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Bunyoz KI, Gromov K, Troelsen A. Starting Up a Lateral Unicompartmental Knee Arthroplasty Practice - Is Outcome Affected? J Arthroplasty 2024:S0883-5403(24)00691-0. [PMID: 39002768 DOI: 10.1016/j.arth.2024.07.005] [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: 03/21/2024] [Revised: 07/01/2024] [Accepted: 07/02/2024] [Indexed: 07/15/2024] Open
Abstract
INTRODUCTION In the past, the utilization of lateral unicompartmental knee arthroplasty (UKA) has been limited at national levels, despite the fact that an estimated 10% of patients who have an indication for arthroplasty, present with isolated lateral compartment osteoarthritis (OA). Units dedicated to UKA have reported good outcomes. Identifying patients for the procedure has been less clear, and the procedure has been perceived to be technically more demanding than medial UKA. This may result in a reluctance to start a lateral UKA practice and challenge the early phase. Therefore, this paper aimed to present the outcomes and learning curve when starting up a lateral UKA practice, as this theme remains unelucidated. METHODS There were 85 primary fixed-bearing lateral UKAs, with a minimum of 1-year follow-up, performed between 2016 and 2022 by two arthroplasty surgeons with existing UKA practices. The indications were primary (n = 79) or post-traumatic (n = 6) osteoarthritis. Patient-reported outcome measures (PROMs) were assessed at 3, 12, and 24 months. A cumulative sum (CUSUM) analysis was used to evaluate surgical duration and the 12-month Oxford Knee Score (OKS). RESULTS Median (Interquartile range (IQR)) 12-month OKS, Activity and Participation Questionnaire (APQ), and Forgotten Joint Score (FJS) were 43 (37.5 to 46), 78 (42.5 to 98.5), and 72 (55 to 90), respectively. The OKS outcomes did not reveal adverse effects from the learning curve. A performance shift in surgical duration was observed around case 33. Kaplan-Meier implant survival reached 95.4% at 7 years for the endpoint "implant revision," and 93.5% for "implant revision/implant addition." CONCLUSION Starting up a lateral UKA practice is safe and efficient for surgeons who have prior medial UKA experience, provided strict adherence to indications. While surgical duration indicated a learning curve over approximately 33 cases, PROMs remained stable, suggesting proficient outcomes irrespective of the learning curve.
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Affiliation(s)
- Kristine I Bunyoz
- Department of Orthopaedic Surgery, Copenhagen University Hospital, Kettegård Alle 30, 2650, Hvidovre, Denmark
| | - Kirill Gromov
- Department of Orthopaedic Surgery, Copenhagen University Hospital, Kettegård Alle 30, 2650, Hvidovre, Denmark
| | - Anders Troelsen
- Department of Orthopaedic Surgery, Copenhagen University Hospital, Kettegård Alle 30, 2650, Hvidovre, Denmark
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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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Wignadasan W, Chang J, Fontalis A, Plastow R, Haddad FS. Short term outcomes following robotic arm-assisted lateral unicompartmental knee arthroplasty. Front Surg 2023; 10:1215280. [PMID: 38162087 PMCID: PMC10757348 DOI: 10.3389/fsurg.2023.1215280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 11/29/2023] [Indexed: 01/03/2024] Open
Abstract
Introduction Robotic-arm assisted medial unicompartmental knee arthroplasty (RA-UKA) is associated with improved accuracy of implant positioning and excellent early functional outcomes. However, there is paucity of evidence regarding outcomes following RA-UKA for isolated lateral compartment osteoarthritis. The purpose of this study was to assess the short-term clinical and patient reported outcomes of lateral compartment UKA, utilising robotic-arm assistance. Methods This was a retrospective study of prospectively collected data of 21 consecutive patients who underwent lateral RA-UKA. The study included 9 (42.9%) males and 12 (57.1%) females with a mean age of 63.4 ± 9.2 years. The Oxford Knee Score (OKS) was measured pre-operatively and at 1-year post-operatively, while range of motion (ROM) and complications were also recorded. Results There was significant improvement of OKS at 1 year's follow up compared with the baseline score (21.8 ± 5.6 vs. 45.2 ± 2.8 respectively; p < 0.001). There was also an improvement in pre-operative ROM when compared to ROM at 1 year's follow up (123.5° ± 8° vs. 131.5° ± 6.3° respectively; p < 0.001). None of the study patients underwent revision surgery within 1 year's follow-up. Conclusion In our study, lateral RA-UKA resulted in significant improvements in clinical and patient reported outcomes with low complications rates. Further long-term comparative studies are needed to assess the utility of lateral RA-UKA vs. conventional UKA.
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Affiliation(s)
- Warran Wignadasan
- Departmentof Trauma and Orthopaedic Surgery, University College Hospital, London, United Kingdom
| | - Justin Chang
- Department of Orthopaedic Surgery, Humber River Hospital, Toronto, ON, Canada
- Division of Orthopaedic Surgery, University of Toronto, Toronto, ON, Canada
| | - Andreas Fontalis
- Departmentof Trauma and Orthopaedic Surgery, University College Hospital, London, United Kingdom
- Department of Orthopaedic Surgery, The Princess Grace Hospital, London, United Kingdom
| | - Ricci Plastow
- Departmentof Trauma and Orthopaedic Surgery, University College Hospital, London, United Kingdom
| | - Fares S. Haddad
- Departmentof Trauma and Orthopaedic Surgery, University College Hospital, London, United Kingdom
- Department of Orthopaedic Surgery, The Princess Grace Hospital, London, United Kingdom
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Lazzara JT, Arthur LW, Jenkins C, Dodd CAF, Mellon SJ, Murray DW. Fixed lateral unicompartmental knee replacement is a reliable treatment for lateral compartment osteoarthritis after mobile-bearing medial unicompartmental replacement. Knee Surg Sports Traumatol Arthrosc 2023; 31:5407-5412. [PMID: 37768357 PMCID: PMC10719134 DOI: 10.1007/s00167-023-07573-y] [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: 06/05/2023] [Accepted: 09/03/2023] [Indexed: 09/29/2023]
Abstract
PURPOSE Lateral osteoarthritis following medial unicompartmental knee replacement (UKR) is usually treated with total knee replacement, however, lateral UKR is a less invasive option that preserves a well-functioning medial UKR. This study aimed to determine the 5-year outcome of the cemented Fixed Lateral Oxford UKR (FLO) when used for the treatment of severe lateral disease after medial Oxford unicompartmental knee replacement. METHODS Forty-four knees with lateral bone-on-bone osteoarthritis (n = 43) and avascular necrosis (n = 1) treated with the FLO following medial Oxford UKR were followed up prospectively. The Oxford Knee Score (OKS) and Tegner Activity Score (TAS) were collected pre- and post-operatively. Life-table analysis was used to determine survival rates. RESULTS The mean patient age at the time of FLO surgery was 74.4 years with a mean time of 12.1 years between the primary medial UKR and the conversion to a bi-UKR with a FLO. Mean follow-up of the FLO was 3.5 years. After FLO no intra-operative or medical complications, re-admissions, or mortality occurred. There was one reoperation in which a bearing was exchanged for a medial bearing dislocation. There were no revisions of the FLO, so the FLO survival rate at 5 years was 100% (24 at risk). The mean pre-operative OKS was 22, which significantly (p < 0.0001) improved to a mean of 42, 42, and 40 at 1, 2, and 5 years, respectively. The median TAS had a non-significant improvement from 2.5 (Range 0-8) pre-operatively to 2 (Range 1-6) at 5 years postoperatively. CONCLUSION The FLO is a reliable treatment for lateral osteoarthritis following medial UKR. At 5 years there was a 100% survival of the FLO with a mean OKS of 40. LEVEL OF EVIDENCE IV, Prospective Case Series.
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Affiliation(s)
- Joseph T Lazzara
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Lachlan W Arthur
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK.
| | - Cathy Jenkins
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Christopher A F Dodd
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Stephen J Mellon
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - David W Murray
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Yang I, Agustoni G, Murray DW, Mellon SJ. Mechanisms of mobile bearing dislocation in lateral unicompartmental knee replacement. Proc Inst Mech Eng H 2023; 237:1167-1176. [PMID: 37776125 PMCID: PMC10634216 DOI: 10.1177/09544119231195678] [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: 09/30/2022] [Accepted: 07/30/2023] [Indexed: 10/01/2023]
Abstract
Mobile bearing dislocation occurs in 1- 6% of Oxford Domed Lateral replacements. Dislocations are predominantly medial, but can occur anteriorly or posteriorly. They tend to occur when the knee is flexed. It is not clear how dislocations can be prevented. A previously described mechanical rig for assessing mobile bearing dislocation was updated so as to study dislocation with the knee in flexion. Sub-categories for the description of each type of dislocation were introduced. Dislocation was only possible when the knee was distracted. As the amount of distraction possible in the knee is variable, the risk of dislocation is related to the amount of distraction in the rig necessary for a dislocation. The type of dislocation requiring the least distraction was medial `edge' dislocation in which the edge of the bearing dislocates onto the tibial wall, which is the most common type of dislocation. The amount of distraction necessary decreased the further the bearing was from the wall and with 50% posterior overhang. Rotation of the knee did not influence the amount of distraction. In conclusion dislocation can only occur if the lateral compartment is distracted. To reduce the dislocation risk, surgeons should aim to position the femoral and tibial components so that the bearing is as close as possible to the wall without jamming against it and the tibial component should be positioned flush with the posterior tibial cortex. If, during the surgery, the mobile bearing can easily be dislocated onto the wall the surgeon should consider changing to a fixed bearing. The tibial component should also be positioned flush with the posterior tibial cortex, as if it is too far forward this may contribute to dislocation.
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Affiliation(s)
- Irene Yang
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Greta Agustoni
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal 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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Wang Z, Ni J, Mao Z, Yu M, Li H, Chen G, Wang Y, Yao Q. Survival of lateral unicompartmental knee arthroplasty at short-, mid-, and long-term follow-up: a systematic review and meta-analysis. ANZ J Surg 2023; 93:980-988. [PMID: 36757833 DOI: 10.1111/ans.18244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 11/20/2022] [Accepted: 12/21/2022] [Indexed: 02/10/2023]
Abstract
BACKGROUND The infrequency of lateral unicompartmental knee arthroplasty (UKA) has led to a lack of understanding of its survival. This study aimed to systematically evaluate the survivorship results of lateral UKA at different follow-ups based on available literature. METHODS Five databases were searched for eligible studies. Pooled survivorships with 95% confidence intervals (CIs) at 3, 5, 10, 15, and 20 years after lateral UKA were estimated using a random-effect model. Subgroup and sensitivity analyses were performed. RESULTS A total of 26 studies involving 5470 lateral UKAs were included. Survivorships of lateral UKA at 3-, 5-, 10-, 15-, and 20-year follow-ups were 96% (95% CI: 95-98%, I2 : 77.5%), 94% (95% CI: 93-96%, I2 : 70.8%), 88% (95% CI: 84-91%, I2 : 70.8%), 85% (95% CI: 79-91%, I2 : 70.8%), and 78% (95% CI: 71-85%, I2 : 54.2%), respectively. Subgroup analyses found that bearing type, the number of surgeons, and year of publication might be associated with implant survival outcomes. CONCLUSION Lateral UKA is an effective procedure with excellent survivorships at short-, mid-, and long-term follow-ups. Results suggest a single-surgeon lateral UKA using fixed-bearing. Additional well-designed studies are needed to elucidate the current findings.
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Affiliation(s)
- Zhenwei Wang
- Department of Orthopedics, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Jie Ni
- Department of Orthopedics, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Zimu Mao
- Department of Orthopedics, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Meng Yu
- Department of Orthopedics, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Hongchuan Li
- Department of Orthopedics, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Guoqiang Chen
- Department of Orthopedics, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Yang Wang
- Department of Orthopedics, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Qi Yao
- Department of Orthopedics, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
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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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Fratini S, Meena A, Alesi D, Cammisa E, Zaffagnini S, Marcheggiani Muccioli GM. Does Implant Design Influence Failure Rate of Lateral Unicompartmental Knee Arthroplasty? A Meta-Analysis. J Arthroplasty 2022; 37:985-992.e3. [PMID: 35121088 DOI: 10.1016/j.arth.2022.01.068] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 01/07/2022] [Accepted: 01/25/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Lateral unicompartmental knee arthroplasty (UKA) is a viable solution for isolated lateral compartment arthritis. Several prosthetic designs are available such as fixed-bearing metal-backed (FB M-B), fixed-bearing all-polyethylene (FB A-P), and mobile-bearing metal-backed (MB M-B) implants. The purpose of this meta-analysis is to compare failure rates of different prosthetic designs. METHODS Preferred Reporting Items for Systematic Reviews and Meta-Analyses systematic review was conducted using 4 databases (MEDLINE, EMBASE, Cochrane, and PubMed) to identify all studies that investigate outcomes of lateral UKA. Twenty-one studies met the inclusion criteria, and failure rates were compared by implant type and follow-up time separately in order to assess potential confounding factors. Two separate analyses have been performed among different implant designs (FB M-B vs FB A-P vs MB M-B) and different follow-ups (<5 years, between 5 and 10 years, >10 years). RESULTS The failure rate of FB M-B lateral UKA was significantly lower compared to other lateral UKA designs present in the market (0.8% vs 8.6% and 7.1% for FB M-B, FB A-P, and MB M-B, respectively). No significative difference among groups has been detected when comparing all implants with regard to follow-up time. CONCLUSION Considering actual evidence, for a surgeon approaching lateral UKA, the FB M-B design is preferable, given the lower failure rates and subsequently a longer implant survivorship.
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Affiliation(s)
- Stefano Fratini
- 2nd Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Amit Meena
- Central Institute of Orthopaedics, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - Domenico Alesi
- 2nd Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Eugenio Cammisa
- 2nd Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Zaffagnini
- 2nd Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy; University of Bologna, Bologna, Italy
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Asadollahi S, Wilson HA, Thomson FR, Vaz K, Middleton R, Jenkins C, Alvand A, Bottomley N, Dodd CA, Price AJ, Murray DW, Jackson WF. Early results of fixed-bearing unicompartmental knee replacement designed for the lateral compartment. J Orthop Surg Res 2022; 17:146. [PMID: 35248092 PMCID: PMC8898523 DOI: 10.1186/s13018-021-02896-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 12/30/2021] [Indexed: 11/30/2022] Open
Abstract
Background Isolated lateral compartment knee arthritis is less prevalent than medial. While the reported results of medial unicompartmental knee replacement (UKR) have been good and comparable to total knee replacement, the results of lateral UKR have been mixed. We present the short-term results and survivorship of a fixed-bearing UKR designed specifically for the lateral compartment. Methods We report the result of 130 primary fixed-bearing lateral Oxford (FLO) UKRs (123 patients) performed between 2015 and 2019 with a minimum follow-up of 1 year. The indications for lateral UKR were: isolated lateral osteoarthritis (n = 122), post-trauma (n = 5) and osteonecrosis (n = 3). The mean age was 69.1 (± 11.6), mean BMI 28.4 (± 4.9), 66.9% female, 60% right-sided, and mean follow-up 3 (range 1–4.8 years, standard deviation ± 1) years. The primary outcome measure was the Oxford knee score (OKS). Survival analysis was performed with “revision for any reason”, “reoperation”, and “implant failure” as the endpoints. Results Six patients died from unrelated reasons. None of the implants failed. One required the addition of a medial UKR for medial arthritis. There were no other reoperations. At 4 years, the survival for implant failure was 100% and for both revision and all reoperations was 99.5% (95% CI 96.7–99.9%). At the last review, at a mean of 3 years, the mean Oxford knee score was 41. Conclusion The good survivorship and outcome scores suggest that UKR designed for the lateral compartment is an excellent alternative to total knee replacement in selected patients with isolated lateral tibiofemoral arthritis at short-term follow-up.
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10
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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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Bonanzinga T, Tanzi P, Altomare D, Dorotei A, Iacono F, Marcacci M. High survivorship rate and good clinical outcomes at mid-term follow-up for lateral UKA: a systematic literature review. Knee Surg Sports Traumatol Arthrosc 2021; 29:3262-3271. [PMID: 32621040 DOI: 10.1007/s00167-020-06129-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 06/24/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of this paper is to systematically review the available literature to understand the effectiveness, the survivorship, the clinical outcomes and the complications of lateral UKA. METHODS A review of the current literature available about lateral UKA was performed in March 2020, according to the PRISMA guidelines. Selection was based on the following inclusion criteria: (1) clinical reports of any level of evidence, (2) written in English language, (3) published from 1996 to 2020, (4) dealing with clinical data on lateral UKA. A total of 47 articles, published between 1996 and 2020, were included in the review. Quality of every article was assessed using the Modified Coleman Methodology Score. RESULTS A total of 47 studies were included. Mean mCMS was 45.27 (range 30-62). Mean age at surgery was 64.5 years (range 34.1-88.0 years). In 1741 patients (65.5%) a metal back implant was used and in 421 patients (15.8%) an all poly design was used. Several scores were used to evaluate clinical results (OKS, AKSS, IKS, KOOS, WOMAC, VAS). Range of motion improved with an overall mean value of 120.3° (range: 105.9°-143.3°). The mean follow-up was 60.7 months (range, 7-204 months), mean survivorship (absence of a revision) with a minimum 60 months of follow-up was 88.6% (range 74.5-100) and mean satisfaction of patients was 78.5% (range 41.0-97.9). CONCLUSIONS Lateral UKA seems to be an effective solution to manage lateral osteoarthritis (OA), based on preliminary results, with survivorship and satisfaction rate comparable to medial UKA and total knee arthroplasty (TKA). Nonetheless, this review highlights that the quality of studies available in current literature is low. LEVEL OF EVIDENCE Systematic review of level IV studies.
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Affiliation(s)
- Tommaso Bonanzinga
- Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089, Rozzano, MI, Italy.,Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, MI, Italy
| | | | - Daniele Altomare
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, MI, Italy.
| | - Andrea Dorotei
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, MI, Italy
| | - Francesco Iacono
- Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089, Rozzano, MI, Italy
| | - Maurilio Marcacci
- Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089, Rozzano, MI, Italy.,Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, MI, Italy
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12
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Abstract
Lateral unicompartmental knee arthroplasty affords excellent functional results and implant survivorship for properly selected patients. More high-quality studies are necessary to determine whether expanded indications for medial unicompartmental knee arthroplasty also apply to lateral unicompartmental knee arthroplasty. Operative adjuncts such as robotics, custom implants, and navigation technology hold promise in minimizing the technical burden and unfamiliarity of lateral unicompartmental knee arthroplasty. Improvements in lateral-specific implants may translate to operational efficiency and improved outcomes, but few lateral-specific implants currently exist. Mobile-bearing devices have increased rates of failure due to bearing dislocation, and further studies are warranted to evaluate this complication with newer designs. Future registry and cohort studies should show medial unicompartmental knee arthroplasty and lateral unicompartmental knee arthroplasty separately to allow for better understanding of the nuances and technical differences between these uniquely different procedures.
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Affiliation(s)
- Evan Smith
- Department of Orthopaedic Surgery, The George Washington University, Washington, DC
| | - Danny Lee
- Department of Orthopaedic Surgery, The George Washington University, Washington, DC
| | - John Masonis
- OrthoCarolina Hip and Knee Center, Charlotte, North Carolina
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13
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Murray JRD, Smith JRA, Bray R, Robinson JR, White P, Porteous AJ. Fixed bearing, all-polyethylene tibia, lateral unicompartmental arthroplasty - A final outcome study with up to 28 year follow-up of a single implant. Knee 2021; 29:101-109. [PMID: 33610116 DOI: 10.1016/j.knee.2020.12.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 12/15/2020] [Accepted: 12/26/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Lateral unicompartmental arthroplasty (UKA) constitutes only 5-10% of all unicompartmental replacements performed. Whilst the short and medium term benefits are well documented, there remains concern regarding the higher revision rate when compared with total knee replacement. We report the long term clinical outcome and survivorship of a large series of lateral UKA. PATIENTS AND METHODS Between 1974 and 1994, 71 patients (82 knees) underwent a lateral fixed-bearing St Georg Sled UKA. Prospective data was collected pre-operatively and at regular intervals post-operatively using the Bristol Knee Score (BKS), with later introduction of the Oxford Knee (OKS) and Western Ontario MacMaster (WOMAC) scores. Kaplan Meier survival analysis was used, with revision, or need for revision, as end point. 85% of the patients were female. No patients were lost to follow-up. RESULTS Functional knee scores improved post-operatively up to 10 years, at which point they demonstrated a steady decline. Survivorship was 72% at 15 years, and 68% at 20 and 25 years. Nineteen knees were revised, with progression of disease in another compartment the commonest reason. There were two revisions due to implant fracture. In patients aged over 70 years at time of index procedure, 81% died with a functioning prosthesis in situ. CONCLUSION This represents the longest follow-up of a large series of lateral UKA. Results of this early design of fixed bearing UKA demonstrate satisfactory long term survivorship. In elderly patients, further intervention is rarely required. More contemporary designs or techniques may show improved long term survivorship in time.
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Affiliation(s)
- James R D Murray
- Avon Orthopaedic Centre, Southmead Hospital, Bristol BS10 5NB, United Kingdom.
| | - James R A Smith
- Avon Orthopaedic Centre, Southmead Hospital, Bristol BS10 5NB, United Kingdom.
| | - Rachel Bray
- Avon Orthopaedic Centre, Southmead Hospital, Bristol BS10 5NB, United Kingdom.
| | - James R Robinson
- Avon Orthopaedic Centre, Southmead Hospital, Bristol BS10 5NB, United Kingdom.
| | - Paul White
- University of the West of England, Bristol BS16 1QL, United Kingdom.
| | - Andrew J Porteous
- Avon Orthopaedic Centre, Southmead Hospital, Bristol BS10 5NB, United Kingdom.
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14
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Xue H, Ma T, Wen T, Yang T, Xue L, Tu Y. Predictors of Satisfactory Outcomes With Fixed-Bearing Lateral Unicompartmental Knee Arthroplasty: Up to 7-year Follow-Up. J Arthroplasty 2021; 36:910-916. [PMID: 33168343 DOI: 10.1016/j.arth.2020.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 09/10/2020] [Accepted: 10/01/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND There is little literature available examining factors that may predict functional recovery after lateral unicompartmental knee arthroplasty (UKA). The purpose of this study was to report short to mid-term effectiveness and evaluate predictors of better outcome following lateral UKA. METHODS We retrospectively reviewed 248 patients (260 knees) who underwent lateral UKA from January 2013, with a mean 5-year follow-up. The primary outcome measures comprised the Hospital for Special Surgery (HSS) score and patient satisfaction. Multivariate regression analyses were implemented to investigate associations between these factors with a satisfactory outcome. Implant survival was estimated by Kaplan-Meier analysis. RESULTS Complete follow-up was available for 186 patients (198 knees). At last follow-up, the HSS scores were changed from 52.1 (range, 38-80) preoperatively to 85.6 (range, 61-98) (P < .001), The OKS improved from 22.8 (range, 16-32) preoperatively to 42.7 (range, 30-47) postoperatively (P < .01). The 5-year survival was 99.5%. The multivariate analysis showed that the following factors tended to obtain a satisfactory outcome: higher proportion of ASA class I (P < .001), diagnosis of primary OA (P = .007), postoperative limb alignment (P = .007), and higher preoperative HSS score (P = .019). Patients with valgus 9°-12° reported the highest HSS scores among different subgroups (P < .001). CONCLUSION Following lateral UKA, postoperative outcomes were satisfactory in patients with lower ASA scores, diagnosis with primary OA, higher preoperative HSS scores and those with postoperative valgus alignment. It is important to understand these correlations to help appropriate patient selection to obtain optimal function after lateral UKA.
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Affiliation(s)
- Huaming Xue
- Department of Orthopaedics, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China
| | - Tong Ma
- Department of Orthopaedics, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China
| | - Tao Wen
- Department of Orthopaedics, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China
| | - Tao Yang
- Department of Orthopaedics, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China
| | - Long Xue
- Department of Orthopaedics, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yihui Tu
- Department of Orthopaedics, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China
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15
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Yang I, Hamilton TW, Mellon SJ, Murray DW. Systematic review and meta-analysis of bearing dislocation in lateral meniscal bearing unicompartmental knee replacement: Domed versus flat tibial surface. Knee 2021; 28:214-228. [PMID: 33422937 DOI: 10.1016/j.knee.2020.10.013] [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: 05/28/2020] [Revised: 08/07/2020] [Accepted: 10/17/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Bearing dislocation is a problem following mobile bearing Oxford lateral Unicompartmental Knee Replacement (UKR). Therefore, the design of the tibial component was changed from a flat tibial surface to a domed tibial surface with a biconcave bearing to increase bearing entrapment. This systematic review compared the dislocation and revision rates of the two designs. METHODS Two authors independently searched MEDLINE, EMBASE and ISI Web of Science, reference lists of retrieved articles, and the internet. Randomised, cohort, case-control and case studies of adult patients with lateral knee osteoarthritis treated with flat or domed Oxford lateral UKR and their outcomes were included. The overall dislocation rate and the annual revision rate (per 100 component years) were determined. RESULTS Nine studies (937 knees) met the inclusion criteria (3 flat, 6 domed). Four studies (all domed) had a low risk of bias and five had a high risk (3 flat, 2 domed), so data should be interpreted with caution. The bearing dislocation rate decreased from 17% (flat) to 3.7% (domed). Dislocations occurred on average at 16 months and medial dislocations were most common. The revision rate excluding dislocation decreased from 1.1%pa to 0.7%pa. PROSPERO registration: CRD42019139250. CONCLUSION Modifying the tibial component from a flat to a domed shape decreased the bearing dislocation rate to 3.7% and increased the 10 year survival rate excluding dislocation to 93%. The dislocation rate is still relatively high so bearing stability should be assessed intra-operatively and if unacceptable, a fixed bearing version of the Oxford lateral tibial component can be inserted.
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Affiliation(s)
- Irene Yang
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK.
| | - Thomas W Hamilton
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK; Nuffield Orthopaedic Centre, Oxford, UK
| | - Stephen J Mellon
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK
| | - David W Murray
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK; Nuffield Orthopaedic Centre, Oxford, UK
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16
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Killen CJ, Murphy MP, Hopkinson WJ, Harrington MA, Adams WH, Rees HW. Minimum twelve-year follow-up of fixed- vs mobile-bearing total knee arthroplasty: Double blinded randomized trial. J Clin Orthop Trauma 2020; 11:154-159. [PMID: 32002005 PMCID: PMC6985168 DOI: 10.1016/j.jcot.2019.03.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 03/22/2019] [Accepted: 03/26/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) with fixed-bearing (FB) implants have demonstrated impressive functional results and survival rates. Meanwhile, rotating-platform (RP) constructs have biomechanically shown to reduce polyethylene wear, lower the risk of component loosening, and better replicate anatomic knee motion. There is growing question of the clinical impact these design changes have long-term.Questions/purposes: The aim of this double-blinded prospective randomized trial was to compare function and implant survival in patients who received either FB or RP press-fit condylar Sigma (PFC Sigma, DePuy, Warsaw, IN) total knee replacements at a minimum follow-up of twelve years. PATIENTS AND METHODS Patient reported outcome measures used included the functional Knee Society Score, Western Ontario and McMaster University Osteoarthritis Index (WOMAC) scores, Medical Outcomes Short Form-36 (SF-36) score, and satisfaction assessment on a four-point Likert scale. The data was collected from times preoperative, two-years, and final encounter (mean 13.95 years). A total of 28 RP and 19 FB knees (58.8%) were analyzed at the final follow-up. RESULTS Among all patients, KSS and WOMAC scores statistically improved from pre-op to 2-year, while KSS statistically worsened from 2-year to final follow-up. The RP group averaged better follow-up scores in all assessments at the final follow-up with exception of overall satisfaction. There was no statistically significant difference in the functional Knee Society Score, Short Form-36, WOMAC scores, patient satisfaction or implant survival between the two groups at any measured period. CONCLUSIONS The use of a fixed-bearing or rotating-platform design does not convey significant superiority in terms of function or implant longevity at a minimum twelve years after total knee arthroplasty. LEVEL OF EVIDENCE Level I, Experimental study, randomized controlled trial (RCT).
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Affiliation(s)
- Cameron J. Killen
- Loyola University Medical Center, Department of Orthopaedic Surgery and Rehabilitation, 2160 S. First Avenue, Maguire Suite 1700, Maywood, IL, 60153, USA
| | - Michael P. Murphy
- Loyola University Medical Center, Department of Orthopaedic Surgery and Rehabilitation, 2160 S. First Avenue, Maguire Suite 1700, Maywood, IL, 60153, USA,Corresponding author.
| | - William J. Hopkinson
- Loyola University Medical Center, Department of Orthopaedic Surgery and Rehabilitation, 2160 S. First Avenue, Maguire Suite 1700, Maywood, IL, 60153, USA
| | - Melvyn A. Harrington
- Baylor College of Medicine, Department of Orthopaedic Surgery and Rehabilitation, 1 Baylor Plaza, Houston, TX, 77030, USA
| | - William H. Adams
- Loyola University Medical Center, Department of Clinical Research, 2160 S. First Avenue, Maguire Suite 1700, Maywood, IL, 60153, USA
| | - Harold W. Rees
- Loyola University Medical Center, Department of Orthopaedic Surgery and Rehabilitation, 2160 S. First Avenue, Maguire Suite 1700, Maywood, IL, 60153, USA
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Walker T, Hariri M, Eckert J, Panzram B, Reiner T, Merle C, Gotterbarm T, Moradi B. Minimally invasive lateral unicompartmental knee replacement: Early results from an independent center using the Oxford fixed lateral prosthesis. Knee 2020; 27:235-241. [PMID: 31806510 DOI: 10.1016/j.knee.2019.09.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 08/17/2019] [Accepted: 09/27/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE The aim of the present study was to assess clinical outcome as well as short-term survivorship of fixed-bearing lateral unicompartmental knee replacement (UKR) from a non-designer centre using the Oxford Fixed Lateral prosthesis. METHODS This single-centre retrospective cohort study reports the short-term results of 51 consecutive patients (52 knees) after fixed-bearing lateral UKR with a minimum follow-up of one year. Survivorship analysis was performed with different endpoints and clinical outcome was measured using the Oxford Knee Score (OKS), objective American Knee Society Score (AKSS-O), range-of-motion (ROM), visual analog scale for pain (VAS), Tegner activity score and UCLA score. RESULTS There was no revision surgery, defined as exchange of at least one of the components resulting in a survival rate of 100% at two years. Three patients required further surgical treatment resulting in a survival rate of 94.2% (95% confidence interval (CI): 83.2-98.1%) with the endpoint 'any reoperation'. Outcome scores, VAS and ROM showed a statistically significant improvement at final follow-up (P < .001). The OKS improved from 26.4 ± 6.9 (12-41) preoperatively to 39.7 ± 8.4 (15-48), the AKSS-O from 54.3 ± 15.3 (18-90) to 82.2 ± 15.6 (40-100), the American Knee Society Functional Score from 56.4 ± 21.3 (10-100) to 83.1 ± 20.2 (five to 100) and the ROM from 123.5 ± 13.5 (90-140) to 134 ± 10.3 (95-150). CONCLUSION Early results of fixed-bearing lateral UKR using the Oxford-Fixed-Lateral prosthesis were encouraging with a significant improvement in pain and knee function as well as an excellent survivorship of 100% at a mean follow-up of two years. Further follow-up is necessary to evaluate the long-term effectiveness of this device and the surgical technique. LEVEL OF EVIDENCE Level IV, retrospective cohort study.
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Affiliation(s)
- Tilman Walker
- Center for Orthopaedics and Trauma Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany
| | - Mustafa Hariri
- Center for Orthopaedics and Trauma Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany
| | - Johannes Eckert
- Center for Orthopaedics and Trauma Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany
| | - Benjamin Panzram
- Center for Orthopaedics and Trauma Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany
| | - Tobias Reiner
- Center for Orthopaedics and Trauma Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany
| | - Christian Merle
- Center for Orthopaedics and Trauma Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany
| | - Tobias Gotterbarm
- Center for Orthopaedics and Trauma Surgery, University of Linz, Krankenhausstr. 7a, 4020 Linz, Austria
| | - Babak Moradi
- Center for Orthopaedics and Trauma Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany.
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18
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Clinical results and 12-year survivorship of the Physica ZUK unicompartmental knee replacement. Knee 2019; 26:750-758. [PMID: 30885547 DOI: 10.1016/j.knee.2019.02.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 01/21/2019] [Accepted: 02/27/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND The Physica ZUK is a fixed bearing unicompartmental knee replacement. The purpose of this prospective cohort study was to determine the mid-term clinical outcomes and survivorship of the Physica ZUK. METHODS From 2005 to 2017 a total of 466 Physica ZUK prostheses were implanted in 398 patients by a single surgeon. The series consisted of 452 medial and 14 lateral unicompartmental knee arthroplasties (UKAs). Three hundred and sixty-seven medial UKAs with a minimum follow-up of two years (median 5.4 years) and 14 lateral UKAs with a minimum follow-up of 18 months (median 5.3 years) were analysed using the Knee Society Knee Score (KS-KS) and Function Score (KS-FS) at latest follow-up. Kaplan Meier survivorship analysis was performed with implant revision as the end point. RESULTS Mean age at the time of surgery was 67 (range 42-88) and 58 (47-69) years for patients undergoing medial and lateral UKA respectively. For medial UKAs the KS-KS and KS-FS improved significantly compared to the pre-operative values from 53.6 and 54.0 to 93.4 and 91.0 respectively (p = 0.0001). For lateral UKAs the KS-KS and KS-FS improved significantly from 46.4 and 48.7 to 91.3 and 93.1 respectively (p = 0.0001). Six cases of medial UKA were revised to total knee arthroplasty. Medial implant survivorship was 97.9% (95% confidence intervals, 95.6-99.0%) at both five and 10 years. No lateral implants were revised. CONCLUSION This prospective cohort study shows encouraging short to mid-term clinical results and survivorship for the Physica ZUK unicompartmental knee replacement.
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Deroche E, Batailler C, Lording T, Neyret P, Servien E, Lustig S. High Survival Rate and Very Low Wear of Lateral Unicompartmental Arthroplasty at Long Term: A Case Series of 54 Cases at a Mean Follow-Up of 17 Years. J Arthroplasty 2019; 34:1097-1104. [PMID: 30777626 DOI: 10.1016/j.arth.2019.01.053] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 12/23/2018] [Accepted: 01/22/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Survivorship of lateral unicompartmental knee arthroplasty (UKA) has progressively improved. However, there are few studies describing long-term results, and no study reports on polyethylene (PE) wear in lateral unicompartmental arthroplasty. The aims of this study are to determine the survival rate of lateral UKA with a fixed, all-PE bearing, and the PE wear of the tibial implant at a minimum of 15 years follow-up. METHODS From January 1988 to October 2003, we performed 54 lateral UKAs in 52 patients. All patients had isolated lateral osteoarthritis (OA). The mean age at the index procedure was 65.4 ± 11 years. Thirty-nine UKAs were available for follow-up (30 alive and 9 dead after 15 years). Twelve patients had died before 15 years and 3 patients were lost to follow-up. The mean follow-up was 17.9 years (range, 15-23 years). RESULTS At the final follow-up, 8 knees of 39 (20.5%) had a surgical revision. The cumulative survival rate was 82.1% at 15 years and 79.4% at 20 years. The main reason of revision was progression of OA (87.5%), followed by aseptic loosening of the tibial component (12.5%). With a mean follow-up of 17.9 years, the mean PE wear was 0.061 mm/y. There was no radiographic loosening in the surviving implants and no revisions for wear. The mean functional International Knee Society score was 66.5 ± 26.8, with a mean objective score of 84.4 points ± 13.2. In the population without revision, 90.5% were satisfied or very satisfied at the latest follow-up. CONCLUSION Lateral UKA with a fixed, all-PE tibial bearing and a femoral resurfacing implant presents a high survivorship at long term, with very low PE wear.
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Affiliation(s)
- Etienne Deroche
- Orthopedic Surgery Department, Croix-Rousse Hospital, Lyon, France
| | - Cécile Batailler
- Orthopedic Surgery Department, Croix-Rousse Hospital, Lyon, France
| | | | - Philippe Neyret
- Orthopedic Surgery Department, Croix-Rousse Hospital, Lyon, France
| | - Elvire Servien
- Orthopedic Surgery Department, Croix-Rousse Hospital, Lyon, France
| | - Sébastien Lustig
- Orthopedic Surgery Department, Croix-Rousse Hospital, Lyon, France
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20
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Hutt JRB, Sur A, Sur H, Ringrose A, Rickman MS. Outcomes and early revision rate after medial unicompartmental knee arthroplasty: prospective results from a non-designer single surgeon. BMC Musculoskelet Disord 2018; 19:172. [PMID: 29843680 PMCID: PMC5975526 DOI: 10.1186/s12891-018-2099-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Accepted: 05/17/2018] [Indexed: 12/11/2022] Open
Abstract
Background This prospective study evaluates outcomes and reoperation rates for unicompartmental knee arthroplasty (UKA) from a single non-designer surgeon using relatively extended criteria of degenerative changes of grade 2 or above in either or both non-operated compartments. Methods 187 consecutive medial mobile bearing UKA implants were included after history, clinical assessment and radiological evaluation. 91 patients had extended clinical outcomes. Post-operative assessment included functional scoring with the Oxford Knee Score (OKS) and radiographic review. Survivorship curves were constructed using the life-table method, with 95% confidence intervals calculated using Rothman’s equation. Separate endpoints were examined: revision for any reason and revision for confirmed loosening. Results The mean follow-up was 3.5 years. The pre-operative OKS improved from a mean of 21.2 to 38.9 (Mann-Whitney U Test, p = < 0.001). Twelve Patients required further operations including 9 revisions. No patients developed deep infection and no surviving implants were loose radiographically. Survivorship at 7 years with endpoints of re-operation, revision and aseptic loosening at surgery or radiographically was 88.4% (95% CI 79.6–93.7), 93.1% (95% CI 85.5–96.9) and 97.3% (95% CI 91.2–99.2) respectively. The presence of pre-operative mild contralateral tibiofemoral or any extent of patellofemoral joint degeneration was of no consequence. Discussion The indications for UKA are being expanded to include patients with greater deformity, more advanced disease in the patellofemoral joint and even certain features in the lateral compartment indicative of an anteromedial pattern of osteoarthritis (OA). However, much of the supporting literature remains available only from designer centres. This study represents a group of patients with what we believe to be wider indications, along with decisions to treat made on clinical grounds and radiographs alone. Conclusion This study shows comparable clinical outcomes of UKA for extended indications from a high volume, high-usage non-designer unit. Electronic supplementary material The online version of this article (10.1186/s12891-018-2099-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jonathan R B Hutt
- Department of Trauma and Orthopaedics, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Avtar Sur
- Department of Trauma and Orthopaedics, St George's University Hospitals NHS Foundation Trust, London, UK.
| | - Hartej Sur
- Department of Trauma and Orthopaedics, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Aine Ringrose
- Department of Trauma and Orthopaedics, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Mark S Rickman
- Department of Orthopaedics and Trauma, The University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
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21
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Walker T, Zahn N, Bruckner T, Streit MR, Mohr G, Aldinger PR, Clarius M, Gotterbarm T. Mid-term results of lateral unicondylar mobile bearing knee arthroplasty: a multicentre study of 363 cases. Bone Joint J 2018; 100-B:42-49. [PMID: 29305449 DOI: 10.1302/0301-620x.100b1.bjj-2017-0600.r1] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
AIMS The aim of this independent multicentre study was to assess the mid-term results of mobile bearing unicondylar knee arthroplasty (UKA) for isolated lateral osteoarthritis of the knee joint. PATIENTS AND METHODS We retrospectively evaluated 363 consecutive, lateral UKAs (346 patients) performed using the Oxford domed lateral prosthesis undertaken in three high-volume knee arthroplasty centres between 2006 and 2014. Mean age of the patients at surgery was 65 years (36 to 88) with a mean final follow-up of 37 months (12 to 93) RESULTS: A total of 36 (10.5%) patients underwent revision surgery, giving a survival rate of 90.1% at three years (95% confidence intervals (CI) 86.1 to 93.1; number at risk: 155) and 85.0% at five years (95% CI 77.9 to 89.9; number at risk: 43). Dislocation of the mobile bearing occurred in 18 patients (5.6%) at three years (95% CI 1.0 to 16.4; number at risk: 154) and in 20 patients (8.5%) at five years (95% CI 1.0 to 27.0; number at risk: 42). There were no significant differences in the dislocation rate between the participating centres or the surgeons. We were not able to identify an effect of each surgeon's learning curve on the dislocation rate of the mobile bearing. The clinical outcome in patients without revision surgery at final follow-up was good to excellent, with a mean Oxford knee score of 40.3 (95% CI 39.4 to 41.2), a mean Tegner activity score of 3.2 (95% CI 3.1 to 3.3) and a mean University of California, Los Angeles score of 5.7 (95% CI 5.5 to 5.9). CONCLUSION Our data, which consists of a high number of patients treated with mobile bearing UKA in the lateral compartment, indicates a high revision rate of 15% at five years with dislocation of the mobile bearing being the main reason for implant failure. Despite the good functional and clinical results and the high patient satisfaction in our study group, we therefore discontinued using mobile-bearing lateral UKA in favour of a fixed-bearing component. Cite this article: Bone Joint J 2018;100-B:42-9.
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Affiliation(s)
- T Walker
- University of Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany
| | - N Zahn
- University of Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany
| | - T Bruckner
- University of Heidelberg, Im Neuenheimer Feld 305, 69120 Heidelberg, Germany
| | - M R Streit
- University of Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany
| | - G Mohr
- Vulpius Clinic, Vulpiusstrasse 29, 74906 Bad Rappenau, Germany
| | - P R Aldinger
- Diakonie Clinic Paulinenhilfe, Rosenbergstrasse 38, 70176 Stuttgart, Germany
| | - M Clarius
- Vulpius Clinic, Vulpiusstrasse 29, 74906 Bad Rappenau, Germany
| | - T Gotterbarm
- University of Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany
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Newman SDS, Altuntas A, Alsop H, Cobb JP. Up to 10 year follow-up of the Oxford Domed Lateral Partial Knee Replacement from an independent centre. Knee 2017; 24:1414-1421. [PMID: 28974402 DOI: 10.1016/j.knee.2017.05.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 03/26/2017] [Accepted: 05/03/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND The Oxford Domed Lateral Partial Knee Replacement (ODLPKR) was designed specifically for the lateral compartment in response to the unacceptable dislocation rate seen with the Oxford Partial Knee. This paper presents the up to 10-year follow-up of an independent, single surgeon series using this implant. The aim of this study is to assess the medium term outcome of the ODLPKR. The primary outcome measures were 13 revision surgery, re-operation and functional outcome. METHODS Sixty-four knees in 58 patients were performed between 2005 and 2009. Patients were interviewed by telephone to determine whether further surgery had been conducted on their knee and to complete an Oxford Knee Score (OKS) questionnaire. RESULTS The status of 61 knees was confirmed with a median follow-up period of 84months. One patient sustained two bearing dislocations ultimately requiring an elective bearing exchange. Two knees underwent revision to TKR and five other patients reported further operations. Median OKS was 26 (range nine to 36) pre-operatively and 42 (10-48) at final follow-up. CONCLUSION The ODLPKR offers an effective and safe treatment for lateral compartment osteoarthritis. Bearing dislocation does not appear to be a significant issue with this implant and implant retention is similar to that achieved by medial unicompartmental knee replacements in the medium term.
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Affiliation(s)
| | - Altay Altuntas
- St Vincent's Hospital, University of Melbourne, Fitzroy, Australia
| | - Helen Alsop
- MSk Lab, Imperial College London, London, UK
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Laterale Schlittenprothese. ARTHROSKOPIE 2017. [DOI: 10.1007/s00142-017-0160-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Lateral unicompartmental knee replacement: a systematic review of reasons for failure. INTERNATIONAL ORTHOPAEDICS 2017; 42:1827-1833. [PMID: 29030653 DOI: 10.1007/s00264-017-3662-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Accepted: 09/24/2017] [Indexed: 01/28/2023]
Abstract
PURPOSE Currently, individual studies lack the power to successively illustrate different failure modes; therefore, we undertook a systematic review to examine lateral unicompartmental knee replacement (lat UKR) failure modes. Furthermore, we compared early with midterm and late failures and fixed-bearing with mobile-bearing implants. METHODS A search using the databases of PubMed, EMBASE, Cochrane, and annual registries was performed to search for failed lat UKRs. Studies were included when they reported more than four failures, described failure modes and were minimum level IV studies. Data was analysed based on overall failure modes, fixed- vs. mobile bearing and early (<5 years) vs. midterm (5-10 years) vs. late failures (>10 years). RESULTS Fourteen cohort studies and two registry-based studies were included. A total of 336 overall failures, 87 time-dependent failures, and 175 implant-specific failures were identified. The main overall causes of failure were osteoarthritis (OA) progression (30%) and aseptic loosening (22%). These were followed by less common causes such as instability (7%), unexplained pain (5%), infection (5%), polyethylene wear (5%), and bearing dislocation (5%). Bearing dislocation was the most common early failure (29%) and also the most common failure among mobile-bearing implants (27%). In midterm and late failures, OA progression had the highest rates (59% and 78% respectively) and was also the most common type of failure in fixed-bearing implants (44%). CONCLUSIONS Progression of OA and aseptic loosening are the major overall failure modes in lat UKR. Bearing dislocation was the main failure mode in early years and in mobile-bearing implants, whereas OA progression caused most failures in late years and in fixed-bearing implants. LEVEL OF EVIDENCE Systematic Review of minimum level IV studies.
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Annual revision rates of partial versus total knee arthroplasty: A comparative meta-analysis. Knee 2017; 24:179-190. [PMID: 27916580 DOI: 10.1016/j.knee.2016.11.006] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Revised: 10/29/2016] [Accepted: 11/07/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Utilization of unicompartmental knee arthroplasty (UKA) and patellofemoral arthroplasty (PFA) as alternatives to total knee arthroplasty (TKA) for unicompartmental knee osteoarthritis (OA) has increased. However, no single resource consolidates survivorship data between TKA and partial resurfacing options for each variant of unicompartmental OA. This meta-analysis compared survivorship between TKA and medial UKA (MUKA), lateral UKA (LUKA) and PFA using annual revision rate as a standardized metric. METHODS A systematic literature search was performed for studies quantifying TKA, MUKA, LUKA and/or PFA implant survivorship. Studies were classified by evidence level and assessed for bias using the MINORS and PEDro instruments. Annual revision rates were calculated for each arthroplasty procedure as percentages/observed component-year, based on a Poisson-normal model with random effects using the R-statistical software package. RESULTS One hundred and twenty-four studies (113 cohort and 11 registry-based studies) met inclusion/exclusion criteria, providing data for 374,934 arthroplasties and 14,991 revisions. The overall evidence level was low, with 96.7% of studies classified as level III-IV. Annual revision rates were lowest for TKA (0.49%, CI 0.41 to 0.58), followed by MUKA (1.07%, CI 0.87 to 1.31), LUKA (1.13%, CI 0.69 to 1.83) and PFA (1.75%, CI 1.19 to 2.57). No difference was detected between revision rates for MUKA and LUKA (p=0.222). CONCLUSIONS Revisions of MUKA, LUKA and PFA occur at an annual rate of 2.18, 2.31 and 3.57-fold that of TKA, respectively. These estimates may be used to inform clinical decision-making, guide patient expectations and evaluate the cost-effectiveness of total versus partial knee replacement in the setting of unicompartmental OA.
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Sport and physical activity following unicompartmental knee arthroplasty: a systematic review. Knee Surg Sports Traumatol Arthrosc 2017; 25:717-728. [PMID: 27209192 PMCID: PMC5332483 DOI: 10.1007/s00167-016-4167-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Accepted: 05/10/2016] [Indexed: 01/22/2023]
Abstract
PURPOSE Unicompartmental knee arthroplasty (UKA) can be a surgical treatment option for patients with high expectations regarding the post-operative level of physical activity. A systematic review was undertaken to answer three research questions: (1) is there an improvement of physical activity based on validated activity scores following UKA? (2) What are the sport disciplines and the sport patterns of UKA patients? (3) What are the pre- and post-operative sport participation rates and the return to activity rates of UKA patients? METHODS Following the PRISMA guidelines, EMBASE, MEDLINE, ISI Web of Science and the Cochrane Central Register of Controlled Trials were searched for studies reporting the level of sport and/or physical activity before and after UKA, and/or included at least one activity score before and after UKA. RESULTS Seventeen studies were identified reporting on 2972 UKAs, of which 89 % were medial UKAs and 92 % were mobile-bearing implants, respectively. Ten studies reported a statistically significant improvement of physical activity following UKA according to the UCLA activity score, the Tegner activity score or the High Activity Arthroplasty Score, respectively. Hiking, cycling and swimming are the most common activities following UKA. Sport participation before the onset of restricting symptoms ranged from 64 to 93 % and slightly decreased by 2-9 % following UKA. The return to activity rate ranged from 87 to 98 %. CONCLUSION Patients following UKA are physically active according to validated activity scores. A significant increase in low-impact activities and a decrease in high-impact activities after UKA was observed. Patients with a UKA regularly participate in sports; however, sport participation slightly decreased compared to pre-arthritic levels. This systematic review helps physicians to manage the expectations of patients regarding the level of physical activity following UKA. LEVEL OF EVIDENCE III.
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Walker T, Aldinger PR, Streit MR, Gotterbarm T. [Lateral unicompartmental knee arthroplasty - a challenge]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2016; 29:17-30. [PMID: 27957592 DOI: 10.1007/s00064-016-0476-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 09/11/2016] [Accepted: 09/15/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Joint surface replacement in the lateral compartment by unicondylar knee arthroplasty. INDICATIONS Lateral unicompartmental osteoarthritis of the knee joint, avascular necrosis of the lateral femoral condyle. CONTRAINDICATIONS Full thickness cartilage defect in the central part of the medial compartment or in the medial aspect of the patellofemoral joint. Instability/contracture of cruciate and collateral ligaments, valgus deformity >15°, valgus deformity not passively correctable, flexion deformity >15°, an intraoperative flexion <100°, failed upper tibial osteotomy, rheumatoid arthritis. SURGICAL TECHNIQUE Leg positioning in leg holder. Minimally invasive parapatellar lateral arthrotomy. Exposure of the lateral compartment and removal of osteophytes. Attachment of the tibial saw guide. Horizontal cut 7-8 mm below the original tibial plateau with protection of the lateral collateral ligament. Vertical saw cut via an incision in the central aspect of the patellar ligament with an internal rotation of 20°. Femoral preparation. Insertion of the intramedullary rod, positioning of the femoral drill guide directing to the anterior superior iliac spine and drilling the holes. Insertion of the posterior resection guide. Saw cut with protection of the lateral collateral ligament. Insertion of the 0 mm spigot and first milling. Measurement of the extension gap. Insertion of the corresponding spigot (never use a spigot >5 mm). Milling and insertion of the trial components. Application of the anti-impingement guide and anterior and posterior resection of bone. Final preparation of the tibial plateau. Cementing of the components. POSTOPERATIVE MANAGEMENT Mobilization under full weight-bearing with two crutches. RESULTS With a mean follow-up of 1.7-4 years, the dislocation rate is about 0-6.6%. Revision-free survival is 90-98%.
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Affiliation(s)
- T Walker
- Zentrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Heidelberg, Schlierbacher Landstr. 200a, 69118, Heidelberg, Deutschland
| | - P R Aldinger
- Orthopädische Klinik Paulinenhilfe, Diakonieklinikum Stuttgart, Rosenbergstr. 38, Stuttgart, 70176, Deutschland
| | - M R Streit
- Zentrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Heidelberg, Schlierbacher Landstr. 200a, 69118, Heidelberg, Deutschland
| | - T Gotterbarm
- Zentrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Heidelberg, Schlierbacher Landstr. 200a, 69118, Heidelberg, Deutschland.
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van der List JP, Chawla H, Villa JC, Pearle AD. Different optimal alignment but equivalent functional outcomes in medial and lateral unicompartmental knee arthroplasty. Knee 2016; 23:987-995. [PMID: 27810436 DOI: 10.1016/j.knee.2016.08.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 07/13/2016] [Accepted: 08/14/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Several differences in kinematics, functional outcomes and alignment exist between medial and lateral unicompartmental knee arthroplasty (UKA). Therefore, the purpose of this study was (1) to compare functional outcomes between both procedures with the hypothesis that both have equivalent outcomes and (2) to assess the role of preoperative and postoperative alignment on functional outcomes in both procedures. METHODS Patients who underwent UKA were included when overall function - using Western Ontario and McMaster Universities Arthritis (WOMAC) score - and joint awareness - using Forgotten Joint Score (FJS) - were available preoperatively and at minimum two-year follow-up. A total of 143 medial UKA and 36 lateral UKA patients reported outcomes at mean 2.4-years follow-up (range 2.0 to 5.0year). RESULTS Preoperatively and postoperatively, no differences were seen between medial and lateral UKA in overall function (89.8±11.7 vs. 90.2±12.4, respectively, p=0.855) and joint awareness (71.2±24.5 vs. 70.9±28.2, respectively, p=0.956). With neutral postoperative alignment (-1° to three degrees), less joint awareness was noted following medial UKA than lateral UKA (72.6±22.6 vs. 55.3±28.5, p=0.024). With undercorrection (three degrees to seven degrees), however, following lateral UKA less joint awareness (85.3±19.5 vs. 68.2±26.8, p=0.020) and better functional outcomes (96.0±5.4 vs. 88.5±11.6, p=0.001) were noted than medial UKA. CONCLUSION Equivalent functional outcomes were noted between medial and lateral UKA at short-term follow-up but different optimal alignment angles seem to exist for both procedures. LEVEL OF EVIDENCE Level III therapeutic study.
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Affiliation(s)
- Jelle P van der List
- Computer Assisted Surgery Center, Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY, United States.
| | - Harshvardhan Chawla
- Computer Assisted Surgery Center, Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY, United States.
| | - Jordan C Villa
- Computer Assisted Surgery Center, Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY, United States.
| | - Andrew D Pearle
- Computer Assisted Surgery Center, Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY, United States.
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van der List JP, McDonald LS, Pearle AD. Systematic review of medial versus lateral survivorship in unicompartmental knee arthroplasty. Knee 2015; 22:454-60. [PMID: 26507286 DOI: 10.1016/j.knee.2015.09.011] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 08/20/2015] [Accepted: 09/22/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Unicompartmental knee arthroplasty (UKA) has gained popularity in patients with isolated unicompartmental osteoarthritis. To our knowledge no systematic review has assessed and compared survivorship of medial and lateral UKA. We performed a systematic review assessing medial and lateral UKA survivorship and comparing survivorship in cohort studies and registry-based studies. METHODS A search was performed using PubMed, Embase and Cochrane systems. Ninety-six eligible studies reported survivorship, of which fifty-eight reported medial and sixteen reported lateral UKA survivorship. Nineteen cohort studies and seven registry-based studies reported combined medial and lateral survivorship. RESULTS The five-year, ten-year and fifteen-year medial UKA survivorship was 93.9%, 91.7% and 88.9%, respectively. Lateral UKA survivorship was 93.2%, 91.4% and 89.4% at five-year, ten-year and fifteen-year, respectively. No statistical difference between both compartments was found. At twenty years and twenty-five years survivorship of medial UKA was 84.7% and 80%, respectively, but no studies reported lateral UKA survivorship at these follow-up intervals. Survivorship of cohort studies was not significantly higher compared to registry-based studies at five years (94.3 vs. 91.7, respectively, p=0.133) but was significantly higher at ten years (90.5 vs. 84.1, p=0.015). CONCLUSION This is the first systematic review that shows no difference in the five-, ten- and fifteen-year survivorship of medial and lateral UKA. We found a lower survivorship in the registry-based studies compared to cohort studies.
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Affiliation(s)
- J P van der List
- Sports Medicine and Shoulder Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, 535 E. 70th Street, New York, NY 10021, United States.
| | - L S McDonald
- Sports Medicine and Shoulder Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, 535 E. 70th Street, New York, NY 10021, United States.
| | - A D Pearle
- Sports Medicine and Shoulder Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, 535 E. 70th Street, New York, NY 10021, United States.
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Peersman G, Stuyts B, Vandenlangenbergh T, Cartier P, Fennema P. Fixed- versus mobile-bearing UKA: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2015; 23:3296-305. [PMID: 24957911 DOI: 10.1007/s00167-014-3131-1] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 06/04/2014] [Indexed: 02/03/2023]
Abstract
PURPOSE Two design concepts are currently used for unicondylar knee arthroplasty (UKA) prostheses: fixed bearing (FB) and mobile bearing (MB). While MB prostheses have theoretical advantages over their FB counterparts, it is not clear whether they are associated with better outcomes. A systematic review was conducted to examine survivorship differences and differences in failure modes of between FB and MB designs. METHODS PubMed, Scirus and Cochrane library databases were searched for medial UKA outcome studies. A total of 44 papers, involving 9,463 knees, were eligible. Outcomes examined included knee function, survivorship and the reasons for, and incidence of, revision for FB and MB prostheses. Random effects meta-analysis was employed to obtain pooled revision rate estimates. Where available, cause-specific time to revision was extracted. RESULTS Mean follow-up was 8.7 years for FB and 5.9 years for MB prostheses. There were no other relevant baseline differences. The overall crude revision rate for FB and for MB prostheses was 0.90 (95 % confidence interval (CI) 0.65-1.21) and 1.51 (95 % CI 1.11-1.93) per 100 component years, respectively. After stratification on follow-up time and age, the revision rates were not substantially different, aside for younger patients in short term from studies with short-term follow-up. CONCLUSION No essential differences between the two designs were observed. MB and FB UKA designs have comparable revision rates. As our study is based on predominantly observational data, with large variations in reporting standards, inferences should be drawn with caution. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Geert Peersman
- Department of Orthopaedic Surgery, Ziekenhuis Netwerk Antwerp, Campus Stuivenberg, Antwerp, Belgium.
| | - Bart Stuyts
- Department of Orthopaedic Surgery, St Augustinus ziekenhuis, Antwerp, Belgium
| | - Tom Vandenlangenbergh
- Department of Orthopaedic Surgery, Ziekenhuis Netwerk Antwerp, Campus Stuivenberg, Antwerp, Belgium
| | - Philippe Cartier
- Institu du Genou, Clinique Hartmann, Neuilly sur Seine, Paris, France
| | - Peter Fennema
- AMR Advanced Medical Research, Hofenstrasse 89b, 8708, Männedorf, Switzerland
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Return to sports, recreational activity and patient-reported outcomes after lateral unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2015; 23:3281-7. [PMID: 24962800 DOI: 10.1007/s00167-014-3111-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Accepted: 05/29/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE As the indication for unicompartmental knee arthroplasty (UKA) in recent years has been extended to young and more active patients, the expectations concerning the postoperative level of activity are high. The aim of the following study was to survey the activity level and the health-related quality of life of patients following lateral UKA. METHODS Forty-five patients were surveyed to determine their sporting and recreational activities at a mean follow-up of 3 years (range 2.0-4.3 years) after lateral UKA. We also assessed health-related quality of life of our patients at the time of the survey by use of the SF-36 Health Survey. RESULTS Before the onset of the first restricting symptoms, 42 of 45 (93 %) patients were active in at least one sport compared to 43 of 45 (96 %) patients after surgery resulting in a return to activity rate of 98 %. Within 3 months, 56 % returned to their activities after surgery and 78 % within 6 months. The mean postoperative UCLA score was 6.7 (±1.5). Two-thirds of the patients reached a high activity level (UCLA ≥7). Most common activities after surgery were biking, hiking and long walks. While high-impact activities showed a significant decrease, low-impact activities showed a significant increase. The main reason for a decrease in patients' level of activity was precaution. There are no statistically significant differences in the postoperative scores of our patients and those of a matched healthy reference population in the SF-36 scores. CONCLUSION The results of the present study demonstrate that a vast majority (98 %) of our patients independent to age or gender returned to sports and recreational activity after lateral UKA. Two-thirds of the patients reached a high activity level. Activities patients were most participating in were low- or mid-impact, whereas high-impact activities were mostly given up. Further follow-up is necessary to assess the effect of activity on implant fixation and wear. LEVEL OF EVIDENCE Retrospective case series, Level IV.
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Seeger JB, Schikschneit JP, Schuld C, Rupp R, Jäger S, Schmitt H, Maier GS, Clarius M. Change of gait in patients with lateral osteoarthritis of the knee after mobile-bearing unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2015; 23:2049-54. [PMID: 24671384 DOI: 10.1007/s00167-014-2944-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 03/10/2014] [Indexed: 01/30/2023]
Abstract
PURPOSE Patients with lateral osteoarthritis of the knee suffer not only from pain but also impaired gait and limited mobility. Common treatment options are total knee replacement and lateral unicompartmental knee arthroplasty (UKA). The domed lateral mobile-bearing Oxford Uni is a new treatment option for patients with isolated osteoarthritis of the lateral compartment of the knee joint. We used instrumented gait analysis and clinical scores to study patients before and after lateral UKA. METHODS Nineteen patients suffering from lateral osteoarthritis underwent implantation of a mobile-bearing lateral UKA. They were examined in a gait analysis before the operation and after an average follow-up time of 7 months. Gait analysis was performed on a treadmill with six infrared cameras to identify gait characteristics (e.g. velocity, stride time, stride length, knee abduction or hip adduction). RESULTS Mean velocity changed from 0.58 to 0.73 m/s. Significant advancements were also found in knee abduction and hip adduction. Time and length of strides improved significantly as well as the clinical scores American Knee Society Score, Oxford-12, FFb-H-OA and Devane Score. CONCLUSION Patients with lateral osteoarthritis of the knee showed an impaired gait with an increased knee abduction and hip adduction angle. Implantation of a lateral mobile UKA can restore normal axis of the leg and improve gait and function of the knee. Instrumented gait analysis is a suitable measuring instrument to quantify and qualify the post-operative change of gait. LEVEL OF EVIDENCE II.
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Affiliation(s)
- J B Seeger
- Department of Orthopaedics and Orthopaedic Surgery, University Hospital Giessen and Marburg (UKGM), Klinikstraße 33, 35392, Giessen, Germany,
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Berend KR, Turnbull NJ, Howell RE, Lombardi AV. The current trends for lateral unicondylar knee arthroplasty. Orthop Clin North Am 2015; 46:177-84. [PMID: 25771313 DOI: 10.1016/j.ocl.2014.10.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Unicompartmental osteoarthritis of the knee is a relatively common disease that is seen in 40% of the population. Although disease isolated to the medial compartment of the knee is more common, isolated lateral disease also frequently exists (25% vs 10%). However, surgeons perform medial unicondylar knee replacement at a ratio of 10:1 when compared with lateral unicondylar knee replacement. This may be attributed to lack of familiarity or the increased difficulty of the procedure. Recent literature suggests that with proper patient selection, surgical technique, and implant choice, early survivorship ranges from 95% to 99%.
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Affiliation(s)
- Keith R Berend
- Joint Implant Surgeons, Inc. 7277 Smith's Mill Road, Suite 200, New Albany, OH 43054, USA.
| | - Nathan J Turnbull
- Joint Implant Surgeons, Inc. 7277 Smith's Mill Road, Suite 200, New Albany, OH 43054, USA
| | - Robert E Howell
- Joint Implant Surgeons, Inc. 7277 Smith's Mill Road, Suite 200, New Albany, OH 43054, USA
| | - Adolph V Lombardi
- Joint Implant Surgeons, Inc. 7277 Smith's Mill Road, Suite 200, New Albany, OH 43054, USA
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Gulati A, Weston-Simons S, Evans D, Jenkins C, Gray H, Dodd CAF, Pandit H, Murray DW. Radiographic evaluation of factors affecting bearing dislocation in the domed lateral Oxford unicompartmental knee replacement. Knee 2014; 21:1254-7. [PMID: 25216805 DOI: 10.1016/j.knee.2014.08.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 07/04/2014] [Accepted: 08/11/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND The rate of bearing dislocation with the domed lateral Oxford Unicompartmental Knee Replacement (OUKR) in different series varies from 1% to 6% suggesting that dislocation is influenced by surgical technique. The aim of this study was to identify surgical factors associated with dislocation. METHODS Aligned post-operative antero-posterior knee radiographs of seven knees that had dislocated and 87 control knees were compared. Component alignment and position and the alignment of the knee were assessed. All bearing dislocations occurred medially over the tibial wall. RESULTS Knees that dislocated tended to be overcorrected: Compared with those that did not dislocate, they were in 2° less valgus (p=0.019) and the tibial components were positioned 2 mm more proximal (p<0.01). Although the relative position of the centre of the femoral component and the tibial component was the same (p=0.8), in the dislocating group the gap between the edge of the femoral component and the top of the wall in flexion was 3mm greater (p=0.019) suggesting that the components were internally rotated. CONCLUSIONS To minimise the risk of dislocation it is recommended that the knee should not be overstuffed. This is best achieved by selecting the bearing thickness that just tightens the ligaments in full extension, and re-cutting the tibia if necessary. In addition to minimise the gap between the femoral and tibial components through which the bearing dislocates, the femoral component should be implanted in neutral rotation and should not be internally rotated. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- A Gulati
- The Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Headington, Oxford OX3 7LD, UK
| | - S Weston-Simons
- The Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Headington, Oxford OX3 7LD, UK
| | - D Evans
- The Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Headington, Oxford OX3 7LD, UK
| | - C Jenkins
- The Nuffield Orthopaedic Centre, Headington, Oxford, UK
| | - H Gray
- The Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Headington, Oxford OX3 7LD, UK
| | - C A F Dodd
- The Nuffield Orthopaedic Centre, Headington, Oxford, UK
| | - H Pandit
- The Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Headington, Oxford OX3 7LD, UK; The Nuffield Orthopaedic Centre, Headington, Oxford, UK
| | - D W Murray
- The Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Headington, Oxford OX3 7LD, UK; The Nuffield Orthopaedic Centre, Headington, Oxford, UK.
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Aldinger PR, Walker T, Gotterbarm T. Erfahrungen mit lateralen unikondylären Prothesen. DER ORTHOPADE 2014; 43:913-22. [DOI: 10.1007/s00132-014-3021-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Walker T, Gotterbarm T, Bruckner T, Merle C, Streit MR. Total versus unicompartmental knee replacement for isolated lateral osteoarthritis: a matched-pairs study. INTERNATIONAL ORTHOPAEDICS 2014; 38:2259-64. [PMID: 25112651 DOI: 10.1007/s00264-014-2473-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 07/17/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE The aim of this study was to compare the functional outcome of patients following unicompartmental knee replacement (UKR) using the Oxford domed lateral UKR to patients who underwent cruciate-retaining total knee replacement (TKR) for isolated osteoarthritis in the lateral compartment. METHODS With the help of our institutional database, we retrospectively identified 22 matched pairs with regards to age, gender and body mass index (BMI). Functional outcome was measured using the Oxford Knee Score (OKS) and range of motion (ROM). Complications and revisions were recorded. RESULTS The mean follow-up was 22 (UKR) and 19 (TKR) months, respectively. Patients following UKR had a statistically significant higher mean postoperative OKS and ROM: mean OKS was 43 [standard deviation (SD) 4] for UKR and 37 (SD 9) for TKR, respectively (p = 0.023); ROM was 127° (SD 13) for UKR and 107° (SD 17) for TKR (p < 0.001). Additionally the change in score was statistically significant higher in patients following UKR in the OKS (14.3 (SD 6) vs. 9.6 (SD 8)) and in the range of motion (+12° (SD 19) vs. -3° (SD 20)), (p = 0.041 and p = 0.01 respectively). Survival at two years using revision for any reason as the endpoint was 96% [95% confidence interval (CI) 72-99] for UKR and 100% for TKR (Log-rank test, p = 0.317). CONCLUSION The functional results of mobile-bearing UKR for isolated osteoarthritis in the lateral compartment compare favourably to those after cruciate-retaining TKR in the short term. To compare survival and complications after both procedures, longer-term follow-up is necessary.
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Affiliation(s)
- Tilman Walker
- Department of Orthopaedic and Trauma Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
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Fixed bearing lateral unicompartmental knee arthroplasty--short to midterm survivorship and knee scores for 101 prostheses. Knee 2014; 21:843-7. [PMID: 24831525 DOI: 10.1016/j.knee.2014.04.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Revised: 03/21/2014] [Accepted: 04/01/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND Isolated unicompartmental knee arthritis is less common laterally than medially. Lateral unicompartmental knee arthroplasty (UKA) constitutes only 1% of all knee arthroplasty performed. Use of medial UKA is supported by several published series showing good long-term survivorship and patient satisfaction, in large patient cohorts. Results of lateral UKA however have been mixed. We present the short and mid-term survivorship and 5-year clinical outcome of 101 lateral UKAs using a single prosthesis. METHODS Over a 9 year period, 100 patients who satisfied inclusion criteria underwent a lateral fixed-bearing unicompartmental arthroplasty. American Knee Society (AKSS), Oxford Knee (OKS) and modified Western Ontario McMaster Universities Arthritis Index (WOMAC) scores were completed preoperatively and at 1, 2 and 5 years postoperatively. Kaplan-Meier survival analysis was used to determine the 2-year and 5-year survivorship, using revision for any cause as end point. RESULTS Survivorship was 98.7% and 95.5% at 2 and 5 years respectively. 1 knee was revised for subsidence of the tibial component and 1 knee for progression of medial compartment osteoarthritis. Of a possible 35 knees in situ at 5 year follow-up, 33 knees were fully scored. Median AKSS, OKS and modified WOMAC scores were 182, 41, and 16 respectively. CONCLUSIONS The mid-term survivorship and outcome scores at 5-years suggest that lateral unicompartmental knee arthroplasty provides a valuable alternative to total joint replacement in selected patients with isolated lateral tibio-femoral arthritis at mid-term follow-up. Level II evidence.
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Weston-Simons JS, Kendrick BJL, Mentink MJA, Pandit H, Gill HS, Murray DW. An analysis of dislocation of the domed Oxford Lateral Unicompartmental Knee Replacement. Knee 2014; 21:304-9. [PMID: 23673196 DOI: 10.1016/j.knee.2013.04.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Revised: 03/22/2013] [Accepted: 04/08/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND The Oxford Unicompartmental Knee Replacement (OUKR) uses a mobile bearing to minimise wear. Bearing dislocation is a problem in the lateral compartment as the ligaments are loose in flexion. A domed tibial component has been introduced to minimise the risk of dislocation, yet they still occur, particularly medially. The aim of this mechanical study was to compare the domed and flat tibial components and to identify surgical factors that influence the risk of dislocation. METHOD A jig was constructed to assess the amount of vertical distraction of the lateral OUKR for a dislocation to occur. Three methods of dislocation were assessed: laterally, medially, 'over the wall' and anteriorly. The study focused on medial dislocation. RESULTS Significantly (p=0.02) greater vertical distraction was required to dislocate the bearing with the domed tibia rather than the flat. For medial dislocation bearing distance from the wall, femoral component external rotation and tibial rotation were associated with significantly less distraction for dislocation. With the optimal technique with the domed tibia the distraction required to dislocate the bearing medially was 6.4 mm, whereas with poor technique it was 4.6 mm. CONCLUSIONS This study suggests that to minimise the risk of dislocation the domed tibia should be used. The component should be implanted so the bearing is close to the wall, but does not hit it, and in flexion the femoral and tibial components should be neutrally aligned.
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Affiliation(s)
- J S Weston-Simons
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Headington, Oxford, OX3 7LD, UK.
| | - B J L Kendrick
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Headington, Oxford, OX3 7LD, UK
| | - M J A Mentink
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Headington, Oxford, OX3 7LD, UK
| | - H Pandit
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Headington, Oxford, OX3 7LD, UK
| | - H S Gill
- Department of Mechanical Engineering, University of Bath, Bath, UK
| | - D W Murray
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Headington, Oxford, OX3 7LD, UK
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Lustig S, Lording T, Frank F, Debette C, Servien E, Neyret P. Progression of medial osteoarthritis and long term results of lateral unicompartmental arthroplasty: 10 to 18 year follow-up of 54 consecutive implants. Knee 2014; 21 Suppl 1:S26-32. [PMID: 25382364 DOI: 10.1016/s0968-0160(14)50006-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 08/12/2014] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The literature results of unicompartmental knee arthroplasty (UKA) for isolated lateral osteoarthritis (OA) are not as good as for isolated medial OA. In 1988 our department started using a UKA with a fixed, all polyethylene tibial component and a resurfacing femoral component. The aim of this retrospective study is to report on the progression of medial OA and the long term results of this prosthesis implanted for isolated lateral OA, at a minimum follow up of ten years. MATERIALS AND METHODS From January 1988 to October 2003, we performed 54 lateral UKAs in 52 patients. All patients had isolated lateral OA, which was post-traumatic in three cases. The mean age at the time of the index procedure was 72.2 ± 15.2 years. Forty-six UKAs in 44 patients were available for follow-up. The mean duration of follow-up was 14.2 years (minimum ten years; range 10.2-18 years). RESULTS At final follow-up, seven had undergone a second operation, three were revised to total knee arthroplasty (TKA), three had medial UKAs implanted for progression of medial disease, and one was converted to TKA for tibial tray malpositioning. No revision surgery was necessary for wear, infection or progression of patellofemoral OA. The mean Knee Society Score (KSS) knee score was 95.1 points and mean KSS function score was 82.2 points. The mean range of motion was 132.6° (range, 115-150°). Implant survival was 94.4% at ten years and 91.4% at 15 years. CONCLUSION The use of a UKA with a fixed, all polyethylene tibial bearing and a femoral resurfacing implant is a reliable option for the management of isolated lateral knee osteoarthritis. We have demonstrated excellent functional results and implant survival in the long term. The most significant factor leading to reoperation is progression of medial disease.
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Affiliation(s)
- Sébastien Lustig
- Albert Trillat Center, Groupement Hospitalier Nord; Université Lyon 1, 103 Grande rue de la Croix Rousse, 69004 Lyon, France.
| | - Timothy Lording
- Albert Trillat Center, Groupement Hospitalier Nord; Université Lyon 1, 103 Grande rue de la Croix Rousse, 69004 Lyon, France; Frankston Hospital, Hastings Rd, Frankston VIC 3199, Australia
| | - Florent Frank
- Albert Trillat Center, Groupement Hospitalier Nord; Université Lyon 1, 103 Grande rue de la Croix Rousse, 69004 Lyon, France
| | - Caroline Debette
- Albert Trillat Center, Groupement Hospitalier Nord; Université Lyon 1, 103 Grande rue de la Croix Rousse, 69004 Lyon, France
| | - Elvire Servien
- Albert Trillat Center, Groupement Hospitalier Nord; Université Lyon 1, 103 Grande rue de la Croix Rousse, 69004 Lyon, France
| | - Philippe Neyret
- Albert Trillat Center, Groupement Hospitalier Nord; Université Lyon 1, 103 Grande rue de la Croix Rousse, 69004 Lyon, France
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Weston-Simons JS, Pandit H, Kendrick BJL, Jenkins C, Barker K, Dodd CAF, Murray DW. The mid-term outcomes of the Oxford Domed Lateral unicompartmental knee replacement. Bone Joint J 2014; 96-B:59-64. [DOI: 10.1302/0301-620x.96b1.31630] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Mobile-bearing unicompartmental knee replacements (UKRs) with a flat tibial plateau have not performed well in the lateral compartment, owing to a high dislocation rate. This led to the development of the Domed Lateral Oxford UKR (Domed OUKR) with a biconcave bearing. The aim of this study was to assess the survival and clinical outcomes of the Domed OUKR in a large patient cohort in the medium term. We prospectively evaluated 265 consecutive knees with isolated disease of the lateral compartment and a mean age at surgery of 64 years (32 to 90). At a mean follow-up of four years (sd 2.2, (0.5 to 8.3)) the mean Oxford knee score was 40 out of 48 (sd 7.4). A total of 12 knees (4.5%) had re-operations, of which four (1.5%) were for dislocation. All dislocations occurred in the first two years. Two (0.8%) were secondary to significant trauma that resulted in ruptured ligaments, and two (0.8%) were spontaneous. In four patients (1.5%) the UKR was converted to a primary TKR. Survival at eight years, with failure defined as any revision, was 92.1% (95% confidence interval 81.3 to 100). The Domed Lateral OUKR gives good clinical outcomes, low re-operation and revision rates and a low dislocation rate in patients with isolated lateral compartmental disease, in the hands of the designer surgeons. Cite this article: Bone Joint J 2014;96-B:59–64.
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Affiliation(s)
- J. S. Weston-Simons
- Nuffield Department of Orthopaedics, Rheumatology
and Musculoskeletal Sciences,, Botnar Research
Centre, University of Oxford, Windmill
Road, Headington, Oxford, OX3
7LD, UK
| | - H. Pandit
- Nuffield Department of Orthopaedics, Rheumatology
and Musculoskeletal Sciences,, Botnar Research
Centre, University of Oxford, Windmill
Road, Headington, Oxford, OX3
7LD, UK
| | - B. J. L. Kendrick
- Nuffield Department of Orthopaedics, Rheumatology
and Musculoskeletal Sciences,, Botnar Research
Centre, University of Oxford, Windmill
Road, Headington, Oxford, OX3
7LD, UK
| | - C. Jenkins
- Nuffield Orthopaedic Centre, Oxford
University Hospitals Trust, Headington, Oxford, OX3 7LD, UK
| | - K. Barker
- Nuffield Orthopaedic Centre, Oxford
University Hospitals Trust, Headington, Oxford, OX3 7LD, UK
| | - C. A. F. Dodd
- Nuffield Orthopaedic Centre, Oxford
University Hospitals Trust, Headington, Oxford, OX3 7LD, UK
| | - D. W. Murray
- Nuffield Department of Orthopaedics, Rheumatology
and Musculoskeletal Sciences,, Botnar Research
Centre, University of Oxford, Windmill
Road, Headington, Oxford, OX3
7LD, UK
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Servien E, Merini A, Lustig S, Neyret P. Lateral uni-compartmental knee replacement: current concepts and future directions. Knee Surg Sports Traumatol Arthrosc 2013; 21:2501-8. [PMID: 23832173 DOI: 10.1007/s00167-013-2585-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Accepted: 06/24/2013] [Indexed: 11/26/2022]
Abstract
Uni-compartmental knee replacement (UKR) is an attractive surgical option for the treatment of single compartment femoro-tibial osteoarthritis. While UKR for medial compartment arthritis is a well-established procedure with an excellent track record, UKR for lateral compartment arthritis has seen more limited success and remains a challenging operation, even in the hands of experienced arthroplasty surgeons. Despite this, several studies have now reported satisfactory mid- and long-term results with lateral UKR in appropriately selected patients. A better understanding of the aetiology and biomechanics of lateral compartment arthritis, as well as an appreciation for the technical challenges unique to lateral UKR, are likely to lead to improved outcomes with this procedure. The purpose of this level 4 study is to highlight the current concepts surrounding lateral UKR, to review the current body of literature, and to explore future directions for improving the results of lateral UKR.
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Affiliation(s)
- E Servien
- Department of Orthopaedic Surgery, Hopital de la Croix-Rousse, Centre Albert Trillat, Lyon University, 103 Grande rue de la Croix-Rousse, 69004, Lyon, France,
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