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Glatzeder K, Igor K, Ambellan F, Zachow S, Potthast W. Dynamic pressure analysis of novel interpositional knee spacer implants in 3D-printed human knee models. Sci Rep 2022; 12:16853. [PMID: 36207344 PMCID: PMC9546830 DOI: 10.1038/s41598-022-20463-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 09/13/2022] [Indexed: 11/09/2022] Open
Abstract
Alternative treatment methods for knee osteoarthritis (OA) are in demand, to delay the young (< 50 Years) patient's need for osteotomy or knee replacement. Novel interpositional knee spacers shape based on statistical shape model (SSM) approach and made of polyurethane (PU) were developed to present a minimally invasive method to treat medial OA in the knee. The implant should be supposed to reduce peak strains and pain, restore the stability of the knee, correct the malalignment of a varus knee and improve joint function and gait. Firstly, the spacers were tested in artificial knee models. It is assumed that by application of a spacer, a significant reduction in stress values and a significant increase in the contact area in the medial compartment of the knee will be registered. Biomechanical analysis of the effect of novel interpositional knee spacer implants on pressure distribution in 3D-printed knee model replicas: the primary purpose was the medial joint contact stress-related biomechanics. A secondary purpose was a better understanding of medial/lateral redistribution of joint loading. Six 3D printed knee models were reproduced from cadaveric leg computed tomography. Each of four spacer implants was tested in each knee geometry under realistic arthrokinematic dynamic loading conditions, to examine the pressure distribution in the knee joint. All spacers showed reduced mean stress values by 84-88% and peak stress values by 524-704% in the medial knee joint compartment compared to the non-spacer test condition. The contact area was enlarged by 462-627% as a result of the inserted spacers. Concerning the appreciable contact stress reduction and enlargement of the contact area in the medial knee joint compartment, the premises are in place for testing the implants directly on human knee cadavers to gain further insights into a possible tool for treating medial knee osteoarthritis.
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Affiliation(s)
- Korbinian Glatzeder
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933, Cologne, Germany.
| | - Komnik Igor
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933, Cologne, Germany
| | - Felix Ambellan
- Zuse Institute Berlin (ZIB), Takustraße 7, 14195, Berlin, Germany.,Freie Universität Berlin, Kaiserswerther Str. 16-18, Berlin, Germany
| | - Stefan Zachow
- Zuse Institute Berlin (ZIB), Takustraße 7, 14195, Berlin, Germany
| | - Wolfgang Potthast
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933, Cologne, Germany
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2
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Choh ACT, Yew A, Yeo SJ, Chong DYR, Chia S. Finite element analysis of tibio‐femoral contact mechanics of a customised knee spacer. BIOSURFACE AND BIOTRIBOLOGY 2022. [DOI: 10.1049/bsb2.12035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Alex C. T. Choh
- Department of Orthopaedic Surgery Singapore General Hospital Singapore Singapore
| | - Andy Yew
- Department of Orthopaedic Surgery Singapore General Hospital Singapore Singapore
| | - Seng Jin Yeo
- Department of Orthopaedic Surgery Singapore General Hospital Singapore Singapore
| | | | - Shi‐Lu Chia
- Department of Orthopaedic Surgery Singapore General Hospital Singapore Singapore
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3
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Austin MS, Ashley BS, Bedard NA, Bezwada HP, Hannon CP, Fillingham YA, Kolwadkar YV, Rees HW, Grosso MJ, Zeegen EN. What is the Level of Evidence Substantiating Commercial Payers' Coverage Policies for Total Joint Arthroplasty? J Arthroplasty 2021; 36:2665-2673.e8. [PMID: 33867209 DOI: 10.1016/j.arth.2021.03.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 03/08/2021] [Accepted: 03/14/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The prevalence of total joint arthroplasty (TJA) in the United States has drawn the attention of health care stakeholders. The payers have also used a variety of strategies to regulate the medical necessity of these procedures. The purpose of this study was to examine the level of evidence of the coverage policies being used by commercial payers in the United States. METHODS The references of the coverage policies of four commercial insurance companies were reviewed for type of document, level of evidence, applicability to a TJA population, and success of nonoperative treatment in patients with severe degenerative joint disease. RESULTS 282 documents were reviewed. 45.8% were primary journal articles, 14.2% were level I or II, 41.2% were applicable to patients who were candidates for TJA, and 9.9% discussed the success of nonoperative treatment in patients who would be candidates for TJA. CONCLUSION Most of the references cited by commercial payers are of a lower level of scientific evidence and not applicable to patients considered to be candidates for TJA. This is relatively uniform across the reviewed payers. The dearth of high-quality literature cited by commercial payers reflects the lack of evidence and difficulty in conducting high level studies on the outcomes of nonoperative versus operative treatment for patients with severe, symptomatic osteoarthritis. Patients, surgeons, and payers would all benefit from such studies and we encourage professional societies to strive toward that end through multicenter collaboration.
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Affiliation(s)
- Matthew S Austin
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Blair S Ashley
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Nicholas A Bedard
- Department of Orthopaedic Surgery, University of Iowa Hospitals & Clinics, Iowa City, IA
| | | | - Charles P Hannon
- Department of Orthopaedic Surgery, The Mayo Clinic, Ochester, MN
| | - Yale A Fillingham
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Yogesh V Kolwadkar
- Department of Orthopaedic Surgery, VA Central California Health Care System, Fresno, CA
| | - Harold W Rees
- Department of Orthopaedic Surgery, Loyola University Medical Center, Maywood, IL
| | - Matthew J Grosso
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA; Connecticut Joint Replacement Institute, Hartford, CT
| | - Erik N Zeegen
- Department of Orthopaedic Surgery, University of California Los Angeles, Santa Monica, CA
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4
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Palmer JS, Monk AP, Hopewell S, Bayliss LE, Jackson W, Beard DJ, Price AJ. Surgical interventions for symptomatic mild to moderate knee osteoarthritis. Cochrane Database Syst Rev 2019; 7:CD012128. [PMID: 31322289 PMCID: PMC6639936 DOI: 10.1002/14651858.cd012128.pub2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Osteoarthritis affecting the knee is common and represents a continuum of disease from early cartilage thinning to full-thickness cartilage loss, bony erosion, and deformity. Many studies do not stratify their results based on the severity of the disease at baseline or recruitment. OBJECTIVES To assess the benefits and harms of surgical intervention for the management of symptomatic mild to moderate knee osteoarthritis defined as knee pain and radiographic evidence of non-end stage osteoarthritis (Kellgren-Lawrence grade 1, 2, 3 or equivalent on MRI/arthroscopy). Outcomes of interest included pain, function, radiographic progression, quality of life, short-term serious adverse events, re-operation rates and withdrawals due to adverse events. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and Embase up to May 2018. We also conducted searches of ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform for ongoing trials. Authors of trials were contacted if some but not all their participants appeared to fit our inclusion criteria. SELECTION CRITERIA We included randomised controlled trials that compared surgery to non-surgical interventions (including sham and placebo control groups, exercise or physiotherapy, and analgesic or other medication), injectable therapies, and trials that compared one type of surgical intervention to another surgical intervention in people with symptomatic mild to moderate knee osteoarthritis. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials and extracted data using standardised forms. We analysed the quality of evidence using the GRADE (Grades of Recommendation, Assessment, Development and Evaluation) approach. MAIN RESULTS A total of five studies involving 566 participants were identified as eligible for this review. Single studies compared arthroscopic partial meniscectomy to physical therapy (320 participants), arthroscopic surgery (debridement ± synovectomy ± chondroplasty) to closed needle joint lavage with saline (32 participants) and high tibial osteotomy surgery to knee joint distraction surgery (62 participants). Two studies (152 participants) compared arthroscopic surgery (washout ± debridement; debridement) to a hyaluronic acid injection. Only one study was at low risk of selection bias, and due to the difficulty of blinding participants to their treatment, all studies were at risk of performance and detection bias.Reporting of results in this summary has been restricted to the primary comparison: surgical intervention versus non-surgical intervention.A single study, included 320 participants with symptoms consistent with meniscal tear. All subjects had the meniscal tear confirmed on knee MRI and radiographic evidence of mild to moderate osteoarthritis (osteophytes, cartilage defect or joint space narrowing). Patients with severe osteoarthritis (KL grade 4) were excluded. The study compared arthroscopic partial meniscectomy and physical therapy to physical therapy alone (a six-week individualised progressive home exercise program). This study was at low risk of selection bias and outcome reporting biases, but was susceptible to performance and detection biases. A high rate of cross-over (30.2%) occurred from the physical therapy group to the arthroscopic group.Low-quality evidence suggests there may be little difference in pain and function at 12 months follow-up in people who have arthroscopic partial meniscectomy and those who have physical therapy. Evidence was downgraded to low quality due to risk of bias and imprecision.Mean pain was 19.3 points on a 0 to 100 point KOOS pain scale with physical therapy at 12 months follow-up and was 0.2 points better with surgery (95% confidence interval (CI) 4.05 better to 3.65 points worse with surgery, an absolute improvement of 0.2% (95% CI 4% better to 4% worse) and relative improvement 0.4% (95% CI 9% better to 8% worse) (low quality evidence). Mean function was 14.5 on a 0 to 100 point KOOS function scale with physical therapy at 12 months follow-up and 0.8 points better with surgery (95% CI 4.3 better to 2.7 worse); 0.8% absolute improvement (95% CI 4% better to 3% worse) and 2.1% relative improvement (95% CI 11% better to 7% worse) (low quality evidence).Radiographic structural osteoarthritis progression and quality of life outcomes were not reported.Due to very low quality evidence, we are uncertain if surgery is associated with an increased risk of serious adverse events, incidence of total knee replacement or withdrawal rates. Evidence was downgraded twice due to very low event rates, and once for risk of bias.At 12 months, the surgery group had a total of three serious adverse events including fatal pulmonary embolism, myocardial infarction and hypoxaemia. The physical therapy alone group had two serious adverse events including sudden death and stroke (Peto OR 1.58, 95% CI 0.27 to 9.21); 1% more events with surgery (95% CI 2% less to 3% more) and 58% relative change (95% CI 73% less to 821% more). One participant in each group withdrew due to adverse events.Two of 164 participants (1.2%) in the physical therapy group and three of 156 in the surgery group underwent conversion to total knee replacement within 12 months (Peto OR 1.76, 95% CI 0.43 to 7.13); 1% more events with surgery (95% CI 2% less to 5% more); 76% relative change (95% CI 57% less to 613% more). AUTHORS' CONCLUSIONS The review found no placebo-or sham-controlled trials of surgery in participants with symptomatic mild to moderate knee osteoarthritis. There was low quality evidence that there may be no evidence of a difference between arthroscopic partial meniscectomy surgery and a home exercise program for the treatment of this condition. Similarly, low-quality evidence from a few small trials indicates there may not be any benefit of arthroscopic surgery over other non-surgical treatments including saline irrigation and hyaluronic acid injection, or one type of surgery over another. We are uncertain of the risk of adverse events or of progressing to total knee replacement due to very small event rates. Thus, there is uncertainty around the current evidence to support or oppose the use of surgery in mild to moderate knee osteoarthritis. As no benefit has been demonstrated from the low quality trials included in this review, it is possible that future higher quality trials for these surgical interventions may not contradict these results.
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Affiliation(s)
- Jonathan S Palmer
- University of OxfordNuffield Department of Orthopaedics, Rheumatology and Musculoskeletal SciencesWindmill Road, HeadingtonOxfordUKOX3 7LD
| | - A Paul Monk
- University of OxfordNuffield Department of Orthopaedics, Rheumatology and Musculoskeletal SciencesWindmill Road, HeadingtonOxfordUKOX3 7LD
| | - Sally Hopewell
- University of OxfordNuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS)Botnar Research Centre, Windmill RoadOxfordOxfordshireUKOX3 7LD
| | - Lee E Bayliss
- University of OxfordNuffield Department of Orthopaedics, Rheumatology and Musculoskeletal SciencesWindmill Road, HeadingtonOxfordUKOX3 7LD
| | - William Jackson
- Oxford University Hospitals NHS TrustNuffield Orthopaedic CentreWindmill RoadOxfordUKOX3 7LD
| | - David J Beard
- University of OxfordNuffield Department of Orthopaedics, Rheumatology and Musculoskeletal SciencesWindmill Road, HeadingtonOxfordUKOX3 7LD
| | - Andrew J Price
- University of OxfordNuffield Department of Orthopaedics, Rheumatology and Musculoskeletal SciencesWindmill Road, HeadingtonOxfordUKOX3 7LD
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Bruni D, Zaffagnini S, Iacono F, Bragonzoni L, Lo Presti M, Neri MP, Muccioli GMM, Nitri M, Raspugli G, Marcacci M. High rate of implant loosening for uncemented resurfacing-type medial unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2016; 24:3175-3182. [PMID: 25416675 DOI: 10.1007/s00167-014-3444-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2013] [Accepted: 11/13/2014] [Indexed: 12/12/2022]
Abstract
PURPOSE To determine the medium-term implant survivorship, the clinical results and the failure mechanisms of a novel unicompartmental arthroplasty for uncemented resurfacing of the medial tibio-femoral compartment. METHODS Seventy-six consecutive patients were prospectively evaluated with a mean final follow-up of 6 years (SD 5.3 months). In 44 patients, the diagnosis was osteoarthritis, and in 32 patients, it was avascular necrosis of the medial femoral condyle. The Hospital for Special Surgery Score was used for objective clinical evaluation, and a self-administered visual analogue scale was used to quantify residual pain at each observation point. Implant survivorship was determined assuming revision for any reason as endpoint. RESULTS Nineteen patients were revised (6 with osteoarthritis and 13 with avascular necrosis of the medial femoral condyle). The mean interval time from index surgery to revision was 11.2 months (SD 4.66 months). Implant survivorship was higher in patients with osteoarthritis with respect to those with avascular necrosis of the medial femoral condyle (p = 0.018). Aseptic loosening was the most frequent failure mechanism. Femoral component loosening was reported in five patients and tibial component loosening was reported in other six patients. Assuming revision for any reason as endpoint, an implant survivorship of 74.3 % at 6-year follow-up was determined. In the remaining 57 patients, satisfactory clinical results were obtained. Hospital for Special Surgery Score and visual analogue scale for residual pain showed significant improvements (p < 0.03 and p < 0.045, respectively). CONCLUSIONS At the present time, the standard cemented implants and the conventional designs for unicompartmental knee replacement still represent the optimal solution. The authors do not recommend the widespread use of this technique. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Danilo Bruni
- 2nd Orthopaedics and Traumatologic Clinic, Rizzoli Orthopaedic Institute, Via Pupilli 1, 40136, Bologna, Italy. .,Biomechanics and Technologic Innovation Laboratory, Codivilla-Putti Research Center, Via di Barbiano 1/10, 40136, Bologna, Italy. .,Bologna University, Bologna, Italy.
| | - Stefano Zaffagnini
- 2nd Orthopaedics and Traumatologic Clinic, Rizzoli Orthopaedic Institute, Via Pupilli 1, 40136, Bologna, Italy
| | - Francesco Iacono
- 2nd Orthopaedics and Traumatologic Clinic, Rizzoli Orthopaedic Institute, Via Pupilli 1, 40136, Bologna, Italy
| | - Laura Bragonzoni
- Biomechanics and Technologic Innovation Laboratory, Codivilla-Putti Research Center, Via di Barbiano 1/10, 40136, Bologna, Italy.,Bologna University, Bologna, Italy
| | - Mirco Lo Presti
- 2nd Orthopaedics and Traumatologic Clinic, Rizzoli Orthopaedic Institute, Via Pupilli 1, 40136, Bologna, Italy
| | - Maria Pia Neri
- 2nd Orthopaedics and Traumatologic Clinic, Rizzoli Orthopaedic Institute, Via Pupilli 1, 40136, Bologna, Italy
| | | | - Marco Nitri
- 2nd Orthopaedics and Traumatologic Clinic, Rizzoli Orthopaedic Institute, Via Pupilli 1, 40136, Bologna, Italy
| | - Giovanni Raspugli
- 2nd Orthopaedics and Traumatologic Clinic, Rizzoli Orthopaedic Institute, Via Pupilli 1, 40136, Bologna, Italy
| | - Maurilio Marcacci
- 2nd Orthopaedics and Traumatologic Clinic, Rizzoli Orthopaedic Institute, Via Pupilli 1, 40136, Bologna, Italy.,Biomechanics and Technologic Innovation Laboratory, Codivilla-Putti Research Center, Via di Barbiano 1/10, 40136, Bologna, Italy.,Bologna University, Bologna, Italy
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6
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Palmer JS, Monk AP, Hopewell S, Bayliss LE, Jackson W, Beard DJ, Price AJ. Surgical interventions for early structural knee osteoarthritis. Hippokratia 2016. [DOI: 10.1002/14651858.cd012128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Jonathan S Palmer
- University of Oxford; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences; Windmill Road, Headington Oxford UK OX3 7LD
| | - A Paul Monk
- University of Oxford; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences; Windmill Road, Headington Oxford UK OX3 7LD
| | - Sally Hopewell
- University of Oxford; Oxford Clinical Trials Research Unit; NDORMS Windmill Road Oxford Oxfordshire UK OX3 7LD
| | - Lee E Bayliss
- University of Oxford; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences; Windmill Road, Headington Oxford UK OX3 7LD
| | - William Jackson
- Oxford University Hospitals NHS Trust; Nuffield Orthopaedic Centre; Windmill Road Oxford UK OX3 7LD
| | - David J Beard
- University of Oxford; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences; Windmill Road, Headington Oxford UK OX3 7LD
| | - Andrew J Price
- University of Oxford; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences; Windmill Road, Headington Oxford UK OX3 7LD
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Stiebel M, Miller LE, Block JE. Post-traumatic knee osteoarthritis in the young patient: therapeutic dilemmas and emerging technologies. Open Access J Sports Med 2014; 5:73-9. [PMID: 24744616 PMCID: PMC3986283 DOI: 10.2147/oajsm.s61865] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Traumatic knee injury is common in young adults and strongly contributes to premature development of knee osteoarthritis (OA). Post-traumatic knee OA poses a therapeutic dilemma to the physician, since no known therapy has an acceptable safety profile, effectively relieves joint pain, and enjoys reasonable patient acceptance. Consequently, these young patients will ultimately be faced with the decision to either undergo surgical intervention, despite prosthesis durability concerns, or to continue with ineffective nonsurgical treatment. Emerging therapies, such as biologics, disease-modifying drugs, partial joint resurfacings, and minimally invasive joint-unloading implants are currently being studied to fill this therapeutic void in the young patient with post-traumatic knee OA.
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Affiliation(s)
| | - Larry E Miller
- Miller Scientific Consulting, Inc, Asheville, NC, USA ; The Jon Block Group, San Francisco, CA, USA
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Arendt EA, Miller LE, Block JE. Early knee osteoarthritis management should first address mechanical joint overload. Orthop Rev (Pavia) 2014; 6:5188. [PMID: 24744839 PMCID: PMC3980155 DOI: 10.4081/or.2014.5188] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 01/30/2014] [Accepted: 02/10/2014] [Indexed: 12/12/2022] Open
Abstract
Early knee osteoarthritis poses a therapeutic dilemma to the musculoskeletal clinician. Despite the recent interest in arthroscopic and injectable regenerative therapies intended to repair or restore a focal target such as cartilage, meniscus, or subchondral bone, none have been shown to slow disease progression. A likely cause of these disappointing treatment outcomes is the failure to address chronic and excessive loading of the knee joint. A growing body of evidence suggests that first-line therapies for early knee osteoarthritis should emphasize unloading the knee joint since any potential therapeutic benefit of regenerative therapies will likely be attenuated by excessive mechanical demand at the knee joint. Minimally invasive medical devices such as patient-specific interpositional implants and extracapsular joint unloading implants are currently in development to address this clinical need.
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Affiliation(s)
- Elizabeth A Arendt
- Department of Orthopedic Surgery, University of Minnesota , Minneapolis, MN, USA
| | - Larry E Miller
- Miller Scientific Consulting Inc., Asheville, NC, USA ; The Jon Block Group, San Francisco, CA, USA
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9
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Marcacci M, Bruni D, Zaffagnini S, Iacono F, Lo Presti M, Neri MP, Giovanni R. Arthroscopic-assisted focal resurfacing of the knee: surgical technique and preliminary results of 13 patients at 2 years follow-up. Knee Surg Sports Traumatol Arthrosc 2011; 19:740-6. [PMID: 21161175 DOI: 10.1007/s00167-010-1345-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Accepted: 11/19/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE The purpose of this study is to describe an arthroscopic-assisted surgical technique for focal resurfacing of medial tibio-femoral compartment and to present the preliminary clinical and radiographic results in a case series of 13 consecutive patients at a mean follow-up of 29 months. METHODS All patients were treated with the presented procedure for Ahlback grade 3 medial compartment osteoarthritis. Subjective evaluation was based on a visual analog scale for pain self-assessment. Objective clinical evaluation was based on Hospital for Special Surgery score. Range of motion was evaluated with a manual goniometer. Radiographic evaluation compared hip-knee-ankle angle pre- and post-operatively. RESULTS Clinical and functional results were satisfactory. Hospital for Special Surgery score and visual analog scale for pain self-assessment showed significant improvements (P < 0.0001 and P = 0.0002, respectively). ROM and axial alignment were not significantly different respect to pre-operative values. CONCLUSIONS Despite the small sample size and short follow-up, this study has shown that an arthroscopic-assisted focal resurfacing of the knee in selected cases can be a viable option for early onset degenerative joint disease, providing satisfactory pain relief and good functional results at 2 years follow-up. LEVEL OF EVIDENCE Retrospective case series, Level IV.
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Affiliation(s)
- Maurilio Marcacci
- 3rd Orthopaedics and Traumatologic Clinic, Rizzoli Orthopaedic Institute, Via Pupilli 1, 40136, Bologna, Italy
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10
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Heyse TJ, Tibesku CO. Lateral unicompartmental knee arthroplasty: a review. Arch Orthop Trauma Surg 2010; 130:1539-48. [PMID: 20559645 DOI: 10.1007/s00402-010-1137-9] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2010] [Indexed: 10/19/2022]
Abstract
Lateral unicondylar knee arthroplasty (UKA) has been utilized as a treatment for isolated lateral tibiofemoral osteoarthritis (OA) since the first description of UKA in the 1970s. To date, there remains some controversy on UKA procedures. As indications for lateral UKA are usually rare, surgeon experience seems to be the key factor for a successful intervention. Better understanding of biomechanics of the knee joint, recent developments in prosthesis design, surgical techniques and indications may add to improved outcomes of lateral UKA. Alternatives that are applied to treat lateral tibiofemoral OA include arthroscopic interventions, osteotomies and total knee arthroplasty (TKA). In comparison with TKA, potential advantages of UKA include a minimally or less invasive approach, less bone resection, preservation of the cruciate ligaments, preservation of the medial tibiofemoral and the patellofemoral compartments, shorter rehabilitation, and physiological knee kinematics. This review aims to summarize the current concepts of implant designs as well as indications and contraindications for lateral UKA. The literature will be presented and discussed as well as results and realistic expectations on both the surgeon's and the patient's side. Alternative treatments and future concepts for lateral UKA will be presented.
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Affiliation(s)
- Thomas J Heyse
- Department of Orthopedics and Rheumatology, University Hospital Marburg, Baldingerstrasse, 35043, Marburg, Germany.
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