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Royon T, Foissey C, Fontalis A, Planchet F, Servien E, Batailler C, Lustig S. Gender does not influence outcomes and complications in medial unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2024; 32:2551-2561. [PMID: 38680026 DOI: 10.1002/ksa.12195] [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: 10/19/2023] [Revised: 03/19/2024] [Accepted: 03/26/2024] [Indexed: 05/01/2024]
Abstract
PURPOSE The impact of gender on the outcomes of unicompartmental knee arthroplasty (UKA) remains a topic of active discussion with limited exploration thus far. The study aims to elucidate the gender effect on clinical outcomes, complications, pre- and postoperative radiological outcomes following the implantation of a medial UKA at mid-term follow-up in a large section of patients. METHODS This was a single-centre, retrospective cohort study encompassing patients undergoing medial UKA between 2011 and 2019. The International Knee Society (IKS) Knee and Function score, patient satisfaction, complications, revisions, pre- and postoperative radiological outcomes (coronal plane alignment, femoral and tibial component positioning, posterior tibial slope) were evaluated. Survival rate at the time of the last follow-up was also recorded. RESULTS Of the 366 knees that met the inclusion criteria, 10 were lost to follow-up, accounting for a 2.7% loss. Mean follow-up was 5.2 ± 2 years [2.1-11.3]. Out of the total population, 205 patients were females (57.6%, 205/356) and 151 were males (42.4%, 151/356). Men exhibited superior pre- and postoperative IKS function scores (p = 0.017). However, no significant differences were observed between women and men regarding improvements of IKS Knee and Function scores, radiographic outcomes and implant survivorship. CONCLUSION At a mean follow-up of 5 years, this study revealed no significant impact of gender on clinical outcomes and complications in patients undergoing medial UKA. Furthermore, no significant differences were evident in radiographic outcomes, implant positioning and knee phenotype. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Thibaut Royon
- Department of Orthopedic Surgery, Lausanne University Hospital-Centre Hospitalier Universitaire Vaudois-CHUV, Hôpital Orthopédique, Lausanne, Switzerland
| | - Constant Foissey
- Orthopaedics surgery and Sports Medicine Department, FIFA Medical Centre of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France
| | - Andreas Fontalis
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Fréderic Planchet
- Laboratoire SAF EA2429, F-69366, Institut de Science Financière et d'Assurances (ISFA), Univ Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Elvire Servien
- Orthopaedics surgery and Sports Medicine Department, FIFA Medical Centre of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France
- LIBM-EA 7424, Interuniversity Laboratory of Biology of Mobility, Claude Bernard Lyon 1 Universit, Lyon, France
| | - Cécile Batailler
- Orthopaedics surgery and Sports Medicine Department, FIFA Medical Centre of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France
| | - Sébastien Lustig
- Orthopaedics surgery and Sports Medicine Department, FIFA Medical Centre of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France
- IFSTTAR, LBMC UMR_T9406, Univ Lyon, Claude Bernard Lyon 1 University, Lyon, France
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Mosegaard SB, Odgaard A, Madsen F, Rømer L, Kristensen PW, Vind TD, Søballe K, Stilling M. Comparison of cementless twin-peg, cemented twin-peg and cemented single-peg femoral component migration after medial unicompartmental knee replacement: a 5-year randomized RSA study. Arch Orthop Trauma Surg 2023; 143:7169-7183. [PMID: 37568057 PMCID: PMC10635966 DOI: 10.1007/s00402-023-04991-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 07/10/2023] [Indexed: 08/13/2023]
Abstract
BACKGROUND The component design and fixation method of joint arthroplasty may affect component migration and survival. The aim of this study was to compare fixation of cementless twin-peg (CLTP), cemented twin-peg (CTP) and cemented single-peg (CSP) femoral components of medial unicompartmental knee replacement (UKR). METHODS Eighty patients (mean age = 63 years, 48 males) with medial knee osteoarthritis were randomized in three ways to CLTP (n = 25), CTP (n = 26) or CSP (n = 29) femoral UKR components. The patients were followed 5 years postoperatively with RSA, bone mineral density (BMD), PROMs and radiological evaluation of radiolucent lines (RLL), femoral component flexion angle and complications. RESULTS At the 5-year follow-up, femoral component total translation was comparable between the three groups (p = 0.60). Femoral component internal rotation was 0.50° (95% CI 0.3; 0.69) for the CLTP group, 0.58° (95% CI 0.38; 0.77) for the CTP group and 0.25° (95% CI 0.07; 0.43) for the CSP group (p = 0.01). BMD decreased peri-prosthetically (range - 11.5%; - 14.0%) until 6-month follow-up and increased toward the 5-year follow-up (range - 3.6%; - 5.8%). BMD change did not correlate with component migration. Lower flexion angle was correlated with higher 5-year subsidence, total translation, varus rotation and maximum total point motion (p = 0.01). Two patients (1 CLTP, 1 CTP) had RLL in the posterior zone. There were two revisions. CONCLUSION At 5-year follow-up, fixation of UKA femoral components with twin-peg was not superior to the single-peg design. Cementless and cemented twin-peg femoral components had similar fixation. A lower flexion angle was correlated with higher component migration.
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Affiliation(s)
- Sebastian Breddam Mosegaard
- Department of Orthopaedic Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
- AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N, Denmark
| | - Anders Odgaard
- Department of Orthopaedic Surgery, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark
| | - Frank Madsen
- Department of Orthopaedic Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Lone Rømer
- Department of Radiology, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Per Wagner Kristensen
- Department of Orthopaedic Surgery, Vejle Hospital, Beriderbakken 4, 7100, Vejle, Denmark
| | - Tobias Dahl Vind
- Department of Orthopaedic Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
- AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Kjeld Søballe
- Department of Orthopaedic Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Maiken Stilling
- Department of Orthopaedic Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
- AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N, Denmark.
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
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Röttinger T, Lisitano L, Wiedl A, Mayr E, Röttinger H. The Anterior Impingement After Mobile-Bearing Unicomparimental Knee Arthroplasty—A Neglected Problem. A Clinical Report of 14 Cases. Arthroplast Today 2022; 17:94-100. [PMID: 36042942 PMCID: PMC9420323 DOI: 10.1016/j.artd.2022.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/20/2022] [Accepted: 06/23/2022] [Indexed: 11/15/2022] Open
Abstract
Background Methods Results Conclusions
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Affiliation(s)
- Timon Röttinger
- Department of Trauma Surgery, Orthopedics, Plastic and Hand Surgery, University Hospital of Augsburg, Augsburg, Germany
| | - Leonard Lisitano
- Department of Trauma Surgery, Orthopedics, Plastic and Hand Surgery, University Hospital of Augsburg, Augsburg, Germany
| | - Andreas Wiedl
- Department of Trauma Surgery, Orthopedics, Plastic and Hand Surgery, University Hospital of Augsburg, Augsburg, Germany
| | - Edgar Mayr
- Department of Trauma Surgery, Orthopedics, Plastic and Hand Surgery, University Hospital of Augsburg, Augsburg, Germany
| | - Heinz Röttinger
- Department of Athroplasty, München Klinik Neuperlach, Munich, Germany
- Faculty of Medical University of Pleven, Pleven, Bulgaria
- Corresponding author. Department of Athroplasty, München Klinik Neuperlach, Oskar-Maria-Graf-Ring 51, 81737 Munich, Germany. Tel.: +49 151 21083727.
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No difference in long-term outcomes between men and women undergoing medial fixed-bearing cemented unicompartmental knee arthroplasty: A retrospective cohort study with minimum 10-year follow up. Knee 2021; 30:26-34. [PMID: 33823334 DOI: 10.1016/j.knee.2021.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/15/2021] [Accepted: 03/09/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Some studies have suggested that women have poorer short-term outcomes after unicompartmental knee arthroplasty (UKA) due to a higher incidence of implant overhang. This study aimed to compare patient-reported outcome measures (PROMs) between men and women after UKA at a minimum follow-up of 10 years. METHODS Patients who underwent medial fixed-bearing UKA by two arthroplasty surgeons were identified from an institutional joint registry. Men and women were matched for age, body mass index, Charlson Comorbidity Index, American Society of Anesthesiologists class, range-of-motion and baseline PROMs using propensity scores. PROMs were compared at 2 and 10 years. Patients also completed a satisfaction questionnaire during these visits. Radiographic outliers were defined as > 2 mm of overhang. RESULTS A total of 128 patients were included. There was no difference in complications, length of stay or readmissions. Women had poorer Knee Society functional scores, Short-Form 36 physical and mental component scores (SF-36 MCS) at 2 years. No difference in PROMs was found at 10 years, except for poorer SF-36 MCS in women (P = 0.041). At 10 years, 96% of women and 92% of men were satisfied (P = 0.243). Fifteen-year survivorship free from any revision was 96% in each group. There were more medial-tibial outliers in women (9%) compared with men (5%) (P = 0.018). However, no association between outliers and outcomes or survivorship was found on multivariate analyses. CONCLUSION There was nodifference in clinical outcomes between men and women undergoing UKA at a minimum follow-up of 10 years. While women had a higher incidence of medial tibial overhang, this was not associated with long-term outcomes or survivorship.
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Lu F, Sun X, Wang W, Zhang Q, Guo W. Anthropometry of the medial femoral condyle in the Chinese population: the morphometric analysis to design unicomparmental knee component. BMC Musculoskelet Disord 2021; 22:95. [PMID: 33472632 PMCID: PMC7819177 DOI: 10.1186/s12891-021-03979-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 01/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aimed to assess the radii of the distal and posterior articular surfaces of the medial femoral condyle in a Chinese population and provide detailed parameters of the knee joint for the future design of UKA components. METHODS This study included 500 consecutive Chinese patients who underwent knee MRI from Jan 2019 to Jan 2020. The two most appropriate circles were used to reveal the distal and posterior joint surfaces in the sagittal plane of the MRI images. The radius of the circle representing the distal articular surface in the sagittal plane was measured as R1, and the radius of the posterior articular surface was measured as R2. The distance between the centers of the two rotation circles was recorded as d. An independent t test was used to compare the differences between men and women. The Pearson correlation coefficient was calculated to analyze the correlation between R1 and R2. SPSS v19.0 software was used for statistical analysis. RESULTS The average values of R1, R2, R1/R2 and d were calculated. Scatter plots were constructed to show the trend of changes in the radius of the distal and posterior articular surfaces of the femoral condyle. R1, R2 and d differed significantly between men and women (p < 0.05). Correlation analysis showed that R1 was positively correlated with R2 (r = 0.61, p < 0.05). CONCLUSIONS The data of the radii of the distal and posterior articular surfaces of the medial femoral condyle were provided. In the UKA design, the relationships between the radii of the distal and posterior articular surfaces should be taken into account.
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Affiliation(s)
- Feifan Lu
- China- Japan Friendship School of Clinical Medicine, Peking University, 100029, Beijing, China
| | - Xiaowei Sun
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, 100029, Beijing, China
| | - Weiguo Wang
- Department of Orthopedic Surgery, Beijing Key Lab Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, Peking Union Medical School, 100029, Beijing, China
| | - Qidong Zhang
- Department of Orthopedic Surgery, Beijing Key Lab Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, Peking Union Medical School, 100029, Beijing, China.
| | - Wanshou Guo
- Department of Orthopedic Surgery, Beijing Key Lab Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, Peking Union Medical School, 100029, Beijing, China.
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Two pegs are better than one: rare mode of femoral component failure in unicompartmental arthroplasty requiring revision to total knee arthroplasty. Arthroplast Today 2018; 4:153-157. [PMID: 29896544 PMCID: PMC5994598 DOI: 10.1016/j.artd.2017.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 10/24/2017] [Indexed: 11/23/2022] Open
Abstract
Femoral component fracture is a rare complication in unicompartmental knee arthroplasty, especially in cemented prostheses. We present a 75-year-old man who presented with a fractured single-peg Vanguard component 9 years postoperatively. He was revised to a total knee arthroplasty with an excellent functional outcome at 1 year. The components were additionally examined at an outside biomechanical engineering laboratory. Theories as to the cause of the component fracture include aseptic loosening due to a thin anterior cement mantle and the single-peg Oxford design.
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Reiner T, Schwarze M, Panzram B, Klotz MC, Bitsch RG, Jaeger S. The influence of the twin peg design on femoral Interface temperature and maximum load to failure in cemented Oxford unicompartmental knee arthroplasty. Clin Biomech (Bristol, Avon) 2018; 55:23-27. [PMID: 29649670 DOI: 10.1016/j.clinbiomech.2018.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 02/20/2018] [Accepted: 04/03/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND The twin peg femoral component was introduced for the cemented Oxford unicondylar knee to increase implant stability. The aim of this experimental study was to investigate the influence of the twin peg design on femoral interface temperature and maximum load to failure in comparison to the single peg design. METHODS In this experimental study medial Oxford unicompartmental knee arthroplasty was performed in 12 pairs of fresh-frozen human knees. A cemented femoral single peg component was implanted on the one side (group A) and a cemented twin peg component on the other side (group B). Cement interface temperature was continuously monitored during the procedure. Maximum tensile forces of the femoral components were measured by pull-out tests. FINDINGS Maximum femoral interface temperatures did not reach critical values for heat necrosis of the bone in group A (mean 28.4, SD 1.2 °C) or group B (mean 27.6, SD 0.5 °C). The maximum load to failure was significantly higher in the twin peg group (mean 3628.41, SD 650.92 N) compared to the single peg group (mean 2979, SD 781 N) (P = 0.016). INTERPRETATION Our experiments showed higher load to failure for the twin peg design compared to the single peg design without raising the risk of heat necrosis at the interfacial bone. The twin peg component offers a save alternative to the single peg component in a cadaveric setting.
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Affiliation(s)
- Tobias Reiner
- Department of Orthopedics and Traumatology, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany
| | - Martin Schwarze
- Department of Orthopedics and Traumatology, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany
| | - Benjamin Panzram
- Department of Orthopedics and Traumatology, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany
| | - Matthias C Klotz
- Department of Orthopedics and Traumatology, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany
| | - Rudi G Bitsch
- Department of Orthopedics and Traumatology, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany
| | - Sebastian Jaeger
- Laboratory of Biomechanics and Implant Research, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany.
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Hutt JRB, Sur A, Sur H, Ringrose A, Rickman MS. Outcomes and early revision rate after medial unicompartmental knee arthroplasty: prospective results from a non-designer single surgeon. BMC Musculoskelet Disord 2018; 19:172. [PMID: 29843680 PMCID: PMC5975526 DOI: 10.1186/s12891-018-2099-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Accepted: 05/17/2018] [Indexed: 12/11/2022] Open
Abstract
Background This prospective study evaluates outcomes and reoperation rates for unicompartmental knee arthroplasty (UKA) from a single non-designer surgeon using relatively extended criteria of degenerative changes of grade 2 or above in either or both non-operated compartments. Methods 187 consecutive medial mobile bearing UKA implants were included after history, clinical assessment and radiological evaluation. 91 patients had extended clinical outcomes. Post-operative assessment included functional scoring with the Oxford Knee Score (OKS) and radiographic review. Survivorship curves were constructed using the life-table method, with 95% confidence intervals calculated using Rothman’s equation. Separate endpoints were examined: revision for any reason and revision for confirmed loosening. Results The mean follow-up was 3.5 years. The pre-operative OKS improved from a mean of 21.2 to 38.9 (Mann-Whitney U Test, p = < 0.001). Twelve Patients required further operations including 9 revisions. No patients developed deep infection and no surviving implants were loose radiographically. Survivorship at 7 years with endpoints of re-operation, revision and aseptic loosening at surgery or radiographically was 88.4% (95% CI 79.6–93.7), 93.1% (95% CI 85.5–96.9) and 97.3% (95% CI 91.2–99.2) respectively. The presence of pre-operative mild contralateral tibiofemoral or any extent of patellofemoral joint degeneration was of no consequence. Discussion The indications for UKA are being expanded to include patients with greater deformity, more advanced disease in the patellofemoral joint and even certain features in the lateral compartment indicative of an anteromedial pattern of osteoarthritis (OA). However, much of the supporting literature remains available only from designer centres. This study represents a group of patients with what we believe to be wider indications, along with decisions to treat made on clinical grounds and radiographs alone. Conclusion This study shows comparable clinical outcomes of UKA for extended indications from a high volume, high-usage non-designer unit. Electronic supplementary material The online version of this article (10.1186/s12891-018-2099-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jonathan R B Hutt
- Department of Trauma and Orthopaedics, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Avtar Sur
- Department of Trauma and Orthopaedics, St George's University Hospitals NHS Foundation Trust, London, UK.
| | - Hartej Sur
- Department of Trauma and Orthopaedics, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Aine Ringrose
- Department of Trauma and Orthopaedics, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Mark S Rickman
- Department of Orthopaedics and Trauma, The University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
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Cho KY, Kim KI, Song SJ, Kim KJ. Intentionally Increased Flexion Angle of the Femoral Component in Mobile Bearing Unicompartmental Knee Arthroplasty. Knee Surg Relat Res 2018; 30:23-27. [PMID: 29482301 PMCID: PMC5853169 DOI: 10.5792/ksrr.17.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 08/21/2017] [Accepted: 09/18/2017] [Indexed: 10/26/2022] Open
Abstract
Purpose The purpose of this study was to determine the results of mobile bearing unicompartmental knee arthroplasty (UKA) with an intentionally increased flexion angle of the femoral component in patients requiring high flexion. Materials and Methods We investigated 45 knees treated by UKA. Clinically, we measured the range of motion (ROM) and the American Knee Society (AKS) score preoperatively and at final follow-up and investigated complications. Radiologically, we measured the flexion angle of the femoral component, the posterior slope angle of the tibial component, the femorotibial angle and mechanical axis of the limb postoperatively. Results The ROM was increased from 123° preoperatively to 139° at the final follow-up. The AKS knee and function scores increased from 59 and 68, respectively, preoperatively to 94 and 96, respectively, at the final follow-up. The flexion angle of the femoral component was 9.1°, and the posterior slope angle of the tibial component was 8.6°. There was one case of bearing dislocation in the largest femoral flexion angle case. Conclusions The results might reflect the positive effect of an increased flexion angle of the femoral component up to 10° on ROM in mobile bearing UKA, which would contribute to better quality of life after UKA especially in populations requiring deep knee flexion.
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Affiliation(s)
- Kye-Youl Cho
- Department of Medicine, Graduate School, Kyung Hee University, Seoul, Korea.,Department of Orthopaedic Surgery, Center for Joint Diseases and Rheumatism, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Kang-Il Kim
- Department of Orthopaedic Surgery, Center for Joint Diseases and Rheumatism, Kyung Hee University Hospital at Gangdong, Seoul, Korea.,Department of Orthopaedic Surgery, Kyung Hee University College of Medicine, Seoul, Korea
| | - Sang-Jun Song
- Department of Orthopaedic Surgery, Kyung Hee University College of Medicine, Seoul, Korea
| | - Kyu-Jin Kim
- Department of Orthopaedic Surgery, Center for Joint Diseases and Rheumatism, Kyung Hee University Hospital at Gangdong, Seoul, Korea
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The twin peg Oxford knee - Medium term survivorship and surgical principles. Knee 2018; 25:314-322. [PMID: 29396055 DOI: 10.1016/j.knee.2018.01.001] [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: 03/10/2017] [Revised: 12/05/2017] [Accepted: 01/03/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND A multicentre study of single peg Oxford knees reported failure associated with osteoarthritis progression, femoral component loosening, unexplained pain and meniscal bearing dislocation. Suboptimally positioned femoral components and intraoperative MCL damage could explain these problems. We hypothesised that modifying implantation technique to optimise femoral component positioning and MCL preservation, and introducing the twin peg Oxford knee would address these problems and improve longer term survival. Moreover, its better congruency in high flexion could reduce wear. This study aims to investigate this hypothesis by asking 1) Is the 98% survivorship up to nine years found in an earlier study sustained at longer term (up to 13 years)? 2) What are the remaining causes of failure? METHODS We described our modified implantation technique. A cohort of all patients treated by the senior author using this modified technique and the Oxford twin peg cemented knee replacement between September 2003 and August 2013 was investigated. A survival analysis was performed and the causes of failure were analysed. RESULTS The cohort consisted of 468 patients with 554 medial cemented implants. In all, 16 implants were revised and the 12-year survivorship was 95%. Patients with extended indications had a lower survivorship than those with anteromedial osteoarthritis (10-year survival rate 78% vs 97%, p<0.001). There were no failures due to femoral loosening. CONCLUSIONS Using our surgical principles the cemented twin peg Oxford knee can result in good medium to long-term implant survival, comparable to those obtained by the originating centre for the single peg Oxford knee.
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Hamilton TW, Rizkalla JM, Kontochristos L, Marks BE, Mellon SJ, Dodd CAF, Pandit HG, Murray DW. The Interaction of Caseload and Usage in Determining Outcomes of Unicompartmental Knee Arthroplasty: A Meta-Analysis. J Arthroplasty 2017. [PMID: 28641970 DOI: 10.1016/j.arth.2017.04.063] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Outcomes after unicompartmental knee arthroplasty (UKA) are variable and influenced by caseload (UKA/y) and usage (percentage of knee arthroplasty that are UKA), which relates to indications. This meta-analysis assesses the relative importance of these factors. METHODS MEDLINE (Ovid), Embase (Ovid), and Web of Science (ISI) were searched for consecutive series of cemented Phase 3 Oxford medial UKA. The primary outcome was revision rate/100 observed component years (% pa) with subgroup analysis based on caseload and usage. RESULTS Forty-six studies (12,520 knees) with an annual revision-rate ranging from 0% to 4.35% pa, mean 1.21% pa (95% confidence interval [CI], 0.97-1.47), were identified. In series with mean follow-up of 10-years, the revision-rate was 0.63% pa (95% CI, 0.46-0.83), equating to a 94% (95% CI, 92%-95%) 10-year survival. Aseptic loosening, lateral arthritis, bearing dislocation, and unexplained pain were the predominant failure mechanisms with revision for patellofemoral problems and polyethylene wear exceedingly rare. The lowest revision-rates were achieved with caseload >24 UKA/y (0.88% pa; 95% CI, 0.63-1.61) and usage >30% (0.69% pa; 95% CI, 0.50-0.90). Usage was more important than caseload; with high usage (≥20%), the revision-rate was low, whether the caseload was high (>12 UKA/y) or low (≤12 UKA/y; (0.94% pa; 95% CI, 0.69-1.23 and 0.85% pa; 95% CI, 0.65-1.08), respectively); with low usage (<20%), the revision-rate was high, whether the caseload was high or low (1.58% pa; 95% CI, 0.57-3.05 and 1.76% pa; 95% CI, 1.21-2.41, respectively). CONCLUSION To achieve optimum results, surgeons, whether high or low caseload, should adhere to the recommended indications such that ≥20%, or ideally >30% of their knee arthroplasties are UKA. If they do this, then they can expect to achieve results similar to those of the long-term series, which all had high usage (>20%) and an average 10-year survival of 94%.
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Affiliation(s)
- Thomas W Hamilton
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - James M Rizkalla
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Leonidas Kontochristos
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Barbara E Marks
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Stephen J Mellon
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Christopher A F Dodd
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Hemant G Pandit
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom
| | - David W Murray
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom; Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
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12
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Jang KM, Lim HC, Han SB, Jeong C, Kim SG, Bae JH. Does new instrumentation improve radiologic alignment of the Oxford® medial unicompartmental knee arthroplasty? Knee 2017; 24:641-650. [PMID: 28330757 DOI: 10.1016/j.knee.2017.02.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Revised: 11/02/2016] [Accepted: 02/02/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND A new instrument system has been introduced to improve the accuracy and reproducibility of implant positioning in Oxford® unicompartmental knee arthroplasty (UKA). This study aimed to determine if the new instrumentation could improve postoperative implant positioning and limb alignment, and reduce the occurrence of outliers in Oxford® UKA. METHODS A total of 77 cases of Oxford® UKA with the new instrumentation were included. Individual matching for the conventional instrument group was performed according to age, sex, and body mass index. Postoperative radiological variables, including the hip-knee-ankle angle and the varus/valgus and flexion/extension angles of the femoral and tibial implants, were measured and compared between the new instrumentation group and the conventional group. The outliers in implant positions and postoperative complications were also compared. RESULTS No significant between-group differences were observed in terms of lower limb alignment and tibial implant alignment. However, statistically significant differences were identified in the varus/valgus and flexion/extension angles of the femoral implant (P=0.01 and P<0.001, respectively). More outliers were observed in the flexion/extension angles of the femoral and tibial implants in the new instrumentation group. Eight meniscal bearing dislocations and three lateral compartmental degenerative changes were found in the conventional group, while there were two meniscal bearing dislocations in the new instrumentation group during the study period. CONCLUSION The present study did not confirm any benefit of the new instrument system in terms of postoperative limb alignment, positioning of the implant, or reducing outliers beyond the use of the conventional instruments.
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Affiliation(s)
- Ki-Mo Jang
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Hong Chul Lim
- Department of Orthopaedic Surgery, Seoul Barunsesang Hospital, Seoul, South Korea
| | - Seung-Beom Han
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Chandong Jeong
- Department of Orthopaedic Surgery, Guro Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Seul-Gi Kim
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Ji-Hoon Bae
- Department of Orthopaedic Surgery, Guro Hospital, Korea University College of Medicine, Seoul, South Korea.
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van der List JP, Chawla H, Zuiderbaan HA, Pearle AD. The Role of Preoperative Patient Characteristics on Outcomes of Unicompartmental Knee Arthroplasty: A Meta-Analysis Critique. J Arthroplasty 2016; 31:2617-2627. [PMID: 27172863 DOI: 10.1016/j.arth.2016.04.001] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 04/01/2016] [Accepted: 04/05/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND In 1989, Kozinn and Scott introduced strict exclusion criteria for unicompartmental knee arthroplasty (UKA). Because outcomes have improved with modern techniques and implants, these criteria have now been challenged. Therefore, the goal was to assess the role of these criteria on (1) functional outcomes and (2) revision rates of medial UKA. The hypothesis was that, with modern surgical techniques and implants, these traditional exclusion criteria are no longer strict contraindications for UKA. METHODS Databases of PubMed, EMBASE, and Cochrane and annual registries were searched for studies comparing UKA results in subgroups: age (young vs old), gender (male vs female), body mass index (obese vs nonobese), present vs absent patellofemoral osteoarthritis, and intact vs deficient anterior cruciate ligament. RESULTS Thirty-one comparative cohort studies (7 level II and 24 level III/IV studies) and 6 registries reported outcomes in 17,147 patients and revision rates in 285,472 patients. Females had inferior functional outcomes compared to males (odds ratio [OR], 4.03; 95% CI, 1.77-6.30). Furthermore, younger patients (in studies: OR, 1.52; 95% CI, 1.06-2.19; in registries: OR, 2.09; 95% CI, 1.70-2.57) and females (OR, 1.13; 95% CI, 1.06-1.21) had increased likelihood for revision. No increased likelihood for inferior outcomes or revisions was detected in patients with obesity, preoperative patellofemoral osteoarthritis, or anterior cruciate ligament deficiency. CONCLUSION Findings of increased revision risk in younger patients and increased revision risk with inferior outcomes in females give a more nuanced perspective on historical criteria, such that surgical decision-making may be based on UKA outcome data for subgroups rather than strict exclusion criteria.
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Affiliation(s)
- Jelle P van der List
- Department of Orthopaedic Surgery, Sports Medicine and Shoulder Service, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York
| | - Harshvardhan Chawla
- Department of Orthopaedic Surgery, Sports Medicine and Shoulder Service, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York
| | | | - Andrew D Pearle
- Department of Orthopaedic Surgery, Sports Medicine and Shoulder Service, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York
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White SH, Roberts S, Kuiper JH. The cemented twin-peg Oxford partial knee replacement survivorship: a cohort study. Knee 2015; 22:333-7. [PMID: 26003214 DOI: 10.1016/j.knee.2015.03.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 02/09/2015] [Accepted: 03/16/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND A new twin-peg version of the Oxford knee was introduced in 2003. However, until now there has been no information about its survivorship. The aim of this study was to determine the survivorship, and the patients' perception of outcome over time. METHODS A cohort of all patients treated from 2003 until 2009 using the twin-peg Oxford partial knee was contacted. The main indication for treatment was anteromedial osteoarthritis (AMOA). The Oxford Knee Score (OKS), American Knee Society Functional (AKS-F) score and satisfaction rate were obtained, and the time-to-failure was used to perform a survival analysis. RESULTS There were 249 patients treated, with 288 medial cemented implants. Of these, 248 patients with 287 implants could be contacted and implant survival or failure was verified. Their mean age was 67years (range: 34-94). The mean follow-up time was 5.1years (maximum: 9.2). The nine years cumulative implant survival rate for all cases using revision for any reason to define failure was 98% (95% CI, 84 to 100). There were no cases of femoral loosening. The mean OKS was 22 pre-operatively, 41 at two years, and 41 at final review, at which point 96% of patients were very or fairly pleased with the result. CONCLUSION The survivorship of the twin-peg knee was better than that of the single peg knee at our centre, and appeared no worse than the results of the single peg knee at the originating centre. It can offer secure femoral fixation, sustained clinical benefit and patient satisfaction. LEVEL OF EVIDENCE Level IV case-series.
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Affiliation(s)
- Stephen H White
- The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, Shropshire SY10 7AG, United Kingdom.
| | - Sharon Roberts
- The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, Shropshire SY10 7AG, United Kingdom.
| | - Jan Herman Kuiper
- The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, Shropshire SY10 7AG, United Kingdom; Institute for Science and Technology in Medicine, Keele University, United Kingdom.
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15
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Radiographic comparison of mobile-bearing partial knee single-peg versus twin-peg design. J Arthroplasty 2015; 30:475-8. [PMID: 25453627 DOI: 10.1016/j.arth.2014.10.015] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 09/23/2014] [Accepted: 10/10/2014] [Indexed: 02/01/2023] Open
Abstract
The femoral component and proprietary instrumentation of a mobile-bearing unicompartmental knee arthroplasty (UKA) was redesigned with an additional peg for enhanced fixation, 15° of extra femoral surface for contact in deep flexion, more rounded profile, better fit into the milled surface, and redesigned intramedullary based instrumentation. To assess the benefit of these changes, we compared postoperative radiographs of 219 single-peg and 186 twin-peg UKAs done in 2008-2011. All surviving knees demonstrated satisfactory position and alignment with no radiolucencies observed. Radiographic analysis showed improved and consistent component positioning with the twin-peg design implanted with updated instrumentation compared with the single-peg. The radiographic benefits of improved implant positioning using the twin-peg component and updated instrumentation are clear and carry tremendous potential. More robust follow-up is imperative.
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Reiner T, Jaeger S, Schwarze M, Klotz MC, Beckmann NA, Bitsch RG. The stability of the femoral component in the Oxford unicompartmental knee replacement: a comparison of single and twin peg designs. Bone Joint J 2014; 96-B:896-901. [PMID: 24986942 DOI: 10.1302/0301-620x.96b7.33478] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Aseptic loosening of the femoral component is an important indication for revision surgery in unicompartmental knee replacement (UKR). A new design of femoral component with an additional peg was introduced for the cemented Oxford UKR to increase its stability. The purpose of this study was to compare the primary stability of the two designs of component. Medial Oxford UKR was performed in 12 pairs of human cadaver knees. In each pair, one knee received the single peg and one received the twin peg design. Three dimensional micromotion and subsidence of the component in relation to the bone was measured under cyclical loading at flexion of 40° and 70° using an optical measuring system. Wilcoxon matched pairs signed-rank test was performed to detect differences between the two groups. There was no significant difference in the relative micromotion (p = 0.791 and 0.380, respectively) and subsidence (p = 0.301 and 0.176, respectively) of the component between the two groups at both angles of flexion. Both designs of component offered good strength of fixation in this cadaver study.
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Affiliation(s)
- T Reiner
- Heidelberg University Hospital, Department of Orthopedics and Traumatology, Schlierbacher Landstraße 200a, Heidelberg, 69118, Germany
| | - S Jaeger
- Clinic for Orthopedics and Trauma Surgery, Laboratory of Biomechanics and Implant Research, Schlierbacher Landstraße 200a, Heidelberg, 69118, Germany
| | - M Schwarze
- Heidelberg University Hospital, Department of Orthopedics and Traumatology, Schlierbacher Landstraße 200a, Heidelberg, 69118, Germany
| | - M C Klotz
- Heidelberg University Hospital, Department of Orthopedics and Traumatology, Schlierbacher Landstraße 200a, Heidelberg, 69118, Germany
| | - N A Beckmann
- Heidelberg University Hospital, Department of Orthopedics and Traumatology, Schlierbacher Landstraße 200a, Heidelberg, 69118, Germany
| | - R G Bitsch
- Heidelberg University Hospital, Department of Orthopedics and Traumatology, Schlierbacher Landstraße 200a, Heidelberg, 69118, Germany
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Abstract
PURPOSE There has been much emphasis on the importance of cam impingement, which is a cause of pain and knee hyperflexion restriction in unicompartmental knee arthroplasty (UKA). This study aimed to correlate cam impingement in the posterior femoral condyle with an α-angle showing the severity of the impingement. METHODS The study groups consisted of 87 knees of 74 patients operated on with phase 3 medial Oxford UKA. Postoperatively, Group A (68 knees, 78.2 %) had no remnant of cam lesion; Group B (19 knees, 21.8 %) had cam lesion remnants. In Group C (18 knees, 20.7 %), which is a subgroup of Group A, cam lesions seen preoperatively were cleaned and not seen postoperatively. RESULTS The mean increase in active flexion was 20.4° (± 7.3°) in Group A, 9.7° (± 6.1°) in Group B and 20.8° (± 7.3°) in Group C. The difference between Group A and Group B and between Group B and Group C was statistically significant (p < 0.001, p < 0.001). The mean decrease of α-angle was 11.2° (± 4.1°) in Group B, and 31.1° (± 3.4°) in Group C. The difference was statistically significant (p < 0.001). Mean Oxford Knee Scores were 24 preoperatively, 41 postoperatively in Group A; 22 preoperatively, 38 postoperatively in Group B; and 24 preoperatively, 40 postoperatively in Group C. The differences were not significant. CONCLUSIONS Posterior condylar cam lesion is an impingement which limits hyperflexion and may be an early clinical finding prior to bearing dislocation and wear. The α-angle is a marker showing the severity of this cam lesion. This problem can be overcome using intraoperative fluoroscan views during cam excison and replacing the femoral component in 105° knee flexion.
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The mid-term clinical results of the phase 3 Oxford unicompartmental knee arthroplasty: a 6- to 8-year follow-up. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2011. [DOI: 10.1007/s00590-011-0828-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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