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Royon T, Foissey C, Fontalis A, Planchet F, Servien E, Batailler C, Lustig S. Gender does not influence outcomes and complications in medial unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38680026 DOI: 10.1002/ksa.12195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 03/19/2024] [Accepted: 03/26/2024] [Indexed: 05/01/2024]
Abstract
PURPOSE The impact of gender on the outcomes of unicompartmental knee arthroplasty (UKA) remains a topic of active discussion with limited exploration thus far. The study aims to elucidate the gender effect on clinical outcomes, complications, pre- and postoperative radiological outcomes following the implantation of a medial UKA at mid-term follow-up in a large section of patients. METHODS This was a single-centre, retrospective cohort study encompassing patients undergoing medial UKA between 2011 and 2019. The International Knee Society (IKS) Knee and Function score, patient satisfaction, complications, revisions, pre- and postoperative radiological outcomes (coronal plane alignment, femoral and tibial component positioning, posterior tibial slope) were evaluated. Survival rate at the time of the last follow-up was also recorded. RESULTS Of the 366 knees that met the inclusion criteria, 10 were lost to follow-up, accounting for a 2.7% loss. Mean follow-up was 5.2 ± 2 years [2.1-11.3]. Out of the total population, 205 patients were females (57.6%, 205/356) and 151 were males (42.4%, 151/356). Men exhibited superior pre- and postoperative IKS function scores (p = 0.017). However, no significant differences were observed between women and men regarding improvements of IKS Knee and Function scores, radiographic outcomes and implant survivorship. CONCLUSION At a mean follow-up of 5 years, this study revealed no significant impact of gender on clinical outcomes and complications in patients undergoing medial UKA. Furthermore, no significant differences were evident in radiographic outcomes, implant positioning and knee phenotype. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Thibaut Royon
- Department of Orthopedic Surgery, Lausanne University Hospital-Centre Hospitalier Universitaire Vaudois-CHUV, Hôpital Orthopédique, Lausanne, Switzerland
| | - Constant Foissey
- Orthopaedics surgery and Sports Medicine Department, FIFA Medical Centre of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France
| | - Andreas Fontalis
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Fréderic Planchet
- Laboratoire SAF EA2429, F-69366, Institut de Science Financière et d'Assurances (ISFA), Univ Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Elvire Servien
- Orthopaedics surgery and Sports Medicine Department, FIFA Medical Centre of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France
- LIBM-EA 7424, Interuniversity Laboratory of Biology of Mobility, Claude Bernard Lyon 1 Universit, Lyon, France
| | - Cécile Batailler
- Orthopaedics surgery and Sports Medicine Department, FIFA Medical Centre of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France
| | - Sébastien Lustig
- Orthopaedics surgery and Sports Medicine Department, FIFA Medical Centre of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France
- IFSTTAR, LBMC UMR_T9406, Univ Lyon, Claude Bernard Lyon 1 University, Lyon, France
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Lee SH, Labott JR, Perico DA, Guarin Perez SF, Sierra RJ. Femoral Coronal Malalignment is Associated With Failure in Mobile-Bearing Medial Unicompartmental Knee Arthroplasty. J Arthroplasty 2024:S0883-5403(24)00308-5. [PMID: 38604276 DOI: 10.1016/j.arth.2024.03.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 03/21/2024] [Accepted: 03/25/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Femur-first (FF) technique for mobile-bearing medial unicompartmental knee arthroplasty (UKA) has been described as an alternative to tibia-first (TF) technique. The aim of this study was to compare the radiographic results in UKAs using FF or TF techniques and their influence on failure rates. METHODS We retrospectively reviewed 288 UKAs with a minimum 2-year follow-up. There were 147 knees in the TF and 141 knees in the FF cohorts. Alignment parameters and overhang were assessed as outliers and far outliers. The mean follow-up was 6 years (range, 2 to 16), the mean age was 63 years (range, 27 to 92), and 45% of patients were women. Univariate and multivariate statistical analyses were carried out with Cox regression models. RESULTS There were 13 and 6 revisions in the TF and FF cohorts, respectively. The FF had lower rates of femoral coronal alignment (FCA) or femoral sagittal alignment outliers compared to the TF (5.7% versus 19%, P = .011). Tibial coronal alignment and tibial sagittal alignment did not significantly differ between the techniques (22.7% in FF versus 29.9% in TF, P = .119). Overhang outliers did not differ significantly between the groups. Younger age was associated with a higher revision rate (P = .006), while FF versus TF, sex, body mass index, and postoperative mechanical axis did not show statistically significant associations. In multivariate analysis, FCA outliers and younger age were significantly associated with revision. CONCLUSIONS The FF technique in mobile-bearing UKA resulted in fewer FCA outliers compared to TF. Despite improved knee alignment with the FF technique, FCA outliers and younger age were associated with a higher revision rate, independent of technique.
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Affiliation(s)
- Sheng-Hsun Lee
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota; Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Josh R Labott
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | | | - Rafael J Sierra
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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Deckey DG, Boddu SP, Christopher ZK, Spangehl MJ, Clarke HD, Gililland JM, Bingham JS. Rheumatoid Arthritis Is Not a Contraindication to Unicompartmental Knee Arthroplasty. J Arthroplasty 2024:S0883-5403(24)00187-6. [PMID: 38428692 DOI: 10.1016/j.arth.2024.02.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 02/16/2024] [Accepted: 02/21/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND Rheumatoid arthritis (RA) has historically been considered a contraindication for unicompartmental knee arthroplasty (UKA). However, the widespread use of disease-modifying antirheumatic drugs has substantially improved the management of RA and prevented disease progression. The objective of this study was to ascertain whether RA impacts UKA revision-free survivorship. METHODS Patients undergoing UKA from 2010 to 2021 were identified in an administrative claims database (n = 105,937) using Current Procedural Terminology code 27446. All patients who underwent UKA who had a diagnosis of RA with a minimum of 2-year follow-up (n = 1,422) were propensity score matched based on age, sex, and Elixhauser Comorbidity Index to those who did not have RA (n = 1,422). Laterality was identified using the 10th Revision of International Classification of Diseases codes. The primary outcome was ipsilateral revision to total knee arthroplasty (TKA) within 2 years, and the secondary outcome was ipsilateral revision at any time. RESULTS Among the 1,422 patients who had a UKA and a diagnosis of RA, 37 patients (2.6%) underwent conversion to TKA within 2 years, and 48 patients (3.4%) underwent conversion to TKA at any point. In comparison, 28 patients (2.0%) in the propensity-matched control group underwent conversion to TKA within 2 years, and 40 patients (2.8%) underwent conversion to TKA at any point. Statistical analysis revealed no significant difference in conversion to TKA between patients who had and did not have RA, either within 2 years (P = .31) or anytime (P = .45). CONCLUSIONS Patients who had RA and underwent UKA did not have an increased risk of revision to TKA compared to those who did not have RA. This may indicate that modern management of RA could allow for expanded UKA indications for RA patients.
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Affiliation(s)
- David G Deckey
- Department of Orthopaedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona
| | - Sayi P Boddu
- Alix School of Medicine, Mayo Clinic, Scottsdale, Arizona
| | - Zachary K Christopher
- Department of Orthopaedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona; Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah
| | - Mark J Spangehl
- Department of Orthopaedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona
| | - Henry D Clarke
- Department of Orthopaedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona
| | - Jeremy M Gililland
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah
| | - Joshua S Bingham
- Department of Orthopaedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona
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Bayoumi T, Ten Noever de Brauw GV, Ruderman LV, van der List JP, Kerkhoffs GMMJ, Pearle AD, Zuiderbaan HA. The phenotypic diversity of anteromedial osteoarthritis before and after treatment with medial unicompartmental knee arthroplasty: A radiographic analysis of 1000 knees. Knee Surg Sports Traumatol Arthrosc 2024; 32:274-286. [PMID: 38226437 DOI: 10.1002/ksa.12043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 12/14/2023] [Accepted: 12/14/2023] [Indexed: 01/17/2024]
Abstract
PURPOSE This study aimed to assess phenotypic variation in the coronal plane of knees with anteromedial osteoarthritis using the functional knee phenotype classification, before and after treatment with medial unicompartmental knee arthroplasty (UKA). METHODS The study comprised 1000 knees of 835 patients (45% females, 55% males, 90% Caucasian) who underwent medial UKA for anteromedial osteoarthritis. Pre and postoperative alignment was evaluated through the hip-knee-ankle angle (HKA), femoral mechanical angle (FMA), and tibial mechanical angle (TMA). Knees were classified according to the functional knee phenotype system which combines limb phenotype (HKA), and femoral and tibial knee phenotypes (FMA and TMA, respectively). Restoration of prearthritic coronal alignment following medial UKA was evaluated by phenotype. RESULTS Preoperatively, 76 distinct and 25 relevant (prevalence ≥1%) functional knee phenotypes were identified, of which VARHKA 6°VARFMA 3°NEUTMA 0° was the most common (9.4% of knees). The most prevalent limb phenotype, VARHKA 6°, comprised 15 distinct knee phenotypes (FMA and TMA combinations). Postoperatively, 58 distinct and 17 relevant functional knee phenotypes were observed, of which VARHKA 3°NEUFMA 0°NEUTMA 0° had the highest prevalence at 18.3%. Knees with combined tibial and femoral deformities were associated with a lower probability of restoration of prearthritic coronal alignment following medial UKA, compared to knees without extra-articular deformity, or knees with an isolated tibial or femoral deformity. CONCLUSION Phenotype analysis using the functional knee phenotype system demonstrated a wide diversity of coronal alignment phenotypes among knees with anteromedial osteoarthritis in a predominantly Caucasian population. Following medial UKA, a reduction from 25 preoperative to 17 postoperative relevant phenotypes was observed. Consideration of phenotypic variation can be of importance when aiming to restore prearthritic coronal alignment during medial UKA. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Tarik Bayoumi
- Hospital for Special Surgery, Sports Medicine Institute, Weill Medical College of Cornell University, New York, New York, USA
- Department of Orthopaedic Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Gaby V Ten Noever de Brauw
- Hospital for Special Surgery, Sports Medicine Institute, Weill Medical College of Cornell University, New York, New York, USA
- Department of Orthopaedic Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Lindsey V Ruderman
- Hospital for Special Surgery, Sports Medicine Institute, Weill Medical College of Cornell University, New York, New York, USA
| | - Jelle P van der List
- Department of Orthopaedic Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Gino M M J Kerkhoffs
- Department of Orthopaedic Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Sports, Amsterdam, The Netherlands
| | - Andrew D Pearle
- Hospital for Special Surgery, Sports Medicine Institute, Weill Medical College of Cornell University, New York, New York, USA
| | - Hendrik A Zuiderbaan
- Department of Orthopaedic Surgery, Medical Clinic Velsen, Velsen-Noord, The Netherlands
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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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6
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Gerow DE, Small SR, Lackey WG, Carter JL, Berend ME. What Role Does Patello-Femoral Joint Degeneration Have on Pain and Function After Unicompartmental Knee Arthroplasty? A Prospective Observational Cohort Study. J Arthroplasty 2024; 39:76-80. [PMID: 37454946 DOI: 10.1016/j.arth.2023.07.004] [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: 02/05/2023] [Revised: 07/05/2023] [Accepted: 07/10/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Influences on anterior knee pain, stair climbing limitations, and function such as rising from sitting are poorly understood in unicompartmental knee arthroplasty (UKA). Original indications for UKA excluded patients who had patello-femoral disease, while more recent studies have expanded the indications to include these patients. This study examined the influence of the patello-femoral joint degeneration on patient-reported outcome measures relating to anterior knee pain and function after UKA. METHODS Between October 2017 and August 2021, Knee Injury and Osteoarthritis Outcome Score of Joint Replacement (KOOS, JR) patient-reported outcome measures were collected preoperatively and at 12 months of follow-up for 678 medial UKAs. Patello-femoral joint status was visually graded intraoperatively. Radiographic or intraoperative medial patellar facet and trochlear patello-femoral arthritis and preoperative anterior knee pain were not considered contraindications for UKA, while grade IV lateral patello-femoral arthritis was considered a contraindication for UKA. Multivariable ordinal logistic regressions were performed, using the KOOS, JR questionnaire assessing pain during stair climbing, standing upright, and function during rising from sitting. Independent regressions were performed for each targeted KOOS, JR question, with adjustments for age at surgery, sex, and baseline pain and function scores. RESULTS No association was observed between 12-month postoperative anterior knee pain (P = .575) and function (P = .854) with patellar osteoarthritis grading after UKA. When comparing fixed and mobile-bearing UKA designs, no association was observed between bearing type and pain (P = .663) or functional outcomes (P = .758). CONCLUSION Pain and function improved significantly following medial UKA and was independent of medial patellar and trochlear degenerative status.
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Affiliation(s)
- Daniel E Gerow
- Department of Orthopaedic Surgery, University of Michigan Health West, Wyoming, Michigan
| | - Scott R Small
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Mekkawy KL, Rodriguez HC, Pannu TS, Rowland RJ, Roche MW, Corces A. Morbidly Obese Patients Undergoing Unicompartmental Knee Arthroplasty Compared to Total Knee Arthroplasty: A Retrospective Case-Controlled Analysis. J Arthroplasty 2023; 38:2510-2516.e1. [PMID: 37301237 DOI: 10.1016/j.arth.2023.05.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/30/2023] [Accepted: 05/31/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND In this study, we assess the effects that morbid obesity (body mass index (BMI) ≥ 40) has on: (1) Ninety-day medical complications and readmission rates; (2) costs of care and lengths of stay (LOS); and (3) 2-year implant complications in patients undergoing unicompartmental knee arthroplasty (UKA) versus total knee arthroplasty (TKA). METHODS A retrospective query of TKA and UKA patients were identified using a national database. Morbidly obese UKA patients were matched 1:5 to morbidly obese TKA patients by demographic and comorbidity profiles. Subgroup analyses were conducted using the same process between morbidly obese UKA patients and BMI <40 TKA patients, as well as to BMI <40 UKA patients. RESULTS Morbidly obese patients who underwent UKA had significantly fewer medical complications, readmissions, and periprosthetic joint infections than TKA patients; however, UKA patients had greater odds of mechanical loosening (ML). The TKA patients had significantly longer LOS (3.0 versus 2.4 days, P < .001), as well as significantly greater costs of care than UKA patients ($12,869 versus $7,105). Morbidly obese UKA patients had similar rates of medical complications, and significantly lower readmissions, decreased LOS, and decreased costs when compared to TKA patients who had a BMI <40. CONCLUSION In patients who have morbid obesity, complications were decreased in UKA compared to TKA. Moreover, morbidly obese UKA patients had lower medical utilizations and similar complication rates when compared to TKA patients with the recommended cutoff of BMI <40. However, UKA patients had greater rates of ML than TKA patients. A UKA may be an acceptable treatment option for unicompartmental osteoarthritis in morbidly obese patients.
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Affiliation(s)
- Kevin L Mekkawy
- Holy Cross Orthopedic Research Institute, Holy Cross Health, Fort Lauderdale, Florida; Department of Orthopaedic Surgery, Hospital for Special Surgery, West Palm Beach, Florida
| | - Hugo C Rodriguez
- Department of Orthopaedic Surgery, Hospital for Special Surgery, West Palm Beach, Florida; Larkin Community Hospital, Department of Orthopaedic Surgery, South Miami, Florida
| | - Tejbir S Pannu
- Larkin Community Hospital, Department of Orthopaedic Surgery, South Miami, Florida
| | - Robert J Rowland
- Larkin Community Hospital, Department of Orthopaedic Surgery, South Miami, Florida
| | - Martin W Roche
- Holy Cross Orthopedic Research Institute, Holy Cross Health, Fort Lauderdale, Florida; Department of Orthopaedic Surgery, Hospital for Special Surgery, West Palm Beach, Florida
| | - Arturo Corces
- Larkin Community Hospital, Department of Orthopaedic Surgery, South Miami, Florida
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Levy KH, Fusco PJ, Salazar-Restrepo SA, Mathew DM, Pandey R, Ahmed S, Varghese KS, Rogando DO, Ahmed A, Ng MK. Unicompartmental knee arthroplasty revised to total knee arthroplasty versus primary total knee arthroplasty: A meta-analysis of matched studies. Knee 2023; 45:1-10. [PMID: 37708740 DOI: 10.1016/j.knee.2023.09.001] [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: 03/23/2023] [Revised: 07/13/2023] [Accepted: 09/03/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Unicompartmental knee arthroplasty (UKA) offers a less invasive alternative to total knee arthroplasty (TKA), but is accompanied by a high revision risk. The aim of our study was to perform a meta-analysis comparing outcomes of UKA revised to TKA versus primary TKA, to assess if UKA is an effective treatment option, despite its potential need for revision. METHODS Studies comparing matched cohorts of patients with UKA revised to TKA versus primary TKA were identified via the PubMed, Ovid EMBASE, and Scopus databases. The following outcome measures were compared between treatment modalities: postoperative reoperation or revision, total complications, range of motion, patient-reported outcome measures, and length of stay. RESULTS Ten studies were included with 1,070 patients: 410 UKA to TKA and 660 primary TKA. At an average follow-up of 5.6 years in the UKA to TKA cohort and 5.7 years in the primary TKA cohort, there were no significant difference in risk of revision (p = 0.81), total complications (p = 0.54), range of motion (p = 0.09), or length of stay (p = 0.31). Both objective and functional Knee Society Score were significantly higher in patients with primary TKA (p < 0.01). However, there was no difference in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) or pain scores (p = 0.13 and p = 0.21, respectively). CONCLUSION UKA revised to TKA produced comparable clinical and patient-reported outcomes to a primary TKA. UKA may be an effective treatment option in unicompartmental arthritis that would allow for improved functionality and satisfaction without the concern of outcomes deteriorating in patients where a revision becomes necessary.
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Affiliation(s)
| | | | | | | | - Roshan Pandey
- CUNY The City College of New York, New York, NY, USA
| | | | | | | | | | - Mitchell K Ng
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
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9
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Lua J, Kripesh A, Kunnasegaran R. Is unicompartmental knee arthroplasty truly contraindicated in an obese patient? A meta-analysis. J Orthop Sci 2023; 28:1317-1324. [PMID: 36336639 DOI: 10.1016/j.jos.2022.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 08/12/2022] [Accepted: 09/21/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Obesity has long been considered a relative contraindication to unicompartmental knee arthroplasty (UKA). However, with improved implants and techniques, the criteria for UKAs have been challenged. This paper aims to assess the impact of body mass index (BMI) on revision rates and functional outcomes in UKAs. METHODS Databases of Pubmed, EMBASE, MEDLINE, CINHL and the Cochrane registries were systematically searched following the PROSPERO protocol. Studies comparing implant survival and functional outcome scores between obese and non-obese patients after a UKA were included. RESULTS Twenty-five articles reported revision rates or functional outcomes in 42,434 UKA surgeries. There was a trend to higher revision rates in patients with BMI > 30 kg/m2 (odds ratio [OR] 0.91 [0.79-1.05]), BMI >35 kg/m2 (OR 0.70 [0.48, 1.01]) or BMI >40 kg/m2 (OR 0.66 [0.41, 1.07]), although the difference was not significant. There was a significant larger improvement in Oxford Knee Scores in obese patients after a UKA (OR 2.68 [1.79, 3.57], p < 0.00001), but no difference in Knee Society Scores or Visual Analogue Scale scores. CONCLUSION With no significant increase in revision rates after a UKA, a significantly greater improvement in Oxford Knee Scores and no differences Knee Society Scores or Visual Analogue Scales, obesity should no longer be viewed as a relative contraindication when performing unicompartmental knee replacements.
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Affiliation(s)
- Jameson Lua
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore.
| | - Aishwarya Kripesh
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore
| | - Remesh Kunnasegaran
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore
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10
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Liang S, Zeng H, Yu M, Liu Y, Wang W. The Impact of Arthroscopy on Surgical Decision-Making and Outcomes in Osteoarthritis Patients Undergoing Unicompartmental Knee Arthroplasty. Cureus 2023; 15:e46684. [PMID: 37942366 PMCID: PMC10629421 DOI: 10.7759/cureus.46684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2023] [Indexed: 11/10/2023] Open
Abstract
Background and objective Although unicompartmental knee arthroplasty (UKA) is a minimally invasive procedure, its application is limited due to strict criteria related to indications. In clinical practice, the aid of procedures such as arthroscopy is occasionally required to determine the surgical indication and thereby improve prognosis. In light of this, this study aimed to evaluate the impact of intraoperative arthroscopy on surgical decision-making in osteoarthritis (OA) patients and the prognosis of patients undergoing UKA. Methodology The clinical records of patients diagnosed with knee OA who underwent knee arthroplasty between January 2017 and January 2020 were retrospectively analyzed. The inclusion criteria were as follows: patients with radiographic evidence of single-compartmental Kellgren-Lawrence (KL) grade 3 or 4 knee OA but presenting symptoms of persistent multicompartmental knee pain or locking for at least six months, with a history of anterior cruciate ligament (ACL) injury or meniscus tear. They had undergone either UKA or total knee arthroplasty (TKA). Data on clinical characteristics and outcomes at baseline and during follow-up were collected. Results A total of 429 patients were included in the study. Patients who underwent arthroscopy were more likely to undergo UKA surgery than those who did not (p<0.05). Among patients who underwent UKA, no instances of blood transfusion during hospitalization or postoperative complications were reported, regardless of whether arthroscopy was performed or not. Although the overall Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores and Knee Society Functional Score (KSFS) did not differ between the two groups, the Knee Society Score (KSS) was significantly higher in patients who underwent arthroscopy (88.77 ±5.09) compared to those who did not (85.53 ±5.11). Similarly, the arthroscopy group had a higher overall Forgotten Joint Score (FJS) (44.6 ±4.20) than the UKA-only group (42.05 ±3.58). Conclusion Arthroscopy findings can assist in surgical decision-making for OA patients. Performing arthroscopy and UKA simultaneously is relatively safe and may be associated with favorable outcomes.
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Affiliation(s)
- Shaohua Liang
- Orthopedics and Sports Medicine, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, CHN
| | - Haiquan Zeng
- Orthopedics and Sports Medicine, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, CHN
| | - Ming Yu
- Orthopedics, Guizhou Medical University, Guiyang, CHN
| | - Yang Liu
- Orthopedics, Suining Central Hospital, Suining, CHN
| | - Wen Wang
- Orthopedics and Sports Medicine, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, CHN
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Gebrye T, Fatoye F, Mbada C, Hakimi Z. A scoping review on quality assessment tools used in systematic reviews and meta-analysis of real-world studies. Rheumatol Int 2023; 43:1573-1581. [PMID: 37326665 PMCID: PMC10348931 DOI: 10.1007/s00296-023-05354-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 05/26/2023] [Indexed: 06/17/2023]
Abstract
Risk of bias tools is important in identifying inherent methodical flaws and for generating evidence in studies involving systematic reviews (SRs) and meta-analyses (MAs), hence the need for sensitive and study-specific tools. This study aimed to review quality assessment (QA) tools used in SRs and MAs involving real-world data. Electronic databases involving PubMed, Allied and Complementary Medicine Database, Cumulated Index to Nursing and Allied Health Literature, and MEDLINE were searched for SRs and MAs involving real-world data. Search was delimited to articles published in English, and between inception to 20 of November 2022 following the SRs and MAs extension for scoping checklist. Sixteen articles on real-world data published between 2016 and 2021 that reported their methodological quality met the inclusion criteria. Seven of these articles were observational studies, while the others were of interventional type. Overall, 16 QA tools were identified. Except one, all the QA tools employed in SRs and MAs involving real-world data are generic, and only three of these were validated. Generic QA tools are mostly used for real-world data SRs and MAs, while no validated and reliable specific tool currently exist. Thus, there is need for a standardized and specific QA tool of SRs and MAs for real-world data.
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Affiliation(s)
- Tadesse Gebrye
- Department of Health Professions, Faculty of Health, Psychology, and Social Care, Manchester Metropolitan University, Brooks Building, Birley Fields Campus, Bonsall Street, 53 Bonsall Street, Manchester, M15 6GX UK
| | - Francis Fatoye
- Department of Health Professions, Faculty of Health, Psychology, and Social Care, Manchester Metropolitan University, Brooks Building, Birley Fields Campus, Bonsall Street, 53 Bonsall Street, Manchester, M15 6GX UK
- Lifestyle Diseases, Faculty of Health Sciences, North-West University, Mahikeng, South Africa
| | - Chidozie Mbada
- Department of Health Professions, Faculty of Health, Psychology, and Social Care, Manchester Metropolitan University, Brooks Building, Birley Fields Campus, Bonsall Street, 53 Bonsall Street, Manchester, M15 6GX UK
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12
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Gowd AK, Plate JF, Lichtig A, Gencer A, Yanmis O, D'Agostino R, Poehling GG. Favourable mid-term outcomes following unicompartmental knee arthroplasty with wider patient selection: A single-centre experience. J ISAKOS 2023; 8:255-260. [PMID: 37004741 DOI: 10.1016/j.jisako.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 02/17/2023] [Accepted: 03/11/2023] [Indexed: 04/03/2023]
Abstract
OBJECTIVE The purpose of this study was to determine surgical outcomes of robotic-assisted UKAs utilizing a wider set of indications than traditionally utilized. Additionally, we seek to determine alternate predictive factors as potential surgical indications and contraindications. METHODS A prospectively maintained institutional joint registry was queried at a single academic centre for all patients that underwent robotic-assisted UKA between January 2010-December 2016. Surgical indication included isolated medial or lateral compartment degenerative disease with a stable knee based on physical exam. In 2013, haemoglobin A1C levels over 7.5% were considered contraindications, which was lowered to 7.0% in 2015. Preoperative alignment, age, activity level and degree of pain were not contraindications for surgery. Preoperative demographics, Oxford scores, radiographic (joint space), comorbidities and operative data were collected and reviewed to determine factors related to conversion to TKA and survivorship of the primary implant. RESULTS In total, 1878 cases were performed; however, excluding multi-joint knees, there were a total of 1186 knees in 1014 patients with a minimum 4-year follow-up. The mean age was 63.4 ± 10.7 years and mean follow-up was 76.4 ± 17.4 months. Mean BMI was 32.3 ± 6.5 kg/m2. (52.9% females, 47.1% males). There were 901 patients undergoing medial UKA, 122 patients undergoing lateral UKA and 69 patients undergoing patellofemoral UKA. In total, 85 (7.2%) knees underwent conversion to TKA. Preoperative factors such as the degree of preoperative valgus deformity (p = 0.01), greater operative joint space (p = 0.04), previous surgery (p = 0.01), inlay implant (p = 0.04) and pain syndrome (p = 0.01) were associated with increased risk of revision surgery. Factors associated with decreased implant survivorship included patients with history of previous surgery (p < 0.01), history of pain syndrome (p < 0.01) and greater preoperative joint space (>2 mm) (p < 0.01). There was no association of BMI to conversion to TKA. CONCLUSION Robotic-assisted UKA with wider patient selection demonstrated favourable outcomes at 4 years with survivorship greater than 92%. The present series agree with emerging indications that do not exclude patients based on age, BMI, or degree of deformity. However, increased operative joint space, inlay design, history of surgery and coexistence of pain syndrome are factors that increase risk of conversion to TKA. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Anirudh K Gowd
- Department of Orthopaedic Surgery Wake Forest Medical Center Watlington Hall, 4th Floor 1 Medical Center Boulevard, Winston Salem, NC 27157, USA
| | - Johannes F Plate
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 3471 Fifth Avenue, Pittsburgh, PA 15213, USA
| | - Asher Lichtig
- Department of Orthopaedic Surgery Wake Forest Medical Center Watlington Hall, 4th Floor 1 Medical Center Boulevard, Winston Salem, NC 27157, USA.
| | - Ahmet Gencer
- Department of Orthopaedic Surgery Wake Forest Medical Center Watlington Hall, 4th Floor 1 Medical Center Boulevard, Winston Salem, NC 27157, USA
| | - Orhan Yanmis
- Department of Orthopaedic Surgery Wake Forest Medical Center Watlington Hall, 4th Floor 1 Medical Center Boulevard, Winston Salem, NC 27157, USA
| | - Ralph D'Agostino
- Department of Orthopaedic Surgery Wake Forest Medical Center Watlington Hall, 4th Floor 1 Medical Center Boulevard, Winston Salem, NC 27157, USA
| | - Gary G Poehling
- Department of Orthopaedic Surgery Wake Forest Medical Center Watlington Hall, 4th Floor 1 Medical Center Boulevard, Winston Salem, NC 27157, USA.
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Veizi E, Güven Ş, Naldöven ÖF, Çepni Ş, Çay N, Işık Ç, Bozkurt M. Low local curvature index and history of previous surgery are risk factors for revision in focal metallic inlay implants. Knee 2023; 43:42-50. [PMID: 37269796 DOI: 10.1016/j.knee.2023.05.003] [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: 12/23/2022] [Revised: 02/27/2023] [Accepted: 05/11/2023] [Indexed: 06/05/2023]
Abstract
BACKGROUND Focal chondral defects are debilitating lesions with poor healing potential. Focal metallic inlay implants were developed as a salvage procedure, whose reoperation causes and risk factors for revision are still debatable. The aim of this study is to analyze the local subchondral curvature matching of focal metallic inlay implants and its effects on survival and clinical results. METHODS Patients operated with a knee focal metallic inlay resurfacing implant between 2014 and 2017 were eligible. Surgery was indicated for painful, focal, full-thickness cartilage lesions that had failed alternative treatments. Inclusion criteria were patients treated for a lesion ≤ 5 cm2 in the femoral condyle, aged 40-65 years, with complete surgical records and a knee CT scan. The curvature index (Kindex) was calculated as the ratio of the mean curvature of the implant (K1) to the mean curvature of the subchondral bone (K2). RESULTS Sixty-nine patients were included, of which 60.9% were female. Mean age was 54.8 ± 6.0. Seven patients (10.1%) underwent revision surgery. When adjusted for age and sex, lesion size was not significantly correlated to revision in a multivariate regression model, while previous surgery and smaller K index were. A positive history for previous surgery was significantly correlated with worse clinical outcomes in surviving patients. CONCLUSION A positive history of previous knee surgery and a low local curvature index are risk factors for revision after focal metallic inlay implant resurfacing. Patients with a history of knee surgery should be counseled on the advantages and disadvantages before undergoing a focal resurfacing procedure.
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Affiliation(s)
- Enejd Veizi
- Ankara City Hospital, Department of Orthopedics and Traumatology, 06000 Ankara, Turkey.
| | - Şahan Güven
- Ankara City Hospital, Department of Orthopedics and Traumatology, Ankara, Turkey
| | - Ömer Faruk Naldöven
- Ankara City Hospital, Department of Orthopedics and Traumatology, Ankara, Turkey
| | - Şahin Çepni
- Ankara City Hospital, Department of Orthopedics and Traumatology, Ankara, Turkey
| | - Nurdan Çay
- Yıldırım Beyazıt University, Faculty of Medicine, Ankara City Hospital, Department of Radiology, Ankara, Turkey
| | - Çetin Işık
- Memorial Ataşehir Hospital, Department of Orthopedics and Traumatology, Istanbul, Turkey
| | - Murat Bozkurt
- Ankara Acıbadem Hospital, Department of Orthopedics and Traumatology, Ankara, Turkey
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14
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Cochrane N, Belay E, Wu M, O'Donnell J, Kim B, Seyler T. An ACS-NSQIP Analysis of Unicompartmental Knee Arthroplasty Trends from 2013 to 2018. J Knee Surg 2023; 36:716-724. [PMID: 34991174 DOI: 10.1055/s-0041-1741389] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Unicompartmental knee arthroplasty (UKA) volume has increased with advances in implant design, perioperative protocols, and patient selection. This study analyzed national trends of UKA from 2013 to 2018 and the relationship between patient demographics and postoperative outcomes. Data on UKA (CPT 27446) from 2013 to 2018 was collected from the National Surgical Quality Improvement Program (NSQIP). Variables collected included patient demographics, American Society of Anesthesiology classification, functional status, NSQIP morbidity probability, operative time, length of stay, 30-day reoperation, and readmission rates. There was an increase in outpatient UKAs performed (920 in 2013; 11,080 in 2018) (p < 0.0001). Analysis of variance from 2013 to 2018 revealed significant decrease in patient body mass index (BMI) (32.5 in 2013; 31.5 in 2018) (p < 0.01) and NSQIP morbidity probability (0.014 in 2013; 0.011 in 2018) (p < 0.0001). Operative time increased (79.1 minutes in 2013; 84.4 minutes in 2018) (p < 0.01), but length of stay decreased (0.9 days in 2013; 0.5 days in 2018) (p < 0.0001). The number of all-cause and related readmissions decreased significantly (p < 0.045; p < 0.01). Age, male gender, BMI >40 and chronic obstructive pulmonary disease (COPD) were significant predictors for 30-day readmission. BMI >40 was a significant predictor for discharge destination. UKA has seen a rise in incidence from 2013 to 2018 with an increasing number of outpatient UKAs. Operative times and 30-day readmissions have both decreased in this time. BMI > 40 is predictive for discharge destination after UKA, while age, male gender, BMI >40, and COPD are independent risk factors for 30-day readmission.
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Affiliation(s)
- Niall Cochrane
- Department of Orthopedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Elshaday Belay
- Department of Orthopedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Mark Wu
- Department of Orthopedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Jeffrey O'Donnell
- Department of Orthopedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Billy Kim
- Department of Orthopedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Thorsten Seyler
- Department of Orthopedic Surgery, Duke University Medical Center, Durham, North Carolina
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15
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Bayoumi T, Kleeblad LJ, Borus TA, Coon TM, Dounchis J, Nguyen JT, Pearle AD. Ten-Year Survivorship and Patient Satisfaction Following Robotic-Arm-Assisted Medial Unicompartmental Knee Arthroplasty: A Prospective Multicenter Study. J Bone Joint Surg Am 2023:00004623-990000000-00793. [PMID: 37146125 DOI: 10.2106/jbjs.22.01104] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
BACKGROUND Robotic-arm-assisted unicompartmental knee arthroplasty (UKA) has been shown to result in high short- and mid-term survivorship. However, it is not known whether these outcomes are maintained at long-term follow-up. This study aimed to evaluate long-term implant survivorship, modes of failure, and patient satisfaction following robotic-arm-assisted medial UKA. METHODS A prospective multicenter study of 474 consecutive patients (531 knees) undergoing robotic-arm-assisted medial UKA was conducted. A cemented, fixed-bearing system with a metal-backed onlay tibial implant was used in all cases. Patients were contacted at 10-year follow-up to determine implant survivorship and satisfaction. Survival was analyzed using Kaplan-Meier models. RESULTS Data were analyzed for 366 patients (411 knees) with a mean follow-up of 10.2 ± 0.4 years. A total of 29 revisions were reported, corresponding to a 10-year survivorship of 91.7% (95% confidence interval, 88.8% to 94.6%). Of all revisions, 26 UKAs were revised to total knee arthroplasty. Unexplained pain and aseptic loosening were the most commonly reported modes of failure, accounting for 38% and 35% of revisions, respectively. Of patients without revision, 91% were either satisfied or very satisfied with their overall knee function. CONCLUSIONS This prospective multicenter study found high 10-year survivorship and patient satisfaction following robotic-arm-assisted medial UKA. Pain and fixation failure remained common causes for revision following cemented fixed-bearing medial UKA, despite the use of a robotic-arm-assisted technique. Prospective comparative studies are needed to assess the clinical value of robotic assistance over conventional techniques in UKA. LEVEL OF EVIDENCE Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Tarik Bayoumi
- Computer Assisted Surgery and Sports Medicine, Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY
| | - Laura J Kleeblad
- Department of Surgery, Northwest Clinics, Alkmaar, the Netherlands
| | - Todd A Borus
- Department of Orthopaedic Surgery, Rebound Orthopedics & Neurosurgery, Portland, Oregon
| | - Thomas M Coon
- Coon Joint Replacement Institute, Department of Orthopaedic Surgery, St. Helena, California
| | - Jon Dounchis
- Department of Orthopaedic Surgery, NCH Orthopedics, Naples, Florida
| | - Joseph T Nguyen
- Biostatistics Core, Healthcare Research Institute, Hospital for Special Surgery, New York, NY
| | - Andrew D Pearle
- Computer Assisted Surgery and Sports Medicine, Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY
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16
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Goodell PB, Johansen PM, Bartels DW, Sherman SL, Amanatullah DF. Comparing Unicompartmental Knee Arthroplasty and High Tibial Osteotomy for Isolated Medial Compartment Knee Osteoarthritis. JBJS Rev 2023; 11:01874474-202303000-00004. [PMID: 36930742 DOI: 10.2106/jbjs.rvw.22.00127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
Abstract
» Both unicompartmental knee arthroplasty (UKA) and high tibial osteotomy (HTO) allow for compartment-specific intervention on an arthritic knee joint that preserves bone stock and native soft tissue compared to a total knee arthroplasty (TKA). Both operations give a more natural feeling with native proprioception compared with a TKA. » HTO is better suited in patients who are younger (<55 years-of-age), have a body mass index (BMI) <30 kg/m2, high activity requirements, mechanical malalignment, asymmetric varus, isolated anterior cruciate ligament insufficiency, need for multiplanar correction, and a preference for joint preserving interventions. Recent data suggest that age (>55 years-of-age) should not solely contraindicate a HTO. » UKA may be chosen in patients who are older (>55 years-of-age), low activity requirements, have a BMI <40 kg/m2, severe osteoarthritis with significant joint space narrowing, acceptable coronal alignment, symmetric varus, and patient preference for arthroplasty.
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Affiliation(s)
- Parker B Goodell
- Department of Orthopaedic Surgery, University of California San Francisco, Fresno, California
| | - Phillip M Johansen
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida
| | - Douglas W Bartels
- Department of Orthopaedic Surgery, Stanford University, Palo Alto, California
| | - Seth L Sherman
- Department of Orthopaedic Surgery, Stanford University, Palo Alto, California
| | - Derek F Amanatullah
- Department of Orthopaedic Surgery, Stanford University, Palo Alto, California
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The patient acceptable symptom state for the knee society score, oxford knee score and short form-36 following unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2023; 31:1113-1122. [PMID: 33912978 DOI: 10.1007/s00167-021-06592-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/21/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The patient acceptable symptom state (PASS) is a target value on a patient-reported outcome measures (PROM) scale beyond which patients deem themselves to have attained an acceptable outcome. This study aimed to define the PASS thresholds for generic and knee-specific PROMs at 2 years after unicompartmental knee arthroplasty (UKA). METHODS Prospectively collected data of 955 patients who underwent UKA for medial osteoarthritis at a single institution was reviewed. Patients were assessed preoperatively and 2 years postoperatively using the Knee Society Knee Score (KSKS), Function Score (KSFS), Oxford Knee Score (OKS), SF-36 Physical Component Score (PCS) and Mental Component Score (MCS). Responses to an anchor question assessing patients' overall rating of treatment results were dichotomized and used to determine if PASS was achieved. PASS thresholds for each PROM were selected based on the Youden index on a receiver operating characteristics (ROC) curve. Sensitivity analyses were performed for different subgroups (by age, gender, BMI), baseline score tertiles and an alternate definition of PASS. RESULTS In total, 92.7% reported their current state as acceptable. The areas under the curve (AUC) for ROCs were 0.72-0.83, except for the SF-36 PCS (AUC 0.64), indicating good discriminative accuracy of the other PROMs. PASS thresholds were 85.5 for KSKS, 77.5 for KSFS, 41.5 for OKS, 49.9 for SF-36 PCS and 54.6 for SF-36 MCS. Sensitivity analyses revealed that the thresholds were robust. Patients who attained a PASS were at least 4-5 times more likely to be satisfied and have expectations fulfilled. CONCLUSION PASS thresholds can be used to define treatment success in future outcome studies. At the individual level, they provide clinically relevant benchmarks for surgeons when assessing postoperative recovery. LEVEL OF EVIDENCE III.
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Marquina Moraleda V, Gastaldi G, Fuentes S, Colomina R, Jover P, Hernández L. Prótesis unicompartimental de rodilla. Resultados clínico-radiográficos y análisis de la supervivencia del implante. REVISTA DE LA ASOCIACIÓN ARGENTINA DE ORTOPEDIA Y TRAUMATOLOGÍA 2022. [DOI: 10.15417/issn.1852-7434.2022.87.6.1540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Objetivo: Evaluar los resultados clínicos y radiográficos en pacientes sometidos a artroplastia unicompartimental de rodilla, así como la tasa de complicaciones y la supervivencia del implante.
Materiales y Métodos: Estudio descriptivo retrospectivo de 68 pacientes consecutivos (70 rodillas) sometidos a artroplastia unicompartimental de rodilla entre 2013 y 2020, con un seguimiento medio de 57.7 meses (rango 24-105) y una media de la edad de 61 años (rango 34-79). El 46,5% eran hombres. El índice demasa corporal medio era de 29,9 (rango 20-39). El diagnóstico más frecuente fue la artrosis del compartimento femorotibial medial con un varo <7°. Los resultados se evaluaron con la escala analógica visual para dolor y el Knee Society Score (KSS). Se evaluó la incidencia de complicaciones y la tasa de supervivencia del implante.
Resultados: La disminución media en la escala analógica visual para dolor fue de 4,4 ± 1,9. Las puntuaciones medias posoperatorias en las escalas funcional y clínica del KSS fueron de 77,4 ± 13,7 y 70,2 ± 17,7, respectivamente. La tasa de complicaciones posquirúrgicas fue del 7% (5 casos). La tasa de reintervención quirúrgica fue del 15,5% (11 pacientes): nueve casos por persistencia del dolor, uno por rigidez articular y otro por aflojamiento aséptico.
Conclusiones: La artroplastia unicompartimental de rodilla es una opción terapéutica eficaz para pacientescon gonartrosis unicompartimental de rodilla; se logran buenos resultados clínicos con una aceptable tasa de complicaciones; sin embargo, la tasa de revisión del implante es considerable.
Nivel de Evidencia: IV
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Foo WYX, Liow MHL, Chen JY, Tay DKJ, Lo NN, Yeo SJ. All-polyethylene unicompartmental knee arthroplasty is associated with increased risks of poorer knee society knee score and lower satisfaction in obese patients. Arch Orthop Trauma Surg 2022; 142:3977-3985. [PMID: 35094135 DOI: 10.1007/s00402-021-04325-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 12/19/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Although metal-backed tibial component (MB) is biomechanically superior to all-polyethylene (AP) implants in fixed-bearing unicompartmental knee arthroplasty (UKA), recent studies have shown comparable functional outcomes between the two. However, no study has examined this comparison in obese patients (BMI ≥ 30 kg/m2). We investigated whether functional outcomes between the two implants differ among obese patients, and whether the extent of obesity influences these outcomes. PATIENTS AND METHODS Four hundred twenty-two UKA implants from 347 obese patients were reviewed retrospectively. Patients were assessed using the Knee Society Knee Score (KSKS) and Function Score (KSFS), the original Oxford Knee Score (OKS), and SF-36 Physical Component Summary (PCS) and Mental Component Summary (MCS). Minimal clinically important difference (MCID) attainment was recorded. Patients' fulfillment of expectations and satisfaction with the surgery outcome was also graded. Patients were further divided into lower obesity (BMI 30-34.9 kg/m2) and higher obesity (BMI ≥ 35 kg/m2) to examine effect modification. RESULTS There were no differences in functional outcomes and quality-of-life scores, MCID attainment of functional scores, as well as satisfaction and expectation fulfillment between AP and MB. Among higher obesity patients, AP was associated with a poorer KSKS (p = 0.031) and lower proportion of satisfaction fulfillment (p = 0.041) 2 years postoperatively compared to MB. CONCLUSION We found no differences in functional and quality-of-life outcomes between fixed-bearing AP and MB tibial components among obese patients who underwent UKA. However, among higher obesity patients (BMI ≥ 35 kg/m2), patients with AP tibial component were associated with lower KSKS score and a lower proportion of attaining satisfaction fulfillment 2 years postoperatively.
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Affiliation(s)
| | - Ming Han Lincoln Liow
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, Singapore, 169865, Singapore
| | - Jerry Yongqiang Chen
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, Singapore, 169865, Singapore
| | - Darren Keng Jin Tay
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, Singapore, 169865, Singapore
| | - Ngai Nung Lo
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, Singapore, 169865, Singapore
| | - Seng Jin Yeo
- Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore.,Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, Singapore, 169865, Singapore
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Obesity increases the risk of conversion to total knee arthroplasty after unicompartimental knee arthroplasty: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 2022; 30:3945-3957. [PMID: 34718836 DOI: 10.1007/s00167-021-06780-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [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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Carender CN, Rand DR, DeMik DE, An Q, Noiseux NO. Presence of a Lateral Trochlear Osteophyte Predicts Medial Unicompartmental Arthroplasty Failure at Midterm Follow-up. Arthroplast Today 2022; 19:101044. [PMCID: PMC9713262 DOI: 10.1016/j.artd.2022.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 08/14/2022] [Accepted: 09/18/2022] [Indexed: 12/03/2022] Open
Abstract
Background Specific clinical and radiographic risk factors for medial unicompartmental knee arthroplasty (UKA) failure are incompletely understood. The purpose of this study was to perform a midterm survivorship analysis of medial UKA from a single, nondesigner surgeon. Based on observations from clinical practice, we hypothesized that the presence of a lateral trochlear osteophyte on preoperative Merchant radiographs may be predictive of medial UKA failure secondary to progressive osteoarthritis (OA). Methods Patients who underwent a mobile-bearing medial UKA by a single surgeon with minimum 24 months of clinical follow-up from 2008 to 2019 were retrospectively identified. Radiographic parameters, including the presence of a lateral trochlear osteophyte, were measured. Kaplan-Meier survivorship analyses were performed. Cox proportional hazards models were used to evaluate variables as risk factors for UKA failure, defined as reoperation or component revision. Results A total of 233 UKAs were included. The mean age was 60 years, mean BMI 32 kg/m2, and 53% of patients were male. The mean follow-up duration was 5.7 years (range, 2.0-13.1 years). Using any reoperation as an endpoint, the 10-year survival was 91%. Using any component revision as an endpoint, the 10-year survival was 93%. Using revision due to progressive OA as an endpoint, the 10-year survival was 95%. The presence of a lateral trochlear osteophyte was associated with an increased risk of any reoperation (hazard ratio 3.6; 95% confidence interval 1.3-9.5) and increased risk of revision due to progressive OA (hazard ratio 9.8; 95% confidence interval 2.9-32.7). Conclusions The presence of a lateral trochlear osteophyte on preoperative Merchant view radiographs was associated with an increased risk of medial UKA failure.
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Affiliation(s)
| | - Dayton R. Rand
- Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - David E. DeMik
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA, USA
| | - Qiang An
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA, USA
| | - Nicolas O. Noiseux
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA, USA,Corresponding author. Department of Orthopedics and Rehabilitation, University of Iowa, 200 Hawkins Dr., 01008 JPP, Iowa City, IA, USA. Tel.: + 1 319 356 2223.
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Preoperative uncorrectable tibiofemoral subluxation can worsen clinical outcomes after fixed-bearing unicompartmental knee arthroplasty: a retrospective analysis. Arch Orthop Trauma Surg 2022; 142:2865-2874. [PMID: 34495364 DOI: 10.1007/s00402-021-04157-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 08/30/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The presence of tibiofemoral subluxation (TFS) in patients with unicompartmental arthritis, a potential contraindication to unicompartmental knee arthroplasty (UKA), remains controversial and is not commonly discussed. This study aimed to determine the predictability of postoperative TFS before surgery and the effect of TFS on clinical outcomes after fixed-bearing UKA. MATERIALS AND METHODS In total, 70 patients with anteromedial osteoarthritis and osteonecrosis of the knee who underwent fixed-bearing UKA from January 2015 to January 2017 were included. The preoperative TFS was assessed using plain anteroposterior and valgus stress radiographs. The patients were classified into three groups as follows: group A (acceptable TFS, n = 36) comprising patients with preoperative TFS less than 5.0 mm; group C (correctable TFS, n = 17) comprising patients with preoperative TFS of more than 5.0 mm but corrected to less than 5.0 mm under valgus stress; and group U (uncorrectable TFS, n = 17) comprising patients with preoperative TFS of more than 5.0 mm under valgus stress. Patient-derived clinical scores were assessed with the 2011 Knee Society Score preoperatively and 2 years postoperatively. The results were compared among the three groups using analysis of variance. RESULTS Group U showed significantly higher postoperative TFS than groups A and C. Improvements in "symptoms" and "patient satisfaction" scores 2 years after surgery were significantly higher in groups A and C than in group U. CONCLUSION Preoperative assessment of TFS under valgus stress could be a predictor of postoperative TFS. Furthermore, preoperative uncorrectable TFS could increase pain and decrease patient satisfaction 2 years after undergoing fixed-bearing UKA.
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Early Outcome Trends of Unicompartmental Knee Arthroplasty in Patients With Morbid Obesity: A Potential for Outpatient Surgery. J Arthroplasty 2022; 37:2009-2013.e3. [PMID: 35483608 DOI: 10.1016/j.arth.2022.04.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/13/2022] [Accepted: 04/20/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Elevated body mass index (BMI) was previously considered a contraindication to unicompartmental knee arthroplasty (UKA). This study sought to determine if outcomes following UKA in patients with elevated BMI have improved over the years. We hypothesized that operative times and length of stay (LOS) following UKA would significantly decrease, while discharge to home rates would increase across all BMI cohorts, especially those with a BMI > 40. METHODS Using the National Surgical Quality Improvement Program registry, surgical cases categorized using the Current Procedural Terminology code 27446 for UKA with a recorded height and weight were included. Three BMI cohorts were created: BMI I (BMI < 30), BMI II (30 ≤ BMI ≤ 40), and BMI III (BMI > 40). Each BMI group was subclassified temporally by year of operation: Years A (2006-2009), Years B (2010-2014), and Years C (2015-2019). RESULTS A total of 14,114 patients were included. For BMI III, both operative time (P < .001) and LOS (P < .001) significantly decreased over the Years cohorts. Discharge home rates increased from 88.3% to 94.4% in BMI III (P = .001). All BMI cohorts saw similar changes in discharge patterns, 30-day readmissions, and reoperations within 30 days in recent years. CONCLUSION This study found that operative times and LOS have decreased significantly in patients with morbid obesity over the past 14 years, while more patients are being discharged home without being readmitted or reoperated on in the first month. As surgeons continue to improve their operative and reconstructive techniques, this study suggests that patients with elevated BMI should be considered candidates to undergo UKA procedures in ambulatory surgery centers or in hospitals with a rapid recovery unit.
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Minimum 10-Year Survivorship of Mobile-Bearing Unicompartmental Arthroplasty: Single Surgeon, North American Non-Designer Consecutive Series. J Arthroplasty 2022; 37:S88-S93. [PMID: 35217182 DOI: 10.1016/j.arth.2022.02.066] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 02/11/2022] [Accepted: 02/14/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Mobile-bearing unicompartmental knee arthroplasty (UKA) provides a durable option for the surgical treatment of monocompartmental knee arthritis. Despite its availability in the United States since 2004, there is only 1 published North American series reporting on the minimum 10-year results of mobile-bearing UKA. The purpose of this study is to determine the survivorship, reasons for failure, and patient-reported outcomes of the Oxford mobile-bearing UKA at minimum 10-year follow-up. METHODS One hundred fifty-seven knees were eligible for inclusion in this study based on the date of their index surgery allowing for a minimum 10-year follow-up. The mean follow-up from implantation was 11.4 years (range 10.0-13.8). Failures were reviewed for potential etiologic factors. Survivorship free of reoperation for any reason and free of revision was determined using Kaplan-Meier curves. Functional outcomes were assessed using the Knee Society Knee and Function scores. RESULTS There were 17 revisions (10.6%). Six were secondary to progression of lateral compartment arthritis, 5 for persistent pain, 3 for femoral component aseptic loosening, 2 polyethylene dislocations, and 1 deep infection. The mean time to revision was 4 years (range 0.1-11). The survivorship free from revision at minimum 10-year follow-up was 85%. At final follow-up, the mean Knee Society Knee Score was 93 (range 66-100) and the mean functional score was 80 (range 30-100). CONCLUSION This single surgeon series demonstrated a survivorship of 85% at minimum 10-year follow-up. These results are comparable to published data from North America, but survivorship is lower than European series.
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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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26
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Bull D, Mannan A, Ansari J, Mason K, London E, Müller JH, London N. Medial/central PF arthritis and functionally stable ACL deficiency do not compromise outcomes of fixed-bearing medial UKA. Knee 2022; 35:8-15. [PMID: 35152155 DOI: 10.1016/j.knee.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 12/16/2021] [Accepted: 01/06/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND There is limited published data assessing functional scores and patient satisfaction following unicompartmental knee arthroplasty (UKA) in patients with patellofemoral (PF) arthritis or anterior cruciate ligament (ACL) deficiency. The purpose of this study was to determine whether medial/central PF arthritis or functionally stable ACL deficiency compromise outcomes of fixed-bearing medial UKA at a minimum follow-up of 2 years. The hypothesis was that equivalent outcomes can be achieved in patients with substantial medial/central PF arthritis or with functionally stable ACL deficiency. METHODS The authors studied a consecutive series of 229 patients (240 knees) at 36.9 ± 6.3 months after receiving fixed-bearing medial UKA. Patients completed pre- and post-operative (2 years) clinical outcome questionnaires for Oxford Knee Score (OKS), EQ-5D, Knee injury and Osteoarthritis Outcome Score Physical Function Short Form (KOOS-PS), University of California, Los Angeles (UCLA) activity score, and Forgotten Joint Score (FJS). Multivariable analyses were performed to determine associations between clinical scores, patient demographics, PF arthritis and functionally stable ACL deficiency. RESULTS Of the 240 knees, 125 (54%) had substantial medial/central PF arthritis and 21 (9%) functionally stable ACL deficiency. Multivariable analyses revealed no association between outcomes and medial/central PF arthritis, but knees with functionally stable ACL deficiency were associated with better KOOS-PS (β = 8.99, p = 0.012). CONCLUSION Fixed-bearing medial UKA grants satisfactory outcomes at 2 years even in knees with substantial medial/central PF arthritis or functionally stable ACL deficiency. Longer-term prospective studies with larger cohorts are needed to confirm these promising findings regarding outcomes in patients traditionally contraindicated for medial UKA.
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Affiliation(s)
- Damian Bull
- Harrogate and District Foundation Trust, North Yorkshire, England
| | - Ashim Mannan
- Leeds Beckett University School of Sport, Leeds, England
| | - Juned Ansari
- Harrogate and District Foundation Trust, North Yorkshire, England
| | | | | | | | | | - Nick London
- Harrogate and District Foundation Trust, North Yorkshire, England; Wexham Park Hospital, Slough, England
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St Mart JP, Goh EL, Goudie E, Crawford R, English H, Donnelly W. Clinical and radiological outcomes of robotic-assisted unicompartmental knee arthroplasty: Early lessons from the first 100 consecutive knees in 85 patients. Knee 2022; 34:195-205. [PMID: 34973482 DOI: 10.1016/j.knee.2021.11.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 11/22/2021] [Accepted: 11/25/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Robotic-assisted unicompartmental knee arthroplasty (UKA) is associated with improved component positioning and comparable short- and mid-term implant survivorship with manual UKA. This study aims to evaluate clinical and radiological outcomes following robotic-assisted UKA as well as any potential learning-curves associated with the introduction of such new technology. METHODS Prospective study of patients undergoing robotic-assisted UKA. Outcome measures were patient-reported outcome measures (PROMs) including Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Society Score (KSS) and Oxford Knee Score (OKS), complications, implant survivorship, component positioning and learning curve. RESULTS Eighty-five patients comprising 100 knees were recruited and followed up for 21.0 ± 4.3 months. At two years, there were significant and sustained improvements in PROMs and 100% implant survivorship rate. A high degree of implant accuracy was achieved with the robotic system. A cumulative learning curve of 20 cases was noted. CONCLUSION Robotic-assisted UKA achieves excellent implant accuracy and clinical outcomes in the short-term. Long-term follow up is needed to evaluate this relationship.
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Affiliation(s)
- Jean-Pierre St Mart
- St Vincent's Hospital Northside, 627 Rode Rd, Chermside QLD 4032, Brisbane, Australia.
| | - En Lin Goh
- Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Kadoorie Centre, University of Oxford, Oxford OX3 9DU, United Kingdom
| | - Ewan Goudie
- St Vincent's Hospital Northside, 627 Rode Rd, Chermside QLD 4032, Brisbane, Australia
| | - Ross Crawford
- St Vincent's Hospital Northside, 627 Rode Rd, Chermside QLD 4032, Brisbane, Australia
| | - Hugh English
- St Vincent's Hospital Northside, 627 Rode Rd, Chermside QLD 4032, Brisbane, Australia
| | - William Donnelly
- St Vincent's Hospital Northside, 627 Rode Rd, Chermside QLD 4032, Brisbane, Australia.
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Jensen CB, Troelsen A, Petersen PB, JØrgensen CC, Kehlet H, Gromov K. Influence of body mass index and age on day-of-surgery discharge, prolonged admission, and 90-day readmission after fast-track unicompartmental knee arthroplasty. Acta Orthop 2021; 92:722-727. [PMID: 34415220 PMCID: PMC8734435 DOI: 10.1080/17453674.2021.1968727] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - The indications for unicompartmental knee arthroplasty (UKA) have become less restrictive and, today, high age and high BMI are not considered contraindications by many surgeons. While the influence of these patient characteristics on total knee arthroplasty is well documented, evidence on UKA is lacking. We investigated the effect of BMI and age on day of surgery (DOS) discharge, prolonged admission, and 90-day readmission following UKA surgery.Patients and methods - This retrospective cohort study included 3,897 UKA patients operated on between 2010 and 2018 in 8 fast-track arthroplasty centers. Patients were divided into 5 BMI groups and 5 age groups. Differences between groups in the occurrence of DOS discharge, prolonged admission > 2 days, and 90-day readmission was investigated using a chi-square test and mixed-effect models adjusted for patient characteristics using surgical center as a random effect.Results - Median LOS was 1 day. DOS discharge was achieved in 26% of patients with no statistically significant differences between BMI groups. DOS discharge was less likely in UKA patients aged > 70 years (age 71-80; odds ratio [OR] 0.7 [95% CI 0.6-0.9]). Prolonged admission was not affected by BMI or age in the adjusted analysis. 90-day readmission was more likely in patients with BMI > 35 (OR 1.9 [CI 1.1-3.1]) and patients aged 71-80 (OR 1.5 [CI 1.1-2.1]).Interpretation - Age > 70 years decreased the likelihood of DOS discharge after UKA. High BMI as well as advanced age increased the likelihood of 90-day readmission. This should be noted by surgeons operating on patients with high BMI and age.
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Affiliation(s)
- Christian Bredgaard Jensen
- Department of Orthopaedic Surgery, Clinical
Orthopaedic Research Hvidovre, Copenhagen University Hospital Hvidovre,
Hvidovre2650, Denmark,Correspondence: Christian Bredgaard JENSEN Department of Orthopaedic Surgery, Clinical Orthopaedic Research Hvidovre,
Copenhagen University Hospital Hvidovre, Hvidovre2650, Denmark
| | - Anders Troelsen
- Department of Orthopaedic Surgery, Clinical
Orthopaedic Research Hvidovre, Copenhagen University Hospital Hvidovre,
Hvidovre2650, Denmark
| | - Pelle Baggesgaard Petersen
- Section for Surgical
Pathophysiology, Rigshospitalet, Copenhagen2100, Denmark,Centre for Fast-track Hip and Knee
Arthroplasty, Rigshospitalet, Copenhagen2100, Denmark
| | - Christoffer Calov JØrgensen
- Section for Surgical
Pathophysiology, Rigshospitalet, Copenhagen2100, Denmark,Centre for Fast-track Hip and Knee
Arthroplasty, Rigshospitalet, Copenhagen2100, Denmark
| | - Henrik Kehlet
- Section for Surgical
Pathophysiology, Rigshospitalet, Copenhagen2100, Denmark,Centre for Fast-track Hip and Knee
Arthroplasty, Rigshospitalet, Copenhagen2100, Denmark
| | - Kirill Gromov
- Department of Orthopaedic Surgery, Clinical
Orthopaedic Research Hvidovre, Copenhagen University Hospital Hvidovre,
Hvidovre2650, Denmark,Centre for Fast-track Hip and Knee
Arthroplasty, Rigshospitalet, Copenhagen2100, Denmark
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Hur ES, Serino J, Bohl DD, Della Valle CJ, Gerlinger TL. Fewer Adverse Events Following Outpatient Compared with Inpatient Unicompartmental Knee Arthroplasty. J Bone Joint Surg Am 2021; 103:2096-2104. [PMID: 34398841 DOI: 10.2106/jbjs.20.02157] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Unicompartmental knee arthroplasty (UKA) is a common procedure for unicompartmental knee arthritis, often resulting in pain relief and improved function. The demand for total knee arthroplasty in the U.S. is projected to grow 85% between 2014 and 2030, and the volume of UKA procedures is growing 3 to 6 times faster than that of total knee arthroplasty. The purpose of the present study was to examine the safety of outpatient and inpatient UKA and to investigate changes over time as outpatient procedures were performed more frequently. METHODS Patients who underwent UKA from 2005 to 2018 as part of the National Surgical Quality Improvement Program were identified. Patients were divided into an early cohort (5,555 patients from 2005 to 2015) and late cohort (5,627 patients from 2016 to 2018). Outpatient status was defined as discharge on the day of surgery. Adverse events within 30 days postoperatively were compared, with adjustment for baseline characteristics with use of standard multivariate regression and propensity-score-matching techniques. RESULTS Among the 5,555 cases in the early cohort, the rate of surgical-site infection was lower for inpatient (0.84%) compared with outpatient UKA (1.69%; adjusted relative risk [RR] for inpatient, 0.5; 95% confidence interval [CI], 0.2 to 1.0; p = 0.045); no other significant differences were identified. Among the 5,627 cases in the late cohort, inpatient UKA had higher rates of any complication (2.53% compared with 0.95% for outpatient UKA; adjusted RR for inpatient, 2.5; 95% CI, 1.4 to 4.3; p = 0.001) and readmission (1.81% compared with 0.88% for outpatient UKA; adjusted RR for inpatient, 2.0; 95% CI, 1.1 to 3.5; p = 0.023). In the propensity-score-matched comparison for the late cohort, inpatient UKA had a higher rate of any complication (RR for inpatient, 2.0; 95% CI, 1.0 to 4.0; p = 0.049) and return to the operating room (RR for inpatient, 4.3; 95% CI, 1.4 to 12.6; p = 0.009). Although the rate of readmission was almost twice as high among inpatients (1.67% compared with 0.84% for outpatients; RR for inpatient, 2.0; 95% CI, 1.0 to 4.1; p = 0.059), this difference did not reach significance with the sample size studied. There was a significant reduction in the overall rate of complications over time (3.44% in the early cohort compared with 2.11% in the late cohort; adjusted RR for late cohort, 0.7; 95% CI, 0.5 to 0.8; p = 0.001), with a more than fourfold reduction among outpatients (3.95% in the early cohort compared with 0.95% in the late cohort; adjusted RR for late cohort, 0.3; 95% CI, 0.1 to 0.5; p < 0.001). CONCLUSIONS Outpatient UKA was associated with a lower risk of complications compared with inpatient UKA when contemporary data are examined. We identified a dramatic reduction in complications across the early and late cohorts, suggesting an improvement in quality over time, with the largest improvements seen among outpatients. This shift may represent changes in patient selection or improvements in perioperative protocols. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Edward S Hur
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
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Hur ES, Bohl DD, Della Valle CJ, Villalobos F, Gerlinger TL. Hypoalbuminemia Predicts Adverse Events following Unicompartmental Knee Arthroplasty. J Knee Surg 2021; 36:491-497. [PMID: 34768290 DOI: 10.1055/s-0041-1739146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Hypoalbuminemia is a potentially modifiable risk factor associated with adverse events following total knee arthroplasty. The present study aimed to evaluate whether hypoalbuminemia similarly predisposes to adverse events following unicompartmental knee arthroplasty (UKA). Patients who underwent UKA during 2006-2018 were identified through the American College of Surgeons National Surgical Quality Improvement Program. Only patients with preoperative serum albumin concentration were included. Outcomes were compared between patients with and without hypoalbuminemia (serum albumin concentration < 3.5 g/dL). All associations were adjusted for demographic, comorbidity, and laboratory differences between populations. A total of 11,342 patients were identified, of whom 6,049 (53.3%) had preoperative serum albumin laboratory values available for analysis. After adjustment for potential confounders, patients with hypoalbuminemia had a greater than 2-fold increased probability for occurrence of any complication (7.02% vs. 2.23%, p = 0.009) and a 4-fold increased probability of receiving a blood transfusion (1.81% vs. 0.25%, p = 0.045). Among procedures performed as inpatients, mean postoperative length of stay (LOS) was longer in patients with hypoalbuminemia (2.2 vs. 1.8 days; p = 0.031). Hypoalbuminemia is independently associated with complications and increased LOS following UKA and a marker for patients at higher risk of postoperative complications. Patients should be screened for hypoalbuminemia and nutritional deficiencies addressed prior to UKA.
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Affiliation(s)
- Edward S Hur
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Daniel D Bohl
- Department of Orthopaedic Surgery, Baylor University Medical Center, Dallas, Texas
| | - Craig J Della Valle
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Felipe Villalobos
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Tad L Gerlinger
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
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Morris BL, Ayres JM, Reinhardt D, Tarakemeh A, Mullen S, Schroeppel JP, Vopat BG. Unicompartmental knee arthroplasty: A PearlDiver study evaluating complications rates, opioid use and utilization in the Medicare population. J Exp Orthop 2021; 8:103. [PMID: 34750676 PMCID: PMC8575771 DOI: 10.1186/s40634-021-00390-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 08/17/2021] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Despite increased utilization of unicompartmental knee arthroplasty (UKA) for unicompartmental knee osteoarthritis, outcomes in Medicare patients are not well-reported. The purpose of this study is to analyze practice patterns and outcome differences between UKA and TKA in the Medicare population. It is hypothesized that UKA utilization will have increased over the course of the study period and that UKA will be associated with reduced opioid use and lower complication rates compared to TKA. METHODS Using PearlDiver, the Humana Claims dataset and the Medicare Standard Analytic File (SAF) were analyzed. Patients who underwent UKA and TKA were identified by CPT codes. Postoperative complications were identified by ICD-9/ICD-10 codes. Opioid use was analyzed by the number of days patients were prescribed opioids postoperatively. Survivorship was defined as conversion to TKA. RESULTS In the Humana dataset, 7,808 UKA and 150,680 TKA patients were identified. 8-year survivorship was 87.7% (95% CI [0.861,0.894]). Postoperative opioid use was significantly higher after TKA (186.1 days) compared to UKA (144.7 days) (p < 0.01, Δ = 41.1, 95% CI = [30.41, 52.39]). In the SAF dataset, 20,592 UKA patients and 110,562 TKA patients were identified. Survivorship was highest in patients > 80 years old and lowest in patients < 70 years old. In both datasets, postoperative complication rates were higher in TKA patients compared to UKA patients in nearly all categories. CONCLUSIONS UKA represents an increasingly utilized treatment for osteoarthritis in the Medicare population and may be comparatively advantageous to TKA due to reduced opioid use and complication rates after surgery. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Brandon L Morris
- Department of Orthopedic Surgery, University of Kansas Medical Center, 3901 Rainbow Bvld, Kansas City, KS, 66160, USA
| | - Jack M Ayres
- Department of Orthopedic Surgery, University of Kansas Medical Center, 3901 Rainbow Bvld, Kansas City, KS, 66160, USA.
| | - Daniel Reinhardt
- Department of Orthopedic Surgery, University of Kansas Medical Center, 3901 Rainbow Bvld, Kansas City, KS, 66160, USA
| | - Armin Tarakemeh
- Department of Orthopedic Surgery, University of Kansas Medical Center, 3901 Rainbow Bvld, Kansas City, KS, 66160, USA
| | - Scott Mullen
- Department of Orthopedic Surgery, University of Kansas Medical Center, 3901 Rainbow Bvld, Kansas City, KS, 66160, USA
| | - J Paul Schroeppel
- Department of Orthopedic Surgery, University of Kansas Medical Center, 3901 Rainbow Bvld, Kansas City, KS, 66160, USA
| | - Bryan G Vopat
- Department of Orthopedic Surgery, University of Kansas Medical Center, 3901 Rainbow Bvld, Kansas City, KS, 66160, USA
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Goh GS, Corvi JJ, Grace TR, Eralp I, Small I, Lonner JH. Octogenarians Undergoing Medial Unicompartmental Knee Arthroplasty Have Similar Patient-Reported Outcomes as Their Younger Counterparts. J Arthroplasty 2021; 36:3656-3661. [PMID: 34226083 DOI: 10.1016/j.arth.2021.06.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 06/09/2021] [Accepted: 06/16/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND As a procedure with lower surgical morbidity, unicompartmental knee arthroplasty (UKA) may present a practical solution for elderly patients with unicompartmental arthritis. However, few studies have analyzed the results of UKA in the extreme elderly. This study compared the functional and perioperative outcomes between octogenarians and age-appropriate controls undergoing UKA. METHODS Prospectively collected data of 44 patients aged ≥80 years who underwent unilateral UKA were analyzed. Each octogenarian was matched 1:3 with 132 patients aged 65-74 years using propensity scores adjusting for gender, body mass index, Charlson comorbidity index, and preoperative scores. Knee Injury and Osteoarthritis Outcome Score for Joint Replacement and Short Form-12 were collected preoperatively and 2 years postoperatively. Complications, reoperations, readmissions, and unplanned visits were recorded up to 1 year postoperatively. RESULTS The mean age was 70.0 ± 2.7 years in the control group and 83.0 ± 3.0 years in the octogenarian group (P < .001). The percentage of outpatient procedures was comparable (control 50.0%; octogenarian 45.5%; P = .601). With the exception of poorer Short Form-12 physical scores in octogenarians at 2 years (39.4 ± 14.1 vs 44.9 ± 9.2, P = .028), there was no difference in final postoperative scores or improvement in scores between the groups. The rate of complications, reoperations, readmissions, and emergency room visits was also similar. The five-year survivorship was 97% in the control group and 93% in the octogenarian group (P = .148). CONCLUSION Octogenarians undergoing UKA can experience clinical outcomes that are similar to those of their younger counterparts. The clinical trajectory outlined may help clinicians provide valuable prognostic information to elderly patients and guide preoperative counseling.
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Affiliation(s)
- Graham S Goh
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - John J Corvi
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Trevor R Grace
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Ipek Eralp
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Ilan Small
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Jess H Lonner
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
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Ekhtiari S, Bozzo A, Madden K, Winemaker MJ, Adili A, Wood TJ. Unicompartmental Knee Arthroplasty: Survivorship and Risk Factors for Revision: A Population-Based Cohort Study with Minimum 10-Year Follow-up. J Bone Joint Surg Am 2021; 103:00004623-990000000-00342. [PMID: 34547009 DOI: 10.2106/jbjs.21.00346] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Operative management for end-stage knee osteoarthritis (OA) primarily consists of arthroplasty. Total knee arthroplasty (TKA) is the so-called gold standard for multicompartmental OA. In selected patients, specifically those with unicompartmental OA and no definite contraindications, realignment osteotomies and unicompartmental knee arthroplasty (UKA) are viable options. UKA offers several advantages over TKA, including preservation of both cruciate ligaments, faster recovery, and less osseous resection. The purpose of this study was to determine the survivorship of UKAs and risk factors for all-cause revision surgery in patients with a minimum follow-up of 10 years in a large population-based database. METHODS We performed a population-based cohort study using linked administrative databases in Ontario, Canada. We identified all UKAs performed from January 2002 through December 2006. All patients had a minimum 10-year follow-up. Demographic data and outcomes were summarized using descriptive statistics. We used a Cox proportional hazards model with the Fine and Gray method accounting for competing risks such as death to analyze the effect of surgical and patient factors on the risk of revision of UKA. RESULTS A total of 4,385 patients were identified as having undergone primary UKA from 2002 through 2006 in Ontario. Of these patients, 779 underwent revision surgery, for a cumulative risk for all-cause revision of 16.5% at 10 years (95% confidence interval [CI]: 15.4% to 17.7%). Mechanical loosening was the reason for 83.4% of all revisions. Male sex, diabetes, an age younger than 50 years, and cementless implants were significant risk factors for revision surgery. Residence in a rural or urban setting, income quintile, discharge destination, and type of OA were not associated with the risk of revision. Survivorship at 1, 5, 10, and 15 years was 97.2%, 90.5%, 83.5%, and 81.9%, respectively. CONCLUSIONS This study demonstrated a >80% long-term survivorship for UKA based on a large administrative database sample and identified important risk factors for failure including male sex, younger age, diabetes, and cementless fixation. This study found rates of survivorship similar to those previously reported in the literature, while identifying key risk factors for failure. Patient selection has always been identified as a key factor in ensuring successful UKA, and the risk factors identified in this study may help guide decision-making for surgeons and patients dealing with unicompartmental knee OA. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Seper Ekhtiari
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Anthony Bozzo
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Kim Madden
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
- Research Institute of St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Mitchell J Winemaker
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
- Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Anthony Adili
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
- Research Institute of St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Thomas J Wood
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
- Hamilton Health Sciences, Hamilton, Ontario, Canada
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Tveit M. The Renaissance of Unicompartmental Knee Arthroplasty appears rational - A radiograph-based comparative Study on adverse Events and patient-reported Outcomes in 353 TKAs and 98 UKAs. PLoS One 2021; 16:e0257233. [PMID: 34529691 PMCID: PMC8445477 DOI: 10.1371/journal.pone.0257233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 08/26/2021] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA) are both considered suitable for antero-medial osteoarthritis and spontaneous osteonecrosis of the knee. National registry data are consistent in showing higher revision rates for UKA. Adequately adjusted, these findings may be challenged by differences in adverse events and patient-reported outcomes, as both can have serious long-term implications. Based on preoperative radiographs, the aim was to retrospectively compare the two principle surgeries in these respects. METHODS All TKA procedures in 2016 in one Swedish county council were, according to certain radiograph-based consensus criteria, visually evaluated for medial UKA suitability. Then, using different regression models, they were compared with the corresponding medial UKAs performed in 2015-2017 regarding complications and patient-reported outcomes one year after surgery. RESULTS The UKA group showed an 82% reduced risk (OR 0.2; 95% CI 0.0-0.6) of any complications, whereas the 55% reduced risk of severe complication did not reach statistical significance (OR 0.5; 95% CI 0.1-2.1). These findings corresponded in high-volume surgeries to an absolute complication rate of 0% in the UKA group and 10% in the TKA group (p = 0.005) and to a severe complication rate of 0% and 5% respectively (p = 0.05). Though no differences were seen in any general patient-reported outcomes, the pain and function based OMERACT-OARSI responder criteria indicated in both around a 60% better chance of any response (OR 1.6 CI % 0.6-4.5) and a high response (OR 1.6; 95% CI 0.7-3.4) in the UKA group. CONCLUSION No differences were shown in patient-reported outcomes but a clear difference in risk of complications, favoring the UKA procedure.
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Affiliation(s)
- Magnus Tveit
- Department of Orthopedics, Skåne University Hospital, Clinical Sciences, Lund University, Lund, Sweden
- * E-mail:
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Unicompartmental Knee Replacement in Obese Patients: A Systematic Review and Meta-Analysis. J Clin Med 2021; 10:jcm10163594. [PMID: 34441889 PMCID: PMC8397050 DOI: 10.3390/jcm10163594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/01/2021] [Accepted: 08/09/2021] [Indexed: 12/27/2022] Open
Abstract
Thanks to modern surgical techniques and implants, traditional exclusion criteria for unicompartmental knee arthroplasty (UKA) are no longer considered contraindications. The aim of this study is to clarify the impact of obesity on functional outcomes and revision rates of UKA. We performed a comprehensive systematic review using PubMed–Medline, Google Scholar and Cochrane Central. Then, we extracted data related to body mass index (BMI), age and follow-up, functional outcome scores and rate of revisions (all-cause, aseptic and septic). Patients were stratified according to BMI into two groups: non-obese (BMI < 30) and obese (BMI ≥ 30). We identified 22 eligible studies, of which 13 were included in the meta-analysis. Patients with a BMI > 30 had a significantly higher likelihood for revision (p = 0.02), while the risk of septic revision was similar (p = 0.79). The clinical outcome measures showed a significant difference in favor of patients with a BMI < 30 (p < 0.0001). The improvements in Oxford Knee Score and Knee Society Score were significant in both obese and non-obese patients, although the latter showed inferior results. The results of this systematic review and meta-analysis show that BMI is not a contraindication to UKA. However, obese patients have a higher risk for aseptic failure and lower improvement in clinical scores compared to non-obese patients.
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Scholes C, Ebrahimi M, Field C, Farah S, Kerr D, Kohan L. Minimally Invasive Inlay Prosthesis Unicompartmental Knee Arthroplasty for the Treatment of Unicompartmental Osteoarthritis: A Prospective Observational Cohort Study with Minimum 2-Year Outcomes and up to 14-Year Survival. J Knee Surg 2021; 34:793-800. [PMID: 31887766 DOI: 10.1055/s-0039-3400536] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
There are limited medium-term outcome data available for the Repicci II device in unicompartmental knee arthroplasty (UKA). The purpose of this study was to report the medium-term (minimum 2 years) patient-reported outcomes and long-term (up to 14 years) procedure survival in a consecutive series of patients undergoing an inlay prosthesis UKA (Repicci II) at an independent orthopaedic clinic. Patients presenting with medially localized unicompartmental knee osteoarthritis and meeting the criteria appropriate for UKA were recruited to a clinical patient registry at the time of presentation. A cemented unicompartmental prosthesis (Repicci II) was implanted using minimally invasive techniques with rapid postoperative mobilization. Patients were asked to complete patient-reported outcomes preoperatively and annually postoperatively. A procedure list was cross-matched with the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), and an analysis of procedure survival was performed with comparison to the national data for UKA. Data from a cohort of 661 primary medial compartment UKA procedures performed in 551 patients over a 15-year period were extracted from the clinical patient registry. Significant improvements were maintained in general health, disease symptoms, pain, and function at an average follow-up of 9 years compared with preoperative data. Threshold analysis revealed that >65% of patients exceeded Patient Acceptable Symptom State at the latest follow-up, with >80% within or exceeding age-matched norms for general health. Cumulative revision rate was significantly lower than that reported for UKA in the AOANJRR at up to 13 years follow-up. This series represents a lower cumulative revision rate than previously reported, with >65% of patients reporting satisfactory functional outcomes at an average of 9 years from surgery. Surgical options for treating unicompartmental knee osteoarthritis could include UKA as a viable alternative; however, clear definitions of procedure success and its overall cost-benefit ratio in the context of ongoing management of knee osteoarthritis remain to be elucidated.
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Affiliation(s)
- Corey Scholes
- EBM Analytics, Crows Nest, Sydney, New South Wales, Australia
| | - Milad Ebrahimi
- EBM Analytics, Crows Nest, Sydney, New South Wales, Australia
| | - Clarice Field
- Joint Orthopaedic Centre, Sydney, New South Wales, Australia
| | - Sami Farah
- Joint Orthopaedic Centre, Sydney, New South Wales, Australia.,AM Orthopaedics, Sydney, New South Wales, Australia
| | - Dennis Kerr
- Joint Orthopaedic Centre, Sydney, New South Wales, Australia
| | - Lawrence Kohan
- Joint Orthopaedic Centre, Sydney, New South Wales, Australia
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No difference in long-term outcomes between men and women undergoing medial fixed-bearing cemented unicompartmental knee arthroplasty: A retrospective cohort study with minimum 10-year follow up. Knee 2021; 30:26-34. [PMID: 33823334 DOI: 10.1016/j.knee.2021.03.006] [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: 11/23/2020] [Revised: 02/15/2021] [Accepted: 03/09/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Some studies have suggested that women have poorer short-term outcomes after unicompartmental knee arthroplasty (UKA) due to a higher incidence of implant overhang. This study aimed to compare patient-reported outcome measures (PROMs) between men and women after UKA at a minimum follow-up of 10 years. METHODS Patients who underwent medial fixed-bearing UKA by two arthroplasty surgeons were identified from an institutional joint registry. Men and women were matched for age, body mass index, Charlson Comorbidity Index, American Society of Anesthesiologists class, range-of-motion and baseline PROMs using propensity scores. PROMs were compared at 2 and 10 years. Patients also completed a satisfaction questionnaire during these visits. Radiographic outliers were defined as > 2 mm of overhang. RESULTS A total of 128 patients were included. There was no difference in complications, length of stay or readmissions. Women had poorer Knee Society functional scores, Short-Form 36 physical and mental component scores (SF-36 MCS) at 2 years. No difference in PROMs was found at 10 years, except for poorer SF-36 MCS in women (P = 0.041). At 10 years, 96% of women and 92% of men were satisfied (P = 0.243). Fifteen-year survivorship free from any revision was 96% in each group. There were more medial-tibial outliers in women (9%) compared with men (5%) (P = 0.018). However, no association between outliers and outcomes or survivorship was found on multivariate analyses. CONCLUSION There was nodifference in clinical outcomes between men and women undergoing UKA at a minimum follow-up of 10 years. While women had a higher incidence of medial tibial overhang, this was not associated with long-term outcomes or survivorship.
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Hamedi R, Pourghane P, Mansour-Ghanaei R, Atrkar-Roushan Z. Efficacy of Knee Arthroplasty on the Outcomes of Knee Osteoarthritis in Iranian Elderly Individuals. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2021; 26:245-251. [PMID: 34277376 PMCID: PMC8262537 DOI: 10.4103/ijnmr.ijnmr_23_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 04/27/2019] [Accepted: 08/03/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Knee osteoarthritis is a common musculoskeletal condition in elderly individuals. This survey was conducted with the aim to identify the problems of this group of patients for compilation of healthcare programs targeted at determining the outcome of osteoarthritis before and 3 months after knee arthroplasty. MATERIALS AND METHODS In the present cross-sectional study, 150 elderly individuals who had volunteered for knee arthroplasty were selected through nonrandomized sampling and were evaluated using the Knee Osteoarthritis Outcome Score (KOOS) questionnaire and a demographic characteristics form before and 3 months after the surgery via nonparametric statistical tests (Wilcoxon, Mann-Whitney U, and Kruskal-Wallis tests). RESULTS The mean (SD) age of the study subjects was 64.40 (7.20) years. A significant difference was observed between the mean scores of all subscales (pain with Z=10.62, knee pain/knee stiffness with Z=10.54, daily activity with Z=10.62, sport with Z=2.95, and quality of life with Z=10.48) before and after knee arthroplasty based on Wilcoxon test (˂0.05). The results of the Mann-Whitney U test showed a significant statistical relationship between the difference in the mean score of daily activities and history of opium consumption (Z=1.90, p ˂ 0.05) as well as that between knee pain/knee stiffness and gender (Z=2.57, p ˂ 0.05) and educational level (Z=2.11, p ˂ 0.05). CONCLUSIONS Knee arthroplasty and history of opium consumption were correlated with improvement of patients' performance in their daily activities, and gender (women) and educational level (unread) were correlated with improvement of the score of the knee pain/knee stiffness subscale.
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Affiliation(s)
- Roya Hamedi
- Department of Nursing, Zeynab (P.B.U.H) School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
| | - Parand Pourghane
- Department of Nursing, Zeynab (P.B.U.H) School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
| | - Roya Mansour-Ghanaei
- Department of Nursing, Zeynab (P.B.U.H) School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Zahra Atrkar-Roushan
- Department of Biostatistics Sciences, Guilan University of Medical Sciences, Rasht, Iran
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[Focal femoral resurfacing and unicompartmental knee replacement : Between osteotomy and total knee replacement]. DER ORTHOPADE 2021; 50:387-394. [PMID: 33847791 DOI: 10.1007/s00132-021-04105-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/12/2021] [Indexed: 10/21/2022]
Abstract
Unicompartmental knee arthroplasty, especially for both femorotibial compartments of the knee, is an established partly joint-saving treatment option for osteoarthritis of the knee if the disease is limited to one compartment. Even smaller implants or resurfacing of the patellofemoral joint have been shown-in smaller patient collectives-to have the potential to yield good clinical results.
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Abstract
Lateral unicompartmental knee arthroplasty affords excellent functional results and implant survivorship for properly selected patients. More high-quality studies are necessary to determine whether expanded indications for medial unicompartmental knee arthroplasty also apply to lateral unicompartmental knee arthroplasty. Operative adjuncts such as robotics, custom implants, and navigation technology hold promise in minimizing the technical burden and unfamiliarity of lateral unicompartmental knee arthroplasty. Improvements in lateral-specific implants may translate to operational efficiency and improved outcomes, but few lateral-specific implants currently exist. Mobile-bearing devices have increased rates of failure due to bearing dislocation, and further studies are warranted to evaluate this complication with newer designs. Future registry and cohort studies should show medial unicompartmental knee arthroplasty and lateral unicompartmental knee arthroplasty separately to allow for better understanding of the nuances and technical differences between these uniquely different procedures.
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Affiliation(s)
- Evan Smith
- Department of Orthopaedic Surgery, The George Washington University, Washington, DC
| | - Danny Lee
- Department of Orthopaedic Surgery, The George Washington University, Washington, DC
| | - John Masonis
- OrthoCarolina Hip and Knee Center, Charlotte, North Carolina
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Seth A, Dobransky J, Albishi W, Dervin GF. Mid-Term Evaluation of the Unicompartmental Knee Arthroplasty in Patients with BMI of 40 or Greater. J Knee Surg 2021; 34:427-433. [PMID: 31505699 DOI: 10.1055/s-0039-1696735] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Limited evidence is available on mid-term follow-up for patients with body mass index (BMI) ≥ 40 receiving a unicompartmental knee arthroplasty (UKA). The primary objective of this study was to investigate survival of the UKA in patients with BMI ≥ 40. Secondary objectives were to assess functional and patient reported outcome measures (PROMs). Survival analysis with endpoint revision of any component for any reason was conducted using Kaplan-Meier technique on 121 knees (103 patients) that underwent UKA with Oxford Phase 3 implant (Oxford Knee, Biomet, Swindon, United Kingdom) between September 2001 and March 2014 by seven surgeons. Survivorship differences were compared using Log Rank (Mantel-Cox) tests, and Cox Proportional Hazard Model was used to assess predictors of failure. Preoperative PROMs were compared at 2 and 5 years postoperatively using paired t-tests. Mean age of patients was 58 years (43-75), mean BMI 43 kg/m2 (40-51), and mean follow-up 7 years (2 months to 15 years). Survival rate for the whole cohort was 92% at 2 years and 86% at 5 years. Females had a significantly higher revision rate than males (p = 0.043). A total of 19 knees required revision (16 to TKA, 2 polyethylene liner exchanges, and 1 femoral component and liner revision). With respect to PROMs, there was a significant improvement at 2 and 5 years (p < 0.001) on 4 of 5 knee injury and osteoarthritis outcome score subscales. The mid-term survival rate for the Oxford UKA in patients with morbid obesity is similar to that of other nondesigner patient series with BMI ≥ 30, which provides further evidence for the safety of the implant in this patient population with significant improvements on PROMs at short and mid-term follow-up.
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Affiliation(s)
- Akshay Seth
- Division of Orthopaedic Surgey, The Ottawa Hospital, General Campus, Ottawa, Ontario, Canada
| | - Johanna Dobransky
- Division of Orthopaedic Surgey, The Ottawa Hospital, General Campus, Ottawa, Ontario, Canada
| | - Waleed Albishi
- Division of Orthopaedic Surgey, The Ottawa Hospital, General Campus, Ottawa, Ontario, Canada
| | - Geoffrey F Dervin
- Division of Orthopaedic Surgey, The Ottawa Hospital, General Campus, Ottawa, Ontario, Canada
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Calkins TE, Hannon CP, Fillingham YA, Culvern CC, Berger RA, Della Valle CJ. Fixed-Bearing Medial Unicompartmental Knee Arthroplasty in Patients Younger Than 55 Years of Age at 4-19 Years of Follow-Up: A Concise Follow-Up of a Previous Report. J Arthroplasty 2021; 36:917-921. [PMID: 33051122 DOI: 10.1016/j.arth.2020.09.042] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 09/18/2020] [Accepted: 09/23/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Unicompartmental knee arthroplasty (UKA) is an effective alternative to total knee arthroplasty (TKA) in isolated unicompartmental disease; however, mid-term to long-term results in young patients are unknown. The purpose of this study is to determine the mid-term outcomes of fixed-bearing medial UKA in patients less than 55 years of age. METHODS Seventy-seven fixed-bearing medial UKAs in patients less than 55 years of age (mean 49.9, range 38-55) from a previously published report were retrospectively reviewed at a mean follow-up of 11.2 years (range 4.1-19.2). RESULTS Eleven knees were converted to TKA (14.3%) at 0.7-13.8 years postoperatively. The indications for revision included 7 for unexplained pain (9.1%), 2 for grade 4 arthritic progression (1 isolated lateral and 1 lateral and patellofemoral compartments; 2.6%), 1 for polyethylene wear (1.3%), and 1 for femoral component loosening (1.3%). Predicted survivorship free from component revision was 90.4% (95% confidence interval 86.9-93.9) at 10 years and 75.1% (95% confidence interval 66.2-84.0) at 19 years. The mean Knee Society Score improved from a mean of 51.9-88.6 points (P < .001). Of the 52 knees with 4-year minimum radiographs, 3 (5.8%) developed isolated grade 4 patellofemoral arthritis that was asymptomatic, and no knees had evidence of component loosening or osteolysis. CONCLUSION Fixed-bearing medial UKA is a durable option for young patients with unicompartmental arthritis, with good clinical outcomes at mid-term follow-up. Unexplained pain was the most common reason for revision to TKA.
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Affiliation(s)
- Tyler E Calkins
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee - Campbell Clinic, Memphis, TN
| | - Charles P Hannon
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | - Yale A Fillingham
- Department of Orthopaedic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Chris C Culvern
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | - Richard A Berger
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | - Craig J Della Valle
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
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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]. DER 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] [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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Kikuchi K, Hiranaka T, Kamenaga T, Hida Y, Fujishiro T, Okamoto K. Anterior Cruciate Ligament Deficiency is Not Always a Contraindication for Medial Unicompartmental Knee Arthroplasty: A Retrospective Study in Nondesigner's Japanese Hospital. J Arthroplasty 2021; 36:495-500. [PMID: 32912672 DOI: 10.1016/j.arth.2020.08.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/07/2020] [Accepted: 08/12/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND An intact anterior cruciate ligament (ACL) is thought to be prerequisite for successful unicompartmental knee arthroplasty (UKA), but recent studies reported successful midterm results of UKA in ACL-deficient (ACLD) knees. We hypothesized that ACLD is not always a contraindication for medial UKA when preoperative radiographs showed typical anteromedial knee patterns. METHODS From April 2012 to March 2016, 401 Oxford mobile-bearing UKAs in 282 patients were retrospectively identified from our database. Patients whose ACL was severely damaged, but preoperative X-rays showed typical anteromedial osteoarthritis patterns, were categorized into the ACLD group. From intraoperative data, those whose ACL was intact were categorized into the ACL functional (ACLF) group. There were 32 and 369 knees in the ACLD and ACLF groups, respectively, and mean follow-up periods were 66.1 and 63.8 months for the ACLD and ACLF groups, respectively. We compared the postoperative clinical outcome and component survivorship, with an endpoint of component revision, between ACLD groups and ACLF groups. RESULTS In both groups, the Oxford knee score, Knee Society score, Tegner activity score, and knee range of motion in extension were improved after surgery. The UKA component survival rate at five years was 100% in the ACLD group and 98.9% in the ACLF group. There were no significant differences between the groups. CONCLUSION Mid-term clinical outcomes of Oxford mobile-bearing UKA in ACLD knees were similar to those in ACLF knees. ACL deficiency is not always a contraindication for medial unicompartmental knee arthroplasty in patients with typical anteromedial osteoarthritis radiographs.
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Affiliation(s)
- Kenichi Kikuchi
- Department of Orthopedic Surgery and Joint Surgery Center, Takatsuki General Hospital, Takatsuki-city, Osaka, Japan
| | - Takafumi Hiranaka
- Department of Orthopedic Surgery and Joint Surgery Center, Takatsuki General Hospital, Takatsuki-city, Osaka, Japan
| | - Tomoyuki Kamenaga
- Department of Orthopedic Surgery and Joint Surgery Center, Takatsuki General Hospital, Takatsuki-city, Osaka, Japan
| | - Yuichi Hida
- Department of Orthopedic Surgery and Joint Surgery Center, Takatsuki General Hospital, Takatsuki-city, Osaka, Japan
| | - Takaaki Fujishiro
- Department of Orthopedic Surgery and Joint Surgery Center, Takatsuki General Hospital, Takatsuki-city, Osaka, Japan
| | - Koji Okamoto
- Department of Orthopedic Surgery and Joint Surgery Center, Takatsuki General Hospital, Takatsuki-city, Osaka, Japan
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Liow MHL, Goh GS, Pang HN, Tay DKJ, Chia SL, Lo NN, Yeo SJ. Should patients aged 75 years or older undergo medial unicompartmental knee arthroplasty? A propensity score-matched study. Arch Orthop Trauma Surg 2020; 140:949-956. [PMID: 32306091 DOI: 10.1007/s00402-020-03440-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION With increasing life expectancies worldwide, more elderly patients with isolated medial compartment osteoarthritis may become suitable UKA candidates. However, there is a paucity of literature comparing outcomes between older patients (≥ 75 years) and younger patients undergoing UKA. The aim of this study was to determine if there were differences in functional and HRQoL measures between older patients (≥ 75 years) and younger controls (< 75 years) undergoing primary UKA. MATERIALS AND METHODS Prospectively collected registry data of 1041 patients who underwent primary, cemented, fixed-bearing medial UKA at a single institution from 2002-2013 were reviewed. Propensity scores generated using logistic regression was used to match older patients (≥ 75 years, n = 94) to controls (< 75 years, n = 188) in a 1:2 ratio. Knee Society Scores, Oxford Knee Score, Short Form-36, satisfaction/expectation scores, proportion of patients attaining OKS/SF-36 PCS MCID and survivorship were analysed. RESULTS Patients ≥ 75 years had significantly lower KSFS (67.1 ± 17.9 vs 79.4 ± 18.2, p < 0.001) and SF-36 PCS (47.3 ± 10.1 vs 50.4 ± 9.1, p = 0.01) as compared to the control group. In addition, a significantly lower proportion of patients ≥ 75 years attained MCID for SF-36 PCS when compared to the controls (50.0% vs 63.8%, p = 0.04). Survival rates at mean 8.3 ± 3.0 years were 98.9% (95% CI, 96.7-100) in the older group versus 92.8% (95% CI, 86.8-98.8) in the younger group (p = 0.31). CONCLUSIONS Our findings highlight the need to counsel older patients regarding potentially reduced improvements in functional outcomes, despite advantages of lower revision. However, UKA in older patients continues to be a viable option for isolated medial compartment osteoarthritis LEVEL OF EVIDENCE: Level III Propensity score matched study.
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Affiliation(s)
- Ming Han Lincoln Liow
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, Singapore, 169865, Singapore
| | - Graham S Goh
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, Singapore, 169865, Singapore.
| | - Hee-Nee Pang
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, Singapore, 169865, Singapore
| | - Darren Keng-Jin Tay
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, Singapore, 169865, Singapore
| | - Shi-Lu Chia
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, Singapore, 169865, Singapore
| | - Ngai-Nung Lo
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, Singapore, 169865, Singapore
| | - Seng-Jin Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, Singapore, 169865, Singapore
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Does the overhang of tibial component in fixed bearing medial unicondylar knee arthroplasty affect 1-year results? JOURNAL OF SURGERY AND MEDICINE 2020. [DOI: 10.28982/josam.759045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Burger JA, Kleeblad LJ, Sierevelt IN, Horstmann WG, van Geenen RCI, van Steenbergen LN, Nolte PA. A Comprehensive Evaluation of Lateral Unicompartmental Knee Arthroplasty Short to Mid-Term Survivorship, and the Effect of Patient and Implant Characteristics: An Analysis of Data From the Dutch Arthroplasty Register. J Arthroplasty 2020; 35:1813-1818. [PMID: 32192831 DOI: 10.1016/j.arth.2020.02.027] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 02/07/2020] [Accepted: 02/12/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The rarity of lateral unicompartmental knee arthroplasty (UKA) results in a lack of large cohort studies and understanding. The aim of this study is to comprehensively evaluate survivorship of lateral UKA with registry data and compare this to medial UKA. METHODS Lateral (n = 537) and medial UKAs (n = 19,295) in 2007-2017 were selected from the Dutch Arthroplasty Register. Survival analyses were performed with revision for any reason as primary endpoint. Adjustments were made for patient and implant characteristics. Stratified analyses according to patient and implant characteristics were performed. Reasons and type of revision were grouped according to laterality and bearing design. RESULTS The 5-year revision rate was 12.9% for lateral UKA and 9.3% for medial UKA. Multivariable regression analyses showed no significant increased risk for revision for lateral UKA (hazard ratio 0.87, 95% confidence interval 0.66-1.15). Stratified analyses showed that the effect of patient characteristics on revision was comparable between lateral and medial UKA; however, the use of mobile-bearing design for lateral UKA was associated with increased revision rate. Progression of osteoarthritis was the main reason for revision on both sides accompanied by tibia component loosening for medial UKA. Reasons and type of revision varied depending on bearing design. CONCLUSION Similar survivorship of lateral and medial UKA was reported. Specifically, there is a notable risk for revision when using mobile-bearing designs for lateral UKA. Failure modes and type of revision depends on laterality and bearing design. These findings emphasize that surgical challenges related to anatomy and kinematics of the lateral and medial knee compartment need to be considered.
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Affiliation(s)
- Joost A Burger
- Department of Orthopaedic Surgery, Computer Assisted Surgery Center, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY
| | - Laura J Kleeblad
- Department of Orthopaedic Surgery, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - Inger N Sierevelt
- Department of Orthopaedic Surgery, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - Wieger G Horstmann
- Department of Orthopaedic Surgery, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | | | | | - Peter A Nolte
- Department of Orthopaedic Surgery, Spaarne Gasthuis, Hoofddorp, The Netherlands
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Zheng C, Lu W, Li Z, Zhou J, Chen D, Wu Y. [Effect of body mass index on short- and medium-term effectiveness of unicompartmental knee arthroplasty]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:442-446. [PMID: 32291978 DOI: 10.7507/1002-1892.201909143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To investigate the effect of body mass index (BMI) on the short- and medium-term effectiveness of unicompartmental knee arthroplasty (UKA) in the treatment of anterior medial compartmental osteoarthritis of knee joint. Methods The clinical data of 55 patients (61 knees) with anterior medial compartmental osteoarthritis of knee joint treated with minimally invasive UKA between May 2014 and May 2019 were retrospectively analyzed. According to BMI, the patients were divided into 3 groups: normal body mass group [group A, BMI 18.50-24.99 kg/m 2, 23 cases (25 knees)], overweight group [group B, BMI 25.00-29.99 kg/m 2, 23 cases (25 knees)], obesity group [group C, BMI 30.00-39.99 kg/m 2, 9 cases (11 knees)]. There was no significant difference in gender, age, sides, disease duration, and preoperative American Special Surgery Hospital (HSS) score, pain visual analogue scale (VAS) score, and knee range of motion (ROM) among 3 groups ( P>0.05). The operation time, intraoperative dominant blood loss, and the postoperative decreased amount of hemoglobin at 1 week were recorded and compared among 3 groups. The HSS score, VAS score, and ROM were used to evaluate the knee function and pain improvement. Results There was no significant difference in the operation time, the intraoperative dominant blood loss, and the postoperative decreased amount of hemoglobin at 1 week among 3 groups ( P>0.05). All the 55 patients were followed up 5-60 months, with an average of 24 months. No complication such as infection, fat embolism, or deep venous thrombosis of lower extremity occurred after operation. The anteroposterior and lateral X-ray films of the knee joint showed that no dislocation or loosening of the prosthesis occurred and the position of the prosthesis was good. At last follow-up, the HSS score, VAS score, and ROM of the 3 groups were significantly improved when compared with preoperative ones ( P<0.05); but there was no significant difference among 3 groups ( P>0.05). Conclusion For obese and overweight patients with anterior medial compartmental osteoarthritis of the knee joint, the use of minimally invasive UKA can achieve satisfactory short- and medium-term effectiveness, and the long-term effectiveness needs further follow-up.
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Affiliation(s)
- Chong Zheng
- Department of Orthopedic Arthrosurgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Guangdong, 510000, P.R.China
| | - Weijie Lu
- Department of Orthopedic Arthrosurgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Guangdong, 510000, P.R.China
| | - Zhichen Li
- Department of Orthopedic Arthrosurgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Guangdong, 510000, P.R.China
| | - Junjie Zhou
- Department of Orthopedics, the First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, 650032, P.R.China
| | - Dongfeng Chen
- Department of Orthopedic Arthrosurgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Guangdong, 510000, P.R.China
| | - Yingbin Wu
- Department of Orthopedic Arthrosurgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Guangdong, 510000, P.R.China
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吴 东, 杨 敏, 曹 正, 孔 祥, 王 毅, 郭 人, 柴 伟. [Research progress in unicompartmental knee arthroplasty]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:145-150. [PMID: 32030942 PMCID: PMC8171978 DOI: 10.7507/1002-1892.201906085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 11/24/2019] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To summarize the clinical application and research progress in unicompartmental knee arthroplasty (UKA). METHODS The literature related to UKA in recent years was reviewed and the emerging indications, implant options, comparisons between other surgical techniques, and recent advances were summarized. RESULTS Clinical studies show that UKA has many advantages, such as less trauma, faster recovery, and fewer postoperative complications. At present, the operative indication has been expanded. The body mass index more than 25 kg/m 2, less than 60 years old, patellofemoral arthritis, and anterior cruciate ligament dysfunction are no longer considered as contraindications. The prosthesis type in UKA should be selected according to the patient's condition. In recent years, the robot-assisted UKA can effectively improve the effectiveness, improve patient satisfaction, and reduce postoperative complications. CONCLUSION With the development of surgical techniques, designs of prosthesis, and the robotic technology, UKA would be further applicated. As more long-term data on UKA become available, it will further guide clinicians in counseling patients on whether UKA should be performed.
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Affiliation(s)
- 东 吴
- 中国人民解放军总医院第一医学中心骨科(北京 100853)Department of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing, 100853, P.R.China
| | - 敏之 杨
- 中国人民解放军总医院第一医学中心骨科(北京 100853)Department of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing, 100853, P.R.China
- 南开大学医学院(天津 300071)Medicine School of Nankai University, Tianjin, 300071, P.R.China
| | - 正 曹
- 中国人民解放军总医院第一医学中心骨科(北京 100853)Department of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing, 100853, P.R.China
- 南开大学医学院(天津 300071)Medicine School of Nankai University, Tianjin, 300071, P.R.China
| | - 祥朋 孔
- 中国人民解放军总医院第一医学中心骨科(北京 100853)Department of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing, 100853, P.R.China
| | - 毅 王
- 中国人民解放军总医院第一医学中心骨科(北京 100853)Department of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing, 100853, P.R.China
| | - 人文 郭
- 中国人民解放军总医院第一医学中心骨科(北京 100853)Department of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing, 100853, P.R.China
| | - 伟 柴
- 中国人民解放军总医院第一医学中心骨科(北京 100853)Department of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing, 100853, P.R.China
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Focal metallic inlay resurfacing prosthesis in articular cartilage defects: short-term results of 118 patients and 2 different implants. Arch Orthop Trauma Surg 2020; 140:209-218. [PMID: 31748883 DOI: 10.1007/s00402-019-03305-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Indexed: 02/09/2023]
Abstract
BACKGROUND The goal of this study was to share our experience with two different inlay metallic implants in the treatment of knee cartilage defects and to analyze their effects on functional scores. METHODS This retrospective study included 118 patients operated on for focal full-thickness knee cartilage lesions, who were treated with a focal metallic inlay resurfacing prosthesis. A cobalt-chromium (Co-Cr) resurfacing implant was applied to 73 patients with a knee chondral lesion, and a biosynthetic implant was applied to 45. All patients were evaluated preoperatively and postoperatively using the KOOS, VAS, and Tegner activity scores. RESULTS The group with the Co-Cr-resurfacing implant showed a significantly greater improvement (p < 0.001) in the Tegner and VAS scores at the 2-year follow-up examination. The KOOS scores were similar in both groups. Median patient age was similar in both groups. All patients had a follow-up of at least 2 years. The preoperative and postoperative scores were compared and significant improvements (p < 0.001) were observed. The biosynthetic implant had a higher revision rate. In the univariate analysis, age and type of implant were significantly associated with revision surgery. In the multivariate Cox-regression analysis model, the type of implant was significantly associated with revision surgery. CONCLUSION All the patients operated with the above-mentioned implants showed significant improvements in pain and activity scores. Despite the overall good clinical results, 17% of patients with a biosynthetic implant and > 6% of patients with Co-Cr-resurfacing implant required revision surgery. Age and implant type were the main risk factors associated with revision.
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