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Lobenhoffer P. [Implant-associated fracture of the tibial plateau in cementless medial unicondylar knee prosthesis : Locking plate osteosynthesis]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2023; 35:397-402. [PMID: 37857816 DOI: 10.1007/s00064-023-00829-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 06/06/2023] [Accepted: 06/08/2023] [Indexed: 10/21/2023]
Abstract
THE PROBLEM Cementless medial unicondylar knee prostheses with mobile inlays have proved to be successful and are increasingly being used worldwide; however, there is a risk of fracture of the medial tibial plateau in the postoperative healing phase. THE SOLUTION In most cases we observed split fractures starting from the keel of the implant. These can be treated with a small posteromedial locking plate, whereby the upper screws are inserted through the keel slot and then interlocked. This achieves an optimally strong bond between the implant and the screws and a stable construct. SURGICAL TECHNIQUE A longitudinal skin incision is made at the level of the keel slot. A radial T‑plate is placed subcutaneously. The plate is fixed with a lag screw in the middle section. The compression usually closes the fracture gap. Then three locking cortical bone screws are inserted through the keel slot in the transverse section of the plate. Distal fixation by locking or standard screws. POSTOPERATIVE MANAGEMENT Immediate pain-adapted partial weight bearing, unrestricted mobility. Healing of the fracture and full weight bearing mostly achieved after 4 weeks.
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Affiliation(s)
- Philipp Lobenhoffer
- go:h Gelenkchirurgie Orthopädie Hannover, Bertastr. 10, 30159, Hannover, Deutschland.
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Şahin A, Çepni Ş, Veizi E, Erdoğan Y, Fırat A, Kılıçarslan K. Advantages of Simultaneous Cementless Bilateral Unicondylar Knee Arthroplasty Compared to Staged Surgery. Clin Orthop Surg 2023; 15:752-759. [PMID: 37811517 PMCID: PMC10551677 DOI: 10.4055/cios22178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/26/2022] [Accepted: 07/28/2022] [Indexed: 10/10/2023] Open
Abstract
Background Unicondylar knee arthroplasty (UKA) is an effective procedure, which reduces pain, increases range of motion, and improves function. UKA could be performed simultaneously or in staged sessions. This study aimed to compare bilateral cementless UKA performed simultaneously and in staged sessions in terms of complications, hemoglobin levels, transfusions, and functional outcomes. Methods Patients undergoing bilateral UKA for symptomatic medial compartment osteoarthritis were retrospectively analyzed. Of the 73 patients who met the inclusion criteria, 40 underwent surgery simultaneously and 33 underwent surgery in separate sessions. Operative time, length of hospital stay, change in hemoglobin, need for blood transfusion, complications, and functional outcomes were assessed. Results There was no statistically significant difference between the two groups in demographic data. Simultaneously operated patients had a significantly shorter hospital stay and shorter operative time. Statistically significant improvements in clinical scores were noted in both groups. The degree of improvement in functional scores did not differ between the groups. There was no difference between the two groups in terms of complication rates, but the number of periprosthetic tibial fractures was higher in the simultaneous group. Conclusions Simultaneous bilateral cementless UKA was more advantageous in terms of cumulative hospital stay and total operation time with similar clinical results when compared to a staged procedure. While the overall complication rate was similar, the rate of periprosthetic fractures was 5% in the simultaneous group.
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Affiliation(s)
- Ali Şahin
- Department of Orthopedics and Traumatology, Ankara City Hospital, Ankara, Türkiye
| | - Şahin Çepni
- Department of Orthopedics and Traumatology, Ankara City Hospital, Ankara, Türkiye
| | - Enejd Veizi
- Department of Orthopedics and Traumatology, Ankara City Hospital, Ankara, Türkiye
| | - Yasin Erdoğan
- Department of Orthopedics and Traumatology, Ankara City Hospital, Ankara, Türkiye
| | - Ahmet Fırat
- Department of Orthopedics and Traumatology, Ankara City Hospital, Ankara, Türkiye
| | - Kasım Kılıçarslan
- Department of Orthopedics and Traumatology, Ankara City Hospital, Ankara, Türkiye
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Zhu X, Xu H, Wang L, Zhang H, Chen H, Wang J, Zhang H. Impact of lateral meniscus injury detected by preoperative magnetic resonance imaging on midterm results after unicompartmental knee arthroplasty. Knee 2023; 44:227-235. [PMID: 37677873 DOI: 10.1016/j.knee.2023.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 08/11/2023] [Accepted: 08/16/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND The significance of lateral meniscus injury and its impact on success rates with medial unicompartmental knee arthroplasty (UKA) is still debated among scholars. This study aims to investigate whether preoperative magnetic resonance imaging (MRI) findings of lateral meniscus injury influence midterm outcomes following UKA. METHODS This study recruited 104 patients who underwent medial mobile-bearing UKA. Based on the extent of lateral meniscus injury indicated by the preoperative MRI and Stoller's classification system, patients were divided into two groups: the normal group (grade 0), and the lateral meniscus injury group (grade 3). Further, preoperative demographic and clinical outcome data (Hospital for Special Surgery score, lateral knee pain, squatting, and knee extension ability) were compared at least 2 years postoperatively. RESULTS No statistically significant difference in knee function or clinical outcome was found between the normal group (n = 59) and the lateral meniscus injury group (n = 45). During the 39.2 months (range: 24-64 months), no patient required any reoperation or revision procedures. CONCLUSION In summary, the presence of lateral meniscus injury as determined by preoperative MRI does not affect the midterm results after UKA. Without additional treatment for lateral meniscus injury, UKA can yield desired outcomes regardless of the presence of lateral meniscus injury on preoperative MRI.
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Affiliation(s)
- Xunpeng Zhu
- Department of Orthopaedics, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, PR China
| | - Hui Xu
- Department of Orthopaedics, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, PR China
| | - Lin Wang
- Department of Orthopaedics, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, PR China
| | - Haigang Zhang
- Department of Orthopaedics, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, PR China
| | - Hongwei Chen
- Department of Orthopaedics, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, PR China
| | - Jun Wang
- Department of Orthopaedics, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, PR China
| | - Hui Zhang
- Department of Orthopaedics, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, PR China.
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Puvanendran A, Jaibaji M, Volpin A, Konan S. Survivorship, clinical outcomes and indications for revision in uncemented unicompartmental knee arthroplasty: systematic review. Acta Orthop Belg 2023; 89:83-95. [PMID: 37294990 DOI: 10.52628/89.1.9873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Modern uncemented unicompartmental knee arthroplasty (UKA) relies on the mechanics of the implant design and a biological bond at the bone-implant interface to create a secure fixation of its components. The aim of this systematic review was to determine implant survivorship, clinical outcomes and indications for revision in uncemented UKAs. A search strategy was employed using keywords related to UKAs and uncemented fixation to identify suitable studies. Both prospective and retrospective studies with a minimum of two year mean follow-up were included. Data was gathered on study design, implant type, patient demographics, survivorship, clinical outcome scores and the indications for revision. Methodological quality was assessed using a ten-point risk of bias scoring tool. Eighteen studies were included in the final review. The mean follow-up of studies ranged between 2-11 years. The primary outcome of survival demonstrated 5 year survivorship ranged between 91.7-100.0% and 10-year survivorship between 91.0-97.5%. Clinical and functional outcome scores were found to be excellent in the majority of studies with the remaining reporting good results. Revisions represented 2.7% of the total operations performed. There were 145 revisions with an overall revision rate of 0.8 per 100 observed component years. Osteoarthritis disease progression (30.2%) and bearing dislocations (23.8%) were the most common causes of implant failure. This review finds uncemented UKAs demonstrate comparable survivorship, clinical outcomes and safety profile to cemented UKAs to consider this fixation a suitable alternative in clinical use.
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Panzram B, Barbian F, Reiner T, Hariri M, Renkawitz T, Walker T. Clinical and Functional Results of Cementless Unicompartmental Knee Arthroplasty with a Minimum Follow Up of 5 Years-A Consecutive Cohort of 201 Patients. J Clin Med 2023; 12:jcm12041694. [PMID: 36836231 PMCID: PMC9966646 DOI: 10.3390/jcm12041694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 02/06/2023] [Accepted: 02/13/2023] [Indexed: 02/23/2023] Open
Abstract
The number of unicompartmental knee replacements (UKR) is increasing. Alongside various advantages, the revision rate of cemented UKR is higher compared to total knee arthroplasty (TKR). In contrast, cementless fixation shows reduced revision rates, compared to the cemented UKR. However, most of the recent literature is based on designer-dependent studies. In this retrospective, single-center cohort study, we investigated patients who underwent cementless Oxford UKR (OUKR) between 2012 and 2016 in our hospital with a minimum follow-up of five years. Clinical outcome was evaluated using the OKS, AKSS-O, AKSS-F, FFbH-OA, UCLA, SF-36, EQ-5D-3L, FJS, ROM, pain, and satisfaction measures. Survival analysis was performed with reoperation and revision as endpoints. We included 201 patients (216 knees) for clinical evaluation. All outcome parameters increased significantly from pre- to postoperative stages. The five-year survival rate was 96.1% for revision surgery and 94.9% for reoperation. The main reasons for revision were the progression of osteoarthritis, inlay dislocation, and tibial overstuffing. Two iatrogenic tibial fractures appeared. Cementless OUKR shows excellent clinical outcome and high survival rates after five years. The tibial plateau fracture in cementless UKR represents a serious complication and requires modification of the surgical technique.
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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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Akagi M, Aya H, Mori S, Syogaku N, Tsukamoto I, Moritake A. A direct referencing method of the tibial plateau for the posterior tibial slope in medial unicompartmental knee arthroplasty. J Orthop Surg Res 2022; 17:329. [PMID: 35752859 PMCID: PMC9233832 DOI: 10.1186/s13018-022-03179-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 05/16/2022] [Indexed: 11/10/2022] Open
Abstract
PURPOSE There is no consensus on intraoperative references for the posterior tibial slope (PTS) in medial unicompartmental knee arthroplasty (UKA). An arthroscopic hook probe placed on the medial second quarter of the medial tibial plateau (MTP) in an anteroposterior direction may be used as a direct anatomical reference for the PTS. The purpose of this study is to investigate the availability and accuracy of this method. METHODS Marginal osteophyte formation and subchondral depression of the MTP and angles between the bony MTP and the cartilage MTP were retrospectively evaluated using preoperative sagittal MRI of 73 knees undergoing medial UKA. In another 36 knees, intraoperative lateral knee radiographs with the probe placed on the MTP were prospectively taken in addition to the preoperative MRI. Then, angles between the bony MTP and the probe axis and angles between the preoperative bony MTP and the postoperative implant MTP were measured. RESULTS Among 73 knees, one knee with grade 4 osteoarthritis had a posterior osteophyte higher than the most prominent point of the cartilage MTP. No subchondral depression affected the direct reference of the MTP. The mean angle between the bony MTP and the cartilage MTP was -0.8° ± 0.7° (-2.6°-1.0°, n = 72), excluding one knee with a "high" osteophyte. The mean angle between the bony MTP and the probe axis on the intraoperative radiograph was -0.6° ± 0.4° (-1.7-0.0, n = 36). The mean angle between the pre- and postoperative MTP was -0.5° ± 1.5° (-2.9°-1.8°). The root-mean-square (RMS) error of these two PTS angles was 1.6° with this method. CONCLUSION Cartilage remnants, osteophyte formation and subchondral bone depression do not affect the direct referencing method in almost all knees for which medial UKA is indicated. When the posterior "high" osteophyte of the MTP is noted on preoperative radiography, preoperative MRI or CT scan is recommended to confirm no "high" osteophyte on the medial second quarter. The accuracy of this method seems equal to that of robotic-assisted surgery (the RMS error in previous reports, 1.6°-1.9°).
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Affiliation(s)
- Masao Akagi
- Department of Orthopaedic Surgery, Kindai University Hospital, 377-2 Ohno-Higashi, Osaka-Sayama City, Osaka, 589-8511, Japan. .,Department of Orthopaedic Surgery, Sakura-Kai Hospital, 2610-1 Handa 5, Osaka-Sayama City, Osaka, 589-0011, Japan.
| | - Hisafumi Aya
- Department of Orthopaedic Surgery, Sakura-Kai Hospital, 2610-1 Handa 5, Osaka-Sayama City, Osaka, 589-0011, Japan
| | - Shigeshi Mori
- Department of Orthopaedic Surgery and Rheumatology, Kindai University Nara Hospital, 1248-1 Otoda-cho, Ikoma City, Nara, 630-0293, Japan
| | - Nobuhisa Syogaku
- Department of Orthopaedic Surgery, Sakura-Kai Hospital, 2610-1 Handa 5, Osaka-Sayama City, Osaka, 589-0011, Japan
| | - Ichiro Tsukamoto
- Department of Orthopaedic Surgery, Kindai University Hospital, 377-2 Ohno-Higashi, Osaka-Sayama City, Osaka, 589-8511, Japan
| | - Akihiro Moritake
- Department of Orthopaedic Surgery, Kindai University Hospital, 377-2 Ohno-Higashi, Osaka-Sayama City, Osaka, 589-8511, Japan
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Uivaraseanu B, Vesa CM, Tit DM, Maghiar O, Maghiar TA, Hozan C, Nechifor AC, Behl T, Andronie-Cioara FL, Patrascu JM, Bungau S. Highlighting the advantages and benefits of cementless total knee arthroplasty (Review). Exp Ther Med 2022; 23:58. [PMID: 34917184 PMCID: PMC8630446 DOI: 10.3892/etm.2021.10980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 10/05/2021] [Indexed: 12/22/2022] Open
Abstract
In the field of orthopedic surgery, cemented total knee arthroplasty (TKA) is considered to be one of the gold standards. However, there are categories of patients (i.e., obese and morbidly obese patients, younger than 65 years old) among whom cemented TKA has however a high failure rate. Moreover, the frequency of using uncemented TKA is increasing due to the potential benefits of long-term biological fixation, being an innovative field that addresses a new generation orthopedic surgical treatment which is more suitable for young patients who have good bone quality (good to very good, in terms of density). The survival rates and functional results of the latest generation of cementless TKAs may be similar to functional results and survival rates of cemented prosthesis. In conclusion, this review-type article can be considered a powerful database, extremely informative, dense, and focused on the topic mentioned above, in the interest of all medical professionals and all interested individuals.
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Affiliation(s)
- Bogdan Uivaraseanu
- Department of Surgical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410081 Oradea, Romania
| | - Cosmin Mihai Vesa
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410081 Oradea, Romania
| | - Delia Mirela Tit
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 410028 Oradea, Romania
| | - Octavian Maghiar
- Department of Surgical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410081 Oradea, Romania
| | - Teodor Andrei Maghiar
- Department of Surgical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410081 Oradea, Romania
| | - Calin Hozan
- Department of Surgical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410081 Oradea, Romania
| | - Aurelia Cristina Nechifor
- Analytical Chemistry and Environmental Engineering Department, Polytechnic University of Bucharest, 011061 Bucharest, Romania
| | - Tapan Behl
- Department of Pharmacology, Chitkara College of Pharmacy, Chitkara University, Chandigarh, Punjab 140401, India
| | - Felicia Liana Andronie-Cioara
- Department of Psycho-Neuroscience and Recovery, Faculty of Medicine and Pharmacy, University of Oradea, 410081 Oradea, Romania
| | - Jenel Marian Patrascu
- Department of Orthopedics, Urology and Medical Imaging, Faculty of Medicine, ‘Victor Babes’ University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Simona Bungau
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 410028 Oradea, Romania
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Burger JA, Jager T, Dooley MS, Zuiderbaan HA, Kerkhoffs GMMJ, Pearle AD. Comparable incidence of periprosthetic tibial fractures in cementless and cemented unicompartmental knee arthroplasty: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2022; 30:852-874. [PMID: 33528591 PMCID: PMC8901491 DOI: 10.1007/s00167-021-06449-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 01/11/2021] [Indexed: 12/18/2022]
Abstract
PURPOSE (I) To determine the incidence of periprosthetic tibial fractures in cemented and cementless unicompartmental knee arthroplasty (UKA) and (II) to summarize the existing evidence on characteristics and risk factors of periprosthetic fractures in UKA. METHODS Pubmed, Cochrane and Embase databases were comprehensively searched. Any clinical, laboratory or case report study describing information on proportion, characteristics or risk factors of periprosthetic tibial fractures in UKA was included. Proportion meta-analysis was performed to estimate the incidence of fractures only using data from clinical studies. Information on characteristics and risk factors was evaluated and summarized. RESULTS A total of 81 studies were considered to be eligible for inclusion. Based on 41 clinical studies, incidences of fractures were 1.24% (95%CI 0.64-2.41) for cementless and 1.58% (95%CI 1.06-2.36) for cemented UKAs (9451 UKAs). The majority of fractures in the current literature occurred during surgery or presented within 3 months postoperatively (91 of 127; 72%) and were non-traumatic (95 of 113; 84%). Six different fracture types were observed in 21 available radiographs. Laboratory studies revealed that an excessive interference fit (press fit), excessive tibial bone resection, a sagittal cut too deep posteriorly and low bone mineral density (BMD) reduce the force required for a periprosthetic tibial fracture to occur. Clinical studies showed that periprosthetic tibial fractures were associated with increased body mass index and postoperative alignment angles, advanced age, decreased BMD, female gender, and a very overhanging medial tibial condyle. CONCLUSION Comparable low incidences of periprosthetic tibial fractures in cementless and cemented UKA can be achieved. However, surgeons should be aware that an excessive interference fit in cementless UKAs in combination with an impaction technique may introduce an additional risk, and could therefore be less forgiving to surgical errors and patients who are at higher risk of periprosthetic tibial fractures. LEVEL OF EVIDENCE V.
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Affiliation(s)
- Joost A Burger
- Department of Orthopaedic Surgery and Computer Assisted Surgery Center, Hospital for Special Surgery, Weill Medical College of Cornell University, 535 East 70th St, New York, NY, 10021, USA.
| | - Tjeerd Jager
- Department of Orthopaedic Surgery, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - Matthew S Dooley
- Department of Orthopaedic Surgery and Computer Assisted Surgery Center, Hospital for Special Surgery, Weill Medical College of Cornell University, 535 East 70th St, New York, NY, 10021, USA
| | - Hendrik A Zuiderbaan
- Department of Orthopaedic Surgery, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - Gino M M J Kerkhoffs
- Department of Orthopedic Surgery, Amsterdam Movement Sciences (AMS), Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Andrew D Pearle
- Department of Orthopaedic Surgery and Computer Assisted Surgery Center, Hospital for Special Surgery, Weill Medical College of Cornell University, 535 East 70th St, New York, NY, 10021, USA
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Mohammad HR, Bullock GS, Kennedy JA, Mellon SJ, Murray D, Judge A. Cementless unicompartmental knee replacement achieves better ten-year clinical outcomes than cemented: a systematic review. Knee Surg Sports Traumatol Arthrosc 2021; 29:3229-3245. [PMID: 32613336 DOI: 10.1007/s00167-020-06091-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 06/03/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE The aim of this study was to report and compare the long-term revision rate, revision indications and patient reported outcome measures of cemented and cementless unicompartmental knee replacements (UKR). METHODS Databases Medline, Embase and Cochrane Central of Controlled Trials were searched to identify all UKR studies reporting the ≥ 10 year clinical outcomes. Revision rates per 100 component years [% per annum (% pa)] were calculated by fixation type and then, subgroup analyses for fixed and mobile bearing UKRs were performed. Mechanisms of failure and patient reported outcome measures are reported. RESULTS 25 studies were eligible for inclusion with a total of 10,736 UKRs, in which there were 8790 cemented and 1946 cementless knee replacements. The revision rate was 0.73% pa (CI 0.66-0.80) and 0.45% pa (CI 0.34-0.58) per 100 component years, respectively, with the cementless having a significantly (p < 0.001) lower overall revision rate. Therefore, based on these studies, the expected 10-year survival of cementless UKR would be 95.5% and cemented 92.7%. Subgroup analysis revealed this difference remained significant for the Oxford UKR (0.37% pa vs 0.77% pa, p < 0.001), but for non-Oxford UKRs there were no significant differences in revision rates of cemented and cementless UKRs (0.57% pa vs 0.69% pa, p = 0.41). Mobile bearing UKRs had significantly lower revision rates than fixed bearing UKRs in cementless (p = 0.001), but not cemented groups (p = 0.13). Overall the revision rates for aseptic loosening and disease progression were significantly lower (p = 0.02 and p = 0.009 respectively) in the cementless group compared to the cemented group (0.06 vs 0.13% pa and 0.10 vs 0.21% pa respectively). CONCLUSIONS Cementless fixation had reduced long-term revision rates compared to cemented for the Oxford UKR. For the non-Oxford UKRs, the revision rates of cementless and cemented fixation types were equivalent. Therefore, cementless UKRs offer at least equivalent if not lower revision rates compared to cemented UKRs. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Hasan R Mohammad
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, OX3 7LD, UK. .,Musculoskeletal Research Unit, Bristol Medical School, Level 1 Learning and Research Building, Southmead Hospital, University of Bristol, Westbury-On-Trym, Bristol, BS10 5NB, UK.
| | - Garrett S Bullock
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, OX3 7LD, UK
| | - James A Kennedy
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, OX3 7LD, UK
| | - Stephen J Mellon
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, OX3 7LD, UK
| | - David Murray
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, OX3 7LD, UK
| | - Andrew Judge
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, OX3 7LD, UK.,Musculoskeletal Research Unit, Bristol Medical School, Level 1 Learning and Research Building, Southmead Hospital, University of Bristol, Westbury-On-Trym, Bristol, BS10 5NB, UK
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Plancher KD, Shanmugam JP, Brite JE, Briggs KK, Petterson SC. Relevance of the Tibial Slope on Functional Outcomes in ACL-Deficient and ACL Intact Fixed-Bearing Medial Unicompartmental Knee Arthroplasty. J Arthroplasty 2021; 36:3123-3130. [PMID: 34053751 DOI: 10.1016/j.arth.2021.04.041] [Citation(s) in RCA: 14] [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] [Received: 03/11/2021] [Revised: 04/13/2021] [Accepted: 04/28/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Excessive posterior tibial slope in medial unicompartmental knee arthroplasty (UKA) has been implicated in early failure. The purpose of this study was to evaluate the relationship between preoperative posterior tibial slope and postoperative slope of the implant (PSI) on outcomes in patients with anterior cruciate ligament (ACL) intact and ACL-deficient knees after fixed-bearing medial UKA. METHODS Patients who underwent a medial UKA between 2002 and 2017 with a minimum 3-year follow-up were included. Preoperative posterior tibial slope and postoperative PSI were measured. Outcomes measures included Knee Injury and Osteoarthritis Outcomes Score (KOOS) subscales, Lysholm, and VR-12. Failure was defined as conversion to total knee arthroplasty. RESULTS Of 241 knees undergoing UKA, 131 patients (70 women, 61 men; average age of 65 ± 10 years (average BMI of 27.9 ± 4) were included. For all patients, survivorship was 98% at 5 years and 96% at 10 years with a mean survival time for UKA was 15.2 years [95% CI: 14.6-15.7]. No failure had a PSI >7°. There were no superficial or deep infections. There were no significant differences in outcome scores between the ACL intact and the ACL-deficient group; therefore, the data were combined for analysis. At mean 8-year follow-up, KOOS pain scores were better in patients with PSI ≤7° (87 ± 16) than those with PSI >7° (81 ± 15). 76% of patients with PSI ≤7° reached the Patient Acceptable Symptom State for KOOS pain; whereas, 59% of patients with PSI >7° reached PASS for KOOS pain (P = .015). CONCLUSION Patients with postoperative posterior slope of the tibial implant >7° had significantly worse postoperative pain, without conversion to TKA, and with maintenance of high function. In ACL deficient and intact knees, nonrobotically-assisted, fixed-bearing medial UKA had a 96% survivorship at 10 years.
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Affiliation(s)
- Kevin D Plancher
- Montefiore Medical Center/Albert Einstein College of Medicine, Department of Orthopaedic Surgery, Bronx, NY; Weill Cornell Medical College, Department of Orthopaedic Surgery, New York, NY; Plancher Orthopaedics & Sports Medicine, New York, NY; Orthopaedic Foundation, Stamford, CT
| | - Jaya Prasad Shanmugam
- Plancher Orthopaedics & Sports Medicine, New York, NY; Orthopaedic Foundation, Stamford, CT
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12
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Inui H, Taketomi S, Yamagami R, Kono K, Kawaguchi K, Nakazato K, Takagi K, Kage T, Tanaka S. Appropriate Timing for Evaluation of the Short-Term Effectiveness of Unicompartmental Knee Arthroplasty. J Knee Surg 2021; 34:864-869. [PMID: 31887763 DOI: 10.1055/s-0039-3402480] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Satisfactory results have been achieved with unicompartmental knee arthroplasty (UKA) for the treatment of isolated unicompartmental knee disease. However, UKA is associated with a significantly higher rate of revision. There is a tendency toward early revision of UKA for persistent pain because surgeons are not aware that outcomes can spontaneously improve with time. The aim of this study was to identify the time period that patients achieved the highest clinical outcomes following UKA. In total, we examined 72 knees that underwent Oxford UKA. We evaluated the range of motion and clinical results including Knee Society Knee Score, Knee Society Function Score (KSFS), and patient-reported scores using the Knee injury and Osteoarthritis Outcome Score (KOOS) at 1, 2, and 3 years postoperatively. The extension angle showed significant recovery from 1 to 2 years postoperatively, but no significant recovery was observed between 2 and 3 years. The flexion angle at 2 years is larger than at 1 year. The KSFS at 3 years is significantly lower than that at 1 year. The KOOS subscale of activities of daily living showed no significant differences among three periods after operation. The subscales of pain, symptom, sports, and quality of life showed significant recovery from 1 to 2 years postoperatively, but no significant recovery was observed from 2 to 3 years. To evaluate the effectiveness of Oxford UKA, surgeons should obtain clinical outcomes 2 years after the operation.
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Affiliation(s)
- Hiroshi Inui
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Shuji Taketomi
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Ryota Yamagami
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Kenichi Kono
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Kohei Kawaguchi
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Keiu Nakazato
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Kentarou Takagi
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Tomofumi Kage
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
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13
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ASLAN H, DUMAN E, ATLI OY, ÇEVİK HB. The effect of unicompartmental knee arthroplasty on lower extremity axis, tibiofemoral subluxation, and lateral knee joint distance. CUKUROVA MEDICAL JOURNAL 2021. [DOI: 10.17826/cumj.860594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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14
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Ellis RT, Nettrour JF, Keeney JA. TKA is More Durable Than UKA for Morbidly Obese Patients: A Two-Year Minimum Follow-Up Study. J Arthroplasty 2021; 36:1933-1941. [PMID: 33483247 DOI: 10.1016/j.arth.2020.12.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 12/19/2020] [Accepted: 12/22/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Unicompartmental knee arthroplasty (UKA) indications have expanded during the past two decades to include some morbidly obese patients (body mass index (BMI) > 40 kg/m2). Few published studies have compared UKA and total knee arthroplasty (TKA) in this unique patient subgroup with conflicting observations. METHODS We retrospectively compared 89 mobile bearing UKA (71 patients) and 201 TKA (175 patients) performed at a single institution with a minimum 2-year follow-up (mean 3.4 years). Demographic characteristics were similar for both patient cohorts. A detailed medical record review was performed to assess the frequency of component revision, revision indications, minor secondary procedures (components retained), and infections. RESULTS UKA was more frequently associated with clinical failure (29.2% vs 2.5%, P < .001) and component revision (15.7% vs 2.5%, P < .001), TKA was more frequently associated with extensor mechanism complications or knee manipulation (5.5% vs 0.0%, P = .02), and there was no difference in the infection rate (3.0% vs 2.2%, P = 1.0). CONCLUSION Early complications were lower following UKA but were outweighed by higher component revision rates for arthritis progression and implant failure. The study findings suggest that TKA provides a more predictable mid-term outcome for morbidly obese patients considering knee arthroplasty surgery.
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Affiliation(s)
- R Tyler Ellis
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO
| | - John F Nettrour
- Department of Orthopaedic Surgery, University of Pittsburgh, VA Pittsburgh Healthcare System, Pittsburgh, PA
| | - James A Keeney
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO
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15
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Kazarian GS, Barrack RL, Barrack TN, Lawrie CM, Nunley RM. Radiological outcomes following manual and robotic-assisted unicompartmental knee arthroplasty. Bone Jt Open 2021; 2:191-197. [PMID: 33739128 PMCID: PMC8009894 DOI: 10.1302/2633-1462.23.bjo-2020-0205.r1] [Citation(s) in RCA: 1] [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] [Indexed: 11/18/2022] Open
Abstract
Aims The purpose of this study was to compare the radiological outcomes of manual versus robotic-assisted medial unicompartmental knee arthroplasty (UKA). Methods Postoperative radiological outcomes from 86 consecutive robotic-assisted UKAs (RAUKA group) from a single academic centre were retrospectively reviewed and compared to 253 manual UKAs (MUKA group) drawn from a prior study at our institution. Femoral coronal and sagittal angles (FCA, FSA), tibial coronal and sagittal angles (TCA, TSA), and implant overhang were radiologically measured to identify outliers. Results When assessing the accuracy of RAUKAs, 91.6% of all alignment measurements and 99.2% of all overhang measurements were within the target range. All alignment and overhang targets were simultaneously met in 68.6% of RAUKAs. When comparing radiological outcomes between the RAUKA and MUKA groups, statistically significant differences were identified for combined outliers in FCA (2.3% vs 12.6%; p = 0.006), FSA (17.4% vs 50.2%; p < 0.001), TCA (5.8% vs 41.5%; p < 0.001), and TSA (8.1% vs 18.6%; p = 0.023), as well as anterior (0.0% vs 4.7%; p = 0.042), posterior (1.2% vs 13.4%; p = 0.001), and medial (1.2% vs 14.2%; p < 0.001) overhang outliers. Conclusion Robotic system navigation decreases alignment and overhang outliers compared to manual UKA. Given the association between component placement errors and revision in UKA, this strong significant improvement in accuracy may improve implant survival. Level of Evidence: III Cite this article: Bone Jt Open 2021;2-3:191–197.
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Affiliation(s)
- Gregory S Kazarian
- Department of Orthopaedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, Missouri, USA.,Hospital for Special Surgery, New York, New York, USA
| | - Robert L Barrack
- Department of Orthopaedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, Missouri, USA
| | - Toby N Barrack
- Department of Orthopaedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, Missouri, USA
| | - Charles M Lawrie
- Department of Orthopaedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, Missouri, USA
| | - Ryan M Nunley
- Department of Orthopaedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, Missouri, USA
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16
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Asokan A, Plastow R, Kayani B, Radhakrishnan GT, Magan AA, Haddad FS. Cementless knee arthroplasty: a review of recent performance. Bone Jt Open 2021; 2:48-57. [PMID: 33537676 PMCID: PMC7842161 DOI: 10.1302/2633-1462.21.bjo-2020-0172.r1] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Cementless knee arthroplasty has seen a recent resurgence in popularity due to conceptual advantages, including improved osseointegration providing biological fixation, increased surgical efficiency, and reduced systemic complications associated with cement impaction and wear from cement debris. Increasingly younger and higher demand patients are requiring knee arthroplasty, and as such, there is optimism cementless fixation may improve implant survivorship and functional outcomes. Compared to cemented implants, the National Joint Registry (NJR) currently reports higher revision rates in cementless total knee arthroplasty (TKA), but lower in unicompartmental knee arthroplasty (UKA). However, recent studies are beginning to show excellent outcomes with cementless implants, particularly with UKA which has shown superior performance to cemented varieties. Cementless TKA has yet to show long-term benefit, and currently performs equivalently to cemented in short- to medium-term cohort studies. However, with novel concepts including 3D-printed coatings, robotic-assisted surgery, radiostereometric analysis, and kinematic or functional knee alignment principles, it is hoped they may help improve the outcomes of cementless TKA in the long-term. In addition, though cementless implant costs remain higher due to novel implant coatings, it is speculated cost-effectiveness can be achieved through greater surgical efficiency and potential reduction in revision costs. There is paucity of level one data on long-term outcomes between fixation methods and the cost-effectiveness of modern cementless knee arthroplasty. This review explores recent literature on cementless knee arthroplasty, with regards to clinical outcomes, implant survivorship, complications, and cost-effectiveness; providing a concise update to assist clinicians on implant choice. Cite this article: Bone Jt Open 2021;2(1):48–57.
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Affiliation(s)
- Ajay Asokan
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK.,Department of Orthopaedic Surgery, The Princess Grace Hospital, London, UK
| | - Ricci Plastow
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK.,Department of Orthopaedic Surgery, The Princess Grace Hospital, London, UK
| | - Babar Kayani
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK.,Department of Orthopaedic Surgery, The Princess Grace Hospital, London, UK
| | - Ganan T Radhakrishnan
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK.,Department of Orthopaedic Surgery, The Princess Grace Hospital, London, UK
| | - Ahmed A Magan
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK.,Department of Orthopaedic Surgery, The Princess Grace Hospital, London, UK
| | - Fares S Haddad
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK.,Department of Orthopaedic Surgery, The Princess Grace Hospital, London, UK
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17
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Campi S, Kendrick BJL, Kaptein BL, Valstar ER, Jackson WFM, Dodd CAF, Price AJ, Murray DW. Five-year results of a randomised controlled trial comparing cemented and cementless Oxford unicompartmental knee replacement using radiostereometric analysis. Knee 2021; 28:383-390. [PMID: 33408039 DOI: 10.1016/j.knee.2020.09.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 08/18/2020] [Accepted: 09/06/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Cementless fixation is an alternative to cemented unicompartmental knee replacement (UKR). The aim of this study was to determine if cementless UKR fixation is as good as cemented by comparing the five-year migration measured radiostereometric analysis (RSA) in a randomised controlled trial. METHODS Thirty-nine patients were randomised to receive either a cemented or a cementless Oxford UKR and were studied at intervals up to five years to assess migration with RSA and radiolucencies with radiographs. RESULTS During the first year there was a small and significant amount of migration, predominantly in an anterior direction, of both the cemented (0.24 mm, SD 0.32, p = 0.01) and cementless (0.26 mm, SD 0.31, p = 0.00) femoral components. Thereafter there was no significant migration in any direction. At no stage was there any significant difference between the migrations of the cemented or cementless femoral components. During the first year, particularly the first three months, the cementless tibial components subsided 0.28 mm (SD 0.19, p = 0.00). This was significantly (p = 0.00) greater than the subsidence of the cemented tibial component (0.09, SD 0.19, p = 0.28). Between the second and fifth years there was no significant migration of either cemented or cementless tibial components. At five years radiolucent lines occurred significantly less with cementless (one partial) compared to cemented (six partial and one complete) tibial components. CONCLUSIONS As, between two and five years, there was no significant migration of cemented or cementless components, and no significant difference between them, we conclude that cementless fixation is as reliable as cemented. It may be better as there are fewer radiolucent lines.
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Affiliation(s)
- S Campi
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK
| | - B J L Kendrick
- Nuffield Orthopaedic Centre, NHS Foundation Trust, Oxford, UK
| | - B L Kaptein
- Biomechanics and Imaging Group, Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
| | - E R Valstar
- Biomechanics and Imaging Group, Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
| | - W F M Jackson
- Nuffield Orthopaedic Centre, NHS Foundation Trust, Oxford, UK
| | - C A F Dodd
- Nuffield Orthopaedic Centre, NHS Foundation Trust, Oxford, UK
| | - A J Price
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK; Nuffield Orthopaedic Centre, NHS Foundation Trust, Oxford, UK
| | - D W Murray
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK; Nuffield Orthopaedic Centre, NHS Foundation Trust, Oxford, UK.
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18
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Kennedy JA, Mohammad HR, Yang I, Mellon SJ, Dodd CAF, Pandit HG, Murray DW. Oxford domed lateral unicompartmental knee arthroplasty. Bone Joint J 2020; 102-B:1033-1040. [PMID: 32731833 DOI: 10.1302/0301-620x.102b8.bjj-2019-1330.r2] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS To report mid- to long-term results of Oxford mobile bearing domed lateral unicompartmental knee arthroplasty (UKA), and determine the effect of potential contraindications on outcome. METHODS A total of 325 consecutive domed lateral UKAs undertaken for the recommended indications were included, and their functional and survival outcomes were assessed. The effects of age, weight, activity, and the presence of full-thickness erosions of cartilage in the patellofemoral joint on outcome were evaluated. RESULTS Median follow-up was seven years (3 to 14), and mean age at surgery was 65 years (39 to 90). Median Oxford Knee Score (OKS) was 43 (interquartile range (IQR) 37 to 47), with 260 (80%) achieving a good or excellent score (OKS > 34). Revisions occurred in 34 (10%); 14 (4%) were for dislocation, of which 12 had no recurrence following insertion of a new bearing, and 12 (4%) were revised for medial osteoarthritis (OA). Ten-year survival was 85% (95% confidence interval (CI) 79 to 90, at risk 72). Age, weight, activity, and patellofemoral erosions did not have a significant effect on the clinical outcome or survival. CONCLUSION Domed lateral UKA provides a good alternative to total knee arthroplasty (TKA) in the management of lateral compartment OA. Although dislocation is relatively easy to treat successfully, the dislocation rate of 4% is high. It is recommended that the stability of the bearing is assessed intraoperatively. If the bearing can easily be displaced, the fixed rather than the mobile bearing version of the Oxford lateral tibial component should be inserted instead. Younger age, heavier weight, high activity, and patellofemoral erosions did not detrimentally affect outcome, so should not be considered contraindications. Cite this article: Bone Joint J 2020;102-B(8):1033-1040.
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Affiliation(s)
- James A Kennedy
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Hasan R Mohammad
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Irene Yang
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Stephen J Mellon
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Christopher A F Dodd
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Hemant G Pandit
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK.,Leeds Institute of Rheumatic and Musculoskeletal Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - David W Murray
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK.,Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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19
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Hefny MH, Smith NA, Waite J. Cementless medial Oxford unicompartmental knee replacement. Five-year results from an independent series. Knee 2020; 27:1219-1227. [PMID: 32711885 DOI: 10.1016/j.knee.2020.05.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 04/09/2020] [Accepted: 05/23/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Unicompartmental knee replacement (UKR) is a common treatment option for patients with advanced medial compartment knee arthritis. The Oxford UKR (OUKR) is the most commonly used implant for partial knee replacement. A cementless Oxford prosthesis was introduced in 2004 aiming to reduce the revision rate by potentially reducing radiolucencies as well as errors of cementation associated with the cemented prosthesis. Whilst results from the designer centre have been reported, there is little independent clinical evidence of outcomes. The aim of this study was to evaluate the survival of the cementless OUKR in a single surgeon series at an independent centre and to assess clinical and radiographic outcomes. METHODS All patients who received a cementless medial OUKR and had a minimum of five-year follow-up were included in the series. The Oxford knee score was used to evaluate patient outcomes at five years postoperatively. Survival rates, complications and evidence of radiolucencies on plain radiographs were also reviewed. RESULTS One hundred and fifty-eight cementless medial OUKR were implanted in 126 patients. Three patients died and four knees were revised. The five-year survival was 97.4% and the median Oxford knee score was 43 at five years postoperatively. No Complete radiolucent lines were observed on radiographs at one year. Four tibial components subsided. CONCLUSIONS This independent series shows that low revision rates and excellent results can be achieved with the use of the cementless OUKR at five years. Early subsidence of the tibial component, which is specific to the cementless prosthesis, warrants further investigation.
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Affiliation(s)
- Mamdouh H Hefny
- Orthopaedic Department, South Warwickshire NHS Foundation Trust, Lakin Road, Warwick CV34 5BW, United Kingdom.
| | - Nick A Smith
- Orthopaedic Department, South Warwickshire NHS Foundation Trust, Lakin Road, Warwick CV34 5BW, United Kingdom
| | - Jon Waite
- Orthopaedic Department, South Warwickshire NHS Foundation Trust, Lakin Road, Warwick CV34 5BW, United Kingdom
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20
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Hiranaka T, Yoshikawa R, Yoshida K, Michishita K, Nishimura T, Nitta S, Takashiba K, Murray D. Tibial shape and size predicts the risk of tibial plateau fracture after cementless unicompartmental knee arthroplasty in Japanese patients. Bone Joint J 2020; 102-B:861-867. [PMID: 32600131 DOI: 10.1302/0301-620x.102b7.bjj-2019-1754.r1] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
AIMS Cementless unicompartmental knee arthroplasty (UKA) has advantages over cemented UKA, including improved fixation, but has a higher risk of tibial plateau fracture, particularly in Japanese patients. The aim of this multicentre study was to determine when cementless tibial components could safely be used in Japanese patients based on the size and shape of the tibia. METHODS The study involved 212 cementless Oxford UKAs which were undertaken in 174 patients in six hospitals. The medial eminence line (MEL), which is a line parallel to the tibial axis passing through the tip of medial intercondylar eminence, was drawn on preoperative radiographs. Knees were classified as having a very overhanging medial tibial condyle if this line passed medial to the medial tibial cortex. They were also classified as very small if a size A/AA tibial component was used. RESULTS The overall rate of fracture was 8% (17 out of 212 knees). The rate was higher in knees with very overhanging condyles (Odds ratio (OR) 13; p < 0.001) and with very small components (OR 7; p < 0.001). The OR was 21 (p < 0.001) in those with both very overhanging condyles and very small components. In all, 69% of knees (147) had neither very overhanging nor very small components, and the fracture rate in these patients was 1.4% (2 out of 147 knees). Males had a significantly reduced risk of fracture (OR 0.13; p = 0.002), probably because no males required very small components and females were more likely to have very overhanging condyles (OR 3; p = 0.013). 31% of knees (66) were in males and in these the rate of fracture was 1.5% (1 out of 66 knees). CONCLUSION The rate of tibial plateau fracture in Japanese patients undergoing cementless UKA is high. We recommend that cemented tibial fixation should be used in Japanese patients who require very small components or have very overhanging condyles, as identified from preoperative radiographs. In the remaining 69% of knees cementless fixation can be used. This approach should result in a low rate of fracture. Cite this article: Bone Joint J 2020;102-B(7):861-867.
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Affiliation(s)
- Takafumi Hiranaka
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Osaka, Japan
| | - Ryo Yoshikawa
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Osaka, Japan
| | | | - Kazuhiko Michishita
- Department of Orthopaedic Surgery, Japan Community Healthcare Organization, Yugawara Hospital, Yugawara, Kanagawa, Japan
| | - Takehiro Nishimura
- Department of Orthopaedic Surgery, Suita Municipal Hospital, Osaka, Japan
| | | | - Kenichiro Takashiba
- Department of Joint Reconstruction Center, Souseikai Fukuoka Mirai Hospital, Fukuoka, Japan
| | - David Murray
- Nuffield Department of Orthopaedic Surgery, Botnar Research Centre, Nuffield Orthopaedic Centre, Windmill Rd, Oxford, UK
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Kazarian GS, Barrack TN, Okafor L, Barrack RL, Nunley RM, Lawrie CM. High Prevalence of Radiographic Outliers and Revisions with Unicompartmental Knee Arthroplasty. J Bone Joint Surg Am 2020; 102:1151-1159. [PMID: 32618922 DOI: 10.2106/jbjs.19.01277] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Alignment outcomes and their impact on implant survival following unicompartmental knee arthroplasty (UKA) are unclear. The purpose of this study was to assess the implant survival and radiographic outcomes after UKA as well as the impact of component alignment and overhang on implant survival. METHODS We performed a retrospective analysis of 253 primary fixed-bearing and mobile-bearing medial UKAs from a single academic center. All UKAs were performed by 2 high-volume fellowship-trained arthroplasty surgeons. UKAs comprised <10% of their knee arthroplasty practices, with an average of 14.2 medial UKAs per surgeon per year. Implant survival was assessed. Femoral coronal (FCA), femoral sagittal (FSA), tibial coronal (TCA), and tibial sagittal (TSA) angles as well as implant overhang were radiographically measured. Outliers were defined for FCA (>±10° deviation from neutral), FSA (>15° of flexion), TCA (>±5° deviation from neutral), and TSA (>±5° deviation from 7°). "Far outliers" were an additional >±2° of deviation. Outliers for overhang were identified as >3 mm for anterior overhang, >2 mm for posterior overhang, and >2 mm for medial overhang. RESULTS Among patients with a failed UKA, revision was performed at an average of 3.7 years (range, 0.03 to 8.7 years). The cumulative revision rate was 14.2%. Kaplan-Meier survival analysis demonstrated 5 and 10-year survival rates of 88.0% (95% confidence interval [CI] = 82.0% to 91.0%) and 70.0% (95% CI = 56.0% to 80.0%), respectively. Only 19.0% (48) of the UKAs met target alignment for all 4 alignment measures, and only 72.7% (184) met all 3 targets for overhang. Only 11.9% (30) fell within all alignment and overhang targets. The risk of implant failure was significantly impacted by outliers for FCA (failure rate = 15.4%, p = 0.036), FSA (16.2%, p = 0.028), TCA (17.9%, p = 0.020), and TSA (15.2%, p = 0.034) compared with implants with no alignment or overhang errors (0%); this was also true for far outliers (p < 0.05). Other risk factors for failure were posterior overhang (failure rate = 25.0%, p = 0.006) and medial overhang (38.2%, p < 0.001); anterior overhang was not a significant risk factor (10.0%, p = 0.090). CONCLUSIONS The proportions of UKA revisions and alignment outliers were greater than expected, even among high-volume arthroplasty surgeons performing an average of 14.2 UKAs per year (just below the high-volume UKA threshold of 15). Alignment and overhang outliers were significant risk factors for implant failure. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Gregory S Kazarian
- Department of Orthopaedic Surgery, Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, Missouri
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22
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Panzram B, Mandery M, Reiner T, Gotterbarm T, Schiltenwolf M, Merle C. Cementless Oxford Medial Unicompartmental Knee Replacement-Clinical and Radiological Results of 228 Knees with a Minimum 2-Year Follow-Up. J Clin Med 2020; 9:jcm9051476. [PMID: 32423118 PMCID: PMC7290835 DOI: 10.3390/jcm9051476] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/06/2020] [Accepted: 05/11/2020] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Studies show several advantages of unicompartmental knee replacement (UKR) over total knee replacements (TKR), whereas registry based revision rates of UKR are significantly higher than for TKA. Registry data report lower revision rates for cementless UKR compared to cemented UKR. The aim of this study was to assess clinical and radiological results of cementless Oxford UKR (OUKR) in an independent cohort. (2) Methods: This retrospective cohort study examines a consecutive series of 228 cementless OUKR. Clinical outcome was measured using functional scores (Oxford Knee Score (OKS), American Knee Society Score (AKSS), Hannover Functional Ability Questionnaire for Osteoarthritis (FFbH-OA), range of motion (ROM)), pain and satisfaction. Radiographs were analyzed regarding the incidence of radiolucent lines (RL), implant positioning, and their possible impact on clinical outcome. (3) Results: At a mean follow-up of 37.1 months, the two and three year revision free survival-rates were 97.5% and 96.9%. Reasons for revision surgery were progression of osteoarthritis, inlay dislocation and pain. All clinical outcome scores showed a significant improvement from pre- to postoperative. The incidence of RL around the implant was highest within the first year postoperatively (36%), and decreased (5%) within the second year. Their presence was not correlated with inferior clinical outcome. Implant positioning showed no influence on clinical outcome. (4) Conclusion: Cementless OUKR showed excellent clinical outcome and survival rates, with reliable osteointegration. Neither the incidence of radiolucent lines nor implant positioning were associated with inferior clinical outcome.
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Castiello E, Affatato S. Progression of osteoarthritis and reoperation in unicompartmental knee arthroplasty: A comparison of national joint registries. Int J Artif Organs 2020; 43:203-207. [DOI: 10.1177/0391398819879697] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Unicompartmental knee arthroplasty remains a challenge for orthopaedic surgeons because of its higher revision rate compare with the total knee arthroplasty. The hypothesis of this work is that the progression of osteoarthritis in unicompartmental knee prostheses is the natural history of the degenerative disease and a reason for reoperation. Most international joint registries consider this fact as a failure of the implant and a cause of revision. Annual joint registries were searched for progression of osteoarthritis in unicompartmental knee arthroplasty and reasons for their revisions. Current data from registries for unicompartmental knee indicate that the revision rate of such prostheses is overestimated. Considering osteoarthritis progression as the development of the existing disease and not as a failure of the implant, revision rate will be reduced. Registries, reports, and studies are needed to evaluate the progression of osteoarthritis as a cause of reoperation instead of a reason for revision, reducing unicompartmental revision rate and encouraging surgeons to implant more of them.
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Affiliation(s)
| | - Saverio Affatato
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Mohammad HR, Kennedy JA, Mellon SJ, Judge A, Dodd CA, Murray DW. Ten-year clinical and radiographic results of 1000 cementless Oxford unicompartmental knee replacements. Knee Surg Sports Traumatol Arthrosc 2020; 28:1479-1487. [PMID: 31209540 PMCID: PMC7176592 DOI: 10.1007/s00167-019-05544-w] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 05/16/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE Unicompartmental knee replacement (UKR) has substantial benefits over total knee replacement (TKR) but has higher revision rates. The cementless Oxford UKR was introduced to address this but there are concerns about fixation and tibial plateau fractures. The first long-term study of the device with clinical and radiographic outcomes is reported. METHODS The first 1000 medial cementless Oxford UKR were prospectively identified and followed up by independent physiotherapists. Survival was calculated using the endpoints reoperation, revision, revision to TKR, major revision requiring revision TKR components and patient mortality. The Oxford Knee Score (OKS), Tegner Activity Score and American Knee Society Score (AKSS) were recorded and radiographs analysed. RESULTS The ten year survival was 96.6% (CI 94.8-97.8), 97.5% (CI 95.7-98.5), 98.9% (CI 97.7-99.4) and 99.6% (CI 98.8-99.9) using reoperation, revision, revision to TKR and major revision as the endpoint, respectively. Commonest causes for revision were bearing dislocation (n = 7, 0.7%), disease progression (n = 4, 0.4%) and pain (n = 2, 0.2%). There was one lateral tibial plateau fracture and one femoral component loosening. At 10 years, the mean OKS was 41.2 (SD 9.8), Tegner 2.8 (SD 1.3), AKSS-O 89.1 (SD 13.0) and AKSS-F 80.4 (SD 14.6). There were no pathological radiolucencies or complete radiolucent lines. There were no implant-related deaths. CONCLUSIONS The cementless Oxford UKR is a safe procedure with excellent long-term clinical results. Our results suggest that reliable fixation was achieved with only one (0.1%) revision for loosening (femoral), no radiographic evidence of loosening in the remaining cases and no fractures related to implantation. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Hasan R. Mohammad
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK ,Oxford University Hospitals NHS Foundation Trust, Nuffield Orthopaedic Centre, Oxford, UK
| | - James A. Kennedy
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK ,Oxford University Hospitals NHS Foundation Trust, Nuffield Orthopaedic Centre, Oxford, UK
| | - Stephen J. Mellon
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Andrew Judge
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Christopher A. Dodd
- Oxford University Hospitals NHS Foundation Trust, Nuffield Orthopaedic Centre, Oxford, UK
| | - David W. Murray
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK ,Oxford University Hospitals NHS Foundation Trust, Nuffield Orthopaedic Centre, Oxford, UK
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Burger JA, Kleeblad LJ, Laas N, Pearle AD. Mid-term survivorship and patient-reported outcomes of robotic-arm assisted partial knee arthroplasty. Bone Joint J 2020; 102-B:108-116. [DOI: 10.1302/0301-620x.102b1.bjj-2019-0510.r1] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Aims Limited evidence is available on mid-term outcomes of robotic-arm assisted (RA) partial knee arthroplasty (PKA). Therefore, the purpose of this study was to evaluate mid-term survivorship, modes of failure, and patient-reported outcomes of RA PKA. Methods A retrospective review of patients who underwent RA PKA between June 2007 and August 2016 was performed. Patients received a fixed-bearing medial or lateral unicompartmental knee arthroplasty (UKA), patellofemoral arthroplasty (PFA), or bicompartmental knee arthroplasty (BiKA; PFA plus medial UKA). All patients completed a questionnaire regarding revision surgery, reoperations, and level of satisfaction. Knee Injury and Osteoarthritis Outcome Scores (KOOS) were assessed using the KOOS for Joint Replacement Junior survey. Results Mean follow-up was 4.7 years (2.0 to 10.8). Five-year survivorship of medial UKA (n = 802), lateral UKA (n = 171), and PFA/BiKA (n = 35/10) was 97.8%, 97.7%, and 93.3%, respectively. Component loosening and progression of osteoarthritis (OA) were the most common reasons for revision. Mean KOOS scores after medial UKA, lateral UKA, and PFA/BiKA were 84.3 (SD 15.9), 85.6 (SD 14.3), and 78.2 (SD 14.2), respectively. The vast majority of the patients reported high satisfaction levels after RA PKA. Subgroup analyses suggested tibial component design, body mass index (BMI), and age affects RA PKA outcomes. Five-year survivorship was 98.4% (95% confidence interval (CI) 97.2 to 99.5) for onlay medial UKA (n = 742) and 99.1% (95% CI 97.9 to 100) for onlay medial UKA in patients with a BMI < 30 kg/m2 (n = 479). Conclusion This large single-surgeon study showed high mid-term survivorship, satisfaction levels, and functional outcomes in RA UKA using metal-backed tibial onlay components. In addition, favourable results were reported in RA PFA and BiKA. Cite this article: Bone Joint J 2020;102-B(1):108–116
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Affiliation(s)
- Joost A. Burger
- Department of Orthopaedic Surgery and Computer Assisted Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Laura J. Kleeblad
- Department of Orthopaedic Surgery and Computer Assisted Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Niels Laas
- Department of Orthopaedic Surgery and Computer Assisted Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Andrew D. Pearle
- Department of Orthopaedic Surgery and Computer Assisted Surgery, Hospital for Special Surgery, New York, New York, USA
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Walker T, Hetto P, Bruckner T, Gotterbarm T, Merle C, Panzram B, Innmann MM, Moradi B. Minimally invasive Oxford unicompartmental knee arthroplasty ensures excellent functional outcome and high survivorship in the long term. Knee Surg Sports Traumatol Arthrosc 2019; 27:1658-1664. [PMID: 30465099 DOI: 10.1007/s00167-018-5299-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 11/13/2018] [Indexed: 01/04/2023]
Abstract
PURPOSE Whether unicompartimental or total knee arthroplasty is superior for treatment of anteromedial knee osteoarthritis, is still uncertain. Therefore, the purpose of this study was to evaluate clinical and radiological outcome as well as long-term survivorship of medial Oxford unicompartmental knee arthroplasty (OUKA) at an independent center with a minimum follow-up of 10 years. METHODS This single-center retrospective cohort study reports the 10-15 years follow-up results of 113 consecutive patients (126 knees) after medial OUKA. Survivorship analysis was performed with several different endpoints and clinical outcome was measured using the Oxford Knee Score (OKS), American Knee Society Score (AKSS-O), range of motion (ROM), Tegner activity score and UCLA score. Radiological analysis was performed with focus on progression of arthritis in the lateral compartment. RESULTS A total of 16 patients (16 knees) underwent revision surgery resulting in a survival rate of 92.4% at 10 years and 88.6% at 15 years with the endpoint device-related revisions. The main reason for revision surgery was progression of arthritis in five patients (31.3%) followed by persistency of pain in three patients (18.7%). Clinical outcome was good to excellent with an OKS of 39.9 at 11 years, an AKSS-O of 89.3 and a mean range of motion of 122°. The radiological analysis revealed a significant progression of degenerative changes in the lateral compartment, however without any impact on the functional outcome. CONCLUSION Oxford UKA of the medial compartment ensures good long-term survivorship with an excellent functional outcome. Therefore, the results of this study support the continued use of OUKA in patients with anteromedial osteoarthritis. LEVEL OF EVIDENCE Retrospective cohort study, Level III.
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Affiliation(s)
- Tilman Walker
- Center for Orthopaedics and Trauma Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Pit Hetto
- Center for Orthopaedics and Trauma Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Thomas Bruckner
- Institute of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 305, 69120, Heidelberg, Germany
| | - Tobias Gotterbarm
- Center for Orthopaedics and Trauma surgery, University of Linz, Krankenhausstr. 7a, 4020, Linz, Austria
| | - Christian Merle
- Center for Orthopaedics and Trauma Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Benjamin Panzram
- Center for Orthopaedics and Trauma Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Moritz M Innmann
- Center for Orthopaedics and Trauma Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Babak Moradi
- Center for Orthopaedics and Trauma Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.
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Stempin R, Stempin K, Kaczmarek W. Medium-term outcome of cementless, mobile-bearing, unicompartmental knee arthroplasty. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:41. [PMID: 30906745 DOI: 10.21037/atm.2018.12.50] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Cemented, mobile-bearing unicondylar knee arthroplasty (UKA) yields good functional results. However, radiolucent lines (RLL) are not uncommon, even in asymptomatic patients, and it has been debated whether these "physiological" RLLs are indicative of loosening. Cementless UKA may lead to fewer RLLs compared with cemented devices. The present study was designed to document mid-term outcome with an emphasis on clinical outcomes. Methods We included 153 knees of 150 consecutive patients in a retrospective study. All patients had received a cementless medial mobile-bearing UKA. Patients were evaluated with use of the Knee Society Score (KSS), which was obtained at baseline and at final follow-up. The WOMAC, Oxford Knee Score (OKS) and Forgotten Joint Scores (FJS-12) were administered at the final follow-up. Anteroposterior (AP) and lateral radiographs were taken at final follow-up. Results At a mean follow-up of 5 years (range, 3-7 years), implant survival was 97.1% (95% confidence interval, 91.1-99.1%). Excellent postoperative KSS, WOMAC, OKS and FJS scores were obtained. Postoperative radiography was available for 78 knees. RLL was observed in 10.3% of the cases, but no cases with complete RLLs were seen. Conclusions Favourable results were found for cementless, mobile-bearing UKA, with no aseptic loosening at an average follow-up of 5 years. Cementless UKA fixation may lead to a clinically "forgotten joint" and may decrease the rate of RLLs.
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Affiliation(s)
- Radosław Stempin
- Department of Orthopedic & Trauma Surgery, J. Strus Memorial (Multispecialistic City) Hospital, Poznan, Poland
| | - Kacper Stempin
- Department of Orthopedic & Trauma Surgery, Westallgäu Clinic, Wangen, Germany
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