TRENDS IN UNICOMPARTMENTAL KNEE ARTHROPLASTY

Patient Satisfaction, Functional Outcomes, and Implant Survivorship in Patients Undergoing Customized Unicompartmental Knee Arthroplasty

Customized unicompartmental knee arthroplasty (C-UKA) utilizes implants manufactured on an individual patient basis, derived from pre-operative computed tomography images in an effort to more closely approximate the natural anatomy of the knee. The outcomes from 349 medial and lateral fixed-bearing C-UKA were reviewed. Implant survivorship analysis was conducted via retrospective chart review, and follow-up analysis was conducted via a single postoperative phone call or email. The rate of follow-up was 69% (242 knees). The average age at surgery was 71.1 years and the average body mass index was 28.8 kg/m2. Seven revision arthroplasties (2.1%) had knowingly been performed at an average of 1.9 years postoperatively (range: 0.1-3.9 years), resulting in an implant survivorship of 97.9% at an average follow-up of 4.2 years (range: 0.1-8.7) and 97.9% at an average of 4.8 years (range: 2.0-8.7) when knees with less than two years of follow-up were excluded. The reasons for revision were implant loosening (one knee), infection (two knees), progression of osteoarthritis (two knees), and unknown reasons (two knees). The average KOOS, JR. interval score was 84 (SD: 14.4). Of those able to be contacted for follow-up analysis, 67% were "very satisfied," 26% were "satisfied," 4% were "neutral," 2% were "dissatisfied," and 1% were "very dissatisfied." When asked if the knee felt "natural," 60% responded with "always," 35% responded with "sometimes," and 5% responded with "never." After analyzing a large cohort of C-UKA, we found favorable rates of survivorship, satisfaction, and patient-reported functional outcomes.

What is the evidence for clinical use of advanced technology in unicompartmental knee arthroplasty?

BACKGROUND

With an aim of improving prosthesis survivorship of unicompartmental knee arthroplasty (UKA), use of computer-assisted technologies (CATs) such as robotics, has been on the rise to reduce intraoperative errors in surgical technique. In light of recent influx of CATs in the UKA, a review of these innovations will help providers to understand their clinical utility.

METHOD

A systematic literature search was performed following Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines.

RESULTS

Among 19 studies comparing robot-assisted UKA with conventional UKA, only 32% were randomized control trials, 47% reported minimum mean follow-up of 2 years, and 21% evaluated prosthesis survival. Similar results were obtained for navigation-assisted UKA and UKA performed with patient-specific instrumentation.

CONCLUSION

While CATs seem to reduce the surgical errors in UKA, the evidence on the efficacy of any of the studied CATs to improve survivorship remains limited and there are issues related to cost-effectiveness, learning curve, and increase in operating time.

Unicondylar Knee Arthroplasty: A Bibliometric Analysis of the 50 Most Commonly Cited Studies

Background

Unicondylar knee arthroplasty (UKA) is an accepted treatment option for unicompartmental femorotibial degeneration and is gaining in popularity. The goal of this review is to evaluate the top 50 most cited articles pertaining to UKA to better help surgeons understand the trends, identify influential articles, and navigate this body of literature more effectively.

Methods

The Institute for Scientific Information Web of Knowledge database was used to identify all articles related to UKA. The initial screening was based on the number of citations for each article. The list was then refined to include only peer-reviewed original articles, review articles, or editorials. Data were extracted from the articles to rank the articles in the descending order from the most citations to the least.

Results

Initial search yielded 1844 articles. Fifty were identified to match the study criteria. The highest ranked article was cited a total of 463 times, whereas the lowest ranked article was cited 101 times. The average total number of citations per publication was 162. The earliest article on the list was published in 1978. The majority of publications assessed long-term outcomes of UKA (n = 6, 52%). The majority of articles were graded a level of evidence of III (n = 21 42%), whereas only 3 articles were graded a level I.

Conclusions

This review provides a quantitative analysis of the most-cited literature pertaining to UKA, which has a paucity of level I studies.

The efficacy and safety of multiple versus single doses dexamethasone in unicompartmental knee arthroplasty: A protocol of randomized controlled trial

BACKGROUND

Concerns exist regarding the analgesia effect and safety of multiple versus single doses dexamethasone in unicompartmental knee arthroplasty. There is an urgent need of studies that efficiently control for confounding, conduct comprehensive and consecutive observation of potential risks of the dexamethasone administration, and investigate its clinical applicability. We thus further designed a randomized controlled study to assess the different dose of dexamethasone on postoperative pain and complications in patients undergoing unicompartmental knee arthroplasty.

METHODS

This randomized, prospective, controlled study was carried out between January 2018 and August 2019. It was approved by the institutional review board in our hospital (HBRM2020013). A total of 80 patients were randomly assigned to each group: the study group (n = 40) and the control group (n = 40). All surgical procedures were performed by a similar orthopedic surgeon. In the study group, patients received intravenously 20 mg dexamethasone (4 mL, Tianjin Kingyork group Co., Ltd., China) just after the anesthesia, and repeated at 24 hours after the surgery. Patients in the control group received intravenously 10 mg dexamethasone solution (2 mL) just after the anesthesia, and repeated at 24 hours after the surgery. CRP, IL-6, VAS pain scores at rest and walking, the VAS scores of nausea, and the incidence of postoperative vomiting and nausea (POVN) were recorded at 24, 48, and 72 hours postoperatively.

CONCLUSION

We hypothesized that patients receiving multiple doses of dexamethasone was associated with better outcomes compared with patients receiving single dose of dexamethasone.

TRIAL REGISTRATION

This study protocol was registered in Research Registry (researchregistry5770).