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Liu L, Li J, Wang Y, Li X, Han P, Li X. Cemented versus cementless Oxford unicompartmental knee arthroplasty for the treatment of medial knee osteoarthritis: an updated systematic review and meta-analysis. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05539-4. [PMID: 39294529 DOI: 10.1007/s00402-024-05539-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 09/03/2024] [Indexed: 09/20/2024]
Abstract
OBJECTIVE This meta-analysis sought to compare the efficacy of cemented versus cementless Oxford unicompartmental knee arthroplasty(UKA) for the treatment of medial knee osteoarthritis. METHODS A comprehensive search of the following databases was conducted: Pubmed, The Cochrane Library, China National Knowledge Infrastructure (CNKI), Embase, the Web of Science, and MEDLINE. The objective was to identify literature comparing cemented versus cementless Oxford unicompartmental knee arthroplasty for the treatment of medial knee osteoarthritis. Duplicate literature, low-quality literature, literature with incompatible observations, and literature for which the full text was not available were excluded. Two independent researchers employed the Cochrane Risk Assessment Tool and the Newcastle-Ottawa Scale (NOS) to evaluate the quality of the included literature. The data then were extracted and subsequently meta-analyzed using RevMan 5.4. RESULTS A total of 12 papers were included in the analysis, encompassing a cumulative of 2558 cumulative cases. Of these, 1258 were cemented and 1300 were cementless. A meta-analysis was conducted to compare the outcomes of cemented versus cementless Oxford UKA. The Oxford UKA group exhibited a significantly longer surgery time than the cementless Oxford UKA group [mean difference (MD) = 9.91, 95% confidence interval (CI) (7.64,12.17)]. Additionally, the cemented Oxford UKA group demonstrated a significantly lower knee OKS score compared to the cementless Oxford UKA group. The mean difference (MD) was - 1.58 (95% CI: -2.30, -0.86), indicating a significantly lower score for the cemented Oxford UKA group. Similarly, the mean difference (MD) was - 1.8 for the knee KSS clinical score, indicating a significantly lower score for the cemented Oxford UKA group. The results demonstrated that the knee KSS functional score was significantly lower in the cemented Oxford UKA group than in the cementless Oxford UKA group [MD=-1.72, 95% CI (-3.26, -0.37)]. 95% CI (-3.27,-0.17)], the cemented Oxford UKA group exhibited a significantly higher incidence of radiolucent lines around the prosthesis than the cementless Oxford UKA group [ratio of ratios (OR) = 3.62, 95% CI (1.08,12.13)]. The revision rate was significantly higher in the cemented Oxford UKA group than in the cementless Oxford UKA group [OR = 2.22, 95% CI (1.40,3.53)]. However, no significant difference was observed between the two groups in terms of reoperation rate, five-year prosthesis survival rate, and complication rate. CONCLUSIONS The findings indicated that, in comparison to cemented Oxford UKA, cementless Oxford UKA resulted in a reduction in surgical time, an improvement in knee OKS score, KSS clinical score, and KSS functional score, and a decrease in the incidence of periprosthetic radiolucent lines and the rate of revisions.
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Affiliation(s)
- Lun Liu
- Department of Orthopaedics, The Second People's Hospital of Changzhi City, No. 83, Heping West Street, Changzhi, Shanxi, 046000, China
- Graduate School, The First Clinical College of Changzhi Medical College, No. 161, Jiefang East Street, Changzhi, Shanxi, 046000, China
| | - Juebei Li
- Graduate School, Huazhong University of Science and Technology, No.13, Hangkong Road, Wuhan, Hubei, 430000, China
| | - Yunlu Wang
- Department of Orthopaedics, The Second People's Hospital of Changzhi City, No. 83, Heping West Street, Changzhi, Shanxi, 046000, China
- Graduate School, The First Clinical College of Changzhi Medical College, No. 161, Jiefang East Street, Changzhi, Shanxi, 046000, China
| | - Xiyong Li
- Graduate School, The First Clinical College of Changzhi Medical College, No. 161, Jiefang East Street, Changzhi, Shanxi, 046000, China
- Department of Orthopaedics, Heping Hospital Affiliated To Changzhi Medical College, No. 110, Yan'an South Road, Changzhi, Shanxi, 046000, China
| | - Pengfei Han
- Department of Orthopaedics, Heping Hospital Affiliated To Changzhi Medical College, No. 110, Yan'an South Road, Changzhi, Shanxi, 046000, China.
| | - Xiaodong Li
- Department of Orthopaedics, The Second People's Hospital of Changzhi City, No. 83, Heping West Street, Changzhi, Shanxi, 046000, China.
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Uchio Y, Ishijima M, Ikeuchi M, Ikegawa S, Ishibashi Y, Omori G, Shiba N, Takeuchi R, Tanaka S, Tsumura H, Deie M, Tohyama H, Yoshimura N, Nakashima Y. Japanese Orthopaedic Association (JOA) clinical practice guidelines on the management of Osteoarthritis of the knee - Secondary publication. J Orthop Sci 2024:S0949-2658(24)00139-8. [PMID: 39127581 DOI: 10.1016/j.jos.2024.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 06/28/2024] [Indexed: 08/12/2024]
Affiliation(s)
- Yuji Uchio
- Department of Orthopaedic Surgery, Shimane University, Izumo, Japan.
| | | | - Masahiko Ikeuchi
- Department of Orthopaedic Surgery, Kochi University, Nankoku, Japan
| | - Shiro Ikegawa
- Laboratory for Bone and Joint Diseases, Center for Integrated Medical Science (IMS), RIKEN, Tokyo, Japan
| | - Yasuyuki Ishibashi
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Go Omori
- Department of Health and Sports, Niigata University of Health and Welfare, Niigata, Japan
| | - Naoto Shiba
- Department of Orthopaedics, Kurume University School of Medicine, Fukuoka, Japan
| | - Ryohei Takeuchi
- Department of Joint Surgery Center, Yokohama Sekishinkai Hospital, Yokohama, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, University of Tokyo, Tokyo, Japan
| | - Hiroshi Tsumura
- Department of Orthopaedic Surgery, Oita University, Oita, Japan
| | - Masataka Deie
- Department of Orthopaedic Surgery, Aichi Medical University, Nagakute, Japan
| | | | - Noriko Yoshimura
- Department of Preventive Medicine for Locomotive Organ Disorders, 22nd Century Medical and Research Center, University of Tokyo, Tokyo, Japan
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Bayoumi T, Burger JA, van der List JP, Sierevelt IN, Spekenbrink-Spooren A, Pearle AD, Kerkhoffs GMMJ, Zuiderbaan HA. Comparison of the early postoperative outcomes of cementless and cemented medial unicompartmental knee arthroplasty. Bone Jt Open 2024; 5:401-410. [PMID: 38767223 PMCID: PMC11103876 DOI: 10.1302/2633-1462.55.bjo-2024-0007.r1] [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] [Indexed: 05/22/2024] Open
Abstract
Aims The primary objective of this registry-based study was to compare patient-reported outcomes of cementless and cemented medial unicompartmental knee arthroplasty (UKA) during the first postoperative year. The secondary objective was to assess one- and three-year implant survival of both fixation techniques. Methods We analyzed 10,862 cementless and 7,917 cemented UKA cases enrolled in the Dutch Arthroplasty Registry, operated between 2017 and 2021. Pre- to postoperative change in outcomes at six and 12 months' follow-up were compared using mixed model analyses. Kaplan-Meier and Cox regression models were applied to quantify differences in implant survival. Adjustments were made for patient-specific variables and annual hospital volume. Results Change from baseline in the Oxford Knee Score (OKS) and activity-related pain was comparable between groups. Adjustment for covariates demonstrated a minimally greater decrease in rest-related pain in the cemented group (β = -0.09 (95% confidence interval (CI) -0.16 to -0.01)). Cementless fixation was associated with a higher probability of achieving an excellent OKS outcome (> 41 points) (adjusted odds ratio 1.2 (95% CI 1.1 to 1.3)). The likelihood of one-year implant survival was greater for cemented implants (adjusted hazard ratio (HR) 1.35 (95% CI 1.01 to 1.71)), with higher revision rates for periprosthetic fractures of cementless implants. During two to three years' follow-up, the likelihood of implant survival was non-significantly greater for cementless UKA (adjusted HR 0.64 (95% CI 0.40 to 1.04)), primarily due to increased revision rates for tibial loosening of cemented implants. Conclusion Cementless and cemented medial UKA led to comparable improvement in physical function and pain reduction during the initial postoperative year, albeit with a greater likelihood of achieving excellent OKS outcomes after cementless UKA. Anticipated differences in early physical function and pain should not be a decisive factor in the choice of fixation technique. However, surgeons should consider the differences in short- and long-term implant survival when deciding which implant to use.
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Affiliation(s)
- Tarik Bayoumi
- Hospital for Special Surgery, Sports Medicine Institute, Weill Medical College of Cornell University, New York, New York, USA
- Department of Orthopaedic Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Joost A. Burger
- Department of Orthopaedic Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Charité – Department of Orthopaedic Surgery, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität, Berlin, Germany
| | - Jelle P. van der List
- Department of Orthopaedic Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Inger N. Sierevelt
- Xpert Clinics, Amsterdam, The Netherlands
- Spaarne Gasthuis Academy, Hoofddorp, The Netherlands
| | | | - Andrew D. Pearle
- Hospital for Special Surgery, Sports Medicine Institute, Weill Medical College of Cornell University, New York, New York, USA
| | - Gino M. M. J. Kerkhoffs
- Department of Orthopaedic Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
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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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Rahman A, Omoregie G, Mellon S, Murray DW. Microporous titanium and hydroxyapatite improve fixation of the tibial wall in unicompartmental knee replacement. Knee Surg Sports Traumatol Arthrosc 2024; 32:704-712. [PMID: 38415874 DOI: 10.1002/ksa.12092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/31/2024] [Accepted: 02/02/2024] [Indexed: 02/29/2024]
Abstract
PURPOSE Cementless Oxford unicompartmental knee replacement (OUKR) is associated with less pain than cemented OUKR 5 years postoperatively. This may be due to improved fixation at the tibial wall, which transmits tension and reduces stress in the bone below the tibial component. This study compares tibial wall fixation with three different types of fixation: cemented, cementless with hydroxyapatite (HA) and cementless with a microporous titanium coat and HA (HA + MPC). METHODS Three consecutive cohorts were identified (n = 221 cemented in 2005-2007, n = 118 HA in 2014-2015, n = 125 HA + MPC in 2016-2017). Analysis was performed on anterior-posterior radiographs aligned on the tibial component taken 1-2 years postoperatively. Aligned radiographs are needed to see narrow radiolucencies adjacent to the wall. Alignment was assessed with rotation ratio (RR = wall width/internal wall height). Perfect RR is 0.3, and a maximum threshold of 0.5 was used. Quality of fixation to the wall was assessed with fixation ratio (FR = bone wall contact height/total wall height). Notable radiographic features at the tibial wall were also recorded. RESULTS A total of 33 knees with cement, 37 knees with cementless with HA and 57 knees cementless with HA + MPC had adequately aligned radiographs. Fixation was significantly better with HA compared with cement (55% vs. 25%, p = 0.0016). The microporous coat further improved fixation (81% vs. 55%, p < 0.0001). FR > 80% was achieved in 3% of the cemented implants, 32% of HA and 68% of HA + MPC. In cementless cohorts, features suggestive of a layer of bone that had delaminated from the wall were seen in 8 (22%) HA and 3 (5%) HA + MPC knees. CONCLUSION Radiographic tibial wall fixation in OUKR is poor with cement. It improves with an HA coating and improves further with an intermediary MPC. Improved tibial wall fixation may explain the lower levels of pain observed with cementless rather than cemented fixation described in the literature, but further clinical correlation is needed. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Azmi Rahman
- Oxford Orthopaedic Engineering Centre, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK
| | | | - Stephen Mellon
- Oxford Orthopaedic Engineering Centre, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK
| | - David W Murray
- Oxford Orthopaedic Engineering Centre, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Watrinet J, Blum P, Maier M, Klingbeil S, Regenbogen S, Augat P, Schipp R, Reng W. Undersizing of the tibial component in Oxford unicompartmental knee arthroplasty (UKA) increases the risk of periprosthetic fractures. Arch Orthop Trauma Surg 2024; 144:1353-1359. [PMID: 38214714 DOI: 10.1007/s00402-023-05142-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 11/11/2023] [Indexed: 01/13/2024]
Abstract
INTRODUCTION Tibial periprosthetic fractures (TPF) after unicompartmental knee arthroplasty (UKA) are a rare condition that affects about 1% of cases. Known risk factors include age, sex, body mass index (BMI), and bone density, as well as surgical technique and prosthesis design. The purpose of the study was to determine if undersizing of the tibial component in relation to the femoral component increases the risk of tibial periprosthetic fractures. MATERIAL AND METHODS Over a 6-year-period 1542 patients with cemented (n = 363) and uncemented (n = 1179) medial UKA were retrospectively evaluated. Tibial periprosthetic fractures were identified and classified, and epidemiologic data were documented at follow-up. Undersizing was defined as a smaller tibial component compared to the femoral implant. The association of potential risk factors for TPF with the incidence of TPF was investigated with binominal logistic regression. RESULTS Fourteen patients (0.9%) suffered from TPF at a median of 1 month after surgery. The mean follow-up period was 5.9 ± 1.7 years. Fractures were more common in cases with undersized tibial components [odds ratio (OR) 3.2, p < 0.05]. Furthermore, older age (OR 1.1, p < 0.05) and female sex (OR 6.5, p < 0.05) were identified as significant risk factors, while BMI (p = 0.8) and cemented implantation (p = 0.2) had no effect on fracture rate. Revision surgery included open reduction and internal fixation or conversion to total knee arthroplasty. CONCLUSIONS Undersizing of implant sizes in UKA increases the risk for TPF especially in patients with small tibial implants. Therefore, mismatched implants should be avoided for UKA particularly when risk factors like obesity, older age, or female gender are present. Tibial periprosthetic fractures were successfully treated by open reduction and internal fixation or conversion to total knee arthroplasty.
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Affiliation(s)
- Julius Watrinet
- Endogap Joint Replacement Institute, Auenstraße 7, 82467, Garmisch-Partenkirchen, Germany.
- Department Trauma Surgery, BG Unfallklinik Murnau, Prof. Küntscher Str. 8, 82418, Murnau, Germany.
| | - Philipp Blum
- Endogap Joint Replacement Institute, Auenstraße 7, 82467, Garmisch-Partenkirchen, Germany
- Department Trauma Surgery, BG Unfallklinik Murnau, Prof. Küntscher Str. 8, 82418, Murnau, Germany
| | - Michael Maier
- Endogap Joint Replacement Institute, Auenstraße 7, 82467, Garmisch-Partenkirchen, Germany
| | - Steffen Klingbeil
- Endogap Joint Replacement Institute, Auenstraße 7, 82467, Garmisch-Partenkirchen, Germany
| | - Stephan Regenbogen
- Endogap Joint Replacement Institute, Auenstraße 7, 82467, Garmisch-Partenkirchen, Germany
- Department Trauma Surgery, BG Unfallklinik Murnau, Prof. Küntscher Str. 8, 82418, Murnau, Germany
| | - Peter Augat
- Institute Institute for Biomechanics, BG Unfallklinik Murnau, Prof. Küntscher Str. 8, 82418, Murnau, Germany
- Institute for Biomechanics, Paracelsus Medical University, Strubergasse 21, 5020, Salzburg, Austria
| | - Rolf Schipp
- Endogap Joint Replacement Institute, Auenstraße 7, 82467, Garmisch-Partenkirchen, Germany
| | - Wolfgang Reng
- Endogap Joint Replacement Institute, Auenstraße 7, 82467, Garmisch-Partenkirchen, Germany
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MacAulay A, Rahman A, Marks L, Murray DW, Mellon SJ. A finite element model for investigating the influence of keel design and position on unicompartmental knee replacement cementless tibial component fixation. Med Eng Phys 2024; 125:104119. [PMID: 38508799 DOI: 10.1016/j.medengphy.2024.104119] [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: 12/13/2022] [Revised: 11/07/2023] [Accepted: 02/14/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVES The cementless Oxford Unicompartmental Knee Replacement (OUKR) tibial component relies on an interference fit to achieve initial fixation. The behaviour at the implant-bone interface is not fully understood and hence modelling of implants using Finite Element (FE) software is challenging. With a goal of exploring alternative implant designs with lower fracture risk and adequate fixation, this study aims to investigate whether optimisation of FE model parameters could accurately reproduce experimental results of a pull-out test which assesses fixation. MATERIALS AND METHODS Finite element models of implants with three methods of fixation (standard keel, small keel, and peg) in a bone analogue foam block were created, in which implants were modelled using an analytical rigid definition and the foam block was modelled as a homogenous linear isotropic material. The total interference and elastic slip were varied in these models and optimised by comparing simulated and experimental results of pull-out tests for two (standard and peg) implant geometries. Then the optimised interference and elastic slip were validated by comparing simulated and experimental data of a third (small keel) implant geometry. RESULTS The optimisation of parameters established an interference of 0.16 mm and an elastic slip of 0.20 mm as most suitable for modelling the experimental force-displacement plots during pull-out. This combination of parameters accurately reproduced the experimental results of the small keel geometry. The maximum pull-out forces from the FE models were consistent with experimental data for each implant design. CONCLUSIONS This study shows that experimental pull-out tests can be accurately modelled using adjusted interference values and non-linear friction and outlines a method for determining these parameters. This study demonstrates that complex problems in modelling implant behaviour can be addressed with relatively simple models. This can potentially lead to the development of implants with reduced risk of failure.
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Affiliation(s)
- Alexander MacAulay
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), Oxford Orthopaedic Engineering Centre (OOEC), University of Oxford, Botnar Research Centre, Oxford, United Kingdom.
| | - Azmi Rahman
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), Oxford Orthopaedic Engineering Centre (OOEC), University of Oxford, Botnar Research Centre, Oxford, United Kingdom
| | - Laurence Marks
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), Oxford Orthopaedic Engineering Centre (OOEC), University of Oxford, Botnar Research Centre, Oxford, United Kingdom
| | - David W Murray
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), Oxford Orthopaedic Engineering Centre (OOEC), University of Oxford, Botnar Research Centre, Oxford, United Kingdom
| | - Stephen J Mellon
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), Oxford Orthopaedic Engineering Centre (OOEC), University of Oxford, Botnar Research Centre, Oxford, United Kingdom
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Bendtsen MAF, Odgaard A, Madsen F, Mosegaard SB, Thomsen JS, Hauge EM, Søballe K, Stilling M. Preoperative proximal tibial bone density, bone microarchitecture, and bone turnover are not associated with postoperative tibial component migration in cemented and cementless medial unicompartmental knee replacements: secondary analyses from a randomized controlled trial. Acta Orthop 2024; 95:121-129. [PMID: 38391197 PMCID: PMC10885816 DOI: 10.2340/17453674.2024.39917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 11/16/2023] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND AND PURPOSE Cementless arthroplasty fixation relies on early bone ingrowth and may be poor in patients with low proximal tibial bone density or abnormal bone turnover. We aimed first to describe the baseline bone properties in patients undergoing medial unicompartmental knee replacement (UKR), and second to investigate its association with cemented and cementless tibial component migration until 2 years. METHODS A subset investigation of 2 patient groups from a 3-armed randomized controlled trial was conducted. There were 26 cemented and 25 cementless medial UKRs with twin-pegged femoral components. Volumetric bone mineral density (vBMD) and microstructure of the excised medial tibial plateau were ascertained with µCT. Bone turnover was estimated using dynamic histomorphometry (eroded surface/bone surface = ES/BS, osteoid surface/bone surface = OS/BS, mineralizing surface/bone surface = MS/BS). Tibial component migration in 4 feature points was followed for 2 years with radiostereometry. RESULTS At the 2-year follow-up, the cementless tibial components migrated 0.38 mm (95% confidence interval [CI] 0.14-0.62) total translation more than the cemented components at the posterior feature point. The greatest migration in the cementless group was subsidence at the posterior feature point of 0.66 mm (CI 0.48-0.84) until 6 weeks, and from 3 months the components were stable. Cemented tibial components subsided very little. Between 1- and 2-year follow-ups, no cementless but 4 cemented tibial components revealed continuous migration. OS/BS was half of the ES/BS. No µCT or histomorphometric parameters showed any clinically relevant correlation with tibial component migration at the posterior feature point for either cemented or cementless UKR at 6 weeks' or 2 years' follow-up after adjustment for age, BMI, and sex. CONCLUSION Preoperative vBMD, bone turnover, and microstructure were not associated with postoperative tibial component migration of cemented and cementless medial UKR.
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Affiliation(s)
- Mathias Alrø Fichtner Bendtsen
- Department of Clinical Medicine, Aarhus University, Aarhus; AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus.
| | - Anders Odgaard
- Department of Orthopaedic Surgery, Rigshospitalet-Copenhagen University Hospital, Copenhagen; Department of Clinical Medicine, University of Copenhagen, Copenhagen
| | - Frank Madsen
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus
| | | | | | | | - Kjeld Søballe
- Department of Clinical Medicine, Aarhus University, Aarhus; Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus
| | - Maiken Stilling
- Department of Clinical Medicine, Aarhus University, Aarhus; AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus; Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus
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9
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Arthur LW, Ghosh P, Mohammad HR, Campi S, Kendrick BJL, Murray DW, Mellon SJ. Polyethylene bearing wear is comparable for cemented and cementless Oxford unicompartmental knee replacements: Ten-year results of a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 2024; 32:405-417. [PMID: 38298004 DOI: 10.1002/ksa.12042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/11/2023] [Accepted: 12/11/2023] [Indexed: 02/02/2024]
Abstract
PURPOSE There is concern that using cementless components may increase polyethylene wear of the Oxford unicompartmental knee replacement (OUKR). Therefore, this study aimed to measure bearing wear at 10 years in patients from a randomized trial comparing Phase 3 cemented and cementless OUKRs and to investigate factors that may affect wear. It was hypothesized that there would be no difference in wear rate between cemented and cementless OUKRs. METHODS Bearing thickness was determined using radiostereometric analysis at postoperative, 3-month, 6-month, 1-year, 2-year, 5-year and 10-year timepoints. As creep occurs early, wear rate was calculated using linear regression between 6 months and 10 years for 39 knees (20 cemented, 19 cementless). Associations between wear and implant, surgical and patient factors were analysed. RESULTS The linear wear rate of the Phase 3 OUKR was 0.06 mm/year with no significant difference (p = 0.18) between cemented (0.054 mm/year) and cementless (0.063 mm/year) implants. Age, Oxford Knee Score, component size and bearing thickness had no correlation with wear. A body mass index ≥ 30 was associated with a significantly lower wear rate (p = 0.007) as was having ≥80% femoral component contact area on the bearing (p = 0.003). Bearings positioned ≥1.5 mm from the tibial wall had a significantly higher wear rate (p = 0.002). CONCLUSIONS At 10 years, the Phase 3 OUKR linear wear rate is low and not associated with the fixation method. To minimize the risk of wear-related bearing fracture in the very long-term surgeons should consider using 4 mm bearings in very young active patients and ensure that components are appropriately positioned, which is facilitated by the current instrumentation. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Lachlan W Arthur
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), Oxford Orthopaedic Engineering Centre, University of Oxford, Oxford, UK
| | - Priyanka Ghosh
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), Oxford Orthopaedic Engineering Centre, University of Oxford, Oxford, UK
| | - Hasan R Mohammad
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), Oxford Orthopaedic Engineering Centre, University of Oxford, Oxford, UK
| | - Stefano Campi
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), Oxford Orthopaedic Engineering Centre, University of Oxford, Oxford, UK
| | - Benjamin J L Kendrick
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), Oxford Orthopaedic Engineering Centre, University of Oxford, Oxford, UK
| | - David W Murray
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), Oxford Orthopaedic Engineering Centre, University of Oxford, Oxford, UK
| | - Stephen J Mellon
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), Oxford Orthopaedic Engineering Centre, University of Oxford, Oxford, UK
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Mosegaard SB, Odgaard A, Madsen F, Rømer L, Kristensen PW, Vind TD, Søballe K, Stilling M. Comparison of cementless twin-peg, cemented twin-peg and cemented single-peg femoral component migration after medial unicompartmental knee replacement: a 5-year randomized RSA study. Arch Orthop Trauma Surg 2023; 143:7169-7183. [PMID: 37568057 PMCID: PMC10635966 DOI: 10.1007/s00402-023-04991-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 07/10/2023] [Indexed: 08/13/2023]
Abstract
BACKGROUND The component design and fixation method of joint arthroplasty may affect component migration and survival. The aim of this study was to compare fixation of cementless twin-peg (CLTP), cemented twin-peg (CTP) and cemented single-peg (CSP) femoral components of medial unicompartmental knee replacement (UKR). METHODS Eighty patients (mean age = 63 years, 48 males) with medial knee osteoarthritis were randomized in three ways to CLTP (n = 25), CTP (n = 26) or CSP (n = 29) femoral UKR components. The patients were followed 5 years postoperatively with RSA, bone mineral density (BMD), PROMs and radiological evaluation of radiolucent lines (RLL), femoral component flexion angle and complications. RESULTS At the 5-year follow-up, femoral component total translation was comparable between the three groups (p = 0.60). Femoral component internal rotation was 0.50° (95% CI 0.3; 0.69) for the CLTP group, 0.58° (95% CI 0.38; 0.77) for the CTP group and 0.25° (95% CI 0.07; 0.43) for the CSP group (p = 0.01). BMD decreased peri-prosthetically (range - 11.5%; - 14.0%) until 6-month follow-up and increased toward the 5-year follow-up (range - 3.6%; - 5.8%). BMD change did not correlate with component migration. Lower flexion angle was correlated with higher 5-year subsidence, total translation, varus rotation and maximum total point motion (p = 0.01). Two patients (1 CLTP, 1 CTP) had RLL in the posterior zone. There were two revisions. CONCLUSION At 5-year follow-up, fixation of UKA femoral components with twin-peg was not superior to the single-peg design. Cementless and cemented twin-peg femoral components had similar fixation. A lower flexion angle was correlated with higher component migration.
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Affiliation(s)
- Sebastian Breddam Mosegaard
- Department of Orthopaedic Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
- AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N, Denmark
| | - Anders Odgaard
- Department of Orthopaedic Surgery, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark
| | - Frank Madsen
- Department of Orthopaedic Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Lone Rømer
- Department of Radiology, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Per Wagner Kristensen
- Department of Orthopaedic Surgery, Vejle Hospital, Beriderbakken 4, 7100, Vejle, Denmark
| | - Tobias Dahl Vind
- Department of Orthopaedic Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
- AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Kjeld Søballe
- Department of Orthopaedic Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Maiken Stilling
- Department of Orthopaedic Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
- AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N, Denmark.
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
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11
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Rahman A, Martin B, Jenkins C, Mohammad H, Barker K, Dodd C, Jackson W, Price A, Mellon S, Murray DW. Less pain reported 5 years after cementless compared to cemented unicompartmental knee replacement: an analysis of pain, neuropathy, and co-morbidity scores. Knee Surg Sports Traumatol Arthrosc 2023; 31:5180-5189. [PMID: 37776359 PMCID: PMC10598111 DOI: 10.1007/s00167-023-07589-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 09/11/2023] [Indexed: 10/02/2023]
Abstract
PURPOSE To compare patient-reported pain scores and assess the influence of neuropathy and co-morbidity, on knee pain following cemented and cementless medial unicompartmental knee replacement (UKR) 5 years after surgery. METHOD In this longitudinal study, 262 cemented and 262 cementless Oxford UKR performed for the same indications and with the same techniques were recruited. Patients were reviewed at five years, evaluating patient-reported pain and association with clinical outcomes. Intermittent and Constant Osteoarthritis Pain (ICOAP), PainDETECT (PD), Charnley score, Oxford Knee Score (OKS) and American Knee Society Score (AKSS) were compared. RESULTS In both cohorts, intermittent pain was more common than constant pain (47% vs 21%). Cementless knees reported significantly less pain than cemented (ICOAP-Total 5/100 vs 11/100, p < 0.0001). A greater proportion of cementless knees experienced no pain at all (ICOAP = 0/100, 61% vs 43%, p < 0.0001) and 75% fewer experienced severe or extreme pain. Pain sub-scores in PD, OKS and AKSS follow this trend. Pain was unlikely to be neuropathic (PD positive: 5.26%), but patients reporting high levels of 'strongest' pain were three times more likely to be neuropathic. Patients with co-morbidities (Charnley C) experienced greater pain than those without (Charnley A+B) across all knee-specific scores, despite scores being knee specific. CONCLUSION Both cemented and cementless UKR in this study had substantially less pain than that reported in literature following TKR. Cementless UKR had significantly less pain than cemented UKR in all scores. Two-thirds of patients with a cementless UKR had no pain at all at 5 years, and pain experienced was most likely to be mild and intermittent with no patients in severe or extreme pain. Patients with cementless UKR that had higher levels of pain were more likely to have co-morbidity or evidence or neuropathic pain. It is unclear why cementless UKR have less pain than cemented; further study is necessary.
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Affiliation(s)
- Azmi Rahman
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
| | - Benjamin Martin
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Cathy Jenkins
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Hasan Mohammad
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Karen Barker
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Christopher Dodd
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - William Jackson
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Andrew Price
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Stephen Mellon
- 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
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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12
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Mancino F, Malahias MA, Loucas R, Ryan L, Kostretzis L, Tornberg H, Gu A, Nikolaou VS, Togninalli D, Alexiades MM. Cementless versus cemented unicompartmental knee arthroplasty: a systematic review of comparative studies. Musculoskelet Surg 2023; 107:255-267. [PMID: 36689086 DOI: 10.1007/s12306-023-00773-2] [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: 05/25/2021] [Accepted: 01/08/2023] [Indexed: 01/24/2023]
Abstract
There are still some controversies regarding the clinical use of cementless UKAs. The aim of this systematic review was to determine whether cementless medial UKA leads to similar outcomes compared to cemented medial UKA. This search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews guidelines (PRISMA). The random effects model with 95% confidence interval (CI) was applied to the analysis. The I2 statistic was used to assess study heterogeneity. Six studies were eligible for inclusion (4784 UKAs, 4776 patients): 2947 cemented UKAs (61.6%) and 1837 cementless UKAs (38.4%). The overall mean follow-up was 4.9 years. The all-cause reoperation rate was 11.3% (80 of 706) at mean 5.7-year follow-up for cemented UKA and 6.9% (57 of 824) at mean 4.1-year follow-up for the cementless. The overall revision rate was 10.2% (303 of 2947) for the cemented and 5.8% (108 of 1837) for the cementless. Aseptic loosening was the most frequent reason of revision (2.3% cemented vs 0.5% cementless). The overall rate of radiolucent lines (RLL) was 28.3% (63 of 223) in the cemented cohort and 11.1% in the cementless (26 of 234). All the studies reported improved functional outcomes. Cementless UKA provides at least equivalent if not better results compared to cemented UKA. Despite the use of cemented UKA outnumber cementless fixation, available data shows that cementless UKA had a reduced midterm revision rate, while providing similar functional outcomes.
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Affiliation(s)
- F Mancino
- Department of Orthopaedic, The Orthopaedic Research Foundation of Western Australia (ORFWA), Fiona Stanley Hospital, Perth, Australia.
| | - M A Malahias
- School of Medicine - Frankfurt, European University Cyprus, Im Vogelsgesang 3, Frankfurt am Main, 60488, Germany
- Department of Orthopedics and Traumatology, Clinica ARS Medica, Via Grumo 16, 6929, Gravesano, Ticino, Switzerland
| | - R Loucas
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - L Ryan
- Department of Orthopedic Surgery, George Washington School of Medicine and Health Sciences, 2300 M St NW, Washington DC, 20037, USA
| | - L Kostretzis
- Hôpital Maisonneuve-Rosemont, CanadaCooper, 5415 Boulevard de L'Assomption, Montréal, QC, H1T 2M4, Canada
| | - H Tornberg
- Medical School of Rowan University, 401 Broadway, Camden, NJ, 08103, USA
| | - A Gu
- Department of Orthopedic Surgery, George Washington School of Medicine and Health Sciences, 2300 M St NW, Washington DC, 20037, USA
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, 535 E 70Th St, New York, 10021, USA
| | - V S Nikolaou
- 2nd Orthopaedic Department, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - D Togninalli
- Department of Orthopedics and Traumatology, Clinica ARS Medica, Via Grumo 16, 6929, Gravesano, Ticino, Switzerland
| | - M M Alexiades
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, 535 E 70th St, New York, 10021, USA
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Westhauser F, Doll J, Bangert Y, Walker T, Reiner T, Renkawitz T. [Treatment of unicompartmental osteoarthritis of the knee]. ORTHOPADIE (HEIDELBERG, GERMANY) 2023:10.1007/s00132-023-04391-5. [PMID: 37318534 DOI: 10.1007/s00132-023-04391-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 04/27/2023] [Indexed: 06/16/2023]
Abstract
Osteoarthritis of the knee is one of the most important degenerative joint diseases in the clinical routine. The treatment of knee osteoarthritis is not only based on the stage, symptoms and duration of the joint disease, but also depends on the existing arthrosis pattern. In the case of unicompartmental arthrosis, damage typical for osteoarthritis is limited to just one joint compartment. Both the conservative and the surgical treatment of unicompartmental osteoarthritis of the knee have to respect the individual characteristics of the respective forms of osteoarthritis. In the context of this manuscript, the genesis, the diagnostics and the guideline-based stage-adapted conservative and operative treatment of unicompartmental osteoarthritis of the knee are addressed.
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Affiliation(s)
- F Westhauser
- Orthopädische Universitätsklinik Heidelberg, Ruprecht-Karls-Universität, Schlierbacher Landstr. 200a, 69118, Heidelberg, Deutschland
| | - J Doll
- Orthopädische Universitätsklinik Heidelberg, Ruprecht-Karls-Universität, Schlierbacher Landstr. 200a, 69118, Heidelberg, Deutschland
| | - Y Bangert
- Orthopädische Universitätsklinik Heidelberg, Ruprecht-Karls-Universität, Schlierbacher Landstr. 200a, 69118, Heidelberg, Deutschland
| | - T Walker
- Orthopädische Universitätsklinik Heidelberg, Ruprecht-Karls-Universität, Schlierbacher Landstr. 200a, 69118, Heidelberg, Deutschland
| | - T Reiner
- Orthopädische Universitätsklinik Heidelberg, Ruprecht-Karls-Universität, Schlierbacher Landstr. 200a, 69118, Heidelberg, Deutschland
| | - T Renkawitz
- Orthopädische Universitätsklinik Heidelberg, Ruprecht-Karls-Universität, Schlierbacher Landstr. 200a, 69118, Heidelberg, Deutschland.
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14
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Gibbons JP, Cassidy RS, Bryce L, Napier RJ, Bloch BV, Beverland DE. Is Cementless Total Knee Arthroplasty Safe in Women Over 75 Y of Age? J Arthroplasty 2023; 38:691-699. [PMID: 36272510 DOI: 10.1016/j.arth.2022.10.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 10/11/2022] [Accepted: 10/13/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Cementless total knee arthroplasty (TKA) is the subject of renewed interest. Previous concerns about survivorship have been addressed and there is an appeal in terms of biological fixation and surgical efficiency. However, even surgeon advocates have concerns about the risk of marked subsidence when using this technology in older patients at risk for osteoporosis. METHODS This was a retrospective analysis of 1,000 consecutive fully cementless mobile bearing TKAs performed at a single institution on women over 75 years of age who had postoperative and 1-year x-rays. The primary outcome was the incidence of subsidence. RESULTS There were three asymptomatic cases with definite subsidence and change in alignment. In a fourth symptomatic case, the femoral component subsided into varus and the tibia into valgus, thus maintaining alignment which facilitated nonoperative treatment in a 92-year-old. Overall, at 1 year, there were two- liner revisions for infection without recurrence. Five patients had further surgery, of which three were washouts and two were for periprosthetic fractures sustained postoperatively within 1 year. Seven patients had further anesthesia, of which five were manipulations and two were nonrecurrent closed reductions for spinouts. CONCLUSION Cementless TKA did not have a high risk of subsidence in this at-risk population. In the hands of experienced surgeons, these procedures can be used safely irrespective of bone quality.
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Affiliation(s)
- John P Gibbons
- Orthopaedic Outcomes Unit, Musgrave Park Hospital, Belfast, Northern Ireland
| | - Roslyn S Cassidy
- Orthopaedic Outcomes Unit, Musgrave Park Hospital, Belfast, Northern Ireland
| | - Leeann Bryce
- Orthopaedic Outcomes Unit, Musgrave Park Hospital, Belfast, Northern Ireland
| | - Richard J Napier
- Orthopaedic Outcomes Unit, Musgrave Park Hospital, Belfast, Northern Ireland
| | - Benjamin V Bloch
- Nottingham Elective Orthopaedic Services, City Hospital Campus, Nottingham University Hospitals NHS Trust, Nottingham, England
| | - David E Beverland
- Orthopaedic Outcomes Unit, Musgrave Park Hospital, Belfast, Northern Ireland
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15
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Mohammad HR, Judge A, Dodd C, Murray D. The effect of activity on the outcome of cementless mobile bearing unicompartmental knee replacements. Knee 2023; 42:153-160. [PMID: 37003091 DOI: 10.1016/j.knee.2023.03.005] [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: 10/22/2022] [Revised: 01/07/2023] [Accepted: 03/09/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND Many surgeons consider high activity levels a contraindication to Unicompartmental Knee Replacement (UKR). Cementless fixation is of particular concern given the lack of cement to augment primary stability. We assessed the effect of pre and post-operative activity levels on the outcomes of cementless UKRs. METHODS A prospective cohort of 1000 medial cementless mobile bearing UKR were analysed. Patients were categorised by their pre-operative and highest post-operative Tegner Activity Score (TAS) and results compared between groups. Outcomes of interest included implant survival, Oxford Knee Score (OKS) and the American Knee Society Score - Objective/Functional (AKSS-O/F). RESULTS Increasing post-operative activity were not associated with higher revision rates. The 10-year survival of the high activity group (TAS ≥ 5, 96.7% (CI 91.3-98.8), and low/medium activity group (TAS ≤ 4, 98.1% (CI 96.5-99.0)) were not significantly different (p = 0.57). The mean 10-year OKS of the high activity group (46.5, SD 3.1) was significantly (p < 0.001) higher than that of the low/medium activity group (41.3, SD 7.7). There was a significant trend for increasing activity being associated with increasing AKSS-F at 5-years (p < 0.001) and 10 years (p = 0.01) and increasing AKSS-O at 5 years (p < 0.001). Higher pre-operative activity did not significantly increase revision rates and resulted in significantly higher 5-year post-operative scores. CONCLUSIONS Neither higher pre-operative nor post-operative activity were associated with increased revision rates, but both were associated with better post-operative function. Therefore activity should not be considered a contraindication to cementless mobile bearing UKR and not be restricted post-operatively.
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Affiliation(s)
- Hasan Raza Mohammad
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences University of Oxford, Nuffield Orthopaedic Centre, Oxford OX3 7LD, United Kingdom; Barts Bone & Joint Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary, University of London, London E1 2AD, United Kingdom.
| | - Andrew Judge
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences University of Oxford, Nuffield Orthopaedic Centre, Oxford OX3 7LD, United Kingdom; Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Level 1 Learning and Research Building, Southmead Hospital, Westbury-on-Trym, Bristol BS10 5NB, United Kingdom
| | - Christopher Dodd
- Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD, United Kingdom
| | - David Murray
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences University of Oxford, Nuffield Orthopaedic Centre, Oxford OX3 7LD, United Kingdom; Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD, United Kingdom
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16
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Mohammad HR, Judge A, Murray DW. The Effect of Body Mass Index on the Relative Revision Rates of Cemented and Cementless Unicompartmental Knee Replacements: An Analysis of Over 10,000 Knee Replacements from National Databases. J Bone Joint Surg Am 2023; 105:527-536. [PMID: 36881643 DOI: 10.2106/jbjs.22.01042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
BACKGROUND Unicompartmental knee replacements (UKRs) are being performed in an increasingly overweight population. There are concerns that cemented fixation will not last. Cementless fixation may offer a solution, but the relative performance in different body mass index (BMI) groups remains unknown. METHODS Ten thousand, four hundred and forty cemented and cementless UKRs were propensity matched. Patients were stratified into 4 BMI groups: underweight (<18.5 kg/m2), normal weight (18.5 to <25 kg/m2), overweight (25 to <30 kg/m2), and obese (≥30 kg/m2). The effect of BMI on the relative performance of UKR fixation groups was studied. Cox regression was used to compare revision and reoperation rates. RESULTS The revision rate per 100 component-years significantly increased (p < 0.001) with BMI for the cemented UKRs. Revision rates per 100 component-years for the normal, overweight, and obese groups were 0.92 (95% confidence interval [CI], 0.91 to 0.93), 1.15 (95% CI, 1.14 to 1.16), and 1.31 (95% CI, 1.30 to 1.33), respectively. This was not observed for the cementless UKR, with revision rates of 1.09 (95% CI, 1.08 to 1.11), 0.70 (95% CI, 0.68 to 0.71), and 0.96 (95% CI, 0.95 to 0.97), respectively. The 10-year implant survival rates for the matched cemented and cementless UKRs in the normal, overweight, and obese groups were 93.8% (95% CI, 89.1% to 96.5%) and 94.3% (95% CI, 90.9% to 96.5%) (hazard ratio [HR], 1.17; p = 0.63), 88.5% (95% CI, 84.2% to 91.7%) and 93.8% (95% CI, 90.2% to 96.2%) (HR, 0.61; p = 0.005), and 90.7% (95% CI, 88.2% to 92.6%) and 91.8% (95% CI, 88.9% to 94.0%) (HR, 0.74; p = 0.02), respectively. There were insufficient numbers in the underweight group for analysis (n = 13). Obese patients had less than half the rates of aseptic loosening (0.46% vs. 1.31%; p = 0.001) and pain (0.60% vs. 1.20%; p = 0.02) in the cementless group as compared with the cemented group. CONCLUSIONS Higher-BMI groups had higher revision rates for the cemented UKRs but not for the cementless UKRs. Cementless fixation was associated with reduced long-term revision rates compared with cement fixation in the overweight and obese groups. In the obese group, the rates of aseptic loosening and pain were at least 50% lower in the cementless UKR group. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Hasan R Mohammad
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom.,Barts Bone & Joint Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, University of London, London, United Kingdom
| | - Andrew Judge
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom.,Musculoskeletal Research Unit, Southmead Hospital, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - David W Murray
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
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17
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Puvanendran A, Jaibaji M, Volpin A, Konan S. Survivorship, clinical outcomes and indications for revision in uncemented unicompartmental knee arthroplasty: systematic review. Acta Orthop Belg 2023; 89:83-95. [PMID: 37294990 DOI: 10.52628/89.1.9873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Modern uncemented unicompartmental knee arthroplasty (UKA) relies on the mechanics of the implant design and a biological bond at the bone-implant interface to create a secure fixation of its components. The aim of this systematic review was to determine implant survivorship, clinical outcomes and indications for revision in uncemented UKAs. A search strategy was employed using keywords related to UKAs and uncemented fixation to identify suitable studies. Both prospective and retrospective studies with a minimum of two year mean follow-up were included. Data was gathered on study design, implant type, patient demographics, survivorship, clinical outcome scores and the indications for revision. Methodological quality was assessed using a ten-point risk of bias scoring tool. Eighteen studies were included in the final review. The mean follow-up of studies ranged between 2-11 years. The primary outcome of survival demonstrated 5 year survivorship ranged between 91.7-100.0% and 10-year survivorship between 91.0-97.5%. Clinical and functional outcome scores were found to be excellent in the majority of studies with the remaining reporting good results. Revisions represented 2.7% of the total operations performed. There were 145 revisions with an overall revision rate of 0.8 per 100 observed component years. Osteoarthritis disease progression (30.2%) and bearing dislocations (23.8%) were the most common causes of implant failure. This review finds uncemented UKAs demonstrate comparable survivorship, clinical outcomes and safety profile to cemented UKAs to consider this fixation a suitable alternative in clinical use.
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18
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Tay ML, Bolam SM, Maxwell AR, Hooper GJ, Monk AP, Young SW. Similar Survivorship but Different Revision Reasons for Uncemented Mobile-Bearing and Cemented Fixed-Bearing Medial UKA: A Long-Term Population-Based Cohort Study of 2,015 Patients. J Bone Joint Surg Am 2023; 105:755-761. [PMID: 36812351 DOI: 10.2106/jbjs.22.00686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
BACKGROUND Long-term survivorship and accurate characterization of revision reasons in unicompartmental knee arthroplasty (UKA) are limited by a lack of long-term data and standardized definitions of revision. The aim of this study was to identify survivorship, risk factors, and reasons for revision in a large cohort of medial UKAs with long-term follow-up (up to 20 years). METHODS Patient, implant, and revision details for 2,015 primary medial UKAs (mean follow-up, 8 years) were recorded following systematic clinical and radiographic review. Survivorship and risk of revision were analyzed using Cox proportional hazards. Reasons for revision were analyzed using competing-risk analysis. RESULTS Implant survivorship at 15 years was 92% for cemented fixed-bearing (cemFB), 91% for uncemented mobile-bearing (uncemMB), and 80% for cemented mobile-bearing (cemMB) UKAs (p = 0.02). When compared with cemFB, the risk of revision was higher for cemMB implants (hazard ratio [HR] = 1.9, 95% confidence interval [CI] = 1.1 to 3.2; p = 0.03). At 15 years, cemented implants had a higher cumulative frequency of revision due to aseptic loosening (3% to 4%, versus 0.4% for uncemented; p < 0.01), cemMB implants had a higher cumulative frequency of revision due to osteoarthritis progression (9% versus 2% to 3% for cemFB/uncemMB; p < 0.05), and uncemMB implants had a higher cumulative frequency of revision due to bearing dislocation (4% versus 2% for cemMB; p = 0.02). Compared with the oldest patients (≥70 years), younger patients had a higher risk of revision (<60 years: HR = 1.9, 95% CI = 1.2 to 3.0; 60 to 69 years: HR = 1.6, 95% CI = 1.0 to 2.4; p < 0.05 for both). At 15 years, there was a higher cumulative frequency of revision for aseptic loosening in these younger groups (3.2% and 3.5% versus 2.7% for ≥70 years; p < 0.05). CONCLUSIONS Implant design and patient age were risk factors for revision of medial UKA. The findings from this study suggest that surgeons should consider using cemFB or uncemMB designs because of their superior long-term implant survivorship compared with cemMB designs. Additionally, for younger patients (<70 years), uncemMB designs had a lower risk of aseptic loosening than cemFB designs at the expense of a risk of bearing dislocation. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Mei Lin Tay
- Department of Surgery, Faculty of Medical and Health Sciences (FMHS), University of Auckland, Auckland, New Zealand.,Department of Orthopaedic Surgery, North Shore Hospital, Auckland, New Zealand
| | - Scott M Bolam
- Department of Surgery, Faculty of Medical and Health Sciences (FMHS), University of Auckland, Auckland, New Zealand.,Department of Orthopaedic Surgery, Auckland City Hospital, Auckland, New Zealand
| | - A Rod Maxwell
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand
| | - Gary J Hooper
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand
| | - A Paul Monk
- Department of Orthopaedic Surgery, Auckland City Hospital, Auckland, New Zealand.,Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Simon W Young
- Department of Surgery, Faculty of Medical and Health Sciences (FMHS), University of Auckland, Auckland, New Zealand.,Department of Orthopaedic Surgery, North Shore Hospital, Auckland, New Zealand
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The effect of body mass index on the outcomes of cementless medial mobile-bearing unicompartmental knee replacements. Knee Surg Sports Traumatol Arthrosc 2023; 31:608-618. [PMID: 33864470 PMCID: PMC9898366 DOI: 10.1007/s00167-021-06549-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 03/25/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE Given an increasingly overweight population, unicompartmental knee replacements (UKRs) are being performed in patients with higher body mass indices (BMIs). There are concerns that cemented fixation will not last. Cementless fixation may offer a solution, but the long term results in different BMI groups has not been assessed. We studied the effect of BMI on the outcomes of cementless UKRs. METHODS A prospective cohort of 1000 medial cementless mobile-bearing UKR with a mean follow up of 6.6 years (SD 2.7) were analysed. UKRs were categorised into four BMI groups: (1) ≥ 18.5 to < 25 kg/m2 (normal), (2) 25 to < 30 kg/m2 (overweight), (3) 30 to < 35 kg/m2 (obese class 1) and (4) ≥ 35 kg/m2 (obese class 2). Implant survival was assessed using endpoints reoperation and revision. Functional outcomes were assessed. RESULTS Ten-year cumulative revision rate for the normal (n = 186), overweight (n = 434), obese class 1 (n = 213) and obese class 2 (n = 127) groups were 1.8% (CI 0.4-7.4), 2.6% (CI 1.3-5.1), 3.8% (CI 1.5-9.2) and 1.7% (CI 0.4-6.8) with no significant differences between groups (p = 0.79). The 10-year cumulative reoperation rates were 2.7% (CI 0.8-8.2), 3.8% (CI 2.2-6.6), 5.2% (CI 2.5-10.7) and 1.7% (CI 0.4-6.8) with no significant differences between groups (p = 0.44). The 10-year median Oxford Knee Score were 43.0, 46.0, 44.0 and 38.0 respectively. CONCLUSION Cementless mobile-bearing UKR has low 10-year reoperation and revision rates across in all BMI groups, and there are no significant differences between the groups. Although higher BMI groups had slightly worse functional outcomes, the improvement in function compared to preoperatively tended to be better. This study suggests that BMI should not be considered a contraindication for the cementless mobile-bearing UKR.
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20
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Mohammad HR, Judge A, Murray DW. The Effect of Age on the Relative Outcomes of Cemented and Cementless Mobile-Bearing Unicompartmental Knee Arthroplasty, Based on Data From National Databases. J Arthroplasty 2023; 38:30-36.e1. [PMID: 35952853 DOI: 10.1016/j.arth.2022.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 07/27/2022] [Accepted: 08/02/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Unicompartmental knee arthroplasty (UKA) is an effective treatment for medial compartment arthritis. A challenge is that patients requiring knee arthroplasty are becoming younger. It is currently unknown what the relative performances of cemented and cementless UKAs are, in different age groups. METHODS A total of 12,882 cemented and cementless UKAs from the National Joint Registry and Hospital Episodes Statistics databases were matched on patient and surgical factors. Patients were stratified into 3 groups: (1) <60 years; (2) 60-69 years; and (3) ≥70 years. Revision and reoperation rates were compared using Cox regression analyses. RESULTS The 10-year implant survival for the matched cemented and cementless UKAs for (1) <60 years were 81.4% (CI 73.6-87.0) and 86.7% (CI 80.7-90.9) (hazard ratio [HR] 0.73, CI 0.56-0.94, P = .02); (2) for 60-69 years were 91.8% (CI 88.9-94.0) and 94.5% (CI 92.9-95.7) (HR 0.90, CI 0.67-1.22, P = .51); and (3) ≥70 years were 93.5% (CI 91.1-95.3) and 94.2% (CI 92.0-95.8) (HR 1.0, CI 0.71-1.40, P = .99). The same trend was observed for reoperations. In the <60 years and 60-69 years groups there were significantly fewer revisions for aseptic loosening in the cementless group (0.5% versus 1.6% [P < .001] and 0.4% versus 1.3% [P = .002], respectively). CONCLUSION Younger ages were associated with higher revision rates in both cemented and cementless UKA groups. Cementless fixation has reduced long-term revision rates compared to cemented fixation in the <60 years group with aseptic loosening rates 3 times lower. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Hasan R Mohammad
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences University of Oxford, Nuffield Orthopaedic Centre, Oxford, United Kingdom; Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Level 1 Learning and Research Building, Southmead Hospital, Bristol, United Kingdom; Barts Bone & Joint Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary, University of London, London, United Kingdom
| | - Andrew Judge
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences University of Oxford, Nuffield Orthopaedic Centre, Oxford, United Kingdom; Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Level 1 Learning and Research Building, Southmead Hospital, Bristol, United Kingdom
| | - David W Murray
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences University of Oxford, Nuffield Orthopaedic Centre, Oxford, United Kingdom
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Grabherr M, Dimitriou D, Schraknepper J, Helmy N, Flury A. Hybrid fixation of unicompartmental knee arthroplasty shows equivalent short-term implant survivorship and clinical scores compared to standard fixation techniques. Arch Orthop Trauma Surg 2022:10.1007/s00402-022-04710-z. [PMID: 36459235 DOI: 10.1007/s00402-022-04710-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 11/22/2022] [Indexed: 12/04/2022]
Abstract
INTRODUCTION There is a paucity of data regarding hybrid-fixated unicompartmental knee arthroplasty (UKA), and no study directly compared all three available fixation techniques (cementless, cemented, and hybrid). The hypothesis was that hybrid fixation might have a lower incidence of radiolucent lines (RLL) than cemented UKA, with equivalent outcomes to uncemented UKA. MATERIALS AND METHODS A total of 104 UKA with a minimal follow-up of 1 year were retrospectively included, of which 40 were cemented, 41 cementless, and 23 hybrid prostheses. The functional outcomes scores included the Oxford Knee (OKS), Subjective Knee (SKS), and Forgotten Joint scores (FJS). RLLs, subsidence, and component positioning were assessed on radiographs. RESULTS At a mean follow-up of 28 months, the survival rate was 95% for cemented UKA and 100% for the cementless and hybrid UKA (n.s.), respectively. Postoperative FJS (93 vs. 82 points, p = 0.007) and SKS (4.7 vs. 4.1 points, p = 0.001) were better in cementless than cemented UKA, with hybrid-fixated UKA in between the two (90 and 4.4 points, n.s.). Improvement of OKS preoperatively to postoperatively did not differ between the groups (n.s.). RLLs were more frequent in cemented (23%) compared to cementless (5%, p = 0.021) and hybrid UKA (9%, n.s.). With an incidence of 12%, subsidence occurred more commonly in cementless UKA compared to cemented (5%) and hybrid (0%) (n.s.) UKA. CONCLUSION Hybrid fixation achieves equivalent results to standard UKA fixation techniques regarding implant survival and functional and radiological outcomes. Therefore, the hybrid fixation technique seems to be a valuable alternative as it combines the advantages of cemented tibial components with those of uncemented femoral components. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Michael Grabherr
- Orthopaedic and Traumatology Department, Bürgerspital Solothurn, Schöngrünstrasse 38, 4500, Solothurn, Switzerland.
| | - Dimitris Dimitriou
- Orthopaedic and Traumatology Department, Bürgerspital Solothurn, Schöngrünstrasse 38, 4500, Solothurn, Switzerland.,Orthopaedic Department, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Johannes Schraknepper
- Orthopaedic and Traumatology Department, Bürgerspital Solothurn, Schöngrünstrasse 38, 4500, Solothurn, Switzerland
| | - Näder Helmy
- Orthopaedic and Traumatology Department, Bürgerspital Solothurn, Schöngrünstrasse 38, 4500, Solothurn, Switzerland
| | - Andreas Flury
- Orthopaedic and Traumatology Department, Bürgerspital Solothurn, Schöngrünstrasse 38, 4500, Solothurn, Switzerland.,Orthopaedic Department, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
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22
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Keppler L, Klingbeil S, Keppler AM, Becker J, Fulghum C, Michel B, Voigts K, Reng W. Impact of keel saw blade design and thickness on the incidence of tibial plateau fracture and tibial implant-loosening in cementless medial UKR. BMC Musculoskelet Disord 2022; 23:597. [PMID: 35729631 PMCID: PMC9210701 DOI: 10.1186/s12891-022-05500-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 05/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tibial plateau fractures and tibial implant- loosening are severe complications in cementless unicompartmental knee replacement (UKR). The tibial keel preparation is particularly demanding and different saw blades can be used. It was hypothesized that different blade designs and thickness have an influence on the frequency of tibial plateau fractures and implant-loosening in cementless medial UKR. METHODS 1258 patients with cementless medial UKR were included in this retrospective study between 2013 and 2020. The tibial keel cut was performed either with a double keel saw blade (DKS; 2.8 mm) and added hand guided pick or a mono reciprocating saw blade (RKB) of different thickness (2.5 mm; 2.65 mm; 2.75 mm). Tibial plateau fracture and loosening were demonstrated by standard two-plane radiographs. Tibial implant-loosening was defined as complete radiolucency and implant migration. Fracture and loosening were combined with pain and loss of function. RESULTS In 126 patients (10%) the tibial keel was prepared with DKS, in 407 patients (32.4%) with RKB 2.5 mm, in 330 patients (26.2%) with RKB 2.65 mm and in 395 patients (31.4%) with 2.75 mm. In 4 patients (3.17%) with DKS tibial plateau fracture occurred, in 4 patients (0.99%) with 2.5 mm RKB, in 3 patients (0.92%) with 2.65 mm RKB and in 1 patient (0.25%) with 2.75 mm RKB. Significantly fewer fractures occurred with a RKB design (p = 0.007). A negative correlation between fracture incidence and RKB saw blade thickness was found (Spearman-r = - 0.93). No difference for tibial implant-loosening was shown (p = 0.51). CONCLUSION Different blade designs and thickness have a significant influence on the incidence of tibial plateau fractures and aseptic tibial implant-loosening. The incidence of tibial plateau fractures in cementless medial UKR can be reduced by changing the design and thickness of the tibial keel saw blade. Greater thickness of RKB leads to significantly fewer tibial plateau fractures while the incidence of implant-loosening is not increasing. TRIAL REGISTRATION This study was retrospectively registered and ethical approval was waived by the local ethical committee (No. 2020-1174).
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Affiliation(s)
- Lena Keppler
- BG Trauma Center Murnau, Trauma Surgery, Prof. Kuentscher Straße 8, 82418, Murnau, Germany
| | - Steffen Klingbeil
- Klinikum Garmisch-Partenkirchen, Endogap, Joint Replacement Institute, Auenstraße 6, 82467, Garmisch-Partenkirchen, Germany
| | - Alexander Martin Keppler
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, 81377, Munich, Germany
| | - Johannes Becker
- Klinikum Garmisch-Partenkirchen, Endogap, Joint Replacement Institute, Auenstraße 6, 82467, Garmisch-Partenkirchen, Germany
| | - Christian Fulghum
- Klinikum Garmisch-Partenkirchen, Endogap, Joint Replacement Institute, Auenstraße 6, 82467, Garmisch-Partenkirchen, Germany
| | - Björn Michel
- Klinikum Garmisch-Partenkirchen, Endogap, Joint Replacement Institute, Auenstraße 6, 82467, Garmisch-Partenkirchen, Germany
| | - Kilian Voigts
- Klinikum Garmisch-Partenkirchen, Endogap, Joint Replacement Institute, Auenstraße 6, 82467, Garmisch-Partenkirchen, Germany
| | - Wolfgang Reng
- Klinikum Garmisch-Partenkirchen, Endogap, Joint Replacement Institute, Auenstraße 6, 82467, Garmisch-Partenkirchen, Germany.
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23
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Medium term results of the cementless Oxford mobile bearing medial unicompartmental knee replacement. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2022; 33:1335-1340. [PMID: 35635590 DOI: 10.1007/s00590-022-03289-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 05/05/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Medial Unicompartmental Knee Replacement (UKR) has well-documented benefits over Total Knee Replacement in the treatment of anteromedial osteoarthritis of the knee. There has been an increasing move from cemented to cementless UKR over the last decade. This non-design centre study assesses the initial experience using the cementless Oxford medial partial knee replacement and provides medium term revision data, as well as Patient Reported Outcome Measures (PROMs). METHODS A cohort of 200 consecutive patients undergoing medial UKR using the cementless Oxford were identified from our knee groups prospectively collected database. Cases were performed in a single centre under the care of one of four surgeons. All patients were beyond the 5-year minimum timepoint following UKR surgery in order to produce medium term results, at a mean of 7.9 years. Eligible patients completed a postal questionnaire to collect PROMs: Oxford Knee Score, WOMAC and modified American Knee Society Score questionnaires in January 2020 and had their clinical records reviewed. RESULTS The survivorship in our cohort was 94.5% at a mean follow up of 7.9 years following surgery. There were 11 re-operations in total with a three percent risk of re-operation within the first 18 months following surgery. There was a sustained improvement in Oxford Knee Score with a near 20 points improvement on pre-operative scores. CONCLUSIONS Our results provide further evidence that partial knee replacements using the cementless Oxford produce good clinical outcomes. Revision rates are similar to those published in the National Joint Registry. LEVEL OF EVIDENCE III.
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The effect of age on the outcomes of cementless mobile bearing unicompartmental knee replacements. Knee Surg Sports Traumatol Arthrosc 2022; 30:928-938. [PMID: 33580344 PMCID: PMC8901511 DOI: 10.1007/s00167-020-06428-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 12/23/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE Unicompartmental Knee Replacements (UKR) are being performed in patients with increasing demands and life expectancies with surgical concerns that cemented fixation will not last. Cementless fixation may offer a solution, but the results in different age groups have not been assessed. The effect of age at surgery on the outcomes of cementless UKRs was investigated. METHODS A prospective cohort of 1000 medial cementless mobile bearing UKR were analysed. Patients were categorised into four age groups (< 55, 55 to < 65, 65 to < 75 and ≥ 75 years). Implant survival was assessed using endpoints reoperation, revision and major revision requiring revision knee replacement components. Functional outcomes were assessed. RESULTS 10 year cumulative revision rate for the < 55, 55 to < 65, 65 to < 75 and ≥ 75 groups were 2.1% (CI 0.6-6.1), 1.8% (CI 0.6-5.3), 3.2% (CI 1.5-6.5) and 4.1% (1.7-9.6) with no differences between groups (p = 0.52). Two of the 22 revisions were considered major. The 10 year cumulative reoperation rates were 4.5% (CI 2.0-10.0), 3.0% (CI 1.3-6.5), 3.8% (CI 2.0-7.1) and 4.1% (CI 1.7-9.6) with no differences between groups (p = 0.81). The 10 year median Oxford Knee Scores were 42.5, 46.5, 45 and 42.5, respectively. The 10 year median Objective American Knee Society Scores were 95 for all age groups. CONCLUSION The cementless mobile bearing UKR has low reoperation and revision rates and similar functional outcomes in all age groups. Cementless UKR should be used in all age groups and age should not be considered a contraindication. LEVEL OF EVIDENCE III.
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25
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Gifstad T, Nordskar JJ, Egeberg T, Wik TS, Winther SB. Cementless unicompartmental knee arthroplasty results in higher pain levels compared to the cemented technique: a prospective register study. Knee Surg Sports Traumatol Arthrosc 2022; 30:2738-2743. [PMID: 34036403 PMCID: PMC9309142 DOI: 10.1007/s00167-021-06617-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 05/18/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE In recent years, the preferred fixation method for unicompartmental knee arthroplasty (UKA) has changed from cemented to cementless. The aim of this study was to compare patient-reported outcome measures (PROMs) from the cemented versus cementless techniques two- and twelve-months post-operation. METHODS From 2015 to 2019, 187 cemented and 261 cementless UKAs were included based on an institutional registry. The Oxford Unicompartmental Knee System™ (Zimmer Biomet, Bridgend, United Kingdom) was used for all patients. Three experienced surgeons performed all procedures. Data were collected pre- and peroperatively, and at two- and twelve-months postoperatively. PROMs included pain (evaluated on a numeric rating scale [NRS] during activity and at rest), and knee function (evaluated with the disease-specific short form of the Knee injury and Osteoarthritis Outcome Score [KOOS-PS]). Patients also rated postoperative joint function (better, unchanged, uncertain or worse) and were asked, "based on your experience to date, would you go through the surgery again?". Duration of surgery was noted and revisions during the first post-operative year were evaluated. RESULTS The cemented group reported significantly lower activity-related pain at both two- and twelve-month follow-up. This was also the case for pain at rest at twelve-month follow-up, and KOOS-PS at two-month follow-up. Duration of surgery (adjusted for surgeon differences) was eight minutes less on average with the cementless technique. Eleven prosthetic joint infections (PJIs) were found following the cementless fixation technique compared to three using the cemented implant. CONCLUSION UKA cases with cemented implants had lower pain scores during activity two and twelve months after surgery compared with those who had cementless implants. Differences in favor of the cemented group were also found for pain at rest one year after surgery and for KOOS-PS two months after. Surgery was significantly shorter in duration in the cementless group, but a relatively high number of PJIs were found in that same group. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Tone Gifstad
- Department of Orthopaedics, Trondheim University Hospital, Postbox 3250, NO 7006, Torgarden, Trondheim, Norway.
- Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Jørgen Jebens Nordskar
- Department of Orthopaedics, Trondheim University Hospital, Postbox 3250, NO 7006, Torgarden, Trondheim, Norway
| | - Tarjei Egeberg
- Department of Orthopaedics, Trondheim University Hospital, Postbox 3250, NO 7006, Torgarden, Trondheim, Norway
| | - Tina Strømdal Wik
- Department of Orthopaedics, Trondheim University Hospital, Postbox 3250, NO 7006, Torgarden, Trondheim, Norway
- Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Siri Bjørgen Winther
- Department of Orthopaedics, Orthopaedic Research Center, Trondheim University Hospital, Trondheim, Norway
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Good mid- to long-term results of the cemented oxford phase 3 unicompartmental knee arthroplasty in a non-designer centre. Knee Surg Sports Traumatol Arthrosc 2022; 30:3215-3219. [PMID: 34251470 PMCID: PMC9418077 DOI: 10.1007/s00167-021-06665-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 07/04/2021] [Indexed: 11/02/2022]
Abstract
PURPOSE Unicompartmental knee arthroplasty (UKA) provides patients with an alternative treatment to TKA in isolated medial compartment osteoarthritis providing better functional outcomes and faster recovery in the short term. Our aim was to quantify revision rates, predictors of revision, mortality rate and functionality of the Oxford Phase 3 UKA in a non-designer institution. METHODS This was a retrospective review of prospectively collected regional registry data. All Oxford Phase 3 UKAs performed for medial tibio-femoral osteoarthritis of the knee joint were included from a single academic institution between the period of January 1st 2006 and December 30th 2009. Kaplan-Meier survivorship curves adjusting for loss to follow-up and deceased patients were generated. Primary outcome variables included all-cause and aseptic revision. Secondary outcome variables included functional outcome scores. Patients were reviewed at 6 months, 2 years, 5 years, 10 years and 15 years. RESULTS A total of 64 cemented Oxford phase 3 UKAs were performed between January 2006 and November 2009. Fifteen-year follow-up data were available for 51 patients, of these 12 required revision. Survival rates, adjusting for patients that were either lost to follow-up or deceased, were 87.5% at 5 years, 81.4% at 10 years and 76.4% at 15 years. The overall aseptic revision rate at the time of review was 18.75% (n = 12). The only significant predictor of postoperative WOMAC score at 15 years was the preoperative WOMAC score (p = 0.03). CONCLUSION The Oxford Phase 3 UKA for medial tibio-femoral arthritis has promising outcomes at 15-year follow-up with a survival rate of 76.4% in a non-designer centre. LEVEL OF EVIDENCE III.
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Martin B, Rahman A, Jenkins C, Mohammad H, Barker K, Dodd C, Jackson W, Price A, Mellon S, Murray D. Comparison of five-year clinical outcomes of 524 cemented and cementless medial unicompartmental knee replacements. Knee 2022; 34:89-97. [PMID: 34883332 DOI: 10.1016/j.knee.2021.08.015] [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: 03/03/2021] [Revised: 07/08/2021] [Accepted: 08/13/2021] [Indexed: 02/02/2023]
Abstract
AIM To compare the outcomes of cemented and cementless Unicompartmental Knee Replacements (UKR) at 5 years after surgery. METHODS 262 cemented and 262 cementless medial mobile-bearing UKR, implanted by four high-volume surgeons using identical indications and surgical techniques, were reviewed by independent physiotherapists at 5 years. Survival, Oxford Knee Score (OKS), American Knee Society Score (AKSS), and EQ-5D-5L were assessed. The cementless cohort was mainly implanted after the cemented. Each cohort was divided into early and late sub-groups and compared, to assess if any differences were due to progressive improvement in surgical practice over time. RESULTS There were no significant differences between the cohorts for demographics, pre-operative scores, and 5-year revision (0.8%), re-operation (1.5%), and complication rates (5%). The cementless cohort had significantly better 5-year OKS (43v41, p = 0.008), AKSS-Objective (94v90, p = 0.049) and EQ-5D-5L (0.81v0.87, p = 0.0001). Pain sub-scores within OKS, AKSS, and EQ-5D-5L were also significantly better in the cementless cohort, and the differences were proportionally much greater and more significant than differences in their respective overall scores. There was no significant improvement in scores between the early and late subgroups of the cohorts, whereas the 'early-cementless' cohort had significantly better scores than the contemporaneously implanted 'late-cemented' cohort. This suggests that differences found were due to implant type, instead of improved surgical practice over time. CONCLUSION Cementless UKR is associated with better clinical outcomes than cemented UKR, which is primarily due to improved pain relief. Both cemented and cementless UKR are safe with low reoperation and complication rates, and a 5-year survival of 99%.
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Affiliation(s)
- Benjamin Martin
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Azmi Rahman
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom.
| | - Cathy Jenkins
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Hasan Mohammad
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Karen Barker
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Christopher Dodd
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - William Jackson
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Andrew Price
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Stephen Mellon
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - David Murray
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
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Beckers L, Dandois F, Ooms D, Berger P, Van Laere K, Scheys L, Vandenneucker H. Assessment of in vivo bone activity patterns in medial mobile-bearing unicompartmental knee arthroplasty : a prospective SPECT/CT study. Bone Joint J 2022; 104-B:34-44. [PMID: 34969270 DOI: 10.1302/0301-620x.104b1.bjj-2021-0121.r2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
AIMS Higher osteoblastic bone activity is expected in aseptic loosening and painful unicompartmental knee arthroplasty (UKA). However, insights into normal bone activity patterns after medial UKAs are lacking. The aim of this study was to identify the evolution in bone activity pattern in well-functioning medial mobile-bearing UKAs. METHODS In total, 34 patients (13 female, 21 male; mean age 62 years (41 to 79); BMI 29.7 kg/m2 (23.6 to 42.1)) with 38 medial Oxford partial UKAs (20 left, 18 right; 19 cementless, 14 cemented, and five hybrid) were prospectively followed with sequential 99mTc-hydroxymethane diphosphonate single photon emission CT (SPECT)/CT preoperatively, and at one and two years postoperatively. Changes in mean osteoblastic activity were investigated using a tracer localization scheme with volumes of interest (VOIs), reported by normalized mean tracer values. A SPECT/CT registration platform additionally explored cortical tracer evolution in zones of interest identified by previous experimental research. RESULTS Significant reduction of tracer activity from the preoperative situation was found in femoral and anteromedial tibial VOIs adjacent to the UKA components. Temporarily increased osteoblastic bone activity was observed in VOIs comprising the UKA keel structure at one year postoperatively compared to the preoperative activity. Persistent higher tracer uptake was found in the posterior tibial cortex at final follow-up. Multivariate analysis showed no statistical difference in osteoblastic bone activity underneath cemented or cementless components. CONCLUSION Well-functioning medial mobile-bearing UKAs showed distinct changes in patterns of normalized bone tracer activity in the different VOIs adjacent to the prosthetic components, regardless of their type of fixation. Compared to the preoperative situation, persistent high bone activity was found underneath the keel and the posterior tibial cortex at final follow-up, with significant reduced activity only being identified in femoral and anteromedial tibial VOIs. Cite this article: Bone Joint J 2022;104-B(1):34-44.
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Affiliation(s)
- Lucas Beckers
- KULeuven/University Hospitals Leuven, Institute for Orthopaedic Research and Training (IORT), Leuven, Belgium
| | - Félix Dandois
- KULeuven/University Hospitals Leuven, Institute for Orthopaedic Research and Training (IORT), Leuven, Belgium
| | - Dirk Ooms
- Department of Nuclear Medicine and Molecular Imaging, Katholieke Universiteit Leuven Universitaire Ziekenhuizen Leuven, Leuven, Belgium.,Department of Nuclear Medicine, OLV Ziekenhuis Campus Aalst, Aalst, Belgium
| | - Pieter Berger
- KULeuven/University Hospitals Leuven, Institute for Orthopaedic Research and Training (IORT), Leuven, Belgium
| | - Koen Van Laere
- Department of Nuclear Medicine and Molecular Imaging, Katholieke Universiteit Leuven Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | - Lennart Scheys
- KULeuven/University Hospitals Leuven, Institute for Orthopaedic Research and Training (IORT), Leuven, Belgium
| | - Hilde Vandenneucker
- KULeuven/University Hospitals Leuven, Institute for Orthopaedic Research and Training (IORT), Leuven, Belgium
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RSA migration of unicondylar knee arthroplasties is comparable to migration of total knee arthroplasties: A meta-analysis. J ISAKOS 2021; 7:17-23. [DOI: 10.1016/j.jisako.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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30
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Mohammad HR, Bullock GS, Kennedy JA, Mellon SJ, Murray D, Judge A. Cementless unicompartmental knee replacement achieves better ten-year clinical outcomes than cemented: a systematic review. Knee Surg Sports Traumatol Arthrosc 2021; 29:3229-3245. [PMID: 32613336 DOI: 10.1007/s00167-020-06091-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 06/03/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE The aim of this study was to report and compare the long-term revision rate, revision indications and patient reported outcome measures of cemented and cementless unicompartmental knee replacements (UKR). METHODS Databases Medline, Embase and Cochrane Central of Controlled Trials were searched to identify all UKR studies reporting the ≥ 10 year clinical outcomes. Revision rates per 100 component years [% per annum (% pa)] were calculated by fixation type and then, subgroup analyses for fixed and mobile bearing UKRs were performed. Mechanisms of failure and patient reported outcome measures are reported. RESULTS 25 studies were eligible for inclusion with a total of 10,736 UKRs, in which there were 8790 cemented and 1946 cementless knee replacements. The revision rate was 0.73% pa (CI 0.66-0.80) and 0.45% pa (CI 0.34-0.58) per 100 component years, respectively, with the cementless having a significantly (p < 0.001) lower overall revision rate. Therefore, based on these studies, the expected 10-year survival of cementless UKR would be 95.5% and cemented 92.7%. Subgroup analysis revealed this difference remained significant for the Oxford UKR (0.37% pa vs 0.77% pa, p < 0.001), but for non-Oxford UKRs there were no significant differences in revision rates of cemented and cementless UKRs (0.57% pa vs 0.69% pa, p = 0.41). Mobile bearing UKRs had significantly lower revision rates than fixed bearing UKRs in cementless (p = 0.001), but not cemented groups (p = 0.13). Overall the revision rates for aseptic loosening and disease progression were significantly lower (p = 0.02 and p = 0.009 respectively) in the cementless group compared to the cemented group (0.06 vs 0.13% pa and 0.10 vs 0.21% pa respectively). CONCLUSIONS Cementless fixation had reduced long-term revision rates compared to cemented for the Oxford UKR. For the non-Oxford UKRs, the revision rates of cementless and cemented fixation types were equivalent. Therefore, cementless UKRs offer at least equivalent if not lower revision rates compared to cemented UKRs. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Hasan R Mohammad
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, OX3 7LD, UK. .,Musculoskeletal Research Unit, Bristol Medical School, Level 1 Learning and Research Building, Southmead Hospital, University of Bristol, Westbury-On-Trym, Bristol, BS10 5NB, UK.
| | - Garrett S Bullock
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, OX3 7LD, UK
| | - James A Kennedy
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, OX3 7LD, UK
| | - Stephen J Mellon
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, OX3 7LD, UK
| | - David Murray
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, OX3 7LD, UK
| | - Andrew Judge
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, OX3 7LD, UK.,Musculoskeletal Research Unit, Bristol Medical School, Level 1 Learning and Research Building, Southmead Hospital, University of Bristol, Westbury-On-Trym, Bristol, BS10 5NB, UK
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31
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Veizi E, Çay N, Güven Ş, Şahin A, Fırat A, Kılıçarslan K. Plain Radiographs Can Safely Be Used to Measure and Follow Up on Tibial Component Alignment in Unicondylar Knee Replacement: A Correlation Study With CT Scans. Cureus 2021; 13:e16902. [PMID: 34513475 PMCID: PMC8418210 DOI: 10.7759/cureus.16902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2021] [Indexed: 11/05/2022] Open
Abstract
Background and objective Unicondylar knee replacement (UKR) is one of the most frequently performed arthroplastic operations worldwide. Migration and subsidence regarding the tibial component of UKR is a well-known phenomenon. In this study, we aimed to analyze whether plain radiographs are a reliable means to measure the true coronal and sagittal alignment of the UKR’s tibial component. Methods Patients undergoing a UKR procedure at our center between December 2020 and March 2011 were eligible for this study. Inclusion criteria were as follows: the presence of well-aligned standard and reproducible anteroposterior and lateral X-rays taken one week before or after a low-radiation artifact-reduced CT scan. Sixty-six knees were included in the study. Coronal and sagittal alignment of the tibial component was measured in a standard manner by two observers on both X-rays and CT scans. A correlation analysis was performed, and the margin of error was established. Results Intra-observer reliability was high among the two observers whether for X-ray or CT scan measurements [intraclass correlation coefficient (ICC): >0.900]. On the other hand, coronal plane measurements had lower inter-observer ICC values on both X-rays and CT scans while reliability on the sagittal plane was higher. There was a high correlation between radiographic measurements on X-rays and CT scans on both planes. Conclusion Even though the measurements on plain radiographs were slightly different from the ones obtained from CT scans, the correlation between them was very strong. Caution should be exercised when measuring the coronal alignment of the tibial implant on X-rays since it is more frequently affected by rotational misalignment.
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Affiliation(s)
- Enejd Veizi
- Orthopedics and Traumatology, Ankara City Hospital, Ankara, TUR
| | - Nurdan Çay
- Radiology, Ankara City Hospital, Ankara, TUR
| | - Şahan Güven
- Orthopedics and Traumatology, Ankara City Hospital, Ankara, TUR
| | - Ali Şahin
- Orthopedics and Traumatology, Ankara City Hospital, Ankara, TUR
| | - Ahmet Fırat
- Orthopedics and Traumatology, Ankara City Hospital, Ankara, TUR
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32
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No Clinical or Radiographic Differences Between Cemented Cobalt-Chromium and Titanium-Niobium Nitride Mobile-Bearing Unicompartmental Knee Arthroplasty. Indian J Orthop 2021; 55:1195-1201. [PMID: 34824720 PMCID: PMC8586226 DOI: 10.1007/s43465-021-00486-3] [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: 06/01/2021] [Accepted: 08/10/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE This study aimed to compare the clinical and radiographic outcomes of patients with positive patch tests undergoing a medial mobile-bearing titanium-niobium nitride (TiNbN) unicompartmental knee arthroplasty (UKA) to patients undergoing standard UKA (cobalt-chromium [CoCr] implants). METHODS Two successive groups of patients, amounting to a total of 246 individuals, who received Oxford (Zimmer-Biomet, Warsaw, Indiana, USA) UKA were included. The first group was composed of a series of 203 consecutive standard CoCr UKAs (Standard Group), while the second group comprised 43 consecutive hypoallergenic TiNbN UKAs (HA group). The patients of the second group had a positive epicutaneous patch test result for metals. Each patient was evaluated using the Oxford Knee Score (OKS) and Knee Society Score (KSS) a day prior to the surgery (T 0) and at two consecutive follow-ups, namely T 1 (minimum follow-up of 12 months) and T 2 (minimum follow-up of 34 months). Radiographic measurements were performed at the final follow-up (T 2). RESULTS No statistical differences were noted between the two groups regarding demographic data (p > 0.05). No clinical or radiographic differences were found between the HA and standard groups at any follow-up (p > 0.05). A statistically significant improvement was found at any follow-up for both OKS and KSS (p < 0.05). CONCLUSIONS No clinical or radiographic differences between the hypoallergenic and standard cobalt-chromium groups at any follow-up were found, with a clinically significant improvement being experienced by both groups during the entire follow-up. LEVEL OF EVIDENCE Level II-comparative prospective study. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s43465-021-00486-3.
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33
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Barrett MC, Wilkinson FO, Blom AW, Whitehouse MR, Kunutsor SK. Incidence, temporal trends and potential risk factors for aseptic loosening following primary unicompartmental knee arthroplasty: A meta-analysis of 96,294 knees. Knee 2021; 31:28-38. [PMID: 34111799 DOI: 10.1016/j.knee.2021.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 03/23/2021] [Accepted: 04/09/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Aseptic loosening (AL) is among the major reasons for revision of failed primary unicompartmental knee arthroplasty (UKA). There is an ongoing temporal increase in the use of UKA with a resultant increase in the revision burden. We aimed to evaluate the incidence of, temporal trends and risk factors for AL. METHODS Longitudinal studies reporting the incidence of AL following primary UKA were sought from MEDLINE, Embase, Web of Science and Cochrane Library up to 6th April 2020. Incidence and relative risks (RR) (with 95% confidence intervals) were calculated. RESULTS We identified 62 studies for inclusion. Overall, 96,294 primary UKA procedures accounting for 1752 AL cases were included. AL incidence ranged from 0.00% to 22.70% over a 7.7 year weighted mean follow-up. The pooled random effects incidence (95% CI) was 1.77% (1.34-2.25) in the same follow-up period. The annual rate of AL was 0.10% (0.02-0.22). AL incidence increased with length of follow-up, but there was a temporal decrease from the 1970s onwards. Tibial loosening was more common than femoral component loosening: incidence (95% CI) of 1.63% (0.96-2.44) and 0.58% (0.20-1.09) respectively over a weighted follow-up of 6.6 years. Fixed bearing implant design and cemented fixation were both associated with increased AL risk, whereas robotic-assisted surgery was associated with decreased risk. CONCLUSION The overall incidence of AL following primary UKA is primarily driven by tibial component loosening and there is a temporal decline in rates. The use of mobile bearing, uncemented implants inserted with robotic assisted surgery may reduce the risk of AL.
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Affiliation(s)
- Matthew C Barrett
- Barts and The London School of Medicine and Dentistry, 4 Newark St, Whitechapel, London E1 2AT, UK.
| | - Florence O Wilkinson
- Barts and The London School of Medicine and Dentistry, 4 Newark St, Whitechapel, London E1 2AT, UK
| | - Ashley W Blom
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK; Translational Health Sciences, Bristol Medical School, Musculoskeletal Research Unit, University of Bristol, Learning & Research Building (Level 1), Southmead Hospital, Bristol BS10 5NB, UK
| | - Michael R Whitehouse
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK; Translational Health Sciences, Bristol Medical School, Musculoskeletal Research Unit, University of Bristol, Learning & Research Building (Level 1), Southmead Hospital, Bristol BS10 5NB, UK
| | - Setor K Kunutsor
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK; Translational Health Sciences, Bristol Medical School, Musculoskeletal Research Unit, University of Bristol, Learning & Research Building (Level 1), Southmead Hospital, Bristol BS10 5NB, UK
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34
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Burger JA, Zuiderbaan HA, Sierevelt IN, van Steenbergen L, Nolte PA, Pearle AD, Kerkhoffs GMMJ. Risk of revision for medial unicompartmental knee arthroplasty according to fixation and bearing type : short- to mid-term results from the Dutch Arthroplasty Register. Bone Joint J 2021; 103-B:1261-1269. [PMID: 34192933 DOI: 10.1302/0301-620x.103b7.bjj-2020-1224.r3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
AIMS Uncemented mobile bearing designs in medial unicompartmental knee arthroplasty (UKA) have seen an increase over the last decade. However, there are a lack of large-scale studies comparing survivorship of these specific designs to commonly used cemented mobile and fixed bearing designs. The aim of this study was to evaluate the survivorship of these designs. METHODS A total of 21,610 medial UKAs from 2007 to 2018 were selected from the Dutch Arthroplasty Register. Multivariate Cox regression analyses were used to compare uncemented mobile bearings with cemented mobile and fixed bearings. Adjustments were made for patient and surgical factors, with their interactions being considered. Reasons and type of revision in the first two years after surgery were assessed. RESULTS In hospitals performing less than 100 cases per year, cemented mobile bearings reported comparable adjusted risks of revision as uncemented mobile bearings. However, in hospitals performing more than 100 cases per year, the adjusted risk of revision was higher for cemented mobile bearings compared to uncemented mobile bearings (hazard ratio 1.78 (95% confidence interval 1.34 to 2.35)). The adjusted risk of revision between cemented fixed bearing and uncemented mobile bearing was comparable, independent of annual hospital volume. In addition, 12.3% of uncemented mobile bearing, 20.3% of cemented mobile bearing, and 41.5% of uncemented fixed bearing revisions were for tibial component loosening. The figures for instability were 23.6%, 14.5% and 11.7%, respectively, and for periprosthetic fractures were 10.0%, 2.8%, and 3.5%. Bearing exchange was the type of revision in 40% of uncemented mobile bearing, 24.3% of cemented mobile bearing, and 5.3% cemented fixed bearing revisions. CONCLUSION The findings of this study demonstrated improved survival with use of uncemented compared to cemented mobile bearings in medial UKA, only in those hospitals performing more than 100 cases per year. Cemented fixed bearings reported comparable survival results as uncemented mobile bearings, regardless of the annual hospital volume. The high rates of instability, periprosthetic fractures, and bearing exchange in uncemented mobile bearings emphasize the need for further research. Cite this article: Bone Joint J 2021;103-B(7):1261-1269.
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Affiliation(s)
- Joost A Burger
- Department of Orthopaedic Surgery and Computer Assisted Surgery Center, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, USA
| | | | - Inger N Sierevelt
- Department of Orthopaedic Surgery, Spaarne Gasthuis, Hoofddorp, Netherlands.,Specialized Centre of Orthopedic Research and Education (SCORE), Xpert Orthopedics, Amsterdam, Netherlands
| | | | - Peter A Nolte
- Department of Orthopaedic Surgery, Spaarne Gasthuis, Hoofddorp, Netherlands
| | - Andrew D Pearle
- Department of Orthopaedic Surgery and Computer Assisted Surgery Center, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, USA
| | - Gino M M J Kerkhoffs
- Department of Orthopedic Surgery, Amsterdam Movement Sciences (AMS), Amsterdam University Medical Centers, Amsterdam, Netherlands
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35
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Xue L, Xue H, Wen T, Guan M, Yang T, Ma T, Tu Y. Assessment of radiolucent lines in patients with lateral unicompartmental knee arthroplasty and the relationship between these lines and the outcome. INTERNATIONAL ORTHOPAEDICS 2021; 45:2017-2023. [PMID: 34173848 DOI: 10.1007/s00264-021-05115-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 06/14/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To assess the radiolucent lines (RLLs) around both tibial and femoral components in patients following lateral unicompartmental knee arthroplasty (UKA). METHODS We performed a retrospective review of the records of a consecutive series of patients who had undergone lateral UKA. The RLLs were assessed with standard anteroposterior and lateral radiographs post-operatively. The patient-reported outcome measures included the Hospital for Special Surgery (HSS) score and Oxford knee score (OKS). The femoral component position (FCP) and femoral-tibial angle (FTA) were also recorded. RESULTS A total of 198 UKAs that had appropriate radiographs and outcome scores were reviewed with a median follow-up of 33 (range, 12-71) months. The results suggested that 69 cases (34.8%) had RLLs on the standard radiographs. The incidence rates of femoral and tibial physiological RLLs were 11.6% (23/198) and 26% (52/198), respectively, of which 3% (6/198) concerned both components. All RLLs were considered "physiologic lines" that developed within one year after surgery. There were no significant differences among the types of RLLs in any of the outcome measures. No differences in FCP (P = .359) or FTA (P = .111) at the last follow-up were seen. CONCLUSIONS It was found that one-third of UKAs had RLLs on radiographs following lateral UKA. All RLLs developed within one year after surgery. As a clinical consequence, the development of RLLs does not affect the short-term outcomes after lateral UKA.
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Affiliation(s)
- Long Xue
- Department of Orthopaedics, Yangpu Hospital Affiliated to Tongji University School of Medicine, 450 Tengyue Road, Shanghai, 200090, China
| | - Huaming Xue
- Department of Orthopaedics, Yangpu Hospital Affiliated to Tongji University School of Medicine, 450 Tengyue Road, Shanghai, 200090, China
| | - Tao Wen
- Department of Orthopaedics, Yangpu Hospital Affiliated to Tongji University School of Medicine, 450 Tengyue Road, Shanghai, 200090, China
| | - Mengying Guan
- Department of Orthopaedics, Yangpu Hospital Affiliated to Tongji University School of Medicine, 450 Tengyue Road, Shanghai, 200090, China
| | - Tao Yang
- Department of Orthopaedics, Yangpu Hospital Affiliated to Tongji University School of Medicine, 450 Tengyue Road, Shanghai, 200090, China
| | - Tong Ma
- Department of Orthopaedics, Yangpu Hospital Affiliated to Tongji University School of Medicine, 450 Tengyue Road, Shanghai, 200090, China
| | - Yihui Tu
- Department of Orthopaedics, Yangpu Hospital Affiliated to Tongji University School of Medicine, 450 Tengyue Road, Shanghai, 200090, China.
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36
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Ma J, Yan Y, Wang W, Wang B, Yue D, Guo W. Lower early revision rates after uncemented Oxford Unicompartmental Knee Arthroplasty (UKA) than cemented Oxford UKA: A meta-analysis. Orthop Traumatol Surg Res 2021; 107:102802. [PMID: 33429085 DOI: 10.1016/j.otsr.2021.102802] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/22/2020] [Accepted: 08/18/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND UKA has been proved to offer good results in treating patients with unicompartmental knee osteoarthritis (OA). However, there is still a controversy about the better fixation mode in UKA procedure between cemented and uncemented prosthesis. Therefore, this meta-analysis was conducted to compare clinical and radiological outcomes of cemented versus uncemented Oxford UKA. HYPOTHESIS The study surmised that uncemented Oxford UKA was associated with shorter operation time, higher function scores, lower revision rate and less radiolucency than cemented Oxford UKA. METHODS A meta-analysis to compare postoperative outcomes between cemented and uncemented Oxford UKA wsa conducted. The primary outcomes included Oxford knee score (OKS), revision rate, and incidence of radiolucency. The secondary outcomes included operation time, knee society score (KSS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), range of motion (ROM). PubMed, Embase, Web of Science, the Cochrane Library and China national knowledge infrastructure were searched until April, 2020 to identify studies for including. Relevant data were analyzed using RevMan v5.3. RESULTS We identified nine studies involving 901 patients meeting our inclusion criteria. No significant difference of OKS was found in both groups. Compared with cemented group, uncemented Oxford UKA group was associated with lower revision rate (95% CI: 0.90 to 3.73; OR=1.83) and less radiolucent lines (95% CI: 0.79 to 9.52; OR=2.75) after following up for at least 2years. The operation time was significantly shorter by 10.12minutes (95% CI: p<0.00001) in the uncemented group when compared against the cemented group. The KSS, WOMAC, ROM were not significantly different between two groups. CONCLUSIONS Uncemented Oxford UKA had lower revision rate, shorter operation time and less radiolucent lines than cemented Oxford UKA did. There is still need for more long follow-up clinical trials with high evidence level to determine which method of fixation is of preferable for Oxford UKA in the future. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Jinhui Ma
- Department of Orthopaedic Surgery, Center for Osteonecrosis and Joint Preserving & Reconstruction, China-Japan Friendship Hospital, 2 Yinghuadong Road, Chaoyang District, Beijing 100029, China
| | - Yan Yan
- Department of Orthopaedic Surgery, Peking University China-Japan Friendship School of Clinical Medicine, Beijing 100029, China
| | - Weiguo Wang
- Department of Orthopaedic Surgery, Center for Osteonecrosis and Joint Preserving & Reconstruction, China-Japan Friendship Hospital, 2 Yinghuadong Road, Chaoyang District, Beijing 100029, China
| | - Bailiang Wang
- Department of Orthopaedic Surgery, Center for Osteonecrosis and Joint Preserving & Reconstruction, China-Japan Friendship Hospital, 2 Yinghuadong Road, Chaoyang District, Beijing 100029, China.
| | - Debo Yue
- Department of Orthopaedic Surgery, Center for Osteonecrosis and Joint Preserving & Reconstruction, China-Japan Friendship Hospital, 2 Yinghuadong Road, Chaoyang District, Beijing 100029, China
| | - Wanshou Guo
- Department of Orthopaedic Surgery, Center for Osteonecrosis and Joint Preserving & Reconstruction, China-Japan Friendship Hospital, 2 Yinghuadong Road, Chaoyang District, Beijing 100029, China
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37
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Veizi E, Fırat A, Tecimel O, Çepni Ş, Subaşı İÖ, Kılıçarslan K. The Change in Posterior Tibial Slope After Cementless Unicondylar Knee Arthroplasty. J Arthroplasty 2021; 36:1784-1791. [PMID: 33478893 DOI: 10.1016/j.arth.2020.12.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 12/14/2020] [Accepted: 12/22/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The posterior tibial slope (PTS) is an important factor in patients undergoing unicondylar knee arthroplasty. It is an area subjected to high shear and compressive forces. Our objective is to investigate the changes taking place on the tibial slope of cementless unicondylar knee arthroplasties and define its relationship with functional scores. METHODS Patients undergoing a cementless unicondylar knee arthroplasty between January 2011 and July 2019 were selected. Exclusion criteria were lack of at least 1 year of follow up, loss to follow-up for any reason, and revision of a metallic component. Overall, 161 cases were included. Patients were analyzed using standard radiographs for changes in PTS, coronal positioning of the implant, and overhanging. Function was analyzed using Oxford Knee Score, Tegner Activity Scale, and Knee Society Score. Changes of the PTS were analyzed for statistical significance and for correlations with all the other variables. RESULTS All postoperative functional scores showed significant improvement (P < .05). Compared to the early postoperative values, increases of ≤5° were detected in 79% of all patients. The greater amount of slope change occurred during the first 6 months postoperatively. Statistical analysis revealed no significant relationship with functional scores of the knee, age, body mass index, overhanging, and coronal alignment of the tibial component. CONCLUSION This study showed that, with time, minimal changes take place in the PTS of cementless unicondylar knee arthroplasty. The change mostly takes place during the first 6 months. These changes do not affect functional scores.
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Affiliation(s)
- Enejd Veizi
- Department of Orthopedics and Traumatology, Ankara City Hospital, Ankara, Turkey
| | - Ahmet Fırat
- Department of Orthopedics and Traumatology, Ankara City Hospital, Ankara, Turkey
| | - Osman Tecimel
- Department of Orthopedics and Traumatology, Ankara City Hospital, Ankara, Turkey
| | - Şahin Çepni
- Department of Orthopedics and Traumatology, Ankara City Hospital, Ankara, Turkey
| | - İzzet Özay Subaşı
- Department of Orthopedics and Traumatology, Ankara City Hospital, Ankara, Turkey
| | - Kasım Kılıçarslan
- Department of Orthopedics and Traumatology, Ankara City Hospital, Ankara, Turkey
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Seth A, Dobransky J, Albishi W, Dervin GF. Mid-Term Evaluation of the Unicompartmental Knee Arthroplasty in Patients with BMI of 40 or Greater. J Knee Surg 2021; 34:427-433. [PMID: 31505699 DOI: 10.1055/s-0039-1696735] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Limited evidence is available on mid-term follow-up for patients with body mass index (BMI) ≥ 40 receiving a unicompartmental knee arthroplasty (UKA). The primary objective of this study was to investigate survival of the UKA in patients with BMI ≥ 40. Secondary objectives were to assess functional and patient reported outcome measures (PROMs). Survival analysis with endpoint revision of any component for any reason was conducted using Kaplan-Meier technique on 121 knees (103 patients) that underwent UKA with Oxford Phase 3 implant (Oxford Knee, Biomet, Swindon, United Kingdom) between September 2001 and March 2014 by seven surgeons. Survivorship differences were compared using Log Rank (Mantel-Cox) tests, and Cox Proportional Hazard Model was used to assess predictors of failure. Preoperative PROMs were compared at 2 and 5 years postoperatively using paired t-tests. Mean age of patients was 58 years (43-75), mean BMI 43 kg/m2 (40-51), and mean follow-up 7 years (2 months to 15 years). Survival rate for the whole cohort was 92% at 2 years and 86% at 5 years. Females had a significantly higher revision rate than males (p = 0.043). A total of 19 knees required revision (16 to TKA, 2 polyethylene liner exchanges, and 1 femoral component and liner revision). With respect to PROMs, there was a significant improvement at 2 and 5 years (p < 0.001) on 4 of 5 knee injury and osteoarthritis outcome score subscales. The mid-term survival rate for the Oxford UKA in patients with morbid obesity is similar to that of other nondesigner patient series with BMI ≥ 30, which provides further evidence for the safety of the implant in this patient population with significant improvements on PROMs at short and mid-term follow-up.
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Affiliation(s)
- Akshay Seth
- Division of Orthopaedic Surgey, The Ottawa Hospital, General Campus, Ottawa, Ontario, Canada
| | - Johanna Dobransky
- Division of Orthopaedic Surgey, The Ottawa Hospital, General Campus, Ottawa, Ontario, Canada
| | - Waleed Albishi
- Division of Orthopaedic Surgey, The Ottawa Hospital, General Campus, Ottawa, Ontario, Canada
| | - Geoffrey F Dervin
- Division of Orthopaedic Surgey, The Ottawa Hospital, General Campus, Ottawa, Ontario, Canada
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Low polyethylene creep and wear following mobile-bearing unicompartmental knee replacement. Knee Surg Sports Traumatol Arthrosc 2021; 29:3433-3442. [PMID: 32940731 PMCID: PMC8458199 DOI: 10.1007/s00167-020-06243-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 08/14/2020] [Indexed: 11/03/2022]
Abstract
PURPOSE The Oxford unicompartmental knee replacement (UKR) has a fully congruent mobile bearing to minimise wear. However, with younger higher demand patients, wear remains a concern. The aim of this study was to quantify the wear rate of Phase 3 Oxford UKR bearings over the course of 5 years and to identify the factors that influence it. METHODS 40 medial Oxford UKRs recruited for a randomised study of cemented and cementless fixation were studied with Radiostereometric analysis (RSA) at 1 week, 3 months, 6 months, 1 year, 2 years, and 5 years post-operatively and bearing thickness was calculated. Penetration, defined as the change in thickness compared to the 1-week measurement, was determined. Creep (early penetration) and wear (late penetration at a constant rate) were calculated. The influence of demographic factors, Oxford Knee Score (OKS), Tegner score, fixation and bearing overhang (determined by RSA) on wear was analysed. RESULTS After 6 months the penetration rate was constant, indicating that wear alone was occurring. The wear rate was 0.07 mm/year (SD 0.03). The creep was 0.06 mm with about 95% occurring during the first 3 months. There was no significant relationship between fixation (cemented/cementless), age, component size, OKS and Tegner score with wear rate. Increasing BMI was associated with decreasing wear (p = 0.042). 37/40 bearings overhung the tibia to some extent and 23/40 overhung the tibia medially. An increase in the area of overhang (p = 0.036), amount of medial overhang (p = 0.028) and distance between the bearing and tibial wall (p = 0.019) were associated with increased wear. Bearings that did not overhang (0.06 mm/year) had less wear (p = 0.025) than those that did (0.08 mm/year). There was no relationship (p = 0.6) between the femoral contact area and wear. CONCLUSION During the first three to six months after implantation, the bearing becomes 0.06 mm thinner due to creep. The combined wear rate of the upper and lower surfaces of the bearing is constant (0.07 mm/year). The wear is lower if the bearing does not overhang the tibia so surgeons should aim for the bearing to be close to the tibial wall. The orientation of the femoral component does not influence wear. LEVEL OF EVIDENCE Retrospective Study, Level III.
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Campi S, Kendrick BJL, Kaptein BL, Valstar ER, Jackson WFM, Dodd CAF, Price AJ, Murray DW. Five-year results of a randomised controlled trial comparing cemented and cementless Oxford unicompartmental knee replacement using radiostereometric analysis. Knee 2021; 28:383-390. [PMID: 33408039 DOI: 10.1016/j.knee.2020.09.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 08/18/2020] [Accepted: 09/06/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Cementless fixation is an alternative to cemented unicompartmental knee replacement (UKR). The aim of this study was to determine if cementless UKR fixation is as good as cemented by comparing the five-year migration measured radiostereometric analysis (RSA) in a randomised controlled trial. METHODS Thirty-nine patients were randomised to receive either a cemented or a cementless Oxford UKR and were studied at intervals up to five years to assess migration with RSA and radiolucencies with radiographs. RESULTS During the first year there was a small and significant amount of migration, predominantly in an anterior direction, of both the cemented (0.24 mm, SD 0.32, p = 0.01) and cementless (0.26 mm, SD 0.31, p = 0.00) femoral components. Thereafter there was no significant migration in any direction. At no stage was there any significant difference between the migrations of the cemented or cementless femoral components. During the first year, particularly the first three months, the cementless tibial components subsided 0.28 mm (SD 0.19, p = 0.00). This was significantly (p = 0.00) greater than the subsidence of the cemented tibial component (0.09, SD 0.19, p = 0.28). Between the second and fifth years there was no significant migration of either cemented or cementless tibial components. At five years radiolucent lines occurred significantly less with cementless (one partial) compared to cemented (six partial and one complete) tibial components. CONCLUSIONS As, between two and five years, there was no significant migration of cemented or cementless components, and no significant difference between them, we conclude that cementless fixation is as reliable as cemented. It may be better as there are fewer radiolucent lines.
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Affiliation(s)
- S Campi
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK
| | - B J L Kendrick
- Nuffield Orthopaedic Centre, NHS Foundation Trust, Oxford, UK
| | - B L Kaptein
- Biomechanics and Imaging Group, Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
| | - E R Valstar
- Biomechanics and Imaging Group, Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
| | - W F M Jackson
- Nuffield Orthopaedic Centre, NHS Foundation Trust, Oxford, UK
| | - C A F Dodd
- Nuffield Orthopaedic Centre, NHS Foundation Trust, Oxford, UK
| | - A J Price
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK; Nuffield Orthopaedic Centre, NHS Foundation Trust, Oxford, UK
| | - D W Murray
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK; Nuffield Orthopaedic Centre, NHS Foundation Trust, Oxford, UK.
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Gupta V, Kejriwal R, Frampton C. Revision Following Cemented and Uncemented Oxford-III Primary Medial Unicompartmental Knee Replacements: A 19-Year Analysis from the New Zealand Joint Registry. J Bone Joint Surg Am 2020; 102:1777-1783. [PMID: 33086344 DOI: 10.2106/jbjs.19.01443] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Oxford-III unicompartmental knee replacements (UKRs) are among the most commonly used prostheses to treat isolated medial compartment osteoarthritis (OA). However, the best mode of implant fixation for primary UKRs remains a source of debate. The hypothesis of this study was that the biologically superior fixation of uncemented Oxford-III primary UKRs would translate into a lower revision rate when compared with cemented Oxford-III primary UKRs used to treat isolated medial compartment OA. METHODS Data on all Oxford-III primary UKRs (n = 8,733) completed for isolated medial compartment OA from January 2000 to December 2018 were obtained from the New Zealand Joint Registry (NZJR). Revision rates were documented for each fixation type and analyzed for associations with patient sex and age at surgery. A multivariate Cox proportional-hazards analysis was completed to determine if type of fixation was an independent risk factor for revision of Oxford-III UKRs. RESULTS Statistical analysis revealed a >1.8-fold greater revision risk for cemented Oxford-III UKRs compared with uncemented Oxford-III UKRs (p = 0.001) when considered independently of other risk factors. Furthermore, compared with uncemented fixation, cemented fixation was associated with a 2.9-fold (p < 0.001) increase in revision risk for women <65 years old and a 1.7-fold (p = 0.008) increase in revision risk for men 55 to 74 years old. There was no significant difference in the risk of revision between fixation methods for women ≥65 years old and men ≥75 years old. CONCLUSIONS We found that the type of fixation was an independent risk factor for revision of Oxford-III UKRs used in the treatment of isolated medial compartment OA. Uncemented Oxford-III primary UKRs had superior implant survivorship in women <65 years old and men 55 to 74 years old. Age and sex are important factors to consider when determining the type of fixation for Oxford-III primary UKRs used to treat isolated medial compartment OA. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Vikesh Gupta
- Department of Orthopaedic Surgery, Whangarei Base Hospital, Whangarei, New Zealand
| | - Ritwik Kejriwal
- Department of Orthopaedic Surgery, Taranaki Base Hospital, New Plymouth, New Zealand
| | - Chris Frampton
- Department of Medicine, The University of Otago, Christchurch, New Zealand
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Mittal A, Meshram P, Kim WH, Kim TK. Unicompartmental knee arthroplasty, an enigma, and the ten enigmas of medial UKA. J Orthop Traumatol 2020; 21:15. [PMID: 32876817 PMCID: PMC7468046 DOI: 10.1186/s10195-020-00551-x] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 07/22/2020] [Indexed: 12/17/2022] Open
Abstract
Unicompartmental knee arthroplasty (UKA) is a bone- and ligament-sparing alternative to total knee arthroplasty in the patients with end-stage single-compartment degeneration of the knee. Despite being a successful procedure, the multiple advantages of UKA do not correlate with its usage, most likely due to the concerns regarding prosthesis survivability, patient selection, ideal bearing design, and judicious use of advanced technology among many others. Therefore, the purpose of this study is to review and summarize the debated literature and discuss the controversies as “Ten Enigmas of UKA.”
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Affiliation(s)
- Anurag Mittal
- TK Orthopedic Surgery, 55 Dongpangyo-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13535, Republic of Korea
| | - Prashant Meshram
- Department of Orthopaedics, Johns Hopkins Medical Institute, 2360 West Joppa Road, Suite 306, Baltimore, MD, 21093, USA
| | - Woo Hyun Kim
- TK Orthopedic Surgery, 55 Dongpangyo-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13535, Republic of Korea
| | - Tae Kyun Kim
- TK Orthopedic Surgery, 55 Dongpangyo-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13535, Republic of Korea.
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Hefny MH, Smith NA, Waite J. Cementless medial Oxford unicompartmental knee replacement. Five-year results from an independent series. Knee 2020; 27:1219-1227. [PMID: 32711885 DOI: 10.1016/j.knee.2020.05.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 04/09/2020] [Accepted: 05/23/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Unicompartmental knee replacement (UKR) is a common treatment option for patients with advanced medial compartment knee arthritis. The Oxford UKR (OUKR) is the most commonly used implant for partial knee replacement. A cementless Oxford prosthesis was introduced in 2004 aiming to reduce the revision rate by potentially reducing radiolucencies as well as errors of cementation associated with the cemented prosthesis. Whilst results from the designer centre have been reported, there is little independent clinical evidence of outcomes. The aim of this study was to evaluate the survival of the cementless OUKR in a single surgeon series at an independent centre and to assess clinical and radiographic outcomes. METHODS All patients who received a cementless medial OUKR and had a minimum of five-year follow-up were included in the series. The Oxford knee score was used to evaluate patient outcomes at five years postoperatively. Survival rates, complications and evidence of radiolucencies on plain radiographs were also reviewed. RESULTS One hundred and fifty-eight cementless medial OUKR were implanted in 126 patients. Three patients died and four knees were revised. The five-year survival was 97.4% and the median Oxford knee score was 43 at five years postoperatively. No Complete radiolucent lines were observed on radiographs at one year. Four tibial components subsided. CONCLUSIONS This independent series shows that low revision rates and excellent results can be achieved with the use of the cementless OUKR at five years. Early subsidence of the tibial component, which is specific to the cementless prosthesis, warrants further investigation.
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Affiliation(s)
- Mamdouh H Hefny
- Orthopaedic Department, South Warwickshire NHS Foundation Trust, Lakin Road, Warwick CV34 5BW, United Kingdom.
| | - Nick A Smith
- Orthopaedic Department, South Warwickshire NHS Foundation Trust, Lakin Road, Warwick CV34 5BW, United Kingdom
| | - Jon Waite
- Orthopaedic Department, South Warwickshire NHS Foundation Trust, Lakin Road, Warwick CV34 5BW, United Kingdom
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Basso M, Arnaldi E, Bruno AAM, Formica M. Outcomes of cementless fixation in medial unicompartmental knee arthroplasty: review of recent literature. Musculoskelet Surg 2020; 105:131-138. [PMID: 32592123 DOI: 10.1007/s12306-020-00672-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 06/10/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Medial unicompartmental knee arthroplasty (UKA) is considered the most effective treatment for anteromedial knee osteoarthritis. Cementless fixation of UKA was developed to reduce aseptic loosening. We performed a review of the recent literature to assess the latest outcomes of cementless UKA. METHODS A review of English literature was performed on Medline through Pubmed. Retrospective or prospective studies with at least 2 years of follow-up (FU) and at least 20 patients were included. The PRISMA 2009 flowchart and checklist were considered to edit the review. Survival rate, revision rate, time for revision, incidence of radiolucent lines and reasons for revision (such as aseptic loosening, osteoarthritis progression, bearing dislocation or periprosthetic fracture) were extrapolated from the papers. RESULTS Nineteen articles were included in the review, only 2 with a level of evidence of I. A total of 3432 UKA with a FU range of 24-132 months were analyzed. The studies showed good clinical and functional outcomes. In 12 studies, survival rate were more than 90%. Revision rate for aseptic loosening were lower than 2% for 15 studies. CONCLUSION Cementless UKA represents a surgical option allowing low revision rate. Further high-quality long-term studies would better clarify complications, clinical and radiological results of this promising fixation method.
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Affiliation(s)
- M Basso
- Humanitas Clinical and Research Center- IRCCS, Via Alessandro Manzon i56, 20089, Rozzano (MI), Italy.
| | - E Arnaldi
- Humanitas Clinical and Research Center- IRCCS, Via Alessandro Manzon i56, 20089, Rozzano (MI), Italy
| | - A A M Bruno
- Humanitas Clinical and Research Center- IRCCS, Via Alessandro Manzon i56, 20089, Rozzano (MI), Italy
| | - M Formica
- U.O. Clinica Ortopedica e Traumatologia -Ospedale Policlinico San Martino - IST, Istituto Nazionale per la Ricerca sul Cancro, Largo Rosanna Benzi, 10, 16132, Genoa, GE, Italy
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Inui H, Taketomi S, Yamagami R, Kawaguchi K, Tanaka S. Femoral migration of the cementless Oxford which caused the bearing dislocation: a report of two cases. BMC Musculoskelet Disord 2020; 21:356. [PMID: 32513265 PMCID: PMC7282144 DOI: 10.1186/s12891-020-03385-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 06/01/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There are no previous reports on the complications around the femoral component of cementless Oxford unicompartmental knee arthroplasty (UKA). However, we experienced two cases of femoral migration to the proximal side, which caused bearing dislocations after cementless Oxford UKA. CASE PRESENTATION Case1. In an 82-year-old woman, bearing dislocation occurred 13 months postoperatively because of femoral migration that was resolved with an revision surgery to cemented component and thicker mobile insert. Case2. In a 52-year-old man, first bearing dislocation occurred 7 months postoperatively. Five months after revising the insert to a thicker one, another dislocation occurred mainly because of the femoral migration. Eventually, a revision to total knee arthroplasty was necessary. CONCLUSIONS The inferred main reasons of femoral migration of cementless Oxford were osteoporosis for the first case and early return to high performance sports activity for the second case. Although several merits of using cementless prosthesis, particularly better fixation and lesser radiolucency than cemented prosthesis, have been reported, surgeons should pay attention to the patient's bone quality and advise a slow return to high-level physical activity.
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Affiliation(s)
- Hiroshi Inui
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
| | - Shuji Taketomi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Ryota Yamagami
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Kohei Kawaguchi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
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Crawford DA, Berend KR, Thienpont E. Unicompartmental Knee Arthroplasty: US and Global Perspectives. Orthop Clin North Am 2020; 51:147-159. [PMID: 32138853 DOI: 10.1016/j.ocl.2019.11.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Unicompartmental knee arthroplasty (UKA) is a treatment option for anteromedial osteoarthritis. Compared with total knee arthroplasty (TKA), UKA offers improved knee range of motion, functional recovery and decreased medical complications. Revision rates continue to be higher with UKA compared with TKA. With current UKA implants, there is no significant difference in mobile bearing or fixed bearing, or between cemented and cementless implants. Enabling technology, such as robotic-assisted surgery, has demonstrated improvements in component positioning, but no long-term difference in survival compared with traditional manual instruments.
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Affiliation(s)
- David A Crawford
- JIS Orthopedics, 7277 Smith's Mill Road, Suite 200, New Albany, OH 43054, USA.
| | - Keith R Berend
- JIS Orthopedics, 7277 Smith's Mill Road, Suite 200, New Albany, OH 43054, USA
| | - Emmanuel Thienpont
- Cliniques universitaires Saint Luc, Avenue Hippocrate 10, Brussels 1200, Belgium
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Koppens D, Rytter S, Dalsgaard J, Sørensen OG, Hansen TB, Stilling M. The Effect of Bone Quality on Tibial Component Migration in Medial Cemented Unicompartmental Knee Arthroplasty. A Prospective Cohort Study Using Dual X-Ray Absorptiometry and Radiostereometric Analysis. J Arthroplasty 2020; 35:675-682.e2. [PMID: 31732369 DOI: 10.1016/j.arth.2019.10.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 10/10/2019] [Accepted: 10/15/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Periprosthetic bone mineral density (BMD) may influence implant fixation and subsequent loosening. Unicompartmental knee arthroplasty (UKA) restores normal knee kinematics and load distribution to the surrounding bone. We studied the influence of systemic and periprosthetic BMD of the proximal tibia on migration of the tibial component of cemented medial UKA. METHODS The cohort was dichotomized into a normal BMD group (T-score ≥ -1; n = 37) and a low BMD group (T-score < -1; n = 28) according to World Health Organization criteria. BMD of the proximal tibia and migration of the tibial component were measured with dual X-ray absorptiometry scans and stereoradiographs with 2-year follow-up. RESULTS Patients with normal systemic BMD had an 11% to15% higher BMD in all regions of interest (ROIs) compared to patients with low systemic BMD throughout follow-up. Over time, a decrease in periprosthetic BMD in ROI 1-3 was seen for both groups. The operated knees and contralateral knees showed a similar reduction in BMD in all ROIs between preoperative and 24 months. Between 12 and 24 months, the normal BMD group migrated (maximal total point motion) 0.03 mm (95% confidence interval, -0.01, 0.08) and the low BMD group migrated 0.02 mm (95% confidence interval, -0.03, 0.07). Migration over time was not influenced by change in periprosthetic BMD. CONCLUSION Migration of cemented medial tibial UKA was low until 24 months and was neither affected by preoperative systemic BMD nor affected by postoperative change in periprosthetic BMD. This suggests good long-term fixation despite an index difference in proximal tibial BMD.
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Affiliation(s)
- Daan Koppens
- Department of Orthopedic Surgery, University Clinic for Hand, Hip and Knee Surgery, Hospital Unit West, Holstebro, Denmark; Department of Clinical Medicine, Aarhus University, Incuba Skejby, Aarhus N, Denmark
| | - Søren Rytter
- Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus N, Denmark
| | - Jesper Dalsgaard
- Department of Orthopedic Surgery, University Clinic for Hand, Hip and Knee Surgery, Hospital Unit West, Holstebro, Denmark
| | - Ole G Sørensen
- Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus N, Denmark
| | - Torben B Hansen
- Department of Orthopedic Surgery, University Clinic for Hand, Hip and Knee Surgery, Hospital Unit West, Holstebro, Denmark; Department of Clinical Medicine, Aarhus University, Incuba Skejby, Aarhus N, Denmark
| | - Maiken Stilling
- Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University, Incuba Skejby, Aarhus N, Denmark
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Scheele CB, Pietschmann MF, Schröder C, Lenze F, Grupp TM, Müller PE. Effect of bone density and cement morphology on biomechanical stability of tibial unicompartmental knee arthroplasty. Knee 2020; 27:587-597. [PMID: 32024609 DOI: 10.1016/j.knee.2020.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 10/08/2019] [Accepted: 01/21/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Unicompartmental knee arthroplasty (UKA) offers good long-term survivorship and superior kinematics and function compared with total knee arthroplasty (TKA). However, revision rates are higher with aseptic loosening representing a major cause. Biomechanical stability depends on cement penetration. The goal of this study was to analyze the influence of cement morphology and bone density on primary stability of tibial UKA under physiological loading conditions in human tibiae. METHODS Thirty-six tibial trays were implanted in fresh-frozen human cadaver knees and tested for primary stability using dynamic compression-shear testing. Prior to implantation, bone density had been quantified for all 18 tibiae. Postoperatively, cement penetration has been assessed on frontal cuts based on eight predefined parameters. The influence of bone density and cement morphology on biomechanical stability was determined using correlation and linear regression analysis. RESULTS Mean failure load was 2691 ± 832.9 N, mean total cement thickness was 2.04 ± 0.37 mm, mean cement penetration was 1.54 ± 0.33 mm and mean trabecular bone mineral density (BMD) was 107.1 ± 29.3 mg/ml. There was no significant correlation between failure load and cement morphology (P > .05). Failure load was significantly positive correlated with trabecular BMD (r = 0.843; P < .0001) and cortical BMD (r = 0.432; P = .0136). CONCLUSIONS Simulating physiological loading conditions, the failure load of tibial UKA is linearly dependent on the trabecular BMD. The observed parameters of cementation morphology seem capable of preventing failure at the bone-cement interface before inherent bone stability is reached. Further research is required to assess the usefulness of a preoperative assessment of bone quality for patient selection in UKA.
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Affiliation(s)
- Christian B Scheele
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Munich, Germany; Technical University Munich, Klinikum rechts der Isar, Department of Orthopedics and Sports Orthopedics, Munich, Germany.
| | - Matthias F Pietschmann
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Munich, Germany
| | - Christian Schröder
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Munich, Germany
| | - Florian Lenze
- Technical University Munich, Klinikum rechts der Isar, Department of Orthopedics and Sports Orthopedics, Munich, Germany
| | - Thomas M Grupp
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Munich, Germany; Aesculap AG Research & Development, Tuttlingen, Germany
| | - Peter E Müller
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Munich, Germany
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吴 东, 杨 敏, 曹 正, 孔 祥, 王 毅, 郭 人, 柴 伟. [Research progress in unicompartmental knee arthroplasty]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:145-150. [PMID: 32030942 PMCID: PMC8171978 DOI: 10.7507/1002-1892.201906085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 11/24/2019] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To summarize the clinical application and research progress in unicompartmental knee arthroplasty (UKA). METHODS The literature related to UKA in recent years was reviewed and the emerging indications, implant options, comparisons between other surgical techniques, and recent advances were summarized. RESULTS Clinical studies show that UKA has many advantages, such as less trauma, faster recovery, and fewer postoperative complications. At present, the operative indication has been expanded. The body mass index more than 25 kg/m 2, less than 60 years old, patellofemoral arthritis, and anterior cruciate ligament dysfunction are no longer considered as contraindications. The prosthesis type in UKA should be selected according to the patient's condition. In recent years, the robot-assisted UKA can effectively improve the effectiveness, improve patient satisfaction, and reduce postoperative complications. CONCLUSION With the development of surgical techniques, designs of prosthesis, and the robotic technology, UKA would be further applicated. As more long-term data on UKA become available, it will further guide clinicians in counseling patients on whether UKA should be performed.
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Affiliation(s)
- 东 吴
- 中国人民解放军总医院第一医学中心骨科(北京 100853)Department of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing, 100853, P.R.China
| | - 敏之 杨
- 中国人民解放军总医院第一医学中心骨科(北京 100853)Department of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing, 100853, P.R.China
- 南开大学医学院(天津 300071)Medicine School of Nankai University, Tianjin, 300071, P.R.China
| | - 正 曹
- 中国人民解放军总医院第一医学中心骨科(北京 100853)Department of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing, 100853, P.R.China
- 南开大学医学院(天津 300071)Medicine School of Nankai University, Tianjin, 300071, P.R.China
| | - 祥朋 孔
- 中国人民解放军总医院第一医学中心骨科(北京 100853)Department of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing, 100853, P.R.China
| | - 毅 王
- 中国人民解放军总医院第一医学中心骨科(北京 100853)Department of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing, 100853, P.R.China
| | - 人文 郭
- 中国人民解放军总医院第一医学中心骨科(北京 100853)Department of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing, 100853, P.R.China
| | - 伟 柴
- 中国人民解放军总医院第一医学中心骨科(北京 100853)Department of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing, 100853, P.R.China
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Mohammad HR, Kennedy JA, Mellon SJ, Judge A, Dodd CA, Murray DW. Ten-year clinical and radiographic results of 1000 cementless Oxford unicompartmental knee replacements. Knee Surg Sports Traumatol Arthrosc 2020; 28:1479-1487. [PMID: 31209540 PMCID: PMC7176592 DOI: 10.1007/s00167-019-05544-w] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 05/16/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE Unicompartmental knee replacement (UKR) has substantial benefits over total knee replacement (TKR) but has higher revision rates. The cementless Oxford UKR was introduced to address this but there are concerns about fixation and tibial plateau fractures. The first long-term study of the device with clinical and radiographic outcomes is reported. METHODS The first 1000 medial cementless Oxford UKR were prospectively identified and followed up by independent physiotherapists. Survival was calculated using the endpoints reoperation, revision, revision to TKR, major revision requiring revision TKR components and patient mortality. The Oxford Knee Score (OKS), Tegner Activity Score and American Knee Society Score (AKSS) were recorded and radiographs analysed. RESULTS The ten year survival was 96.6% (CI 94.8-97.8), 97.5% (CI 95.7-98.5), 98.9% (CI 97.7-99.4) and 99.6% (CI 98.8-99.9) using reoperation, revision, revision to TKR and major revision as the endpoint, respectively. Commonest causes for revision were bearing dislocation (n = 7, 0.7%), disease progression (n = 4, 0.4%) and pain (n = 2, 0.2%). There was one lateral tibial plateau fracture and one femoral component loosening. At 10 years, the mean OKS was 41.2 (SD 9.8), Tegner 2.8 (SD 1.3), AKSS-O 89.1 (SD 13.0) and AKSS-F 80.4 (SD 14.6). There were no pathological radiolucencies or complete radiolucent lines. There were no implant-related deaths. CONCLUSIONS The cementless Oxford UKR is a safe procedure with excellent long-term clinical results. Our results suggest that reliable fixation was achieved with only one (0.1%) revision for loosening (femoral), no radiographic evidence of loosening in the remaining cases and no fractures related to implantation. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Hasan R. Mohammad
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK ,Oxford University Hospitals NHS Foundation Trust, Nuffield Orthopaedic Centre, Oxford, UK
| | - James A. Kennedy
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK ,Oxford University Hospitals NHS Foundation Trust, Nuffield Orthopaedic Centre, Oxford, UK
| | - Stephen J. Mellon
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Andrew Judge
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Christopher A. Dodd
- Oxford University Hospitals NHS Foundation Trust, Nuffield Orthopaedic Centre, Oxford, UK
| | - David W. Murray
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK ,Oxford University Hospitals NHS Foundation Trust, Nuffield Orthopaedic Centre, Oxford, UK
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