1
|
Long X, Ren J, Liu Q, Zhu S, Chen X, Zhang W, Liang T, Wang Z, Li Y, Hou J, Wang K, He R. The footprint of the anterior horn of medial meniscus: A novel and reliable landmark for the tibial vertical cut in Oxford mobile-bearing medial unicompartmental knee arthroplasty. Knee 2023; 44:236-244. [PMID: 37677874 DOI: 10.1016/j.knee.2023.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 06/07/2023] [Accepted: 08/07/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Tibial vertical cut is crucial for rotational position and bony coverage in Oxford mobile-bearing medial unicompartmental knee arthroplasty (UKA). This study aimed to determine whether the footprint of the anterior horn of medial meniscus (FAM) is a reliable landmark for tibial vertical cut. METHODS The FAM and the line through FAM and the edge of anterior cruciate ligament insertion (FAMA line) were identified by dissection five knee joint specimens. The angle between FAMA line and standard Akagi's line was measured. From 2022 to 2023, 64 patients (74 knees) diagnosed as anteromedial osteoarthritis were included to undergo primary Oxford medial UKA by two surgeons (Group 1 and 2), using FAMA line as a landmark for tibial vertical cut. The anteroposterior (AP) length, mediolateral (ML) length of tibial cut and tibial prothesis were measured by vernier caliper. ML/AP ratio was also calculated, and data were compared intragroup and intergroup. Mediolateral position and external rotation of tibial components were assessed postoperatively. RESULTS FAMA line was parallel to standard Akagi's line. No significant differences were found in AP and ML lengths between tibial cut and tibial component (AP different value = 0.007 ± 0.154 cm, P = 0.674, ML different value = 0.020 ± 0.195 cm, P = 0.155). The ML/AP ratio was similar between the two groups (P = 0.141, 0.646, 0.255, 0.607, 0.384, size AA ∼ D). No significant difference was found in mediolateral position (0.87 ± 0.03 vs. 0.86 ± 0.03, P = 0.156) and external rotation (6.88 ± 2.08 vs. 6.68 ± 2.22, P = 0.746) of the tibial component between the two groups. CONCLUSION The FAM is a reliable landmark for tibial vertical cut in Oxford UKA.
Collapse
Affiliation(s)
- Xiangyu Long
- Department of Joint and Trauma Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jianhua Ren
- Department of Joint and Trauma Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Qian Liu
- Department of Joint and Trauma Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Shaoshen Zhu
- Department of Joint and Trauma Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xi Chen
- Department of Joint and Trauma Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Wenhui Zhang
- Department of Joint and Trauma Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Tangzhao Liang
- Department of Joint and Trauma Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhe Wang
- Department of Joint and Trauma Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yuhang Li
- Department of Joint and Trauma Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jianfeng Hou
- Department of Joint and Trauma Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Kun Wang
- Department of Joint and Trauma Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
| | - Ronghan He
- Department of Joint and Trauma Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
| |
Collapse
|
2
|
Hardy V, Garaud M, Hetaimish BM, Samargandi R. The Reliability of the Divergence Angle for Evaluating Rotational Implant Positioning in Medial Unicompartmental Knee Replacement. Cureus 2023; 15:e42956. [PMID: 37667718 PMCID: PMC10475295 DOI: 10.7759/cureus.42956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2023] [Indexed: 09/06/2023] Open
Abstract
Background Unicompartmental knee arthroplasty (UKA) is a highly effective surgical procedure used to treat patients with osteoarthritis affecting a single knee compartment. UKA has gained significant popularity, accompanied by an expansion of its surgical indications. This increasing trend can be attributed to the consistently excellent clinical outcomes associated with UKA, which rival those achieved with total knee arthroplasty (TKA). However, despite these advancements, implant rotation malposition remains a prevalent factor contributing to early failure in UKA cases. The aim of this study is to analyze the rotational positioning of femorotibial implants in UKA and to identify an appropriate angle formed by the femoral component and the tibial component using a newly described angle. Methods This was a retrospective study of patients' data of 40 medial UKA cases of 33 patients who were operated on in our hospital between October 1998 and March 2019. The study introduces a new angle called the "divergence angle." This angle is formed between the lateral portion of the femoral component and the lateral part of the tibial component, as measured on a patellofemoral Merchant view at 30 degrees of knee flexion. The divergence angle was evaluated through radiographic assessment by two independent reviewers. Results According to statistical analysis, the divergence angle was highly reliable with both intra- and inter-observer reproducibility. Intra-observer reproducibility was excellent with an intra-class correlation coefficient (ICC) between 0.901 and 0.933 (p < 0.001). The inter-observer reproducibility was excellent with an ICC of 0.92 (p < 0.001). The Gaussian curve confirmed the normal distribution of the divergence angle values with moderate dispersion of values. The majority of the angles of divergence (85%) measured between the femoral and tibial components were less than 10 degrees (n = 34), with a mean angle of 6.3 ± 4.5°. Conclusion The divergence angle between the femoral and tibial components, measured at 30 degrees of knee flexion using the Merchant view, is an easily accessible, reliable, and reproducible method. This technique enables the assessment of the optimal rotational positioning of implants in medial UKA.
Collapse
Affiliation(s)
- Vincent Hardy
- Orthopedic Surgery Department, Centre Hospitalier Régional Universitaire (CHRU) d'Orléans, Orléans, FRA
| | - Marwan Garaud
- Orthopedic Surgery Department, Centre Hospitalier Régional Universitaire (CHRU) d'Orléans, Orléans, FRA
| | - Bandar M Hetaimish
- Orthopedic Surgery Department, Faculty of Medicine, University of Jeddah, Jeddah, SAU
| | - Ramy Samargandi
- Orthopedic Surgery Department, Faculty of Medicine, University of Jeddah, Jeddah, SAU
- Orthopedic Surgery Department, Centre Hospitalier Régional Universitaire (CHRU) de Tours, Tours, FRA
| |
Collapse
|
3
|
Suda Y, Hiranaka T, Kamenaga T, Fujishiro T, Okamoto K, Matsumoto T. Mobile bearing orbit on the tibial component in Oxford unicompartmental knee arthroplasty. Knee 2023; 42:136-142. [PMID: 37001330 DOI: 10.1016/j.knee.2023.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/22/2023] [Accepted: 03/08/2023] [Indexed: 06/19/2023]
Abstract
PURPOSE To evaluate the bearing orbit of the tibial component during extension-flexion motion in Oxford unicompartmental knee arthroplasty. MATERIALS AND METHODS A total of 32 knees in 25 patients with medial osteoarthritis who underwent Oxford unicompartmental knee arthroplasty were evaluated. The distance between the vertical wall of the tibial component and the bearing (wall-bearing distance) and that between the anterior edge of the tibial component and the bearing (sagittal bearing position) were measured at 0°, 30°, 60°, 90° and 120° knee flexion with neutral tibial rotation (extension-flexion motion), and internal and external tibial rotation with 90° knee flexion (tibial rotation motion). A custom-made rounded trial bearing and caliper were used for this measurement. We calculated the wall-bearing distance, change in extension-flexion motion and tibial rotation motion. Wall-bearing distances and change in wall-bearing distance were compared using ANOVA or t-test. RESULTS The wall-bearing distance was smallest at 60° and increased 1.0 ± 1.1 mm in knee extension and 1.1 ± 1.5 mm in knee flexion. The bearing moved posteriorly with knee flexion, and the sagittal bearing position increased by 8.1 ± 3.4 mm during extension-flexion motion. Consequently, the bearing moved in a rough C-shaped orbit of the tibial component. CONCLUSIONS The mobile bearing moves in a rough C-shape and is mostly close to the vertical wall of the tibial component at 60°. The wall-bearing distance can change during extension-flexion motion and might be influenced by tibial component rotation. To avoid bearing separation from or contact with the vertical wall that may cause bearing dislocation, the wall-bearing distance should be evaluated before keel slot preparation.
Collapse
Affiliation(s)
- Yoshihito Suda
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Osaka, Japan; Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Takafumi Hiranaka
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Osaka, Japan.
| | - Tomoyuki Kamenaga
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Osaka, Japan; Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Takaaki Fujishiro
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Osaka, Japan
| | - Koji Okamoto
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Osaka, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Hyogo, Japan
| |
Collapse
|
4
|
Zhou X, Sun C, Xu R, Zhang X, Yu X. The effect of tibial component rotational alignment on clinical outcomes of mobile-bearing unicompartmental knee arthroplasty. J Orthop Surg Res 2023; 18:217. [PMID: 36935479 PMCID: PMC10026499 DOI: 10.1186/s13018-023-03707-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 03/13/2023] [Indexed: 03/21/2023] Open
Abstract
BACKGROUND The optimal tibial component rotational alignment in unicompartmental knee arthroplasty has not been defined. This study aimed to explore the effect of tibial component rotational alignment on the clinical outcomes of UKA. METHODS Clinical and follow-up data from 269 patients were retrospectively analysed. They were assigned into Groups A (- 5° to 0°), B (0°-3°), C (3°-6°) and D (> 6°) according to the external rotation of the tibial component to Akagi's line. The Knee Society Score clinical (KSS-c), Knee Society Score function (KSS-f), Forgotten Joint Score (FJS) and postoperative complications at 2 years postsurgically were analysed. RESULTS The mean rotation of the tibial component relative to Akagi's line in 269 patients was 4.56 ± 3.79°. There were 15, 84, 89 and 81 patients in Groups A, B, C and D, respectively. The postoperative KSS-c and KSS-f in Groups B and C were significantly higher than those in Group D. No significant differences in KSS-c and KSS-f were detected between Groups B and C. The postoperative FJS in Group B was significantly higher than that in Group C, which was significantly higher in Group C than in Group D. There were 5, 8 and 15 cases of postoperative knee pain in Groups B, C and D, respectively, and the difference was statistically significant. CONCLUSION Tibial component rotational alignment is of significance to Oxford Phase III UKA in patients. External rotation of the tibial component by 0°-3° is optimal to achieve satisfactory clinical outcomes.
Collapse
Affiliation(s)
- Xiaoqiang Zhou
- Department of Orthopaedics Surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, 215000, China
| | - Chao Sun
- Department of Orthopaedics Surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, 215000, China
| | - Renjie Xu
- Department of Orthopaedics Surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, 215000, China
| | - Xiangxin Zhang
- Department of Orthopaedics Surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, 215000, China
| | - Xiao Yu
- Department of Orthopaedics Surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, 215000, China.
| |
Collapse
|
5
|
Aliyev O, Ağır M, Aghazada A, Çeşme DH, Kara D, Toprak A, Tuncay İ, Yıldız F. Antero-posterior axis of the tibia is a better landmark for tibial component rotation in Oxford medial unicompartmental knee arthroplasty. ORTHOPADIE (HEIDELBERG, GERMANY) 2022; 51:996-1002. [PMID: 36125536 DOI: 10.1007/s00132-022-04308-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/22/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND This retrospective study compares tibial component rotations and radiological and functional outcomes in patients who underwent Oxford medial unicompartmental knee arthroplasty (UKA), using the antero-posterior (AP) tibia axis or anterior superior iliac spine (ASIS) as the landmarks for the direction of the vertical cut. METHODS A total of 86 patients, who underwent Oxford medial UKA were divided into 2 groups, each consisting of 43 patients, according to the use of AP axis (group I) or ASIS (group II) as landmarks for the rotation of vertical tibial cut and compared for the radiological and functional outcomes. Tibial component rotations (α-angle), involvement of the posterior cruciate ligament (PCL) fossa, and instant bearing position (IBP) were measured on computed tomography (CT) images. Functional outcomes were evaluated using Oxford knee score (OKS) and Knee Society score (KSS). RESULT The median α‑angle was significantly smaller in group I than group II (2.5°, range -4-5.5° vs. -6°, range -13-0.5°, p < 0.001). The rates of PCL fossa involvements were 14 (32.6%) and 17 (39.5%, p = 0.7). The median flexion angle of the femoral component (7° vs. 10.5°) and posterior tibial slope (6° vs. 8°) were significantly lower in group I than group II (p = 0.001). All other radiological parameters, preoperative and final OKS and KSS were statistically similar in both groups. CONCLUSION Taking the AP tibial axis as a landmark for vertical tibial cut rotation provides more neutral tibial component rotation in Oxford medial UKA compared to ASIS; however, this difference may not influence the clinical outcomes.
Collapse
Affiliation(s)
- Orkhan Aliyev
- Department of Orthopaedics and Traumatology, Bezmialem Vakıf University, İskender Paşa Mh Adnan Menderes Bulvarı, Adnan Menderes Blv., 34093, Fatih/İstanbul, Turkey
| | - Muzaffer Ağır
- Department of Orthopaedics and Traumatology, Bezmialem Vakıf University, İskender Paşa Mh Adnan Menderes Bulvarı, Adnan Menderes Blv., 34093, Fatih/İstanbul, Turkey
| | - Aghamazahir Aghazada
- Department of Orthopaedics and Traumatology, Bezmialem Vakıf University, İskender Paşa Mh Adnan Menderes Bulvarı, Adnan Menderes Blv., 34093, Fatih/İstanbul, Turkey
| | - Dilek Hacer Çeşme
- Department of Radiology, Bezmialem Vakıf University, Fatih/İstanbul, Turkey
| | - Deniz Kara
- Department of Orthopaedics and Traumatology, Bezmialem Vakıf University, İskender Paşa Mh Adnan Menderes Bulvarı, Adnan Menderes Blv., 34093, Fatih/İstanbul, Turkey
| | - Ali Toprak
- Department of Biostatistics and Medical Informatics, Bezmialem Vakıf University, İskender Paşa Mh Adnan Menderes Bulvarı, Adnan Menderes Blv., 34093, Fatih/İstanbul, Turkey
| | - İbrahim Tuncay
- Department of Orthopaedics and Traumatology, Bezmialem Vakıf University, İskender Paşa Mh Adnan Menderes Bulvarı, Adnan Menderes Blv., 34093, Fatih/İstanbul, Turkey
| | - Fatih Yıldız
- Department of Orthopaedics and Traumatology, Bezmialem Vakıf University, İskender Paşa Mh Adnan Menderes Bulvarı, Adnan Menderes Blv., 34093, Fatih/İstanbul, Turkey.
| |
Collapse
|
6
|
Kitazawa D, Hiranaka T, Shigemoto R, Anjiki K, Fujishiro T, Okamoto K. Trans patellar tendon sagittal tibial cut for lateral unicompartmental knee arthroplasty-location of the split- CT simulation study. J Orthop Sci 2022:S0949-2658(22)00113-0. [PMID: 35570057 DOI: 10.1016/j.jos.2022.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 03/29/2022] [Accepted: 04/14/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND In lateral unicompartmental knee arthroplasty (UKA), a sagittal cut is often performed through the patellar tendon (PT). Although the approach is likely widely used, it has not been described in detail, especially regarding the site of the split. This study aimed to clarify where the split should be made. METHODS This single-center retrospective cohort study included 49 consecutive patients and 51 knees with lateral osteoarthritis. Using preoperative computed tomography, we measured the distance from the medial edge of the PT to the intersection of the PT and the sagittal cutting line, defined as a line parallel to the Akagi's line and passing the tip of the lateral tibial spine. RESULTS The sagittal cut line passed a mean of 45 ± 11% of the patellar tendon width from the PT medial edge. CONCLUSIONS The tendon split should be made just medial to the center of the PT because it is where the sagittal cut line for lateral UKA passes.
Collapse
Affiliation(s)
- Daiya Kitazawa
- Department of Orthopedic Surgery and Joint Surgery Centre, Takatsuki General Hospital Takatsuki, Osaka, 5691192, Japan
| | - Takafumi Hiranaka
- Department of Orthopedic Surgery and Joint Surgery Centre, Takatsuki General Hospital Takatsuki, Osaka, 5691192, Japan.
| | - Rika Shigemoto
- Department of Orthopedic Surgery and Joint Surgery Centre, Takatsuki General Hospital Takatsuki, Osaka, 5691192, Japan
| | - Kensuke Anjiki
- Department of Orthopedic Surgery and Joint Surgery Centre, Takatsuki General Hospital Takatsuki, Osaka, 5691192, Japan
| | - Takaaki Fujishiro
- Department of Orthopedic Surgery and Joint Surgery Centre, Takatsuki General Hospital Takatsuki, Osaka, 5691192, Japan
| | - Koji Okamoto
- Department of Orthopedic Surgery and Joint Surgery Centre, Takatsuki General Hospital Takatsuki, Osaka, 5691192, Japan
| |
Collapse
|
7
|
Tensho K, Iwaasa T, Koyama S, Shimodaira H, Horiuchi H, Saito N, Takahashi J. Potential risk of medial cortex perforation due to peg position of morphometric tibial component in unicompartmental knee arthroplasty: a computer simulation study. Knee Surg Sports Traumatol Arthrosc 2022; 30:536-544. [PMID: 32865659 DOI: 10.1007/s00167-020-06242-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 08/14/2020] [Indexed: 02/14/2023]
Abstract
PURPOSE The purpose of this study is to evaluate the risk of medial tibial cortical perforation in unicompartmental knee arthroplasty (UKA) due to peg positions on the tibial tray of the Persona Partial Knee (PPK). METHODS Preoperative CT images of 60 patients and 60 osteoarthritic knees (30 male and 30 female patients) were used. A tibial multiplanar reconstruction (MPR) image was reconstructed in preoperative planning software, and the implant was placed in a virtual osteotomy plane. In addition to PPK, Zimmer Unicompartmental Knee (ZUK) and TRIBRID (TBD) were used for evaluation. The horizontal distances from the medial tibial cortex to the anterior and posterior pegs (APCD/PPCD, respectively) were measured under neutral, 3-degree varus, 3-degree valgus and 2 mm distal positions. The differences between implants under the same positions and between positions using the same implants were compared. The percentage of total cases with APCD/PPCD of less than 3 mm and the perforation risk rate were calculated. RESULTS The APCD of PPK was significantly shorter at all positions except for the varus position of TBD. The PPCD of PPK was significantly shorter at all positions compared to ZUK and TBD. There were no cases with an APCD of less than 3 mm. Except for varus positions, the perforation risk rate of PPCD was significantly higher for PPK than the other two implants. CONCLUSION The posterior pegs of the PPK are located more medially than the other two implants, which may result in perforation of the medial tibial cortex during implantation. Surgeons should consider the risk involved in the type of implant used.
Collapse
Affiliation(s)
- Keiji Tensho
- Department of Orthopedic Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, 390-8621, Japan.
| | - Tomoya Iwaasa
- Department of Orthopedic Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, 390-8621, Japan
| | - Suguru Koyama
- Department of Orthopedic Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, 390-8621, Japan
| | - Hiroki Shimodaira
- Department of Orthopedic Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, 390-8621, Japan
| | - Hiroshi Horiuchi
- Department of Orthopedic Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, 390-8621, Japan
| | - Naoto Saito
- Department of Orthopedic Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, 390-8621, Japan
| | - Jun Takahashi
- Department of Orthopedic Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, 390-8621, Japan
| |
Collapse
|
8
|
Fujita M, Hiranaka T, Mai B, Kamenaga T, Tsubosaka M, Takayama K, Kuroda R, Matsumoto T. External rotation of the tibial component should be avoided in lateral unicompartmental knee arthroplasty. Knee 2021; 30:70-77. [PMID: 33873088 DOI: 10.1016/j.knee.2021.03.016] [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: 03/18/2020] [Revised: 01/13/2021] [Accepted: 03/23/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Lateral unicompartmental knee arthroplasty (UKA) leads to good clinical outcomes for isolated lateral osteoarthritis. However, the impact of the tibial component position on postoperative outcomes in lateral UKA is yet to be determined. PURPOSE This study investigated the influence of tibial component malposition on clinical outcomes in lateral UKA. MATERIALS This was a retrospective study of 50 knees (mean age 73.5 years) who underwent lateral UKA between September 2013 and January 2019. The Oxford Knee Score (OKS), Knee Society Score - Knee (KSSK), and Knee Society Score - Function (KSSF) were evaluated. The coronal alignment, posterior slope of tibial component, tibial component rotation relative to Akagi's line (angle α), and femoral anteroposterior (AP) axis (angle β) were measured postoperatively. The average follow up period was 2.3 (range, 1-4.9) years. RESULTS Clinical scores were significantly improved after lateral UKA. The mean coronal alignment was 0.9° ± 3.2° varus (range, 9.1° varus to 5.5° valgus), the mean posterior slope was 6.8° ± 3.8° (range, 0.8° to 14.8°). The mean α and β angles, were 4.1° ± 5.8° (range, -9.7° to 16.5°) and 6.7° ± 7.1° (range, -7.0° to 20.5°) external rotation. The angle α had significant negative correlations with postoperative OKS (r = -0.36), KSSK (r = -0.28), and KSSF (r = -0.39), and angle β had significant negative correlations with postoperative OKS (r = -0.34) and KSSK (r = -0.46). CONCLUSION Excessive external rotation of the tibial component could negatively influence the postoperative outcomes of lateral UKA.
Collapse
Affiliation(s)
- Masahiro Fujita
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Osaka, Japan; Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Takafumi Hiranaka
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Osaka, Japan.
| | - Brang Mai
- Department of Orthopaedic Surgery, Mandalay Orthopedic Hospital, Myanmar
| | - Tomoyuki Kamenaga
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Masanori Tsubosaka
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Koji Takayama
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Ryosuke Kuroda
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| |
Collapse
|
9
|
Sun X, Liu P, Lu F, Wang W, Guo W, Zhang Q. Bearing dislocation of mobile bearing unicompartmental knee arthroplasty in East Asian countries: a systematic review with meta-analysis. J Orthop Surg Res 2021; 16:28. [PMID: 33413535 PMCID: PMC7791981 DOI: 10.1186/s13018-020-02190-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 12/28/2020] [Indexed: 11/25/2022] Open
Abstract
Background Bearing dislocation is a common postoperative complication of mobile-bearing unicompartmental knee arthroplasty, and East Asian patients tend to be at higher risk. However, whether this high dislocation rate is common in all East Asian populations remains unclear. This meta-analysis was performed to explore this issue and describe various features of dislocation in East Asians, including the onset time, dislocation direction, and re-dislocation rate. Methods The literature was searched in PubMed, Embase, Ovid, and Cochrane Library up to May 2020. Studies were scrutinized by two independent authors, and the bearing dislocation rate, onset time, direction, and re-dislocation rate were specifically analyzed. RevMan 5.3 was used for the statistical analysis. Results Seven case series from Korea, China, and Japan were included. The pooled analysis showed that the total dislocation rate was 2.37%, while the subgroup analysis showed that the dislocation rate in Korea and other countries was 4.50% and 0.74%, respectively (P < 0.01). Another subgroup analysis of the onset time showed a significant difference before and after the first 5 years postoperatively (P < 0.01). Anterior and posterior dislocations were more frequent than medial and lateral dislocations (P < 0.01). The average re-dislocation rate was 32.45%, which was approximately seven times higher than the primary dislocation rate (P < 0.01). Conclusion Our meta-analysis demonstrated that Korea had a higher bearing dislocation rate among East Asian countries, especially in the first 5 years after primary UKA. Anterior and posterior dislocations were common. The most important finding is that the re-dislocation rate can be much higher than the initial dislocation rate.
Collapse
Affiliation(s)
- Xiaowei Sun
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.,Department of Orthopaedic Surgery, China-Japan Friendship Hospital, No. 2, Yinghuadong Road, Chaoyang District, Beijing, 100029, China
| | - Pei Liu
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, No. 2, Yinghuadong Road, Chaoyang District, Beijing, 100029, China.,Beijing University of Chinese Medicine, Beijing, China
| | - Feifan Lu
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, No. 2, Yinghuadong Road, Chaoyang District, Beijing, 100029, China.,China-Japan Friendship School of Clinical Medicine, Peking University, Beijing, 100029, China
| | - Weiguo Wang
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, No. 2, Yinghuadong Road, Chaoyang District, Beijing, 100029, China
| | - Wanshou Guo
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.,Department of Orthopaedic Surgery, China-Japan Friendship Hospital, No. 2, Yinghuadong Road, Chaoyang District, Beijing, 100029, China
| | - Qidong Zhang
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, No. 2, Yinghuadong Road, Chaoyang District, Beijing, 100029, China.
| |
Collapse
|
10
|
Charng JR, Chen ACY, Chan YS, Hsu KY, Wu CT. Proximal tibial morphology and risk of posterior tibial cortex impingement in patients with AA-sized Oxford unicompartmental knee arthroplasty tibial implants. J Orthop Surg Res 2020; 15:380. [PMID: 32883334 PMCID: PMC7470608 DOI: 10.1186/s13018-020-01900-6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 08/17/2020] [Indexed: 02/08/2023] Open
Abstract
Background In cases of Oxford unicompartmental knee arthroplasty (UKA), an increase in anteroposterior and medial-lateral length is usually disproportional when comparing AA and A-sized tibial components. Asynchronous increments may cause tibial keel impingement leading to complications. Methods Radiographic measurements were performed in five patients with AA-sized tibial implants. The posterior cortex of proximal tibia had two angles recorded as ∠ M1 and ∠ M2. The minimum distance between the tibial component keel and outer margin of the posterior tibial cortex (mDKC) was measured, and the correlation between the preoperative posterior slope angle (PSA), ∠ M1, and mDKC was analyzed. Results All patients showed an acceptable component positioning. Only one patient had an mDKC of < 4 mm that fulfilled the criteria for the posterior tibial cortex at risk. The patient had an increased PSA and ∠ M1 compared to other patients. A negative correlation was found between preoperative PSA and mDKC (r = − 0.935, p = 0.0193); and ∠ M1 and mDKC (r = − 0.969, p = 0.0032). However, no stem tip pain, periprosthetic fracture, or component loosening were observed. Conclusions The distance between the tibial keel and posterior tibial cortex was reduced in AA-sized patients with a large PSA and ∠M1; therefore, the risk of the tibial cortex injury should be considered.
Collapse
Affiliation(s)
- Jiun-Ran Charng
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No. 5, Fu-Hsin Street, Kweishan, Taoyuan, Taiwan.,Bone and Joint Research Center, Chang Gung Memorial Hospital, No. 5, Fu-Hsin Street, Kweishan, Taoyuan, Taiwan.,School of Medicine, Chang Gung University, No. 259, Wenhua 1st Road, Kweishan, Taoyuan, Taiwan
| | - Alvin Chao-Yu Chen
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No. 5, Fu-Hsin Street, Kweishan, Taoyuan, Taiwan.,Bone and Joint Research Center, Chang Gung Memorial Hospital, No. 5, Fu-Hsin Street, Kweishan, Taoyuan, Taiwan.,School of Medicine, Chang Gung University, No. 259, Wenhua 1st Road, Kweishan, Taoyuan, Taiwan
| | - Yi-Shen Chan
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No. 5, Fu-Hsin Street, Kweishan, Taoyuan, Taiwan.,Bone and Joint Research Center, Chang Gung Memorial Hospital, No. 5, Fu-Hsin Street, Kweishan, Taoyuan, Taiwan.,School of Medicine, Chang Gung University, No. 259, Wenhua 1st Road, Kweishan, Taoyuan, Taiwan
| | - Kuo Yao Hsu
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No. 5, Fu-Hsin Street, Kweishan, Taoyuan, Taiwan.,Bone and Joint Research Center, Chang Gung Memorial Hospital, No. 5, Fu-Hsin Street, Kweishan, Taoyuan, Taiwan.,School of Medicine, Chang Gung University, No. 259, Wenhua 1st Road, Kweishan, Taoyuan, Taiwan
| | - Chen-Te Wu
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, No. 5, Fu-Hsin Street, Kweishan, Taoyuan, Taiwan.
| |
Collapse
|
11
|
Does the overhang of tibial component in fixed bearing medial unicondylar knee arthroplasty affect 1-year results? JOURNAL OF SURGERY AND MEDICINE 2020. [DOI: 10.28982/josam.759045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
12
|
Gao G, Li Z, Wang Y, Yang G, Huang J, An S, Qiao J, Cao G. Effect of vertical cut on coronal coverage and rotation of tibial component in Oxford unicompartmental knee arthroplasty. J Int Med Res 2020; 48:300060520922426. [PMID: 32425078 PMCID: PMC7238449 DOI: 10.1177/0300060520922426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective This study was performed to investigate the influence of a standard Oxford
vertical cut on the coronal coverage and rotation of the tibial component
and determine whether a relationship exists between coverage and
rotation. Methods We retrospectively analyzed 71 patients with anteromedial osteoarthritis of
the knee treated by Oxford unicompartmental knee arthroplasty in one center
from October 2016 to October 2017. The distance of coronal coverage was
measured on a postoperative anteroposterior view of the tibial component.
Two different reference lines between the lateral wall of the tibial
component were defined as rotation angle α and β, respectively, on a
computed tomography scan. Results The mean distance was 0.3 ± 1.1 mm. The mean angle α and β were 5.7° ± 4.6°
and 8.4° ± 4.6°, respectively. There were no significant differences in the
distance according to the tibial component rotation or in the α and β angles
according to the coronal coverage. No significant correlation was found
between the α and β angles and the distance. Conclusion A standard tibial vertical cut caused various changes in coronal coverage and
rotation of the tibial component. The rotation of the tibial component did
not affect coverage within a certain range.
Collapse
Affiliation(s)
- Guanghan Gao
- Department of Orthopaedics, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Zheng Li
- Department of Orthopaedics, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Yannong Wang
- Department of Orthopaedics, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Guangzhong Yang
- Department of Orthopaedics, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Jiang Huang
- Department of Orthopaedics, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Shuai An
- Department of Orthopaedics, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Junjie Qiao
- Department of Orthopaedics, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Guanglei Cao
- Department of Orthopaedics, Xuanwu Hospital Capital Medical University, Beijing, China
| |
Collapse
|
13
|
Kamenaga T, Hiranaka T, Nakanishi Y, Takayama K, Kuroda R, Matsumoto T. Valgus Subsidence of the Tibial Component Caused by Tibial Component Malpositioning in Cementless Oxford Mobile-Bearing Unicompartmental Knee Arthroplasty. J Arthroplasty 2019; 34:3054-3060. [PMID: 31378509 DOI: 10.1016/j.arth.2019.07.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 06/05/2019] [Accepted: 07/08/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Valgus subsidence (VS) of the tibial component is a rare complication of unicompartmental knee arthroplasty (UKA), and surgeons might consider revision surgery. The present study aimed to identify the factors related to VS of the tibial component after cementless Oxford mobile-bearing UKA. METHODS The study included 120 patients who underwent Oxford mobile-bearing UKA using a cementless tibial component in our center between September 2015 and September 2016. Six showed VS of >2° after surgery. Patients were stratified into 2 groups according to the occurrence of VS of the tibial component (VS group, n = 6; no-subsidence group, n = 114). Postoperative radiographic evaluations were conducted to assess the varus/valgus alignment, rotation, and mediolateral position of the tibial and femoral components. The Oxford Knee Score (OKS) was assessed at 3, 6, and 12 months postoperatively. Positional parameters and sequential change in OKS were compared between the two groups using unpaired t-test (P < .05, statistically significant). RESULTS At 3 months postoperatively, an average VS of 3.4° in the VS group was observed, with a significant decrease in OKS. VS was associated with a significantly more medial position and external rotation of the tibial component. After 3 months, VS stopped, and the OKS gradually improved without revision surgery. CONCLUSIONS VS might be caused by the malpositioning of the tibial component. VS of the tibial component after UKA appears to stop, with simultaneous pain relief, even without revision after 3 months postoperatively.
Collapse
Affiliation(s)
- Tomoyuki Kamenaga
- Department of Orthopaedic Surgery and Joint Surgery Center, Takatsuki General Hospital, Takatsuki, Osaka, Japan; Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takafumi Hiranaka
- Department of Orthopaedic Surgery and Joint Surgery Center, Takatsuki General Hospital, Takatsuki, Osaka, Japan
| | - Yuta Nakanishi
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Koji Takayama
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| |
Collapse
|
14
|
Kamenaga T, Hiranaka T, Takayama K, Tsubosaka M, Kuroda R, Matsumoto T. Adequate Positioning of the Tibial Component Is Key to Avoiding Bearing Impingement in Oxford Unicompartmental Knee Arthroplasty. J Arthroplasty 2019; 34:2606-2613. [PMID: 31235342 DOI: 10.1016/j.arth.2019.05.054] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 05/22/2019] [Accepted: 05/29/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Bearing dislocation is a serious complication of unicompartmental knee arthroplasty (UKA) with the Oxford knee prosthesis equipped with a mobile bearing. We aimed to clarify the extent of intraoperative movement of the mobile bearing and its relationship with the positioning of prosthesis components in patients undergoing Oxford UKA. METHODS This retrospective study included 50 patients (50 knees) who underwent Oxford UKA for anteromedial osteoarthritis or osteonecrosis of the knee. Intraoperative bearing movement was assessed at various angles of knee flexion (0°, 30°, 60°, 90°, and 120°). We stratified patients according to the extent of bearing movement posteriorly during intraoperative knee flexion, with or without contacting the lateral wall of the tibial component (with contact, 20 knees; without contact, 30 knees). Postoperative radiographic evaluations were conducted at 1 week postoperatively to assess the positional parameters of the tibial and femoral components (varus/valgus alignment, rotation, mediolateral position). Clinical evaluations were conducted at 1 year postoperatively (maximum flexion angle, Oxford Knee Score). RESULTS Abnormal intraoperative movement of the mobile bearing resulting in contact with the lateral wall of the tibial component was associated with a significantly more medial position and external rotation of the tibial component, as well as poorer improvement in knee flexion angle at 1 year postoperatively. CONCLUSION In Oxford UKA recipients, the bearing may impinge on the lateral wall of the tibial component during flexion above 60° if the tibial component is placed too medially or exhibits pronounced external rotation, which may limit knee function improvement postoperatively.
Collapse
Affiliation(s)
- Tomoyuki Kamenaga
- Department of Orthopedic Surgery, Joint Surgery Center, Takatsuki General Hospital, Takatsuki, Osaka, Japan; Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takafumi Hiranaka
- Department of Orthopedic Surgery, Joint Surgery Center, Takatsuki General Hospital, Takatsuki, Osaka, Japan
| | - Koji Takayama
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masanori Tsubosaka
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| |
Collapse
|
15
|
Al-Dadah O, Hing C. Editorial. Knee 2019; 26:283-284. [PMID: 31023474 DOI: 10.1016/j.knee.2019.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
|