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Zheng N, Dai H, Zou D, Wang Q, Tsai TY. Safe bearing region for avoiding meniscal bearing impingement and overhang in mobile-bearing unicompartmental knee arthroplasty. J Orthop Res 2024; 42:1200-1209. [PMID: 38084771 DOI: 10.1002/jor.25767] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 10/30/2023] [Accepted: 11/14/2023] [Indexed: 01/17/2024]
Abstract
The purposes of this study were to propose a quantitative method of bearing overhang to minimize the effect of bearing spinning on mobile-bearing unicompartmental knee arthroplasty (MB UKA), suggest and apply safe bearing regions in daily activities. The overhang distance and area were calculated for neutral and spinning positions. The safe bearing regions were based on the relationship between bearing overhang and linear wear rate. Eleven patients were included in an in-vivo experiment under dual fluoroscopic imaging following medial MB UKA. The bearing position was tracked by minimal joint space width, and the bearing overhang was calculated accordingly. Due to an equal contribution of 1 mm increase in medial overhang and 30 mm2 overhang areato wear rate, the maximum effect of potential bearing spinning on medial overhang distance was approximately three times as large as the overhang area. The safe bearing distance and area regions were rectangles and arches with different scales for different size combinations of bearing, femoral and tibial components. The maximum bearing overhang area during lunge (R = 0.76, p = 0.006) and open-chain exercise (R = 0.68, p = 0.02) significantly correlated with the overhang area in standing. The overhang area can be an appropriate parameter for evaluating dislocation degree less affected by potential bearing spinning than the overhang distance in clinical practice. The corresponding safe overhang area regions were proposed for surgical planning and postoperative dislocation degree evaluation. The bearing overhang area in static standing posture can be a valuable reference to estimate the dynamic overhang area and dislocation degree during motion.
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Affiliation(s)
- Nan Zheng
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
- Engineering Research Center for Digital Medicine of the Ministry of Education, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Orthopaedic Implants & Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huiyong Dai
- Department of Orthopedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Diyang Zou
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
- Engineering Research Center for Digital Medicine of the Ministry of Education, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Orthopaedic Implants & Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qi Wang
- Department of Orthopedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tsung-Yuan Tsai
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
- Engineering Research Center for Digital Medicine of the Ministry of Education, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Orthopaedic Implants & Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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刘 典, 黄 文, 翟 文, 李 颖, 陈 东, 郑 仕, 吴 颖, 卢 伟. [A prospective comparative study on effectiveness of single versus continuous adductor canal block combined with local infiltration anesthesia in unicompartmental knee arthroplasty]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2024; 38:448-454. [PMID: 38632065 PMCID: PMC11024521 DOI: 10.7507/1002-1892.202312103] [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] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 03/17/2024] [Accepted: 03/18/2024] [Indexed: 04/19/2024]
Abstract
Objective To compare the early analgesic effects and the impact on knee joint function recovery after unicompartmental knee arthroplasty (UKA) between single adductor canal block (SACB) and continuous adductor canal block (CACB) combined with local infiltration anesthesia (LIA) using a prospective study. Methods The patients with knee osteoarthritis admitted between April 2022 and December 2023 were enrolled as a subject. Among them, 60 patients met the selection criteria and were enrolled in the study. They were randomly assigned to the SACB group or CACB group in a ratio of 1:1 using a random number table method. There was no significant difference between the two groups ( P>0.05) in terms of age, gender, height, body mass, body mass index, affected side, and preoperative resting visual analogue scale (VAS) score and active VAS score, Oxford knee score (OKS), and American Hospital of Special Surgery (HSS) score. All patients received multimodal analgesia management using LIA combined with SACB or CACB. The operation time, pain related indicators (resting and activity VAS scores, number and timing of breakthrough pain, opioid consumption), joint function related indicators (quadriceps muscle strength, knee range of motion, OKS score, and HSS score), as well as postoperative block complications and adverse events were recorded and compared between the two groups. Results There was no significant difference in the operation time between the two groups ( P<0.05). All patients in the two groups were followed up with a follow-up time of (9.70±4.93) months in the SACB group and (12.23±5.05) months in the CACB group, and the difference was not significant ( P>0.05). The CACB group had a significant lower resting VAS score at 24 hours after operation compared to the SACB group ( P<0.05). There was no significant difference in resting and active VAS scores between the two groups at other time points ( P>0.05). The CACB group had a significantly lower incidence of breakthrough pain compared to the SACB group [9 cases (30.00%) vs. 17 cases (56.67%); P<0.05). However, there was no significant difference in the timing of breakthrough pain occurrence and opioid consumption between the two groups ( P>0.05). Four cases in the SACB group and 7 cases in the CACB group experienced adverse events, with no significant difference in the incidence of adverse events between the two groups ( P>0.05). The CACB group had significantly better knee joint mobility than the SACB group at 1 and 2 days after operation ( P<0.05). There was no significant difference between the two groups in knee joint mobility on 0 day after operation and quadriceps muscle strength and OKS and HSS scores at different time points ( P>0.05). Conclusion In UKA, the analgesic effects and knee joint function recovery are similar when compared between LIA combined with SACB and LIA combined with CACB. However, SACB is simpler to perform and can avoid adverse events such as catheter displacement and dislocation. Therefore, SACB may be a better choice.
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Affiliation(s)
- 典琦 刘
- 广州医科大学附属第一医院关节外科(广州 510120)Department of Joint Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Guangdong, 510120, P. R. China
| | - 文彬 黄
- 广州医科大学附属第一医院关节外科(广州 510120)Department of Joint Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Guangdong, 510120, P. R. China
| | - 文润 翟
- 广州医科大学附属第一医院关节外科(广州 510120)Department of Joint Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Guangdong, 510120, P. R. China
| | - 颖芬 李
- 广州医科大学附属第一医院关节外科(广州 510120)Department of Joint Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Guangdong, 510120, P. R. China
| | - 东峰 陈
- 广州医科大学附属第一医院关节外科(广州 510120)Department of Joint Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Guangdong, 510120, P. R. China
| | - 仕聪 郑
- 广州医科大学附属第一医院关节外科(广州 510120)Department of Joint Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Guangdong, 510120, P. R. China
| | - 颖斌 吴
- 广州医科大学附属第一医院关节外科(广州 510120)Department of Joint Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Guangdong, 510120, P. R. China
| | - 伟杰 卢
- 广州医科大学附属第一医院关节外科(广州 510120)Department of Joint Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Guangdong, 510120, P. R. China
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Laoruengthana A, Reosanguanwong K, Rattanaprichavej P, Sahasoonthorn K, Santisathaporn N, Pongpirul K. Cruciate-Retaining Total Knee Arthroplasty versus Unicompartmental Knee Arthroplasty in Medial Compartmental Osteoarthritis: A Propensity Score-Matched Analysis of Early Postoperative Recovery. Orthop Res Rev 2024; 16:103-110. [PMID: 38616802 PMCID: PMC11016268 DOI: 10.2147/orr.s444547] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 03/19/2024] [Indexed: 04/16/2024] Open
Abstract
Background Cruciate-retaining (CR) total knee arthroplasty (TKA) may provide better physiological knee kinematics, proprioception, and quadricep recovery than posterior-stabilized (PS) TKA. Therefore, we hypothesized that CR TKA with multimodal pain control may provide comparable postoperative pain and recovery as unicompartmental knee arthroplasty (UKA). Methods This study included patients with isolated medial compartment knee osteoarthritis who underwent CR TKA and UKA. TKA and UKA patients were propensity score-matched with age and body mass index (BMI) and compared using visual analog scales (VAS) for pain scores, total amount of morphine use (TMU), knee flexion angle, straight leg raise (SLR), independent ambulation, length of hospital stay (LOS), and costs during hospitalization. Results After propensity score matching, 46 patients were included in the TKA and UKA groups, respectively, with no differences in demographic data. VAS at 6-72 h and TMU at 48 h after surgery were comparable between the groups. The knee flexion angle in the UKA group was significantly higher at 24 h (60.0° vs 46.6°; p<0.001) and 48 h (76.9° vs 69.1°; p = 0.021) than that in the TKA group. The SLR in the UKA group was significantly higher than that in the TKA group at 24-72 h. The UKA group ambulated significantly earlier (1.56 vs 2.13 days; p<0.001), had shorter LOS (3.68 vs 4.28 days; p<0.004) and incurred 12.43% lower costs when compared to the TKA group. Conclusion Patients who underwent CR TKA with multimodal pain management did not experience more postoperative pain or morphine use than those who underwent UKA. However, UKA patients seem to experienced faster recovery and shorter LOS than CR-TKA patients during the early postoperative course. Accordingly, UKA may be considered instead of TKA for patients who are good candidates for UKA and require expedited recovery.
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Affiliation(s)
- Artit Laoruengthana
- Department of Orthopaedics, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand
| | - Kongpob Reosanguanwong
- Department of Orthopaedics, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand
| | - Piti Rattanaprichavej
- Department of Orthopaedics, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand
| | - Kamonnop Sahasoonthorn
- Department of Orthopaedics, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand
| | | | - Krit Pongpirul
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 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 110 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] [What about the content of this article? (0)] [Affiliation(s)] [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. Complication 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. Average follow-up was 6 years (2-19.5). According to Outerbridge, 22 knees (20%) were grade 2, 59 (53.6%) grade 3 and 29 (26.4%) grade 4. All 3 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 (20º vs 15º). 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 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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Sarrel K, Hameed D, Dubin J, Mont MA, Jacofsky DJ, Coppolecchia AB. Understanding economic analysis and cost-effectiveness of CT scan-guided, 3-dimensional, robotic-arm assisted lower extremity arthroplasty: a systematic review. J Comp Eff Res 2024; 13:e230040. [PMID: 38488048 PMCID: PMC11044952 DOI: 10.57264/cer-2023-0040] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 12/21/2023] [Indexed: 03/23/2024] Open
Abstract
Aim: The overall goal of this review was to examine the cost-utility of robotic-arm assisted surgery versus manual surgery. Methods: We performed a systematic review of all health economic studies that compared CT-based robotic-arm assisted unicompartmental knee arthroplasty, total knee arthroplasty and total hip arthroplasty with manual techniques. The papers selected focused on various cost-utility measures. In addition, where appropriate, secondary aims encompassed various clinical outcomes (e.g., readmissions, discharges to subacute care, etc.). Only articles directly comparing CT-based robotic-arm assisted joint arthroplasty with manual joint arthroplasty were included, for a resulting total of 21 reports. Results: Almost all twenty-one studies demonstrated a positive effect of CT scan-guided robotic-assisted joint arthroplasty on health economic outcomes. For studies reporting on 90-day episodes of costs, 10 out of 12 found lower costs in the robotic-arm assisted groups. Conclusion: Robotic-arm assisted joint arthroplasty patients had shorter lengths of stay and cost savings based on their 90-day episodes of care, among other metrics. Payors would likely benefit from encouraging the use of this CT-based robotic technology.
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Affiliation(s)
- Kara Sarrel
- Department of Orthopaedic Surgery, Northwell Hospital Lenox Hill, New York City, NY 10075, USA
| | - Daniel Hameed
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD 21215, USA
| | - Jeremy Dubin
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD 21215, USA
| | - Michael A Mont
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD 21215, USA
| | - David J Jacofsky
- The CORE Institute, Phoenix, AZ 85023, USA
- HOPCo, Phoenix, AZ 85023, USA
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Kono K, Tomita T, Yamazaki T, Inui H, Tanaka S, D'Lima DD. In Vivo Kinematics and Cruciate Ligament Tension Are Not Restored to Normal After Bicruciate-Preserving Arthroplasty. J Arthroplasty 2024:S0883-5403(24)00300-0. [PMID: 38552864 DOI: 10.1016/j.arth.2024.03.060] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 03/19/2024] [Accepted: 03/21/2024] [Indexed: 04/23/2024] Open
Abstract
BACKGROUND Whether cruciate ligament forces in cruciate-preserving designs, such as unicompartmental knee arthroplasty (UKA) or bi-cruciate-retaining total knee arthroplasty (BCR-TKA), differ from those in normal knees remains unknown. The purpose of this study was to compare the in vivo kinematics and cruciate ligament force in knees before and after UKA or BCR-TKA to those in normal knees during high-flexion activity. METHODS Overall, twenty normal knees, 17 knees with medial UKA, and 15 knees with BCR-TKA were fluoroscopically examined while performing a squatting activity. A 2-dimensional or 3-dimensional registration technique was employed to measure tibio-femoral kinematics. Ligament strains and tensions in the anteromedial bundle of the anterior cruciate ligament and posterolateral bundle of the anterior cruciate ligament and the anterolateral bundle of the posterior cruciate ligament (aPCL) and posteromedial bundle of the posterior cruciate ligament (pPCL) during knee flexion were analyzed. RESULTS Tension in both bundles of the anterior cruciate ligament decreased with flexion. At 60° of flexion, anteromedial bundle of the anterior cruciate ligament tension in postoperative UKA knees was greater than that in normal knees. At 30° of flexion, posterolateral bundle of the anterior cruciate ligament tension in postoperative UKA knees was greater than that in normal knees. On the other hand, aPCL and pPCL tensions increased with flexion. From 40 to 110° of flexion, the postoperative aPCL tension in UKA knees was greater than that in normal knees. At 110° of flexion, the preoperative pPCL tension in UKA knees was greater than that in normal knees. In addition, the postoperative pPCL tension in UKA knees was larger than that in normal knees beyond 20° of flexion. Furthermore, the pPCL tension of postoperative BCR-TKA knees was larger than that in normal knees from 20 to 50° and beyond 90° of flexion. CONCLUSIONS The cruciate ligament tensions, especially posterior cruciate ligament tension in knees after UKA, were greater than those in the normal knees. Surgeons performing bi-cruciat-preserving knee arthroplasties should therefore balance cruciate ligament tension more carefully in flexion and extension.
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Affiliation(s)
- Kenichi Kono
- Faculty of Medicine, Department of Orthopedic Surgery, The University of Tokyo, Tokyo, Japan; Department of Orthopedic Biomaterial Science, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tetsuya Tomita
- Department of Orthopedic Biomaterial Science, Osaka University Graduate School of Medicine, Osaka, Japan; Department of Health Science, Graduate School of Health Science, Morinomiya University of Medical Sciences, Osaka, Japan
| | - Takaharu Yamazaki
- Faculty of Engineering, Department of Information Systems, Saitama Institute of Technology, Fukaya, Saitama, Japan
| | - Hiroshi Inui
- Faculty of Medicine, Department of Orthopedic Surgery, The University of Tokyo, Tokyo, Japan; Department of Orthopedic Surgery, Saitama Medical University, Saitama Medical Center, Kawagoe, Saitama, Japan
| | - Sakae Tanaka
- Faculty of Medicine, Department of Orthopedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Darryl D D'Lima
- Shiley Center for Orthopaedic Research & Education, Scripps Health, La Jolla, California
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McCormick KL, Xu W, Cozzarelli NF, Crawford D, Wilson EJ, Berend KR, Fricka KB, Lonner JH, Geller JA. Debridement, Antibiotics, and Implant Retention in Unicompartmental Knee Arthroplasty Infection. J Arthroplasty 2024:S0883-5403(24)00273-0. [PMID: 38548232 DOI: 10.1016/j.arth.2024.03.057] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 03/18/2024] [Accepted: 03/20/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND This multicenter study sought to further investigate the method and outcome of debridement, antibiotics, and implant retention (DAIR) for the management of unicompartmental knee periprosthetic joint infection (PJI). METHODS This retrospective study was performed on 52 patients who underwent DAIR for PJI of a unicompartmental knee arthroplasty (UKA) across 4 academic medical centers, all performed by fellowship-trained arthroplasty surgeons. Patient demographics, American Society of Anesthesiologists score, infecting organism, operative data, antibiotic data, and success in infection control at 1 year were collected. RESULTS The average time from index surgery to diagnosis of PJI was 11.1 weeks (range, 1.4 to 48). There was no correlation between time of diagnosis and success at 1 year (R = 0.09, P = .46). There was an association between surgical synovectomy and the eradication of infection (R = 0.28, P = .04). Overall, there was an 80.8% (42 of 52) infection-controlled success rate at 1 year from the DAIR procedure. All DAIR failures went on to require another procedure, either 1-stage (2 of 10) or 2-stage (8 of 10) revision to total knee arthroplasty (TKA). Of the DAIR successes, 6 (14.3%) went on to require conversion to TKA for progression of arthritis within 5 years. CONCLUSIONS This study demonstrates that DAIR is a safe and moderately effective procedure in the setting of acute PJI of UKA across institutions, with a success rate consistent with DAIR for TKA. The data suggest that a wide exposure and thorough synovectomy be incorporated during the DAIR UKA to improve the likelihood of successful eradication of PJI at the 1-year mark. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Kyle L McCormick
- Department of Orthopedic Surgery, New York Presbyterian - Columbia University, New York, New York
| | - Winnie Xu
- Department of Orthopedic Surgery, New York Presbyterian - Columbia University, New York, New York
| | - Nicholas F Cozzarelli
- Department of Orthopedic Surgery, Rothman Orthopaedic Institute, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - David Crawford
- Department of Orthopedic Surgery, Joint Implant Surgeons (JIS) Orthopedics, New Albany, Ohio
| | - Eric J Wilson
- Department of Orthopedic Surgery, Anderson Orthopaedic Clinic, Alexandria, Virginia
| | - Keith R Berend
- Department of Orthopedic Surgery, Joint Implant Surgeons (JIS) Orthopedics, New Albany, Ohio
| | - Kevin B Fricka
- Department of Orthopedic Surgery, Anderson Orthopaedic Clinic, Alexandria, Virginia
| | - Jess H Lonner
- Department of Orthopedic Surgery, Rothman Orthopaedic Institute, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jeffrey A Geller
- Department of Orthopedic Surgery, New York Presbyterian - Columbia University, New York, New York
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Sato H, Kijima H, Iwami T, Tsukamoto H, Saito H, Kudo D, Kimura R, Kasukawa Y, Miyakoshi N. Unicompartmental Knee Arthroplasty for Osteoarthritis Eliminates Lateral Thrust: Associations between Lateral Thrust Detected by Inertial Measurement Units and Clinical Outcomes. Sensors (Basel) 2024; 24:2019. [PMID: 38610231 PMCID: PMC11014390 DOI: 10.3390/s24072019] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 03/13/2024] [Accepted: 03/20/2024] [Indexed: 04/14/2024]
Abstract
The purpose of this study was to investigate the relationship between clinical outcomes and lateral thrust before and after unicompartmental knee arthroplasty (UKA) using inertial measurement sensor units. Eleven knees were evaluated with gait analysis. The varus angular velocity was used to evaluate lateral thrust. The femorotibial angle (FTA) and hip-knee-ankle angle (HKA) were used to evaluate lower-limb alignment, and the Oxford Knee Score (OKS) and Japanese Orthopaedic Association Score (JOA) were used to evaluate clinical outcomes. The mean pre-UKA peak varus velocity was 37.1 ± 9.8°/s, and that for post-UKA was 28.8 ± 9.1°/s (p = 0.00003), such that instabilities clearly improved. Assuming the definition of lateral thrust is when the varus angular velocity is more than 28.1°/s, 81.8% of patients had lateral thrust preoperatively, but this decreased to 55.6% postoperatively, such that the symptoms and objective findings improved. Both OKS and JOA improved after surgery. In addition, HKA was -7.9° preoperatively and -5.8° postoperatively (p = 0.024), and FTA was 181.4° preoperatively and 178.4° postoperatively (p = 0.012). There was a positive correlation between postoperative JOA and FTA, indicating that changes in postoperative alignment affected clinical outcomes. This study quantitatively evaluated the disappearance of lateral thrust by UKA, and it found that the stability can be achieved by UKA for unstable knees with lateral thrust.
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Affiliation(s)
- Hikaru Sato
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan
| | - Hiroaki Kijima
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan
| | - Takehiro Iwami
- Department of System Design Engineering, Faculty of Engineering Science, Akita University Graduate School of Engineering Science, 1-1 Tegatagakuenmachi, Akita 010-8502, Japan
| | - Hiroaki Tsukamoto
- Noshiro Kousei Medical Center, Ochiaiazakamimaedachinai, Noshiro 016-0014, Japan
| | - Hidetomo Saito
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan
| | - Daisuke Kudo
- Division of Rehabilitation Medicine, Akita University Hospital, 44-2, Hiroomote Hasunuma, Akita 010-8543, Japan
| | - Ryota Kimura
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan
| | - Yuji Kasukawa
- Division of Rehabilitation Medicine, Akita University Hospital, 44-2, Hiroomote Hasunuma, Akita 010-8543, Japan
| | - Naohisa Miyakoshi
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan
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Park DY, Park KH, Jin YJ, Yun HW, Lee JM, Chung JY, Park JY, Min BH, Lim S. Fixed-Bearing Unicompartmental Knee Arthroplasty in Tibia Vara Knees Results in Joint Surface Malalignment and Varus Joint Line Obliquity, but Does Not Affect Functional Outcomes at Greater Than 5 Years Follow-Up. J Arthroplasty 2024; 39:645-650. [PMID: 37757984 DOI: 10.1016/j.arth.2023.09.024] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 09/10/2023] [Accepted: 09/16/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND This study aimed to investigate the clinical outcomes of fixed-bearing medial unicompartmental knee arthroplasty (UKA) for tibia vara knees and the associated changes in joint space malalignment (JSM) and joint line obliquity (JLO). METHODS We retrospectively analyzed a consecutive group of 100 patients who underwent fixed-bearing medial UKA with a preoperative medial proximal tibia angle (MPTA) ≥86° (n = 50) and MPTA <86° (n = 50) and who had a minimum 5-year follow-up. Radiological parameters, including the hip-knee-ankle angle, MPTA, and the postoperative JSM and JLO, were measured. Functional evaluation was performed using the range of motion, visual analog scale, Knee Society Knee Score, Knee Society Function Score, and Western Ontario and McMaster Universities Osteoarthritis Index score. RESULTS The MPTA <86° group showed significantly higher postoperative JLO (91.8 versus 90.4°, respectively; P = .002) and JSM (6.1 versus 4.2°, respectively; P = .026) compared to the MPTA ≥86° group. Functional outcomes, including range of motion, visual analog scale, Knee Society Knee Score, Knee Society Function Score, and Western Ontario and McMaster Universities Osteoarthritis Index scores, were not significantly different between the 2 groups. CONCLUSIONS Fixed-bearing medial UKA is a safe and effective surgical option for patients who have tibia vara knees, as an increase in JLO and JSM postoperatively does not have a clinically relevant impact, even after a minimum 5-year follow-up.
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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; Ajou University Leading Convergence of Healthcare and Medicine, Institute of Science and Technology, School of Medicine, Ajou University, Suwon, Korea
| | - Ki-Hoon Park
- Department of Orthopedic Surgery, School of Medicine, Ajou University, Suwon, Korea; Daprtment of Orthopedic Surgery, Armed Forces Yangju Medical Center, Yangju-si, Korea
| | - Yong Jun Jin
- Cell Therapy Center, Ajou University Medical Center, Suwon, Korea
| | - Hee-Woong Yun
- Department of Orthopedic Surgery, School of Medicine, Ajou University, Suwon, Korea; Cell Therapy Center, Ajou University Medical Center, Suwon, Korea
| | - Jong Min Lee
- Department of Orthopedic Surgery, School of Medicine, Ajou University, Suwon, Korea
| | - Jun Young Chung
- Department of Orthopedic Surgery, School of Medicine, Ajou University, Suwon, Korea
| | - Jae-Young Park
- Department of Orthopaedic Surgery, CHA University, CHA Bundang Medical Center, Seongnam-si, Korea
| | - Byoung-Hyun Min
- Department of Orthopedic Surgery, School of Medicine, Ajou University, Suwon, Korea; Cell Therapy Center, Ajou University Medical Center, Suwon, Korea
| | - Sumin Lim
- Department of Orthopedic Surgery, School of Medicine, Ajou University, Suwon, Korea
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Baba R, Ohkoshi Y, Maeda T, Suzuki K, Iwadate A, Iwasaki K, Onodera T, Kondo E, Iwasaki N. The Influence of Patello-Femoral Overstuffing After Modular Unlinked Bicompartmental Knee Arthroplasty (BiKA) for Medial Tibio-Femoral and Patello-Femoral Osteoarthritis of the Knee. J Arthroplasty 2024; 39:638-644. [PMID: 37633506 DOI: 10.1016/j.arth.2023.08.069] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 08/18/2023] [Accepted: 08/19/2023] [Indexed: 08/28/2023] Open
Abstract
BACKGROUND The factors affecting results after bicompartmental knee arthroplasty (BiKA) have not been fully elucidated. This major ligament-preserving procedure may be more susceptible to overstuffing of the patello-femoral (PF) joint than the major ligament-sacrificing total knee arthroplasty. Currently, we investigated the effect of PF overstuffing after BiKA on its clinical outcome. METHODS There were 71 patients (74 knees) who underwent modular unlinked BiKA at our clinic who had a follow-up of 5 to 9 years. Final follow-up results were assessed by evaluating knee range of motion, the 2011 Knee Society Score (2011KSS), Japanese Knee Osteoarthritis Measure, and radiological findings. The degree of postoperative PF overstuffing was evaluated by computed tomography and magnetic resonance images for 55 knees, and the correlation between the degree of overstuffing and postoperative clinical results were examined. RESULTS Overall clinical results improved significantly after surgery without any revision cases. The X-ray measurements showed the improved coronal alignments and the appropriate implant installation angles. Higher degree of postoperative PF overstuffing caused by insufficient amount of osteotomy on the anterior surface of the femur correlated with worse postoperative total 2011KSS at 2 years after surgery (Spearman's rank correlation coefficient (rs) = -0.387, P = .004), as opposed to no correlation at the time of the final follow-up (Spearman's rank correlation coefficient = 0.068, P = .623). CONCLUSION Modular unlinked BiKA provided patients with a high level of satisfaction and functional improvement over 5 to 9 years postoperatively. However, because PF overstuffing affects initial patient satisfaction, the amount of osteotomy should be determined carefully during the surgery.
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Affiliation(s)
- Rikiya Baba
- Department of Orthopedic Surgery, Hakodate Orthopedics Clinic, Hakodate, Japan; Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Yasumitsu Ohkoshi
- Department of Orthopedic Surgery, Hakodate Orthopedics Clinic, Hakodate, Japan
| | - Tatsunori Maeda
- Department of Orthopedic Surgery, Hakodate Orthopedics Clinic, Hakodate, Japan
| | - Ko Suzuki
- Department of Orthopedic Surgery, Hakodate Orthopedics Clinic, Hakodate, Japan
| | - Akane Iwadate
- Department of Orthopedic Surgery, Hakodate Orthopedics Clinic, Hakodate, Japan
| | - Koji Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Tomohiro Onodera
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Eiji Kondo
- Centre for Sports Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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11
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Harris CG, Ziemba-Davis M, Deckard ER, Sonn KA, Meneghini RM. Implant Position, Survivorship, and Patient-Reported Outcomes in Manual Medial Unicompartmental Knee Arthroplasty. J Arthroplasty 2024; 39:632-637. [PMID: 37717834 DOI: 10.1016/j.arth.2023.09.010] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/29/2023] [Accepted: 09/03/2023] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND Two related recent reports described high error rates for implant positioning and reduced implant survivorship in manual unicompartmental knee arthroplasty (MUKA) compared to robotic-assisted unicompartmental knee arthroplasty (RUKA). The present study scientifically replicated these reports by comparing MUKAs similarly performed by an experienced high-volume surgeon in similar patients using the same study methods as these reports. METHODS A total of 216 consecutive MUKAs were retrospectively evaluated radiographically for achievement of implant positioning targets. Achievement of targets was compared to the published MUKA and RUKA outcomes and correlated with revision rates and patient-reported outcome measures. RESULTS There were 20% of study MUKAs compared to 88.1% of comparison MUKAs (P < .001) and 31.4% of comparison RUKAs (P < .048) that failed to meet all 7 implant positioning targets. The MUKA revision rates were significantly lower in the study sample than for comparison MUKAs (3.2% versus 14.2%, P < .001). Implant survivorship was 91.7% (95% confidence interval 84.9, 98.5%) at 8.9 years compared to 70.0% (95% confidence interval 56.0, 80.0%) at 10.2 years, respectively. Most patient-reported outcome measures did not differ based on achievement of implant positioning targets (P ≥ .072). CONCLUSIONS Present study findings indicate that observations in the 2 recent reports may not be generalizable to all UKA surgeons. Additional data on the relationship between implant positioning and revision as well as functional outcomes are needed to identify appropriate robotic arthroplasty applications.
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Affiliation(s)
- Colin G Harris
- Department of Graduate Medical Education, Indiana University School of Medicine, Indianapolis, Indiana
| | - Mary Ziemba-Davis
- Indiana University Health Saxony Hip and Knee Center, Fishers, Indiana
| | - Evan R Deckard
- Indiana Joint Replacement Institute, Indianapolis, Indiana
| | - Kevin A Sonn
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - R Michael Meneghini
- Indiana Joint Replacement Institute, Indianapolis, Indiana; Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
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12
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Deckey DG, Boddu SP, Christopher ZK, Spangehl MJ, Clarke HD, Gililland JM, Bingham JS. Rheumatoid Arthritis Is Not a Contraindication to Unicompartmental Knee Arthroplasty. J Arthroplasty 2024:S0883-5403(24)00187-6. [PMID: 38428692 DOI: 10.1016/j.arth.2024.02.067] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 02/16/2024] [Accepted: 02/21/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND Rheumatoid arthritis (RA) has historically been considered a contraindication for unicompartmental knee arthroplasty (UKA). However, the widespread use of disease-modifying antirheumatic drugs has substantially improved the management of RA and prevented disease progression. The objective of this study was to ascertain whether RA impacts UKA revision-free survivorship. METHODS Patients undergoing UKA from 2010 to 2021 were identified in an administrative claims database (n = 105,937) using Current Procedural Terminology code 27446. All patients who underwent UKA who had a diagnosis of RA with a minimum of 2-year follow-up (n = 1,422) were propensity score matched based on age, sex, and Elixhauser Comorbidity Index to those who did not have RA (n = 1,422). Laterality was identified using the 10th Revision of International Classification of Diseases codes. The primary outcome was ipsilateral revision to total knee arthroplasty (TKA) within 2 years, and the secondary outcome was ipsilateral revision at any time. RESULTS Among the 1,422 patients who had a UKA and a diagnosis of RA, 37 patients (2.6%) underwent conversion to TKA within 2 years, and 48 patients (3.4%) underwent conversion to TKA at any point. In comparison, 28 patients (2.0%) in the propensity-matched control group underwent conversion to TKA within 2 years, and 40 patients (2.8%) underwent conversion to TKA at any point. Statistical analysis revealed no significant difference in conversion to TKA between patients who had and did not have RA, either within 2 years (P = .31) or anytime (P = .45). CONCLUSIONS Patients who had RA and underwent UKA did not have an increased risk of revision to TKA compared to those who did not have RA. This may indicate that modern management of RA could allow for expanded UKA indications for RA patients.
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Affiliation(s)
- David G Deckey
- Department of Orthopaedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona
| | - Sayi P Boddu
- Alix School of Medicine, Mayo Clinic, Scottsdale, Arizona
| | - Zachary K Christopher
- Department of Orthopaedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona; Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah
| | - Mark J Spangehl
- Department of Orthopaedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona
| | - Henry D Clarke
- Department of Orthopaedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona
| | - Jeremy M Gililland
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah
| | - Joshua S Bingham
- Department of Orthopaedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona
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D’Amario F, De Berardinis L, Zanon G, Qordja F, Vitale U, Gigante AP. First Italian Experience with the Oxinium Metal-Backed Fixed-Bearing Medial Journey II Unicompartmental Knee System: Promising Short-Term Outcomes of 145 Cases. J Clin Med 2024; 13:1303. [PMID: 38592148 PMCID: PMC10932057 DOI: 10.3390/jcm13051303] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 02/21/2024] [Accepted: 02/23/2024] [Indexed: 04/10/2024] Open
Abstract
(1) Background: Unicompartmental knee arthroplasty (UKA) provides a viable alternative to total knee arthroplasty (TKA) in patients with isolated medial osteoarthritis (OA). From 2007 to 2021, 23% of all primary knee arthroplasties in Italy were UKAs. We retrospectively evaluated clinical outcomes and satisfaction in patients implanted with a new oxinium metal-backed fixed-bearing medial unicompartmental prosthesis at a 24-month follow-up. (2) Methods: From December 2020 to December 2021, 145 patients were treated by a single surgeon at a single institution using the hypoallergenic Journey II prosthesis. Clinical outcome measures included the Knee Society Knee Score (KSKS), Knee Society Function Score (KSFS), Oxford Knee Society (OKS) score, University of California Los Angeles Activity Score (UCLA), the Physical Component Summary (PCS), and the Mental Component Summary (MCS), and were calculated preoperatively and at 12 and 24 months. The Forgotten Joint Score-12 (FJS-12) was calculated at 12 and 24 months. Patient satisfaction was collected at 24 months. The scores were compared using the Friedman test. (3) Results: All clinical scores improved significantly from baseline to 24 months (p < 0.0001), except for the FJS-12, which from 12 to 24 months did not improve significantly (p = 0.041). Patient satisfaction was 9.32 ± 0.74 out of 10. No patient experienced complications or required revision surgery. (4) Conclusions: The Journey II unicompartmental prosthesis is a valuable treatment option for end-stage medial OA, improving knee function, providing pain relief, and ensuring high patient satisfaction at 24 months.
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Affiliation(s)
- Federico D’Amario
- Orthopedic Unit, Humanitas San Pio X, Via Francesco Nava, 31, 20159 Milano, Italy; (F.D.); (G.Z.)
| | - Luca De Berardinis
- Clinical Orthopedics, Department of Clinical and Molecular Sciences, School of Medicine, Università Politecnica delle Marche, Via Tronto, 10/a, 60126 Ancona, Italy; (F.Q.); (A.P.G.)
| | - Giacomo Zanon
- Orthopedic Unit, Humanitas San Pio X, Via Francesco Nava, 31, 20159 Milano, Italy; (F.D.); (G.Z.)
| | - Fjorela Qordja
- Clinical Orthopedics, Department of Clinical and Molecular Sciences, School of Medicine, Università Politecnica delle Marche, Via Tronto, 10/a, 60126 Ancona, Italy; (F.Q.); (A.P.G.)
| | - Umberto Vitale
- IRCCS Humanitas Research Hospital, Via Manzoni, 56, Rozzano, 20089 Milano, Italy;
| | - Antonio Pompilio Gigante
- Clinical Orthopedics, Department of Clinical and Molecular Sciences, School of Medicine, Università Politecnica delle Marche, Via Tronto, 10/a, 60126 Ancona, Italy; (F.Q.); (A.P.G.)
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14
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Cozzarelli NF, Khan IA, Arshi A, Sherman MB, Lonner JH, Fillingham YA. Return to Sport After Unicompartmental Knee Arthroplasty and Patello-Femoral Arthroplasty. J Arthroplasty 2024:S0883-5403(24)00103-7. [PMID: 38367903 DOI: 10.1016/j.arth.2024.02.004] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 01/24/2024] [Accepted: 02/05/2024] [Indexed: 02/19/2024] Open
Abstract
BACKGROUND Data on sports/physical activity participation following unicompartmental knee arthroplasty (UKA) and patello-femoral arthroplasty (PFA) is variable and limited. The purpose of this study was to assess participations, outcomes, and limitations in sports following UKA and PFA. METHODS Patients who underwent UKA and PFA at a single institution from 2015 to 2020 were surveyed on sports participation before and after surgery. Data was correlated with perioperative patient characteristics and outcome scores. Among 776 patients surveyed, 356 (50%) patients responded. Of respondents, 296 (83.1%) underwent UKA, 44 (12.6%) underwent PFA, and 16 (4.5%) underwent both UKA/PFA. RESULTS Activity participation rates were 86.5, 77.3, and 87.5% five years prior, and 70.9, 61.4, and 75% at one year prior to UKA, PFA, and UKA/PFA, respectively. Return to sports rates were 81.6, 64.7, and 62.3% at mean 4.6 years postoperatively, respectively. The most common activities were recreational walking, swimming, cycling, and golf. Patients returned to a similar participation level for low-impact activities, whereas participation decreased for intermediate- and high-impact activities. Patients participating in activities had higher postoperative Knee Injury and Osteoarthritis Outcome Score Joint Replacement (P < .001), 12-Item Short Form Physical Component Score (P = .045) and Mental Component Score (P = .012). Activity restrictions were reported among 25, 36.4, and 25% of UKA, PFA, and UKA/PFA patients, respectively, and were more commonly self-imposed than surgeon-directed. CONCLUSIONS Though UKA patients' postoperative sports participation may improve compared to one year preoperatively, participation for patients surgically treated for isolated osteoarthritis is decreased compared to 5 years preoperatively and varies among patient subsets.
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Affiliation(s)
- Nicholas F Cozzarelli
- Department of Orthopedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Irfan A Khan
- Department of Orthopedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Armin Arshi
- Department of Orthopedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania; Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Matthew B Sherman
- Department of Orthopedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jess H Lonner
- Department of Orthopedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Yale A Fillingham
- Department of Orthopedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
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Mohammad HR, Judge A, Murray DW. A Comparison of the Periprosthetic Fracture Rate of Cemented and Cementless Mobile Bearing Unicompartmental Knee Arthroplasties: An Analysis of Data From the National Joint Registry for England, Wales, Northern Ireland, and the Isle of Man. J Arthroplasty 2024:S0883-5403(24)00117-7. [PMID: 38355062 DOI: 10.1016/j.arth.2024.02.019] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 02/04/2024] [Accepted: 02/07/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Periprosthetic fractures are rare but serious complications of unicompartmental knee arthroplasty (UKA). Although cementless UKA has a lower risk of loosening than cemented, there are concerns that tibial fracture risk may be higher given the reliance on interference fit for primary stability. The risk of fracture and the effect of surgical fixation are currently unknown. We compared the periprosthetic fracture rate following cemented and cementless UKA surgery. METHODS A total of 14,122 medial mobile-bearing UKAs (7,061 cemented and 7,061 cementless) from the National Joint Registry and Hospital Episodes Statistics database were propensity score-matched. Cumulative fracture rates were calculated and Cox regressions were used to compare fixation groups. RESULTS The three-month periprosthetic fracture rates were similar (P = .80), being 0.10% in the cemented group and 0.11% in the cementless group. The fracture rates were highest during the first three months postoperatively, but then decreased and remained constant between one and 10 years after surgery. The one-year cumulative fracture rates were 0.2% (confidence interval [CI]: 0.1 to 0.3) for cemented and 0.2% (CI: 0.1 to 0.3) for cementless cases. The 10-year cumulative fracture rates were 0.8% (CI: 0.2 to 1.3) and 0.8% (CI: 0.3 to 1.3), respectively. The hazard ratio during the whole study period was 1.06 (CI: 0.64 to 1.77; P = .79). CONCLUSIONS The periprosthetic fracture rate following mobile bearing UKA surgery is low, being about 1% at 10 years. There were no significant differences in fracture rates between cemented and cementless implants after matching. We surmise that surgeons are aware of the higher theoretical risk of early fracture with cementless components and take care with tibial preparation. LEVELS OF EVIDENCE III.
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Affiliation(s)
- Hasan R Mohammad
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Oxford, United Kingdom; Barts Bone & Joint Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Andrew Judge
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Oxford, United Kingdom; Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Southmead Hospital, Westbury-on-Trym, Bristol, United Kingdom
| | - David W Murray
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Oxford, United Kingdom
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Koh JH, Lim S, Park JY, Chung JY, Jin YJ, Yun HW, Noh S, Park DY. Controlled posterior condylar milling technique for unicompartmental knee arthroplasty minimises tibia resection during gap balancing: Short-term clinical results. Knee Surg Sports Traumatol Arthrosc 2024; 32:499-508. [PMID: 38240064 DOI: 10.1002/ksa.12029] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 12/01/2023] [Indexed: 02/12/2024]
Abstract
PURPOSE The purpose of this study was to demonstrate the clinical utility of controlled posterior condylar milling (CPCM) in gap balancing while minimally resecting the tibia during fixed-bearing unicompartmental knee arthroplasty (UKA). METHODS This study is a retrospective cohort study. Patients who underwent medial UKA for isolated medial compartment osteoarthritis with a minimum follow-up of 2 years were included. The patients were divided into two groups: the conventional group (n = 56) and the CPCM group (n = 66). In the CPCM group, the proximal tibia was resected at the level of the distal end of the subchondral bone. If the flexion gap was tighter than extension, the posterior condyle was additionally milled to adjust gap tightness. Standing knee X-ray and scanogram were used to evaluate alignment and tibia resection amount. Range of motion (ROM) and Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) scores were used to evaluate clinical outcomes. RESULTS The CPCM group showed significantly smaller tibia resection (3.6 ± 1.9 mm) compared to the conventional group (5.2 ± 2.7 mm) (p < 0.001). Postoperative ROM (133.0 ± 8.3°, 135.2 ± 7.2°, n.s.) and WOMAC (19.3 ± 13.6, 23.6 ± 17.7, n.s.) were not significantly different between the two groups. Postoperative periprosthetic fractures occurred in two patients in conventional group, while the CPCM group had no periprosthetic fractures. CONCLUSION The CPCM technique may be a simple and useful intraoperative technique that can achieve minimal tibia resection and promising clinical outcomes while easily adjusting gap tightness between flexion and extension during medial fixed-bearing UKA. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Jeong-Hyun Koh
- Department of Orthopaedic Surgery, School of Medicine, Ajou University, Suwon, Korea
| | - Sumin Lim
- Department of Orthopaedic Surgery, School of Medicine, Ajou University, Suwon, Korea
| | - Jae-Young Park
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University, Seongnam-si, Korea
| | - Jun Young Chung
- Department of Orthopaedic Surgery, School of Medicine, Ajou University, Suwon, Korea
| | - Yong Jun Jin
- Department of Orthopaedic Surgery, School of Medicine, Ajou University, Suwon, Korea
- Cell Therapy Center, Ajou University Medical Center, Suwon, Korea
| | - Hee-Woong Yun
- Department of Orthopaedic Surgery, School of Medicine, Ajou University, Suwon, Korea
- Cell Therapy Center, Ajou University Medical Center, Suwon, Korea
| | - Sujin Noh
- Cell Therapy Center, Ajou University Medical Center, Suwon, Korea
- Department of Biomedical Sciences, Graduate School of Ajou University, Suwon, Korea
| | - Do Young Park
- Department of Orthopaedic Surgery, School of Medicine, Ajou University, Suwon, Korea
- Cell Therapy Center, Ajou University Medical Center, Suwon, Korea
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17
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Bayoumi T, Ten Noever de Brauw GV, Ruderman LV, van der List JP, Kerkhoffs GMMJ, Pearle AD, Zuiderbaan HA. The phenotypic diversity of anteromedial osteoarthritis before and after treatment with medial unicompartmental knee arthroplasty: A radiographic analysis of 1000 knees. Knee Surg Sports Traumatol Arthrosc 2024; 32:274-286. [PMID: 38226437 DOI: 10.1002/ksa.12043] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 12/14/2023] [Accepted: 12/14/2023] [Indexed: 01/17/2024]
Abstract
PURPOSE This study aimed to assess phenotypic variation in the coronal plane of knees with anteromedial osteoarthritis using the functional knee phenotype classification, before and after treatment with medial unicompartmental knee arthroplasty (UKA). METHODS The study comprised 1000 knees of 835 patients (45% females, 55% males, 90% Caucasian) who underwent medial UKA for anteromedial osteoarthritis. Pre and postoperative alignment was evaluated through the hip-knee-ankle angle (HKA), femoral mechanical angle (FMA), and tibial mechanical angle (TMA). Knees were classified according to the functional knee phenotype system which combines limb phenotype (HKA), and femoral and tibial knee phenotypes (FMA and TMA, respectively). Restoration of prearthritic coronal alignment following medial UKA was evaluated by phenotype. RESULTS Preoperatively, 76 distinct and 25 relevant (prevalence ≥1%) functional knee phenotypes were identified, of which VARHKA 6°VARFMA 3°NEUTMA 0° was the most common (9.4% of knees). The most prevalent limb phenotype, VARHKA 6°, comprised 15 distinct knee phenotypes (FMA and TMA combinations). Postoperatively, 58 distinct and 17 relevant functional knee phenotypes were observed, of which VARHKA 3°NEUFMA 0°NEUTMA 0° had the highest prevalence at 18.3%. Knees with combined tibial and femoral deformities were associated with a lower probability of restoration of prearthritic coronal alignment following medial UKA, compared to knees without extra-articular deformity, or knees with an isolated tibial or femoral deformity. CONCLUSION Phenotype analysis using the functional knee phenotype system demonstrated a wide diversity of coronal alignment phenotypes among knees with anteromedial osteoarthritis in a predominantly Caucasian population. Following medial UKA, a reduction from 25 preoperative to 17 postoperative relevant phenotypes was observed. Consideration of phenotypic variation can be of importance when aiming to restore prearthritic coronal alignment during medial UKA. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Tarik Bayoumi
- Hospital for Special Surgery, Sports Medicine Institute, Weill Medical College of Cornell University, New York, New York, USA
- Department of Orthopaedic Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Gaby V Ten Noever de Brauw
- Hospital for Special Surgery, Sports Medicine Institute, Weill Medical College of Cornell University, New York, New York, USA
- Department of Orthopaedic Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Lindsey V Ruderman
- Hospital for Special Surgery, Sports Medicine Institute, Weill Medical College of Cornell University, New York, New York, USA
| | - Jelle P van der List
- Department of Orthopaedic Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Gino M M J Kerkhoffs
- Department of Orthopaedic Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Sports, Amsterdam, The Netherlands
| | - Andrew D Pearle
- Hospital for Special Surgery, Sports Medicine Institute, Weill Medical College of Cornell University, New York, New York, USA
| | - Hendrik A Zuiderbaan
- Department of Orthopaedic Surgery, Medical Clinic Velsen, Velsen-Noord, The Netherlands
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Karasavvidis T, Fackler NP, Callan KT, Lung BE, Wang D. Comparison of Early Complication Rates After High Tibial Osteotomy Versus Unicompartmental Knee Arthroplasty for Knee Osteoarthritis. Orthop J Sports Med 2024; 12:23259671231219975. [PMID: 38188617 PMCID: PMC10768598 DOI: 10.1177/23259671231219975] [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: 07/06/2023] [Accepted: 07/31/2023] [Indexed: 01/09/2024] Open
Abstract
Background Although both high tibial osteotomy (HTO) and unicompartmental knee arthroplasty (UKA) can be utilized to treat unicompartmental osteoarthritis (OA) in select patients, the early complication rates between the 2 procedures are not well understood. Understanding of the complication profiles for both procedures would help clinicians counsel patients with unicompartmental knee OA who may be eligible for either treatment option. Purpose To compare the 30-day complication rates after HTO versus UKA for the treatment of knee OA using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. Study Design Cohort study; Level of evidence, 3. Methods NSQIP registries between 2006 and 2019 were queried using Current Procedural Terminology codes to identify patients undergoing HTO and UKA for knee OA. Patients >60 years of age were excluded. Patient demographics, preoperative comorbidities, and intraoperative data were collected. Postoperative 30-day complications, including venous thromboembolism (VTE), urinary tract infection (UTI), transfusion, surgical-site infection (SSI), and reoperations were recorded. Complication rates between treatment groups were compared using a multivariate logistic regression model adjusted for sex, age, body mass index, steroid use, respiratory status (smoking/dyspnea/chronic obstructive pulmonary disease), diabetes, and hypertension. Results A total of 156 patients treated with HTO and 4755 patients treated with UKA for knee OA were identified. Mean patient ages were 46 years for the HTO group and 53.4 years for the UKA group. Operative time was significantly longer in the HTO group versus the UKA group (112 minutes vs 90 minutes; P < .001). Multivariate analyses found no significant differences in VTE (1.3% vs 0.6%), UTI (0.6% vs 0.3%), transfusion (0.6% vs 0.2%), deep SSI (0.6% vs 0.1%), and reoperation (1.3% vs 1%) rates between HTO and UKA groups. The HTO group had a higher rate of superficial SSI compared with the UKA group (2.6% vs 0.6%; P = .006) (adjusted odds ratio, 4.2; 95% CI, 1.4-12.5; P = .01). Conclusion There were no differences in 30-day VTE, UTI, transfusion, deep SSI, and reoperation rates for HTO versus UKA in the treatment of knee OA. HTO was associated with a higher rate of superficial SSI compared with UKA. These findings serve to guide clinicians in counseling patients regarding the early risks after HTO and UKA.
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Affiliation(s)
- Theofilos Karasavvidis
- Department of Orthopaedic Surgery, University of California, Irvine, Orange, California, USA
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Nathan P. Fackler
- Department of Orthopaedic Surgery, University of California, Irvine, Orange, California, USA
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, California, USA
| | - Kylie T. Callan
- Department of Orthopaedic Surgery, University of California, Irvine, Orange, California, USA
| | - Brandon E. Lung
- Department of Orthopaedic Surgery, University of California, Irvine, Orange, California, USA
| | - Dean Wang
- Department of Orthopaedic Surgery, University of California, Irvine, Orange, California, USA
- Department of Biomedical Engineering, University of California, Irvine, Irvine, California, USA
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Bayoumi T, Ten Noever de Brauw GV, Ruderman LV, van der List JP, Kerkhoffs GMMJ, Zuiderbaan HA, Pearle AD. Magnitude of Change in Leg Length and Clinical Impact Following Medial Unicompartmental Knee Arthroplasty. J Arthroplasty 2024; 39:68-75. [PMID: 37479193 DOI: 10.1016/j.arth.2023.07.013] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 07/11/2023] [Accepted: 07/13/2023] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND Change in leg length and leg-length discrepancy (LLD) are common concerns among patients undergoing medial unicompartmental knee arthroplasty (UKA). This study aimed to quantify the magnitude of leg-length change, prevalence of postoperative LLD, and their clinical implications following medial UKA. METHODS Leg length and mechanical hip-knee-ankle angle (mHKA) were retrospectively measured in 332 patients following unilateral robotic-arm assisted medial UKA for medial compartment osteoarthritis, using calibrated long-leg radiographs. The Knee Injury and Osteoarthritis Otcome Score for Joint Replacement and patient satisfaction were analyzed to assess impact of leg-length change and LLD on outcomes. RESULTS Following medial UKA, median leg-length change was 2.0 mm (interquartile range, -1.0 to 5.0 mm; P < .001) with a mean correction in mHKA of 4.4° ± 2.7 (P < .001). A total of 158 patients (48%) had a leg-length increase by 0 to 5 mm, 64 (19%) by 6 to 10 mm, and 11 (3%) by >10 mm. Leg-length change was positively correlated with mHKA correction (R = 0.44, P < .001). Postoperatively, moderate (5 to 10 mm) and substantial LLD (≥10 mm) were present in 49% and 17% of patients, respectively. Four-year Knee Injury and Osteoarthritis Outcome Score for Joint Replacement were comparable between patients with and without substantial postoperative LLD (P = .976). Proportions of satisfied patients were similar between groups (P = .687). CONCLUSION Following medial UKA, the majority of patients had a moderate increase in leg length, the magnitude of which was positively correlated to the correction in mechanical alignment. Postoperative substantial LLD was not uncommon (17% prevalence); however, it had no significant impact on patient-reported outcomes or satisfaction at 4 years follow-up.
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Affiliation(s)
- Tarik Bayoumi
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Computer Assisted Surgery Center & Sports Medicine, Weill Medical College of Cornell University, New York, New York; Department of Orthopaedic Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Gaby V Ten Noever de Brauw
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Computer Assisted Surgery Center & Sports Medicine, Weill Medical College of Cornell University, New York, New York; Department of Orthopaedic Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Lindsey V Ruderman
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Computer Assisted Surgery Center & Sports Medicine, Weill Medical College of Cornell University, New York, New York
| | - Jelle P van der List
- Department of Orthopaedic Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Movement Sciences, Sports, Ageing & Vitality, Amsterdam, The Netherlands
| | - Gino M M J Kerkhoffs
- Department of Orthopaedic Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Movement Sciences, Sports, Ageing & Vitality, Amsterdam, The Netherlands
| | - Hendrik A Zuiderbaan
- Department of Orthopaedic Surgery, Medische Kliniek Velsen, Velsen, The Netherlands
| | - Andrew D Pearle
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Computer Assisted Surgery Center & Sports Medicine, Weill Medical College of Cornell University, New York, New York
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20
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Wignadasan W, Chang J, Fontalis A, Plastow R, Haddad FS. Short term outcomes following robotic arm-assisted lateral unicompartmental knee arthroplasty. Front Surg 2023; 10:1215280. [PMID: 38162087 PMCID: PMC10757348 DOI: 10.3389/fsurg.2023.1215280] [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] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 11/29/2023] [Indexed: 01/03/2024] Open
Abstract
Introduction Robotic-arm assisted medial unicompartmental knee arthroplasty (RA-UKA) is associated with improved accuracy of implant positioning and excellent early functional outcomes. However, there is paucity of evidence regarding outcomes following RA-UKA for isolated lateral compartment osteoarthritis. The purpose of this study was to assess the short-term clinical and patient reported outcomes of lateral compartment UKA, utilising robotic-arm assistance. Methods This was a retrospective study of prospectively collected data of 21 consecutive patients who underwent lateral RA-UKA. The study included 9 (42.9%) males and 12 (57.1%) females with a mean age of 63.4 ± 9.2 years. The Oxford Knee Score (OKS) was measured pre-operatively and at 1-year post-operatively, while range of motion (ROM) and complications were also recorded. Results There was significant improvement of OKS at 1 year's follow up compared with the baseline score (21.8 ± 5.6 vs. 45.2 ± 2.8 respectively; p < 0.001). There was also an improvement in pre-operative ROM when compared to ROM at 1 year's follow up (123.5° ± 8° vs. 131.5° ± 6.3° respectively; p < 0.001). None of the study patients underwent revision surgery within 1 year's follow-up. Conclusion In our study, lateral RA-UKA resulted in significant improvements in clinical and patient reported outcomes with low complications rates. Further long-term comparative studies are needed to assess the utility of lateral RA-UKA vs. conventional UKA.
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Affiliation(s)
- Warran Wignadasan
- Departmentof Trauma and Orthopaedic Surgery, University College Hospital, London, United Kingdom
| | - Justin Chang
- Department of Orthopaedic Surgery, Humber River Hospital, Toronto, ON, Canada
- Division of Orthopaedic Surgery, University of Toronto, Toronto, ON, Canada
| | - Andreas Fontalis
- Departmentof Trauma and Orthopaedic Surgery, University College Hospital, London, United Kingdom
- Department of Orthopaedic Surgery, The Princess Grace Hospital, London, United Kingdom
| | - Ricci Plastow
- Departmentof Trauma and Orthopaedic Surgery, University College Hospital, London, United Kingdom
| | - Fares S. Haddad
- Departmentof Trauma and Orthopaedic Surgery, University College Hospital, London, United Kingdom
- Department of Orthopaedic Surgery, The Princess Grace Hospital, London, United Kingdom
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21
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Akkawi I, Draghetti M, Zmerly H. Outcome of simultaneous bi- unicompartmental knee arthroplasty: a systematic review. Acta Biomed 2023; 94:e2023240. [PMID: 38054676 PMCID: PMC10734244 DOI: 10.23750/abm.v94i6.15006] [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] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 08/25/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND AND AIM Simultaneous medial and lateral tibiofemoral osteoarthritis (OA) could be treated with bi-unicompartmental knee arthroplasty (Bi-UKA) as an alternative to total knee arthroplasty (TKA). The present systematic review aims to assess if simultaneous Bi-UKA is a feasible option for treating medial and lateral tibiofemoral OA. MATERIALS AND METHODS A comprehensive search of PubMed, MEDLINE, Cochrane Library, and Google Scholar was performed to find studies that reported on the outcome of simultaneous Bi-UKA for both medial and lateral tibiofemoral OA. RESULTS Seven studies were considered eligible for inclusion in the present systematic review. Intraoperative fractures occurred 8 times. Overall, there were 22 revisions of the prosthetic components for any reason with a survival rate that ranged from 83 to 100%. Of these, 16 revisions were for the aseptic loosening of the prosthetic components. Out of 302 surgeries, three were revised due to symptomatic OA progression in the patello-femoral joint. All clinical scores improved at the latest follow-up compared to preoperative values. Moreover, there were no differences in clinical scores of Bi-UKA compared to unicompartmental knee arthroplasty (UKA), or medial UKA plus patello-femoral prosthesis. Whereas, compared to TKA, Bi-UKA patients had comparable or superior scores. Finally, the Bi-UKA group had a significantly shorter hospital stay compared to the TKA group. CONCLUSIONS The use of simultaneous Bi-UKA is a valid option to address bicompartmental knee OA in selected patients with low intraoperative fracture rate, low revision rate, satisfactory clinical outcome, and fast recovery.
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Affiliation(s)
| | - Maurizio Draghetti
- Orthopaedics and Traumatology Unit, Villa Erbosa Hospital, Bologna, Italy.
| | - Hassan Zmerly
- Orthopaedics and Traumatology Unit, Villa Erbosa Hospital, Bologna, Italy.
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22
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Mikkelsen M, Rasmussen LE, Price A, Pedersen AB, Gromov K, Troelsen A. Does changes in unicompartmental knee arthroplasty practice pattern influence reasons for revision? Bone Jt Open 2023; 4:923-931. [PMID: 38043568 PMCID: PMC10693936 DOI: 10.1302/2633-1462.412.bjo-2023-0096.r1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2023] Open
Abstract
Aims The aim of this study was to describe the pattern of revision indications for unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA) and any change to this pattern for UKA patients over the last 20 years, and to investigate potential associations to changes in surgical practice over time. Methods All primary knee arthroplasty surgeries performed due to primary osteoarthritis and their revisions reported to the Danish Knee Arthroplasty Register from 1997 to 2017 were included. Complex surgeries were excluded. The data was linked to the National Patient Register and the Civil Registration System for comorbidity, mortality, and emigration status. TKAs were propensity score matched 4:1 to UKAs. Revision risks were compared using competing risk Cox proportional hazard regression with a shared γ frailty component. Results Aseptic loosening (loosening) was the most common revision indication for both UKA (26.7%) and TKA (29.5%). Pain and disease progression accounted for 54.6% of the remaining UKA revisions. Infections and instability accounted for 56.1% of the remaining TKA revision. The incidence of revision due to loosening or pain decreased over the last decade, being the second and third least common indications in 2017. There was a decrease associated with fixation method for pain (hazard ratio (HR) 0.40; 95% confidence interval (CI) 0.17 to 0.94) and loosening (HR 0.29; 95% CI 0.10 to 0.81) for cementless compared to cemented, and units UKA usage for pain (HR 0.67, 95% CI 0.50 to 0.91), and loosening (HR 0.51; 95% CI 0.37 to 0.70) for high usage. Conclusion The overall revision patterns for UKA and TKA for the last 20 years are comparable to previous published patterns. We found large changes to UKA revision patterns in the last decade, and with the current surgical practice, revision due to pain or loosening are significantly less likely.
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Affiliation(s)
- Mette Mikkelsen
- Department of Orthopaedic Surgery, Clinical Orthopaedic Research Hvidovre (CORH), Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | | | - Andrew Price
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Oxford, UK
| | - Alma B. Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
| | - Kirill Gromov
- Department of Orthopaedic Surgery, Clinical Orthopaedic Research Hvidovre (CORH), Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Anders Troelsen
- Department of Orthopaedic Surgery, Clinical Orthopaedic Research Hvidovre (CORH), Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
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23
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Liu S, Zhang B, Zhang B, Liu Y, Chen X, Li M, Liu B, Huo J, Zhang X, Han Y. A new joint reconstruction technique in the treatment of giant cell tumors around the knee: Structural allograft and unicompartmental arthroplasty. J Surg Oncol 2023; 128:1179-1189. [PMID: 37519101 DOI: 10.1002/jso.27406] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 07/04/2023] [Accepted: 07/16/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVE The long-term prognosis of patients who underwent unicompartmental knee arthroplasty (UKA) with a structural allograft or hemiarticular allograft transplantation to treat giant cell tumors (GCTs) around the knee and the prosthesis survival rate were analyzed. METHODS We retrospectively reviewed 73 patients who were diagnosed with GCTs around the knee and underwent surgery to restore joint function from 2000 to 2015. Patients were divided into two groups according to the surgical procedure used for functional knee reconstruction: hemiarticular allograft transplantation or structural allograft and UKA. The Knee Society Score (KSS) and Western Ontario and McMaster Universities Arthritis Index (WOMAC) were used to analyze postoperative knee function between the two groups. The Kellgren-Lawrence (K-L) classification system was used to evaluate the progression of osteoarthritis. The incidence of complications and the prosthesis survival rate were also investigated. RESULTS Patients who underwent UKA to treat GCT demonstrated significantly improved knee function. The rate of an excellent or good KSS was significantly different between the two groups (p = 0.041 at the 1-year follow-up, p = 0.033 at the last follow-up). The proportion of severe cases according to WOMAC in the two groups was also different (p = 0.030 at the 1-year follow-up, p = 0.021 at the last follow-up). According to the K-L grade of unaffected compartments, UKA better prevented the progression of osteoarthritis (p = 0.034). CONCLUSIONS Patients with GCTs around the knee could benefit from UKA. In addition to providing better knee function and range of motion, UKA could also slow the progression of osteoarthritis in the knee joint. This new surgical method could meet the needs of patients wishing to preserve joint integrity and favorable joint function.
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Affiliation(s)
- Sikai Liu
- Department of Orthopaedic Surgery, Hebei Medical University Third Affiliated Hospital, Shijiazhuang, China
| | - Bingshi Zhang
- Department of Orthopaedic Surgery, Hebei Medical University Third Affiliated Hospital, Shijiazhuang, China
| | - Binquan Zhang
- Department of Orthopaedic Surgery, Hebei Medical University Third Affiliated Hospital, Shijiazhuang, China
| | - Yawei Liu
- Department of Orthopaedic Surgery, Hebei Medical University Third Affiliated Hospital, Shijiazhuang, China
| | - Xiao Chen
- Department of Orthopaedic Surgery, Hebei Medical University Third Affiliated Hospital, Shijiazhuang, China
| | - Mengnan Li
- Department of Orthopaedic Surgery, Hebei Medical University Third Affiliated Hospital, Shijiazhuang, China
| | - Bo Liu
- Department of Orthopaedic Surgery, Hebei Medical University Third Affiliated Hospital, Shijiazhuang, China
| | - Jia Huo
- Department of Orthopaedic Surgery, Hebei Medical University Third Affiliated Hospital, Shijiazhuang, China
| | - Xiaoxuan Zhang
- Department of Orthopaedic Surgery, Hebei Medical University Third Affiliated Hospital, Shijiazhuang, China
| | - Yongtai Han
- Department of Orthopaedic Surgery, Hebei Medical University Third Affiliated Hospital, Shijiazhuang, China
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Mekkawy KL, Rodriguez HC, Pannu TS, Rowland RJ, Roche MW, Corces A. Morbidly Obese Patients Undergoing Unicompartmental Knee Arthroplasty Compared to Total Knee Arthroplasty: A Retrospective Case-Controlled Analysis. J Arthroplasty 2023; 38:2510-2516.e1. [PMID: 37301237 DOI: 10.1016/j.arth.2023.05.093] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/30/2023] [Accepted: 05/31/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND In this study, we assess the effects that morbid obesity (body mass index (BMI) ≥ 40) has on: (1) Ninety-day medical complications and readmission rates; (2) costs of care and lengths of stay (LOS); and (3) 2-year implant complications in patients undergoing unicompartmental knee arthroplasty (UKA) versus total knee arthroplasty (TKA). METHODS A retrospective query of TKA and UKA patients were identified using a national database. Morbidly obese UKA patients were matched 1:5 to morbidly obese TKA patients by demographic and comorbidity profiles. Subgroup analyses were conducted using the same process between morbidly obese UKA patients and BMI <40 TKA patients, as well as to BMI <40 UKA patients. RESULTS Morbidly obese patients who underwent UKA had significantly fewer medical complications, readmissions, and periprosthetic joint infections than TKA patients; however, UKA patients had greater odds of mechanical loosening (ML). The TKA patients had significantly longer LOS (3.0 versus 2.4 days, P < .001), as well as significantly greater costs of care than UKA patients ($12,869 versus $7,105). Morbidly obese UKA patients had similar rates of medical complications, and significantly lower readmissions, decreased LOS, and decreased costs when compared to TKA patients who had a BMI <40. CONCLUSION In patients who have morbid obesity, complications were decreased in UKA compared to TKA. Moreover, morbidly obese UKA patients had lower medical utilizations and similar complication rates when compared to TKA patients with the recommended cutoff of BMI <40. However, UKA patients had greater rates of ML than TKA patients. A UKA may be an acceptable treatment option for unicompartmental osteoarthritis in morbidly obese patients.
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Affiliation(s)
- Kevin L Mekkawy
- Holy Cross Orthopedic Research Institute, Holy Cross Health, Fort Lauderdale, Florida; Department of Orthopaedic Surgery, Hospital for Special Surgery, West Palm Beach, Florida
| | - Hugo C Rodriguez
- Department of Orthopaedic Surgery, Hospital for Special Surgery, West Palm Beach, Florida; Larkin Community Hospital, Department of Orthopaedic Surgery, South Miami, Florida
| | - Tejbir S Pannu
- Larkin Community Hospital, Department of Orthopaedic Surgery, South Miami, Florida
| | - Robert J Rowland
- Larkin Community Hospital, Department of Orthopaedic Surgery, South Miami, Florida
| | - Martin W Roche
- Holy Cross Orthopedic Research Institute, Holy Cross Health, Fort Lauderdale, Florida; Department of Orthopaedic Surgery, Hospital for Special Surgery, West Palm Beach, Florida
| | - Arturo Corces
- Larkin Community Hospital, Department of Orthopaedic Surgery, South Miami, Florida
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Sang W, Qiu H, Xu Y, Pan Y, Ma J, Zhu L. Malposition is main cause of failure of Oxford mobile-bearing medial unicompartmental knee arthroplasty. Bone Jt Open 2023; 4:914-922. [PMID: 38035610 PMCID: PMC10689062 DOI: 10.1302/2633-1462.412.bjo-2023-0135.r1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2023] Open
Abstract
Aims Unicompartmental knee arthroplasty (UKA) is the preferred treatment for anterior medial knee osteoarthritis (OA) owing to the rapid postoperative recovery. However, the risk factors for UKA failure remain controversial. Methods The clinical data of Oxford mobile-bearing UKAs performed between 2011 and 2017 with a minimum follow-up of five years were retrospectively analyzed. Demographic, surgical, and follow-up data were collected. The Cox proportional hazards model was used to identify the risk factors that contribute to UKA failure. Kaplan-Meier survival was used to compare the effect of the prosthesis position on UKA survival. Results A total of 407 patients who underwent UKA were included in the study. The mean age of patients was 61.8 years, and the mean follow-up period of the patients was 91.7 months. The mean Knee Society Score (KSS) preoperatively and at the last follow-up were 64.2 and 89.7, respectively (p = 0.001). Overall, 28 patients (6.9%) with UKA underwent revision due to prosthesis loosening (16 patients), dislocation (eight patients), and persistent pain (four patients). Cox proportional hazards model analysis identified malposition of the prostheses as a high-risk factor for UKA failure (p = 0.007). Kaplan-Meier analysis revealed that the five-year survival rate of the group with malposition was 85.1%, which was significantly lower than that of the group with normal position (96.2%; p < 0.001). Conclusion UKA constitutes an effective method for treating anteromedial knee OA, with an excellent five-year survival rate. Aseptic loosening caused by prosthesis malposition was identified as the main cause of UKA failure. Surgeons should pay close attention to prevent the potential occurrence of this problem.
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Affiliation(s)
- Weilin Sang
- Department of Joint Surgery, Shanghai General Hospital, Shanghai, China
- Department of Orthopaedics, Yiliang People’s Hospital, Yunnan, China
| | - Hongjiu Qiu
- Department of Orthopaedics, Yiliang People’s Hospital, Yunnan, China
| | - Ying Xu
- Shanghai International Medical Center, Shanghai, China
| | - Yuqin Pan
- Department of Surgery, Shanghai General Hospital, Shanghai, China
| | - Jinzhong Ma
- Department of Joint Surgery, Shanghai General Hospital, Shanghai, China
| | - Libo Zhu
- Department of Joint Surgery, Shanghai General Hospital, Shanghai, China
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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] [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: 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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Foissey C, Batailler C, Vahabi A, Fontalis A, Servien E, Lustig S. Combination of a High Residual Varus and Joint-Line Lowering Strongly Increases the Risk of Early Implant Failure in Medial Unicompartmental Knee Arthroplasty. J Arthroplasty 2023; 38:2275-2281. [PMID: 37271228 DOI: 10.1016/j.arth.2023.05.055] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 09/26/2022] [Revised: 05/18/2023] [Accepted: 05/20/2023] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND Outliers in implant positioning, malalignment, and joint line height change are risk factors for unicompartmental knee arthroplasty (UKA) failure. However, their relationships and patterns in large datasets remain unexplored. This study assessed medial UKA survival in a large cohort and explored associated risk factors. METHODS This was a retrospective cohort study on medial UKA patients (2011 to 2019). Radiological outcomes included tibial implant positioning in the coronal plane, posterior tibial slope, residual knee deformity, and joint line restitution. Survival rate at last follow-up was recorded. Multinomial logistic regression analyzed risk factors, incorporating demographic and univariate analysis data. RESULTS Three hundred and sixty-six knees met inclusion criteria, with 10 lost to follow-up (2.7%). Mean follow-up was 61.3 months [24.1 to 135.1]. 5- and 10-year implant survival rates were 92% ± 1.6 and 88.4% ± 3.8, respectively. Multivariate analysis identified post-operative hip-knee-ankle angle (HKA) ≤ 175° (OR = 5.30 [1.64 to 17.13], P = .005) and joint line lowering ≥2 mm (OR = 8.86 [2.06 to 38.06]) as significant risk factors for tibial implant failure. Their combination carried a significantly high risk of failure (OR = 10.3 [3.1 to 34.3]). Post-operative HKA < 175° was common in knees with pre-operative HKA < 172°. CONCLUSION This study reports encouraging 5- and 10-year survival outcomes for medial UKA. Tibial loosening was the main reason for revision. Patients with joint line lowering ≥ 2 mm and post-operative HKA ≤ 175° were at high risk of tibial implant failure. Surgeons should carefully restore the joint line in cases of pre-operative HKA < 172°.
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Affiliation(s)
- Constant Foissey
- Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, FIFA Medical Center of Excellence, Lyon, France
| | - Cécile Batailler
- Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, FIFA Medical Center of Excellence, Lyon, France
| | - Arman Vahabi
- Department of Orthopaedics and Traumatology, Ege University, Izmir, Turkey
| | - Andreas Fontalis
- Department of Trauma and Orthopaedics Surgery, University College Hospital, London, United Kingdom; Division of Surgery and Interventional Science, University College London, London, United Kingdom
| | - Elvire Servien
- Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, FIFA Medical Center of Excellence, Lyon, France; EA 7424, Interuniversity Laboratory of Human Movement Science, Université Lyon 1, Lyon, France
| | - Sébastien Lustig
- Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, FIFA Medical Center of Excellence, Lyon, France; Université Claude Bernard Lyon 1, IFSTTAR, LBMC UMR_T9406, Université de Lyon, Lyon, France
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Rahman TM, Hansen L, Blackmond N, Sandhu A, Shaw JH, Davis JJ. Impact of Alignment and Alignment Correction on Outcomes Following Robotic Medial Unicompartmental Knee Arthroplasty. J Arthroplasty 2023; 38:2282-2287. [PMID: 37271235 DOI: 10.1016/j.arth.2023.05.046] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 05/15/2023] [Accepted: 05/20/2023] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND The purpose of this study was to retrospectively examine the relationship between preoperative and postoperative alignment in robotic unicompartmental knee arthroplasty (UKA) and postoperative patient-reported outcome measures. METHODS A retrospective review of 374 patients who underwent robotic-assisted UKA was conducted. Patient demographics, history, and preoperative and postoperative Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS-JR) scores were obtained via chart review. Average follow-up period was 2.4 years (range: 0.4 to 4.5 years) to chart review and 9.5 months (range: 6 to 48 months) to latest KOOS-JR. Preoperative and postoperative robotically-measured knee alignment was obtained from operative reports. Incidence of conversion to total knee arthroplasty (TKA) was determined by review of a health information exchange tool. RESULTS Multivariate regressions showed no statistically significant relationship between preoperative alignment, postoperative alignment, or degrees of alignment correction and change in KOOS-JR score or achievement of KOOS-JR minimal clinically important difference (MCID) (P > .05). Patients who had >8 degrees of postoperative varus alignment had on average a 20% lower achievement of KOOS-JR MCID compared to patients who had <8 degrees of postoperative varus alignment; however, this difference was not statistically significant (P > .05). There were 3 patients who required conversion to TKA in the follow-up period, with no significant relationship to alignment variables (P > .05). CONCLUSION There was no significant difference in KOOS-JR change for those patients who had a larger or smaller degree of deformity correction, and correction did not predict MCID achievement.
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Affiliation(s)
- Tahsin M Rahman
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan. https://twitter.com/trahman1994wsu
| | - Logan Hansen
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan
| | - Nicholas Blackmond
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan
| | - Amar Sandhu
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan
| | - Jonathan H Shaw
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan
| | - Jason J Davis
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan
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Takahashi T, Takeshita K. Artifact Reduction Proton Density Magnetic Resonance Imaging Can Better Visualize Unicompartmental Knee Arthroplasty Components but Does Not Improve Measurement Accuracy at 3T: An In Vitro Phantom Study. Cureus 2023; 15:e46338. [PMID: 37790872 PMCID: PMC10544766 DOI: 10.7759/cureus.46338] [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] [Subscribe] [Scholar Register] [Accepted: 10/01/2023] [Indexed: 10/05/2023] Open
Abstract
Background There are no studies of the efficacy of slice encoding for metal artifact correction (SEMAC) magnetic resonance imaging (MRI) at 3T for patients following unicompartmental knee arthroplasty (UKA), although the artifact is expected to increase compared with 1.5T. Purpose To clarify whether SEMAC MRI can better visualize UKA components and improve measurement accuracy at 3T MRI. Materials and methods The phantom consisted of femoral and tibial standard UKA components embedded in agarose gel. The MR images were scanned on a 3T MR system including proton density (PD) MR images. Six orthopedic surgeons blinded to the size and details of the components independently scored the diagnostic value for measurement and measured the lengths of the femoral posterior condyle, femoral peg, anterior-posterior (AP) tibial component, medial-lateral (ML) tibial component, and tibial keel, with and without SEMAC. Visualization scores were stratified as 0 = definitely nondiagnostic, 1 = probably nondiagnostic, 2 = possibly diagnostic, 3 = probably diagnostic, and 4 = definitely diagnostic. In addition, the differences between actual length and 95% confidence intervals of five measurement points were analyzed. Results The diagnostic values of the posterior condyle (2.0; 1.5 vs. 0; 0) and femoral peg (1.5; 1.0 vs. 0; 0) were significantly better in SEMAC-PD MRI than in non-SEMAC-PD MRI (P<0.05). On the other hand, there were no significant differences in the visualizations of AP, ML, and keel of the tibial components. Measurements of the femoral posterior condyle and tibial keel approached the actual length, but were not involved within the 95% confidence interval (actual length, 19.4 mm vs. 95% CI, 15.7-19.1 mm). Conclusion A significant reduction of metal artifacts was observed only around the femoral component in SEMAC-PD MRI. Despite artifact reduction, this sequence did not result in better visualization for measurement.
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Affiliation(s)
- Tsuneari Takahashi
- Department of Orthopaedic Surgery, Ishibashi General Hospital, Shimotsuke, JPN
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Salmons HI, Lu Y, Labott JR, Wyles CC, Camp CL, Taunton MJ. Identifying Modifiable Cost Drivers of Outpatient Unicompartmental Knee Arthroplasty With Machine Learning. J Arthroplasty 2023; 38:2051-2059.e2. [PMID: 36265720 DOI: 10.1016/j.arth.2022.10.017] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 10/06/2022] [Accepted: 10/11/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Implementing tools that identify cost-saving opportunities for ambulatory orthopaedic surgeries can improve access to value-based care. We developed and internally validated a machine learning (ML) algorithm to predict cost drivers of total charges after ambulatory unicompartmental knee arthroplasty (UKA). METHODS We queried the New York State Ambulatory Surgery and Services database to identify patients who underwent ambulatory, defined as <24 hours of care before discharge, elective UKA between 2014 and 2016. A total of 1,311 patients were included. The median costs after ambulatory UKA were $14,710. Patient demographics and intraoperative parameters were entered into 4 candidate ML algorithms. The most predictive model was selected following internal validation of candidate models, with conventional linear regression as a benchmark. Global variable importance and partial dependence curves were constructed to determine the impact of each input parameter on total charges. RESULTS The gradient-boosted ensemble model outperformed all candidate algorithms and conventional linear regression. The major differential cost drivers of UKA identified (in decreasing order of magnitude) were increased operating room time, length of stay, use of regional and adjunctive periarticular analgesia, utilization of computer-assisted navigation, and routinely sending resected tissue to pathology. CONCLUSION We developed and internally validated a supervised ML algorithm that identified operating room time, length of stay, use of computer-assisted navigation, regional primary anesthesia, adjunct periarticular analgesia, and routine surgical pathology as essential cost drivers of UKA. Following external validation, this tool may enable surgeons and health insurance providers optimize the delivery of value-based care to patients receiving outpatient UKA. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Harold I Salmons
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Yining Lu
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Joshua R Labott
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Cody C Wyles
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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Ghazal AH, Fozo ZA, Matar SG, Kamal I, Gamal MH, Ragab KM. Robotic Versus Conventional Unicompartmental Knee Surgery: A Comprehensive Systematic Review and Meta-Analysis. Cureus 2023; 15:e46681. [PMID: 37869054 PMCID: PMC10589056 DOI: 10.7759/cureus.46681] [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] [Subscribe] [Scholar Register] [Accepted: 10/08/2023] [Indexed: 10/24/2023] Open
Abstract
Robotic-assisted surgery is a computer-controlled technique that may improve the accuracy and outcomes of unicompartmental total knee arthroplasty (TKA), a partial knee replacement surgery. The purpose of a meta-analysis about robotic-assisted versus conventional surgery for unicompartmental TKA is to compare the effectiveness of these two methods based on the current evidence. Our meta-analysis can help inform clinical decisions and guidelines for surgeons and patients who are considering unicompartmental TKA as a treatment option. We searched four online databases for studies that compared the two methods until March 2023. We used RevMan software to combine the data from the studies. We calculated the mean difference (MD) and the 95% confidence interval (CI) for each outcome, which are statistical measures of the difference and the uncertainty between the two methods. We included 16 studies in our analysis. We found that robotic-assisted surgery had a better hip-knee-ankle angle, which is a measure of how well the knee is aligned, than conventional surgery (MD = 0.86, 95% CI = 0.16-1.56). We also found that robotic-assisted surgery had a better Oxford Knee score, which is a measure of how well the knee functions, than conventional surgery (MD = 3.03, 95% CI = 0.96-5.110). This study compared the results of conventional and robotic-assisted unicompartmental knee arthroplasty in 12 studies. We concluded that robotic-assisted surgery may have some benefits over conventional surgery in terms of alignment and function of the knee. However, we did not find any significant difference between the two methods in terms of other outcomes, such as pain, range of motion, health status, and joint awareness. Therefore, we suggest that more research is needed to confirm these results and evaluate the long-term effects and cost-effectiveness of robotic-assisted surgery.
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Affiliation(s)
- Ahmed Hussein Ghazal
- Orthopaedics, Northwick Park Hospital, London North West University Healthcare NHS Trust, Harrow, GBR
| | | | - Sajeda G Matar
- Pharmacology and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman, JOR
| | - Ibrahim Kamal
- General Medicine, Al-Azhar University, Alexandria, EGY
| | - Mohamed Hesham Gamal
- Pharmacology and Therapeutics, Faculty of Pharmacy, Tanta University, Tanta, EGY
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Houserman DJ, Berend KR, Lombardi AV, Fischetti CE, Duhaime EP, Jain A, Crawford DA. The Viability of an Artificial Intelligence/Machine Learning Prediction Model to Determine Candidates for Knee Arthroplasty. J Arthroplasty 2023; 38:2075-2080. [PMID: 35398523 DOI: 10.1016/j.arth.2022.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 02/08/2022] [Revised: 03/16/2022] [Accepted: 04/02/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The purpose of this study is to assess the viability of a knee arthroplasty prediction model using 3-view X-rays that helps determine if patients with knee pain are candidates for total knee arthroplasty (TKA), unicompartmental knee arthroplasty (UKA), or are not arthroplasty candidates. METHODS Analysis was performed using radiographic and surgical data from a high-volume joint replacement practice. The dataset included 3 different X-ray views (anterior-posterior, lateral, and sunrise) for 2,767 patients along with information of whether that patient underwent an arthroplasty surgery (UKA or TKA) or not. This resulted in a dataset including 8,301 images from 2,707 patients. This dataset was then split into a training set (70%) and holdout test set (30%). A computer vision model was trained using a transfer learning approach. The performance of the computer vision model was evaluated on the holdout test set. Accuracy and multiclass receiver operating characteristic area under curve was used to evaluate the performance of the model. RESULTS The artificial intelligence model achieved an accuracy of 87.8% on the holdout test set and a quadratic Cohen's kappa score of 0.811. The multiclass receiver operating characteristic area under curve score for TKA was calculated to be 0.97; for UKA a score of 0.96 and for No Surgery a score of 0.98 was achieved. An accuracy of 93.8% was achieved for predicting Surgery versus No Surgery and 88% for TKA versus not TKA was achieved. CONCLUSION The artificial intelligence/machine learning model demonstrated viability for predicting which patients are candidates for a UKA, TKA, or no surgical intervention.
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Affiliation(s)
- David J Houserman
- Department of Orthopedic Surgery, Kettering Health Network-Grandview Medical Center, Dayton, OH
| | - Keith R Berend
- Joint Implant Surgeons, Inc, New Albany, OH; Mount Carmel Health System, New Albany, OH
| | - Adolph V Lombardi
- Joint Implant Surgeons, Inc, New Albany, OH; Mount Carmel Health System, New Albany, OH
| | - Chanel E Fischetti
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | | | | | - David A Crawford
- Joint Implant Surgeons, Inc, New Albany, OH; Mount Carmel Health System, New Albany, OH
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Liang S, Zeng H, Yu M, Liu Y, Wang W. The Impact of Arthroscopy on Surgical Decision-Making and Outcomes in Osteoarthritis Patients Undergoing Unicompartmental Knee Arthroplasty. Cureus 2023; 15:e46684. [PMID: 37942366 PMCID: PMC10629421 DOI: 10.7759/cureus.46684] [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] [Subscribe] [Scholar Register] [Accepted: 10/06/2023] [Indexed: 11/10/2023] Open
Abstract
Background and objective Although unicompartmental knee arthroplasty (UKA) is a minimally invasive procedure, its application is limited due to strict criteria related to indications. In clinical practice, the aid of procedures such as arthroscopy is occasionally required to determine the surgical indication and thereby improve prognosis. In light of this, this study aimed to evaluate the impact of intraoperative arthroscopy on surgical decision-making in osteoarthritis (OA) patients and the prognosis of patients undergoing UKA. Methodology The clinical records of patients diagnosed with knee OA who underwent knee arthroplasty between January 2017 and January 2020 were retrospectively analyzed. The inclusion criteria were as follows: patients with radiographic evidence of single-compartmental Kellgren-Lawrence (KL) grade 3 or 4 knee OA but presenting symptoms of persistent multicompartmental knee pain or locking for at least six months, with a history of anterior cruciate ligament (ACL) injury or meniscus tear. They had undergone either UKA or total knee arthroplasty (TKA). Data on clinical characteristics and outcomes at baseline and during follow-up were collected. Results A total of 429 patients were included in the study. Patients who underwent arthroscopy were more likely to undergo UKA surgery than those who did not (p<0.05). Among patients who underwent UKA, no instances of blood transfusion during hospitalization or postoperative complications were reported, regardless of whether arthroscopy was performed or not. Although the overall Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores and Knee Society Functional Score (KSFS) did not differ between the two groups, the Knee Society Score (KSS) was significantly higher in patients who underwent arthroscopy (88.77 ±5.09) compared to those who did not (85.53 ±5.11). Similarly, the arthroscopy group had a higher overall Forgotten Joint Score (FJS) (44.6 ±4.20) than the UKA-only group (42.05 ±3.58). Conclusion Arthroscopy findings can assist in surgical decision-making for OA patients. Performing arthroscopy and UKA simultaneously is relatively safe and may be associated with favorable outcomes.
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Affiliation(s)
- Shaohua Liang
- Orthopedics and Sports Medicine, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, CHN
| | - Haiquan Zeng
- Orthopedics and Sports Medicine, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, CHN
| | - Ming Yu
- Orthopedics, Guizhou Medical University, Guiyang, CHN
| | - Yang Liu
- Orthopedics, Suining Central Hospital, Suining, CHN
| | - Wen Wang
- Orthopedics and Sports Medicine, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, CHN
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Hou Z, Lyu X, Zhang J. [Effect of Pin Holes Location of Unicompartmental Knee Arthroplasty on Postoperative Tibial Plateau Mechanical Properties]. Zhongguo Yi Liao Qi Xie Za Zhi 2023; 47:502-506. [PMID: 37753887 DOI: 10.3969/j.issn.1671-7104.2023.05.007] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
OBJECTIVE The purpose of this study is to explore the biomechanical characteristics of the tibia after unicompartmental knee arthroplasty with different distributions of two-pin holes, and to optimize the two-pin holes scheme to reduce the risk of tibial fractures after unicompartmental knee arthroplasty. METHODS Lower limbs model is segmented and reconstructed from computed tomography images. Four combinations of two pin holes created for tibial cutting guide placement are simulated with finite element analysis. RESULTS In the third mode, the positioning hole at the proximal medial edge of the tibial plateau has the highest stress value, and the position of the positioning hole near the medial edge of the proximal tibial plateau appears stress concentration. CONCLUSIONS The present study revealed that placing tibial cutting guide holding pins centrally would lower the risks of periprosthetic fracture of the medial tibial plateau.
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Affiliation(s)
- Zengtao Hou
- Qingdao Traditional Chinese Medicine Hospital(Qingdao Hiser Hospital), Qingdao Hiser Hospital Affiliated of Qingdao University, Qingdao, 266033
| | - Xiao Lyu
- Qingdao Municipal Hospital, Qingdao, 266071
| | - Jinfeng Zhang
- Qingdao Traditional Chinese Medicine Hospital(Qingdao Hiser Hospital), Qingdao Hiser Hospital Affiliated of Qingdao University, Qingdao, 266033
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Zhuang Z, Huang C, Chen X, Wei Q, Guo J, Xu Z, Wu R, Wu Z, Xu F. Prevalence of osteoporosis in patients awaiting unicompartmental knee arthroplasty: a cross-sectional study. Front Endocrinol (Lausanne) 2023; 14:1224890. [PMID: 37766681 PMCID: PMC10520455 DOI: 10.3389/fendo.2023.1224890] [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: 05/26/2023] [Accepted: 08/28/2023] [Indexed: 09/29/2023] Open
Abstract
Objectives Osteoporosis may contribute to failure of unicompartmental knee arthroplasty (UKA), yet the prevalence of osteoporosis in the population awaiting UKA has not been adequately studied. The objectives of this study were to report the prevalence of osteoporosis in people awaiting UKA and the rate of anti-osteoporosis treatment, and to explore factors associated with osteoporosis prevalence in people awaiting UKA. Methods Participants awaiting UKA from January 2019 to May 2023 were consecutively enrolled. Participants ' age, gender, BMI, knee K-L score, VAS score, history of previous DXA testing, history of anti-osteoporosis treatment, and possible underlying risk factors were recorded. All participants were given a dual-energy x-ray absorptiometry (DXA) test after the visit. The diagnosis of osteoporosis was made according to the World Health Organization criteria. Compare the prevalence of osteoporosis between people waiting for UKA and the general population. Risk factors associated with osteoporosis were analyzed using multiple linear regression and binary logistic regression models. Results A total of 340 participants were included in the study, 259 in female and 81 in male, with a mean age of 63.53 years (range: 41-84 years), and all participants completed UKA and had DXA prior to UKA. The prevalence of osteoporosis was 40.88% (44.79% in female and 28.40% in male). The prevalence of osteoporosis was higher in female than in male (p<0.001). The prevalence of osteoporosis in the population waiting for UKA was significantly higher than that in the general population (p < 0.001). DXA testing was performed in 12.06% within 1 year prior to the visit. The percentage of those who had received anti-osteoporosis treatment was 20.59% (20.86% in osteoporosis, 22.39% in Osteopenia and 16.42% in normal bone mass). The correlation between age, gender, body mass index, visual analogue scale score and osteoporosis was statistically significant. Conclusion Osteoporosis is common in people waiting for UKA, but screening and treatment rates are low. Female patients of advanced age and low weight combined with significant pain should be considered for osteoporosis screening and appropriate treatment before UKA.
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Affiliation(s)
- Zhikun Zhuang
- Department of Orthopaedic Surgery, Quanzhou Orthopedic-traumatological Hospital, Quanzhou, China
| | - Changyu Huang
- Department of Orthopaedic Surgery, Quanzhou Orthopedic-traumatological Hospital, Quanzhou, China
| | | | - Qiushi Wei
- Traumatology & Orthopedics Institute of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Jinhua Guo
- Department of Orthopaedic Surgery, Quanzhou Orthopedic-traumatological Hospital, Quanzhou, China
| | - Zhiqing Xu
- Department of Orthopaedic Surgery, Quanzhou Orthopedic-traumatological Hospital, Quanzhou, China
| | - Rongkai Wu
- Department of Orthopaedic Surgery, Quanzhou Orthopedic-traumatological Hospital, Quanzhou, China
| | - Zhaoke Wu
- Department of Orthopaedic Surgery, Quanzhou Orthopedic-traumatological Hospital, Quanzhou, China
| | - Fudong Xu
- Department of Orthopaedic Surgery, Quanzhou Orthopedic-traumatological Hospital, Quanzhou, China
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Ma J, Yan Y, Wang B, Wang W, Yue D, Guo W. Clinical Outcomes of Unicompartmental Knee Arthroplasty in Patients with Full-versus Partial-Thickness Cartilage Loss: A Systematic Review and Meta-Analysis. Cartilage 2023; 14:312-320. [PMID: 37265047 PMCID: PMC10601561 DOI: 10.1177/19476035231155633] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 01/19/2023] [Accepted: 01/21/2023] [Indexed: 06/03/2023] Open
Abstract
OBJECTIVE The objective of the study was to compare postoperative patient-reported outcomes and reoperation rates following unicompartmental knee arthroplasty (UKA) between patients with full-thickness cartilage loss (FTCL) and partial-thickness cartilage loss (PTCL). DESIGN Multiple databases, including PubMed, Embase, Cochrane Library, and CNKI, were searched until October 2019 for studies comparing the Oxford Knee Score (OKS), American Knee Society (AKS) score, and reoperation rates between patients with FTCL and PTCL following UKA. Data analysis was performed using Review Manager software. RESULTS A total of 613 UKA cases from 5 retrospective cohort studies were included. The mean difference in postoperative OKSs was significantly higher by 2.92 in FTCL group than in PTCL group (95% confidence interval [CI] = -5.29 to -0.55; P = 0.02). Improvement in OKS was significantly higher by 2.69 in FTCL group than in PTCL group (95% CI = -4.79 to -0.60; P = 0.01). However, the differences in OKSs were not clinically significant. The mean difference in AKS knee scores was similar between the 2 groups (95% CI = -9.14 to -3.34; P = 0.36), whereas the pooled mean difference in AKS function scores was higher by 5.63 in FTCL group than in PTCL group (95% CI = -9.27 to -1.98; P = 0.002), which was clinically relevant. The reoperation rates were statistically higher in PTCL group than in FTCL group (odds ratio = 2.24; 95% CI = 1.15 to 4.38; P = 0.02). CONCLUSIONS Patients with FTCL achieved superior postoperative patient-reported outcomes and lower reoperation rates following UKA compared with those with PTCL. Thus, we believe this procedure should only be applied to end-stage medial osteoarthritis of the knee joint.
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Affiliation(s)
- Jinhui Ma
- Department of Orthopaedic Surgery, Center for Osteonecrosis and Joint Preserving & Reconstruction, China-Japan Friendship Hospital, Beijing, China
| | - Yan Yan
- Department of Orthopaedic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Bailiang Wang
- Department of Orthopaedic Surgery, Center for Osteonecrosis and Joint Preserving & Reconstruction, China-Japan Friendship Hospital, Beijing, China
| | - Weiguo Wang
- Department of Orthopaedic Surgery, Center for Osteonecrosis and Joint Preserving & Reconstruction, China-Japan Friendship Hospital, Beijing, China
| | - Debo Yue
- Department of Orthopaedic Surgery, Center for Osteonecrosis and Joint Preserving & Reconstruction, China-Japan Friendship Hospital, Beijing, China
| | - Wanshou Guo
- Department of Orthopaedic Surgery, Center for Osteonecrosis and Joint Preserving & Reconstruction, China-Japan Friendship Hospital, Beijing, China
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Neubauer M, Reinberger EM, Dammerer D, Moser LB, Neugebauer J, Gottsauner-Wolf F, Nehrer S. Unicompartmental Knee Arthroplasty Provides Superior Clinical and Radiological Outcomes Compared to High Tibial Osteotomy at a Follow-Up of 5-8 Years. J Clin Med 2023; 12:5387. [PMID: 37629429 PMCID: PMC10455152 DOI: 10.3390/jcm12165387] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 08/07/2023] [Accepted: 08/14/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Knee Osteoarthritis (OA) is a debilitating disease. Initially, the medial compartments are affected in most cases. For this pathology, joint preservation is preferable. Two surgical procedures aim to meet this goal: high-tibial osteotomy (HTO) and unicompartmental knee arthroplasty (UKA). The aim was to compare clinical and radiological outcomes of HTO versus UKA in patients with unicompartmental, medial OA. METHOD Retrospective case series. A total of 86 (61 UKA, 25 HTO) patients that received either treatment at a single, specialized center were assessed pre-operatively and at a single follow-up examination at 77.13 months (±8.170). The Knee Society Score (KSS), range of motion (ROM), SF36 questionnaire and the Tegner score were used. The Kellgren-Lawrence score was assessed pre- and post-surgically. Survivorship with the endpoint "revision" was assessed. RESULTS The UKA group showed significantly better improvements in KSS scores for pain (p < 0.006) and function (p < 0.001). OA progression (p < 0.02) and survivorship (p < 0.018) differed, significantly favoring UKA. ROM, SF36 and Tegner score did not differ significantly. CONCLUSIONS The presented mid-to long-term data suggest that UKA provides superior results in selected outcomes. Nevertheless, significant differences in the demographics of treatments indicate the challenge of comparing these two treatments.
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Affiliation(s)
- Markus Neubauer
- Center for Regenerative Medicine and Orthopaedics, University for Continuing Education Krems, Dr. Karl-Dorrek-Str. 30, 3500 Krems, Austria; (M.N.); (D.D.); (L.B.M.)
- Department of Orthopaedics & Traumatology, Karl Landsteiner University of Health Sciences, University Hospital Krems, Mitterweg 10, 3500 Krems, Austria; (E.-M.R.); (J.N.); (F.G.-W.)
| | - Eva-Maria Reinberger
- Department of Orthopaedics & Traumatology, Karl Landsteiner University of Health Sciences, University Hospital Krems, Mitterweg 10, 3500 Krems, Austria; (E.-M.R.); (J.N.); (F.G.-W.)
| | - Dietmar Dammerer
- Center for Regenerative Medicine and Orthopaedics, University for Continuing Education Krems, Dr. Karl-Dorrek-Str. 30, 3500 Krems, Austria; (M.N.); (D.D.); (L.B.M.)
- Department of Orthopaedics & Traumatology, Karl Landsteiner University of Health Sciences, University Hospital Krems, Mitterweg 10, 3500 Krems, Austria; (E.-M.R.); (J.N.); (F.G.-W.)
| | - Lukas B. Moser
- Center for Regenerative Medicine and Orthopaedics, University for Continuing Education Krems, Dr. Karl-Dorrek-Str. 30, 3500 Krems, Austria; (M.N.); (D.D.); (L.B.M.)
- Department of Orthopaedics & Traumatology, Karl Landsteiner University of Health Sciences, University Hospital Krems, Mitterweg 10, 3500 Krems, Austria; (E.-M.R.); (J.N.); (F.G.-W.)
| | - Johannes Neugebauer
- Department of Orthopaedics & Traumatology, Karl Landsteiner University of Health Sciences, University Hospital Krems, Mitterweg 10, 3500 Krems, Austria; (E.-M.R.); (J.N.); (F.G.-W.)
| | - Florian Gottsauner-Wolf
- Department of Orthopaedics & Traumatology, Karl Landsteiner University of Health Sciences, University Hospital Krems, Mitterweg 10, 3500 Krems, Austria; (E.-M.R.); (J.N.); (F.G.-W.)
| | - Stefan Nehrer
- Center for Regenerative Medicine and Orthopaedics, University for Continuing Education Krems, Dr. Karl-Dorrek-Str. 30, 3500 Krems, Austria; (M.N.); (D.D.); (L.B.M.)
- Department of Orthopaedics & Traumatology, Karl Landsteiner University of Health Sciences, University Hospital Krems, Mitterweg 10, 3500 Krems, Austria; (E.-M.R.); (J.N.); (F.G.-W.)
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Xue H, Ma T, Wen T, Yang T, Xue L, Lei X, Ji J, Zhang W, Tu Y. [Short- and mid-term effectiveness of unicompartmental knee arthroplasty for post-traumatic arthritis of knee]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2023; 37:647-652. [PMID: 37331937 DOI: 10.7507/1002-1892.202303051] [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] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
Objective To investigate the short- and mid-term effectiveness of unicompartmental knee arthroplasty (UKA) for post-traumatic arthritis (PTA) of knee. Methods The clinical data of 30 patients with PTA of unilateral knee between March 2014 and September 2021 was retrospectively analyzed. There were 14 males and 16 females with an average of 64.5 years (range, 33-81 years). The average body mass index was 26.7 kg/m 2 (range, 19.8-35.6 kg/m 2). The types of injuries that caused PTA included intra-articular fracture in 16 cases, extra-articular fracture in 8 cases, and soft tissue injury in 6 cases. The initial injuries were treated by conservative therapy in 12 cases and by surgical therapy in 18 cases. Ten cases were medial compartment osteoarthritis and 20 cases were lateral compartment osteoarthritis. According to Kellgren-Lawrence staging, there were 19 cases of grade Ⅲ and 11 cases of grade Ⅳ. The operative time, the length of hospital stay, complications, and subjective satisfaction were recorded. The Oxford Knee Function Score (OKS), Hospital for Special Surgery (HSS) score, and knee range of motion (ROM) were used to evaluate knee function. Weight-bearing X-ray films were taken to measure the femoro-tibial angle (FTA) and to assess alignment correction of the lower limb. Results The operative time ranged from 50 to 95 minutes (mean, 63.7 minutes), the length of hospital stay ranged from 3 to 8 days (mean, 6.9 days). Superficial infection occurred in 2 patients, while the remaining incisions healed by first intention. There was no deep vein thrombosis or neurovascular injury. All patients were followed up 17-109 months (median, 70 months). At last follow-up, OKS score, HSS score, and ROM in 30 cases significantly improved when compared with those before operation (P<0.05). Lower limb alignment was significantly corrected and there was significant difference in FTA of the varus and valgus knees between pre- and post-operation ( P<0.05). The patient satisfaction rate was 86.7% (26/30). Two cases developed contralateral osteoarthritis progression during follow-up. No bearing dislocation, prosthesis loosening or sinking occurred and none required further revision. Conclusion For patients with PTA of knee, UKA can obtain definite short- and mid-term effectiveness with high patient satisfaction.
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Affiliation(s)
- Huaming Xue
- Department of Joint Surgery, Yangpu Hospital Affiliated to Tongji University, Shanghai, 200090, P. R. China
| | - Tong Ma
- Department of Joint Surgery, Yangpu Hospital Affiliated to Tongji University, Shanghai, 200090, P. R. China
| | - Tao Wen
- Department of Joint Surgery, Yangpu Hospital Affiliated to Tongji University, Shanghai, 200090, P. R. China
| | - Tao Yang
- Department of Joint Surgery, Yangpu Hospital Affiliated to Tongji University, Shanghai, 200090, P. R. China
| | - Long Xue
- Department of Joint Surgery, Yangpu Hospital Affiliated to Tongji University, Shanghai, 200090, P. R. China
| | - Xuefeng Lei
- Department of Joint Surgery, Yangpu Hospital Affiliated to Tongji University, Shanghai, 200090, P. R. China
| | - Jiazhong Ji
- Department of Joint Surgery, Yangpu Hospital Affiliated to Tongji University, Shanghai, 200090, P. R. China
| | - Wenzheng Zhang
- Department of Joint Surgery, Yangpu Hospital Affiliated to Tongji University, Shanghai, 200090, P. R. China
| | - Yihui Tu
- Department of Joint Surgery, Yangpu Hospital Affiliated to Tongji University, Shanghai, 200090, P. R. China
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Ng MK, Gordon AM, Lam A, Piuzzi N, Erez O, Scuderi G, Mont MA. Surgical Trends for Managing Knee Osteonecrosis: A 2010 to 2020 United States Nationwide Study. J Arthroplasty 2023; 38:S125-S130. [PMID: 36738865 DOI: 10.1016/j.arth.2023.01.038] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 01/02/2023] [Accepted: 01/24/2023] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Knee osteonecrosis (ON) is rare, with an estimated incidence of 0.01-0.17 per 1,000 person years. Our study aimed to do the following: 1) quantify total operative procedures with rates normalized to the United States population; 2) compare arthroplasty versus joint-preserving procedural trends; and 3) determine rates of specific operative techniques/demographics in patients aged <50 versus >50 years. METHODS Using a nationwide database, 8,269 patients diagnosed with knee ON underwent surgical treatment from 2010 to 2020. Documented surgical procedures included total knee arthroplasty (TKA), unicompartmental knee arthroplasty (UKA), and core decompression. Primary outcomes included procedural utilization with subanalyses comparing arthroplasty versus joint-preserving procedures, and age-stratified by under/over 50 years. Linear regressions were evaluated for trends in procedural volumes over time. RESULTS From 2010 to 2014, 0.54% of all knee procedures were to treat ON compared to 0.71% from 2015 to 2020 (P < .001). Overall rates of TKA (85.4%) and UKA (10.3%) far exceeded rates of joint preserving procedures (4.3%). Comparing 2010-2014 with 2015-2019, joint-preserving procedures proportionally increased (0.7 to 5.0%, P < .001). Patients <50 years had significantly more joint-preserving procedures (19.5 versus 2.7%). Overall, TKA was the most common procedure (7,062; 85.40%), following by UKA 853; 10.32%) and core decompression (354; 4.28%). CONCLUSION To our knowledge, this is the first study to characterize surgical trends in management of knee ON. Overall surgical volume for knee ON has continued to increase, outpacing population growth. Patients who have knee ON are most commonly managed with arthroplasty procedures, specifically TKA. Younger aged patients (<50 years) are more likely to undergo joint-preserving procedures, namely core decompression.
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Affiliation(s)
- Mitchell K Ng
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
| | - Adam M Gordon
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
| | - Aaron Lam
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
| | - Nicolas Piuzzi
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Orry Erez
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
| | - Giles Scuderi
- Northwell Health Orthopaedics, Lenox Hill Hospital, New York, New York
| | - Michael A Mont
- Northwell Health Orthopaedics, Lenox Hill Hospital, New York, New York; Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
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Plancher KD, Voigt C, Bernstein DN, Briggs KK, Petterson SC. Return to Sport in Middle-aged and Older Athletes After Unicompartmental Knee Arthroplasty at a Mean 10-Year Follow-up: Radiographic and Clinical Outcomes. Am J Sports Med 2023:3635465231163859. [PMID: 37092711 DOI: 10.1177/03635465231163859] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
BACKGROUND Return to sport is essential information when an athlete contemplates surgical intervention. Young athletes, <30 years of age, may undergo complex cartilage procedures or femoral/tibial osteotomies to successfully treat single-compartment knee osteoarthritis. Unicompartmental knee arthroplasty (UKA) may offer an attractive alternative option to middle-aged/older athletes with timely return to the same sport without a lengthy rehabilitation. PURPOSE The purpose of this study was to determine if athletes are able to return to the same level of vigorous and moderate sports after fixed-bearing intramedullary nonrobotic UKA and the specific sports activities that these athletes continued to participate in at a minimum of 5 years. We hypothesized that UKA in the appropriately selected middle-aged/older athlete would yield high return to sport after UKA with high patient satisfaction. We also hypothesized that UKA would allow athletes to return to their sports of choice. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS We identified 245 patients who underwent a UKA by a single surgeon between 2003 and 2017. Athletes were included if they participated in vigorous or moderate sports, as defined by the American College of Sports Medicine, and had minimum 5-year follow-up. The primary outcome was return to vigorous or moderate sports after UKA. Secondary outcomes included the Knee injury and Osteoarthritis Outcome Score (KOOS) Activities of Daily Living score, KOOS Sport and Recreation score, Lysholm score, Patient Acceptable Symptom State (PASS) analysis, and radiographic analysis. RESULTS An overall 169 athletes met the inclusion criteria and were evaluated for return to sports. A total of 98% (165/169) returned to vigorous or moderate sports participation. The mean ± SD time to return to sport was 5.2 ± 2.3 months in the 39- to 50-year-old cohort, 5.8 ± 3.2 months in athletes aged 51 to 64 years, and 5.2 ± 3.0 months in athletes aged ≥65 years. A total of 143 athletes had minimum 5-year clinical and radiographic follow-up (mean, 10 years; range, 5-19 years). Maintenance of vigorous and moderate sport was seen in 99% (142/143) of athletes at a mean 10 years. In athletes who participated in vigorous sports, the mean Lysholm score was 85 ± 17, and 83% reached the PASS for KOOS Sport and Recreation. Radiographic analysis revealed no evidence of implant loosening (ie, subsidence, radiolucency) or osteolysis, and limb alignment and posterior slope of the implant were within normal limits. CONCLUSION Athletes returned to sport at a mean 5 months after UKA implantation, with 98% (165/169) participating in vigorous or moderate sports. UKA is recommended as an alternative procedure in middle-aged and older athletes with single-compartment osteoarthritis who are contemplating a return to vigorous or moderate sport.
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Affiliation(s)
- Kevin D Plancher
- Department of Orthopaedic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Orthopaedic Surgery, Weill Cornell Medical College, New York, New York, USA
- Plancher Orthopaedics and Sports Medicine, New York, New York, USA
- Orthopaedic Foundation, Stamford, Connecticut, USA
| | - Clifford Voigt
- Plancher Orthopaedics and Sports Medicine, New York, New York, USA
- Orthopaedic Foundation, Stamford, Connecticut, USA
| | - David N Bernstein
- Harvard Combined Orthopaedic Residency Program, Boston, Massachusetts, USA
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Weber P, Beck M, Klug M, Klug A, Klug A, Glowalla C, Gollwitzer H. Survival of Patient-Specific Unicondylar Knee Replacement. J Pers Med 2023; 13:jpm13040665. [PMID: 37109051 PMCID: PMC10144963 DOI: 10.3390/jpm13040665] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/26/2023] [Accepted: 04/02/2023] [Indexed: 04/29/2023] Open
Abstract
Unicompartmental knee arthroplasty (UKA) in isolated medial or lateral osteoarthritis leads to good clinical results. However, revision rates are higher in comparison to total knee arthroplasty (TKA). One reason is suboptimal fitting of conventional off-the-shelf prostheses, and major overhang of the tibial component over the bone has been reported in up to 20% of cases. In this retrospective study, a total of 537 patient-specific UKAs (507 medial prostheses and 30 lateral prostheses) that had been implanted in 3 centers over a period of 10 years were analyzed for survival, with a minimal follow-up of 1 year (range 12 to 129 months). Furthermore, fitting of the UKAs was analyzed on postoperative X-rays, and tibial overhang was quantified. A total of 512 prostheses were available for follow-up (95.3%). Overall survival rate (medial and lateral) of the prostheses after 5 years was 96%. The 30 lateral UKAs showed a survival rate of 100% at 5 years. The tibial overhang of the prosthesis was smaller than 1 mm in 99% of cases. In comparison to the reported results in the literature, our data suggest that the patient-specific implant design used in this study is associated with an excellent midterm survival rate, particularly in the lateral knee compartment, and confirms excellent fitting.
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Affiliation(s)
- Patrick Weber
- ECOM, Arabellastraße 17, 81925 München, Germany
- ATOS Klinik München, Effnerstraße 38, 81925 München, Germany
- Dr. Lubos Kliniken München-Bogenhausen, Denninger Straße 44, 81925 München, Germany
| | - Melina Beck
- ECOM, Arabellastraße 17, 81925 München, Germany
| | - Michael Klug
- Knee Centre, Schweinfurter Straße 7, 97080 Würzburg, Germany
- Praxisklinik Werneck, Balthasar-Neumann-Platz 11-15, 97440 Werneck, Germany
| | - Andreas Klug
- Knee Centre, Schweinfurter Straße 7, 97080 Würzburg, Germany
- König Ludwig Haus, Brettreichstraße 11, 97074 Würzburg, Germany
| | - Alexander Klug
- Knee Centre, Schweinfurter Straße 7, 97080 Würzburg, Germany
- BG Unfallklinik, Friedberger Landstraße 430, 60389 Frankfurt, Germany
| | - Claudio Glowalla
- Klinik und Poliklinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675 München, Germany
| | - Hans Gollwitzer
- ECOM, Arabellastraße 17, 81925 München, Germany
- ATOS Klinik München, Effnerstraße 38, 81925 München, Germany
- Dr. Lubos Kliniken München-Bogenhausen, Denninger Straße 44, 81925 München, Germany
- Klinik und Poliklinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675 München, Germany
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Wang Z, Ni J, Mao Z, Yu M, Li H, Chen G, Wang Y, Yao Q. Survival of lateral unicompartmental knee arthroplasty at short-, mid-, and long-term follow-up: a systematic review and meta-analysis. ANZ J Surg 2023; 93:980-988. [PMID: 36757833 DOI: 10.1111/ans.18244] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 11/20/2022] [Accepted: 12/21/2022] [Indexed: 02/10/2023]
Abstract
BACKGROUND The infrequency of lateral unicompartmental knee arthroplasty (UKA) has led to a lack of understanding of its survival. This study aimed to systematically evaluate the survivorship results of lateral UKA at different follow-ups based on available literature. METHODS Five databases were searched for eligible studies. Pooled survivorships with 95% confidence intervals (CIs) at 3, 5, 10, 15, and 20 years after lateral UKA were estimated using a random-effect model. Subgroup and sensitivity analyses were performed. RESULTS A total of 26 studies involving 5470 lateral UKAs were included. Survivorships of lateral UKA at 3-, 5-, 10-, 15-, and 20-year follow-ups were 96% (95% CI: 95-98%, I2 : 77.5%), 94% (95% CI: 93-96%, I2 : 70.8%), 88% (95% CI: 84-91%, I2 : 70.8%), 85% (95% CI: 79-91%, I2 : 70.8%), and 78% (95% CI: 71-85%, I2 : 54.2%), respectively. Subgroup analyses found that bearing type, the number of surgeons, and year of publication might be associated with implant survival outcomes. CONCLUSION Lateral UKA is an effective procedure with excellent survivorships at short-, mid-, and long-term follow-ups. Results suggest a single-surgeon lateral UKA using fixed-bearing. Additional well-designed studies are needed to elucidate the current findings.
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Affiliation(s)
- Zhenwei Wang
- Department of Orthopedics, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Jie Ni
- Department of Orthopedics, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Zimu Mao
- Department of Orthopedics, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Meng Yu
- Department of Orthopedics, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Hongchuan Li
- Department of Orthopedics, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Guoqiang Chen
- Department of Orthopedics, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Yang Wang
- Department of Orthopedics, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Qi Yao
- Department of Orthopedics, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
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Tay ML, Monk AP, Frampton CM, Hooper GJ, Young SW. The Strongest Oxford Knee Score Predictors of Subsequent Revision are 'Overall Pain,' 'Limping when Walking,' and 'Knee Giving Way'. J Arthroplasty 2023:S0883-5403(23)00218-8. [PMID: 36898485 DOI: 10.1016/j.arth.2023.03.001] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 02/27/2023] [Accepted: 03/01/2023] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND The Oxford Knee Score (OKS) is used to measure knee arthroplasty outcomes, however, it is unclear which questions are more relevant. Our aims were to: 1) identify which OKS question(s) were the strongest predictors of subsequent revision and 2) compare predictive ability of the 'pain' and 'function' domains. PATIENTS AND METHODS All primary total (TKAs) and unicompartmental knee arthroplasties (UKAs) in the New Zealand Joint Registry between 1999 and 2019 with an OKS at six months (TKA n=27,708, UKA n=8,415), five years (TKA n=11,519, UKA n=3,365) or ten years (TKA n=6,311, UKA n=1,744) were included. Prediction models were assessed using logistic regressions and receiver operating characteristic analyses. RESULTS A reduced model with three questions ('overall pain,' 'limping when walking,' 'knee giving way') showed better diagnostic ability than full OKS for predicting UKA revision at six months (area under the curve (AUC): 0.80 vs. 0.78; P<0.01) and five years (0.81 vs. 0.77; P=0.02), and comparable diagnostic ability for predicting TKA revision at all timepoints (6 months, 0.77 vs. 0.76; 5 years, 0.78 vs. 0.75; 10 years, 0.76 vs. 0.73; all not significant (NS)), and UKA revision at 10 years (0.80 vs. 0.77; NS). The pain domain had better diagnostic ability for predicting subsequent revision for both procedures at five and ten years. CONCLUSION Questions on 'overall pain', 'limping when walking', and 'knee 'giving way' were the strongest predictors of subsequent revision. Attention to low scores from these questions during follow-up may allow for prompt identification of patients most at risk of revision.
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Affiliation(s)
- Mei Lin Tay
- Department of Surgery, Faculty of Medical and Health Sciences (FMHS), University of Auckland, Private bag 92019, Auckland 1023, New Zealand; Department of Orthopaedic Surgery, North Shore Hospital, Private Bag 93-503, Auckland 0620, New Zealand.
| | - A Paul Monk
- Department of Orthopaedic Surgery, Auckland City Hospital, Private Bag 92-024, Auckland, New Zealand; Auckland Bioengineering Institute, University of Auckland, Private Bag 93-503, Auckland 0620, New Zealand
| | - Chris M Frampton
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, PO Box 4545, Christchurch 8140, New Zealand
| | - Gary J Hooper
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, PO Box 4545, Christchurch 8140, New Zealand
| | - Simon W Young
- Department of Surgery, Faculty of Medical and Health Sciences (FMHS), University of Auckland, Private bag 92019, Auckland 1023, New Zealand; Department of Orthopaedic Surgery, North Shore Hospital, Private Bag 93-503, Auckland 0620, New Zealand
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Du G, Qiu H, Zhu J, Wang H, Xiao Q, Zhang Z, Lin X, Zheng G. No Difference Unicompartmental Knee Arthroplasty for Medial Knee Osteoarthritis With or Without Anterior Cruciate Ligament Deficiency: A Systematic Review and Meta-analysis. J Arthroplasty 2023; 38:586-593.e1. [PMID: 36265719 DOI: 10.1016/j.arth.2022.10.018] [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: 07/14/2022] [Revised: 10/10/2022] [Accepted: 10/11/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND A functional intact anterior cruciate ligament (ACLI) is considered to be a prerequisite for unicompartmental knee arthroplasty (UKA). However, UKA has been shown to have good clinical efficacy in ACL-deficient (ACLD) knees at 3 to 10 years follow-up. Therefore, the role of ACLD in UKA remains controversial, and more evidence is needed to clarify the role of ACLD in UKA. METHODS PubMed, the Web of Science, EMBASE, and Cochrane Central were queried for articles comparing the results of the ACLD and ACLI groups after UKA. Outcomes of interest included the Tegner Activity Scale, the Oxford Knee Score (OKS), postoperative slope of the implant (PSI), the Knee Injury and Osteoarthritis Outcomes Score (KOOS), the Lysholm score, and revision rate. There were eight studies included. The mean age was 66 years (range 49 to 87 year old) and the mean follow-up time was 6.9 years (range 1.3 to 16.6 years). There was baseline comparability regarding mean age, duration of follow-up, and body mass index (P > .5) between the ACLD and ACLI groups. RESULTS The ACLD and ACLI groups had improved postoperative functional indicators, and that postoperative revision rate (mean difference [MD], 1.24; 95% confidence interval [CI], 0.75 to 2.04; P = .4), Tegner score (MD, -0.1; 95% CI, -0.26 to 0.05; P = .19), and Lysholm score (95% CI, -2.46 to 7.32; P = .33) were similar between the groups, with no significant differences; however, the ACLD groups had significantly better KOOS Activities of Daily Living scores, with a significant difference (MD, 4.53; 95% CI, 1.75 to 7.3; P = .001). Also, there were no significant differences between two groups in the PSI, OKS, KOOS. CONCLUSION ACL deficiency is not always a contraindication for UKA. With correct patient selection, UKA could be considered for medial knee osteoarthritis with ACL deficiency without antero-posterior instability, especially these people over 60 years of age.
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Yang HY, Kwak WK, Song EK, Seon JK. Preoperative Bone Marrow Edema Negatively Impacts 10-Year Outcomes After Unicompartmental Knee Arthroplasty. J Arthroplasty 2023; 38:456-463. [PMID: 36265722 DOI: 10.1016/j.arth.2022.10.010] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 10/03/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The purpose of this study was to investigate the association between the extent of subchondral bone marrow edema (BME), as classified by magnetic resonance imaging, and intermediate to long-term outcomes after unicompartmental knee arthroplasty (UKA) for medial compartment osteoarthritis. METHODS We enrolled 150 knees (144 patients) that underwent fixed-bearing UKA between April 2003 and December 2014 with a minimum follow-up of 5 years; the mean overall follow-up duration was 10 years (range, 5-18 years). We divided the patients into 2 groups based on the presence or absence of preoperative BME. Patients were also subdivided into 4 groups according to their BME scores determined by the magnetic resonance imaging Osteoarthritis Knee Score method. Clinical outcomes were assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Forgotten Joint Score. Furthermore, survival rates and relevant risk factors that affect joint survivorship were analyzed. RESULTS The groups with BME demonstrated significantly worse postoperative WOMAC pain and Forgotten Joint Scores at the final follow-up than the group without BME (all P < .05). We also found significant differences among the scores of groups with different BME grades (all P < .05). Post hoc analysis demonstrated differences between groups 1 and 2, 1 and 3, 1 and 4, and 2 and 4 (all P < .05) with a significant correlation between postoperative clinical outcomes and the extent of BME (r = 0.430 [WOMAC pain], r = -0.342 [Forgotten Joint Score]; P < .05). The survival rate was 95.4% for a mean period of 10 years for the UKAs, and the UKA survival was not associated with the presence of BME (P = .232; log-rank test). CONCLUSION At a mean of 10 years, preoperative BME negatively impacted the clinical outcomes, especially pain, after UKA. However, UKA contributed to excellent survival rates for the same duration of follow-up, regardless of BME severity. Although this study does not provide any evidence that preoperative BME should be identified as a contraindication, evaluation of BME can provide crucial information about the expected outcomes.
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Affiliation(s)
- Hong-Yeol Yang
- Department of Orthopaedic Surgery, Chonnam National University Medical School and Hospital, Hwasun, Republic of Korea
| | - Woo-Kyoung Kwak
- Department of Orthopaedic Surgery, Chonnam National University Medical School and Hospital, Hwasun, Republic of Korea
| | - Eun-Kyoo Song
- Department of Orthopaedic Surgery, Chonnam National University Medical School and Hospital, Hwasun, Republic of Korea
| | - Jong-Keun Seon
- Department of Orthopaedic Surgery, Chonnam National University Medical School and Hospital, Hwasun, Republic of Korea
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Paisner ND, Upfill-Brown AM, Donnelly PC, De A, Sassoon AA. Racial Disparities in Rates of Revision and use of Modern Features in Total Knee Arthroplasty, a National Registry Study. J Arthroplasty 2023; 38:464-469.e3. [PMID: 36162710 DOI: 10.1016/j.arth.2022.09.023] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 09/12/2022] [Accepted: 09/18/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The purpose of our study was to investigate the association of race and ethnicity with rates of modern implant use and postoperative outcomes in total knee arthroplasty (TKA) using the American Academy of Orthopaedic Surgeons American Joint Replacement Registry. METHODS Adult TKAs from 2012 to 2020 were queried from the American Joint Replacement Registry. A total of 1,121,457 patients were available for analysis for surgical features and 1,068,210 patients for analysis of outcomes. Mixed-effects multivariable logistic regression models were used to examine the association of race with each individual surgical feature (unicompartmental knee arthroplasty (UKA) and robotic-assisted TKA (RA-TKA)) and 30- and 90-day readmission. A proportional subdistribution hazard model was used to model the risk of revision TKA. RESULTS On multivariate analyses, compared to White patients, Black (odds ratio (OR): 0.52 P < .0001), Hispanic (OR 0.75 P < .001), and Native American (OR: 0.69 P = .0011) patients had lower rates of UKA, while only Black patients had lower rates of RA-TKA (OR = 0.76 P < .001). White (hazard ratio (HR) = 0.8, P < .001), Asian (HR = 0.51, P < .001), and Hispanic-White (HR = 0.73, P = .001) patients had a lower risk of revision TKA than Black patients. Asian patients had a lower revision risk than White (HR = 0.64, P < .001) and Hispanic-White (HR = 0.69, P = .011) patients. No significant differences existed between groups for 30- or 90-day readmissions. CONCLUSION Black, Hispanic, and Native American patients had lower rates of UKA compared to White patients, while Black patients had lower rates of RA-TKA compared to White, Asian, and Hispanic patients. Black patients also had higher rates of revision TKA than other races.
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Affiliation(s)
- Noah D Paisner
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California; Pacific Northwest University School of Health Sciences, Yakima, Washington
| | - Alexander M Upfill-Brown
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Patrick C Donnelly
- American Joint Replacement Registry, American Academy of Orthopaedic Surgery, Rosemont, Illinois
| | - Ayushmita De
- American Joint Replacement Registry, American Academy of Orthopaedic Surgery, Rosemont, Illinois
| | - Adam A Sassoon
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California
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Zheng N, Dai H, Zou D, Dimitriou D, Wang Q, Tsai TY. Altered In Vivo Knee Kinematics and Lateral Compartment Contact Position During the Single-Leg Lunge After Medial Unicompartmental Knee Arthroplasty. Orthop J Sports Med 2023; 11:23259671221150958. [PMID: 36846813 PMCID: PMC9947695 DOI: 10.1177/23259671221150958] [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: 02/25/2023] Open
Abstract
Background Osteoarthritis (OA) progression in the lateral compartment is the most common reason for revision after medial unicompartmental knee arthroplasty (UKA). Altered contact kinematics in the lateral compartment may be related to the pathogenesis of OA. Purpose To quantify the in vivo 6 degrees of freedom (6-DOF) knee kinematics and contact points in the lateral compartment during a single-leg lunge in knees after medial UKA and compare them with the contralateral native knee. Study Design Descriptive laboratory study. Methods Included were 13 patients (3 male, 10 female; mean age, 64.7 ± 6.2 years) who had undergone unilateral medial UKA. All patients underwent computed tomography preoperatively and 6 months postoperatively, and bilateral knee posture was tracked using dual fluoroscopic imaging system during a single-leg deep lunge to evaluate the in vivo 6-DOF kinematics. The closest points between the surface models of the femoral condyle and the tibial plateau were determined to locate the lateral compartment contact positions. The Wilcoxon signed-rank test was used to compare knee kinematics and lateral contact position between the UKA and native knees. Spearman correlation was used to test the associations of bilateral 6-DOF range difference and lateral compartment contact excursion difference with bilateral limb alignment difference and functional scores. Results Compared with native knees, UKA knees had an increased anterior femoral translation of 2.0 ± 0.3 mm during the entire lunge (P < .05). The lateral contact position in UKA knees was located 2.0 ± 0.9 mm posteriorly and with 3.3 ± 4.0 mm less range of contact excursion than native knees (P < .05). Decreased range of lateral compartment contact excursion in the anterior-posterior direction was significantly associated with increased hip-knee-ankle angle in the UKA side (P < .05). Conclusion The current study revealed altered knee 6-DOF kinematics and the reduced contact excursion range during single-leg lunge after unilateral medial UKA. Clinical Relevance The altered contact kinematics and reduced range of contact excursion in UKA knees could lead to excessive cumulative articular surface contact stress, which is implicated in the pathogenesis of OA.
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Affiliation(s)
- Nan Zheng
- School of Biomedical Engineering and Med-X Research Institute,
Shanghai Jiao Tong University, Shanghai, China.,Engineering Research Center of Digital Medicine and Clinical
Translation, Ministry of Education, Shanghai, China.,Shanghai Key Laboratory of Orthopaedic Implants and Clinical
Translation R&D Center of 3D Printing Technology, Department of Orthopaedic
Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of
Medicine, Shanghai, China
| | - Huiyong Dai
- Department of Orthopedics, Shanghai Sixth People’s Hospital
Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai,
China
| | - Diyang Zou
- School of Biomedical Engineering and Med-X Research Institute,
Shanghai Jiao Tong University, Shanghai, China.,Engineering Research Center of Digital Medicine and Clinical
Translation, Ministry of Education, Shanghai, China.,Shanghai Key Laboratory of Orthopaedic Implants and Clinical
Translation R&D Center of 3D Printing Technology, Department of Orthopaedic
Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of
Medicine, Shanghai, China
| | - Dimitris Dimitriou
- Department of Orthopedics, Balgrist University Hospital, Zürich,
Switzerland
| | - Qi Wang
- Department of Orthopedics, Shanghai Sixth People’s Hospital
Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai,
China
| | - Tsung-Yuan Tsai
- School of Biomedical Engineering and Med-X Research Institute,
Shanghai Jiao Tong University, Shanghai, China.,Engineering Research Center of Digital Medicine and Clinical
Translation, Ministry of Education, Shanghai, China.,Shanghai Key Laboratory of Orthopaedic Implants and Clinical
Translation R&D Center of 3D Printing Technology, Department of Orthopaedic
Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of
Medicine, Shanghai, China.,Tsung-Yuan Tsai, PhD, School of Biomedical Engineering and Med-X
Research Institute, Shanghai Jiao Tong University; Engineering Research Center
of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai
200030, China ()
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Li J, Zhao F, Gao J, Dong W, Yu X, Zhu C, Liu S, Jiang X, Liu G. Enhanced recovery after surgery (ERAS) protocol in geriatric patients underwent unicompartmental knee arthroplasty: A retrospective cohort study. Medicine (Baltimore) 2023; 102:e32941. [PMID: 36820541 PMCID: PMC9907920 DOI: 10.1097/md.0000000000032941] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
The enhanced recovery after surgery (ERAS) pathway was formulated with the aim to reduce surgical stress response, alleviate pain and guarantee the best-fit experience of patients' perioperative period. However, the application of ERAS in geriatric patients who underwent unicompartmental knee arthroplasty (UKA) was relatively lacking. We hypothesize that UKA patients can benefit from the ERAS protocol. A total of 238 patients were recruited in this retrospective study from August 2018 to December 2021, and Oxford phase III UKA was applied to all patients. ERAS pathway included nutrition support, anesthesia mode, interoperative temperature, and blood pressure control, application of tranexamic acid, early initiation of oral intake and mobilization, and pain management. Demographic data, operation-relative variables, and postoperative complications were analyzed. Forgotten Joint Scores, Oxford Knee Score, Lysholm score, numerical rating scale, and knee range of motion were introduced to estimate the activity function and pain of surgical knee, and these variables were compared between the 2 groups. There were 117 patients in the ERAS group and 121 patients in the traditional group, respectively. The ERAS group had a shorter length of surgical incision and less intraoperative blood loss. Postoperative hemoglobin and albumin of patients in the ERAS group were better than those in the traditional group (P < .05), after 17.0 ± 10.8 months follow-up, the numerical rating scale, Lysholm, Oxford Knee Score, Forgotten Joint Scores, and knee range of motion of patients in the ERAS group were significantly better than the traditional group. The length of hospital stay for patients who underwent ERAS was 11.7 ± 3.8 days and the postoperative complication rate was lower for the ERAS group patients (P = .000 and 0.031). ERAS can reduce the length of hospital stay, and patients can achieve excellent postoperative knee function. The formulation and implementation of the ERAS protocol require good collaboration across multiple disciplines, as well as a deep understanding of the existing clinical evidence and the concept of the ERAS program.
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Affiliation(s)
- Jia Li
- Department of Orthopedic Surgery, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, PR China
| | - Feng Zhao
- Department of Orthopedic Surgery, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, PR China
| | - Jianbao Gao
- Department of Orthopedic Surgery, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, PR China
| | - Wei Dong
- Department of Orthopedic Surgery, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, PR China
| | - Xiaoguang Yu
- Department of Orthopedic Surgery, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, PR China
| | - Chaohua Zhu
- Department of Orthopedic Surgery, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, PR China
| | - Sen Liu
- Department of Orthopedic Surgery, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, PR China
| | - Xiangming Jiang
- Lingshui Hospital of First Hospital of Hebei Medical University, Lingshui, Hainan, PR China
| | - Guobin Liu
- Department of Orthopedic Surgery, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, PR China
- * Correspondence: Guobin Liu, Department of Orthopedic Surgery, The First Hospital of Hebei Medical University, NO. 89 Donggang Road, Shijiazhuang 050031, PR China (e-mail: )
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Cozzarelli NF, Longenecker AS, Uhr A, Davis DE, Lonner JH. Unicompartmental Knee Arthroplasty Is Cost-Effective in an Outpatient Setting. Cureus 2023; 15:e35059. [PMID: 36942167 PMCID: PMC10024511 DOI: 10.7759/cureus.35059] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2023] [Indexed: 02/18/2023] Open
Abstract
INTRODUCTION Increasingly, unicompartmental knee arthroplasty (UKA) is being performed on an outpatient basis, with the growing utilization of ambulatory surgery centers (ASCs). The purpose of this study was to compare the costs of UKAs performed in an ASC to UKAs done in a hospital, either on an outpatient or inpatient basis. METHODS This study involved three matched groups, each with 50 consecutive patients, undergoing UKA either on an outpatient basis in an ASC or a community hospital, or who were admitted overnight to the same community hospital. Identical perioperative analgesic regimens and care protocols were used in each group. The primary outcomes evaluated included direct facility costs. Secondary outcomes were postoperative complications and readmissions. RESULTS Average age, gender ratio, and comorbidities were similar in all three cohorts. Only two patients in the study experienced complications and these were without secondary adverse consequences. Mean costs were substantially reduced when UKAs were performed in an ASC ($9,025) compared to a community hospital on either an outpatient ($12,032) or inpatient basis ($14,542). CONCLUSION UKA can be safely performed in the outpatient setting, in appropriately selected patients, at substantial cost savings, particularly when performed in an ASC.
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Affiliation(s)
- Nicholas F Cozzarelli
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, USA
| | - Andrew S Longenecker
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, USA
| | - Alex Uhr
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, USA
| | - Daniel E Davis
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, USA
| | - Jess H Lonner
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, USA
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50
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Mohammad HR, Judge A, Murray DW. The Influence of Surgeon Caseload and Usage on the Long-Term Outcomes of Mobile-Bearing Unicompartmental Knee Arthroplasty: An Analysis of Data From the National Joint Registry for England, Wales, Northern Ireland, and the Isle of Man. J Arthroplasty 2023; 38:245-251. [PMID: 35964854 DOI: 10.1016/j.arth.2022.08.011] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 08/04/2022] [Accepted: 08/07/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Unicompartmental knee arthroplasty (UKA) revision rates are variable and known to be influenced by a surgeon's caseload (number of UKAs performed annually) and usage (UKA as a proportion of overall knee arthroplasty practice). It is not known which is more important. We explored the influence of caseload and usage on cemented and cementless UKA. METHODS A total of 34,277 medial Oxford UKAs (23,707 cemented and 10,570 cementless) from the National Joint Registry were analyzed. UKAs were subdivided by the following: (1) surgeon caseload, into low (<10 UKAs/y) and high (≥10 UKAs/y) categories; and (2) usage, into low (<20%) and high (≥20%) categories. The 10-year revision rates were compared. RESULTS The 10-year survival of the low-caseload/low-usage cemented and cementless UKA was 82.8% (CI 81.6-83.9) and 86.2% (CI 72.1-93.4), respectively. The 10-year survival of the high-caseload/high-usage cemented and cementless UKA was 90.0% (CI 89.2-90.6) and 93.3% (CI 91.3-94.8), respectively. For cemented UKA, the high-caseload/high-usage group had lower revision rates (hazard ratio [HR] 0.57, CI 0.52-0.63, P < .001) compared to the low-caseload/low-usage group. The high-caseload/low-usage (HR 0.74, CI 0.66-0.83, P < .001) and the low-caseload/high-usage (HR 0.86, CI 0.74-0.99, P = .04) groups also had lower revision rates than the low-caseload/low-usage group. CONCLUSION Mobile-bearing UKA revision rates improve with both increasing surgeon UKA caseload and usage. Surgeons using cemented UKA who have usage ≥20% and caseload ≥10/year had a 10-year survival of 90%. Higher survivorship was associated with higher caseload, higher usage, and cementless fixation. LEVELS OF EVIDENCE III.
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Affiliation(s)
- Hasan R Mohammad
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Oxford, United Kingdom; Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Level 1 Learning and Research Building, Southmead Hospital, Westbury-on-Trym, Bristol, United Kingdom; Barts Bone & Joint Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary, University of London, London, United Kingdom
| | - Andrew Judge
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Oxford, United Kingdom; Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Level 1 Learning and Research Building, Southmead Hospital, Westbury-on-Trym, Bristol, United Kingdom
| | - David W Murray
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Oxford, United Kingdom
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