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Zaribaf FP, Koster LA, Kaptein BL, Pegg EC, Gill HS. Model-based Roentgen Stereophotogrammetric Analysis (RSA) of polyethylene implants. Med Eng Phys 2024; 130:104201. [PMID: 39160015 DOI: 10.1016/j.medengphy.2024.104201] [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: 04/28/2023] [Revised: 06/11/2024] [Accepted: 06/27/2024] [Indexed: 08/21/2024]
Abstract
Model-based Roentgen Stereophotogrammetric Analysis (RSA) is able to measure the migration of metallic prostheses with submillimeter accuracy through contour-detection and 3D surface model matching techniques. However, contour-detection is only possible if the prosthesis is clearly visible in the radiograph; consequently Model-based RSA cannot be directly used for polymeric materials due to their limited X-ray attenuation; this is especially clinically relevant for all-polyethylene implants. In this study the radiopacity of unicompartmental Ultra-High Molecular Weight Polyethylene (UHMWPE) knee bearings was increased by diffusing an oil-based contrast agent into the surface to create three different levels of surface radiopacity. Model-based RSA was performed on the bearings alone, the bearings alongside a metallic component held in position using a phantom, the bearings cemented into a Sawbone tibia, and the bearings at different distances from the femoral component. For each condition the precision and accuracy of zero motion of Model-based RSA were assessed. The radiopaque bearings could be located in the stereo-radiographs using Model-based RSA an accuracy comparable to metallic parts for translational movements (0.03 mm to 0.50 mm). For rotational movements, the accuracy was lower (0.1∘ to 3.0∘). The measurement accuracy was compared for all the radiopacity levels and no significant difference was found (p=0.08). This study demonstrates that contrast enhanced radiopaque polyethylene can be used for Model-based RSA studies and has equivalent translational measurement precision to metallic parts in the superior-inferior direction.
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Affiliation(s)
- F P Zaribaf
- Centre for Therapeutic Innovation and Department of Mechanical Engineering, University of Bath, Bath, UK
| | - L A Koster
- Department of Orthopaedics Leiden University Medical Center, Leiden, Netherlands
| | - B L Kaptein
- Department of Orthopaedics Leiden University Medical Center, Leiden, Netherlands
| | - E C Pegg
- Centre for Therapeutic Innovation and Department of Mechanical Engineering, University of Bath, Bath, UK.
| | - H S Gill
- Centre for Therapeutic Innovation and Department of Mechanical Engineering, University of Bath, Bath, UK
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Hariri M, Hagemann M, Koch KA, Reiner T, Panzram B, Merle C, Renkawitz T, Walker T. Short- to mid-term results of minimally invasive lateral unicompartmental knee replacement: 133 cases in a non-designer series. Arch Orthop Trauma Surg 2023; 143:5849-5856. [PMID: 36917240 PMCID: PMC10450018 DOI: 10.1007/s00402-023-04841-x] [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: 12/28/2022] [Accepted: 03/01/2023] [Indexed: 03/16/2023]
Abstract
INTRODUCTION The aim of the current study was to demonstrate short- to mid-term survivorship as well as clinical outcome of lateral unicompartmental knee replacement (UKR) with a fixed-bearing (FB) design from a non-designer center using the Oxford Fixed Lateral prosthesis. MATERIALS AND METHODS This single-center retrospective cohort study reports the results of 133 consecutive lateral FB-UKR. Survivorship analysis was performed with different endpoints and clinical outcome was measured using the Oxford-Knee-Score (OKS), American-Knee-Society-Score (AKSS-O), range-of-motion (ROM) and visual-analog-scale for pain (VAS). RESULTS There were two revision surgeries with conversion to total knee replacements (TKR) due to persistent pain resulting in a survival rate of 98.5% (95% CI 93.5-99.6) with a mean follow-up (FU) of 3.3 ± 1.8 years (range 1-8.5). All outcome scores, VAS and ROM showed a significant improvement at final FU (p < 0.001). The OKS improved from 26 ± 7.8 (range 11-45) preoperatively to 39 ± 8.3 (range 13-48), the AKSS-O from 49.2 ± 14.6 (range 18-90) to 81.8 ± 15.1 (range 40-100), the AKSS-F from 53 ± 23.7 (range 0-100) to 80.4 ± 21.4 (range 5-100) and the ROM from 118 ± 17 (range 90-160) to 134 ± 9.5 (range 100-155). CONCLUSIONS The short- to mid-term results following lateral FB-UKR demonstrate a high survivorship and good clinical outcome from an independent series. We, therefore, suggest that FB-UKR is a safe treatment option for isolated lateral OA if sufficient surgical experience is provided. LEVEL OF EVIDENCE Retrospective cohort study, level IV.
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Affiliation(s)
- Mustafa Hariri
- Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Merlin Hagemann
- Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Kevin-Arno Koch
- Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Tobias Reiner
- Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Benjamin Panzram
- Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Christian Merle
- Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Tobias Renkawitz
- Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Tilman Walker
- Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.
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Hariri M, Zahn N, Mick P, Jaber A, Reiner T, Renkawitz T, Innmann M, Walker T. Fixed-bearing is superior to mobile-bearing in lateral unicompartmental knee replacement: a retrospective matched-pairs analysis. Knee Surg Sports Traumatol Arthrosc 2023; 31:3947-3955. [PMID: 37093235 PMCID: PMC10435651 DOI: 10.1007/s00167-023-07417-9] [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: 02/02/2023] [Accepted: 04/08/2023] [Indexed: 04/25/2023]
Abstract
PURPOSE Due to low incidence of isolated lateral osteoarthritis (OA), there are limited data on whether a fixed-bearing (FB) or a mobile-bearing (MB) design is superior for lateral unicompartmental knee replacement (UKR). The aim of this matched-pairs analysis was to compare both designs in terms of implant survival and clinical outcome. METHODS Patients who received MB-UKR (Group A) and FB-UKR (Group B) at a single centre were matched according to gender, age at time of surgery and body mass index (BMI). Survivorship analysis was performed with the endpoint set as "revision for any reason". Clinical outcome was assessed using the Oxford knee score (OKS), visual analogue scale for pain (VAS), patients' satisfaction, University of California Los Angeles activity scale (UCLA) and the Tegner activity score (TAS). RESULTS A total of 60 matched pairs were included with a mean follow-up (FU) of 3.4 ± 1.3 (range 1.2-5.0) years in Group A and 2.7 ± 1.2 (range 1.0-5.0) years in Group B. Survivorship between both groups differed significantly (Group A: 78.7%; Group B: 98.3%, p = 0.003) with bearing dislocation being the most common reason for revision in Group A (46.2%). The relative and absolute risk reduction were 92.2% and 20%, respectively, with 5 being the number needed to treat. There were no differences in OKS (Group A: 41.6 ± 6.5; Group B: 40.4 ± 7.7), VAS (Group A: 2.9 ± 3.2; Group B: 1.6 ± 2.2), UCLA (Group A: 5.7 ± 1.3; Group B: 5.9 ± 1.8) and TAS (Group A: 3.0 ± 1.0; Group B: 3.1 ± 1.2) between both groups on follow-up. CONCLUSION Despite modern prosthesis design and surgical technique, implant survival of lateral MB-UKR is lower than that of FB-UKR on the short- to mid-term due to bearing dislocation as the most common cause of failure. Since clinical results are equivalent in both groups, FB-UKR should be preferred in treatment of isolated lateral OA. LEVEL OF EVIDENCE Retrospective case-control study, Level III.
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Affiliation(s)
- Mustafa Hariri
- Department of Orthopaedics, University Hospital of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Niklas Zahn
- Department of Orthopaedics, University Hospital of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Paul Mick
- Department of Orthopaedics, University Hospital of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Ayham Jaber
- Department of Orthopaedics, University Hospital of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Tobias Reiner
- Department of Orthopaedics, University Hospital of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Tobias Renkawitz
- Department of Orthopaedics, University Hospital of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Moritz Innmann
- Department of Orthopaedics, University Hospital of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Tilman Walker
- Department of Orthopaedics, University Hospital of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.
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Tay ML, Matthews BG, Monk AP, Young SW. Disease progression, aseptic loosening and bearing dislocations are the main revision indications after lateral unicompartmental knee arthroplasty: a systematic review. J ISAKOS 2022; 7:132-141. [PMID: 35777698 DOI: 10.1016/j.jisako.2022.06.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/03/2022] [Accepted: 06/12/2022] [Indexed: 10/17/2022]
Abstract
IMPORTANCE Lateral unicompartmental knee arthroplasty (UKA) is a surgical option for patients with isolated lateral osteoarthritis however, the procedure has higher revision rates than medial UKA. The reason for this remains unclear; therefore, a better understanding of the indications for lateral UKA revision is needed. AIM The primary aim of this systematic review was to identify revision indications for lateral UKA. Secondary aims were to further investigate if revision indications were influenced by implant design and time from surgery. EVIDENCE REVIEW A systematic literature review was performed according to the PRISMA 2020 guidelines. Search was performed in January 2022 in MedLine, EMBASE, CINAHL and the Cochrane Library using the keywords "knee arthroplasty", "unicompartmental", "reoperation", synonyms and abbreviations. Articles published in 2000-2021 that were at least level III retrospective cohort studies with at least 10 lateral UKAs and reported all failure modes were included. Risk of bias was assessed using the ROBINS-I tool. Revision indications, patient characteristics, study design, implant types and time to failure were extracted from the selected studies. Collated data were tabulated and differences were tested using Chi-square or Fisher's exact test. FINDINGS A total of 29 cohort and 4 registry studies that included 7,668 UKAs met the inclusion criteria. Studies were judged as having moderate or severe risk of bias; this was associated with the retrospective nature of studies required to investigate long-term outcomes of knee arthroplasty. The main indications for lateral UKA revision were OA progression (35%), aseptic loosening (17%) and bearing dislocation (14%). The incidence of revision was similar for mobile-bearing implants (7.6%) and fixed-bearing (6.4%). For mobile-bearing implants, there was introduction of bearing dislocations as an additional mode of failure (24% cf. 0%, p < 0.001). For fixed-bearing implants, the incidence of revision was higher for all-poly-ethylene (13.9%) than metal-backed (1.8%) tibial components. Early lateral UKA failures were associated with bearing dislocations (sequential decrease from 69% under 6 months to 0% 10+ years, p < 0.001), whereas late failures were associated with OA progression (sequential increase from 0% under 6 months to 100% > 10+ years, p < 0.01). Compared with medial UKA, OA progression (41% cf. 30%, p = 0.004), malalignment (2.7% cf. 0.8%, p = 0.02), instability (4% cf. 1%, p = 0.02) and bearing dislocations (20% cf. 10%, p < 0.001) were more common for lateral UKA. CONCLUSIONS AND RELEVANCE OA progression, aseptic loosening and bearing dislocation were the three main revision indications for lateral UKA. Compared to medial UKA, OA progression, malalignment, instability and bearing dislocations were more common revision indications for lateral UKA. Higher survivorship of metal-backed fixed-bearing implants was found. The findings suggest that the outcomes of lateral UKA may be improved with more optimal alignment, gap balancing and patient selection. LEVEL OF EVIDENCE Level III systematic review.
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Affiliation(s)
- Mei Lin Tay
- Department of Surgery, University of Auckland, 85 Park Road, Grafton, Auckland, New Zealand; Department of Orthopaedic Surgery, North Shore Hospital, 124 Shakespeare Road, Takapuna, Auckland, New Zealand.
| | - Brya G Matthews
- Department of Molecular Medicine and Pathology, University of Auckland, 85 Park Road, Grafton, Auckland, New Zealand
| | - A Paul Monk
- Department of Orthopaedic Surgery, Auckland City Hospital, 2 Park Road, Grafton 1023, Auckland, New Zealand; Auckland Bioengineering Institute, University of Auckland, 70 Symonds Street, Auckland 1010, New Zealand
| | - Simon W Young
- Department of Surgery, University of Auckland, 85 Park Road, Grafton, Auckland, New Zealand; Department of Orthopaedic Surgery, North Shore Hospital, 124 Shakespeare Road, Takapuna, Auckland, New Zealand
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Yang I, Gammell JD, Murray DW, Mellon SJ. The Oxford Domed Lateral Unicompartmental Knee Replacement implant: Increasing wall height reduces the risk of bearing dislocation. Proc Inst Mech Eng H 2021; 236:349-355. [PMID: 34696644 PMCID: PMC8822200 DOI: 10.1177/09544119211048558] [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] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Due to lateral ligament laxity, bearing dislocation occurs in 1%–6% of Oxford Domed
Lateral replacements. Most dislocations are medial but they do rarely occur anteriorly or
posteriorly. The aim was to decrease the risk of dislocation. For a bearing to dislocate
the femoral component has to be distracted from the tibial component. A
robotic-path-planning-algorithm was used with a computer model of the implant in different
configurations to determine the Vertical Distraction needed for Dislocation (VDD). With
current components, VDD anteriorly/posteriorly was 5.5 to 6.5 mm and medially was 3.5 to
5.75 mm. A thicker bearing increased VDD medially and decreased VDD anteriorly/posteriorly
(0.1 mm/1 mm thickness increase). VDD medially increased with the bearing closer to the
tibial wall (0.5 mm/1 mm closer), or by increasing the tibial wall height (1 mm/1 mm
height increase). VDD anteriorly/posteriorly was not influenced by bearing position or
wall height. To prevent collision between the femoral and tibial components an increase in
wall height must be accompanied by a similar increase in minimum bearing thickness.
Increasing the wall height and minimum bearing thickness by 2 mm and ensuring the bearing
is 4 mm or less from the wall increased the minimum VDD medially to 5.5 mm. The lower VDD
medially than anteriorly/posteriorly explains why medial dislocation is more common. If
the wall height is increased by 2 mm, the minimum bearing thickness is 5 mm and the
surgeon ensured the bearing is 4 mm or less from the wall, the medial dislocation rate
should be similar to the anterior/posterior dislocation rate, which should be
acceptable.
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Affiliation(s)
- Irene Yang
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Jonathan D Gammell
- Oxford Robotics Institute, Department of Engineering Sciences, University of Oxford, Oxford, UK
| | - David W Murray
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Stephen J Mellon
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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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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