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Albishi W, AbuDujain NM, Aldhahri M, Alzeer M. Unicompartmental knee replacement: controversies and technical considerations. ARTHROPLASTY 2024; 6:21. [PMID: 38693586 PMCID: PMC11064323 DOI: 10.1186/s42836-024-00242-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 02/20/2024] [Indexed: 05/03/2024] Open
Abstract
BACKGROUND Unicompartmental knee replacement (UKR) is one of the effective interventions for the treatment of symptomatic knee osteoarthritis. Moreover, it has multiple advantages over total knee arthroplasty (TKA), including reduced intraoperative blood loss, decreased risk of transfusion, and faster recovery. This study aimed to discuss critical technical considerations regarding UKR and some of the controversies and updates. METHODS We conducted a review to provide an overview of the controversies and technical considerations about UKR in several aspects. Only peer-reviewed articles were included, up to December 2023 using PubMed, Google Scholar, ERIC, and Cochrane database for systematic reviews databases. RESULT UKR is associated with superior patient-reported clinical and functional outcomes, as well as shorter hospital stays, fewer postoperative complications, and revealed favorable outcomes in patients' return to sport. The choice between mobile- and fixed-bearing prostheses depends, in part, on the surgeon's preference. The mobile-bearing UKR is a less constrained prosthesis and can potentially result in less wear, but it is more technically demanding. While no significant difference between mobile-bearing versus fixed-bearing prostheses, cementless is superior to cemented design. Furthermore, UKR can be a good alternative for high tibial osteotomy (HTO) and still can be considered after a failed HTO. Lastly, recent reviews have shown a revision rate comparable to that of TKA. This is probably influenced by Improved comprehension of the best indications, patient selection criteria, as well as of the design, materials, and technological advances. CONCLUSION UKR treatment for unicompartmental knee osteoarthritis is secure and effective. Based on clinical and functional outcomes, decreased morbidity and mortality, and cost-effectiveness, long-term studies suggest that UKR is superior to TKA. Further investigation in this area is warranted.
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Affiliation(s)
- Waleed Albishi
- Department of Orthopedic Surgery, College of Medicine, King Saud University, Riyadh, 11362, Saudi Arabia
| | - Nasser M AbuDujain
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, 2925, Saudi Arabia.
| | - Mohammed Aldhahri
- Department of Orthopedic Surgery, College of Medicine, King Saud University, Riyadh, 11362, Saudi Arabia
| | - Meshari Alzeer
- College of Medicine, King Saud University, Riyadh, 11362, Saudi Arabia
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D'Ambrosi R, Rubino F, Ursino C, Mariani I, Ursino N, Formica M, Prinz J, Migliorini F. Change in patellar height in medial and lateral unicompartmental knee arthroplasty: a clinical trial. Arch Orthop Trauma Surg 2024; 144:1345-1352. [PMID: 38108862 PMCID: PMC10896931 DOI: 10.1007/s00402-023-05139-8] [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: 07/24/2023] [Accepted: 11/13/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION Evidence on patellar height changes following unicompartmental knee arthroplasty (UKA) is lacking. Therefore, this study compared the patella height in patients who underwent medial versus lateral UKA. Moreover, a subgroup analysis was conducted to investigate whether sex, age, and BMI of the patients exert an influence on the postoperative patellar height. METHODS Radiographs and hospital records of patients undergoing UKA were prospectively collected. Surgeries were performed by one author with long experience in UKA in a highly standardised fashion. The implants were fixed-bearing medial PPK (Zimmer Biomet, Warsaw, Indiana, USA) and fixed-bearing lateral ZUK (Lima Corporate, Udine, Italy). The patellar height was measured using the Insall-Salvati and Caton-Deschamps indices. RESULTS A total of 203 patients were included: 119 patients were included in the medial and 84 in the lateral UKA. The mean age of the patients was 68.9 ± 6.7 years, and the mean BMI was 28.1 ± 4.1 kg/m2. 54% (110 of 203 patients) were women. On admission, between-group comparability was found in age, BMI, sex, and length of the follow-up. No between-group and within-group difference was detected pre- and post-operatively in the Insall-Salvati and Caton-Deschamps indices in patients who have undergone medial versus lateral UKA. Concerning the subgroup analyses, no between-group and within-group difference was detected pre- and post-operatively in all comparisons according to sex, age, and BMI. CONCLUSION No difference was found in patella height in patients who have undergone medial compared to lateral UKA. Furthermore, there was no evidence of an association between patient characteristics (sex, age, BMI) and patella height between medial and lateral UKA.
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Affiliation(s)
- Riccardo D'Ambrosi
- IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
| | - Francesco Rubino
- Orthopaedic Clinic, IRCCS Hospital Policlinico San Martino, Genoa, Italy
- DISC - Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - Chiara Ursino
- Orthopaedic Clinic, IRCCS Hospital Policlinico San Martino, Genoa, Italy
- DISC - Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - Ilaria Mariani
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | | | - Matteo Formica
- Orthopaedic Clinic, IRCCS Hospital Policlinico San Martino, Genoa, Italy
- DISC - Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - Julia Prinz
- Department of Ophthalmology, RWTH University Hospital, 52074, Aachen, Germany
| | - Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany.
- Department of Orthopaedics and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical University, 39100, Bolzano, Italy.
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Marullo M, Tandogan RN, Kort N, Meena A, Attri M, Gomberg B, D'Ambrosi R. Trends in unicompartmental knee arthroplasty among 138 international experienced arthroplasty knee surgeons. Heliyon 2024; 10:e24307. [PMID: 38304773 PMCID: PMC10830546 DOI: 10.1016/j.heliyon.2024.e24307] [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: 04/21/2023] [Revised: 01/05/2024] [Accepted: 01/05/2024] [Indexed: 02/03/2024] Open
Abstract
Purpose Unicompartmental knee arthroplasty (UKA) is an established option for treating isolated unicompartmental knee osteoarthritis (OA), but controversies still exist about patient selection, indications, perioperative management and alignment goals. This survey was designed to understand the current trends of experienced arthroplasty knee surgeons performing UKA. Methods An online questionnaire was created with SurveyMonkey® to assess global tendencies in the utilization of UKA. A link to the survey was shared with all ESSKA (European Society for Sports Traumatology, Knee Surgery and Arthroscopy) members. The questionnaire consisted of free and multiple-choice questions and was divided into four sections: demographic information, the surgical activity of the respondents, indications for surgery and postoperative alignment goals. Results A total of 138 ESSKA members from 34 different countries completed the survey. A total of 81 % of the responders performed fewer than 50 UKAs per year; 53 % of UKAs represented less than 20 % of their knee replacements; 71 % used mainly or only fixed-bearing implants; 81 % performed UKA in a shorter time compared to TKA; and 61 % and 72 % were interested in custom-made UKA and robotics, respectively. Thirty-six percent considered a minimum postoperative alignment of 0° for medial UKA, and 32 % considered 10° as the maximum valgus deformity for lateral UKA. Fifty-five percent had no minimum age cut-off, 47 % had no BMI cut-off, and 57 % believed TKA was better than UKA in knees with concomitant high-grade patellofemoral OA. Approximately 50 % of the surgeons desired a coronal alignment that was the same as the predegeneration alignment. Conclusion A high level of agreement was reached regarding the following: preference for fixed-bearing UKAs, lower surgical time for UKA compared to TKA, interest in custom-made and robotic UKAs, no age and weight cut-off, TKA preferred in the presence of patellofemoral OA, and a final alignment goal of the predegenerative state both for medial and lateral. There was no agreement regarding length of stay, rehabilitation protocol, preoperative varus and valgus cut-off values, and treatment in cases of absence of anterior cruciate ligament or previous osteotomy.
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Affiliation(s)
| | - Reha N. Tandogan
- Department of Orthopaedics and Traumatology, Emsey Hospital, Istanbul, Turkey
- Department of Orthopaedics and Traumatology, Halic University Istanbul & Cankaya Orthopedics, Ankara, Turkey
| | | | - Amit Meena
- Gelenkpunkt – Sports and Joint Surgery, FIFA Medical Centre of Excellence, Innsbruck, Austria
| | - Manish Attri
- Central Institute of Orthopaedics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Bruce Gomberg
- Northern Light Mercy Orthopaedics, Portland, ME, USA
| | - Riccardo D'Ambrosi
- IRCCS Ospedale Galeazzi – Sant’Ambrogio, Milan, Italy
- Università Degli Studi di Milano, Dipartimento di Scienze Biomediche per La Salute, Milan, Italy
| | - EKA Small Implants Focus Group
- IRCCS Ospedale Galeazzi – Sant’Ambrogio, Milan, Italy
- Department of Orthopaedics and Traumatology, Emsey Hospital, Istanbul, Turkey
- Department of Orthopaedics and Traumatology, Halic University Istanbul & Cankaya Orthopedics, Ankara, Turkey
- CortoClinics, Nederweert, Netherlands
- Gelenkpunkt – Sports and Joint Surgery, FIFA Medical Centre of Excellence, Innsbruck, Austria
- Central Institute of Orthopaedics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
- Northern Light Mercy Orthopaedics, Portland, ME, USA
- Università Degli Studi di Milano, Dipartimento di Scienze Biomediche per La Salute, Milan, Italy
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Yuan B, Mo Z, Zhang K, Zhu X, Yan S, Zeng J. The effect of different posterior inclinations of tibial component on tibiofemoral contact pressures after unicompartmental knee arthroplasty. J Orthop Surg Res 2023; 18:909. [PMID: 38031176 PMCID: PMC10685639 DOI: 10.1186/s13018-023-04222-5] [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: 06/16/2023] [Accepted: 09/19/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Different posterior inclinations of tibial component after unicompartmental knee arthroplasty (UKA) may lead to different biomechanical characteristics of the knee joint. This finite element study was designed to investigate the tibiofemoral contact pressures after UKA with different posterior inclinations of tibial component. METHODS Finite element model of a healthy knee joint was constructed, and mobile-bearing (MB) UKA models with 5 different posterior inclinations (3°, 5°, 7°, 9° and 11°) of tibial components were simulated. The maximum contact pressures of tibial plateau cartilage in the lateral compartment and polyethylene insert in the medial compartment were calculated based on the ground reaction force and the angle of the knee flexion obtained by 3D motion capture system. RESULTS The loading ratio of medial and lateral compartments during standing stance (medial 54.49%, lateral 45.51%) and tibial anterior displacement (134 N, 3.89 mm) of healthy knee was basically consistent with previous experimental data. The maximum contact pressures of the medial meniscus and lateral tibial plateau cartilage of the healthy knee during standing stance were 2.14 MPa and 1.57 MPa, respectively. At the static standing phase, the maximum contact pressures of the polyethylene insert decreased from 17.90 to 17.29 Mpa, and the maximum contact pressures of the tibial plateau cartilage in the lateral compartment increased from 0.81 to 0.92 Mpa following an increase in the posterior inclination of the tibial component. At the first peak of ground reaction force, the maximum contact pressures of polyethylene insert increased from 22.37 to 25.16 MPa, and the maximum contact pressures of tibial plateau cartilage in the lateral compartment increased from 3.03 to 3.33 MPa, with the increase in the posterior inclination of the tibial component. At the second peak of ground reaction force, the maximum contact pressures of polyethylene insert decreased from 2.34 to 2.22 MPa with the increase in posterior inclination of tibial component. CONCLUSION The preoperative and postoperative finite element models of MB UKA were well established. The results showed that the maximum contact pressures of the polyethylene insert did not change significantly with the increase in the posterior inclination of the tibial prosthesis, while the maximum contact pressures of the tibial plateau cartilage of the lateral compartment increased when the posterior inclination of the tibial prosthesis was > 7°. Our results also show that the maximum contact pressures were greater with an excessive inclination angle (11°) of the tibial component, and the pressures of the tibial plateau cartilage in the lateral compartment were more concentrated on the posterior area. This study, therefore, proposes that excessive osteotomy should be avoided.
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Affiliation(s)
- Bo Yuan
- Department of Bone and Joint Surgery, Beijing Luhe Hospital, Capital Medical University, No. 82 Xinhua South Road, Tongzhou District, Beijing, 101149, China
| | - Zhongjun Mo
- Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, Key Laboratory of Human Motion Analysis and Rehabilitation Technology of the Ministry of Civil Affairs, National Research Centre for Rehabilitation Technical Aids, Beijing, 100176, China
| | - Kuan Zhang
- Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, No.10 Xitoutiao, You An Men Wai, Beijing, 100069, China
- School of Biomedical Engineering, Capital Medical University, Beijing, 100069, China
| | - Xu Zhu
- Department of Bone and Joint Surgery, Beijing Luhe Hospital, Capital Medical University, No. 82 Xinhua South Road, Tongzhou District, Beijing, 101149, China
| | - Songhua Yan
- Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, No.10 Xitoutiao, You An Men Wai, Beijing, 100069, China
- School of Biomedical Engineering, Capital Medical University, Beijing, 100069, China
| | - Jizhou Zeng
- Department of Bone and Joint Surgery, Beijing Luhe Hospital, Capital Medical University, No. 82 Xinhua South Road, Tongzhou District, Beijing, 101149, China.
- Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, No.10 Xitoutiao, You An Men Wai, Beijing, 100069, China.
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Migliorini F, Feierabend M, Hofmann UK. Fostering Excellence in Knee Arthroplasty: Developing Optimal Patient Care Pathways and Inspiring Knowledge Transfer of Advanced Surgical Techniques. J Healthc Leadersh 2023; 15:327-338. [PMID: 38020721 PMCID: PMC10676205 DOI: 10.2147/jhl.s383916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 11/13/2023] [Indexed: 12/01/2023] Open
Abstract
Osteoarthritis of the knee is common. Early sports trauma or cartilage defects are risk factors for osteoarthritis. If conservative treatment fails, partial or total joint replacement is often performed. A joint replacement aims to restore physiological biomechanics and the quality of life of affected patients. Total knee arthroplasty is one of the most performed surgeries in musculoskeletal medicine. Several developments have taken place over the last decades that have truly altered the way we look at knee arthroplasty today. Some of the fascinating aspects will be presented and discussed in the present narrative review.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Medical Centre, Aachen, 52074, Germany
- Department of Orthopedics and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsus Medical University, 39100 Bolzano, Italy
| | - Martina Feierabend
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Medical Centre, Aachen, 52074, Germany
| | - Ulf Krister Hofmann
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Medical Centre, Aachen, 52074, Germany
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D'Ambrosi R, Valli F, Nuara A, Mariani I, Di Feo F, Ursino N, Formica M, Mangiavini L, Hantes M, Migliorini F. No difference in mobile and fixed bearing partial knee arthroplasty in octogenarians: a clinical trial. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:3081-3088. [PMID: 37017739 PMCID: PMC10074352 DOI: 10.1007/s00590-023-03537-7] [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: 11/13/2022] [Accepted: 03/20/2023] [Indexed: 04/06/2023]
Abstract
BACKGROUND A clinical trial comparing MB (mobile-bearing) versus FB (fixed-bearing) in medial partial knee arthroplasty (PKA) in octagenarians has been conducted. The focus of the present study was on PROMs, range of motion (ROM), implant positioning and implants survivorship. The hypothesis of the present study was that MB implants performed better than FB in PKA in octogenarians. METHODS The first group received FB PKA-PPK®; the second received MB PKA-Oxford. Patients were not randomly allocated. The following PROMs were administered at T0 (pre-operatively), T1 (1 year after surgery), and T2 (3 years after surgery): visual analogue scale (VAS), Knee Society Score (KSS) and Oxford Knee Score (OKS). Data regarding the implant survivorship and ROM were also collected. Furthermore, the following radiographic parameters were measured: Femoral component varus/valgus; Tibial component varus/valgus; Anteroposterior slope. RESULTS At T0, 28 patients were included in the FB and 33 in the MB group. The surgical time was shorter in the FB group (p < 0.001). No difference between FB and MB in ROM, VAS, KSS, and OKS at each follow-up (p > 0.05). No difference was found in implant positioning (p > 0.05). At last follow-up, FB group reported three failures caused by aseptic loosening. Four failures were observed in the MB cohort: two for bearing dislocation and two for aseptic loosening. The Kaplan-Meier Curve found no differences in implant survivorship. CONCLUSIONS According to the main findings of the present clinical trial, MB implants performed similar to FB in PKA in octogenarians. The FB group demonstrated shorted surgical time. No difference was found in patient reported outcome measures, ROM, implant positioning, and survivorship. LEVEL OF EVIDENCE Level II, prospective study.
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Affiliation(s)
- Riccardo D'Ambrosi
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.
| | | | | | - Ilaria Mariani
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | | | | | - Matteo Formica
- Orthopaedic Clinic, IRCCS Hospital Policlinico San Martino, Genoa, Italy
- DISC - Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - Laura Mangiavini
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Michael Hantes
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Thessalia, University Hospital of Larissa, Larissa, Greece
| | - Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, 52074, Aachen, Germany
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Khalid A, Senan EM, Al-Wagih K, Ali Al-Azzam MM, Alkhraisha ZM. Hybrid Techniques of X-ray Analysis to Predict Knee Osteoarthritis Grades Based on Fusion Features of CNN and Handcrafted. Diagnostics (Basel) 2023; 13:diagnostics13091609. [PMID: 37175000 PMCID: PMC10178472 DOI: 10.3390/diagnostics13091609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 04/25/2023] [Accepted: 04/28/2023] [Indexed: 05/15/2023] Open
Abstract
Knee osteoarthritis (KOA) is a chronic disease that impedes movement, especially in the elderly, affecting more than 5% of people worldwide. KOA goes through many stages, from the mild grade that can be treated to the severe grade in which the knee must be replaced. Therefore, early diagnosis of KOA is essential to avoid its development to the advanced stages. X-rays are one of the vital techniques for the early detection of knee infections, which requires highly experienced doctors and radiologists to distinguish Kellgren-Lawrence (KL) grading. Thus, artificial intelligence techniques solve the shortcomings of manual diagnosis. This study developed three methodologies for the X-ray analysis of both the Osteoporosis Initiative (OAI) and Rani Channamma University (RCU) datasets for diagnosing KOA and discrimination between KL grades. In all methodologies, the Principal Component Analysis (PCA) algorithm was applied after the CNN models to delete the unimportant and redundant features and keep the essential features. The first methodology for analyzing x-rays and diagnosing the degree of knee inflammation uses the VGG-19 -FFNN and ResNet-101 -FFNN systems. The second methodology of X-ray analysis and diagnosis of KOA grade by Feed Forward Neural Network (FFNN) is based on the combined features of VGG-19 and ResNet-101 before and after PCA. The third methodology for X-ray analysis and diagnosis of KOA grade by FFNN is based on the fusion features of VGG-19 and handcrafted features, and fusion features of ResNet-101 and handcrafted features. For an OAI dataset with fusion features of VGG-19 and handcrafted features, FFNN obtained an AUC of 99.25%, an accuracy of 99.1%, a sensitivity of 98.81%, a specificity of 100%, and a precision of 98.24%. For the RCU dataset with the fusion features of VGG-19 and the handcrafted features, FFNN obtained an AUC of 99.07%, an accuracy of 98.20%, a sensitivity of 98.16%, a specificity of 99.73%, and a precision of 98.08%.
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Affiliation(s)
- Ahmed Khalid
- Computer Department, Applied College, Najran University, Najran 66462, Saudi Arabia
| | - Ebrahim Mohammed Senan
- Department of Artificial Intelligence, Faculty of Computer Science and Information Technology, Alrazi University, Sana'a, Yemen
| | - Khalil Al-Wagih
- Department of Artificial Intelligence, Faculty of Computer Science and Information Technology, Alrazi University, Sana'a, Yemen
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Zhou X, Sun C, Xu R, Zhang X, Yu X. The effect of tibial component rotational alignment on clinical outcomes of mobile-bearing unicompartmental knee arthroplasty. J Orthop Surg Res 2023; 18:217. [PMID: 36935479 PMCID: PMC10026499 DOI: 10.1186/s13018-023-03707-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 03/13/2023] [Indexed: 03/21/2023] Open
Abstract
BACKGROUND The optimal tibial component rotational alignment in unicompartmental knee arthroplasty has not been defined. This study aimed to explore the effect of tibial component rotational alignment on the clinical outcomes of UKA. METHODS Clinical and follow-up data from 269 patients were retrospectively analysed. They were assigned into Groups A (- 5° to 0°), B (0°-3°), C (3°-6°) and D (> 6°) according to the external rotation of the tibial component to Akagi's line. The Knee Society Score clinical (KSS-c), Knee Society Score function (KSS-f), Forgotten Joint Score (FJS) and postoperative complications at 2 years postsurgically were analysed. RESULTS The mean rotation of the tibial component relative to Akagi's line in 269 patients was 4.56 ± 3.79°. There were 15, 84, 89 and 81 patients in Groups A, B, C and D, respectively. The postoperative KSS-c and KSS-f in Groups B and C were significantly higher than those in Group D. No significant differences in KSS-c and KSS-f were detected between Groups B and C. The postoperative FJS in Group B was significantly higher than that in Group C, which was significantly higher in Group C than in Group D. There were 5, 8 and 15 cases of postoperative knee pain in Groups B, C and D, respectively, and the difference was statistically significant. CONCLUSION Tibial component rotational alignment is of significance to Oxford Phase III UKA in patients. External rotation of the tibial component by 0°-3° is optimal to achieve satisfactory clinical outcomes.
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Affiliation(s)
- Xiaoqiang Zhou
- Department of Orthopaedics Surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, 215000, China
| | - Chao Sun
- Department of Orthopaedics Surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, 215000, China
| | - Renjie Xu
- Department of Orthopaedics Surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, 215000, China
| | - Xiangxin Zhang
- Department of Orthopaedics Surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, 215000, China
| | - Xiao Yu
- Department of Orthopaedics Surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, 215000, China.
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9
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No difference between mobile and fixed bearing in primary total knee arthroplasty: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 2022; 30:3138-3154. [PMID: 35861866 PMCID: PMC9418337 DOI: 10.1007/s00167-022-07065-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 07/01/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE Both mobile (MB) and fixed (FB) bearing implants are routinely used for total knee arthroplasty (TKA). This meta-analysis compared MB versus FB for TKA in terms of implant positioning, joint function, patient reported outcome measures (PROMs), and complications. It was hypothesised that MB performs better than FB implants in primary TKA. METHODS This meta-analysis was conducted according to the 2020 PRISMA statement. In February 2022, the following databases were accessed: Pubmed, Web of Science, Google Scholar, Embase. All the randomized clinical trials (RCTs) comparing mobile versus fixed bearing for primary TKA were considered. RESULTS Data from 74 RCTs (11,116 procedures) were retrieved. The mean follow-up was 58.8 (7.5 to 315.6) months. The MB group demonstrated greater range of motion (ROM) (P = 0.02), Knee Society Score (KSS) score (P < 0.0001), and rate of deep infections (P = 0.02). No difference was found in implant positioning: tibial slope, delta angle, alpha femoral component angle, gamma femoral component angle, beta tibial component angle, tibiofemoral alignment angle, posterior condylar offset, radiolucent lines. No difference was found in duration of the surgical procedure. No difference was found in the following PROMs: Oxford Knee Score (OKS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), visual analogue scale (VAS), function and pain subscales of the KSS score. No difference was found in the rate of anterior knee pain, revision, aseptic loosening, fractures, and deep vein thrombosis. CONCLUSION There is no evidence in support that MB implants promote greater outcomes compared to FB implants in primary TKA. LEVEL OF EVIDENCE Level I.
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