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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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Legnani C, Ventura A, Mangiavini L, Maffulli N, Peretti GM. Management of Medial Femorotibial Knee Osteoarthritis in Conjunction with Anterior Cruciate Ligament Deficiency: Technical Note and Literature Review. J Clin Med 2024; 13:3143. [PMID: 38892854 PMCID: PMC11172484 DOI: 10.3390/jcm13113143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 05/17/2024] [Accepted: 05/24/2024] [Indexed: 06/21/2024] Open
Abstract
In recent years, there has been increased interest in the management of medial femorotibial knee osteoarthritis (OA) in conjunction with anterior cruciate ligament (ACL) deficiency. Traditional treatment modalities included conservative therapy, high tibial osteotomy with or without ACL reconstruction, and total knee replacement. Since younger patients with higher physical demands are more likely to suffer from this pathological condition, reduced invasiveness, faster recovery time, and improved knee kinematics are preferred to allow for satisfying clinical and functional outcomes. Thus, a new surgical strategy combining medial unicompartmental knee replacement (UKR) and ACL reconstruction has been proposed to allow bone stock preservation, to reduce surgical morbidity and recovery time, and ultimately to improve joint kinematics and clinical outcomes. Based on the data present in the literature, in the setting of unicompartmental OA in association with ACL deficiency, UKR combined with ACL reconstruction provided encouraging early results. Studies evaluating the outcomes of combined ACL reconstruction and UKR demonstrate promising results in select patient populations. Improved knee stability, pain relief, functional recovery, and patient satisfaction improved after surgery. Moreover, the combined approach offered advantages such as reduced surgical trauma, faster rehabilitation, and preservation of native knee anatomy compared with traditional treatment strategies. However, still, high-level studies on this topic are lacking; therefore, more comparative studies reporting long-term outcomes are needed to support the potential of this combined procedure to become mainstream. In this paper, we discuss the relevant features and rationale behind the indications and technique of this combined surgical procedure, to help surgeons choose the correct therapeutic approach for a patient with concomitant medial OA and ACL insufficiency. Continued advancements in surgical techniques, patient selection criteria, and rehabilitation strategies will further enhance the success of this combined approach, offering hope to individuals with concomitant ACL injuries and unicompartmental knee OA.
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Affiliation(s)
- Claudio Legnani
- IRCCS Istituto Ortopedico Galeazzi, Sport Traumatology and Minimally Invasive Surgery Center, 20161 Milan, Italy
| | - Alberto Ventura
- IRCCS Istituto Ortopedico Galeazzi, Sport Traumatology and Minimally Invasive Surgery Center, 20161 Milan, Italy
| | - Laura Mangiavini
- IRCCS Istituto Ortopedico Galeazzi, 20157 Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, 20122 Milan, Italy
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Baronissi, Italy
- Centre for Sports and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London E1 4NS, UK
- School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, Stoke on Trent ST4 7QB, UK
| | - Giuseppe M. Peretti
- IRCCS Istituto Ortopedico Galeazzi, 20157 Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, 20122 Milan, Italy
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Aslan H, Çevik HB. Outcomes of Combined Unicondylar Knee Arthroplasty and Anterior Cruciate Ligament Reconstruction. J Knee Surg 2022; 35:1087-1090. [PMID: 33545722 DOI: 10.1055/s-0040-1722322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Young and more active patients with medial compartmental osteoarthritis (OA) in conjunction with anterior cruciate ligament (ACL) deficiency are challenging for orthopaedic surgeons. The aim of the present study was to examine the early-mid clinical and radiological outcomes of combined Oxford unicondylar knee arthroplasty (UKA) and ACL reconstruction for the patients presenting ACL deficiency and concomitant medial compartment symptomatic OA. Twelve patients were included in the study. All patients were treated by combination of ACL reconstruction with medial UKA. The varus-valgus angles of the tibial and femoral components, and pathological radiolucent lines were measured on anteroposterior and lateral knee radiographs. Clinical evaluations include knee osteoarthritis outcome score (KOOS pain, symptom, daily life, sports, and quality of life), Oxford knee score (OKS), EQ-5D-3L, and EQ-visual analog scale (VAS). All the patients were followed up for an average of 45.6 months. The leg alignment showed 3.6 degrees ± 1 of varus deformity before surgery and 2.6 degrees ± 1 of valgus after surgery. With the exception of KOOS sports (p > 0.001), the KOOS pain, symptom, daily life, and quality of life, OKS, EQ-5D-3L, and EQ-VAS improved significantly after surgery (p < 0.001). Preoperative knee instability showed anterior translation of 5 to 10 mm in eight patients and >10 mm in four patients. There were no complications at follow-up. The early-mid clinical data have shown that UKA in conjunction with ACL reconstruction has revealed promising results. However, long-term follow-up studies are required to confirm the combined procedure in these patients.
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Affiliation(s)
- Hakan Aslan
- Department of Orthopaedics and Traumatology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Hüseyin Bilgehan Çevik
- Department of Orthopaedics and Traumatology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, University of Health Sciences, Ankara, Turkey
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Yue L, Lamontagne M, Xiong Z, Zhengfei Z, Run T, Zhe L, Ning K, Chunsheng W, Pei Y, Kunzheng W. Evaluation of Knee Kinematics and Moments during Active Deep Flexion Activity after Oxford Mobile-Bearing Medial UKA-A Two-Year Follow-Up Study. J Knee Surg 2022; 35:896-903. [PMID: 33401312 DOI: 10.1055/s-0040-1721033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Few studies have assessed knee range of motion (ROM) and moments of patients with mobile-bearing unicompartmental knee arthroplasty (MB UKA) during active deep flexion activities. We analyze knee kinematic and kinetic parameters during postoperative squatting-standing activity, aiming to evaluate the efficacy of MB UKA and postoperative rehabilitation progress. This was a clinical cohort study. We followed up with 37 patients diagnosed with medial knee osteoarthritis (OA) with primary UKA. After screening 31 patients were recruited to take gait tests. Squatting-standing activities were performed under the test of 10-camera motion analysis system and force plates preoperatively at different stages after UKA (12, 18, and 24 months). The average duration of follow-up was 24.4 months (from 22.8 to 26.7 months). Hip-knee-ankle angle improved significantly compared with pre-UKA as well as scores of American Knee Society Score, numeric rating scale, ORS, and Western Ontario and McMasters. University Osteoarthritis Index. About 83.6% (31/37) of follow-up patients completed squatting-standing activity independently. At 1-year follow-up, peak varus angle (20.6 ± 2.8 degrees), internal rotation angle (13.6 ± 1.8 degrees), extensor moment (1.44 ± 0.04N*m/kg), and internal rotator moment (0.02 ± 0.005N*m/kg) of UKA knees were inferior to contralateral knees. Peak adductor moment (0.76 ± 0.05N*m/kg) was superior to contralateral knees. At 2-year follow-up, peak flexion angle (125.0 ± 2.8 degrees) showed a growing trend meanwhile extensor (1.70 ± 0.03N*m/kg) and adductor (0.68 ± 0.06 N*m/kg) moment closely resembled those of the contralateral knee. MB UKA could alleviate the affected knee mainly in flexion-extension ROM and moment meanwhile did not affect the biomechanical indicators of healthy limbs. OA knees in the early postoperative period showed decreased extensor moment and increased adductor moment during active deep flexion activity. Better ROM and relatively more natural extensor and adductor moment of UKA knee with rehabilitation time increasing may predict ideal rehabilitation outcome in the medium or longer term.
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Affiliation(s)
- Li Yue
- Department of Orthopaedics, The Second Affiliated Hospital of Xi'an Jiaotong University, Shaanxi Province, P.R. China.,School of Human Kinetics, University of Ottawa, Ottawa Ontario, Canada
| | - Mario Lamontagne
- School of Human Kinetics, University of Ottawa, Ottawa Ontario, Canada
| | - Zhao Xiong
- School of Human Kinetics, University of Ottawa, Ottawa Ontario, Canada
| | - Zhu Zhengfei
- State Key Laboratory for Manufacturing Systems Engineering, School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an, China
| | - Tian Run
- Department of Orthopaedics, The Second Affiliated Hospital of Xi'an Jiaotong University, Shaanxi Province, P.R. China
| | - Li Zhe
- Department of Orthopaedics, The Second Affiliated Hospital of Xi'an Jiaotong University, Shaanxi Province, P.R. China
| | - Kong Ning
- Department of Orthopaedics, The Second Affiliated Hospital of Xi'an Jiaotong University, Shaanxi Province, P.R. China
| | - Wang Chunsheng
- Department of Orthopaedics, The Second Affiliated Hospital of Xi'an Jiaotong University, Shaanxi Province, P.R. China
| | - Yang Pei
- Department of Orthopaedics, The Second Affiliated Hospital of Xi'an Jiaotong University, Shaanxi Province, P.R. China
| | - Wang Kunzheng
- Department of Orthopaedics, The Second Affiliated Hospital of Xi'an Jiaotong University, Shaanxi Province, P.R. China
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Hiranaka T, Hida Y, Tanaka T, Okimura K, Fujishiro T, Okamoto K. Validation of the Macroscopic Anterior Cruciate Ligament Status Using the Oxford Classification System in Relation to Cartilage Defects on the Medial Tibial Plateau in Osteoarthritic Knees. J Knee Surg 2022; 35:884-889. [PMID: 33176366 DOI: 10.1055/s-0040-1721032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This study evaluated the relationships between anterior cruciate ligament (ACL) grading using the Oxford classification system and cartilage defects on the medial tibial plateau to clarify the validity of the system. We studied the location and size of a full-thickness cartilage defect of the medial tibial plateau in 154 knees (97 patients) treated by unicompartmental (113) or total (41) knee arthroplasty between April 2017 and January 2018, and analyzed their relationship to the anterior cruciate ligament (ACL) grade, Grade 1 (normal), Grade 2 (synovial damage), Grade 3 (longitudinal split), Grade 4 (friable and fragmented), and Grade 5 (absent). Significant trends in decreased posterior preserved cartilage, increased defect length, and posteriorized defect center were associated with increasing ACL grade. Multiple comparison analysis revealed that the measurements were significantly different between ACL functional (Grades 1-3) and ACL deficient (Grades 4 and 5). On the other hand, the anterior preserved cartilage was consistent among the Grades. The macroscopic Oxford ACL classification system well described the disease progression where the cartilage defect extends posteriorly with ACL damage. However, 38% of ACL deficient knees had well-preserved posterior cartilage with no evident tibial anterior translation.
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Affiliation(s)
- Takafumi Hiranaka
- Department of Orthopedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Osaka, Japan
| | - Yuichi Hida
- Department of Orthopedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Osaka, Japan.,Department of Orthopaedic Surgery, Kasai City Hospital, Hyogo, Japan
| | - Toshikazu Tanaka
- Department of Orthopedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Osaka, Japan
| | - Kenjiro Okimura
- Department of Orthopedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Osaka, Japan
| | - Takaaki Fujishiro
- Department of Orthopedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Osaka, Japan
| | - Koji Okamoto
- Department of Orthopedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Osaka, Japan
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Derreveaux V, Schmidt A, Shatrov J, Sappey-Marinier E, Batailler C, Servien E, Lustig S. Combined procedures with unicompartmental knee arthroplasty: High risk of stiffness but promising concept in selected indications. SICOT J 2022; 8:4. [PMID: 35191830 PMCID: PMC8862640 DOI: 10.1051/sicotj/2022002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 01/07/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction: Unicompartmental knee arthroplasty (UKA) has traditionally been contraindicated in the presence of an ACL deficient knee, bi-compartmental disease, or significant coronal deformity due to concerns regarding increased risk of persisted pain, knee instability, tibial loosening, or progression of osteoarthritis. The aim of this study was to evaluate the outcomes of patients undergoing UKA with an associated surgical procedure in these specific indications. Method: This was a retrospective cohort study of patients undergoing UKA between December 2015 and October 2020. Patients were categorized into groups based on associated procedures: UKA + ACL, UKA + HTO, and bicompartmental arthroplasty. Outcomes were assessed using the Knee Society Score (KSS) knee and function scores and the Forgotten Joint Score. Radiological and complication analysis was performed at the last clinical follow-up. Results: Thirty-two patients (13 men and 19 women) were included. The mean age was 56.2 years ± 11.1 (range, 33–84) with a mean follow-up of 26.3 months ± 15 (7.3–61.1). There was a significant improvement between the pre-and postoperative KSS Knee (+34.3 ± 16.5 [12–69]), Function (+34.3 ± 18.6 [0–75]), and Total scores (+68.5 ± 29.4 [24–129]) (p = 0.001). Seven patients (21.8%) required an arthroscopic arthrolysis for persistent stiffness. Two patients (UKA + PFA and UKA + ACL) underwent revision to TKA. Patient satisfaction was 90%, and mean flexion at last follow-up was 122° ± 6 (120–140). The implant survival rate was 94%. Discussion: This study found performing UKA with an additional procedure to address relative contraindications to the arthroplasty in physically active patients with monocompartmental knee arthritis is an efficient strategy with good results at short-term follow-up. It should be reserved for patients where TKA is likely to have unsatisfactory results, and the patient has been fully counseled regarding the management options. Even if there is a high rate of complications with stiffness requiring a re-intervention, the final results are very satisfying with no impact of the reintervention on the clinical result in the short term.
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Affiliation(s)
- Vianney Derreveaux
- FIFA Medical Center of Excellence, Orthopaedics Surgery and Sports Medicine Department, Croix-Rousse Hospital, Hospices Civils de Lyon 103 Grande rue de la Croix Rousse 69004 Lyon France
| | - Axel Schmidt
- FIFA Medical Center of Excellence, Orthopaedics Surgery and Sports Medicine Department, Croix-Rousse Hospital, Hospices Civils de Lyon 103 Grande rue de la Croix Rousse 69004 Lyon France
- Corresponding author:
| | - Jobe Shatrov
- Sydney Orthopaedic Research Institute Chatswood Sydney 2067 Australia
- University of Notre Dame Australia Orthopaedic Research Institute Sydney 2007 Australia
- Hornsby and Ku-Ring Hospital Sydney 2077 Australia
| | - Elliot Sappey-Marinier
- FIFA Medical Center of Excellence, Orthopaedics Surgery and Sports Medicine Department, Croix-Rousse Hospital, Hospices Civils de Lyon 103 Grande rue de la Croix Rousse 69004 Lyon France
- Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406 25 Avenue François Mitterand 69500 Lyon France
| | - Cécile Batailler
- FIFA Medical Center of Excellence, Orthopaedics Surgery and Sports Medicine Department, Croix-Rousse Hospital, Hospices Civils de Lyon 103 Grande rue de la Croix Rousse 69004 Lyon France
- Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406 25 Avenue François Mitterand 69500 Lyon France
| | - Elvire Servien
- FIFA Medical Center of Excellence, Orthopaedics Surgery and Sports Medicine Department, Croix-Rousse Hospital, Hospices Civils de Lyon 103 Grande rue de la Croix Rousse 69004 Lyon France
- LIBM – EA 7424, Interuniversity Laboratory of Biology of Mobility, Claude Bernard Lyon 1 University 43 boulevard du 11 Novembre 69622 Villeurbanne France
| | - Sébastien Lustig
- FIFA Medical Center of Excellence, Orthopaedics Surgery and Sports Medicine Department, Croix-Rousse Hospital, Hospices Civils de Lyon 103 Grande rue de la Croix Rousse 69004 Lyon France
- Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406 25 Avenue François Mitterand 69500 Lyon France
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Post-traumatic ACL Tear With Oxford Mobile Bearing UKA In Situ: Management Tips and Pearls. Tech Orthop 2021. [DOI: 10.1097/bto.0000000000000446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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8
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Superior patient satisfaction in medial pivot as compared to posterior stabilized total knee arthroplasty: a prospective randomized study. Knee Surg Sports Traumatol Arthrosc 2021; 29:3633-3640. [PMID: 33155090 DOI: 10.1007/s00167-020-06343-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 10/20/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Medial pivot (MP) total knee arthroplasty (TKA) aims to restore native knee kinematics due to highly conforming medial tibio-femoral articulation with survival comparable to contemporary knee designs. Posterior stabilized (PS) TKAs use cam-post mechanism to restore native femoral rollback. However, there is conflicting evidence regarding the reported patient satisfaction with MP TKA designs when compared to PS TKAs. The primary aim of this study is to compare the patient satisfaction between MP and PS TKA and the secondary aim is to establish potential reasons behind any differences in the outcomes noted between these two design philosophies. METHODS In this IRB-approved single surgeon, single centre prospective RCT, 53 patients (mean age 62 years, 42 women) with comparable bilateral end-stage knee arthritis undergoing simultaneous bilateral TKA were randomized to receive MP TKA in one knee and PS TKA in the contralateral knee. At 4 years post-surgery, all patients were assessed using Knee Society Score (KSS)-Satisfaction and -Expectation scores, and Oxford Knee Score (OKS). In addition, all the patients underwent standardized radiological and in vivo kinematic assessment. RESULTS Patients were more satisfied with the MP TKA as compared to PS TKA: mean KSS-Satisfaction [34.5 ± 3.05 in MP and 31.7 ± 3.16 in PS TKAs (p < 0.0001)] and mean KSS-Expectation scores [12.5 ± 1.39 in MP TKAs and 11.2 ± 1.41 in PS TKAs (p < 0.0001)]. No significant difference was noted in any other clinical outcomes. The in vivo kinematics of MP TKAs was significantly better than those of PS TKAs. CONCLUSION MP TKAs provide superior patient satisfaction and patient expectations as compared to PS TKA. This may be related to better replication of natural knee kinematics with MP TKA. LEVEL OF EVIDENCE I.
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Which one restores in vivo knee kinematics effectively-medial or lateral pivot? J Clin Orthop Trauma 2020; 13:70-73. [PMID: 33717879 PMCID: PMC7920103 DOI: 10.1016/j.jcot.2020.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/01/2020] [Accepted: 08/19/2020] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Total knee arthroplasty (TKA) usually provides good pain relief and improved function but has generally been unable to fully restore normal knee kinematics. Does Medial or Lateral Pivot TKA designs guide us to native knee kinematics needs to be elucidated? METHODS Kinematic assessment of 13 knees with Medial Pivot TKA and 13 knees with Lateral Pivot TKA was done. The subjects were asked to perform step-up and weight bearing deep knee bend exercise under fluoroscopy for kinematic assessment. Patellar Tendon Angle (PTA) was measured after correcting f luoroscopic images for distortion against Knee Flexion Angle (KFA). RESULTS During the weight bearing deep knee bend, the average active maximum flexion achieved with Medial Pivot design was 113.8 ͦ as compared to 102.9 ͦ with Lateral Pivot design. There was no significant difference in PTA in step up and deep knee bend exercise between both the designs. CONCLUSION The kinematic assessment of both the Medial and Lateral Pivot TKA designs revealed linear trend of PTA with increasing KFA as described for normal knee. Both the designs were able to achieve functional knee range of motion.
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Kakar RS, Fu YC, Kinsey TL, Brown CN, Mahoney OM, Simpson KJ. Lower limb kinematics of unicompartmental knee arthroplasty individuals during stair ascent. J Orthop 2020; 22:173-178. [PMID: 32419760 DOI: 10.1016/j.jor.2020.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 04/24/2020] [Accepted: 04/25/2020] [Indexed: 10/24/2022] Open
Abstract
Objective Purpose of the study was to compare lower-limb kinematics and interlimb asymmetry during stair ascent in individuals post-medial or lateral unicompartmental knee arthroplasty (UKA). Methods 60 patients (20 medial; 10 lateral) post-UKA and 30 matched healthy controls performed stair ascent. Spatio-temporal, lower-limb kinematics and interlimb asymmetries during stair ascent were compared. Results Medial-UKA group displayed 5° less knee extension of the UKA limb than controls (p = 0.005) and 2° less than the contralateral limb during stance phase. No interlimb asymmetries were found for lateral-UKA. Conclusion Patients post-UKA demonstrate satisfactory lower-limb kinematics and minimal interlimb asymmetry during stair ascent compared to healthy individuals.
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Affiliation(s)
- Rumit Singh Kakar
- School of Rehabilitation Sciences, Old Dominion University, Norfolk, VA, USA
| | | | | | - Cathleen N Brown
- Department of Kinesiology, Oregon State University, Corvallis, OR, USA
| | - Ormonde M Mahoney
- Athens Orthopedic Clinic, PA, Athens, GA, USA.,Department of Kinesiology, University of Georgia, Athens, GA, USA
| | - Kathy J Simpson
- Department of Kinesiology, University of Georgia, Athens, GA, USA
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11
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Komnik I, David S, Funken J, Haberer C, Potthast W, Weiss S. Compromised knee internal rotation in total knee arthroplasty patients during stair climbing. PLoS One 2018; 13:e0205492. [PMID: 30304032 PMCID: PMC6179266 DOI: 10.1371/journal.pone.0205492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 09/26/2018] [Indexed: 11/19/2022] Open
Abstract
Due to the significant role of rotational properties for normal knee function, this study aimed to investigate transverse plane kinematics and kinetics in total knee arthroplasty and unicondylar knee arthroplasty patients during activities of daily living compared to a healthy control group, including stair ascent and descent. The study participants consisted of a total knee arthroplasty group including posterior cruciate retaining and posterior stabilized designs as well as a unicondylar knee arthroplasty group and a healthy control group. Three-dimensional kinematics and kinetics were captured using a Vicon system and two Kistler force plates embedded in the floor and another two in a staircase. Inverse dynamics of the lower limbs was computed in Anybody™ Modeling System. Transverse plane joint angles and joint moments were analyzed utilizing the statistical non-parametric mapping approach, considering the entire curve shape for statistical analysis. The patients with total knee arthroplasty exhibited significantly reduced knee internal rotation of the operated knee compared to the control group and the patients’ unimpaired limb, especially during the stair climbing tasks. Both unicondylar and total knee arthroplasty patients were found to have similar reduced internal rotation motion time series in stair descent. In conclusion, potential kinematic and kinetic benefits of unicondylar knee arthroplasty over total knee arthroplasty could not be proven in the current study. Aside from the usually mentioned reasons inducing constrained knee internal rotation in total knee arthroplasty patients, future studies should investigate to what extent co-contraction may contribute to this functional impairment in patients after knee arthroplasty surgery.
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Affiliation(s)
- Igor Komnik
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Nordrhein-Westfalen, Germany
- * E-mail:
| | - Sina David
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Nordrhein-Westfalen, Germany
| | - Johannes Funken
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Nordrhein-Westfalen, Germany
| | | | - Wolfgang Potthast
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Nordrhein-Westfalen, Germany
| | - Stefan Weiss
- ARCUS Clinics Pforzheim, Pforzheim, Baden-Württemberg, Germany
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12
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Motesharei A, Rowe P, Blyth M, Jones B, Maclean A. A comparison of gait one year post operation in an RCT of robotic UKA versus traditional Oxford UKA. Gait Posture 2018. [PMID: 29524796 DOI: 10.1016/j.gaitpost.2018.02.029] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Robot-assisted unicompartmental knee surgery has been shown to improve the accuracy of implant alignment. However, little research has been conducted to ascertain if this results in a measureable improvement in knee function post operatively and a more normal gait. The kinematics of 70 OA knees were assessed using motion analysis in an RCT (31 receiving robotic-assisted surgery, and 39 receiving traditional manual surgery) and compared to healthy knees. Statistically significant kinematic differences were seen between the two surgical groups from foot-strike to mid-stance. The robotic-assisted group achieved a higher knee excursion (18.0°, SD 4.9°) compared to the manual group (15.7°, SD 4.1°). There were no significant difference between the healthy group and the robotic assisted group, however there was a significant difference between the healthy group and the manual group (p < 0.001). Hence robotically-assisted knee replacement with Mako Restoris Implants appears to lead not only to better implant alignment but also some kinematic benefits to the user during gait.
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Affiliation(s)
- Arman Motesharei
- Biomedical Engineering Department, University of Strathclyde, 106 Rottenrow East, Glasgow, G4 0NW, UK
| | - Philip Rowe
- Biomedical Engineering Department, University of Strathclyde, 106 Rottenrow East, Glasgow, G4 0NW, UK.
| | - Mark Blyth
- Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, UK
| | - Bryn Jones
- Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, UK
| | - Angus Maclean
- Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, UK
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The role of the patellar tendon angle and patellar flexion angle in the interpretation of sagittal plane kinematics of the knee after knee arthroplasty: A modelling analysis. Knee 2018; 25:240-248. [PMID: 29501390 DOI: 10.1016/j.knee.2018.01.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 01/05/2018] [Accepted: 01/15/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Many different measures have been used to describe knee kinematics. This study investigated the changes of two measures, the patellar tendon angle and the patellar flexion angle, in response to variations in the geometry of the knee due to surgical technique or implant design. METHODS A mathematical model was developed to calculate the equilibrium position of the extensor mechanism for a particular tibiofemoral position. Calculating the position of the extensor mechanism allowed for the determination of the patellar tendon angle and patellar flexion angle relationships to the knee flexion angle. The model was used to investigate the effect of anterior-posterior position of the femur, change in joint line, patellar thickness (overstuffing, understuffing), and patellar tendon length; these parameters were varied to determine the effect on the patellar tendon angle/knee flexion angle and patellar flexion angle/knee flexion angle relationships. RESULTS The patellar tendon angle was a good indicator of anterior-posterior femoral position and change in patellar thickness, and the patellar flexion angle a good indicator of change in joint line, and patellar tendon length. CONCLUSIONS The patellar tendon angle/knee flexion angle relationship was found to be an effective means of identifying abnormal kinematics post-knee arthroplasty. However, the use of both the patellar tendon angle and patellar flexion angle together provided a more informative overview of the sagittal plane kinematics of the knee.
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Reduced Bearing Excursion After Mobile-Bearing Unicompartmental Knee Arthroplasty is Associated With Poor Functional Outcomes. J Arthroplasty 2018; 33:366-371. [PMID: 29103778 DOI: 10.1016/j.arth.2017.09.057] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 08/17/2017] [Accepted: 09/21/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND A small proportion of patients with mobile unicompartmental knee arthroplasty (UKA) report poor functional outcomes in spite of optimal component alignment on postoperative radiographs. The purpose of this study is to assess whether there is a correlation between functional outcome and knee kinematics. METHODS From a cohort of consecutive cases of 150 Oxford medial UKA, patients with fair/poor functional outcome at 1-year postsurgery (Oxford Knee Score [OKS] < 34, n = 15) were identified and matched for age, gender, preoperative clinical scores, and follow-up period with a cohort of patients with good/excellent outcome (OKS ≥ 34, n = 15). In vivo kinematic assessment was performed using step-up and deep knee bend exercises under fluoroscopic imaging. The fluoroscopic videos were analyzed using MATLAB software to measure the variation in time taken to complete the exercises, patellar tendon angle, and bearing position with knee flexion angle. RESULTS Mean OKS in the fair/poor group was 29.9 and the mean OKS in the good/excellent group was 41.1. The tibial slope, time taken to complete the exercises, and patellar tendon angle trend over the flexion range were similar in both the groups; however, bearing position and the extent of bearing excursion differed significantly. The total bearing excursion in the OKS < 34 group was significantly smaller than the OKS ≥ 34 group (35%). Furthermore, on average, the bearing was positioned 1.7 mm more posterior on the tibia in the OKS < 34 group. CONCLUSION This study provides evidence that abnormal knee kinematics, in particular bearing excursion and positioning, are associated with worse functional outcomes after mobile UKA.
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15
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Becker R, Kopf S. Unikondyläre Prothese und vordere Kreuzbandplastik. ARTHROSKOPIE 2017. [DOI: 10.1007/s00142-017-0157-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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16
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Mentink MJA, Van Duren BH, Murray DW, Gill HS. A novel flexible capacitive load sensor for use in a mobile unicompartmental knee replacement bearing: An in vitro proof of concept study. Med Eng Phys 2017; 46:44-53. [DOI: 10.1016/j.medengphy.2017.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 04/10/2017] [Accepted: 05/16/2017] [Indexed: 11/25/2022]
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Adravanti P, Budhiparama NC, Berend KR, Thienpont E. ACL-deficient knee and unicompartmental OA: state of the art. J ISAKOS 2017. [DOI: 10.1136/jisakos-2016-000066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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18
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Komnik I, Peters M, Funken J, David S, Weiss S, Potthast W. Non-Sagittal Knee Joint Kinematics and Kinetics during Gait on Level and Sloped Grounds with Unicompartmental and Total Knee Arthroplasty Patients. PLoS One 2016; 11:e0168566. [PMID: 28002437 PMCID: PMC5176302 DOI: 10.1371/journal.pone.0168566] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 12/04/2016] [Indexed: 11/19/2022] Open
Abstract
After knee arthroplasty (KA) surgery, patients experience abnormal kinematics and kinetics during numerous activities of daily living. Biomechanical investigations have focused primarily on level walking, whereas walking on sloped surfaces, which is stated to affect knee kinematics and kinetics considerably, has been neglected to this day. This study aimed to analyze over-ground walking on level and sloped surfaces with a special focus on transverse and frontal plane knee kinematics and kinetics in patients with KA. A three-dimensional (3D) motion analysis was performed by means of optoelectronic stereophogrammetry 1.8 ± 0.4 years following total knee arthroplasty (TKA) and unicompartmental arthroplasty surgery (UKA). AnyBody™ Modeling System was used to conduct inverse dynamics. The TKA group negotiated the decline walking task with reduced peak knee internal rotation angles compared with a healthy control group (CG). First-peak knee adduction moments were diminished by 27% (TKA group) and 22% (UKA group) compared with the CG during decline walking. No significant differences were detected between the TKA and UKA groups, regardless of the locomotion task. Decline walking exposed apparently more abnormal knee frontal and transverse plane adjustments in KA patients than level walking compared with the CG. Hence, walking on sloped surfaces should be included in further motion analysis studies investigating KA patients in order to detect potential deficits that might be not obvious during level walking.
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Affiliation(s)
- Igor Komnik
- Institute for Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Nordrhein-Westfalen, Germany
| | - Markus Peters
- Institute for Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Nordrhein-Westfalen, Germany
| | - Johannes Funken
- Institute for Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Nordrhein-Westfalen, Germany
| | - Sina David
- Institute for Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Nordrhein-Westfalen, Germany
| | - Stefan Weiss
- ARCUS Clinics Pforzheim, Pforzheim, Baden-Württemberg, Germany
| | - Wolfgang Potthast
- Institute for Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Nordrhein-Westfalen, Germany
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19
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Tian S, Wang B, Wang Y, Ha C, Liu L, Sun K. Combined unicompartmental knee arthroplasty and anterior cruciate ligament reconstruction in knees with osteoarthritis and deficient anterior cruciate ligament. BMC Musculoskelet Disord 2016; 17:327. [PMID: 27496245 PMCID: PMC4974734 DOI: 10.1186/s12891-016-1186-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 07/28/2016] [Indexed: 11/10/2022] Open
Abstract
Background Relative young and more active patients with osteoarthritis (OA) of the isolated medial femorotibial compartment in conjunction with anterior cruciate ligament (ACL) deficiency are difficult to treat. The aim of this study was to explore the early clinical outcomes of combined Oxford unicompartmental knee arthroplasty (UKA) and ACL reconstruction for the patients presenting ACL deficiency and isolated OA of the medial compartment. Methods Twenty-eight patients were included into the study. All patients were treated by combined Oxford UKA and ACL reconstruction. Plain radiographs in the antero-posterior and lateral view and long-leg standing radiographs were routinely performed prior to and after surgery. Stress radiographs in valgus were additionally available in order to verify the well-preserved lateral compartment. The varus deformity of the knee prior to surgery and the valgus degree after surgery, the posterior slope of the tibial component and the range of motion (ROM) of the knee after surgery were measured and recorded. Clinical evaluations include Oxford Knee Score (OKS), Knee Society Score (KSS-clinical score; KSS-function score) and Tegner activity score. Results All the patients were followed up for 52 ± 8 months. The leg alignment showed 3.1 ± 0.6° of varus deformity prior to surgery and 4.0 ± 0.7° of valgus after surgery. The OKS, KSS and Tegner activity score improved significantly after surgery (P < 0.05). The mean ROM of the operated knee was 123.5 ± 2.8° at the last follow-up. The posterior slope of the tibial component was 3.9 ± 1.2°. A significant correlation was found between them according to the Pearson’s correlation (r = 0.39, P = 0.03). There were 2 patients (7 %) with the complication of mobile bearing dislocation, and a second operation of replacing a thicker mobile bearing was performed for them. Conclusion The early clinical data have shown that combined surgery of UKA and ACL reconstruction has revealed promising results. However, long-term follow-up studies should be done in these patients. Trial registration Current trial ISRCTN24663935 (Retrospectively registered on 21 July 2016).
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Affiliation(s)
- Shaoqi Tian
- Department of Orthopaedics, the Affiliated Hospital of Qingdao University, No. 1677 Wutaishan Road, Huangdao District, Qingdao, Shandong, 266000, China.
| | - Bin Wang
- Department of Orthopaedics, Qingdao 3rd People's Hospital, Qingdao, 266000, China
| | - Yuanhe Wang
- Department of Orthopaedics, the Affiliated Hospital of Qingdao University, No. 1677 Wutaishan Road, Huangdao District, Qingdao, Shandong, 266000, China
| | - Chengzhi Ha
- Department of Orthopaedics, the Affiliated Hospital of Qingdao University, No. 1677 Wutaishan Road, Huangdao District, Qingdao, Shandong, 266000, China
| | - Lun Liu
- Department of Orthopaedics, the Affiliated Hospital of Qingdao University, No. 1677 Wutaishan Road, Huangdao District, Qingdao, Shandong, 266000, China
| | - Kang Sun
- Department of Orthopaedics, the Affiliated Hospital of Qingdao University, No. 1677 Wutaishan Road, Huangdao District, Qingdao, Shandong, 266000, China.
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Mancuso F, Dodd CA, Murray DW, Pandit H. Medial unicompartmental knee arthroplasty in the ACL-deficient knee. J Orthop Traumatol 2016; 17:267-75. [PMID: 27160183 PMCID: PMC4999376 DOI: 10.1007/s10195-016-0402-2] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 03/12/2016] [Indexed: 01/14/2023] Open
Abstract
Symptomatic osteoarthritis (OA) of the knee develops often in association with anterior cruciate ligament (ACL) deficiency. Two distinct pathologies should be recognised while considering treatment options in patients with end-stage medial compartment OA and ACL deficiency. Patients with primary ACL deficiency (usually traumatic ACL rupture) can develop secondary OA (typically presenting with symptoms of instability and pain) and these patients are typically young and active. Patients with primary end stage medial compartment OA can develop secondary ACL deficiency (usually degenerate ACL rupture) and these patients tend to be older. Treatment options in either of these patient groups include arthroscopic debridement, reconstruction of the ACL, high tibial osteotomy (HTO) with or without ACL reconstruction, unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA). General opinion is that a functionally intact ACL is a fundamental prerequisite to perform a UKA. This is because previous reports showed higher failure rates when ACL was deficient, probably secondary to wear and tibial loosening. Nevertheless in some cases of ACL deficiency with end-stage medial compartment OA, UKA has been performed in isolation and recent papers confirm good short- to mid-term outcome without increased risk of implant failure. Shorter hospital stay, fewer blood transfusions, faster recovery and significantly lower risk of developing major complications like death, myocardial infarction, stroke, deep vein thrombosis (as compared to TKA) make the UKA an attractive option, especially in the older patients. On the other hand, younger patients with higher functional demands are likely to benefit from a simultaneous or staged ACL reconstruction in addition to UKA to regain knee stability. These procedures tend to be technically demanding. The main aim of this review was to provide a synopsis of the existing literature and outline an evidence-based treatment algorithm.
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Affiliation(s)
- Francesco Mancuso
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK. .,Orthopaedics and Traumatology Unit, "Santa Maria della Misericordia" University Hospital, Udine, Piazzale Santa Maria della Misericordia 15, 33100, Udine, UD, Italy.
| | - Christopher A Dodd
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - David W Murray
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Hemant Pandit
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
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21
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Szivek JA, Ruth JT, Heden GJ, Martinez MA, Diggins NH, Wenger KH. Determination of joint loads using new sensate scaffolds for regenerating large cartilage defects in the knee. J Biomed Mater Res B Appl Biomater 2016; 105:1409-1421. [DOI: 10.1002/jbm.b.33677] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 01/14/2016] [Accepted: 03/20/2016] [Indexed: 11/09/2022]
Affiliation(s)
- John A. Szivek
- Orthopaedic Research Lab; University of Arizona; Tucson Arizona
| | - John T. Ruth
- Orthopaedic Research Lab; University of Arizona; Tucson Arizona
| | - Greg J. Heden
- Orthopaedic Research Lab; University of Arizona; Tucson Arizona
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22
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Pegg EC, Mancuso F, Alinejad M, van Duren BH, O'Connor JJ, Murray DW, Pandit HG. Sagittal kinematics of mobile unicompartmental knee replacement in anterior cruciate ligament deficient knees. Clin Biomech (Bristol, Avon) 2016; 31:33-9. [PMID: 26518281 DOI: 10.1016/j.clinbiomech.2015.10.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 10/05/2015] [Accepted: 10/05/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND There is a greater risk of tibial component loosening when mobile unicompartmental knee replacement is performed in anterior cruciate ligament deficient knees. We previously reported on a cohort of anterior cruciate ligament deficient patients (n=46) who had undergone surgery, but no difference was found in implant survivorship at a mean 5-year follow-up. The purpose of this study was to examine the kinematic behaviour of a subcohort of these patients. METHODS The kinematic behaviour of anterior cruciate deficient knees (n=16) after mobile unicompartmental knee replacement was compared to matched intact knees (n=16). Sagittal plane knee fluoroscopy was taken while patients performed step-up and forward lunge exercises. The patellar tendon angle, knee flexion angle and implant position was calculated for each video frame. FINDINGS The patellar tendon angle was 5° lower in the deficient group, indicating greater anterior tibial translation compared to the intact group between 30 and 40° of flexion. Large variability, particularly from 40-60° of flexion, was observed in the bearing position of the deficient group, which may represent different coping mechanisms. The deficient group took 38% longer to perform the exercises. INTERPRETATION Kinematic differences were found between the deficient and intact knees after mobile unicompartmental knee replacement; but these kinematic changes do not seem to affect the medium-term clinical outcome. Whether these altered knee kinematics will have a clinical impact is as yet undetermined, but more long-term outcome data is required before mobile unicompartmental knee replacement can be recommended for an anterior cruciate ligament deficient patient.
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Affiliation(s)
- Elise C Pegg
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom.
| | - Francesco Mancuso
- Orthopaedics and Traumatology Unit, San Donà di Piave General Hospital, Venice, Italy
| | - Mona Alinejad
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Bernard H van Duren
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - John J O'Connor
- Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - David W Murray
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Hemant G Pandit
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
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23
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Halewood C, Traynor A, Bellemans J, Victor J, Amis AA. Anteroposterior Laxity After Bicruciate-Retaining Total Knee Arthroplasty Is Closer to the Native Knee Than ACL-Resecting TKA: A Biomechanical Cadaver Study. J Arthroplasty 2015. [PMID: 26205088 DOI: 10.1016/j.arth.2015.06.021] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
The purpose of this study was to examine whether a bicruciate retaining (BCR) TKA would yield anteroposterior (AP) laxity closer to the native knee than a posterior cruciate ligament retaining (CR) TKA. A BCR TKA was designed and compared to CR TKA and the native knee using cadaver specimens. AP laxity with the CR TKA was greater than the native knee (P=0.006) and BCR TKA (P=0.039), but no difference was found between the BCR TKA and the native knee. No significant differences were found in rotations between the prostheses and the native knee. BCR TKA was shown to be surgically feasible, reduced AP laxity versus CR TKA, and may improve knee stability without using conforming geometry in the implant design.
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Affiliation(s)
- Camilla Halewood
- The Biomechanics Group, Department of Mechanical Engineering, Imperial College London, London, UK.
| | | | - Johan Bellemans
- Department of Orthopaedic Surgery, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Jan Victor
- Department of Orthopaedic Surgery, UZ Ghent, Ghent, Belgium
| | - Andrew A Amis
- The Biomechanics Group, Department of Mechanical Engineering, Imperial College London, London, UK; The Musculoskeletal Surgery Lab, Department of Surgery and Cancer, Imperial College London, London, UK
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24
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Pegg EC, Baré J, Gill HS, Pandit HG, O'Connor JJ, Murray DW, Price AJ. Influence of consciousness, muscle action and activity on medial condyle translation after Oxford unicompartmental knee replacement. Knee 2015; 22:646-52. [PMID: 26514940 DOI: 10.1016/j.knee.2015.09.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 09/09/2015] [Accepted: 09/30/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Quantification of the in vivo position of the medial condyle throughout flexion is important for knee replacement design, and understanding knee pathology. The influence of consciousness, muscle action, and activity type on condyle translation was examined in patients who had undergone medial unicompartmental knee replacement (UKR) using lateral video fluoroscopy. METHODS The position of the centre of the femoral component relative to the tibial component was measured for nine patients under different conditions. The following activities were assessed; passive flexion and extension when anaesthetised, passive flexion and extension when conscious, and active flexion, extension and step-up. RESULTS The position of the centre of the femoral component relative to the tibial component was highly patient dependent. The greatest average translation range (14.9 mm) was observed in anaesthetised patients, and the condyle was significantly more anterior near to extension. Furthermore, when conscious but being moved passively, the femoral condyle translated a greater range (8.9 mm) than when moving actively (5.2mm). When ascending stairs, the femoral condyle was more posterior at 20-30° of flexion than during flexion/extension. CONCLUSIONS The similarity between these results and published data suggest that knee kinematics following mobile-bearing UKR is relatively normal. The results show that in the normal knee and after UKR, knee kinematics is variable and is influenced by the patient, consciousness, muscle action, and activity type. CLINICAL RELEVANCE It is therefore essential that all these factors are considered during knee replacement design, if the aim is to achieve more normal knee kinematics.
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Affiliation(s)
- E C Pegg
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
| | - J Baré
- Melbourne Orthopaedic Group, 33 The Avenue, Windsor, VIC 3181, Australia
| | - H S Gill
- Department of Mechanical Engineering, University of Bath, Bath, UK
| | - H G Pandit
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - J J O'Connor
- Department of Engineering Science, University of Oxford, Oxford, UK
| | - D W Murray
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - A J Price
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Akkawi I, Colle F, Bruni D, Raspugli GF, Bignozzi S, Zaffagnini S, Iacono F, Marcacci M. Deep-dished highly congruent tibial insert in CR-TKA does not prevent patellar tendon angle increase and patellar anterior translation. Knee Surg Sports Traumatol Arthrosc 2015; 23:1622-30. [PMID: 24519618 DOI: 10.1007/s00167-014-2889-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 01/31/2014] [Indexed: 12/29/2022]
Abstract
PURPOSE Starting from the hypothesis that a deep-dished highly congruent tibial insert in cruciate-retaining total knee arthroplasty would prevent the increase in patellar tendon angle and anterior patellar translation by reducing the paradoxical anterior femoral translation, the main purpose of the present study was to investigate the effect of this prosthesis design, and secondary to assess the clinical outcomes at 6-month follow-up. METHODS Twenty patients treated with cruciate-retaining total knee arthroplasty with navigation technique were enrolled and prospectively followed up at 6 months. The median value of age was 71 years (57-83). Before and after surgery, the following parameters were calculated: patellar tendon angle, anterior-posterior and medio-lateral patellar translation, patellar height and range of motion. All patients were assessed with the SF-36 Physical Functioning and the Knee injury and Osteoarthritis Outcome Score ADL scores. RESULTS Patellar tendon angle and anterior patellar translation significantly increased in post-operative conditions (p < 0.0001); a statistically significant medial patellar translation was found (p < 0.0001), while patellar height did not show any difference between pre- and post-operative conditions (n.s). A significant correlation was found between patellar tendon angle and anterior patellar translation and the clinical scores (p < 0.0417). There was a significant post-operative decrease (p < 0.0033) in the range of motion. CONCLUSIONS The present study failed to demonstrate that deep-dished highly congruent tibial insert prevents the anterior translation of the patella in cruciate-retaining total knee arthroplasty, thus causing inferior clinical scores. It provided useful information about the biomechanical role of the patella in total knee arthroplasty, allowing to choose the most appropriate surgical approach. LEVEL OF EVIDENCE Case series, Level IV.
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Affiliation(s)
- Ibrahim Akkawi
- Biomechanics and Technological Innovation Laboratory, Codivilla-Putti Research Center, Bologna University, Via Di Barbiano 1-10, 40136, Bologna, Italy,
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Plancher KD, Dunn ASM, Petterson SC. The anterior cruciate ligament-deficient knee and unicompartmental arthritis. Clin Sports Med 2014; 33:43-55. [PMID: 24274844 DOI: 10.1016/j.csm.2013.08.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Treatment of medial and lateral compartment arthritis in the anterior cruciate ligament (ACL)-deficient knee remains a topic of debate among orthopedic surgeons. This article discusses the treatment options for the ACL-deficient knee with unicompartmental arthritis and provides a rationale for clinical decision making in this difficult group of patients. Unicondylar knee arthroplasty (UKA) is a viable option in a select group of patients to decrease pain and maintain an active lifestyle. When performing a UKA in an ACL-deficient knee, it is important to manage appropriate expectations for a successful outcome.
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Affiliation(s)
- Kevin D Plancher
- Plancher Orthopaedics & Sports Medicine, 1160 Park Avenue, New York, NY 10128, USA; Orthopaedic Foundation for Active Lifestyles, Greenwich, CT, USA; Department of Orthopaedics, Albert Einstein College of Medicine, New York, NY, USA.
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27
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Van Duren B, Pandit H, Murray D, Gill H. Approximation of the functional kinematics of posterior stabilised total knee replacements using a two-dimensional sagittal plane patello-femoral model: comparing model approximation toin vivomeasurement. Comput Methods Biomech Biomed Engin 2014; 18:1191-1199. [PMID: 24559039 DOI: 10.1080/10255842.2014.887697] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Palumbo BT, Scott RD. Diagnosis and Indications for Treatment of Unicompartmental Arthritis. Clin Sports Med 2014; 33:11-21. [DOI: 10.1016/j.csm.2013.06.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
BACKGROUND For unicompartmental knee arthroplasty (UKA), abnormal loading on the tibiofemoral joint could exacerbate knee osteoarthritis or implant wear. Joint moments are an indirect measure of such loading. However, little is known about knee moments of patients with UKA, tempering enthusiasm for its use. QUESTIONS/PURPOSES In patients with UKAs performing stair ascent, we (1) determined whether interlimb differences for knee moments are demonstrated, (2) described the knee kinetics of patients with medial and lateral UKAs, and (3) investigated possible factors that might influence the knee abductor moments. METHODS In our cross-sectional study, we recruited 26 patients with UKA with nondiseased contralateral limbs who performed stair ascent. Seventeen patients had medial UKAs and nine had lateral UKAs. Paired t-tests and CIs were applied to determine interlimb differences within each UKA group for peak knee moments and times to peak moments. RESULTS During stair ascent, the medial UKA group displayed greater peak extensor moments for the nondiseased compared to the UKA limb (p = 0.030), whereas the lateral UKA group did not (p = 0.087). For both medial and lateral UKA groups, the UKA limb demonstrated greater internal peak abductor moments (p = 0.005 and 0.013, respectively). Both UKA groups exhibited knee moments similar to those in the literature. Limb dominance and postoperative time were correlated for both UKA groups. CONCLUSIONS Reduced knee extensor moments of limbs with UKA displayed by some participants may indicate less compressive loading on the tibiofemoral joint surfaces, whereas the increased abductor moments suggest increased compression on the medial compartment. These findings suggest UKA knees may not be subjected to excessive loads regardless of the side reconstructed.
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Pandit H, van Duren BH, Price M, Tilley S, Gill HS, Thomas NP, Murray DW. Constraints in posterior-stabilised TKA kinematics: a comparison of two generations of an implant. Knee Surg Sports Traumatol Arthrosc 2013; 21:2800-9. [PMID: 23052124 DOI: 10.1007/s00167-012-2233-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Accepted: 09/24/2012] [Indexed: 11/27/2022]
Abstract
PURPOSE This study tests the hypothesis that the design changes incorporated in the newer generation Triathlon posterior-stabilised TKA design result in kinematics that more closely reproduce the kinematics observed in healthy knees than those achieved by the older generation Scorpio posterior-stabilised TKA design. METHODS Eleven patients with Triathlon posterior-stabilised TKA, twelve patients with Scorpio posterior-stabilised TKA, and 22 subjects with normal asymptomatic knees underwent fluoroscopic assessment of the knee during a step-up exercise and a weight-bearing deep knee bend. Two-dimensional and three-dimensional knee kinematics were assessed including the maximum flexion, the patella tendon angle (PTA), the patella flexion angle (PFA), the minimum distance between cam and post, and the tibio-femoral contact positions. RESULTS The average maximum flexion achieved was 114° (SD 3°), 91° (SD 10°), and 143° (SD 14°) for the Triathlon, Scorpio, and Normal groups. The average cam/post mechanism engagement was at 63° (SD 24°) and 82° (SD 16°) for the Triathlon and Scorpio groups. The condylar contact points showed a paradoxical anterior slide for the Scorpio group which was not present in the Triathlon group. The PTA and PFA values of both implants showed significant differences from normal. CONCLUSION Overall, the Triathlon implant design, as compared to Scorpio TKA, produced kinematics closer to that of normal knees as proposed by the hypothesis. However, despite being closer to normal, the kinematics exhibited by the Triathlon group were still different from normal. A comparison of kinematic performance, taking into account altered design parameters, will contribute to improved understanding and future design considerations.
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Affiliation(s)
- Hemant Pandit
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS) Nuffield Orthopaedic Centre (NOC), University of Oxford, Headington, Oxford, UK
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Sébilo A, Casin C, Lebel B, Rouvillain JL, Chapuis S, Bonnevialle P. Clinical and technical factors influencing outcomes of unicompartmental knee arthroplasty: Retrospective multicentre study of 944 knees. Orthop Traumatol Surg Res 2013; 99:S227-34. [PMID: 23623316 DOI: 10.1016/j.otsr.2013.02.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2013] [Accepted: 02/26/2013] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Unicompartmental knee arthroplasty (UKA) is reserved for osteoarthritis confined to a single femoro-tibial compartment with an intact anterior cruciate ligament. UKA remains controversial. The objective of this retrospective multicentre study in a large sample was to assess the influence of age, sex, body mass index (BMI), patellofemoral involvement, and implant design on functional outcomes and prosthesis survival rates. MATERIAL AND METHODS Nine hundred and forty-four patients who underwent UKA at centres located in western France between 1988 and 2008 were re-evaluated. The IKS scores and KOOS were determined. Prosthesis survival according to various factors was assessed using the Kaplan-Meier method. RESULTS A clinical evaluation was performed in 720 cases after a mean follow-up of 62 months. The IKS function score improved by 23.6 points in men and 17.3 points in women (P=0.007). Ten-year prosthesis survival was 83.7% overall; 79% in women versus 87% in men (P<0.01); and 76.7% in patients younger than 70 years versus 88.3% in those 70 years or over (P<0.01). BMI had no significant influence on prosthesis survival. No significant differences between clinical outcomes or prosthesis survival were found across implant design categories. DISCUSSION The retrospective design and large number of centres and surgeons mandate caution when interpreting our results. Subgroup sizes were too small for an analysis of factors such as anterior cruciate ligament deficiency, BMI>40 kg/m(2), or cementless implant. LEVEL OF EVIDENCE Level IV, retrospective study.
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Affiliation(s)
- A Sébilo
- Département de chirurgie orthopédique, CHU de Caen, avenue de la Côte-de-Nacre, Caen, France.
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Tuncer M, Cobb JP, Hansen UN, Amis AA. Validation of multiple subject-specific finite element models of unicompartmental knee replacement. Med Eng Phys 2013; 35:1457-64. [PMID: 23647863 DOI: 10.1016/j.medengphy.2013.03.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Revised: 01/04/2013] [Accepted: 03/29/2013] [Indexed: 11/29/2022]
Abstract
Accurate computer modelling of the fixation of unicompartmental knee replacements (UKRs) is a valuable design tool. However, models must be validated with in vitro mechanical tests to have confidence in the results. Ten fresh-frozen cadaveric knees with differing bone densities were CT-scanned to obtain geometry and bone density data, then implanted with cementless medial Oxford UKRs by an orthopaedic surgeon. Five strain gauge rosettes were attached to the tibia and femur of each knee and the bone constructs were mechanically tested. They were re-tested following implanting the cemented versions of the implants. Finite element models of four UKR tibiae and femora were developed. Sensitivity assessments and convergence studies were conducted to optimise modelling parameters. The cemented UKR pooled R(2) values for predicted versus measured bone strains were 0.85 and 0.92 for the tibia and femur respectively. The cementless UKR pooled R(2) values were slightly lower at 0.62 and 0.73 which may have been due to the irregularity of bone resections. The correlation of the results was attributed partly to the improved material property prediction method used in this project. This study is the first to validate multiple UKR tibiae and femora for bone strain across a range of specimen bone densities.
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Affiliation(s)
- Mahmut Tuncer
- Mechanical Engineering Department, Imperial College London, Exhibition Road, London SW7 2AZ, UK
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Pegg E, Walter J, Mellon S, Pandit H, Murray D, D'Lima D, Fregly B, Gill H. Evaluation of factors affecting tibial bone strain after unicompartmental knee replacement. J Orthop Res 2013. [PMID: 23192787 PMCID: PMC3602347 DOI: 10.1002/jor.22283] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Persistent pain is an important cause of patient dissatisfaction after unicompartmental knee replacement (UKR) and has been correlated with localized tibial strain. However, the factors that influence these strains are not well understood. To address this issue, we created finite element models to examine the effect on tibial strain of: (1) muscle forces (estimated using instrumented knee data) acting on attachment sites on the proximal tibia, (2) UKR implantation, (3) loading position, and (4) changes in gait pattern. Muscle forces acting on the tibia had no significant influence on strains within the periprosthetic region, but UKR implantation increased strain by 20%. Strain also significantly increased if the region of load application was moved >3 mm medially. The strain within the periprosthetic region was found to be dependent on gait pattern and was influenced by both medial and lateral loads, with the medial load having a greater effect (regression coefficients: medial = 0.74, lateral = 0.30). These findings suggest that tibial strain is increased after UKR and may be a cause of pain. It may be possible to reduce pain through modification of surgical factors or through altered gait patterns.
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Affiliation(s)
- E.C Pegg
- University of Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, Oxford, UK
| | - J. Walter
- Department of Mechanical & Aerospace Engineering, University of Florida, Gainesville, FL, USA
| | - S.J. Mellon
- University of Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, Oxford, UK
| | - H.G. Pandit
- University of Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, Oxford, UK
| | - D.W. Murray
- University of Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, Oxford, UK
| | - D.D. D'Lima
- Shiley Center for Orthopaedic Research & Education, Scripps Clinic, La Jolla, CA, USA
| | - B.J. Fregly
- Department of Mechanical & Aerospace Engineering, University of Florida, Gainesville, FL, USA
| | - H.S. Gill
- University of Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, Oxford, UK
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Abstract
BACKGROUND Unicompartmental knee arthroplasty (UKA) has long been a treatment option for patients with disease limited primarily to one compartment with small, correctable deformities. However, some surgeons presume that normal kinematics of a lateral compartment UKA are difficult to achieve. Furthermore, it is unclear whether UKA restores normal knee kinematics and interlimb symmetry. QUESTIONS/PURPOSES We determined knee kinematics exhibited during stair ascent by patients with medial- (MED-UKA) or lateral-UKA (LAT-UKA) and if the knee kinematics of the operated and nonoperated limbs were symmetrical. METHODS Participants were 17 individuals with MED-UKA and nine with LAT-UKA, all with nondiseased contralateral limbs. For each limb, participants walked up four stairs for five trials while a motion-capture system obtained reflective marker locations. Temporal events were determined by force platform signals. Interlimb symmetry was classified for temporal gait and knee angular kinematics by comparing observed interlimb differences with clinically meaningful differences set at 5% of stride time for temporal variables and 5° for angular variables. The minimum postoperative followup was 6 months (median, 24 months; range, 6-53 months). RESULTS Neither group demonstrated clinically meaningful mean interlimb differences. However, approximately half of participants of each UKA group displayed asymmetry favoring the operative or nonoperative limb with similar frequency. CONCLUSIONS Many patients undergoing UKA demonstrate kinematic interlimb symmetry during stair ascent. Interlimb asymmetry may be affected by a variety of factors unrelated to the UKA. CLINICAL RELEVANCE A MED- or LAT-UKA can potentially restore normal knee function for a demanding task of daily life.
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Bicruciate substituting total knee replacement: how effective are the added kinematic constraints in vivo? Knee Surg Sports Traumatol Arthrosc 2012; 20:2002-10. [PMID: 22124846 DOI: 10.1007/s00167-011-1796-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Accepted: 11/14/2011] [Indexed: 10/15/2022]
Abstract
PURPOSE The Journey bicruciate substituting (BCS) TKR was designed to restore normal knee kinematics. It has two cam-post mechanisms which substitute for the ACL and PCL. The aim of this study was to undertake a comprehensive study of the Journey BCS kinematics in vivo to assess the function of the cam-post mechanisms and their effect on functional kinematics and compared to the kinematics of a group of normal knees. METHODS The kinematics of 10 Journey BCS were assessed fluoroscopically during step-up and lunge exercises, and were compared to those of 20 normal knees. The fluoroscopic images were used to determine relative implant orientation using a 2D to 3D reconstruction method. The determined relative tibio-femoral orientations allowed for cam-post engagement and tibio-femoral contact points to be determined. Functional kinematics were assessed using the patella tendon angle (PTA) and the patella flexion angle (PFA) relationship with the knee flexion angle (KFA). RESULTS The average maximum flexion achieved by the Journey was 124.7°. Both cam mechanisms engaged: The anterior cam during extension at 12.6° and the posterior cam in flexion at 45.4°. During flexion, the contacts points on the tibia moved posteriorly with no paradoxical anterior translation. The PTA/KFA relationships of the Journey implant group for both the step-up and lunge exercises were broadly similar in terms of trend to those established for the normal knee but the PTA between 10° KFA and 140° KFA were significantly (P < 0.05) lower than that for the normal knees. The PFA/KFA trend for both the implant and normal groups showed a linear relationship; however, the values of PFA were higher for the Journey compared to the normal. CONCLUSION The Journey BCS showed no paradoxical anterior movement and sufficient posterior femoral roll back which corresponded with the engagement of the anterior and posterior cam-post mechanisms. Trends shown by the PTA/KFA and PFA/KFA kinematic profiles observed for the Journey group were more normal than those seen with other designs of TKR. However, despite being more close to normal than other implants, the Journey group showed a different kinematic profile to that of the normal knees, which is most likely due to the femur being too far posterior relative to the tibia. LEVEL OF EVIDENCE Case-control study, retrospective, comparative study, Level III.
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Weston-Simons JS, Pandit H, Jenkins C, Jackson WFM, Price AJ, Gill HS, Dodd CAF, Murray DW. Outcome of combined unicompartmental knee replacement and combined or sequential anterior cruciate ligament reconstruction. ACTA ACUST UNITED AC 2012; 94:1216-20. [DOI: 10.1302/0301-620x.94b9.28881] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The Oxford unicompartmental knee replacement (UKR) is an established treatment option in the management of symptomatic end-stage medial compartmental osteoarthritis (MCOA), which works well in the young and active patient. However, previous studies have shown that it is reliable only in the presence of a functionally intact anterior cruciate ligament (ACL). This review reports the outcomes, at a mean of five years and a maximum of ten years, of 52 consecutive patients with a mean age of 51 years (36 to 57) who underwent staged or simultaneous ACL reconstruction and Oxford UKR. At the last follow-up (with one patient lost to follow-up), the mean Oxford knee score was 41 (sd 6.3; 17 to 48). Two patients required conversion to TKR: one for progression of lateral compartment osteoarthritis and one for infection. Implant survival at five years was 93% (95% CI 83 to 100). All but one patient reported being satisfied with the procedure. The outcome was not significantly influenced by age, gender, femoral or tibial tunnel placement, or whether the procedure was undertaken at one- or two-stages. In summary, ACL reconstruction and Oxford UKR gives good results in patients with end-stage MCOA secondary to ACL deficiency.
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Affiliation(s)
- J. S. Weston-Simons
- Botnar Research Centre, Nuffield Department
of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University
of Oxford, Windmill Road, Oxford
OX3 7LD, UK
| | - H. Pandit
- Botnar Research Centre, Nuffield Department
of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University
of Oxford, Windmill Road, Oxford
OX3 7LD, UK
| | - C. Jenkins
- Nuffield Orthopaedic Centre, Windmill
Road, Headington, Oxford
OX3 7HE, UK
| | - W. F. M. Jackson
- Nuffield Orthopaedic Centre, Windmill
Road, Headington, Oxford
OX3 7HE, UK
| | - A. J. Price
- Botnar Research Centre, Nuffield Department
of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University
of Oxford, Windmill Road, Oxford
OX3 7LD, UK
| | - H. S. Gill
- Botnar Research Centre, Nuffield Department
of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University
of Oxford, Windmill Road, Oxford
OX3 7LD, UK
| | - C. A. F. Dodd
- Nuffield Orthopaedic Centre, Windmill
Road, Headington, Oxford
OX3 7HE, UK
| | - D. W. Murray
- Botnar Research Centre, Nuffield Department
of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University
of Oxford, Windmill Road, Oxford
OX3 7LD, UK
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In vivo sagittal plane kinematics of the FPV patellofemoral replacement. Knee Surg Sports Traumatol Arthrosc 2012; 20:1104-9. [PMID: 22009560 DOI: 10.1007/s00167-011-1717-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Accepted: 10/10/2011] [Indexed: 10/16/2022]
Abstract
PURPOSE Isolated symptomatic patellofemoral osteoarthritis has been reported in 2% of men and 8% of women older than the age of 55 years in the community. With the development of improved designs and surgical techniques, interest in the use of patellofemoral replacement has increased. The primary aim of the newer generation of patellofemoral replacement implant designs has been to more closely reproduce normal knee kinematics. This study compares the functional sagittal plane in vivo kinematics of a contemporary patellofemoral prosthesis, the FPV, with normal knee kinematics using the patella tendon angle and patella flexion angle relationships with the knee flexion angle. METHODS The in vivo kinematics for a group of 8 patients (15 knees) with patellofemoral replacement and 22 normal subjects was measured for both a step-up and a lunge exercise using an established fluoroscopic method. RESULTS The patella tendon angle characteristics of the implanted knees were similar to those of the normal knees for the step-up exercise with a significant difference only observed at 50° knee flexion angle. For the lunge exercise, the patella tendon angle for the implanted knee was consistently lower than that measured for the normal knee. Overall the subjects had excellent clinical scores post-patellofemoral replacement showing a significant improvement from their pre-operative scores. CONCLUSION The kinematics of the FPV implant was closer to normal than those of total knee implants; however, there were still differences from the normal knees. LEVEL OF EVIDENCE III.
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Tinius M, Hepp P, Becker R. Combined unicompartmental knee arthroplasty and anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2012; 20:81-7. [PMID: 21559848 DOI: 10.1007/s00167-011-1528-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2011] [Accepted: 04/19/2011] [Indexed: 11/27/2022]
Abstract
PURPOSE Patients presenting anterior cruciate ligament (ACL) deficiency and isolated osteoarthritis of the medial compartment are treated either with biplanar osteotomy or with total knee arthroplasty (TKA). However, these patients between the forties and fifties are often very active in daily life and feel limited due to their knee. In order to follow the idea of preserving as much as possible from the joint, the concept of unicondylar joint replacement in conjunction with ACL reconstruction has been followed. There seems to be a limited experience with this concept. The purpose of the follow-up study was to evaluate the midterm clinical and functional outcome. METHODS Twenty-seven patients were followed up for 53 months. The mean age of the 11 men and 16 women was 44 years. All patients were treated by combined unicompartmental knee arthroplasty and anterior cruciate ligament reconstruction. RESULTS The Knee Society Score improved significantly from 77.1 ± 11.6 points to 166.0 ± 12.1 points (P ≤ 0.01). No revision surgery was required and no radiolucent lines were observed on the radiographs at the time of follow-up. The anterior translation showed less than 5 mm in 24 patients and 5 mm in the remaining 3 patients. CONCLUSIONS The midterm clinical data have shown that combined surgery of UKA and anterior cruciate ligament reconstruction has revealed promising results. The restored knee stability seems to prevent the failure of UKA. However, long-term follow-up studies are required in these patients who received partial joint replacement fairly early in their life. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Marco Tinius
- Center for Joint Surgery, Knee Group, Praxisklinik- Stollberg, Hohensteiner Strasse 56, 09366, Stollberg, Germany.
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Citak M, Bosscher MRF, Citak M, Musahl V, Pearle AD, Suero EM. Anterior cruciate ligament reconstruction after unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2011; 19:1683-8. [PMID: 21344229 DOI: 10.1007/s00167-011-1449-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Accepted: 02/08/2011] [Indexed: 01/14/2023]
Abstract
PURPOSE ACL deficiency may cause abnormal knee kinematics and is associated with a tenfold increase in surgical failures after unicompartmental knee arthroplasty, such as aseptic loosening of the tibial compartment and medial bearing instability. The current investigators hypothesized that in a knee with UKA, single-bundle ACL reconstruction would restore tibiofemoral translation to levels similar to those of the intact ACL. METHODS Two fresh frozen pelvis-to-toes specimens (four paired knees) were used. On each knee, medial unicompartmental knee arthroplasty was performed by a single surgeon. ACL reconstructions were performed by conventional single-bundle technique. Three trials of Lachman and pivot shift tests were performed and recorded for each knee with the ACL-intact, after sectioning the ACL and after single-bundle ACL reconstruction. A mechanized pivot shifter was used to perform the pivot shift maneuvers. A surgical navigation system (Praxim Grenoble, France) simultaneously tracked tibiofemoral kinematics. RESULTS There was a significant difference in lateral compartment translation during the Lachman and pivot shift tests between the ACL-intact/UKA knee and the ACL-deficient/UKA knee (P < 0.05). There was no significant difference in lateral compartment translation during the Lachman and pivot shift tests between the intact/UKA knee and the ACL-reconstructed/UKA knee (n.s.). CONCLUSIONS For both the Lachman test and the pivot shift test, single-bundle ACL reconstruction restored kinematics in the UKA knee to magnitudes similar to those in the ACL-intact knee.
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Affiliation(s)
- Musa Citak
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY 10021, USA.
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Ward TR, Burns AW, Gillespie MJ, Scarvell JM, Smith PN. Bicruciate-stabilised total knee replacements produce more normal sagittal plane kinematics than posterior-stabilised designs. ACTA ACUST UNITED AC 2011; 93:907-13. [DOI: 10.1302/0301-620x.93b7.26208] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Bicruciate-stabilised total knee replacement (TKR) aims to restore normal kinematics by replicating the function of both cruciate ligaments. We performed a prospective, randomised controlled trial in which bicruciate- and posterior-stabilised TKRs were implanted in 13 and 15 osteo-arthritic knees, respectively. The mean age of the bicruciate-stabilised group was 63.9 years (sd 10.00) and that of the posterior-stabilised group 63.2 years (sd 6.7). A control group comprised 14 normal subjects with a mean age of 67.9 years (sd 7.9). The patellar tendon angle (PTA) was measured one week pre-operatively and at seven weeks post-operatively during knee extension, flexion and step-up exercises. At near full extension during step-up, the bicruciate-stabilised TKR produced a higher mean PTA than the posterior-stabilised TKR, indicating that the bicruciate design at least partially restored the kinematic role of the anterior cruciate ligament. The bicruciate-stabilised TKR largely restored the pre-operative kinematics, whereas the posterior-stabilised TKR resulted in a consistently lower PTA at all activities. The PTA in the pre-operative knees was higher than in the control group during the step-up and at near full knee extension. Overall, both groups generated a more normal PTA than that seen in previous studies in high knee flexion. This suggested that both designs of TKR were more effective at replicating the kinematic role of the posterior cruciate ligament than those used in previous studies.
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Affiliation(s)
- T. R. Ward
- Trauma and Orthopaedic Research Unit, Canberra Hospital, Building 6, Level 1, P. O. Box 11, Woden, ACT 2606, Australia
| | - A. W. Burns
- Trauma and Orthopaedic Research Unit, Canberra Hospital, Building 6, Level 1, P. O. Box 11, Woden, ACT 2606, Australia
| | - M. J. Gillespie
- Trauma and Orthopaedic Research Unit, Canberra Hospital, Building 6, Level 1, P. O. Box 11, Woden, ACT 2606, Australia
| | - J. M. Scarvell
- Trauma and Orthopaedic Research Unit, Canberra Hospital, Building 6, Level 1, P. O. Box 11, Woden, ACT 2606, Australia
| | - P. N. Smith
- Trauma and Orthopaedic Research Unit, Canberra Hospital, Building 6, Level 1, P. O. Box 11, Woden, ACT 2606, Australia
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Simpson DJ, Kendrick BJL, Dodd CAF, Price AJ, Gill HS, Murray DW. Load transfer in the proximal tibia following implantation with a unicompartmental knee replacement. Proc Inst Mech Eng H 2011; 225:521-9. [DOI: 10.1177/2041303310395074] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Unicompartmental knee replacement (UKR) is an appealing alternative to total knee replacement when the patient has isolated medial compartment osteoarthritis. A common observation post-operatively is radiolucency between the tibial tray wall and the bone. In addition, some patients complain of persistent pain over the proximal tibia antero-medially; this may be related to elevated bone strains in the tibia. Currently, there is no intentionally made mechanical bond between the vertical wall of an Oxford UKR and the adjacent bone; whether one exists or not will influence the load transmission in the proximal tibia and may affect the elevated tibia strain. The aim of this study was to investigate how introducing a mechanical tie between the tibial tray wall and the adjacent bone might alter the load carried into the tibia for both cemented and cementless UKRs. Strain energy density in the region of bone adjacent to the tray wall was considerably increased when a mechanical tie was introduced; this has the potential of reducing the likelihood of a radiolucency occurring in that region. Moreover, a mechanical tie had the effect of reducing proximal tibia strain, which may decrease the incidence of pain following implantation with a UKR.
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Affiliation(s)
- D J Simpson
- OOEC, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - B J L Kendrick
- OOEC, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | | | - A J Price
- OOEC, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Nuffield Orthopaedic Centre, Oxford, UK
| | - H S Gill
- OOEC, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - D W Murray
- OOEC, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Nuffield Orthopaedic Centre, Oxford, UK
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Pandit H, Jenkins C, Gill HS, Barker K, Dodd CAF, Murray DW. Minimally invasive Oxford phase 3 unicompartmental knee replacement: results of 1000 cases. ACTA ACUST UNITED AC 2011; 93:198-204. [PMID: 21282759 DOI: 10.1302/0301-620x.93b2.25767] [Citation(s) in RCA: 252] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
This prospective study describes the outcome of the first 1000 phase 3 Oxford medial unicompartmental knee replacements (UKRs) implanted using a minimally invasive surgical approach for the recommended indications by two surgeons and followed up independently. The mean follow-up was 5.6 years (1 to 11) with 547 knees having a minimum follow-up of five years. At five years their mean Oxford knee score was 41.3 (sd 7.2), the mean American Knee Society Objective Score 86.4 (sd 13.4), mean American Knee Society Functional Score 86.1 (sd 16.6), mean Tegner activity score 2.8 (sd 1.1). For the entire cohort, the mean maximum flexion was 130° at the time of final review. The incidence of implant-related re-operations was 2.9%; of these 29 re-operations two were revisions requiring revision knee replacement components with stems and wedges, 17 were conversions to a primary total knee replacement, six were open reductions for dislocation of the bearing, three were secondary lateral UKRs and one was revision of a tibial component. The most common reason for further surgical intervention was progression of arthritis in the lateral compartment (0.9%), followed by dislocation of the bearing (0.6%) and revision for unexplained pain (0.6%). If all implant-related re-operations are considered failures, the ten-year survival rate was 96% (95% confidence interval, 92.5 to 99.5). If only revisions requiring revision components are considered failures the ten-year survival rate is 99.8% (confidence interval 99 to 100). This is the largest published series of UKRs implanted through a minimally invasive surgical approach and with ten-year survival data. The survival rates are similar to those obtained with a standard open approach whereas the function is better. This demonstrates the effectiveness and safety of a minimally invasive surgical approach for implanting the Oxford UKR.
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Affiliation(s)
- H Pandit
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK.
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Maduekwe UI, Zywiel MG, Bonutti PM, Johnson AJ, Delanois RE, Mont MA. Scientific evidence for the use of modern unicompartmental knee arthroplasty. Expert Rev Med Devices 2010; 7:219-39. [PMID: 20214428 DOI: 10.1586/erd.09.65] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Unicompartmental knee arthroplasty as a surgical treatment for monocompartmental knee arthritis remains a controversial procedure with questions surrounding the benefits and survivorship of the procedure versus osteotomies or total knee arthroplasties. The authors, by examining the complete body of literature for scientific evidence concerning the procedure, will describe the history of usage of these prostheses, their rationale for usage, modern devices and their results, and why they may have advantages as a treatment modality for monocompartmental knee arthritis. Outcomes of current unicompartmental designs will be presented and evaluated to determine which aspects of the design and patient selection technique are associated with success or failure. Commonly asked questions regarding the use of these devices will be addressed. The authors will also describe some potential modifications that might affect the use of these components in the future, including minimally invasive procedures and robotics, and how these devices may change over the next 5 years.
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Affiliation(s)
- Uma I Maduekwe
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215, USA
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Krishnan SRSR, Randle R. ACL reconstruction with unicondylar replacement in knee with functional instability and osteoarthritis. J Orthop Surg Res 2009; 4:43. [PMID: 20017914 PMCID: PMC2806375 DOI: 10.1186/1749-799x-4-43] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2009] [Accepted: 12/17/2009] [Indexed: 11/13/2022] Open
Abstract
Severe symptomatic osteoarthritis in young and active patients with pre-existing deficiency of the anterior cruciate ligament and severe functionally instability is a difficult subgroup to manage. There is considerable debate regarding management of young patients with isolated unicompartment osteoarthritis and concomitant ACL deficiency. A retrospective analysis of was done in 9 patients with symptomatic osteoarthritis with ACL deficiencies and functional instability that were treated with unicompartment knee arthroplasty and ACL reconstruction between April 2002 and June 2005. The average arc of flexion was 119° (range 85° to 135°) preoperatively and 125° (range 105° to 140°). There were no signs of instability during the follow up of patients. No patients in this group were reoperated. In this small series we have shown that instability can be corrected and pain relieved by this combined procedure.
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Elevated proximal tibial strains following unicompartmental knee replacement—A possible cause of pain. Med Eng Phys 2009; 31:752-7. [DOI: 10.1016/j.medengphy.2009.02.004] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2008] [Revised: 01/23/2009] [Accepted: 02/10/2009] [Indexed: 11/21/2022]
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Confalonieri N, Manzotti A, Cerveri P, De Momi E. Bi-unicompartmental versus total knee arthroplasty: a matched paired study with early clinical results. Arch Orthop Trauma Surg 2009; 129:1157-63. [PMID: 18696093 DOI: 10.1007/s00402-008-0713-8] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2008] [Indexed: 12/01/2022]
Abstract
INTRODUCTION The authors performed a matched paired study between two groups: bi-unicompartmental (Bi-UKR) versus total knee replacements (TKR) for the treatment of isolated bicompartmental tibio-femoral knee arthritis with an asymptomatic patello-femoral joint. The Authors believe that Bi-UKR could achieve comparable outcomes than TKR, but with a real less invasive surgery and maintaining a higher joint function. MATERIALS AND METHODS A total of 22 patients with bicompartmental tibio-femoral knee arthritis, who underwent Bi-UKR between January 1999 and March 2003, were included in the study (group A). In all the knees the arthritic changes were graded according to the classification of Alback. All patients had an asymptomatic patello-femoral joint. All patients had a varus deformity lower than 8 degrees , a body-mass index lower than 34, no clinical evidence of ACL laxity or flexion deformity and a preoperative range of motion of a least 110 degrees . At a minimum follow-up of 48 months, every single patient in group A was matched with a patient who had undergone a computer assisted TKR between August 1999 and September 2002 (group B). In the Bi-UKR group, in two cases we registered intraoperatively the avulsion of the treated tibial spines, requiring intra-operative internal fixation and without adverse effects on the final outcome. Statistical analysis of the results was performed. RESULTS At a minimum follow-up of 48 months there were no statistical significant differences in the surgical time while the hospital stay was statistically longer in TKR group. No statistically significant difference was seen for the Knee Society, Functional and GIUM scores between the two groups. Statistically significant better WOMAC Function and Stiffness indexes were registered for the Bi-UKR group. TKR implants were statistically better aligned with all the implants positioned within 4 degrees of an ideal hip-knee-ankle (HKA) angle of 180 degrees . CONCLUSIONS The results of this 48 months follow-up study suggest that Bi-UKR is a viable option for bicompartmental tibio-femoral arthritis at least as well as TKR but maintaining a higher level of function.
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Affiliation(s)
- N Confalonieri
- Ist Orthopaedic Department, C.T.O. Hospital, Istituti Clinici di Perfezionamento, Milan, Italy
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The effect of bearing congruency, thickness and alignment on the stresses in unicompartmental knee replacements. Clin Biomech (Bristol, Avon) 2008; 23:1148-57. [PMID: 18639960 DOI: 10.1016/j.clinbiomech.2008.06.001] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2008] [Revised: 06/03/2008] [Accepted: 06/04/2008] [Indexed: 02/07/2023]
Abstract
BACKGROUND Unicompartmental knee replacement offers an effective treatment for patients with single compartment knee disease and is becoming an increasingly popular alternative to total knee replacement. An important cause of failure in a unicompartmental knee replacement implant is polyethylene wear. Significant contributory factors to the amount of polyethylene wear are contact stress, bearing alignment, congruency and thickness. METHODS Four different unicompartmental knee replacement implant designs (Fully-Congruent; Partially-Congruent; Non-Congruent-metal-backed; Non-Congruent-all-polyethylene) were inserted into a validated finite element model of a proximal tibia. The effect that bearing congruency, alignment and thickness had on the polyethylene stresses during a simulated step-up activity for each design was investigated. Additionally, contact pressures were compared to those calculated from Hertz elastic theory. FINDINGS Only the Fully-Congruent bearing experienced peak von Mises and contact stresses below the lower fatigue limit for polyethylene during the step-up activity. The highest polyethylene contact stresses were observed for the Partially-Congruent and Non-Congruent-metal-backed designs, which experienced approximately three times the polyethylene lower fatigue limit. Increasing the bearing thickness from 3.5mm to 8.5mm of the Non-Congruent design decreased the contact stresses in the bearing; however they did not fall below the lower fatigue limit for polyethylene. Good agreement between finite element and Hertz contact pressures was found. INTERPRETATION Fully congruent unicompartmental knee replacement bearings can be markedly thinner without approaching the material failure limit, have a greater potential to preserve bone stock and are less likely to fail mechanically.
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