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Mohammad HR, Judge A, Murray DW. A Matched Comparison of Implant and Functional Outcomes of Cemented and Cementless Unicompartmental Knee Replacements: A Study from the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man and the Hospital Episode Statistics Patient Reported Outcome Measures Database. J Bone Joint Surg Am 2024; 106:1553-1562. [PMID: 38980924 DOI: 10.2106/jbjs.23.01418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/11/2024]
Abstract
BACKGROUND Unicompartmental knee replacement (UKR) is an effective treatment for end-stage medial compartment osteoarthritis, but there can be problems with fixation. The cementless UKR was introduced to address this issue. It is unknown how its functional outcomes compare with those of the cemented version on a national scale. We performed a matched comparison of the clinical and functional outcomes of cementless and cemented UKRs. METHODS Using the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man (NJR), 14,764 Oxford UKRs with linked data regarding patient-reported outcomes were identified. A total of 6,906 UKRs (3,453 cemented and 3,453 cementless) were propensity score matched on the basis of patient, surgical, and implant factors. RESULTS The 10-year cumulative implant survival rate was 93.0% (95% confidence interval [CI], 90.0% to 95.1%) for cementless UKRs and 91.3% (95% CI, 89.0% to 93.0%) for cemented UKRs. The cementless UKR group had a significantly lower revision risk (hazard ratio [HR], 0.74; p = 0.02). Subgroup analyses showed a stronger effect size (HR, 0.66) among UKRs performed by high-caseload surgeons (i.e., surgeons performing ≥30 UKRs/year). In the overall cohort, the postoperative Oxford Knee Score (OKS) in the cementless group (mean and standard deviation, 39.1 ± 8.7) was significantly higher (p = 0.001) than that in the cemented group (38.5 ± 8.6). The cementless group gained a mean of 17.6 ± 9.3 points in the OKS postoperatively and the cemented group gained 16.5 ± 9.6 points, with a difference of 1.1 points between the groups (p < 0.001). The difference in OKS points gained postoperatively was highest among UKRs performed by high-caseload surgeons, with the cementless group gaining 1.8 points more (p < 0.001) than the cemented group. CONCLUSIONS The cementless UKR demonstrated better 10-year implant survival and postoperative functional outcomes than the cemented UKR. The difference was largest among UKRs performed by high-caseload surgeons, with the cementless fixation group having an HR for revision of 0.66 and an approximately 2-point greater improvement in the OKS compared with the cemented fixation group. LEVEL OF EVIDENCE Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Hasan R Mohammad
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Oxford, United Kingdom
- Barts Bone & Joint Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Andrew Judge
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Oxford, United Kingdom
- Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - David W Murray
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Oxford, United Kingdom
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Hiranaka T. Advantages and limitations of mobile-bearing unicompartmental knee arthroplasty: an overview of the literature. Expert Rev Med Devices 2024; 21:587-600. [PMID: 38873929 DOI: 10.1080/17434440.2024.2367002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 06/07/2024] [Indexed: 06/15/2024]
Abstract
INTRODUCTION Interest in unicompartmental knee arthroplasty (UKA) has recently grown. Mobile bearing UKA, in which the bearing is not fixed but rather perfectly conforms with femoral and tibial components and moves completely passively between the femoral and tibial implant, has now been used for approximately half a century. AREAS COVERED Alongside the recognized advantages of UKA, the mobile-bearing variant benefits from an extremely low rate of polyethylene wear and tolerable minor malalignment. Revision rates for UKA have been reported to exceed those of total knee arthroplasty, but long-term survival rates and outcomes from mobile-bearing UKA have been found to be satisfactory. In addition to the lateral osteoarthritis and loosening, which are main complications of UKA, bearing dislocation is a specific complication of mobile bearing UKA. Fractures and valgus subsidence are more prevalent than in the cementless UKA. While these continue to be features to be addressed, they have been partially solved. EXPERT OPINION Given the manifold benefits of UKA, its application could be extended to a larger patient population. Successful outcomes rely on careful patient selection and the surgeon's extensive familiarity with the procedure. Looking ahead, the incorporation of robotic surgery, already a feature of some fixed-bearing UKAs, might shape the future trajectory of mobile-bearing UKA.
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Affiliation(s)
- Takafumi Hiranaka
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Takatsuki, Osaka, Japan
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Albishi W, AbuDujain NM, Aldhahri M, Alzeer M. Unicompartmental knee replacement: controversies and technical considerations. ARTHROPLASTY 2024; 6:21. [PMID: 38693586 PMCID: PMC11064323 DOI: 10.1186/s42836-024-00242-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 02/20/2024] [Indexed: 05/03/2024] Open
Abstract
BACKGROUND Unicompartmental knee replacement (UKR) is one of the effective interventions for the treatment of symptomatic knee osteoarthritis. Moreover, it has multiple advantages over total knee arthroplasty (TKA), including reduced intraoperative blood loss, decreased risk of transfusion, and faster recovery. This study aimed to discuss critical technical considerations regarding UKR and some of the controversies and updates. METHODS We conducted a review to provide an overview of the controversies and technical considerations about UKR in several aspects. Only peer-reviewed articles were included, up to December 2023 using PubMed, Google Scholar, ERIC, and Cochrane database for systematic reviews databases. RESULT UKR is associated with superior patient-reported clinical and functional outcomes, as well as shorter hospital stays, fewer postoperative complications, and revealed favorable outcomes in patients' return to sport. The choice between mobile- and fixed-bearing prostheses depends, in part, on the surgeon's preference. The mobile-bearing UKR is a less constrained prosthesis and can potentially result in less wear, but it is more technically demanding. While no significant difference between mobile-bearing versus fixed-bearing prostheses, cementless is superior to cemented design. Furthermore, UKR can be a good alternative for high tibial osteotomy (HTO) and still can be considered after a failed HTO. Lastly, recent reviews have shown a revision rate comparable to that of TKA. This is probably influenced by Improved comprehension of the best indications, patient selection criteria, as well as of the design, materials, and technological advances. CONCLUSION UKR treatment for unicompartmental knee osteoarthritis is secure and effective. Based on clinical and functional outcomes, decreased morbidity and mortality, and cost-effectiveness, long-term studies suggest that UKR is superior to TKA. Further investigation in this area is warranted.
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Affiliation(s)
- Waleed Albishi
- Department of Orthopedic Surgery, College of Medicine, King Saud University, Riyadh, 11362, Saudi Arabia
| | - Nasser M AbuDujain
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, 2925, Saudi Arabia.
| | - Mohammed Aldhahri
- Department of Orthopedic Surgery, College of Medicine, King Saud University, Riyadh, 11362, Saudi Arabia
| | - Meshari Alzeer
- College of Medicine, King Saud University, Riyadh, 11362, Saudi Arabia
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Arthur LW, Ghosh P, Mohammad HR, Campi S, Kendrick BJL, Murray DW, Mellon SJ. Polyethylene bearing wear is comparable for cemented and cementless Oxford unicompartmental knee replacements: Ten-year results of a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 2024; 32:405-417. [PMID: 38298004 DOI: 10.1002/ksa.12042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/11/2023] [Accepted: 12/11/2023] [Indexed: 02/02/2024]
Abstract
PURPOSE There is concern that using cementless components may increase polyethylene wear of the Oxford unicompartmental knee replacement (OUKR). Therefore, this study aimed to measure bearing wear at 10 years in patients from a randomized trial comparing Phase 3 cemented and cementless OUKRs and to investigate factors that may affect wear. It was hypothesized that there would be no difference in wear rate between cemented and cementless OUKRs. METHODS Bearing thickness was determined using radiostereometric analysis at postoperative, 3-month, 6-month, 1-year, 2-year, 5-year and 10-year timepoints. As creep occurs early, wear rate was calculated using linear regression between 6 months and 10 years for 39 knees (20 cemented, 19 cementless). Associations between wear and implant, surgical and patient factors were analysed. RESULTS The linear wear rate of the Phase 3 OUKR was 0.06 mm/year with no significant difference (p = 0.18) between cemented (0.054 mm/year) and cementless (0.063 mm/year) implants. Age, Oxford Knee Score, component size and bearing thickness had no correlation with wear. A body mass index ≥ 30 was associated with a significantly lower wear rate (p = 0.007) as was having ≥80% femoral component contact area on the bearing (p = 0.003). Bearings positioned ≥1.5 mm from the tibial wall had a significantly higher wear rate (p = 0.002). CONCLUSIONS At 10 years, the Phase 3 OUKR linear wear rate is low and not associated with the fixation method. To minimize the risk of wear-related bearing fracture in the very long-term surgeons should consider using 4 mm bearings in very young active patients and ensure that components are appropriately positioned, which is facilitated by the current instrumentation. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Lachlan W Arthur
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), Oxford Orthopaedic Engineering Centre, University of Oxford, Oxford, UK
| | - Priyanka Ghosh
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), Oxford Orthopaedic Engineering Centre, University of Oxford, Oxford, UK
| | - Hasan R Mohammad
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), Oxford Orthopaedic Engineering Centre, University of Oxford, Oxford, UK
| | - Stefano Campi
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), Oxford Orthopaedic Engineering Centre, University of Oxford, Oxford, UK
| | - Benjamin J L Kendrick
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), Oxford Orthopaedic Engineering Centre, University of Oxford, Oxford, UK
| | - David W Murray
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), Oxford Orthopaedic Engineering Centre, University of Oxford, Oxford, UK
| | - Stephen J Mellon
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), Oxford Orthopaedic Engineering Centre, University of Oxford, Oxford, UK
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Mosegaard SB, Odgaard A, Madsen F, Rømer L, Kristensen PW, Vind TD, Søballe K, Stilling M. Comparison of cementless twin-peg, cemented twin-peg and cemented single-peg femoral component migration after medial unicompartmental knee replacement: a 5-year randomized RSA study. Arch Orthop Trauma Surg 2023; 143:7169-7183. [PMID: 37568057 PMCID: PMC10635966 DOI: 10.1007/s00402-023-04991-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 07/10/2023] [Indexed: 08/13/2023]
Abstract
BACKGROUND The component design and fixation method of joint arthroplasty may affect component migration and survival. The aim of this study was to compare fixation of cementless twin-peg (CLTP), cemented twin-peg (CTP) and cemented single-peg (CSP) femoral components of medial unicompartmental knee replacement (UKR). METHODS Eighty patients (mean age = 63 years, 48 males) with medial knee osteoarthritis were randomized in three ways to CLTP (n = 25), CTP (n = 26) or CSP (n = 29) femoral UKR components. The patients were followed 5 years postoperatively with RSA, bone mineral density (BMD), PROMs and radiological evaluation of radiolucent lines (RLL), femoral component flexion angle and complications. RESULTS At the 5-year follow-up, femoral component total translation was comparable between the three groups (p = 0.60). Femoral component internal rotation was 0.50° (95% CI 0.3; 0.69) for the CLTP group, 0.58° (95% CI 0.38; 0.77) for the CTP group and 0.25° (95% CI 0.07; 0.43) for the CSP group (p = 0.01). BMD decreased peri-prosthetically (range - 11.5%; - 14.0%) until 6-month follow-up and increased toward the 5-year follow-up (range - 3.6%; - 5.8%). BMD change did not correlate with component migration. Lower flexion angle was correlated with higher 5-year subsidence, total translation, varus rotation and maximum total point motion (p = 0.01). Two patients (1 CLTP, 1 CTP) had RLL in the posterior zone. There were two revisions. CONCLUSION At 5-year follow-up, fixation of UKA femoral components with twin-peg was not superior to the single-peg design. Cementless and cemented twin-peg femoral components had similar fixation. A lower flexion angle was correlated with higher component migration.
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Affiliation(s)
- Sebastian Breddam Mosegaard
- Department of Orthopaedic Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
- AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N, Denmark
| | - Anders Odgaard
- Department of Orthopaedic Surgery, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark
| | - Frank Madsen
- Department of Orthopaedic Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Lone Rømer
- Department of Radiology, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Per Wagner Kristensen
- Department of Orthopaedic Surgery, Vejle Hospital, Beriderbakken 4, 7100, Vejle, Denmark
| | - Tobias Dahl Vind
- Department of Orthopaedic Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
- AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Kjeld Søballe
- Department of Orthopaedic Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Maiken Stilling
- Department of Orthopaedic Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
- AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N, Denmark.
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
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Mohammad HR, Judge A, Murray DW. The Effect of Body Mass Index on the Relative Revision Rates of Cemented and Cementless Unicompartmental Knee Replacements: An Analysis of Over 10,000 Knee Replacements from National Databases. J Bone Joint Surg Am 2023; 105:527-536. [PMID: 36881643 DOI: 10.2106/jbjs.22.01042] [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] [Indexed: 03/09/2023]
Abstract
BACKGROUND Unicompartmental knee replacements (UKRs) are being performed in an increasingly overweight population. There are concerns that cemented fixation will not last. Cementless fixation may offer a solution, but the relative performance in different body mass index (BMI) groups remains unknown. METHODS Ten thousand, four hundred and forty cemented and cementless UKRs were propensity matched. Patients were stratified into 4 BMI groups: underweight (<18.5 kg/m2), normal weight (18.5 to <25 kg/m2), overweight (25 to <30 kg/m2), and obese (≥30 kg/m2). The effect of BMI on the relative performance of UKR fixation groups was studied. Cox regression was used to compare revision and reoperation rates. RESULTS The revision rate per 100 component-years significantly increased (p < 0.001) with BMI for the cemented UKRs. Revision rates per 100 component-years for the normal, overweight, and obese groups were 0.92 (95% confidence interval [CI], 0.91 to 0.93), 1.15 (95% CI, 1.14 to 1.16), and 1.31 (95% CI, 1.30 to 1.33), respectively. This was not observed for the cementless UKR, with revision rates of 1.09 (95% CI, 1.08 to 1.11), 0.70 (95% CI, 0.68 to 0.71), and 0.96 (95% CI, 0.95 to 0.97), respectively. The 10-year implant survival rates for the matched cemented and cementless UKRs in the normal, overweight, and obese groups were 93.8% (95% CI, 89.1% to 96.5%) and 94.3% (95% CI, 90.9% to 96.5%) (hazard ratio [HR], 1.17; p = 0.63), 88.5% (95% CI, 84.2% to 91.7%) and 93.8% (95% CI, 90.2% to 96.2%) (HR, 0.61; p = 0.005), and 90.7% (95% CI, 88.2% to 92.6%) and 91.8% (95% CI, 88.9% to 94.0%) (HR, 0.74; p = 0.02), respectively. There were insufficient numbers in the underweight group for analysis (n = 13). Obese patients had less than half the rates of aseptic loosening (0.46% vs. 1.31%; p = 0.001) and pain (0.60% vs. 1.20%; p = 0.02) in the cementless group as compared with the cemented group. CONCLUSIONS Higher-BMI groups had higher revision rates for the cemented UKRs but not for the cementless UKRs. Cementless fixation was associated with reduced long-term revision rates compared with cement fixation in the overweight and obese groups. In the obese group, the rates of aseptic loosening and pain were at least 50% lower in the cementless UKR group. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Hasan R Mohammad
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom.,Barts Bone & Joint Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, University of London, London, United Kingdom
| | - Andrew Judge
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom.,Musculoskeletal Research Unit, Southmead Hospital, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - David W Murray
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
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Mohammad HR, Judge A, Murray DW. The Effect of Age on the Relative Outcomes of Cemented and Cementless Mobile-Bearing Unicompartmental Knee Arthroplasty, Based on Data From National Databases. J Arthroplasty 2023; 38:30-36.e1. [PMID: 35952853 DOI: 10.1016/j.arth.2022.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 07/27/2022] [Accepted: 08/02/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Unicompartmental knee arthroplasty (UKA) is an effective treatment for medial compartment arthritis. A challenge is that patients requiring knee arthroplasty are becoming younger. It is currently unknown what the relative performances of cemented and cementless UKAs are, in different age groups. METHODS A total of 12,882 cemented and cementless UKAs from the National Joint Registry and Hospital Episodes Statistics databases were matched on patient and surgical factors. Patients were stratified into 3 groups: (1) <60 years; (2) 60-69 years; and (3) ≥70 years. Revision and reoperation rates were compared using Cox regression analyses. RESULTS The 10-year implant survival for the matched cemented and cementless UKAs for (1) <60 years were 81.4% (CI 73.6-87.0) and 86.7% (CI 80.7-90.9) (hazard ratio [HR] 0.73, CI 0.56-0.94, P = .02); (2) for 60-69 years were 91.8% (CI 88.9-94.0) and 94.5% (CI 92.9-95.7) (HR 0.90, CI 0.67-1.22, P = .51); and (3) ≥70 years were 93.5% (CI 91.1-95.3) and 94.2% (CI 92.0-95.8) (HR 1.0, CI 0.71-1.40, P = .99). The same trend was observed for reoperations. In the <60 years and 60-69 years groups there were significantly fewer revisions for aseptic loosening in the cementless group (0.5% versus 1.6% [P < .001] and 0.4% versus 1.3% [P = .002], respectively). CONCLUSION Younger ages were associated with higher revision rates in both cemented and cementless UKA groups. Cementless fixation has reduced long-term revision rates compared to cemented fixation in the <60 years group with aseptic loosening rates 3 times lower. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Hasan R Mohammad
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences University of Oxford, Nuffield Orthopaedic Centre, Oxford, United Kingdom; Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Level 1 Learning and Research Building, Southmead Hospital, Bristol, United Kingdom; Barts Bone & Joint Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary, University of London, London, United Kingdom
| | - Andrew Judge
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences University of Oxford, Nuffield Orthopaedic Centre, Oxford, United Kingdom; Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Level 1 Learning and Research Building, Southmead Hospital, Bristol, United Kingdom
| | - David W Murray
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences University of Oxford, Nuffield Orthopaedic Centre, Oxford, United Kingdom
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Grabherr M, Dimitriou D, Schraknepper J, Helmy N, Flury A. Hybrid fixation of unicompartmental knee arthroplasty shows equivalent short-term implant survivorship and clinical scores compared to standard fixation techniques. Arch Orthop Trauma Surg 2022:10.1007/s00402-022-04710-z. [PMID: 36459235 DOI: 10.1007/s00402-022-04710-z] [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: 01/04/2022] [Accepted: 11/22/2022] [Indexed: 12/04/2022]
Abstract
INTRODUCTION There is a paucity of data regarding hybrid-fixated unicompartmental knee arthroplasty (UKA), and no study directly compared all three available fixation techniques (cementless, cemented, and hybrid). The hypothesis was that hybrid fixation might have a lower incidence of radiolucent lines (RLL) than cemented UKA, with equivalent outcomes to uncemented UKA. MATERIALS AND METHODS A total of 104 UKA with a minimal follow-up of 1 year were retrospectively included, of which 40 were cemented, 41 cementless, and 23 hybrid prostheses. The functional outcomes scores included the Oxford Knee (OKS), Subjective Knee (SKS), and Forgotten Joint scores (FJS). RLLs, subsidence, and component positioning were assessed on radiographs. RESULTS At a mean follow-up of 28 months, the survival rate was 95% for cemented UKA and 100% for the cementless and hybrid UKA (n.s.), respectively. Postoperative FJS (93 vs. 82 points, p = 0.007) and SKS (4.7 vs. 4.1 points, p = 0.001) were better in cementless than cemented UKA, with hybrid-fixated UKA in between the two (90 and 4.4 points, n.s.). Improvement of OKS preoperatively to postoperatively did not differ between the groups (n.s.). RLLs were more frequent in cemented (23%) compared to cementless (5%, p = 0.021) and hybrid UKA (9%, n.s.). With an incidence of 12%, subsidence occurred more commonly in cementless UKA compared to cemented (5%) and hybrid (0%) (n.s.) UKA. CONCLUSION Hybrid fixation achieves equivalent results to standard UKA fixation techniques regarding implant survival and functional and radiological outcomes. Therefore, the hybrid fixation technique seems to be a valuable alternative as it combines the advantages of cemented tibial components with those of uncemented femoral components. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Michael Grabherr
- Orthopaedic and Traumatology Department, Bürgerspital Solothurn, Schöngrünstrasse 38, 4500, Solothurn, Switzerland.
| | - Dimitris Dimitriou
- Orthopaedic and Traumatology Department, Bürgerspital Solothurn, Schöngrünstrasse 38, 4500, Solothurn, Switzerland.,Orthopaedic Department, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Johannes Schraknepper
- Orthopaedic and Traumatology Department, Bürgerspital Solothurn, Schöngrünstrasse 38, 4500, Solothurn, Switzerland
| | - Näder Helmy
- Orthopaedic and Traumatology Department, Bürgerspital Solothurn, Schöngrünstrasse 38, 4500, Solothurn, Switzerland
| | - Andreas Flury
- Orthopaedic and Traumatology Department, Bürgerspital Solothurn, Schöngrünstrasse 38, 4500, Solothurn, Switzerland.,Orthopaedic Department, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
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Chen Z, Bains SS, Hameed D, Dubin JA, Stern JM, Mont MA. Robust Randomized Controlled Data Is Lacking in Total Joint Arthroplasty. J Knee Surg 2022; 35:1533-1539. [PMID: 36427523 DOI: 10.1055/s-0042-1758550] [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] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Randomized controlled trials (RCTs)are regarded as highest level of scientific evidence. There is belief that while prospective randomized control trials (PRCTs) are the gold standard for evaluating efficacy of interventions, there are very few conducted on lower extremity joint arthroplasty. However, there was a more than adequate amount (n=197) of published RCTs in knee arthroplasty during the 2021 calendar year. Therefore, we studied RCTs on knee arthroplasties for 2021 and assessed them for overall study topic reasons (i.e., devices as well as prostheses, rehabilitation, pain control, blood loss [tranexamic acid], and other), which were then subcategorized by: (1) country of origin; (2) sample size; and (3)whether or not they were follow-up studies. After this, we specifically focused on the studies (n=26) concerning devices or prostheses. METHODS A search of PubMed on "knee arthroplasty" specifying "RCT" using their search function and dates between January 1, 2021 to December 24, 2021 resulted in the analyzed reports. A total of 17.3% reports analyzed rehabilitation methods while 28.4% studied pain control. A total of 20.3% examined blood loss topics and 20.8% investigated other topics. RESULTS We found that 26 studies (13.2%) involved prosthetic design and implantation. Overall, only 15% knee arthroplasty RCTs were conducted in the United States, the mean total final sample size was 133±146 patients, and 7% were follow-up studies. None of the prostheses studies were performed in the United States, and the mean total final sample size of all of these studies was 86±54 patients, and 23% were follow-up studies. Total knee arthroplasty prospective RCTs were not performed in the United States. CONCLUSION The authors believe that other study designs, such as database or registry analyses, are also appropriate in this rapidly advancing field of joint arthroplasty for the continuing evaluation and approval of new prostheses and techniques, while we await more PRCTs in our field.
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Affiliation(s)
- Zhongming Chen
- Department of Orthopedic Surgery, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
| | - Sandeep S Bains
- Department of Orthopedic Surgery, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
| | - Daniel Hameed
- Department of Orthopedic Surgery, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
| | - Jeremy A Dubin
- Department of Orthopedic Surgery, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
| | - Jonathan M Stern
- Department of Orthopedic Surgery, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
| | - Michael A Mont
- Department of Orthopedic Surgery, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
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Villa JM, Pannu TS, Higuera-Rueda CA. What's New in Adult Reconstructive Knee Surgery. J Bone Joint Surg Am 2022; 104:97-106. [PMID: 34780387 DOI: 10.2106/jbjs.21.01080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Jesus M Villa
- Levitetz Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, Florida
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Ricciardi B. Editorial. Knee 2021; 28:A1-A2. [PMID: 33706913 DOI: 10.1016/j.knee.2021.02.001] [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]
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