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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] [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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D'Ambrosi R, Milinkovic DD, Migliorini F, Mariani I, Ursino N, Hewett T. Learning curve of Persona Partial Knee (PPK) arthroplasty: a clinical trial. BMC Musculoskelet Disord 2024; 25:128. [PMID: 38341539 PMCID: PMC10858461 DOI: 10.1186/s12891-024-07215-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 01/19/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Unicompartmental knee arthroplasty (UKA) procedures are considered to be more technically demanding than conventional total knee arthroplasty (TKA), requiring a longer learning curve and more expert surgical skills. Despite some clear advantages of UKA over TKA (such as lesser blood loss, greater bone stock, greater knee performances, etc.), UKA evidenced a greater rate of revision. OBJECT This study investigated the learning curve of Persona Partial Knee (PPK) arthroplasty for primary medial UKA performed by a single, non-designer surgeon. PPK is a fixed-bearing, compartment-specific implant. The primary outcome of interest for this study was to evaluate the learning curve of the surgical duration. The secondary outcome of interest was to evaluate the learning curve of radiological implant positioning. METHODS Patients who underwent primary medial UKA using PPK (Zimmer-Biomet, Warsaw IN, USA) were prospectively enrolled for the study. All surgeries were performed by a single, non-designer surgeon experienced in knee and hip arthroplasty. The primary outcome of interest was to evaluate the surgical duration. The secondary outcome of interest was to evaluate the implant positioning. The learning curve was estimated using an appropriate nonlinear polynomial regression model with a lower Akaike Information Criterion (AIC). RESULTS One hundred twenty five patients were enrolled in the study. 59% of them (74 of 125 patients) were women. The patients' mean age at the time of surgery was 70.1 ± 9.5 years and their mean body mass index (BMI) was 27.8 ± 4.2 kg/m2. Curve stabilisation of the surgical time was at the 94th patient, of the tibial angle at the 47th patient, of the tibial slope at the 54th patient, of the anterior protrusion at the 29th patient, and of the posterior protrusion at the 51st patient. CONCLUSIONS The learning curve for component positioning was achieved in approximately 50 cases. The curve of the surgical time achieved a plateau at 94 Persona Partial Knee. Additionally, the factors directly correlated with earlier stabilization of the learning curve in terms of component positioning were: male gender, younger age, right side, and larger components.
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Affiliation(s)
- Riccardo D'Ambrosi
- IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
- Dipartimento Di Scienze Biomediche Per La Salute, Università Degli Studi Di Milano, Milan, Italy
| | - Danko Dan Milinkovic
- Department of Orthopedic and Trauma Surgery, Arcus Sportclinic, Pforzheim, Germany
| | - Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Medical Centre, Pauwelsstraße 30, 52074, Aachen, Germany.
- Department of Orthopaedic and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical University, 39100, Bolzano, Italy.
| | - Ilaria Mariani
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
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Marullo M, Tandogan RN, Kort N, Meena A, Attri M, Gomberg B, D'Ambrosi R. Trends in unicompartmental knee arthroplasty among 138 international experienced arthroplasty knee surgeons. Heliyon 2024; 10:e24307. [PMID: 38304773 PMCID: PMC10830546 DOI: 10.1016/j.heliyon.2024.e24307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 01/05/2024] [Accepted: 01/05/2024] [Indexed: 02/03/2024] Open
Abstract
Purpose Unicompartmental knee arthroplasty (UKA) is an established option for treating isolated unicompartmental knee osteoarthritis (OA), but controversies still exist about patient selection, indications, perioperative management and alignment goals. This survey was designed to understand the current trends of experienced arthroplasty knee surgeons performing UKA. Methods An online questionnaire was created with SurveyMonkey® to assess global tendencies in the utilization of UKA. A link to the survey was shared with all ESSKA (European Society for Sports Traumatology, Knee Surgery and Arthroscopy) members. The questionnaire consisted of free and multiple-choice questions and was divided into four sections: demographic information, the surgical activity of the respondents, indications for surgery and postoperative alignment goals. Results A total of 138 ESSKA members from 34 different countries completed the survey. A total of 81 % of the responders performed fewer than 50 UKAs per year; 53 % of UKAs represented less than 20 % of their knee replacements; 71 % used mainly or only fixed-bearing implants; 81 % performed UKA in a shorter time compared to TKA; and 61 % and 72 % were interested in custom-made UKA and robotics, respectively. Thirty-six percent considered a minimum postoperative alignment of 0° for medial UKA, and 32 % considered 10° as the maximum valgus deformity for lateral UKA. Fifty-five percent had no minimum age cut-off, 47 % had no BMI cut-off, and 57 % believed TKA was better than UKA in knees with concomitant high-grade patellofemoral OA. Approximately 50 % of the surgeons desired a coronal alignment that was the same as the predegeneration alignment. Conclusion A high level of agreement was reached regarding the following: preference for fixed-bearing UKAs, lower surgical time for UKA compared to TKA, interest in custom-made and robotic UKAs, no age and weight cut-off, TKA preferred in the presence of patellofemoral OA, and a final alignment goal of the predegenerative state both for medial and lateral. There was no agreement regarding length of stay, rehabilitation protocol, preoperative varus and valgus cut-off values, and treatment in cases of absence of anterior cruciate ligament or previous osteotomy.
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Affiliation(s)
| | - Reha N. Tandogan
- Department of Orthopaedics and Traumatology, Emsey Hospital, Istanbul, Turkey
- Department of Orthopaedics and Traumatology, Halic University Istanbul & Cankaya Orthopedics, Ankara, Turkey
| | | | - Amit Meena
- Gelenkpunkt – Sports and Joint Surgery, FIFA Medical Centre of Excellence, Innsbruck, Austria
| | - Manish Attri
- Central Institute of Orthopaedics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Bruce Gomberg
- Northern Light Mercy Orthopaedics, Portland, ME, USA
| | - Riccardo D'Ambrosi
- IRCCS Ospedale Galeazzi – Sant’Ambrogio, Milan, Italy
- Università Degli Studi di Milano, Dipartimento di Scienze Biomediche per La Salute, Milan, Italy
| | - EKA Small Implants Focus Group
- IRCCS Ospedale Galeazzi – Sant’Ambrogio, Milan, Italy
- Department of Orthopaedics and Traumatology, Emsey Hospital, Istanbul, Turkey
- Department of Orthopaedics and Traumatology, Halic University Istanbul & Cankaya Orthopedics, Ankara, Turkey
- CortoClinics, Nederweert, Netherlands
- Gelenkpunkt – Sports and Joint Surgery, FIFA Medical Centre of Excellence, Innsbruck, Austria
- Central Institute of Orthopaedics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
- Northern Light Mercy Orthopaedics, Portland, ME, USA
- Università Degli Studi di Milano, Dipartimento di Scienze Biomediche per La Salute, Milan, Italy
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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] [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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