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Myatt D, Marshall M, Ankers T, Robb C. Are relative contraindications for unicompartmental knee replacements in medial compartment osteoarthritis really contraindications? J Orthop 2024; 56:123-126. [PMID: 38828470 PMCID: PMC11137378 DOI: 10.1016/j.jor.2024.05.014] [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: 04/23/2024] [Accepted: 05/12/2024] [Indexed: 06/05/2024] Open
Abstract
Background Medial unicompartment knee replacement (UKR) is performed for isolated medial compartment osteoarthritis. Understanding the factors influencing functional outcomes helps patient selection and outcomes. We will review the association between pre-operative BMI and patellofemoral articular wear on post operative Oxford Knee Scores at >2 and > 5 years. Methods A retrospective review of a prospectively collected database was performed. Inclusion criteria were medial UKR for medial compartment OA. The exclusion criteria were age <16, revision procedures and lateral UKR's. Data was collected between 26/6/2014 and 25/8/2022. Statistical analysis was performed using SPSS. Significance was given to variables that reached p < 0.05. Results 159 UKR procedures were identified in 155 patients. 116 procedures carried out on 111 patients had follow up at > 2 years. At 5 years there were 14 patients had OKS recorded. There was no statistical difference in the ICRS grade I&II vs III&IV groups for >2 year or >5 year OKS with p = 0.408 and p = 0.876. For BMI there was a moderately negative correlation on spearman's rank p(df) = -0.339 (CI 95 % -0.538, -0.104) at >2 years, which was statistically significant with p = 0.004. >5 year data didn't reach significance with p = 0.828. Conclusion BMI maybe an important patient factor in predicting post operative OKS at 2-5 years. This is beneficial to surgeons for patient selection in medial UKR. Patellofemoral wear doesn't appear to impact on post operative functional outcomes. This supports the theory that patient who suffer from patellofemoral wear, as well as medial compartment wear can benefit from UKR, expanding the current indications.
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Affiliation(s)
- Darren Myatt
- Mersey and West Lancashire Teaching Hospitals, NHS Trust, UK
| | - Morgan Marshall
- Warrington and Halton Teaching Hospitals, NHS Foundation Trust, UK
| | - Thomas Ankers
- Mersey and West Lancashire Teaching Hospitals, NHS Trust, UK
| | - Curtis Robb
- Warrington and Halton Teaching Hospitals, NHS Foundation Trust, UK
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Elliott J, Ahedi H, Parker D. Anatomical site of radiographic degeneration is an independent variable influencing outcome of total knee arthroplasty. J ISAKOS 2024; 9:253-257. [PMID: 38185248 DOI: 10.1016/j.jisako.2024.01.002] [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: 08/02/2023] [Revised: 12/26/2023] [Accepted: 01/02/2024] [Indexed: 01/09/2024]
Abstract
OBJECTIVES We aimed to determine whether the site of anatomical degenerative change could be identified as an independent risk factor influencing clinical outcome of total knee arthroplasty (TKA) 12 months postoperatively. METHODS We compared preoperative, postoperative and the change observed in Oxford Knee Score (OKS) amongst TKA patients categorised as primarily medial, lateral or patellofemoral osteoarthritis (PFJOA). Multivariable regression analysis was conducted on 434 consecutive knees in 333 patients, adjusting for sex, age and body mass index (BMI). RESULTS Adjusted estimates showed that preoperatively, patients with medial and lateral osteoarthritis (OA) had a lower mean OKS of 2.1 (p = 0.049) and 2.3 (p = 0.056) points respectively, while those with PFJOA had mean scores 2.7 points higher (p = 0.062). There was no statistically significant difference between compartments in absolute postoperative OKS. The greatest improvement of 30.1 points (95% confidence interval (CI) 16.9-36.0, p = 0.012) in OKS was observed for those with lateral OA, followed by 28.9 points (95% CI 16.7-35.3, p = 0.049) for those with medial OA. The improvement observed postoperatively in patients with PFJOA was less than that observed for the average of the cohort at 24.5 (95% CI 11.5-29.7, p = 0.088). CONCLUSIONS The site of compartmental involvement in knee OA is an independent factor influencing clinical outcome of TKA. With arthroplasty registry adoption of patient-reported outcome measures (PROMs), this study supports precise anatomical categorisation of knee OA in outcome studies. LEVEL OF EVIDENCE Level III, Retrospective consecutive clinical study.
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Affiliation(s)
- Johanna Elliott
- Sydney Orthopaedic Research Institute Landmark Orthopaedics, Level 2, 500 Pacific Highway, St Leonards, NSW 2065, Australia; St Vinzenz Hospital, 31-33 Dr. Otto-Seidel Strasse, Dinslaken, 46535, Germany.
| | - Harbeer Ahedi
- Sydney Orthopaedic Research Institute Landmark Orthopaedics, Level 2, 500 Pacific Highway, St Leonards, NSW 2065, Australia
| | - David Parker
- Sydney Orthopaedic Research Institute Landmark Orthopaedics, Level 2, 500 Pacific Highway, St Leonards, NSW 2065, Australia
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Vossen RJM, Burger JA, Ten Noever de Brauw GV, Bayoumi T, Fiore JA, Ruderman LAV, Zuiderbaan HA, Pearle AD. Preservation of prearthritic coronal knee phenotype and prearthritic coronal alignment yielded improved Kujala scores following ligament-guided medial unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38804655 DOI: 10.1002/ksa.12282] [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: 03/18/2024] [Revised: 05/14/2024] [Accepted: 05/14/2024] [Indexed: 05/29/2024]
Abstract
PURPOSE There is a lack of literature evaluating outcomes of the ligament-guided approach in medial unicompartmental knee arthroplasty (UKA). An improved comprehension of the distribution of coronal plane alignment of the knee (CPAK) phenotypes and sagittal tibial wear patterns and their associations with patient-reported outcome measures (PROMs) and implant survivorship could provide insights into its further application in daily practice. METHODS A registry was reviewed for patients with a minimal 2-year follow-up who underwent robotic-assisted, ligament-guided, medial UKA between 2008 and 2016. Survivorship and postoperative PROMs were collected. CPAK phenotypes and sagittal tibial wear patterns were determined. Survivorship, Knee Injury and Osteoarthritis Outcome Score (KOOS), Kujala and patient satisfaction were compared between phenotypes and sagittal tibial wear patterns. RESULTS A total of 618 knees were included at a mean follow-up of 4.1 [2.0-9.6] years. Four-year conversion to the TKA survival rate was 98.9% [98.4%-99.3%] and 94.3% [93.3%-95.3%] for all-cause revision. Patients with preservation of the CPAK phenotype (84.5 ± 14.9, 81.8 ± 15.5, p = 0.033) and restoration of prearthritic coronal alignment (84.1 ± 14.9, 81.7 ± 15.9, p = 0.045) had a significantly higher Kujala score. No other significant differences in survivorship or PROMs were observed between phenotypes or sagittal tibial wear patterns. Additionally, no difference in survival rates was observed between preserved or altered phenotypes. CONCLUSION This study demonstrated that preservation of CPAK phenotype and preservation of prearthritic coronal alignment yielded a significantly higher Kujala score. No other significant differences in PROMs or implant survivorship were observed, suggesting that robotic-assisted, ligament-guided medial UKA provides equal outcomes for all observed phenotypes and sagittal tibial wear patterns in medial compartment OA as long as preoperative CPAK phenotype is preserved postoperatively. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Roderick J M Vossen
- Department of Computer Assisted Surgery and Sports Medicine, Hospital for Special Surgery, New York, New York, USA
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Joost A Burger
- Charité-Universitatsmedizin Berlin, Corporate Member of Freie Universität and Humboldt Universität, Berlin, Germany
| | - Gaby V Ten Noever de Brauw
- Department of Computer Assisted Surgery and Sports Medicine, Hospital for Special Surgery, New York, New York, USA
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Tarik Bayoumi
- Department of Computer Assisted Surgery and Sports Medicine, Hospital for Special Surgery, New York, New York, USA
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Jake A Fiore
- Department of Computer Assisted Surgery and Sports Medicine, Hospital for Special Surgery, New York, New York, USA
| | - Lindsey A V Ruderman
- Department of Computer Assisted Surgery and Sports Medicine, Hospital for Special Surgery, New York, New York, USA
| | - Hendrik A Zuiderbaan
- Medisch Kliniek Velsen, Department of Orthopaedic Surgery and Sports Medicine, Velsen-Noord, The Netherlands
| | - Andrew D Pearle
- Department of Computer Assisted Surgery and Sports Medicine, Hospital for Special Surgery, New York, New York, USA
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Gaggiotti S, Gaggiotti S, Ringa JC, Gaggiotti G. Associated patellofemoral osteoarthritis is not a contraindication for unicompartmental knee replacement. Report of one hundred ten prostheses with an average 6-year follow-up. J ISAKOS 2024:S2059-7754(24)00073-7. [PMID: 38588803 DOI: 10.1016/j.jisako.2024.04.003] [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: 09/02/2023] [Revised: 03/27/2024] [Accepted: 04/03/2024] [Indexed: 04/10/2024]
Abstract
INTRODUCTION Associated patellofemoral joint osteoarthritis (APFJ-OA) has typically been considered a contraindication for unicompartmental knee arthroplasty (UKA) in the treatment of femorotibial joint osteoarthritis. However, this contraindication is being challenged. The aim of this study was to assess clinical and functional outcomes, complications, and implant survival in medial or lateral UKA, regardless of clinical symptoms or radiographic signs of APFJ-OA. METHODS This retrospective, comparative study included patients treated with medial or lateral UKA regardless of preoperative symptoms or signs of APFJ-OA, with a minimum 2-year follow-up. Intraoperatively, knees were subdivided based on APFJ-OA grade, according to the Outerbridge classification. Clinical and functional outcomes were analyzed using the 2011 Knee Society Score (KSS) at the last follow-up control. APFJ-OA was treated systematically, in a tailored, stepwise fashion according to its severity. Complications and implant survival rates were evaluated. Two-sided paired T-test, ANOVA, and Kruskal-Wallis tests were used with a significance level of 5%. RESULTS Finally, 110 UKAs were assessed 81 (73.6%) medial and 29 (26.4%) laterals. The average follow-up was 6 years (2-19.5). According to Outerbridge, 22 knees (20%) were in grade 2, 59 (53.6%) were in grade 3, and 29 (26.4%) were in grade 4. All three groups showed a statistically significant increase in KSS scores and range of motion. There were no significant differences in clinical KSS improvement and flexion contracture between Outerbridge groups (average 35.7 and -4.9, respectively). Group 3 showed statistically significant improvement in functional KSS when compared to group 2 (68.8 vs 61.2). In maximum flexion, groups 3 and 4 did significantly better than group 2 (20° vs 15°). Three prostheses (2.7%) needed revision after 7, 8.6, and 12 years due to aseptic tibial loosening. Implant survival was 100% at 5 (64 of 64), 97% at 7 (30 of 31), 93% at 9 (14 of 15), and 89% at 12 years, respectively (8 of 9). CONCLUSION Clinical and functional results, complications, and survival of medial or lateral UKA were not negatively affected by APFJ-OA assessed intraoperatively using the Outerbridge classification after an average follow-up of 6 years. We consider that APFJ-OA is not a contraindication for UKA when treated systematically according to its severity. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Stéfano Gaggiotti
- Orthopedics and Traumatology Center Santa Fe & Rafaela, Argentina; Orthopedic Surgery Service Sanatorio Mayo, Santa Fe, Argentina.
| | - Santino Gaggiotti
- Orthopedics and Traumatology Center Santa Fe & Rafaela, Argentina; Orthopedic Surgery Service Sanatorio Mayo, Santa Fe, Argentina
| | - Julio César Ringa
- Orthopedics and Traumatology Center Santa Fe & Rafaela, Argentina; Orthopedic Surgery Service Sanatorio Mayo, Santa Fe, Argentina
| | - Gabriel Gaggiotti
- Orthopedics and Traumatology Center Santa Fe & Rafaela, Argentina; Orthopedic Surgery Service Sanatorio Mayo, Santa Fe, Argentina
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Theus-Steinmann C, Lustig S, Calliess T. [Evolving indications for partial knee replacement : New aspects]. ORTHOPADIE (HEIDELBERG, GERMANY) 2024; 53:238-245. [PMID: 38498206 DOI: 10.1007/s00132-024-04484-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/12/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND Partial knee replacement has proven to be an effective therapy for advanced unicompartmental arthrosis of the knee. Despite continuous advancements in implants and surgical techniques over the past decades, the global preference for total knee arthroplasty still persists for historical reasons. OBJECTIVES This report aims to illuminate advantages and disadvantages of partial knee replacement considering long-term results, the evolution of indication criteria over recent decades and new aspects in patient selection with potential improvements through emerging technologies. MATERIAL AND METHODS The analysis involves the examination of long-term results from clinical studies and registry data, highlighting the risk factors for potential failures and their influence on the development of indication criteria. RESULTS Present-day long-term results demonstrate excellent prosthetic survival, aligning with outcomes from total knee arthroplasty. New perspectives for expanding indication criteria are discussed, including the possible application of partial knee replacement in cases of severe varus deformity > 15°, anterior cruciate ligament insufficiency, young active patients, anterior knee pain, and/or patellofemoral arthritis, as well as mild radiographic arthritis with degenerative medial meniscus root tear and meniscal extrusion. DISCUSSION Indication criteria have consistently expanded in recent years, taking into account modern insights, and the application of advanced technologies can enhance precision and minimize surgical errors. Furthermore, this report emphasizes that revision rates are not the sole criterion for success and underscores the necessity for a comprehensive examination of clinical results.
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Affiliation(s)
- Carlo Theus-Steinmann
- articon Spezialpraxis für Gelenkchirurgie, Berner Prothetikzentrum Salem-Spital, Schänzlistrasse 39, 3013, Bern, Schweiz.
| | - Sébastien Lustig
- Centre Albert Trillat, Hôpital de la Croix-Rousse, 103 Grande Rue de la Croix Rousse, 69004, Lyon, Frankreich
| | - Tilman Calliess
- articon Spezialpraxis für Gelenkchirurgie, Berner Prothetikzentrum Salem-Spital, Schänzlistrasse 39, 3013, Bern, Schweiz
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Zgouridou A, Kenanidis E, Potoupnis M, Tsiridis E. Global mapping of institutional and hospital-based (Level II-IV) arthroplasty registries: a scoping review. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1219-1251. [PMID: 37768398 PMCID: PMC10858160 DOI: 10.1007/s00590-023-03691-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 08/13/2023] [Indexed: 09/29/2023]
Abstract
PURPOSE Four joint arthroplasty registries (JARs) levels exist based on the recorded data type. Level I JARs are national registries that record primary data. Hospital or institutional JARs (Level II-IV) document further data (patient-reported outcomes, demographic, radiographic). A worldwide list of Level II-IV JARs must be created to effectively assess and categorize these data. METHODS Our study is a systematic scoping review that followed the PRISMA guidelines and included 648 studies. Based on their publications, the study aimed to map the existing Level II-IV JARs worldwide. The secondary aim was to record their lifetime, publications' number and frequency and recognise differences with national JARs. RESULTS One hundred five Level II-IV JARs were identified. Forty-eight hospital-based, 45 institutional, and 12 regional JARs. Fifty JARs were found in America, 39 in Europe, nine in Asia, six in Oceania and one in Africa. They have published 485 cohorts, 91 case-series, 49 case-control, nine cross-sectional studies, eight registry protocols and six randomized trials. Most cohort studies were retrospective. Twenty-three per cent of papers studied patient-reported outcomes, 21.45% surgical complications, 13.73% postoperative clinical and 5.25% radiographic outcomes, and 11.88% were survival analyses. Forty-four JARs have published only one paper. Level I JARs primarily publish implant revision risk annual reports, while Level IV JARs collect comprehensive data to conduct retrospective cohort studies. CONCLUSIONS This is the first study mapping all Level II-IV JARs worldwide. Most JARs are found in Europe and America, reporting on retrospective cohorts, but only a few report on studies systematically.
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Affiliation(s)
- Aikaterini Zgouridou
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece
| | - Eustathios Kenanidis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece.
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece.
| | - Michael Potoupnis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece
| | - Eleftherios Tsiridis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece
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Ruderman LV, Bayoumi T, Burger JA, Zuiderbaan HA, Pearle AD. Higher incidence of patellar incongruence after under correction of pre-arthritic coronal alignment following medial unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2023; 31:5773-5782. [PMID: 37934285 DOI: 10.1007/s00167-023-07645-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: 09/06/2023] [Accepted: 10/19/2023] [Indexed: 11/08/2023]
Abstract
PURPOSE This study aimed to compare patellofemoral joint alignment of knees with restored pre-arthritic coronal alignment versus knees with under- or overcorrection from their pre-arthritic coronal alignment following medial unicompartmental knee arthroplasty (UKA) and evaluate the effect of patellofemoral joint alignment on patient-reported outcomes. METHODS A retrospective analysis of 517 knees following robotic-arm assisted medial UKA was conducted. Postoperative mechanical hip-knee-ankle angle (mHKA) was compared to estimated pre-arthritic coronal alignment, using the arithmetic hip-knee-ankle angle (aHKA). Knees were considered restored to the pre-arthritic coronal alignment if mHKA was within 2.0° of aHKA (Group 1). Non-restored knees were subdivided into > 2.0° over correction (Group 2), or > 2.0° under correction (Group 3) from the pre-arthritic coronal alignment. Patellar congruence and patellar tilt angles were compared between groups. The Kujala score and Knee Injury and Osteoarthritic Outcome Score for Joint Replacement (KOOS, JR) were analyzed by group. Continuous data was compared using analysis of variance or Kruskal-Wallis tests. Chi-squared tests were used to compare discrete variables. Logistic regressions were conducted to estimate the probability of postoperative patellofemoral malalignment. RESULTS Group 1 included 357 knees (69.1%), Group 2 included 57 knees (11.0%), and Group 3 included 57 knees (11.0%). The prevalence of postoperative abnormal patellar congruence (i.e. ≥ 17°) was higher in Group 3 at 40.4% (p = 0.009), with a higher odds ratio of having an abnormal patellar congruence angle (2.3, p = 0.01) compared to Group 1. The prevalence of postoperative abnormal patellar tilt (i.e. ≥ 14°) was comparable between groups (n.s.). At mean follow up of 4.4 ± 1.6 years, Kujala was worse in Group 3 (76.6 ± 17.4 compared to 84.0 ± 14.9 and 85.0 ± 14.4 in Groups 1 and 2, respectively; p = 0.006). Mean KOOS, JR outcomes were comparable among groups. No significantly inferior Kujala or KOOS, JR outcomes were observed in patients across all groups with abnormal patellar congruence or tilt angles. CONCLUSION Knees with under correction from their pre-arthritic coronal alignment following medial UKA were associated with a two-fold higher probability of having postoperative patellofemoral incongruence, as well as inferior mid-term Kujala scores compared to knees with restored pre-arthritic coronal alignment and knees with overcorrection from their pre-arthritic coronal alignment. Patellofemoral incongruence alone did not negatively impact functional outcome scores. LEVEL OF EVIDENCE IV, case series.
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Affiliation(s)
- L V Ruderman
- Hospital for Special Surgery, Department of Orthopaedic Surgery, Computer Assisted Surgery Center & Sports Medicine, Weill Medical College of Cornell University, New York, USA.
| | - T Bayoumi
- Hospital for Special Surgery, Department of Orthopaedic Surgery, Computer Assisted Surgery Center & Sports Medicine, Weill Medical College of Cornell University, New York, USA
- Department of Orthopaedic Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - J A Burger
- Department of Orthopaedic Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität, Berlin, Germany
| | - H A Zuiderbaan
- Department of Orthopaedic Surgery, Medical Clinic Velsen, Velsen, The Netherlands
| | - A D Pearle
- Hospital for Special Surgery, Department of Orthopaedic Surgery, Computer Assisted Surgery Center & Sports Medicine, Weill Medical College of Cornell University, New York, USA
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Lim S, Kim TH, Park DY, Lee JM, Chung JY. Can bone scintigraphy reflect the progression of osteoarthritis after unicompartmental knee arthroplasty? PLoS One 2023; 18:e0288616. [PMID: 37939074 PMCID: PMC10631669 DOI: 10.1371/journal.pone.0288616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 06/29/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Bone scintigraphy (BS) has been reported to be a useful predictor of osteoarthritis (OA) progression in primary knee OA. However, no previous studies have explored the relationship between BS and OA progression in the retained compartments after unicompartmental knee arthroplasty (UKA). Thus, we evaluated whether OA progresses to other compartments in patients who undergo UKA and if increased uptake on BS is associated with OA progression in other compartments after UKA. METHODS A total of 41 patients with knee BS at least five years after UKA were included. Radiographic OA progression in other compartments was assessed by grading and comparing OA severity in each patient using the Kellgren-Lawrence grading system (K-L grade) and Osteoarthritis Research Society International (OARSI) atlas score. After UKA, the correlation between BS uptake and radiographic OA progression was analyzed in each retained compartment. A correlation analysis was also performed to evaluate the association between BS uptake and OA progression grades. RESULTS A significant progression of OA was observed in both contralateral tibiofemoral and patellofemoral compartments after UKA at 98.5 ± 26.0 months of follow-up (all p<0.001). No correlation was found between BS uptake and radiographic OA progression nor between BS uptake and radiographic OA progression grade in the contralateral and patellofemoral compartments. CONCLUSIONS Following UKA, OA progresses in the retained contralateral tibiofemoral and patellofemoral compartments over a minimum five-year follow-up period. Thus, BS is ineffective in assessing the progression of OA in these compartments.
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Affiliation(s)
- Sumin Lim
- Department of Orthopedic Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Tae Hun Kim
- Department of Orthopedic Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Do Young Park
- Department of Orthopedic Surgery, Ajou University School of Medicine, Suwon, Korea
- Cell Therapy Center, Ajou University Medical Center, Suwon, Korea
| | - Jong Min Lee
- Department of Orthopedic Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Jun Young Chung
- Department of Orthopedic Surgery, Ajou University School of Medicine, Suwon, Korea
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Park DY, Chung JY, Jin YJ, Yoon HS, Min BH, Park JY, Lim S. Lateral Retinacular Release During Medial Unicompartmental Knee Arthroplasty in the Presence of Patello-Femoral Joint Arthritis Relieves Patello-Femoral Joint Pressure and Improves Associated Symptoms. J Arthroplasty 2023; 38:2288-2294. [PMID: 37271229 DOI: 10.1016/j.arth.2023.05.049] [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: 12/27/2022] [Revised: 05/15/2023] [Accepted: 05/20/2023] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND This study evaluated the effects of concomitant lateral patellar retinacular release (LPRR) during medial unicompartmental knee arthroplasty (UKA). METHODS We retrospectively analyzed 100 patients who had patello-femoral joint (PFJ) arthritis who underwent medial UKA with (n = 50) and without (n = 50) LPRR who had ≥2 years follow-up. Radiological parameters associated with lateral retinacular tightness, including patellar tilt angle (PTA), lateral patello-femoral angle (LPFA), and congruence angle, were measured. Functional evaluation was performed using the Knee Society Pain Score, Knee Society Function Score (KSFS), Kujala Score, and the Western Ontario McMaster Universities Osteoarthritis Index score. Intraoperative patello-femoral pressure evaluation was performed on 10 knees to evaluate the pressure changes before and after LPRR. Mann-Whitney U-tests were used for statistical analyses. RESULTS Demographic data did not differ between the LPRR(+) and LPRR(-) groups. A decrease in PTA and an increase in LPFA were observed in the LPRR(+) group compared to those in the LPRR(-) group (PTA; -0.54 versus -1.74, P = .002, LPFA; 0.51 versus 2.01, P = .010). The LPRR(+) group showed significantly better KSFS and Kujala scores than the LPRR(-) group (KSFS: 90 versus 80, P = .017; Kujala score: 86 versus 79, P = .009). Intraoperative patello-femoral pressure analysis showed a 22.6% reduction in the PFJ contact pressure and an 18.7% reduction in PFJ peak pressure after LPRR. (P = .0015, P < .0001, respectively) CONCLUSION: A LPRR during UKA may be a simple and useful adjunct procedure to relieve PFJ symptoms with concomitant PFJOA.
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Affiliation(s)
- Do Young Park
- Department of Orthopedic Surgery, School of Medicine, Ajou University, Suwon, Korea; Cell Therapy Center, Ajou University Medical Center, Suwon, Korea
| | - Jun Young Chung
- Department of Orthopedic Surgery, School of Medicine, Ajou University, Suwon, Korea
| | - Yong Jun Jin
- Cell Therapy Center, Ajou University Medical Center, Suwon, Korea
| | - Ha Seung Yoon
- Department of Orthopedic Surgery, School of Medicine, Ajou University, Suwon, Korea
| | - Byoung-Hyun Min
- Department of Orthopedic Surgery, School of Medicine, Ajou University, Suwon, Korea; Cell Therapy Center, Ajou University Medical Center, Suwon, Korea; Department of Molecular Science and Technology, Ajou University, Suwon, Korea
| | - Jae-Young Park
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University, Seongnam-si, Gyeonggi-do, Korea
| | - Sumin Lim
- Department of Orthopedic Surgery, School of Medicine, Ajou University, Suwon, Korea
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Andronic O, Helmy N, Kellner C, Graf DA. A decreased tibial tuberosity-trochlear groove distance is associated with lateral patellofemoral joint degeneration after implantation of medial fixed-bearing unicompartmental knee arthroplasty - a minimum five year follow-up. INTERNATIONAL ORTHOPAEDICS 2023; 47:2225-2233. [PMID: 37100957 DOI: 10.1007/s00264-023-05812-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 04/11/2023] [Indexed: 04/28/2023]
Abstract
PURPOSE The influence of lateral patellofemoral osteoarthritis (PFOA) in medial unicompartmental knee arthroplasty (UKA) is controversial. Our aim was to identify radiographic factors that may lead to progressive PFOA after implantation of a fixed-bearing medial UKA and their impact on patient-reported outcomes (PROMs). METHODS A retrospective consecutive cohort of patients undergoing medial UKA with a minimum follow-up of 60 months between September 2011 and January 2017 was identified. All UKAs had a fixed-bearing design with cemented femoral and tibial components. PROMs included documentation of the Oxford Knee Score (OKS). The following radiographic parameters were evaluated on conventional radiographs and computer tomography (CT) scans: patella tilt angle, patella congruence angle, Caton-Deschamps index, medial and lateral patellofemoral degeneration (Kellgren-Lawrence Classification (KL)), mechanical anteroposterior axis, femoral torsion, tibial tuberosity to trochlear groove distance (TTTG), anteroposterior translation of the femoral component. A hierarchical multiple regression analysis and partial Pearson correlation analysis (SPSS) were used to evaluate for predictors of progression of lateral PFOA. RESULTS Forty-nine knees allowed PFOA assessment and had an average follow-up of 62 months (range 60-108). Twenty-three patients did not exhibit any progression of lateral PFOA. Twenty-two progressed with 1 stage, whereas four had progressed 2 stages according to the KL classification. TTTG negatively correlated with progressive lateral PFOA (r = - 0.436, p = 0.01). Progression of lateral PFOA did not correlate with OKS at last follow-up (p = 0.613). CONCLUSION A decreased TTGT correlated with radiographic progression of lateral PFOA after medial fixed-bearing cemented UKA. PFOA however did not influence PROMs at a minimum of five years postoperatively.
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Affiliation(s)
- Octavian Andronic
- Department of Traumatology and Orthopaedics, Bürgerspital Solothurn, Schöngrünstrasse, 42, Solothurn, Switzerland.
| | - Näder Helmy
- Department of Traumatology and Orthopaedics, Bürgerspital Solothurn, Schöngrünstrasse, 42, Solothurn, Switzerland
| | - Christoph Kellner
- Department of Traumatology and Orthopaedics, Bürgerspital Solothurn, Schöngrünstrasse, 42, Solothurn, Switzerland
| | - David Alexander Graf
- Department of Traumatology and Orthopaedics, Bürgerspital Solothurn, Schöngrünstrasse, 42, Solothurn, Switzerland
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Bayoumi T, Burger JA, Ruderman LV, van der List JP, Zuiderbaan HA, Kerkhoffs GMMJ, Pearle AD. Restoration or relative overcorrection of pre-arthritic coronal alignment leads to improved results following medial unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2023; 31:3981-3991. [PMID: 37145133 DOI: 10.1007/s00167-023-07441-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 04/23/2023] [Indexed: 05/06/2023]
Abstract
PURPOSE A pre-arthritic alignment strategy for medial unicompartmental knee arthroplasty (UKA) aims to restore a patient's native lower limb alignment which may translate into improved outcomes. This study aimed to assess whether patients with pre-arthritically aligned knees versus patients with non-pre-arthritically aligned knees demonstrated improved mid-term outcomes and survivorship following medial UKA. The hypothesis was that pre-arthritic alignment in medial UKA would lead to better postoperative outcomes. METHODS A retrospective study of 537 robotic-assisted fixed-bearing medial UKA was conducted. During this procedure, the surgical goal was to restore pre-arthritic alignment guided by re-tensioning of the medial collateral ligament (MCL). For study purposes, coronal alignment was retrospectively evaluated using the mechanical hip-knee-ankle angle (mHKA). Pre-arthritic alignment was estimated through the arithmetic hip-knee-ankle (aHKA) algorithm. Knees were grouped according to the difference between postoperative mHKA and estimated pre-arthritic alignment (i.e., mHKA - aHKA) as Group 1 (pre-arthritically aligned: mHKA restored within 2.0° of the aHKA), Group 2 (mHKA > 2.0° overcorrected relative to the aHKA), or Group 3 (mHKA > 2.0° undercorrected relative to the aHKA). Outcomes included the Knee Injury and Osteoarthritic Outcome Score for Joint Replacement (KOOS, JR), Kujala, proportions of knees achieving the patient acceptable symptom state (PASS) for these scores, and survivorship. PASS thresholds for KOOS, JR and Kujala were determined using a receiver operating characteristic curve method. RESULTS A total of 369 knees were categorized as Group 1, 107 as Group 2, and 61 as Group 3. At 4.4 ± 1.6 years follow-up, mean KOOS, JR was comparable among groups, while Kujala was significantly worse in Group 3. The proportion of knees achieving the PASS for Kujala (76.5 points) was lower in Group 3 (n = 32; 59%) compared to Group 1 (n = 260; 74%) (p = 0.02). 5-year survivorship was higher in Group 1 and Group 2 (99% and 100%, respectively) compared to Group 3 (91%) (p = 0.04). CONCLUSION Pre-arthritically aligned knees and knees with relative overcorrection from their pre-arthritic alignment following medial UKA demonstrated improved mid-term outcomes and survivorship compared to knees with relative under correction from their pre-arthritic alignment. These results encourage restoring or relatively overcorrecting pre-arthritic alignment to optimize outcomes following medial UKA, and caution against under correction from the pre-arthritic alignment. LEVEL OF EVIDENCE IV, case series.
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Affiliation(s)
- Tarik Bayoumi
- Department of Orthopaedic Surgery and Computer Assisted Surgery Center, Hospital for Special Surgery, Weill Medical College of Cornell University, 535 East 70th Street, New York, NY, 10021, USA.
| | - Joost A Burger
- Department of Orthopaedic Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität, Berlin, Germany
| | - Lindsey V Ruderman
- Department of Orthopaedic Surgery and Computer Assisted Surgery Center, Hospital for Special Surgery, Weill Medical College of Cornell University, 535 East 70th Street, New York, NY, 10021, USA
| | - Jelle P van der List
- Department of Orthopaedic Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Sports, Amsterdam, The Netherlands
| | - Hendrik A Zuiderbaan
- Department of Orthopaedic Surgery, Medische Kliniek Velsen, Velsen, The Netherlands
| | - Gino M M J Kerkhoffs
- Department of Orthopaedic Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Sports, Amsterdam, The Netherlands
| | - Andrew D Pearle
- Department of Orthopaedic Surgery and Computer Assisted Surgery Center, Hospital for Special Surgery, Weill Medical College of Cornell University, 535 East 70th Street, New York, NY, 10021, USA
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Plancher KD, Briggs KK, Tucker EE, Zuccaro P, Petterson SC. The Role of Severe Lateral Facet Patellar Osteoarthritis in Patient Selection for Success of a Medial Unicompartmental Knee Arthroplasty: Mean Follow-Up of 10 Years. J Arthroplasty 2023; 38:S145-S149. [PMID: 37230228 DOI: 10.1016/j.arth.2023.05.024] [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: 12/01/2022] [Revised: 05/11/2023] [Accepted: 05/15/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Lateral facet patellar osteoarthritis (LFPOA) has been reported as a contraindication for medial unicompartmental (UKA). The purpose of this paper was to determine if severe LFPOA was related to lower survivorship and patient-reported outcomes following medial UKA. METHODS A total of 170 medial UKAs were performed. Severe LFPOA was defined as Outerbridge grade 3 to 4 damage on the lateral facet cartilage surfaces of the patella as noted intraoperatively. There were 122 of 170 patients (72%) who had noLFPOA and 48 of 170 patients (28%) who had had severe LFPOA. A routine patelloplasty was performed in all patients. Patients completed the Veterans RAND 12-Item Health Survey (VR-12) Mental Component Score (MCS) and Physical Component Score (PCS), Knee Injury and Osteoarthritis Outcome Score (KOOS), and Knee Society Score. RESULTS There were 4 patients in the noLFPOA group who required total knee arthroplasty and 2 in the LFPOA group. There was no significant difference in mean survival time: noLFPOA = 17.2 years [95% confidence interval (CI): 17 to 18] and LFPOA = 18.0 years [95% CI: 17 to 19] (P = .94). At mean follow-up of 10 years, there were no significant differences in knee flexion or extension. Patello-femoral crepitus without pain was noted in 7 patients who had LFPOA and 21 patients who had noLFPOA. There were no significant differences in VR-12 MCS, PCS, KOOS subscales, or Knee Society Score between groups. Patient acceptable symptom state (PASS) was achieved in 80% (90 of 112) for KOOS ADL in the noLFPOA group and 82% (36 of 44) in the LFPOA group (P = .68). PASS was achieved in 82% (92 of 112) for KOOS Sport in the noLFPOA group and 82% (36/44) in the LFPOA group (P = .87). CONCLUSION At a mean of 10 years, patients who had LFPOA had equivalent survivorship and functional outcomes to patients who did not have LFPOA. These long-term results suggest that asymptomatic grade 3 or 4 LFPOA is not a contraindication to medial UKA.
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Affiliation(s)
- Kevin D Plancher
- Department of Orthopaedic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, New York; Department of Orthopaedic Surgery, Weil Cornell Medical College, New York, New York; Plancher Orthopaedics & Sports Medicine, New York, New York; Orthopaedic Foundation, Stamford, Connecticut
| | | | - Erin E Tucker
- Plancher Orthopaedics & Sports Medicine, New York, New York
| | - Philip Zuccaro
- Plancher Orthopaedics & Sports Medicine, New York, New York
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Lee QJ, Chang WYE, Wong YC. Mid-term survivorship of fixed bearing unicondylar knee arthroplasty with no exclusion of early PFJ arthritis or ACL deficiency: Analysis of clinical and radiological predictors. J Orthop Surg (Hong Kong) 2022; 30:10225536221141782. [PMID: 36419402 DOI: 10.1177/10225536221141782] [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: 11/25/2022] Open
Abstract
PURPOSE Fixed bearing (FB) UKA constituted 63.7% of unicondylar knee arthroplasties in 2020 Australian Registry with the longest UKA survivorship. The significance of patellofemoral joint (PFJ) arthritis, ACL deficiency, post-operative anteromedial pain, radiosclerosis or radiolucency on survivorship of FB UKA is not established. The aim of this study was to analyze the medium-term survivorship of fixed-bearing UKA with no exclusion of PFJ OA and ACL deficiency. Predictors for failure were analyzed. METHODS FB UKA performed in 2011-17 were reviewed. Cases with PFJ OA or ACL deficiency were not excluded. The effect on survivorship by ACL deficiency, PFJ arthritis, post-operative anteromedial pain and radiological abnormalities were analyzed. RESULTS There were 96 UKA with follow-up time of 66 ± 18 months (27-98). The mean age was 70 ± 9 years, BMI 25.8 ± 2.6 kg/m2. Alignment was varus 9° ± 4° pre-operatively and varus 3° ± 3° post-operatively. There were four revisions (4.2%) and 4 deaths (4.2%). Reasons for revisions were loosening (n = 1), persistent pain (n = 2) and lateral compartment disease (n = 1). Estimated survival at 8.3 years was 94.7% (95% CI 91.6-97.7). BMI ≥30 was found to be a significant predictor for failure. The incidence of radiographic abnormalities was 75% for PFJ arthritis, 39% for tibial tray overhang, 14% for radiolucency or radiosclerosis, 5% for ACL deficiency and 5% for edge loading respectively but they were not significantly associated with lower survivorship or anteromedial knee pain. The presence of anteromedial pain after surgery in 36.5% was also not significantly associated with survivorship. CONCLUSION FB UKA with no exclusion of early PFJ arthritis and ACL deficiency has satisfactory medium-term survivorship. BMI ≥30 could have higher risk of all-cause revision. Tibial tray overhang, non-progressive radiolucency or radiosclerosis do not seem to be associated with anteromedial knee pain or poorer medium term survivorship.
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Affiliation(s)
- Qunn Jid Lee
- Total Joint Replacement Center, 71210Yan Chai Hospital, Hong Kong, China
| | | | - Yiu Chung Wong
- Total Joint Replacement Center, 71210Yan Chai Hospital, Hong Kong, China
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Wang Z, Deng W, Shao H, Zhou Y, Yang D, Li H. Predictors of a forgotten joint after medial fixed-bearing unicompartmental knee arthroplasty. Knee 2022; 37:103-111. [PMID: 35753203 DOI: 10.1016/j.knee.2022.06.004] [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: 03/27/2022] [Accepted: 06/09/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND A forgotten joint is considered the ultimate goal of joint replacement. We aim to explore the predictive factors of a forgotten joint after fixed-bearing unicompartmental knee arthroplasty (UKA). METHODS This retrospective cohort study used prospectively collected data from 302 cases of medial-compartment UKA with a minimum of 2-year follow-up. The primary outcome was the achievement of a forgotten joint after UKA, according to the Forgotten Joint Score (FJS-12) at the last follow-up. Patients with FJS-12 > 84 were considered to have forgotten UKA. Univariate and multivariate logistic regression analyses were conducted with preoperative patient characteristics and surgery-related factors as potential predictors. RESULTS Of patients, 94 (31.1%) achieved a forgotten joint post-surgery. Multivariate logistic regression analysis revealed that preoperative hip-knee-ankle angle (HKAA), anatomic lateral distal femoral angle (aLDFA), and postoperative HKAA and HKAA changes were independent predictors of a forgotten joint. The probability of achieving a forgotten joint increased by 29% (OR = 1.29, 95% CI: 1.12-1.51) with a 1° increase in aLDFA. Preoperative HKAA, postoperative HKAA, HKAA changes (ΔHKAA), and outcomes exhibited a non-linear relationship. The probability of achieving a forgotten joint was the highest with preoperative HKAA > 172.0°, postoperative HKAA of 176.0-178.5°, and ΔHKAA < 5.5°. CONCLUSION To achieve the forgotten joint state, the ideal HKAA range after medial fixed-bearing UKA is 176.0-178.5° and ΔHKAA should be <5.5°. Patients with smaller preoperative aLDFA and HKAA have a lower probability of achieving a forgotten joint after UKA.
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Affiliation(s)
- Zhaolun Wang
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No. 31 Xinjiekou East Street, Xicheng District, Beijing 100035, China
| | - Wang Deng
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No. 31 Xinjiekou East Street, Xicheng District, Beijing 100035, China
| | - Hongyi Shao
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No. 31 Xinjiekou East Street, Xicheng District, Beijing 100035, China
| | - Yixin Zhou
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No. 31 Xinjiekou East Street, Xicheng District, Beijing 100035, China.
| | - Dejin Yang
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No. 31 Xinjiekou East Street, Xicheng District, Beijing 100035, China
| | - Hua Li
- Department of Orthopedics, General Hospital of Chinese PLA, No. 28 Fuxing Road, Beijing 100853, China; National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, No. 28 Fuxing Road, Beijing 100853, China
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15
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Wu LP, Mayr HO, Zhang X, Huang YQ, Chen YZ, Li YM. Knee Scores of Patients with Non-Lateral Compartmental Knee Osteoarthritis Undergoing Mobile, Fixed-Bearing Unicompartmental Knee and Total Knee Arthroplasties: A Randomized Controlled Trial. Orthop Surg 2021; 14:73-87. [PMID: 34870364 PMCID: PMC8755879 DOI: 10.1111/os.13111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 04/21/2021] [Accepted: 05/26/2021] [Indexed: 11/29/2022] Open
Abstract
Objective To evaluate knee scores and clinical efficacies of patients with non‐lateral unicompartmental knee osteoarthritis (OA) who randomly underwent mobile‐bearing (MB) unicompartmental knee arthroplasty (UKA), fixed‐bearing (FB) UKA, and total knee arthroplasty (TKA). Methods From September 2015 to February 2017, a prospective, randomized, parallel, single‐center trial of 180 patients (78 males and 102 females; 63.3 ± 6.9 years) with non‐lateral compartmental knee OA was performed in the first author‐affiliated hospital. The patients were randomly divided into three groups (each group included 60 patients) and received medial cemented Oxford phase 3 MB UKA, medial cemented Link FB UKA, or cemented DePuy Sigma PFC TKA, respectively. A similar perioperative management and fast‐track surgery program was carried out for all patients. The knee scores at 3‐year follow‐up after operation and clinical efficacies of these three groups of patients were recorded, investigated, and compared. Results Primarily, compared to the TKA group, the UKA groups (MB UKA and FB UKA) had shorter operative time (median 63.2 < 67.1 min), less bleeding (8.6 < 30.0 mL), earlier resumption of walking without crutches (3.0 < 8.0 days) and walking up and down the stairs (5.0 < 10.0 days) (P < 0.001), higher FJS scores (78.0 > 74.5) (P = 0.007), better results in all knee scores (except VAS and KSS function scores) (P < 0.05), and a larger maximum flexion angle of the knee at the 3‐year follow‐up (123.0° > 96.0°) (P = 0.001). Secondarily, compared to the TKA group, the MB UKA group showed better results in the Western Ontario and McMaster Universities index (WOMAC) stiffness (83.6 > 79.6), WOMAC total (86.3 > 83.2), Oxford knee score (OKS) (20.0 < 23.0), Forgotten Joint Score (FJS) (78.5 > 74.5), and a larger maximum flexion angle of the knee (123.0 > 96.0) (P < 0.05). Moreover, the FB UKA group showed higher Hospital for Special Surgery Knee Score (HSS) (91.0 > 88.5), WOMAC stiffness (84.3 > 79.6), WOMAC function (85.2 > 81.7), WOMAC total scores (87.6 > 83.2), and a larger maximum flexion angle of the knee (119.0° > 96.0°) than the TKA group (P < 0.05). Overall, there was no significant difference in all knee scores and maximum flexion angles of the knee for the MB UKA and FB UKA groups (P > 0.05). There was one case with original bearing dislocation in MB UKA group. One patient with displacement of the femoral component caused by a fall injury, and another patient, who lost his life in a car accident, were involved in the FB UKA group. There was an infection case and an intermuscular vein thrombosis case in TKA group. Conclusion UKA showed more advantages than TKA; however, there was no significant difference between the MB UKA and FB UKA groups for treatment of non‐lateral compartmental knee OA.
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Affiliation(s)
- Li-Ping Wu
- Department of Orthopedic Surgery, Jiangmen Central Hospital (Affiliated Jiangmen Hospital of Sun Yat-Sen University), Jiangmen, China
| | - Hermann O Mayr
- Department of Orthopedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Xing Zhang
- Clinical Experimental Center, Jiangmen Central Hospital (Affiliated Jiangmen Hospital of Sun Yat-Sen University), Jiangmen, China
| | - Yuan-Qiao Huang
- Department of Orthopedic Surgery, Jiangmen Central Hospital (Affiliated Jiangmen Hospital of Sun Yat-Sen University), Jiangmen, China
| | - Yuan-Zhuang Chen
- Department of Orthopedic Surgery, Jiangmen Central Hospital (Affiliated Jiangmen Hospital of Sun Yat-Sen University), Jiangmen, China
| | - Yu-Ming Li
- Department of Orthopedic Surgery, Jiangmen Central Hospital (Affiliated Jiangmen Hospital of Sun Yat-Sen University), Jiangmen, China
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17
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Does patellofemoral osteoarthritis affect functional outcomes and survivorship after medial unicompartmental knee arthroplasty? A meta-analysis. J Orthop Surg Res 2020; 15:584. [PMID: 33276784 PMCID: PMC7716458 DOI: 10.1186/s13018-020-02063-0] [Citation(s) in RCA: 4] [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: 06/03/2020] [Accepted: 11/02/2020] [Indexed: 01/01/2023] Open
Abstract
PURPOSE The argument that patellofemoral osteoarthritis (PFOA) is a contraindication to unicompartmental knee arthroplasty (UKA) remains to be resolved. The purpose of this study was to perform a meta-analysis to determine whether PFOA affects functional outcomes and survivorship after medial UKA. METHODS A literature search was performed in PubMed, Medline, Cochrane Library and Web of science to identify studies published in English (the last search was updated on June 1, 2020). The primary outcome measure was the Oxford Knee Score (OKS), whereas the secondary outcomes included range of motion (ROM) and the revision rate. Patients with patellofemoral joint narrowing or cartilage lesions as assessed intraoperatively or by radiography were assigned to the PFOA group. RESULTS A total of 8 studies involving 3504 patients and 3975 knees were included in this meta-analysis. No patients had a severe lateral patellar groove. The results showed that there was no significant difference in the OKS, revision rate and ROM between PFOA patients and patients without PFOA. CONCLUSIONS No significant difference in functional outcomes and survivorship was found between patients with and without PFOA. Patients with PFOA assessed by radiographs or intraoperatively but without a lateral patellar groove should be considered candidates for medial UKA.
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Goh JKM, Chen JY, Yeo NEM, Liow MHL, Chia SL, Yeo SJ. Ten year outcomes for the prospective randomised trial comparing unlinked, modular bicompartmental knee arthroplasty and total knee arthroplasty. Knee 2020; 27:1914-1922. [PMID: 33221689 DOI: 10.1016/j.knee.2020.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/24/2020] [Accepted: 08/12/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND A sizeable proportion of knee osteoarthritis is limited to the medial and patellofemoral compartments. Whilst short- and medium-term studies comparing bicompartmental knee arthroplasty (BCA) and total knee arthroplasty (TKA) have shown similar outcome scores, there are no studies comparing long-term outcomes. This study aims to determine which procedure resulted in superior long-term outcome scores. METHODS Forty-eight patients with medial and patellofemoral compartment knee osteoarthritis were randomised to receive treatment in two groups: unlinked, modular BCA and TKA. The main outcome measures compared were the range of motion, Knee Society Function Score, Knee Society Knee Score, Oxford Knee Score, Physical Component Score and Mental Component Score of SF-36 pre-operatively and post-operatively up to 10 years. Radiographs of the operated knees were taken pre-operatively, post-operatively and at 10-year follow-up. RESULTS Twenty-six underwent BCA and 22 underwent TKA. Overall improvement was seen in both groups compared to pre-operatively, however there were no significant differences detected between the groups at 10 years. The median Hip-Knee-Ankle (HKA) angle was 183.38 (175.17-187.94) in the BCA group and 180.73 (174.96-185.65) in the TKA group. One patient from the BCA group had a peri-prosthetic fracture necessitating revision surgery to a TKA. CONCLUSIONS Outcome scores for BCA results were comparable to TKA at long-term follow-up. BCA is an alternative arthroplasty option in selected patients.
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Affiliation(s)
- Jeremy Keng Meng Goh
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road Academia Building Level 4, Singapore 119228, Singapore.
| | - Jerry Yongqiang Chen
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road Academia Building Level 4, Singapore 119228, Singapore
| | - Nicholas Eng Meng Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road Academia Building Level 4, Singapore 119228, Singapore
| | - Ming Han Lincoln Liow
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road Academia Building Level 4, Singapore 119228, Singapore
| | - Shi-Lu Chia
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road Academia Building Level 4, Singapore 119228, Singapore
| | - Seng Jin Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road Academia Building Level 4, Singapore 119228, Singapore
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Deckard ER, Jansen K, Ziemba-Davis M, Sonn KA, Meneghini RM. Does Patellofemoral Disease Affect Outcomes in Contemporary Medial Fixed-Bearing Unicompartmental Knee Arthroplasty? J Arthroplasty 2020; 35:2009-2015. [PMID: 32234327 DOI: 10.1016/j.arth.2020.03.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 02/24/2020] [Accepted: 03/02/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Pre-existing patellofemoral disease has traditionally been a contraindication to unicompartmental knee arthroplasty (UKA), as proposed by Kozinn and Scott. More recently, some propose that patellofemoral disease can be ignored in UKA; however, the supporting research is predominantly in mobile-bearing designs. The study purpose was to evaluate the effect of patellofemoral disease osteoarthritis severity on latest outcomes after fixed-bearing medial UKA. METHODS A retrospective review of 147 consecutive medial fixed-bearing UKAs with minimum 1-year follow-up was performed. The medial and lateral patellofemoral compartments were graded according to the Kellgren & Lawrence grading system, Osteoarthritis Research Society International atlas, and intraoperative assessment performed using the Outerbridge classification. Prospectively collected University of California Los Angeles Activity Level, modern Knee Society pain and function scores, and Likert scale satisfaction were correlated with presence and severity of pre-existing patellofemoral disease. RESULTS One hundred forty-three medial UKAs were analyzed with mean age, body mass index, and follow-up of 64.1 years, 30.7 kg/m2, and 24.0 months, respectively. No correlations were observed between patellofemoral disease severity and patient-reported outcome measures at latest follow-up or improvement scores for Kellgren & Lawrence grading system or Osteoarthritis Research Society International atlas (P ≥ .058). Improvement in activity level scores was significantly higher for patients with less patellar and trochlear chondral damage despite not reaching minimal clinically important difference of 2.0 (P ≤ .028). Regardless of patellofemoral disease severity, 93% of UKAs were satisfied or very satisfied. CONCLUSION Clinical outcomes of fixed-bearing medial UKA were not adversely impacted by intraoperatively visualized or radiographically evaluated patellofemoral disease. Furthermore, long-term follow-up is warranted and caution should be used before considering patellofemoral disease as a contraindication for UKA.
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Affiliation(s)
- Evan R Deckard
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Kirsten Jansen
- Indiana University Health Physicians, IU Health Hip & Knee Center, Fishers, IN
| | - Mary Ziemba-Davis
- Indiana University Health Physicians, IU Health Hip & Knee Center, Fishers, IN
| | - Kevin A Sonn
- Indiana University Health Physicians, IU Health Hip & Knee Center, Fishers, IN
| | - R Michael Meneghini
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN; Indiana University Health Physicians, IU Health Hip & Knee Center, Fishers, IN
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Burger JA, Dooley MS, Kleeblad LJ, Zuiderbaan HA, Pearle AD. What is the impact of patellofemoral joint degeneration and malalignment on patient-reported outcomes after lateral unicompartmental knee arthroplasty? Bone Joint J 2020; 102-B:727-735. [DOI: 10.1302/0301-620x.102b6.bjj-2019-1429.r1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims It remains controversial whether patellofemoral joint pathology is a contraindication to lateral unicompartmental knee arthroplasty (UKA). This study aimed to evaluate the effect of preoperative radiological degenerative changes and alignment on patient-reported outcome scores (PROMs) after lateral UKA. Secondarily, the influence of lateral UKA on the alignment of the patellofemoral joint was studied. Methods A consecutive series of patients who underwent robotic arm-assisted fixed-bearing lateral UKA with at least two-year follow-up were retrospectively reviewed. Radiological evaluation was conducted to obtain a Kellgren Lawrence (KL) grade, an Altman score, and alignment measurements for each knee. Postoperative PROMs were assessed using the Kujala (Anterior Knee Pain Scale) score, Knee Injury and Osteoarthritis Outcome Score Joint Replacement (KOOS JR), and satisfaction levels. Results A total of 140 knees (130 patients) were identified for analysis. At mean 4.1 years (2.0 to 8.5) follow-up, good to excellent Kujala scores were reported. The presence of mild to moderate preoperative patellofemoral joint osteoarthritis had no impact on these scores (KL grade 0 vs 1 to 3, p = 0.203; grade 0 to 1 vs 2 to 3, p = 0.674). Comparable scores were reported by patients with osteoarthritis (Altman score of ≥ 2) evident on either the medial or lateral patellofemoral joint facet (medial, p = 0.600 and lateral, p = 0.950). Patients with abnormal patellar congruence and tilt angles (≥ 17° and ≥ 14°, respectively) reported good to excellent Kujala scores. Furthermore, lateral UKA resulted in improvements to patellofemoral alignment. Conclusion This is the first study demonstrating that mild to moderate preoperative radiological degenerative changes and malalignment of the patellofemoral joint are not associated with poor patient-reported outcomes at mid-term follow-up after lateral fixed-bearing UKA. Our data suggest that this may be explained by realignment of the patella and thereby redistribution of loads across the patellofemoral joint. Cite this article: Bone Joint J 2020;102-B(6):727–735.
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Affiliation(s)
- Joost A. Burger
- Department of Orthopaedic Surgery and Computer Assisted Surgery Center, Hospital for Special Surgery, New York, New York, USA
| | - Matthew S. Dooley
- Department of Orthopaedic Surgery and Computer Assisted Surgery Center, Hospital for Special Surgery, New York, New York, USA
| | - Laura J. Kleeblad
- Department of Orthopaedic Surgery, Noordwest Ziekenhuisgroep, Alkmaar, Netherlands
| | | | - Andrew D. Pearle
- Department of Orthopaedic Surgery and Computer Assisted Surgery Center, Hospital for Special Surgery, New York, New York, USA
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