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Deng T, Gong S, Cheng Y, Wang J, Zhang H, Li K, Nie Y, Shen B. Stochastic lattice-based porous implant design for improving the stress transfer in unicompartmental knee arthroplasty. J Orthop Surg Res 2024; 19:499. [PMID: 39175032 PMCID: PMC11340161 DOI: 10.1186/s13018-024-05006-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Accepted: 08/16/2024] [Indexed: 08/24/2024] Open
Abstract
BACKGROUND Unicompartmental knee arthroplasty (UKA) has been proved to be a successful treatment for osteoarthritis patients. However, the stress shielding caused by mismatch in mechanical properties between human bones and artificial implants remains as a challenging issue. This study aimed to properly design a bionic porous tibial implant and evaluate its biomechanical effect in reconstructing stress transfer pathway after UKA surgery. METHODS Voronoi structures with different strut sizes and porosities were designed and manufactured with Ti6Al4V through additive manufacturing and subjected to quasi-static compression tests. The Gibson-Ashby model was used to relate mechanical properties with design parameters. Subsequently, finite element models were developed for porous UKA, conventional UKA, and native knee to evaluate the biomechanical effect of tibial implant with designed structures during the stance phase. RESULTS The internal stress distribution on the tibia plateau in the medial compartment of the porous UKA knee was found to closely resemble that of the native knee. Furthermore, the mean stress values in the medial regions of the tibial plateau of the porous UKA knee were at least 44.7% higher than that of the conventional UKA knee for all subjects during the most loading conditions. The strain shielding reduction effect of the porous UKA knee model was significant under the implant and near the load contact sites. For subject 1 to 3, the average percentages of nodes in bone preserving and building region (strain values range from 400 to 3000 μm/m) of the porous UKA knee model, ranging from 68.7 to 80.5%, were higher than that of the conventional UKA knee model, ranging from 61.6 to 68.6%. CONCLUSIONS The comparison results indicated that the tibial implant with designed Voronoi structure offered better biomechanical functionality on the tibial plateau after UKA. Additionally, the model and associated analysis provide a well-defined design process and dependable selection criteria for design parameters of UKA implants with Voronoi structures.
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Grants
- 2020YFB1711500 the National Key Research and Development Program of China
- ZYYC21004 the 1•3•5 project for disciplines of excellence, West China Hospital, Sichuan University
- ZYGX2022YGRH007 Medico-Engineering Cooperation Funds from University of Electronic Science and Technology by the Fundamental Research Funds for the Central Universities
- 2023YFB4606700 National Key Research and Development Program
- ZYAI24038 1•3•5 project for disciplines of excellence, West China Hospital, Sichuan University
- 2022SCUH0015 0-1 Innovation Project of Sichuan University
- 2023HXFH024 1·3·5 project for disciplines of excellence-Clinical Research Fund, West China Hospital, Sichuan University
- the Interdisciplinary Crossing and Integration of Medicine and Engineering for Talent Training Fund, West China Hospital, Sichuan University
- 1·3·5 project for disciplines of excellence–Clinical Research Fund, West China Hospital, Sichuan University
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Affiliation(s)
- Tao Deng
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China
- School of Mechanical Engineering, Sichuan University, Chengdu, 610065, China
| | - Shan Gong
- Sichuan University-Pittsburgh Institute, Sichuan University, Chengdu, 610207, China
| | - Yiwei Cheng
- Sichuan University-Pittsburgh Institute, Sichuan University, Chengdu, 610207, China
| | - Junqing Wang
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Hui Zhang
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, P.R. China
| | - Kang Li
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, P.R. China.
- Med-X Center for Informatics, Sichuan University, Chengdu, Sichuan, 610041, P.R. China.
| | - Yong Nie
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China.
| | - Bin Shen
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China
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Bibliometric Analysis of the Top-Cited Articles on Unicompartmental Knee Arthroplasty. J Arthroplasty 2021; 36:1810-1818.e3. [PMID: 33423879 DOI: 10.1016/j.arth.2020.11.038] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 11/23/2020] [Accepted: 11/30/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Unicompartmental knee arthroplasty (UKA) has been proven to be an effective surgical technique for unilateral compartment osteoarthritis. The purpose of this study is to identify and analyze the top 100 cited articles in the field of UKA research. METHODS Publications on UKA from 1980 to 2020 in the Web of Science database were retrieved. The characteristics of the top 100 cited articles were analyzed, including information of publications and citations, level of evidence, and research interests. RESULTS The number of publications and citations increased over time. The majority of the highly cited articles were from the Nuffield Orthopedic Centre (Oxford, England) and the Brigham and Women's Hospital (Boston, USA). Long-term outcome of UKA and comparison between UKA and TKA gathered most research interests. The most frequently occurring keywords were "survival" and "revision." Since 2012, "life quality" and "robotics" have been used. There was no level I evidence, and most studies provided level IV evidence. CONCLUSION There was a rising trend in publications and citations in the field of UKA research, the majority of them were from a few centers, and were low-level evidence. Most studies focused on the long-term outcomes of UKA; in recent years, patient satisfaction and navigation surgery have become new research trends.
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Park KK, Han CD, Yang IH, Lee WS, Han JH, Kwon HM. Robot-assisted unicompartmental knee arthroplasty can reduce radiologic outliers compared to conventional techniques. PLoS One 2019; 14:e0225941. [PMID: 31794587 PMCID: PMC6890211 DOI: 10.1371/journal.pone.0225941] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 11/15/2019] [Indexed: 11/24/2022] Open
Abstract
Background The aim of this study was to compare the clinical and radiologic outcomes of robot-assisted unicompartmental knee arthroplasty (UKA) to those of conventional UKA in Asian patients. Methods Fifty-five patients underwent robot-assisted UKA and 57 patients underwent conventional UKA were assessed in this study. Preoperative and postoperative range of motion (ROM), American Knee Society (AKS) score, Western Ontario McMaster University Osteoarthritis Index scale score (WOMAC), and patellofemoral (PF) score values were compared between the two groups. The mechanical femorotibial angle (mFTA) and Kennedy zone were also measured. Coronal alignments of the femoral and tibial components and posterior slopes of the tibial component were compared. Additionally, polyethylene (PE) liner thicknesses were compared. Results There was no significant difference between the two groups regarding postoperative ROM, AKS, WOMAC and PF score. Robot group showed fewer radiologic outliers in terms of mFTA and coronal alignment of tibial and femoral components (p = 0.022, 0.037, 0.003). The two groups showed significantly different PE liner thicknesses (8.4 ± 0.8 versus 8.8 ± 0.9, p = 0.035). Robot group was the only influencing factor for reducing radiologic outlier (postoperative mFTA) in multivariate model (odds ratio: 2.833, p = 0.037). Conclusion In this study, robot-assisted UKA had many advantages over conventional UKA, such as its ability to achieve precise implant insertion and reduce radiologic outliers. Although the clinical outcomes of robot-assisted UKA over a short-term follow-up period were not significantly different compared to those of conventional UKA, longer follow-up period is needed to determine whether the improved radiologic accuracy of the components in robotic-assisted UKA will lead to better clinical outcomes and improved long-term survival.
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Affiliation(s)
- Kwan Kyu Park
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Chang Dong Han
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Ick-Hwan Yang
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Woo-Suk Lee
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Joo Hyung Han
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Hyuck Min Kwon
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea
- * E-mail:
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Plate JF, Augart MA, Seyler TM, Bracey DN, Hoggard A, Akbar M, Jinnah RH, Poehling GG. Obesity has no effect on outcomes following unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2017; 25:645-651. [PMID: 25863681 DOI: 10.1007/s00167-015-3597-5] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 04/01/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Although obesity has historically been described as a contraindication to UKA, improved outcomes with modern UKA implant designs have challenged this perception. The purpose of this study was to assess the influence of obesity on the outcomes of UKA with a robotic-assisted system at a minimum follow-up of 24 months with the hypothesis that obesity has no effect on robotic-assisted UKA outcomes. METHODS There were 746 medial robotic-assisted UKAs (672 patients) with a mean age of 64 years (SD 11) and a mean follow-up time of 34.6 months (SD 7.8). Mean overall body mass index (BMI) was 32.1 kg/m2 (SD 6.5), and patients were stratified into seven weight categories according to the World Health Organization classification. RESULTS Patient BMI did not influence the rate of revision surgery to TKA (5.8 %) or conversion from InLay to OnLay design (1.7 %, n.s.). Mean postoperative Oxford knee score was 37 (SD 11) without correlation with BMI (n.s.). The type of prosthesis (InLay/OnLay) regardless of BMI had no influence on revision rate (n.s.). BMI did not influence 90-day readmissions (4.4 %, n.s.), but showed significant correlation with higher opioid medication requirements and a higher number of physical therapy session needed to reach discharge goals (p = 0.031). CONCLUSION These findings suggest that BMI does not influence clinical outcomes and readmission rates of robotic-assisted UKA at mid-term. The classic contraindication of BMI >30 kg/m2 may not be justified with the use of modern UKA designs or techniques. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Johannes F Plate
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA.
| | - Marco A Augart
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA.,Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Germany
| | - Thorsten M Seyler
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Daniel N Bracey
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Aneitra Hoggard
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Michael Akbar
- Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Germany
| | - Riyaz H Jinnah
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA.,Southeastern Orthopedics, Southeastern Regional Medical Center, Lumberton, NC, 28358, USA
| | - Gary G Poehling
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
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Abstract
The purpose of this article is to provide a synopsis of the current medical understanding of knee osteoarthritis. We describe the prevalence, causes and associated risk factors, symptoms, diagnosis and classification, and treatment options. A quiz serves to assist readers in their understanding of the presented material.
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Affiliation(s)
- Michelle J Lespasio
- Assistant Professor and Adult Nurse Practitioner in Orthopedic Surgery at the Boston Medical Center in MA.
| | - Nicolas S Piuzzi
- Orthopedic Regenerative Medicine and Cellular Therapy Fellow at the Cleveland Clinic in OH.
| | - M Elaine Husni
- Rheumatologist and Immunologist and Director of the Arthritis & Musculoskeletal Treatment Center in the Department of Rheumatologic and Immunologic Disease at the Cleveland Clinic in OH.
| | - George F Muschler
- Professor of Orthopedic Surgery, Director of the Regenerative Medicine Laboratory, and Attending Physician at the Cleveland Clinic in OH.
| | - Aj Guarino
- Professor of Biostatistics formerly at Massachusetts General Hospital Institute of Health Professions in Boston and currently at New England College of Optometry in Boston.
| | - Michael A Mont
- Chairman of Orthopedic Surgery at the Cleveland Clinic in OH.
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Analysis of an early intervention distal femoral resurfacing implant for medial osteoarthritis. J Biomech 2016; 49:3676-3681. [PMID: 28029358 DOI: 10.1016/j.jbiomech.2016.09.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 08/21/2016] [Accepted: 09/30/2016] [Indexed: 11/21/2022]
Abstract
A design concept was formulated for implants to treat medial osteoarthritis of the knee, using a metal plate resurfacing of the tibia plateau and a plastic bearing embedded in the distal end of the femur. A finite element analysis was carried out to determine whether a metal backing would be needed for the femoral component, and to what extent the stress and strain distribution in the trabecular bone surrounding the implant would match the normal intact condition. The CT scans from three knees scheduled for unicompartmental replacement were selected to generate computer models with variable bone densities in each element to cover a range of density patterns. Loading conditions were defined for a range of flexion angles, from loads at the center to the end of the component. A 2-peg fixation design was analyzed for both an all-plastic and a metal-backed construction. For the metal-backed, the interface von Mises stresses were close to intact values at the same level in the bone, although there was a 34 percent increase for loading at the end of the component. However, the all-plastic gave stresses elevated up to 109 percent. The maximum principal strain values for metal-backed in the trabecular bone below the implant were variable between specimens but close to intact under all conditions. In contrast the all-plastic showed strains up to 81 percent increased. The metal pegs showed load transfer, but the loads transmitted by the plastic pegs was small, as evidenced by the low interface stresses. The conclusion was that metal-backing was necessary to avoid excessive bone stresses and strains, while metal peg fixation was evidently an advantage.
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Longo UG, Loppini M, Trovato U, Rizzello G, Maffulli N, Denaro V. No difference between unicompartmental versus total knee arthroplasty for the management of medial osteoarthtritis of the knee in the same patient: a systematic review and pooling data analysis. Br Med Bull 2015; 114:65-73. [PMID: 25743408 DOI: 10.1093/bmb/ldv009] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/31/2015] [Indexed: 01/09/2023]
Abstract
INTRODUCTION One-third of patients with knee osteoarthritis (OA) has involvement of only one compartment, especially the medial one. SOURCES OF DATA We performed a comprehensive search of studies comparing unicompartmental knee arthoplasty (UKA) and total knee arthroplasty (TKA) in the same patient on PubMed, OVID/Medline, Cochrane, CINAHL, Google scholar and Embase databases. AREAS OF AGREEMENT UKA is indicated in knee with medial OA, no flexion deformity, no joint instability and no varus deformity. AREAS OF CONTROVERSY Although high tibial osteotomy, UKA and TKA have been proposed to address medial OA of the knee, the best management is still controversial. GROWING POINTS Studies investigating surgical management of medial OA of the knee are increasingly frequent. AREAS TIMELY FOR DEVELOPING RESEARCH Large, multicentre, powered, randomized trials comparing UKA and TKA are needed to identify the best management for medial OA of the knee. Moreover, new score systems for satisfaction of the patient should be formulated.
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Affiliation(s)
- Umile Giuseppe Longo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, Trigoria, Rome 00128, Italy
| | - Mattia Loppini
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, Trigoria, Rome 00128, Italy
| | - Ugo Trovato
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, Trigoria, Rome 00128, Italy
| | - Giacomo Rizzello
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, Trigoria, Rome 00128, Italy
| | - Nicola Maffulli
- Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London E1 4DG, UK Department of Musculoskeletal Disorders, University of Salerno School of Medicine and Surgery, Via Salvador Allende, Baronissi, Salerno 84081, Salerno, Italy
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, Trigoria, Rome 00128, Italy
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Fixed- versus mobile-bearing unicondylar knee arthroplasty: are failure modes different? Knee Surg Sports Traumatol Arthrosc 2013; 21:2433-41. [PMID: 23007412 DOI: 10.1007/s00167-012-2208-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2012] [Accepted: 08/17/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE An ongoing controversy exists on whether mobile-bearing design is superior over fixed-bearing design in unicondylar knee arthroplasties (UKAs). The present study conducted a systematic review to ascertain differences in performance between fixed- and mobile-bearing designs in UKAs. METHODS A literature search was performed in PubMed, Embase, Scopus and the Cochrane Library. A total of 9 comparative studies involving 915 knees comparing outcomes of mobile-bearing UKAs with fixed-bearing UKAs were included in the current analysis. Outcomes of interest included knee function, quality of life, radiographic outcomes, reasons and incidence of reoperation, timing of failures, and survivorship. RESULTS The results presented no significant differences between the two designs in terms of knee scores, range of motion, limb alignment, implant positioning, incidence of radiolucent lines and overall reoperation rates. However, their differences have been noted in their modes and timing of failures. Early failures are related to the risk of bearing dislocation in the mobile-bearing design. In contrast, later failures are related to the risk of polyethylene wear in the fixed-bearing design. CONCLUSIONS The available evidence has not confirmed the advantage of mobile-bearing UKAs over fixed-bearing UKAs but pointed out specific modes of failure.
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Plate JF, Mofidi A, Mannava S, Smith BP, Lang JE, Poehling GG, Conditt MA, Jinnah RH. Achieving accurate ligament balancing using robotic-assisted unicompartmental knee arthroplasty. Adv Orthop 2013; 2013:837167. [PMID: 23634304 PMCID: PMC3619543 DOI: 10.1155/2013/837167] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Accepted: 02/21/2013] [Indexed: 12/19/2022] Open
Abstract
Unicompartmental knee arthroplasty (UKA) allows replacement of a single compartment in patients with limited disease. However, UKA is technically challenging and relies on accurate component positioning and restoration of natural knee kinematics. This study examined the accuracy of dynamic, real-time ligament balancing using a robotic-assisted UKA system. Surgical data obtained from the computer system were prospectively collected from 51 patients (52 knees) undergoing robotic-assisted medial UKA by a single surgeon. Dynamic ligament balancing of the knee was obtained under valgus stress prior to component implantation and then compared to final ligament balance with the components in place. Ligament balancing was accurate up to 0.53 mm compared to the preoperative plan, with 83% of cases within 1 mm at 0°, 30°, 60°, 90°, and 110° of flexion. Ligamentous laxity of 1.31 ± 0.13 mm at 30° of flexion was corrected successfully to 0.78 ± 0.17 mm (P < 0.05). Robotic-assisted UKA allows accurate and precise reproduction of a surgical balance plan using dynamic, real-time soft-tissue balancing to help restore natural knee kinematics, potentially improving implant survival and functional outcomes.
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Affiliation(s)
- Johannes F. Plate
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1070, USA
| | | | - Sandeep Mannava
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1070, USA
| | - Beth P. Smith
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1070, USA
| | - Jason E. Lang
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1070, USA
| | - Gary G. Poehling
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1070, USA
| | | | - Riyaz H. Jinnah
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1070, USA
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Khatri PJ, O'Connor AM, Dervin GF. Decision support needs of patients choosing between unicompartmental and total knee arthroplasty for advanced medial compartment osteoarthritis of the knee. J Arthroplasty 2011; 26:1343-9. [PMID: 21397451 DOI: 10.1016/j.arth.2010.12.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2010] [Accepted: 12/17/2010] [Indexed: 02/01/2023] Open
Abstract
Patients with isolated medial knee osteoarthritis are often candidates for both unicompartmental knee arthroplasty and total knee arthroplasty and must choose between these 2 options. We interviewed 20 such patients to describe their decision support needs and 14 knee arthroplasty surgeons to describe their requirements in supporting patients' decision making. Patients and surgeons both desired active patient participation in the decision. Of 14 surgeons, 13 identified a knowledgeable patient as the most important factor in facilitating decision making, but many worried about confusing patients from information overload. Patients, on the other hand, demonstrated poor knowledge of the advantages and disadvantages of each surgical option, and 17 of 20 desired supplemental educational resources. Thus, most patients choosing between unicompartmental knee arthroplasty and total knee arthroplasty would appreciate and benefit from a decision support intervention.
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Affiliation(s)
- Prateek J Khatri
- Department of Orthopaedic Surgery, Ottawa Hospital, Ottawa, Ontario, Canada
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Biomechanical evaluation of proximal tibial behavior following unicondylar knee arthroplasty: modified resected surface with corresponding surgical technique. Med Eng Phys 2011; 33:1175-82. [PMID: 21741289 DOI: 10.1016/j.medengphy.2011.05.007] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Revised: 05/11/2011] [Accepted: 05/11/2011] [Indexed: 11/22/2022]
Abstract
Persistent pain and periprosthetic fracture of the proximal tibia are troublesome complications in modern unicondylar knee arthroplasty (UKA). Surgical errors and acute corners on the resected surface can place excessive strains on the bone, leading to bone degeneration. This study attempted to lower strains by altering the orthogonal geometry and avoiding extended vertical saw cuts. Finite element models were utilized to predict biomechanical behavior and were subsequently compared against experimental data. On the resected surface of the extended saw cut model, the greatest strains showed a 50% increase over a standard implant; conversely, the strains decreased by 40% for the radial-corner shaped model. For all UKA models, the peak strains below the resection level increased by 40% relative to an intact tibia. There was no significant difference among the implanted models. This study demonstrated that a large increase in strains arises on the tibial plateau to resist a cantilever-like bending moment following UKA. Surgical errors generally weaken the tibial support and increase the risk of fractures. This study provides guidance on altering the orthogonal geometry into a radial-shape to reduce strains and avoid degenerative remodeling. Furthermore, it could be expected that predrilling a posteriorly sloped tunnel through the tibia prior to cutting could achieve greater accuracy in surgical preparations.
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