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Pornrattanamaneewong C, Ruangsillapanan N, Ruangsomboon P, Narkbunnam R, Chareancholvanich K, Udomkiat P. No association between different in tibial resection level and clinical outcomes six months after Oxford unicompartmental knee arthroplasty: a prospective cohort study. BMC Musculoskelet Disord 2023; 24:3. [PMID: 36597083 PMCID: PMC9808939 DOI: 10.1186/s12891-022-06088-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 12/13/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Localized tibial strain is one of the hypotheses to explain residual pain after Oxford UKA. We evaluate whether the depth of the vertical cut during tibial resection correlates with medial knee pain. We aimed to investigate the association between the depth of tibial resection and medial knee pain after OUKA. METHODS This prospective cohort study enrolled 85 patients (mean age: 64.5 ± 7.7 years) who underwent cemented OUKA at our institute during October 2018-June 2019. The depth of tibial resection was measured intraoperatively as the thickness of the anterior, middle, and posterior parts. The greatest of the three thicknesses was recorded. Medial knee pain was assessed at 6 weeks and followed to 6 months. Patients were divided into the pain (P) and no pain (NP) groups. Preoperative and postoperative radiographic findings and OKS were compared between groups. We used logistic regression to analyze the independent association. RESULTS The mean preoperative Oxford Knee Score (OKS) was 27.2 ± 7.6. The incidence of medial knee pain was 23.5% at 6 weeks after OUKA. The P group had a significantly lower OKS at 6 weeks compared to the NP group (28.9 ± 9.7 vs 33.7 ± 6.5, p = 0.049). There was no significant difference in the depth of tibial resection between groups. Medial knee pain had resolved by 6 months in all patients, and the 6-month OKS was similar between groups. CONCLUSION Medial knee pain was found to be common in the early postoperative period after OUKA, but this pain spontaneously resolved by 6 months. As a range of tibial resection level, post-operative pain is not associated with tibial resection thickness in this study. LEVEL OF EVIDENCE Level II. TRIAL REGISTRATION The study was approved by the Institutional review board of Siriraj Hospital, Mahidol university. [SIRB 691/2560(EC4)].
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Affiliation(s)
- Chaturong Pornrattanamaneewong
- grid.10223.320000 0004 1937 0490Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wang Lang Road, Bangkok, Bangkok Noi 10700 Thailand
| | - Naruepol Ruangsillapanan
- Department of Orthopaedic Surgery, Maharat nakornratchasima hospital, Nakhon Ratchasima, Thailand
| | - Pakpoom Ruangsomboon
- grid.10223.320000 0004 1937 0490Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wang Lang Road, Bangkok, Bangkok Noi 10700 Thailand ,grid.17063.330000 0001 2157 2938 Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Rapeepat Narkbunnam
- grid.10223.320000 0004 1937 0490Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wang Lang Road, Bangkok, Bangkok Noi 10700 Thailand
| | - Keerati Chareancholvanich
- grid.10223.320000 0004 1937 0490Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wang Lang Road, Bangkok, Bangkok Noi 10700 Thailand
| | - Pacharapol Udomkiat
- grid.10223.320000 0004 1937 0490Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wang Lang Road, Bangkok, Bangkok Noi 10700 Thailand
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Araki S, Hiranaka T, Okimura K, Fujishiro T, Okamoto K. Approximately 41% of knees have a looser gap in full extension than in 20° flexion after Oxford unicompartmental arthroplasty. Arch Orthop Trauma Surg 2023; 143:495-500. [PMID: 35041083 DOI: 10.1007/s00402-022-04350-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 01/06/2022] [Indexed: 02/04/2023]
Abstract
INTRODUCTION In Oxford unicompartmental knee arthroplasty (OUKA), the flexion and extension gaps should be adjusted to prevent mobile-bearing dislocation. The extension gap is recommended to be evaluated in the 20° flexion position to avoid underestimation due to tension of the posterior capsule. However, we have become aware of a looser gap in full extension than in 20° flexion in some instances. MATERIALS AND METHODS We retrospectively investigated 83 knees in 60 patients who underwent OUKA between January and June 2020. During surgery, the extension gaps were measured in both full extension and 20° flexion. The knees were classified into two groups: the gap was looser in full extension (0° group), and the gap was equal or looser in 20° flexion than in full extension (20° group). The hip-knee-ankle angle (HKAA), the lateral distal femoral angle (LDFA), the medial proximal tibia angle (MPTA), the posterior tibial slope angle (PTSA), and the last spigot size were also measured and compared between the groups. RESULTS There was looseness in approximately 41% of knees (34 out of 83 knees) in full extension. In the knees in the 0° group, the last spigot size was significantly smaller (median 1 and 2, P < 0.01). However, there were no significant differences in the HKAA, MPTA, LDFA or PTSA between the groups. CONCLUSIONS Approximately 41% of knees have a looser gap in full extension than in 20° flexion after OUKA. Further investigation is needed to better understand which extension gap should be used in such cases, and to find the contributing factors in loose full extension gap other than the size of the last spigot.
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Suda Y, Hiranaka T, Kamenaga T, Koide M, Fujishiro T, Okamoto K, Matsumoto T. Varus placement of the tibial component of Oxford unicompartmental knee arthroplasty decreases the risk of postoperative tibial fracture. Bone Joint J 2022; 104-B:1118-1125. [PMID: 36177640 DOI: 10.1302/0301-620x.104b10.bjj-2021-1508.r2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
AIMS A fracture of the medial tibial plateau is a serious complication of Oxford mobile-bearing unicompartmental knee arthroplasty (OUKA). The risk of these fractures is reportedly lower when using components with a longer keel-cortex distance (KCDs). The aim of this study was to examine how slight varus placement of the tibial component might affect the KCDs, and the rate of tibial plateau fracture, in a clinical setting. METHODS This retrospective study included 255 patients who underwent 305 OUKAs with cementless tibial components. There were 52 males and 203 females. Their mean age was 73.1 years (47 to 91), and the mean follow-up was 1.9 years (1.0 to 2.0). In 217 knees in 187 patients in the conventional group, tibial cuts were made orthogonally to the tibial axis. The varus group included 88 knees in 68 patients, and tibial cuts were made slightly varus using a new osteotomy guide. Anterior and posterior KCDs and the origins of fracture lines were assessed using 3D CT scans one week postoperatively. The KCDs and rate of fracture were compared between the two groups. RESULTS Medial tibial fractures occurred after surgery in 15 patients (15 OUKAs) in the conventional group, but only one patient (one OUKA) had a tibial fracture after surgery in the varus group. This difference was significant (6.9% vs 1.1%; p = 0.029). The mean posterior KCD was significantly shorter in the conventional group (5.0 mm (SD 1.7)) than in the varus group (6.1 mm (SD 2.1); p = 0.002). CONCLUSION In OUKA, the distance between the keel and posterior tibial cortex was longer in our patients with slight varus alignment of the tibial component, which seems to decrease the risk of postoperative tibial fracture.Cite this article: Bone Joint J 2022;104-B(10):1118-1125.
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Affiliation(s)
- Yoshihito Suda
- Department of Orthopedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Takatsuki, Japan.,Department of Orthopaedic Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Takafumi Hiranaka
- Department of Orthopedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Takatsuki, Japan
| | - Tomoyuki Kamenaga
- Department of Orthopedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Takatsuki, Japan.,Department of Orthopaedic Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Motoki Koide
- Department of Orthopedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Takatsuki, Japan
| | - Takaaki Fujishiro
- Department of Orthopedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Takatsuki, Japan
| | - Koji Okamoto
- Department of Orthopedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Takatsuki, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
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Eckert JA, Bitsch RG, Sonntag R, Reiner T, Schwarze M, Jaeger S. The primary stability of the femoral component in cemented single and twin peg Oxford unicompartmental knee arthroplasty under adverse conditions. Bone Joint Res 2022; 11:82-90. [PMID: 35124977 PMCID: PMC8882328 DOI: 10.1302/2046-3758.112.bjr-2020-0507.r2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Aims The cemented Oxford unicompartmental knee arthroplasty (OUKA) features two variants: single and twin peg OUKA. The purpose of this study was to assess the stability of both variants in a worst-case scenario of bone defects and suboptimal cementation. Methods Single and twin pegs were implanted randomly allocated in 12 pairs of human fresh-frozen femora. We generated 5° bone defects at the posterior condyle. Relative movement was simulated using a servohydraulic pulser, and analyzed at 70°/115° knee flexion. Relative movement was surveyed at seven points of measurement on implant and bone, using an optic system. Results At the main fixation zone, the twin peg shows less relative movement at 70°/115°. At the transition zone, relative movements are smaller for the single peg for both angles. The single peg shows higher compression at 70° flexion, whereas the twin peg design shows higher compression at 115°. X-displacement is significantly higher for the single peg at 115°. Conclusion Bony defects should be avoided in OUKA. The twin peg shows high resilience against push-out force and should be preferred over the single peg. Cite this article: Bone Joint Res 2022;11(2):82–90.
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Affiliation(s)
- Johannes Adrian Eckert
- Laboratory of Biomechanics and Implant Research, Centre for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany.,Orthopaedic University Hospital, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Robert Sonntag
- Laboratory of Biomechanics and Implant Research, Centre for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany
| | - Tobias Reiner
- Laboratory of Biomechanics and Implant Research, Centre for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany.,Orthopaedic University Hospital, Heidelberg University Hospital, Heidelberg, Germany
| | - Martin Schwarze
- Laboratory of Biomechanics and Implant Research, Centre for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany.,Orthopaedic University Hospital, Heidelberg University Hospital, Heidelberg, Germany
| | - Sebastian Jaeger
- Laboratory of Biomechanics and Implant Research, Centre for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany
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Kerens B, Schotanus MGM, Boonen B, Boog P, Emans PJ, Lacroix H, Kort NP. Cementless versus cemented Oxford unicompartmental knee arthroplasty: early results of a non-designer user group. Knee Surg Sports Traumatol Arthrosc 2017; 25:703-709. [PMID: 27161197 DOI: 10.1007/s00167-016-4149-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 04/26/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE Although fewer tibial radiolucent lines are observed in cementless Oxford unicompartmental knee arthroplasty (UKA) compared with cemented Oxford UKA, an independent comparative study on this topic is lacking. METHODS In this multicentre retrospective study, a cohort of 60 consecutive cases of cementless Oxford UKA is compared with a cohort of 60 consecutive cases of cemented Oxford UKA. Radiolucent lines, survival, perioperative data and clinical results were compared. RESULTS No complete tibial radiolucent lines were observed in either group. Seventeen per cent of partial tibial radiolucent lines were observed in the cementless group versus 21 % in the cemented group (n.s.). The percentage of tibial radiolucent zones was 4 versus 9 %, respectively (p = 0.036). Survival rates were 90 % at 34 months for the cementless group and 84 % at 54 months for the cemented group (n.s.). Mean operation time was 10 min shorter in the cementless group (p < 0.001), and clinical results were not significantly different. CONCLUSIONS Although no significant differences in radiolucent lines were found between both groups, they appear to be more common in the cemented group. This confirms previous results from reports by prosthesis designers. The presence of radiolucent lines after cemented Oxford UKA does not correlate with clinical outcome or survival. LEVEL OF EVIDENCE III.
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Affiliation(s)
- B Kerens
- AZ St Maarten, Leopoldstraat 2, Mechelen, Belgium.
| | | | - B Boonen
- Zuyderland Medical Centre, Sittard-Geleen, The Netherlands
| | - P Boog
- Elkerliek Ziekenhuis, Helmond, The Netherlands
| | - P J Emans
- Maastricht University Medical Centre, Maastricht, The Netherlands
| | - H Lacroix
- Elkerliek Ziekenhuis, Helmond, The Netherlands
| | - N P Kort
- Zuyderland Medical Centre, Sittard-Geleen, The Netherlands
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Inui H, Taketomi S, Tahara K, Yamagami R, Sanada T, Tanaka S. A modified technique to reduce tibial keel cutting errors during an Oxford unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2017; 25:710-716. [PMID: 27139228 DOI: 10.1007/s00167-016-4151-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 04/26/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Bone cutting errors can cause malalignment of unicompartmental knee arthroplasties (UKA). Although the extent of tibial malalignment due to horizontal cutting errors has been well reported, there is a lack of studies evaluating malalignment as a consequence of keel cutting errors, particularly in the Oxford UKA. The purpose of this study was to examine keel cutting errors during Oxford UKA placement using a navigation system and to clarify whether two different tibial keel cutting techniques would have different error rates. METHODS The alignment of the tibial cut surface after a horizontal osteotomy and the surface of the tibial trial component was measured with a navigation system. Cutting error was defined as the angular difference between these measurements. The following two techniques were used: the standard "pushing" technique in 83 patients (group P) and a modified "dolphin" technique in 41 patients (group D). RESULTS In all 123 patients studied, the mean absolute keel cutting error was 1.7° and 1.4° in the coronal and sagittal planes, respectively. In group P, there were 22 outlier patients (27 %) in the coronal plane and 13 (16 %) in the sagittal plane. Group D had three outlier patients (8 %) in the coronal plane and none (0 %) in the sagittal plane. Significant differences were observed in the outlier ratio of these techniques in both the sagittal (P = 0.014) and coronal (P = 0.008) planes. CONCLUSION Our study demonstrated overall keel cutting errors of 1.7° in the coronal plane and 1.4° in the sagittal plane. The "dolphin" technique was found to significantly reduce keel cutting errors on the tibial side. This technique will be useful for accurate component positioning and therefore improve the longevity of Oxford UKAs. LEVEL OF EVIDENCE Retrospective comparative study, Level III.
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Affiliation(s)
- Hiroshi Inui
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
| | - Shuji Taketomi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Keitarou Tahara
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Ryota Yamagami
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Takaki Sanada
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
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Abstract
Aims Medial unicompartmental knee arthroplasty (UKA) is associated
with successful outcomes in carefully selected patient cohorts.
We hypothesised that severity and location of patellofemoral cartilage
lesions significantly influences functional outcome after Oxford
medial compartmental knee arthroplasty. Patients and Methods We reviewed 100 consecutive UKAs at minimum eight-year follow-up
(96 to 132). A single surgeon performed all procedures. Patients
were selected based on clinical and plain radiographic assessment.
All patients had end-stage medial compartment osteoarthritis (OA)
with sparing of the lateral compartment and intact anterior cruciate ligaments.
None of the patients had end-stage patellofemoral OA, but patients
with anterior knee pain or partial thickness chondral loss were
not excluded. There were 57 male and 43 female patients. The mean
age at surgery was 69 years (41 to 82). At surgery the joint was
carefully inspected for patellofemoral chondral loss and this was documented
based on severity of cartilage loss (0 to 4 Outerbridge grading)
and topographic location (medial, lateral, central, and superior
or inferior). Functional scores collected included Oxford Knee Score
(OKS), patient satisfaction scale and University College Hospital
(UCH) knee score. Intraclass correlation was used to compare chondral
damage to outcomes. Results All patients documented significant improvement in pain and improved
functional scores at mid-term follow-up. There were four revisions
(mean 2.9 years, 2 to 4; standard deviation (sd) 0.9) in
this cohort, three for tibial loosening and one for femoral loosening.
There was one infection that was treated with debridement and insert exchange.
The mean OKS improved from 23.2 (sd 7.1) to 39.1 (sd 6.9);
p < 0.001. The cohort with central and lateral grade 3 patellofemoral
OA documented lower mean satisfaction with pain (90, sd 11.8)
and function (87.5, sd 10.3) on the patient satisfaction
scale. On the UCH scale, patients reported significantly decreased
mean overall scores (7.3, sd 1.2 vs 9, sd 2.3)
as well as stair climb task (3.5, sd 0.3 vs 5, sd 0.1)
when cartilage lesions were located centrally or laterally on the
PFJ. Patients with medial chondral PFJ lesions behave similar to
patients with no chondral lesions. Conclusion Topographical location and severity of cartilage damage of the
patella can significantly influence function after successful Oxford
medial UKA. Surgeons should factor this in when making their operative
decision, and undertake to counsel patients appropriately. Cite this article: Bone Joint J 2016;98-B(10
Suppl B):11–15.
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Affiliation(s)
- S Konan
- University College London Hospitals NHS Trust, 250 Euston Road, London NW1 2BU, UK
| | - F S Haddad
- University College London Hospitals, 235 Euston Road, London, NW1 2BU, UK
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