthritis After Partial Knee Arthroplasty

BACKGROUND

Progressive arthritis in the unresurfaced compartments of the knee is one failure mode after partial knee arthroplasty (PKA). While progressive arthritis after PKA is typically treated with revision to TKA (rTKA), staged bicompartmental knee arthroplasty (sBiKA) -the addition of another PKA - is an alternative. This study compared outcomes of sBiKA and rTKA for progressive arthritis after PKA.

METHODS

A retrospective comparative study of non-consecutive cases at four institutions were performed in patients with an intact PKA, without loosening or wear, who underwent sBiKA (n = 27) or rTKA (n = 30), for progressive osteoarthritis. Outcomes studied were new Knee Society Function and Objective Scores (KSSF, KSSO), KOOS, Jr., ROM, operative times, length of stay, complication rates and the need for reoperations.

RESULTS

Mean time to conversion was 7.4 ± 6 years for sBiKA and 9.7 ± 8 for rTKA, P = .178. Patient demographics and pre-operative outcomes were similar among cohorts. At an average of 5.7 ± 3 (sBiKA) and 3.2 ± 2 years (rTKA), KOOS, Jr. significantly improved, P < .001, by an equivalent amount. Post-operative KSSO and KSSF were significantly higher in the sBiKA cohort, respectively, (90.4 ± 10 vs 72.1 ± 20, P < .001) and (80.3 ± 18 vs 67.1 ± 19, P = .011). sBiKA patients had significantly greater improvement in KSSO (30.7 ± 33 vs 5.2 ± 18, P = .003). One sBiKA patient underwent reoperation for continued pain.

CONCLUSION

SBiKA has equivalent survivorship, but greater improvement in functional outcomes as rTKA at short to midterm follow-up. Given the shorter operative times and length of stay, sBiKA is a safe and cost-effective alternative to rTKA for progressive osteoarthritis following PKA. Nevertheless, further follow-up is necessary to determine whether sBiKA is a durable option.

Does bicompartmental knee arthroplasty hold an advantage over total knee arthroplasty? Systematic review and meta-analysis

INTRODUCTION

The role of bicompartmental knee arthroplasty (BKA) in the treatment of medial patellofemoral osteoarthritis (MPFOA) has been debated by orthopaedic surgeons for years. The BKA is a cruciate ligament retaining prosthesis designed to mimic the kinematics of the native knee that requires resurfacing of only two knee compartments. In this study, we aim to assess the patient recorded outcome measures (PROMs), range of motion (ROM), perioperative morbidity, and implant revision rate in patients undergoing BKA and compare them to those undergoing total knee arthroplasty (TKA) for bicompartmental knee osteoarthritis (OA).

PATIENTS AND METHODS

We followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses Statement (PRISMA). Articles from any country and written in any language were considered. We included all randomized control trials and retrospective cohort studies examining BKA versus TKA for bicompartmental knee OA. The primary outcome measure was knee society score (KSS) at one year and the secondary outcome measures were Oxford knee score (OKS) and short-form survey (SF-)12 at six and twelve months.

RESULTS

We included five studies in our meta-analysis. In terms of OKS, KSS, and SF-12, our meta-analysis suggests better short-term results for the TKA compared with the BKA. TKA was also associated with a shorter operative time and a lower revision rate. The BKA implant did however result in marginally less intraoperative blood loss and slightly better post-operative ROM.

CONCLUSIONS

BKA did not prove to be an equivalent alternative to TKA in bicompartmental knee OA. It was associated with inferior KSS, OKS, and SF-12 at short-term follow-up and a higher revision rate.

[Expert consensus on surgical treatment of patellofemoral osteoarthritis]

Patellofemoral osteoarthritis (PFOA) is one of the most common causes of anterior knee pain in middle-aged and elderly population. In general, elementary therapy and drug therapy are the preferred choices for PFOA management. However, for those who cannot achieve satisfactory effectiveness with standard non-surgical treatment, surgical therapy stands as an alternative treatment. The surgical therapy includes repair surgery and reconstruction surgery. The choice of surgical plans for PFOA management mainly depends on the etiology, pathogenesis, location, and severity of the lesions. To aid clinical decision-making, the National Clinical Research Center for Geriatric Disorders (Xiangya Hospital) and the Joint Surgery Branch of the Chinese Orthopedic Association arranged nationwide orthopedic specialists to set up a work panel. After reviewing the research progress of surgical therapy and the latest guidelines and consensus for PFOA management, the work panel discussed repeatedly to reach this consensus. The present consensus aims to provide valid evidences for clinical practices of the surgical therapy of PFOA, so as to avoid inappropriate and irregular treatment behaviors, reduce surgical trauma, improve surgical efficacy and the quality of life, and to ease the burden of PFOA.