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Calliess T, Christen B, Theus-Steinmann C. [The combination of partial knee arthroplasties in knee osteoarthritis with an intact anterior cruciate ligament - a future model?]. Orthopadie (Heidelb) 2024; 53:255-264. [PMID: 38451274 DOI: 10.1007/s00132-024-04482-x] [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] [Accepted: 02/12/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND Preserving both cruciate ligaments in knee prosthetics enables approximately physiological joint kinematics. In this way, faster rehabilitation and a higher return-to-sports rate can be achieved. Accordingly, there are considerations to preserve both cruciate ligaments by combining two partial prostheses in the case of symptomatic bicompartmental (BiCom) knee osteoarthritis. METHODS This article summarizes the literature on BiCom arthroplasty and describes our own experiences from 54 consecutive cases with robotic-assisted technology. RESULTS According to current data, BiCom arthroplasty shows good clinical results, without being able to demonstrate a clear advantage over conventional TKA. The revision risk is slightly increased in the short-term interval, which could be positively addressed with robotic-assistance. The disadvantages are the increased implant costs and the risk of subsequent osteoarthritis. Accordingly, patients who may potentially take advantage of this treatment must be critically selected.
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Affiliation(s)
- Tilman Calliess
- articon Spezialpraxis für Gelenkchirurgie, Berner Prothetikzentrum, Salem-Spital, Schänzlistrasse 39, 3013, Bern, Schweiz.
| | - Bernhard Christen
- articon Spezialpraxis für Gelenkchirurgie, Berner Prothetikzentrum, Salem-Spital, Schänzlistrasse 39, 3013, Bern, Schweiz
| | - Carlo Theus-Steinmann
- articon Spezialpraxis für Gelenkchirurgie, Berner Prothetikzentrum, Salem-Spital, Schänzlistrasse 39, 3013, Bern, Schweiz
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Yeung MHY, Fu H, Cheung A, Kwan VCW, Cheung MH, Chan PK, Chiu KY, Yan CH. Robotic arm-assisted unicondylar knee arthroplasty resulted in superior radiological accuracy: a propensity score-matched analysis. Arthroplasty 2023; 5:55. [PMID: 37915082 PMCID: PMC10621242 DOI: 10.1186/s42836-023-00210-6] [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: 06/21/2023] [Accepted: 09/01/2023] [Indexed: 11/03/2023] Open
Abstract
INTRODUCTION Unicompartmental knee arthroplasty (UKA) is an effective surgical treatment for medial compartment arthritis of the knee, yet surgical outcomes are directly related to surgical execution. Robotic arm-assisted surgery aims to address these difficulties by allowing for detailed preoperative planning, real-time intraoperative assessment and haptic-controlled bone removal. This study aimed to compare the clinical and radiological outcomes between conventional manual mobile bearing and robot arm-assisted fixed bearing medial UKA in our local population. MATERIALS AND METHODS This is a retrospective case-control study of 148 UKAs performed at an academic institution with a minimum of 1-year follow-up. 74 robotic arm-assisted UKAs were matched to 74 conventional UKAs via propensity score matching. Radiological outcomes included postoperative mechanical axis and individual component alignment. Clinical parameters included a range of motion, Knee Society knee score and functional assessment taken before, 6 and 12 months after the operation. RESULTS Robot arm-assisted UKA produced a more neutral component coronal alignment in both femoral component (robotic -0.2 ± 2.8, manual 2.6 ± 2.3; P = 0.043) and tibial component (robotic -0.3 ± 4.0, manual 1.7 ± 5.3; P < 0.001). While the postoperative mechanical axis was comparable, robot arm-assisted UKA demonstrated a smaller posterior tibial slope (robotic 5.7 ± 2.7, manual 8.2 ± 3.3; P = 0.02). Clinical outcomes did not show any statistically significant differences. CONCLUSION Compared with conventional UKA, robotic arm-assisted UKA demonstrated improved component alignment and comparable clinical outcomes. Improved radiological accuracy with robotic-arm assistance demonstrated promising early results.
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Affiliation(s)
- Matthew H Y Yeung
- Li Ka Shing Faculty of Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Henry Fu
- Department of Orthopaedics and Traumatology, School of Clinical Medicine, The University of Hong Kong, Hong Kong SAR, China.
| | - Amy Cheung
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, Hong Kong SAR, China
| | - Vincent Chan Wai Kwan
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, Hong Kong SAR, China
| | - Man Hong Cheung
- Department of Orthopaedics and Traumatology, School of Clinical Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Ping Keung Chan
- Department of Orthopaedics and Traumatology, School of Clinical Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Kwong Yuen Chiu
- Department of Orthopaedics and Traumatology, School of Clinical Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Chun Hoi Yan
- Department of Orthopaedics and Traumatology, Gleneagles Hospital Hong Kong, Hong Kong SAR, China
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Sava MP, Leica A, Scala I, Beckmann J, Hirschmann MT. Significant correlations between postoperative outcomes and various limb and component alignment strategies in medial unicompartmental knee arthroplasty: a systematic review. J Exp Orthop 2023; 10:93. [PMID: 37718325 PMCID: PMC10505601 DOI: 10.1186/s40634-023-00655-3] [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: 06/25/2023] [Accepted: 09/03/2023] [Indexed: 09/19/2023] Open
Abstract
PURPOSE To investigate the correlation between postoperative limb/component alignments and clinical/functional outcomes following medial unicondylar knee arthroplasty (mUKA). METHODS Inclusion criteria included peer-reviewed English- or German-language publications assessing postoperative limb or implant alignment and clinical outcomes of mUKA. Methodological Index for Non-Randomized Studies (MINORS) was used to assess article quality. RESULTS A total of 2767 knees from 2604 patients were evaluated. Significant correlations were observed between postoperative limb/component alignments and clinical/functional outcomes after mUKA. Inferior outcomes were associated with lower placement and excessive valgus alignment of the tibia component (> 3°). A recommended external rotation of 4°-5° was identified for the tibia component, with specific cut-off values for the femoral and tibia components. CONCLUSIONS Optimal outcomes in mUKA were associated with a varus coronal limb alignment. The tibia implant component performed well within a specific alignment range. An exact external rotation value was recommended for the tibia component, while internal rotation correlated negatively with the femoral component. LEVEL OF EVIDENCE IV (level IV retrospective case series were included).
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Affiliation(s)
- Manuel-Paul Sava
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), CH-4101, Bruderholz, Switzerland
- Department of Clinical Research, Regenerative Medicine & Biomechanics, Research Group Michael T. Hirschmann, University of Basel, CH-4001, Basel, Switzerland
| | - Alexandra Leica
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), CH-4101, Bruderholz, Switzerland
- Department of Clinical Research, Regenerative Medicine & Biomechanics, Research Group Michael T. Hirschmann, University of Basel, CH-4001, Basel, Switzerland
| | - Isabel Scala
- Department of Clinical Research, Regenerative Medicine & Biomechanics, Research Group Michael T. Hirschmann, University of Basel, CH-4001, Basel, Switzerland
- Faculty of Biomedical Sciences, University of Italian Switzerland (USI), CH-6900, Lugano, Switzerland
| | - Johannes Beckmann
- Clinic for Orthopaedics and Traumatology, Krankenhaus Barmherzige Brüder München, 80639, Munich, Germany
| | - Michael T Hirschmann
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), CH-4101, Bruderholz, Switzerland.
- Department of Clinical Research, Regenerative Medicine & Biomechanics, Research Group Michael T. Hirschmann, University of Basel, CH-4001, Basel, Switzerland.
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Kulshrestha V, Sood M, Kumar S, Kharat K, Padhi PP, Kumar P, Shrama S, Stanley A. Early Outcomes of Modified Technique of Mobile Bearing Unicondylar Knee Replacement. Indian J Orthop 2023; 57:1209-1218. [PMID: 37525741 PMCID: PMC10387039 DOI: 10.1007/s43465-023-00907-5] [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: 10/27/2022] [Accepted: 05/08/2023] [Indexed: 08/02/2023]
Abstract
Background Recent years have seen a resurgence in utilization of partial knee replacement. One such device frequently used is Oxford partial knee implant (OPK). Deeper tibial bone cut while performing OPK replacement may risk early failure. Methods We prospectively looked at early outcomes of a modified technique (MT) of OPK replacement adopted by our centre to save tibial bone stock at 24 months of follow up as compared to designer group described technique (DT) as a prospective cohort. Results At 2 years follow up New Knee Society Score showed patient satisfaction (38.25 in DT vs 39.02 in MT, p value 0.10), objective (92.77 in DT vs 91.07 in MT, p value 0.21), expectation scores (14.77 in DT vs 14.85 in MT, p value 0.81) and activity (60.72 in DT vs 68.17 in MT, p value 0.79 were similar in MT group as compared to DT. The stair climbing ability (22.46 in MT vs 29.96 in DT, p value < 0.001) and getting up from chair (13.16 in MT vs 19.80 in DT, p value < 0.001), was better with MT group but most other patient performance scores were similar as assessed by DOP (Delaware Osteoarthritis Profile). Both groups had failure rate of 5% at 24 months follow up. Conclusion MT resulted in similar early outcomes in terms of patient reported outcomes, satisfaction and performance as compared to DT group. The MT to save tibial bone stock did not compromise early outcomes and can be utilised in certain patients with higher risk of tibial failure.
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Affiliation(s)
- Vikas Kulshrestha
- Department of Orthopaedics, Command Hospital Air Force, Bangalore, India
| | - Munish Sood
- Department of Orthopaedics, Indian Naval Hospital Ship Asvini, Mumbai, India
| | - Santhosh Kumar
- Joint Replacement Center, Army Hospital Research and Referral, New Delhi, 110010 India
| | - Kiran Kharat
- Ruby Hall Clinic, Survey No 59/6, Azad Nagar, Wanowrie, Pune, 411040 India
| | - Prashanth P. Padhi
- Department of Orthopaedics and Joint Replacement Surgery, 7 Air Force Hospital Kanpur, Kanpur, India
| | - Pardeep Kumar
- Department of Orthopaedics, Command Hospital Air Force, Bangalore, India
| | - Saurabh Shrama
- Joint Replacement Center, Army Hospital Research and Referral, New Delhi, India
| | - Abin Stanley
- Department of Orthopaedics and Joint Replacement Surgery, 7 Air Force Hospital Kanpur, Kanpur, India
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Vasso M, Corona K, Gomberg B, Marullo M; European Knee Associates Small Implants focus group. Obesity increases the risk of conversion to total knee arthroplasty after unicompartimental knee arthroplasty: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 2022; 30:3945-57. [PMID: 34718836 DOI: 10.1007/s00167-021-06780-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 06/22/2021] [Accepted: 10/14/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE The aim of this meta-analysis was to to determine the influence of obesity on patient outcome and implant survivorship after primary unicompartmental knee arthroplasty (UKA). METHODS A PRISMA systematic review was conducted by searching the Medline (PubMed), EMBASE, and Cochrane electronic databases to identify clinical studies investigating the effect of obesity on outcomes after UKA. Data were collected on aspecifically designed extraction form. Methodological quality was assessed using the Methodological Index for Nonrandomized Studies score. Quantitative meta-analysis was carried out using RevMan 5.4 software. RESULTS A total of 17 studies were included; 43,845 primary UKA patients were classified by their BMI: on-obese (BMI 25 to < 30 kg/m2); obese (BMI 30 to < 35 kg/m2); severely obese (BMI > 35 kg/m2). Pooled analysis showed no statistically significant difference in Knee Society Score (KSS) pain in the obese (n.s.) and the severely obese (n.s.) group compared to the non-obese group, while the KSS function score was lower in the severely obese (P = 0.0002) compared to the obese (P = 0.06) and the non-obese group. Postoperative Oxford Knee Score (OKS) was lower in the obese group (P = 0.01) but not in the severely obese group (P = 0.16). Postoperative Range of Motion (ROM) was comparable in the obese and non-obese group (P = 0.16). Implant survival at 10 years follow-up was significantly lower in the obese (82.5-95.3%; P < 0.0001) and the severely obese group (87.5-93.8%; P < 0.0001) thanthe non-obese group (83.6-98.6%). CONCLUSION Obesity and severe obesity were associated with significantly higher revision and lower implant survival rates. Obesity did not influence clinical and most functional outcomes after UKA, whereas KSS function score was significantly lower only for the severely obese patient group. LEVEL OF EVIDENCE III, meta-analysis.
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Marullo M, Bargagliotti M, Vigano' M, Lacagnina C, Romagnoli S. Patellofemoral arthroplasty: obesity linked to high risk of revision and progression of medial tibiofemoral osteoarthritis. Knee Surg Sports Traumatol Arthrosc 2022; 30:4115-22. [PMID: 35348817 DOI: 10.1007/s00167-022-06947-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 01/07/2022] [Accepted: 03/12/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE The purpose of this study was to determine the effect of obesity on patient outcome, procedure failure rate and osteoarthritis (OA) progression in the tibiofemoral compartments in a series of isolated patellofemoral arthroplasty (PFA) performed with a third-generation implant. METHODS The study population was patients who had undergone third-generation PFA at a specialized orthopedic center between 2007 and 2017. Patients were categorized by body-mass index (BMI) as obese (O, BMI > 30 kg/m2) or nonobese (NO, BMI < 30 kg/m2). Preoperative and postoperative clinical and functional assessment included knee range of motion, Knee Society Score (KSS), University of California Los Angeles (UCLA) Activity Score, Tegner Activity Level Scale, and visual analogue scale (VAS) for pain. Preoperative and postoperative radiographs were evaluated for progression of tibiofemoral compartment OA, changes in patellar height and in knee coronal alignment. Multiple logistic regression models were used to assess the effect of BMI on outcomes together with other covariates. RESULTS A total of 120 PFAs with a mean follow-up of 6.9 ± 2.5 years were included: 25 in the O group and 95 in the NO group. Significant improvement was noted in in knee range of motion (P < 0.001), clinical and functional KSS (P < 0.001), UCLA Activity Score (P < 0.001), Tegner score (P < 0.001) and VAS pain (P < 0.001) without inter-groups differences. Worsening of the medial Kellgren-Lawrence (KL) grade (but not the lateral KL grade) was more frequent in the O than the NO group during the follow-up period (P = 0.014). Failure occurred in 4.2% of NO and in 20% of O group patients; the difference was solely due to failure because of OA progression in the tibiofemoral compartment (16% in the O group). There were no between group differences in the failure rate for any cause other than OA progression (4.2% in the NO group, 4.0% in the O group). CONCLUSIONS An equal improvement in function after PFA was noted in both obese and nonobese patients; however, the high failure rate due to OA progression in the medial tibiofemoral compartment warrants caution when considering PFA in obese patients.
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Rajani AM, Shah UA, Mittal ARS, Gupta S, Garg R, Punamiya M. Role of debulking mucoid ACL in unicompartmental knee arthroplasty: a prospective multicentric study. Knee Surg Relat Res 2022; 34:40. [PMID: 36274173 PMCID: PMC9590154 DOI: 10.1186/s43019-022-00169-9] [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: 07/11/2022] [Accepted: 10/07/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Mucoid degeneration of the anterior cruciate ligament (ACL) has been shown to cause restricted terminal range of motion and rest pain. If present in a patient undergoing unicompartmental knee arthroplasty, it can deteriorate the final outcome. This study aims to compare functional and clinical outcomes of debulking the mucoid ACL in patients undergoing mobile-bearing unicompartmental knee arthroplasty (UKA). METHODS Patients with mucoid ACL undergoing mobile-bearing UKA at five different centres by five different arthroplasty surgeons were included. They were segregated into two groups matched for all demographic and pre-operative values: group A did not undergo debulking; group B underwent open debulking by a 15-number blade prior to UKA. Patient-related outcome measures, rest pain, clinical outcomes, and subjective patient satisfaction were recorded and compared at 2 years follow-up. RESULTS A total of 442 patients (226 patients underwent debulking, 216 patients did not undergo debulking) were included. Both groups showed overall improvement after surgery, however, patients who underwent debulking performed better at 2 years follow-up in terms of Knee Society functional score, International Knee Documentation Committee scores, range of motion, rest pain and overall patient satisfaction (p < 0.05) as compared with their counterparts. CONCLUSIONS Debulking of mucoid ACL in patients undergoing unicompartmental knee arthroplasty significantly reduces the rest pain and improves the final range of motion of the knee joint, subsequently improving the overall functional and clinical outcome of the patient and resulting in greater patient satisfaction.
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Affiliation(s)
- Amyn M. Rajani
- grid.414597.a0000 0004 1799 5016Breach Candy Hospital, 60 A Bhulabhai Desai Marg, Breach Candy, Cumballa Hill, Mumbai, Maharashtra 400026 India
| | - Urvil A. Shah
- Surgikids Hospital, 507-509, Aarohi Verve, Nr Vakil Saheb Bridge, Ambli-Bopal Cross Roads, Ambli, Ahmedabad, Gujarat 380058 India
| | - Anmol R. S. Mittal
- OAKS Clinic, 707 Panchshil Plaza, N S Patkar Marg, opp. Ghanasingh Fine Jewels, next to Dharam Palace, Gamdevi, Mumbai, Maharashtra 400007 India
| | - Sheetal Gupta
- Galaxy Hospital, Kolar Road, Bhopal, Madhya Pradesh 462042 India
| | - Rajesh Garg
- Canadian Hospital, Abu Hail, Dubai, United Arab Emirates
| | - Meenakshi Punamiya
- OAKS Clinic, 707 Panchshil Plaza, N S Patkar Marg, opp. Ghanasingh Fine Jewels, next to Dharam Palace, Gamdevi, Mumbai, Maharashtra 400007 India
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Walker T, Stupp J, Reiner T, Panzram B, Nees TA, Innmann MM, Gotterbarm T, Merle C. Minimally invasive Oxford medial unicompartmental knee replacement in patients 50 years of age or younger. Arch Orthop Trauma Surg 2022; 143:3077-3084. [PMID: 35849185 DOI: 10.1007/s00402-022-04539-6] [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: 12/14/2021] [Accepted: 06/28/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The aim of the present study was to assess clinical outcome and mid-term survivorship of mobile-bearing unicompartmental knee arthroplasty in patients 50 years of age or younger. METHODS This study reports the results of 119 patients (130 knees) following mobile-bearing medial UKA. Primary indication was advanced osteoarthritis or avascular necrosis of the femoral condyle. The anterior cruciate ligament (ACL) as well as the collateral ligaments were functionally intact, the varus deformity was manually correctable and there was no evidence of osteoarthritis in the lateral compartment. Survivorship analysis was performed with different endpoints and clinical outcome was measured using the Oxford Knee Score (OKS), American Knee Society Score and Functional Score (AKSS-O, AKSS-F), range of motion (ROM), Tegner activity score, University of California Los Angeles score (UCLA) and visual analogue scale for pain (VAS). RESULTS The survival rate was 96.6% at 6.5 years (95% CI 98.7-91.3%; number at risk: 56) and 91.7% (95% CI 96.7-80%; number at risk: 22) at 10 years for the endpoint device related revisions and 91.5% at 6.5 years (95% CI 95.4-84.5%; number at risk: 56) and 86.8% (95% CI 93-76.2%; number at risk: 22) at 10 years for the endpoint revision for any reason. Outcome scores, VAS and ROM showed significant improvements (p < 0.001). The mean OKS increased from 26.7 (standard deviation (sd): 7.2) preoperatively to 40.9 (sd: 7.6) at final follow-up, the mean AKSS-O from 48.3 (sd: 13.3) to 87.8 (sd: 14.4) and the mean ROM from 118° (sd: 16.7) to 125° (sd: 11.4). The radiological analysis revealed progression of degenerative changes in the lateral compartment in 39.6% of patients without affecting the functional outcome. CONCLUSIONS Medial mobile-bearing UKA is a viable surgical treatment option in young patients with significant improvements in knee function and pain. Further follow-up is necessary to evaluate the long-term efficacy. LEVEL OF EVIDENCE Retrospective cohort study, Level III.
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Affiliation(s)
- Tilman Walker
- Department of Orthopaedic Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Julius Stupp
- Department of Orthopaedic Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Tobias Reiner
- Department of Orthopaedic Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Benjamin Panzram
- Department of Orthopaedic Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Timo A Nees
- Department of Orthopaedic Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Moritz M Innmann
- Department of Orthopaedic Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Tobias Gotterbarm
- Center for Orthopaedics and Trauma Surgery, University of Linz, Krankenhausstr. 7a, 4020, Linz, Austria
| | - Christian Merle
- Department of Orthopaedic Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.
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Abstract
AIMS Unicompartmental knee arthroplasty (UKA) has a higher risk of revision than total knee arthroplasty (TKA), particularly for younger patients. The outcome of knee arthroplasty is typically defined as implant survival or revision incidence after a defined number of years. This can be difficult for patients to conceptualize. We aimed to calculate the 'lifetime risk' of revision for UKA as a more meaningful estimate of risk projection over a patient's remaining lifetime, and to compare this to TKA. METHODS Incidence of revision and mortality for all primary UKAs performed from 1999 to 2019 (n = 13,481) was obtained from the New Zealand Joint Registry (NZJR). Lifetime risk of revision was calculated for patients and stratified by age, sex, and American Society of Anesthesiologists (ASA) grade. RESULTS The lifetime risk of revision was highest in the youngest age group (46 to 50 years; 40.4%) and decreased sequentially to the oldest (86 to 90 years; 3.7%). Across all age groups, lifetime risk of revision was higher for females (ranging from 4.3% to 43.4% vs males 2.9% to 37.4%) and patients with a higher ASA grade (ASA 3 to 4, ranging from 8.8% to 41.2% vs ASA 1 1.8% to 29.8%). The lifetime risk of revision for UKA was double that of TKA across all age groups (ranging from 3.7% to 40.4% for UKA, and 1.6% to 22.4% for TKA). The higher risk of revision in younger patients was associated with aseptic loosening in both sexes and pain in females. Periprosthetic joint infection (PJI) accounted for 4% of all UKA revisions, in contrast with 27% for TKA; the risk of PJI was higher for males than females for both procedures. CONCLUSION Lifetime risk of revision may be a more meaningful measure of arthroplasty outcomes than implant survival at defined time periods. This study highlights the higher lifetime risk of UKA revision for younger patients, females, and those with a higher ASA grade, which can aid with patient counselling prior to UKA. Cite this article: Bone Joint J 2022;104-B(6):672-679.
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Affiliation(s)
- Mei L Tay
- Department of Surgery, University of Auckland, Faculty of Medical and Health Sciences, Auckland, New Zealand.,Department of Orthopaedic Surgery, North Shore Hospital, Auckland, New Zealand
| | - Simon W Young
- Department of Surgery, University of Auckland, Faculty of Medical and Health Sciences, Auckland, New Zealand.,Department of Orthopaedic Surgery, North Shore Hospital, Auckland, New Zealand
| | - Christopher M Frampton
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Gary J Hooper
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago Christchurch, Christchurch, New Zealand
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Shamdasani S, Vogel N, Kaelin R, Kaim A, Arnold MP. Relevant changes of leg alignment after customised individually made bicompartmental knee arthroplasty due to overstuffing. Knee Surg Sports Traumatol Arthrosc 2022; 30:567-73. [PMID: 32915259 DOI: 10.1007/s00167-020-06271-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 06/02/2020] [Accepted: 09/01/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE The purpose of this study is to analyse the change in knee alignment after customised individually made (CIM) bicompartmental knee arthroplasty (BKA) and the subsequent consequences for patellar tracking. METHODS Medical records of 23 patients who received 26 CIM BKA (ConforMIS iDuo G2) at our clinic between November 2015 and July 2018 were reviewed. The objective part of the Knee Society Score (KSS), the hip-knee-ankle angle (HKA), the tibial mechanical angle (TMA) and femoral mechanical angle (FMA) were recorded preoperative and four months postoperative. Leg alignment was classified as neutral (HKA = 180° ± 3°), varus (HKA < 177°) or valgus (HKA > 183°). Furthermore, patellar tracking was determined on skyline view radiographs and adverse events were recorded. Implant survival rate was determined with the Kaplan-Meier method. Patient-reported outcome measures (PROMs) were pain, satisfaction, overall improvement and if the patient would undergo the surgery again. RESULTS The mean KSS improved from 61 points preoperative [standard deviation (SD) 14] to 90 points postoperative (SD 7, p < 0.001). The mean change for HKA was 6.3° (SD 3.5), for TMA 1.5° (SD 1.2) and for FMA 3.8° (SD 2.3). Postoperative leg alignment was neutral in 13 CIM BKA (50%), varus in two (8%) and valgus in 11 (42%) and patella tracking was central in 19 CIM BKA (73%) and lateral in seven (27%), respectively. Adverse events occurred in five CIM BKA: three patients required a patella resurfacing and one patient with bilateral CIM BKA needed a revision to a total knee arthroplasty. Implant survival rate was 92.3% at a follow-up of 3.2 years (SD 0.8). PROMs for CIM BKA without revision surgery were available at a mean follow-up of 3.2 years (SD 0.8). Mean pain with level walking decreased to 0.8 points (SD 1.4, p < 0.001) and mean pain with stairs or inclines to 1.6 points (SD 1.3, p < 0.001). Patient satisfaction was very satisfied or satisfied (78%), neutral (17%) or unsatisfied (4%). Overall improvement was much better or considerably better for 91% of all patients; 87% would undergo the surgery again. CONCLUSION A relevant change of the leg axis away from the treated femorotibial compartment due to overstuffing was observed. Although, neutral leg alignment was not restored in every case, clinical and patient-reported outcomes improved significantly. Further studies with long-term clinical and patient-reported outcomes are required to evaluate whether patients with bicompartmental knee osteoarthritis benefit from CIM BKA. LEVEL OF EVIDENCE IV, case series.
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Burger JA, Jager T, Dooley MS, Zuiderbaan HA, Kerkhoffs GMMJ, Pearle AD. Comparable incidence of periprosthetic tibial fractures in cementless and cemented unicompartmental knee arthroplasty: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2022; 30:852-874. [PMID: 33528591 PMCID: PMC8901491 DOI: 10.1007/s00167-021-06449-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [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] [Received: 07/22/2020] [Accepted: 01/11/2021] [Indexed: 12/18/2022]
Abstract
PURPOSE (I) To determine the incidence of periprosthetic tibial fractures in cemented and cementless unicompartmental knee arthroplasty (UKA) and (II) to summarize the existing evidence on characteristics and risk factors of periprosthetic fractures in UKA. METHODS Pubmed, Cochrane and Embase databases were comprehensively searched. Any clinical, laboratory or case report study describing information on proportion, characteristics or risk factors of periprosthetic tibial fractures in UKA was included. Proportion meta-analysis was performed to estimate the incidence of fractures only using data from clinical studies. Information on characteristics and risk factors was evaluated and summarized. RESULTS A total of 81 studies were considered to be eligible for inclusion. Based on 41 clinical studies, incidences of fractures were 1.24% (95%CI 0.64-2.41) for cementless and 1.58% (95%CI 1.06-2.36) for cemented UKAs (9451 UKAs). The majority of fractures in the current literature occurred during surgery or presented within 3 months postoperatively (91 of 127; 72%) and were non-traumatic (95 of 113; 84%). Six different fracture types were observed in 21 available radiographs. Laboratory studies revealed that an excessive interference fit (press fit), excessive tibial bone resection, a sagittal cut too deep posteriorly and low bone mineral density (BMD) reduce the force required for a periprosthetic tibial fracture to occur. Clinical studies showed that periprosthetic tibial fractures were associated with increased body mass index and postoperative alignment angles, advanced age, decreased BMD, female gender, and a very overhanging medial tibial condyle. CONCLUSION Comparable low incidences of periprosthetic tibial fractures in cementless and cemented UKA can be achieved. However, surgeons should be aware that an excessive interference fit in cementless UKAs in combination with an impaction technique may introduce an additional risk, and could therefore be less forgiving to surgical errors and patients who are at higher risk of periprosthetic tibial fractures. LEVEL OF EVIDENCE V.
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Affiliation(s)
- Joost A Burger
- Department of Orthopaedic Surgery and Computer Assisted Surgery Center, Hospital for Special Surgery, Weill Medical College of Cornell University, 535 East 70th St, New York, NY, 10021, USA.
| | - Tjeerd Jager
- Department of Orthopaedic Surgery, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - Matthew S Dooley
- Department of Orthopaedic Surgery and Computer Assisted Surgery Center, Hospital for Special Surgery, Weill Medical College of Cornell University, 535 East 70th St, New York, NY, 10021, USA
| | - Hendrik A Zuiderbaan
- Department of Orthopaedic Surgery, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - Gino M M J Kerkhoffs
- Department of Orthopedic Surgery, Amsterdam Movement Sciences (AMS), Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Andrew D Pearle
- Department of Orthopaedic Surgery and Computer Assisted Surgery Center, Hospital for Special Surgery, Weill Medical College of Cornell University, 535 East 70th St, New York, NY, 10021, USA
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12
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Beckmann J, Hirschmann MT, Matziolis G, Holz J, V Eisenhart-Rothe R, Becher C. [Recommendations for unicondylar knee replacement in the course of time : A current inventory]. Orthopade 2021; 50:104-111. [PMID: 33346867 DOI: 10.1007/s00132-020-04054-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND A higher patient satisfaction stands in contrast to higher revision rates of unicondylar knee joint endoprosthetics (UKE) compared to total knee joint endoprosthetics (TKE). Furthermore, old "dogmas" regarding indications and contraindications persist, which is still reflected in the significantly different case numbers. AIM The aim of this article is to provide an overview of the current literature regarding 1. indication and contraindication (BMI, age, sport, arthrosis of other compartments, ligament status) and 2. the "eternal rival" fixed or mobile bearing for UKE. RESULTS The choice of the right patient remains essential, even if all the old "dogmas" of contraindications have been relativized or even outdated. Arthroses of the contralateral (in medial UKE correspondingly lateral) compartment and advanced arthroses of the lateral patella facet remain the only persistent contraindications. In contrast, a high BMI, age, chondrocalcinosis, medial patella facet and a defective (but particularly functionally stable) ACL are not contraindications; however, severe obesity is responsible for a significantly higher complication rate and probably a higher rate of loosening. Rather, the experience and thus the number of UKEs of the individual surgeon is decisive for the outcome, to which the discussion about mobile or fixed inlays must also be completely subordinated. CONCLUSION The indications for UKE can, therefore, be extended with a clear conscience on the basis of literature, and the current 1:10 UKE:TKE ratio in Germany can be shifted significantly.
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Affiliation(s)
- J Beckmann
- Sportklinik Stuttgart, Taubenheimstr. 8, 70372, Stuttgart, Deutschland.
| | | | - G Matziolis
- Waldkliniken Eisenberg, Eisenberg, Deutschland
| | - J Holz
- OrthoCentrum Hamburg, Hamburg, Deutschland
| | - R V Eisenhart-Rothe
- Klinikum rechts der Isar der Technischen Universität München, München, Deutschland
| | - C Becher
- IZO - Internationales Zentrum für Orthopädie, ATOS Klinik Heidelberg, Heidelberg, Deutschland
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13
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Abstract
BACKGROUND Unicondylar knee arthroplasty offers the advantage that partial degenerative changes can be addressed with partial prosthetic solutions, thus preserving as much of the native joint as possible, including the cruciate ligaments. On the other hand, the number of revisions is still higher than for total knee endoprosthetics. In the literature, the causes mentioned are insufficient fit of the components as well as surgical errors. The use of new technologies to achieve a better fit and higher surgical precision and reproducibility, therefore, represents a promising approach. INDIVIDUAL ENDOPROSTHETICS Individual endoprosthetics offers the advantage that the prosthesis is adapted to the individual anatomy of each patient and not the patient's anatomy to the prosthesis, as is the case with standard prostheses. This allows for an optimal fit of the prosthesis while avoiding excessive bone resections and soft tissue releases. ROBOTICS The use of robotics in endoprosthetics makes it easier to correctly perform bone resections and align components. This ensures high and reproducible precision even for surgeons with lower case numbers. Studies on individual unicondylar endoprosthetics and robotics are reporting promising results. However, long-term results of high-quality randomized studies must be awaited in order to make a scientifically sound statement.
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Affiliation(s)
- Malin Meier
- Universitätsklinik für Orthopädische Chirurgie und Traumatologie, Inselspital, Bern, Schweiz
| | | | | | - Johannes Beckmann
- Sportklinik Stuttgart, Taubenheimstr. 8, 70372, Stuttgart, Deutschland.
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14
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Walker T, Hariri M, Eckert J, Panzram B, Reiner T, Merle C, Gotterbarm T, Moradi B. Minimally invasive lateral unicompartmental knee replacement: Early results from an independent center using the Oxford fixed lateral prosthesis. Knee 2020; 27:235-241. [PMID: 31806510 DOI: 10.1016/j.knee.2019.09.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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: 06/15/2019] [Revised: 08/17/2019] [Accepted: 09/27/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE The aim of the present study was to assess clinical outcome as well as short-term survivorship of fixed-bearing lateral unicompartmental knee replacement (UKR) from a non-designer centre using the Oxford Fixed Lateral prosthesis. METHODS This single-centre retrospective cohort study reports the short-term results of 51 consecutive patients (52 knees) after fixed-bearing lateral UKR with a minimum follow-up of one year. Survivorship analysis was performed with different endpoints and clinical outcome was measured using the Oxford Knee Score (OKS), objective American Knee Society Score (AKSS-O), range-of-motion (ROM), visual analog scale for pain (VAS), Tegner activity score and UCLA score. RESULTS There was no revision surgery, defined as exchange of at least one of the components resulting in a survival rate of 100% at two years. Three patients required further surgical treatment resulting in a survival rate of 94.2% (95% confidence interval (CI): 83.2-98.1%) with the endpoint 'any reoperation'. Outcome scores, VAS and ROM showed a statistically significant improvement at final follow-up (P < .001). The OKS improved from 26.4 ± 6.9 (12-41) preoperatively to 39.7 ± 8.4 (15-48), the AKSS-O from 54.3 ± 15.3 (18-90) to 82.2 ± 15.6 (40-100), the American Knee Society Functional Score from 56.4 ± 21.3 (10-100) to 83.1 ± 20.2 (five to 100) and the ROM from 123.5 ± 13.5 (90-140) to 134 ± 10.3 (95-150). CONCLUSION Early results of fixed-bearing lateral UKR using the Oxford-Fixed-Lateral prosthesis were encouraging with a significant improvement in pain and knee function as well as an excellent survivorship of 100% at a mean follow-up of two years. Further follow-up is necessary to evaluate the long-term effectiveness of this device and the surgical technique. LEVEL OF EVIDENCE Level IV, retrospective cohort study.
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Affiliation(s)
- Tilman Walker
- Center for Orthopaedics and Trauma Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany
| | - Mustafa Hariri
- Center for Orthopaedics and Trauma Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany
| | - Johannes Eckert
- Center for Orthopaedics and Trauma Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany
| | - Benjamin Panzram
- Center for Orthopaedics and Trauma Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany
| | - Tobias Reiner
- Center for Orthopaedics and Trauma Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany
| | - Christian Merle
- Center for Orthopaedics and Trauma Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany
| | - Tobias Gotterbarm
- Center for Orthopaedics and Trauma Surgery, University of Linz, Krankenhausstr. 7a, 4020 Linz, Austria
| | - Babak Moradi
- Center for Orthopaedics and Trauma Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany.
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15
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Smith S, Alvand A, Locock L, Ryan S, Smith J, Bayliss L, Wilson H, Price A. Partial or total knee replacement? Identifying patients' information needs on knee replacement surgery: a qualitative study to inform a decision aid. Qual Life Res 2019; 29:999-1011. [PMID: 31848846 PMCID: PMC7142054 DOI: 10.1007/s11136-019-02381-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2019] [Indexed: 11/27/2022]
Abstract
Purpose For patients with end-stage knee osteoarthritis, joint replacement is a widely used and successful operation to help improve quality-of-life when non-operative measures have failed. For a significant proportion of patients there is a choice between a partial or total knee replacement. Decision aids can help people weigh up the need for and benefits of treatment against possible risks and side-effects. This study explored patients’ experiences of deciding to undergo knee replacement surgery to identify information priorities, to inform a knee replacement decision aid. Methods Four focus groups were held with 31 patients who were candidates for both partial and total knee replacement surgery. Two focus groups included patients with no prior knee replacement surgery (pre-surgery); two with patients with one knee already replaced and who were candidates for a second surgery on their other knee (post-surgery). Data were analysed using Framework Analysis. Results Participants described a process of arriving at ‘readiness for surgery’ a turning point where the need for treatment outweighed their concerns. Referral and personal factors influenced their decision-making and expectations of surgery in the hope to return to a former self. Those with previous knee surgery offered insights into whether their expectations were met. ‘Information for decisions’ details the practicality and the optimal timing for the delivery of a knee replacement decision aid. In particular, participants would have valued hearing about the experiences of other patients and seeing detailed pictures of both surgical options. Information priorities were identified to include in a decision aid for knee replacement surgery. Conclusions Patients’ experiences of surgical decision-making have much in common with the Necessity-Concerns Framework. Whilst originally developed to understand drug treatment decisions and adherence, it provides a useful lens to understand decision-making about surgery. The use of a decision aid could enhance decision-making on knee replacement surgery. Ultimately, patients’ understanding of the risks and benefits of both surgical options could be improved and in turn, help informed decision-making. The knee replacement decision aid is perceived as a useful tool to be associated with other detailed information resources as recommended. Electronic supplementary material The online version of this article (10.1007/s11136-019-02381-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stephanie Smith
- Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK.
| | - Abtin Alvand
- Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK
| | - Louise Locock
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK.,Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Sara Ryan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - James Smith
- Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK.,Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Lee Bayliss
- Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK
| | - Hannah Wilson
- Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK
| | - Andrew Price
- Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK
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16
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Jones GG, Clarke S, Harris S, Jaere M, Aldalmani T, de Klee P, Cobb JP. A novel patient-specific instrument design can deliver robotic level accuracy in unicompartmental knee arthroplasty. Knee 2019; 26:1421-1428. [PMID: 31519328 DOI: 10.1016/j.knee.2019.08.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 08/01/2018] [Revised: 05/03/2019] [Accepted: 08/01/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND A previous randomised controlled trial (RCT) by our group found that robotic assisted unicompartmental knee arthroplasty (UKA) surgery was significantly more accurate than conventional instrumentation. The aim of this study was to determine whether a low-cost novel PSI design could deliver the same level of accuracy as the robot in the same time efficient manner as conventional instruments. METHODS Thirty patients undergoing medial UKA took part. Tibial component position was planned using a low dose CT-scan, and compared to a day 1 postoperative CT-scan to determine the difference between the planned and achieved positions. Operations were performed by one expert surgeon using PSI (Embody, London, UK). RESULTS The mean absolute difference between planned and achieved tibial implant positions using PSI was 2.0° (SD 1.0°) in the coronal plane, 1.8° (SD 1.5) in the sagittal plane, and 4.5° (SD 3.3) in the axial plane. These results were not significantly different to the 13 historical robotic cases (mean difference 0.5°, 0.5°, and 1.7°, p = 0.1907, 0.2867 and 0.1049 respectively). PSI mean operating time was on average 62 min shorter than the robotic group (p < 0.0001) and 40 min shorter than the conventional instrument group (p < 0.0001). No complications were reported. CONCLUSIONS In conclusion, this clinical trial demonstrates that for tibial component positioning in UKA, a novel design PSI guide in the hands of an expert surgeon, can safely deliver comparable accuracy to a robotic system, whilst being significantly faster than conventional instruments. NIHR Clinical Research Network Reference: 16100.
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Affiliation(s)
- Gareth G Jones
- MSk Lab, Imperial College London, 7(th) Floor Lab Block, Charing Cross Hospital, London W6 8RF, UK.
| | - Susannah Clarke
- MSk Lab, Imperial College London, 7(th) Floor Lab Block, Charing Cross Hospital, London W6 8RF, UK.
| | - Simon Harris
- MSk Lab, Imperial College London, 7(th) Floor Lab Block, Charing Cross Hospital, London W6 8RF, UK.
| | - Martin Jaere
- MSk Lab, Imperial College London, 7(th) Floor Lab Block, Charing Cross Hospital, London W6 8RF, UK.
| | - Thunayan Aldalmani
- Royal College of Surgeons in Ireland, 123 St. Stephen's Green, Dublin 2, Ireland.
| | - Patrick de Klee
- MSk Lab, Imperial College London, 7(th) Floor Lab Block, Charing Cross Hospital, London W6 8RF, UK; Embody Orthopaedic, MSk Lab, 7th Floor Lab Block, Charing Cross Hospital, London, W6 8RF, UK
| | - Justin P Cobb
- MSk Lab, Imperial College London, 7(th) Floor Lab Block, Charing Cross Hospital, London W6 8RF, UK.
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17
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Rivière C, Harman C, Leong A, Cobb J, Maillot C. Kinematic alignment technique for medial OXFORD UKA: An in-silico study. Orthop Traumatol Surg Res 2019; 105:63-70. [PMID: 30595413 DOI: 10.1016/j.otsr.2018.11.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 09/22/2018] [Revised: 11/20/2018] [Accepted: 11/20/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Mobile bearing unicompartmental knee arthroplasty (UKA) Oxford™ components are recommended to be systematically and mechanically aligned (MA) for restoring the constitutional lower-limb alignment. Good long-term clinical outcomes have been generated with the medially implanted MA Oxford™, but some sub-optimal biomechanical-related complications still remain. Kinematic Alignment (KA) is a personalised technique for anatomically and kinematically implanting components (total knee, fixed bearing partial knee, total hip) aimed at creating more physiological prosthetic joint biomechanics. Interestingly, for decades the principles for implanting fixed bearing UKA components were consistent with those promoted by the KA technique, but differently formulated. We initiated this computational study to assess the feasibility of this technique with the Oxford™ components, as we thought this more anatomical implantation may be clinically advantageous. HYPOTHESIS We surmised that kinematically aligning the Oxford™ medial UKA would maximise the prosthesis-bone interface through maximising the implants' size used (question 1), and alter, within an acceptable limit, the components' orientation (question 2) compared to conventional mechanical alignment. METHODS A cohort of 40 consecutive medial osteoarthritic knee patients scheduled for UKA had a preoperative CT scan that was segmented to create 3D knee bone models. MA and KA of medial UKA Oxford® components (Zimmer-Biomet, Warsaw, Indiana, USA) were simulated. Component sizing and positioning were compared between the two techniques. RESULTS We found no difference in component size, but significantly fewer occurrences of borderline fit with the KA simulation. KA technique oriented the femoral component 3.6° more valgus (from 1° varus to 7° valgus) and the tibial component 2.9° more varus (from 8° varus to 0°) compared to the MA technique. The tibial component slope in KA simulation was 6.4° posterior (from 0 to 12°) compared to a systematic 7° posterior for MA positioning. DISCUSSION AND CONCLUSION Kinematic alignment of the medial Oxford™ generated a different, albeit still acceptable (Oxford group recommendations), implant orientation, in addition to a likely better shape-fit between components and the supportive bone cut, compared to the MA technique. The potential to improve the implants' interaction and to restore a more physiological bone loading makes the KA of Oxford™ an attractive, potentially clinically beneficial option. Clinical investigations are needed to assess its true value. LEVEL OF EVIDENCE I, computational study.
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Affiliation(s)
- Charles Rivière
- The MSK Lab-Imperial college London, South West London Elective Orthopaedic Centre, London, United Kingdom.
| | - Ciara Harman
- South West London Elective Orthopaedic Centre, Dorking road, KT18 7EG Epsom, United Kingdom
| | - Anthony Leong
- The MSK Lab-Imperial college London, Charing Cross Campus, Laboratory Block, W6 8RP London, United Kingdom
| | - Justin Cobb
- The MSK Lab-Imperial college London, Charing Cross Campus, Laboratory Block, W6 8RP London, United Kingdom
| | - Cedric Maillot
- The MSK Lab-Imperial college London, South West London Elective Orthopaedic Centre, London, United Kingdom
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18
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Volpin A, Kini SG, Meuffels DE. Satisfactory outcomes following combined unicompartmental knee replacement and anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2018; 26:2594-2601. [PMID: 28364321 DOI: 10.1007/s00167-017-4536-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 01/30/2017] [Accepted: 03/27/2017] [Indexed: 12/15/2022]
Abstract
PURPOSE There exist limited options for treatment of patients with combined medial compartment arthritis and anterior cruciate ligament (ACL) deficiency. Ideal treatment is one that offers lasting relief of symptoms not compromising any future surgery. Unicompartmental knee replacement has shown consistently good results in the relatively young and active population, but there is a high reported incidence of failure up to 20%, if performed in ACL-deficient knees. One of the recognized treatment modality is combined ACL reconstruction and unicompartmental arthroplasty. A systematic review was conducted looking at the demographics, techniques, complications and outcome of combined ACL reconstruction with unicompartmental knee arthroplasty. METHODS A systematic literature search within the online Medline, PubMed Database, EMBASE, Web of Science, Cochrane and Google Scholar was carried out until October 2016 to identify relevant articles. A study was defined eligible if it met the following inclusion criteria: the surgical procedure combined unicompartmental knee arthroplasty and anterior cruciate ligament reconstruction; patient's clinical and/or functional outcomes were reported; any complications intra-operatively and post-operatively were reported; and the full-text articles, written in English, German, Italian, Dutch or Spanish, were available. Quality and risk of bias assessments were done using standardized criteria set. RESULTS A total of 8 studies met the inclusion criteria encompassing 186 patients who were treated with simultaneous ACL reconstruction and unicompartmental knee arthroplasty. The mean age was 50.5 years (range from 44 to 56) with a mean follow-up of 37.6 months (range from 24 to 60). There was an improvement in mean Oxford Score from 27.5 to 36.8. Complications reported included tibial inlay dislocation (n = 3), conversion to a total knee arthroplasty (n = 1), infection requiring two-stage revision (n = 2), deep-vein thrombosis (n = 1), stiffness requiring manipulation under anaesthesia (n = 1), retropatellar pain requiring arthroscopic adhesiolysis (n = 1). CONCLUSION Unicompartmental knee arthroplasty combined with ACL reconstruction can be a valid treatment option for selected patients, with combined medial unicompartmental knee osteoarthritis and ACL deficiency. LEVEL OF EVIDENCE Systematic Review of Level IV Studies, Level IV.
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Affiliation(s)
- Andrea Volpin
- Department of Trauma and Orthopaedics, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK.
| | - S G Kini
- Department of Trauma and Orthopaedics, Manipal Hospital, Bangalore, India
| | - D E Meuffels
- Department of Orthopaedic Surgery, Erasmus MC, University Medical Centre Rotterdam, s' Gravendijkwal 230, 3000 CA, Rotterdam, The Netherlands
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19
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Abstract
Unicompartmental knee replacement (UKR) is an effective treatment for end-stage, symptomatic unicompartmental osteoarthritis of the knee. However, certain aspects of the procedure are still debated. These areas of discussion include patient selection criteria, implant design and the discrepancy in survival rates between national registries and independent case series. These may contribute in limiting the more widespread acceptance of unicompartmental knee replacement. The aim of this paper is to review the up-to-date evidence on UKR and discuss the most relevant controversies regarding this procedure.
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Affiliation(s)
- Stefano Campi
- Department of Orthopaedics, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Saket Tibrewal
- Department of Trauma & Orthopaedic Surgery, Lewisham & Greenwich NHS Trust, University Hospital Lewisham, High Street, London, SE13 6LH, United Kingdom,Corresponding author.
| | - Rory Cuthbert
- Department of Trauma & Orthopaedic Surgery, Lewisham & Greenwich NHS Trust, University Hospital Lewisham, High Street, London, SE13 6LH, United Kingdom
| | - Sheo B. Tibrewal
- Department of Trauma & Orthopaedic Surgery, Lewisham & Greenwich NHS Trust, Queen Elizabeth Hospital, London SE18 4QH, United Kingdom
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20
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Jones GG, Logishetty K, Clarke S, Collins R, Jaere M, Harris S, Cobb JP. Do patient-specific instruments (PSI) for UKA allow non-expert surgeons to achieve the same saw cut accuracy as expert surgeons? Arch Orthop Trauma Surg 2018; 138:1601-1608. [PMID: 30178169 PMCID: PMC6182679 DOI: 10.1007/s00402-018-3031-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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] [Received: 05/29/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION High-volume unicompartmental knee arthroplasty (UKA) surgeons have lower revision rates, in part due to improved intra-operative component alignment. This study set out to determine whether PSI might allow non-expert surgeons to achieve the same level of accuracy as expert surgeons. MATERIALS AND METHODS Thirty-four surgical trainees with no prior experience of UKA, and four high-volume UKA surgeons were asked to perform the tibial saw cuts for a medial UKA in a sawbone model using both conventional and patient-specific instrumentation (PSI) with the aim of achieving a specified pre-operative plan. Half the participants in each group started with conventional instrumentation, and half with PSI. CT scans of the 76 cut sawbones were then segmented and reliably orientated in space, before saw cut position in the sagittal, coronal and axial planes was measured, and compared to the pre-operative plan. RESULTS The compound error (absolute error in the coronal, sagittal and axial planes combined) for experts using conventional instruments was significantly less than that of the trainees (11.6°±4.0° v 7.7° ±2.3º, p = 0.029). PSI improved trainee accuracy to the same level as experts using conventional instruments (compound error 5.5° ±3.4º v 7.7° ±2.3º, p = 0.396) and patient-specific instruments (compound error 5.5° ±3.4º v 7.3° ±4.1º, p = 0.3). PSI did not improve the accuracy of high-volume surgeons (p = 0.3). CONCLUSIONS In a sawbone model, PSI allowed inexperienced surgeons to achieve more accurate saw cuts, equivalent to expert surgeons, and thus has the potential to reduce revision rates. The next test will be to determine whether these results can be replicated in a clinical trial.
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Affiliation(s)
- Gareth G. Jones
- MSk Lab, Imperial College London, 7th Floor Lab Block Charing Cross Hospital, London, W6 8RF UK
| | - K. Logishetty
- MSk Lab, Imperial College London, 7th Floor Lab Block Charing Cross Hospital, London, W6 8RF UK
| | - S. Clarke
- MSk Lab, Imperial College London, 7th Floor Lab Block Charing Cross Hospital, London, W6 8RF UK
| | - R. Collins
- MSk Lab, Imperial College London, 7th Floor Lab Block Charing Cross Hospital, London, W6 8RF UK
| | - M. Jaere
- MSk Lab, Imperial College London, 7th Floor Lab Block Charing Cross Hospital, London, W6 8RF UK
| | - S. Harris
- MSk Lab, Imperial College London, 7th Floor Lab Block Charing Cross Hospital, London, W6 8RF UK
| | - J. P. Cobb
- MSk Lab, Imperial College London, 7th Floor Lab Block Charing Cross Hospital, London, W6 8RF UK
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21
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Shankar S, Tetreault MW, Jegier BJ, Andersson GB, Della Valle CJ. A cost comparison of unicompartmental and total knee arthroplasty. Knee 2016; 23:1016-1019. [PMID: 27810433 DOI: 10.1016/j.knee.2015.11.012] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [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: 09/10/2015] [Revised: 11/26/2015] [Accepted: 11/29/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Unicompartmental knee arthroplasty (UKA) is an alternative to total knee arthroplasty (TKA) in appropriately selected patients. There is a paucity of data comparing hospital resource utilization and costs for UKA versus TKA. METHODS We retrospectively reviewed 128 patients who underwent UKA or TKA for osteoarthritis by a single surgeon in the 2011 Fiscal Year. Sixty-four patients in each group were matched based on sex, age, race, body mass index, Charlson Comorbidity Index, and insurance type. Clinical data were obtained from medical records while costs were obtained from hospital billing. Bivariate analyses were used to compare outcomes. RESULTS Both anesthesia and operative time (minutes) were significantly shorter for patients undergoing UKA (125.7 vs. 156.4; p<0.001, and 81.4 vs. 112.2; p<0.001). UKA patients required fewer transfusions (0% vs. 11.0%; p=0.007) and had a shorter hospital stay (2.2 vs. 3.8days; p<0.001). 96% of UKAs were discharged home compared with 75% of TKAs (p<0.001). Hospital direct costs were lower for UKA ($7893 vs. $11,156; p<0.001) as were total costs (hospital direct costs plus overhead; $11,397 vs. $16,243; p<0.001). Supply costs and implant costs were similarly lower for UKA ($701 vs. $781; p<0.001, and $3448 vs. $5006; p<0.001). CONCLUSION Our data suggest that UKA provides a cost-effective alternative to TKA in appropriately selected patients. As the number of patients with end-stage arthritis of the knee requiring surgical care continues to rise, the costs of caring for these patients must be considered. LEVEL OF EVIDENCE Level III, case control study.
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Affiliation(s)
- Sheila Shankar
- Department of Health Systems Management, Rush University Medical Center, Chicago, IL 60612, USA
| | - Matthew W Tetreault
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL 60612, USA.
| | - Briana J Jegier
- Department of Health Systems Management, Rush University Medical Center, Chicago, IL 60612, USA; Department of Health Services Administration, D'Youville College, Buffalo, NY 14201, USA
| | - Gunnar B Andersson
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL 60612, USA
| | - Craig J Della Valle
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL 60612, USA
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22
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Calliess T, Schado S, Richter BI, Becher C, Ezechieli M, Ostermeier S. Quadriceps force during knee extension in different replacement scenarios with a modular partial prosthesis. Clin Biomech (Bristol, Avon) 2014; 29:218-22. [PMID: 24342453 DOI: 10.1016/j.clinbiomech.2013.11.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [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: 04/13/2013] [Revised: 11/06/2013] [Accepted: 11/07/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Previous biomechanical studies have shown that bi-cruciate retaining knee replacement does not significantly alter normal knee kinematics, however, there are no data on the influence of a combined medial and patellofemoral bi-compartimental arthroplasty. The purpose of this in vitro study was to evaluate the effect of different replacement scenarios with a modular partial knee replacement system on the amount of quadriceps force required to extend the knee during an isokinetic extension cycle. METHODS Ten human knee specimens were tested in a kinematic knee simulator under (1) physiologic condition and after subsequent implantation of (2) a medial unicondylar and (3) a trochlear replacement. An isokinetic extension cycle of the knee with a constant extension moment of 31 Nm was simulated. The resulting quadriceps extension force was measured from 120° to full knee extension. FINDINGS The quadriceps force curve described a typically sinusoidal characteristic before and after each replacement scenario. The isolated medial replacement resulted in a slightly, but significantly higher maximum quadriceps force (1510 N vs. 1585 N, P = 0.006) as well as the subsequent trochlear replacement showed an additional increase (1801 N, P = 0.008). However, for both replacements no significant difference to the untreated condition could be detected in mid-flexion (10-50°). INTERPRETATION When considering a bi-compartimental replacement an increase of required maximum quadriceps force needed to extend the knee has to keep in mind. However, the close to physiological movement in mid-flexion suggests that patients with a bi-crutiate retaining arthroplasty might have an advantage in knee stability compared to total knee arthroplasty.
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Affiliation(s)
- Tilman Calliess
- Department of Orthopaedic Surgery, Hannover Medical School, Anna-von-Borries-Str. 3, 30625 Hannover, Germany.
| | - Ssuheib Schado
- Department of Orthopaedic Surgery, Hannover Medical School, Anna-von-Borries-Str. 3, 30625 Hannover, Germany
| | - Berna I Richter
- Department of Orthopaedic Surgery, Hannover Medical School, Anna-von-Borries-Str. 3, 30625 Hannover, Germany
| | - Christoph Becher
- Department of Orthopaedic Surgery, Hannover Medical School, Anna-von-Borries-Str. 3, 30625 Hannover, Germany
| | - Marco Ezechieli
- Department of Orthopaedic Surgery, Hannover Medical School, Anna-von-Borries-Str. 3, 30625 Hannover, Germany
| | - Sven Ostermeier
- Department of Orthopaedic Surgery, Hannover Medical School, Anna-von-Borries-Str. 3, 30625 Hannover, Germany
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23
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Thienpont E, Schwab PE, Omoumi P. Wear patterns in anteromedial osteoarthritis of the knee evaluated with CT-arthrography. Knee 2014; 21 Suppl 1:S15-9. [PMID: 25382362 DOI: 10.1016/s0968-0160(14)50004-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [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: 05/18/2014] [Revised: 08/17/2014] [Accepted: 08/20/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To analyze the value of CT-arthrography imaging in the diagnosis of knee osteoarthritis and to facilitate the selection of partial versus total knee replacement. METHODS A retrospective study of 100 patients that had either medial unicompartmental knee replacement (UKR) (N=50) or total knee replacement (TKR) (N=50). One observer measured lower limb mechanical alignment and osteoarthritis patterns of the knee in each compartment with radiographs, CT-arthrography and full leg standing radiographs. RESULTS All patients had Kellgren-Lawrence grade IV osteoarthritis of the medial femorotibial joint with a mean (SD) varus alignment of the lower limb (172° (3.5°) HKA-angle). Zone mechanical axis distribution showed strong correlation with HKA-axis. Arthritis patterns were different for patients selected for UKR or TKR. UKR patients had anteromedial osteoarthritis and wear of the medial facet of the patella in contrast to TKR patients who had medial osteoarthritis associated with diffuse or lateral patellofemoral wear and wear of the central or posterior zones of the lateral compartment. Medial facet wear of the patella is related to more important varus alignment of the lower limb (Kennedy zone 0 and 1). CONCLUSION CT-arthrography imaging can show lesions that are not visible on plain or stress radiographs because of central or posterior localization with surrounding intact cartilage. Patients who develop tri-compartmental osteoarthritis despite varus alignment have probably other risk factors than their mechanical alignment and should be considered candidates for TKR.
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Affiliation(s)
- Emmanuel Thienpont
- Department of Orthopaedic Surgery, Cliniques universitaires Saint Luc, Brussels, Belgium.
| | - Pierre-Emmanuel Schwab
- Department of Orthopaedic Surgery, Cliniques universitaires Saint Luc, Brussels, Belgium
| | - Patrick Omoumi
- Department of Radiology, Cliniques universitaires Saint Luc, Brussels, Belgium
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