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Rodriguez M, Heida K, Rider DE, Goodman GP, Waterman BR, Belmont PJ. Occupational Outcomes and Revision Rates for Medial Unicondylar Knee Arthroplasty in U.S. Military Servicemembers. J Knee Surg 2022; 35:1393-1400. [PMID: 33607676 DOI: 10.1055/s-0041-1723968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This study evaluates return to work and revision rates for medial unicondylar knee arthroplasty (UKA) in a high-demand military cohort. Patient demographic and clinical variables were isolated from the medical records of active-duty military servicemembers with at least 2 years of postoperative follow-up and correlated with return to work, medial UKA survivorship, and perioperative complications. The medial UKA annual revision rate was calculated as the percentage of implants revised per observed component year. A total of 39 servicemembers underwent 46 primary medial UKAs (32 unilateral and 7 bilateral) with a mean follow-up of 3.9 (2.0-6.6) years. At a minimum of 2 years postoperatively, 33 (85%) servicemembers returned to military service or successfully completed their service obligation. Older servicemembers (odds ratio [OR] = 0.67; 95% confidence interval [CI]: 0.45, 0.99) had a significantly decreased OR for knee-related medical separation. Nine servicemembers (20%) had conversion to TKA at an average of 2.4 (range, 0.6-5.6) years with a medial UKA annual revision rate of 5%. When compared with Navy/Air Force, Army/Marine servicemembers had an increased TKA conversion rate (OR = 5.40; 95% CI: 1.13, 25.81). Older age decreased the likelihood of medical separation and Army/Marines service was the sole risk factor associated with conversion to TKA. The level of evidence is IV, therapeutic case series.
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Affiliation(s)
- Marina Rodriguez
- Department of Orthopaedic Surgery and Rehabilitation, William Beaumont Army Medical Center, El Paso, Texas
| | - Ken Heida
- Department of Orthopaedic Surgery and Rehabilitation, William Beaumont Army Medical Center, El Paso, Texas
| | | | - Gens P Goodman
- Department of Orthopaedic Surgery and Rehabilitation, William Beaumont Army Medical Center, El Paso, Texas
| | - Brian R Waterman
- Division of Sports Medicine, Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Philip J Belmont
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland
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Haffar A, Krueger CA, Marullo M, Banerjee S, Dobelle E, Argenson JN, Sprenzel JF, Berger RA, Romagnoli S, Lonner JH. Staged BiCompartmental Knee Arthroplasty has Greater Functional Improvement, but Equivalent Midterm Survivorship, as Revision TKA for Progressive Osteoarthritis After Partial Knee Arthroplasty. J Arthroplasty 2022; 37:1260-1265. [PMID: 35227809 DOI: 10.1016/j.arth.2022.02.084] [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: 11/10/2021] [Revised: 02/11/2022] [Accepted: 02/19/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Progressive arthritis in the unresurfaced compartments of the knee is one failure mode after partial knee arthroplasty (PKA). While progressive arthritis after PKA is typically treated with revision to TKA (rTKA), staged bicompartmental knee arthroplasty (sBiKA) -the addition of another PKA - is an alternative. This study compared outcomes of sBiKA and rTKA for progressive arthritis after PKA. METHODS A retrospective comparative study of non-consecutive cases at four institutions were performed in patients with an intact PKA, without loosening or wear, who underwent sBiKA (n = 27) or rTKA (n = 30), for progressive osteoarthritis. Outcomes studied were new Knee Society Function and Objective Scores (KSSF, KSSO), KOOS, Jr., ROM, operative times, length of stay, complication rates and the need for reoperations. RESULTS Mean time to conversion was 7.4 ± 6 years for sBiKA and 9.7 ± 8 for rTKA, P = .178. Patient demographics and pre-operative outcomes were similar among cohorts. At an average of 5.7 ± 3 (sBiKA) and 3.2 ± 2 years (rTKA), KOOS, Jr. significantly improved, P < .001, by an equivalent amount. Post-operative KSSO and KSSF were significantly higher in the sBiKA cohort, respectively, (90.4 ± 10 vs 72.1 ± 20, P < .001) and (80.3 ± 18 vs 67.1 ± 19, P = .011). sBiKA patients had significantly greater improvement in KSSO (30.7 ± 33 vs 5.2 ± 18, P = .003). One sBiKA patient underwent reoperation for continued pain. CONCLUSION SBiKA has equivalent survivorship, but greater improvement in functional outcomes as rTKA at short to midterm follow-up. Given the shorter operative times and length of stay, sBiKA is a safe and cost-effective alternative to rTKA for progressive osteoarthritis following PKA. Nevertheless, further follow-up is necessary to determine whether sBiKA is a durable option.
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Affiliation(s)
- Amer Haffar
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Chad A Krueger
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Matteo Marullo
- Joint Replacement Department, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Samik Banerjee
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Emile Dobelle
- Department of Orthopedics and Traumatology, Institute for Locomotion, St. Marguerite Hospital, Marseille, France
| | - Jean N Argenson
- Department of Orthopedics and Traumatology, Institute for Locomotion, St. Marguerite Hospital, Marseille, France
| | - Jenny F Sprenzel
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | - Richard A Berger
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | - Sergio Romagnoli
- Joint Replacement Department, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Jess H Lonner
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
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Sershon RA, Fricka KB, Hamilton WG, Nam D, Parks NL, DeBenedetti A, Della Valle CJ. Early Results of a Randomized Controlled Trial of Partial Versus Total Knee Arthroplasty. J Arthroplasty 2022; 37:S94-S97. [PMID: 35227810 DOI: 10.1016/j.arth.2022.02.076] [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: 11/19/2021] [Revised: 02/11/2022] [Accepted: 02/18/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Debate still exists regarding the benefits of unicompartmental (UKA) versus total knee arthroplasty (TKA) for the treatment of medial compartment osteoarthritis. The purpose of this randomized trial is to compare the early outcomes of UKA versus TKA. METHODS One-hundred and seven candidates for UKA were randomized at two centers; 57 candidates received UKA and 50 received TKA. Six-week and 6-month outcome measures including Knee Injury and Osteoarthritis Outcome Score, Joint Replacement (KOOS, JR), Knee Society Score (KSS), Forgotten Joint Score (FJS), and VR-12 global health scores were obtained. No demographic or baseline patient reported outcome (PRO) differences were present suggesting successful randomization (P > .05). RESULTS UKA demonstrated shorter operative times (UKA = 65 minutes, TKA = 74 minutes; P < .001) and length of stay (UKA = 0.7 nights, TKA = 1.2 nights; P < .01). At 6 weeks, there were no differences in KOOS, JR (P = .755), KSS (P = .754), FJS (P = .664), or PRO change from preoperative scores (P = .468). There were three surgical complications within 90 days in each group. The duration of opioid consumption (UKA = 33.8 days, TKA = 28.5 days; P = .290) and return to work (UKA = 57.1 days, TKA = 47.3 days; P = .346) did not differ between groups. CONCLUSION Data suggest no clinically significant differences between UKA and TKA in the early postoperative period in regards to patient-reported outcome measures, duration of opioid use, or return to work. Patients undergoing UKA can anticipate a shorter length of stay and greater early range of motion. All-cause short-term complications may be more prevalent with TKA.
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Affiliation(s)
| | - Kevin B Fricka
- Anderson Orthopaedic Research Institute, Alexandria, Virginia
| | | | - Dennis Nam
- Anderson Orthopaedic Research Institute, Alexandria, Virginia
| | - Nancy L Parks
- Anderson Orthopaedic Research Institute, Alexandria, Virginia
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Derreveaux V, Schmidt A, Shatrov J, Sappey-Marinier E, Batailler C, Servien E, Lustig S. Combined procedures with unicompartmental knee arthroplasty: High risk of stiffness but promising concept in selected indications. SICOT J 2022; 8:4. [PMID: 35191830 PMCID: PMC8862640 DOI: 10.1051/sicotj/2022002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 01/07/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction: Unicompartmental knee arthroplasty (UKA) has traditionally been contraindicated in the presence of an ACL deficient knee, bi-compartmental disease, or significant coronal deformity due to concerns regarding increased risk of persisted pain, knee instability, tibial loosening, or progression of osteoarthritis. The aim of this study was to evaluate the outcomes of patients undergoing UKA with an associated surgical procedure in these specific indications. Method: This was a retrospective cohort study of patients undergoing UKA between December 2015 and October 2020. Patients were categorized into groups based on associated procedures: UKA + ACL, UKA + HTO, and bicompartmental arthroplasty. Outcomes were assessed using the Knee Society Score (KSS) knee and function scores and the Forgotten Joint Score. Radiological and complication analysis was performed at the last clinical follow-up. Results: Thirty-two patients (13 men and 19 women) were included. The mean age was 56.2 years ± 11.1 (range, 33–84) with a mean follow-up of 26.3 months ± 15 (7.3–61.1). There was a significant improvement between the pre-and postoperative KSS Knee (+34.3 ± 16.5 [12–69]), Function (+34.3 ± 18.6 [0–75]), and Total scores (+68.5 ± 29.4 [24–129]) (p = 0.001). Seven patients (21.8%) required an arthroscopic arthrolysis for persistent stiffness. Two patients (UKA + PFA and UKA + ACL) underwent revision to TKA. Patient satisfaction was 90%, and mean flexion at last follow-up was 122° ± 6 (120–140). The implant survival rate was 94%. Discussion: This study found performing UKA with an additional procedure to address relative contraindications to the arthroplasty in physically active patients with monocompartmental knee arthritis is an efficient strategy with good results at short-term follow-up. It should be reserved for patients where TKA is likely to have unsatisfactory results, and the patient has been fully counseled regarding the management options. Even if there is a high rate of complications with stiffness requiring a re-intervention, the final results are very satisfying with no impact of the reintervention on the clinical result in the short term.
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Affiliation(s)
- Vianney Derreveaux
- FIFA Medical Center of Excellence, Orthopaedics Surgery and Sports Medicine Department, Croix-Rousse Hospital, Hospices Civils de Lyon 103 Grande rue de la Croix Rousse 69004 Lyon France
| | - Axel Schmidt
- FIFA Medical Center of Excellence, Orthopaedics Surgery and Sports Medicine Department, Croix-Rousse Hospital, Hospices Civils de Lyon 103 Grande rue de la Croix Rousse 69004 Lyon France
- Corresponding author:
| | - Jobe Shatrov
- Sydney Orthopaedic Research Institute Chatswood Sydney 2067 Australia
- University of Notre Dame Australia Orthopaedic Research Institute Sydney 2007 Australia
- Hornsby and Ku-Ring Hospital Sydney 2077 Australia
| | - Elliot Sappey-Marinier
- FIFA Medical Center of Excellence, Orthopaedics Surgery and Sports Medicine Department, Croix-Rousse Hospital, Hospices Civils de Lyon 103 Grande rue de la Croix Rousse 69004 Lyon France
- Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406 25 Avenue François Mitterand 69500 Lyon France
| | - Cécile Batailler
- FIFA Medical Center of Excellence, Orthopaedics Surgery and Sports Medicine Department, Croix-Rousse Hospital, Hospices Civils de Lyon 103 Grande rue de la Croix Rousse 69004 Lyon France
- Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406 25 Avenue François Mitterand 69500 Lyon France
| | - Elvire Servien
- FIFA Medical Center of Excellence, Orthopaedics Surgery and Sports Medicine Department, Croix-Rousse Hospital, Hospices Civils de Lyon 103 Grande rue de la Croix Rousse 69004 Lyon France
- LIBM – EA 7424, Interuniversity Laboratory of Biology of Mobility, Claude Bernard Lyon 1 University 43 boulevard du 11 Novembre 69622 Villeurbanne France
| | - Sébastien Lustig
- FIFA Medical Center of Excellence, Orthopaedics Surgery and Sports Medicine Department, Croix-Rousse Hospital, Hospices Civils de Lyon 103 Grande rue de la Croix Rousse 69004 Lyon France
- Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406 25 Avenue François Mitterand 69500 Lyon France
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Robotic-assisted knee arthroplasty: an evolution in progress. A concise review of the available systems and the data supporting them. Arch Orthop Trauma Surg 2021; 141:2099-2117. [PMID: 34491411 DOI: 10.1007/s00402-021-04134-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 08/19/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION A review of the data supporting robotic systems currently available is presented focussing on precision and reproducibility, radiological outcomes, clinical outcomes, and survivorship. MATERIALS AND METHODS Scientific literature published on robotic systems for knee arthroplasty was reviewed using the reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Inclusion criteria were any study involving robotic-assisted UKA or TKA that reported precision of implant positioning or functional outcomes or range of motion or survivorship, including cadaveric or dry bone studies with a minimum of 6-month follow-up. RESULTS Thirty-nine studies were identified for robotic-assisted unicompartmental knee arthroplasty, and 24 studies for robotic-assisted total knee arthroplasty. Those that reported on radiological outcomes or cadaver studies consistently demonstrated improved precision with the use of robotic systems irrespective of the system. PROMS and survival data demonstrated equivalent short-term results. However, many studies reported outcomes inconsistently and few had long-term clinical follow-up or survivorship data. CONCLUSIONS This review adds to the body of evidence supporting improved precision and reproducibility with robotic assistance in knee arthroplasty. Despite intensive funding of research into robotic knee systems, there remains considerable heterogeneity in exposure and outcome analysis and few quality long-term studies demonstrating translation to better clinical outcomes and implant survivorship.
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Lee CS, Su EP, Cross MB, Carli AV, Landy DC, Chalmers BP. Unicompartmental Knee Arthroplasty Is Associated With a Lower Rate of Periprosthetic Joint Infection Compared to Total Knee Arthroplasty. Arthroplast Today 2021; 10:117-122. [PMID: 34355051 PMCID: PMC8321892 DOI: 10.1016/j.artd.2021.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/10/2021] [Accepted: 06/14/2021] [Indexed: 11/29/2022] Open
Abstract
Background Several studies have reported lower perioperative complications with unicompartmental knee arthroplasty (UKA) than with total knee arthroplasty (TKA). However, there is a paucity of data analyzing the incidence of periprosthetic joint infection (PJI) in similar patients undergoing UKA and TKA. As such, we sought to analyze the incidence of UKA and TKA PJI in a large matched population. Material and Methods The Mariner data set of the PearlDiver database was queried for all patients undergoing UKA or TKA during 2010-2017. Included patients were required to have at least 2 years of database inclusion after surgery. Patients were then matched at a 1:3 ratio (UKA:TKA) on age, gender, Elixhauser Comorbidity Index, tobacco use, and obesity. Rates of PJI requiring operative intervention within 90 days and 1 year were calculated. Results In total, 5636 patients having undergone UKA were matched to 16,890 patients having undergone TKA. Fifteen (0.27%) after UKA and 79 (0.47%) after TKA had a PJI surgically managed within 90 days (risk ratio = 0.57, 95% confidence interval = 0.33-0.99, P = .04). Thirty (0.53%) after UKA and 136 (0.81%) after TKA had a PJI surgically managed within 1 year (risk ratio = 0.66, 95% confidence interval = 0.45-0.98, P = .04). Conclusions In a large group of rigorously matched patients, UKA was associated with a significantly lower rate of surgically managed PJI than TKA at 90 days and 1 year; however, the rate of PJI in both groups remained low at <1% at 90 days and 1 year.
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Affiliation(s)
- Cody S Lee
- Department of Orthopedic Surgery, Univesity of Chicago, Chicago, IL
| | - Edwin P Su
- Department of Orthopedic Surgery Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY
| | - Michael B Cross
- Department of Orthopedic Surgery Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY
| | - Alberto V Carli
- Department of Orthopedic Surgery Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY
| | - David C Landy
- Department of Orthopedic Surgery, University of Kentucky, Lexington, KY
| | - Brian P Chalmers
- Department of Orthopedic Surgery Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY
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Tille E, Beyer F, Auerbach K, Tinius M, Lützner J. Better short-term function after unicompartmental compared to total knee arthroplasty. BMC Musculoskelet Disord 2021; 22:326. [PMID: 33810795 PMCID: PMC8019176 DOI: 10.1186/s12891-021-04185-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 03/22/2021] [Indexed: 11/24/2022] Open
Abstract
Background Unicompartmental knee arthroplasty (UKA) is an established treatment option for patients with unicompartmental osteoarthritis (OA). However, strict patient selection is crucial for its success. The proposed advantages include nearly natural knee kinematics, faster rehabilitation and better functional outcomes. Despite the aforementioned facts and it’s proven cost-effectiveness, there are still hesitations for the use of UKA as an alternative to total knee arthroplasty (TKA). Key objectives of this study were therefore to assess clinical and patient-reported outcome (PRO) as well as patient’s satisfaction after medial UKA in comparison to TKA. Methods To assess the outcome after UKA we conducted a prospective multi-center study. 116 patients with unicompartmental OA and indication for UKA were included. Overall 54 females and 62 males with an average age of 62.7 years (±9.8) and an average body mass index (BMI) of 29.2 (± 3.7) were recruited. Clinical results and PRO were assessed using the Knee Society Score (KSS). Follow-ups took place 3 months, 1 and 2 years after surgery including clinical examination, radiographs, assessment of PRO and adverse events. Pain and satisfaction was evaluated using a visual analog scale (VAS, 0 (worst) to 10 (best)). For comparison with TKA a propensity score matched-pair analysis was performed to eliminate confounders. Matching criteria were gender, patient’s age, BMI and comorbidities. A total of 116 matched-pairs were analysed. Results There was no revision in the UKA group until 2 years after surgery. Revision rates were higher in the TKA group (0.6%). Preoperative KSS-Scores were higher within the UKA cohort (p < 0.001). After surgical treatment, PROMs displayed a significant improvement (p < 0,001) in both cohorts. Regarding the Knee-Score (Pain, Alignment, ROM) we observed no differences between cohorts after 12 months. The Function-Score demonstrated significantly better results in the UKA cohort (UKA vs. TKA 95 vs 80, p < 0.001). Patient satisfaction was also higher in UKA patients (UKA vs TKA 9.0 vs 8.8, p = 0.019). Conclusion Patients of both cohorts showed high satisfaction after knee arthroplasty. UKA resulted in higher function scores compared to TKA without increased revision rate during short-term follow-up. Therefore, UKA is a good treatment option for unicompartmental OA. Trial registration Clinicaltrials.gov, NCT04598568. Registered 22 October 2020 - Retrospectively registered.
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Affiliation(s)
- Eric Tille
- University Center for Orthopaedic, Trauma- and Plastic Surgery, University Medicine Carl Gustav Carus Dresden, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
| | - Franziska Beyer
- University Center for Orthopaedic, Trauma- and Plastic Surgery, University Medicine Carl Gustav Carus Dresden, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Kai Auerbach
- Arthromed Praxisklinik Chemnitz, Chemnitz, Germany
| | | | - Jörg Lützner
- University Center for Orthopaedic, Trauma- and Plastic Surgery, University Medicine Carl Gustav Carus Dresden, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany
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Deng M, Hu Y, Zhang Z, Zhang H, Qu Y, Shao G. Unicondylar knee replacement versus total knee replacement for the treatment of medial knee osteoarthritis: a systematic review and meta-analysis. Arch Orthop Trauma Surg 2021; 141:1361-1372. [PMID: 33512583 PMCID: PMC8295078 DOI: 10.1007/s00402-021-03790-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 01/11/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Since the optimal surgery for isolated medial knee osteoarthritis (OA) is unclear, this study aimed at comparing the effectiveness of unicondylar knee replacement (UKR) with total knee replacement (TKR) for simple medial knee OA. METHODS Literature searches of PubMed, Embase, Web of Science, and the Cochrane Library were searched up to 1th April 2020. Only studies comparing UKR with TKR for isolated medial knee OA were included. Data collection and extraction, quality assessment, and data analyses were performed according to the Cochrane standards. RESULTS A total of 13 articles with 1888 patients were included, among which, 944 and 944 underwent UKR and TKR, respectively. The analyzed postoperative outcomes were mostly within 5 years of follow-up. The meta-analysis showed that UKR improved knee general function (P < 0.00001) and health (P = 0.02), moreover, reduced post-operative pain (P = 0.01) and complications (P < 0.05) more than TKR. There were no significant differences in postoperative revision (P = 0.252), high-activity arthroplasty score (HAAS) (P = 0.307) and Oxford knee score (OKS) (P = 0.15) between the two techniques. CONCLUSIONS The patients of UKR could achieve better clinical results than that of TKR, moreover, there were negligible differences between the two techniques in postoperative revision in the early and mid-term follow-up and surgeons should be aware of the important reasons for revision of UKR. Thus, UKR instead of TKR should be performed in patients with late-stage isolated medial knee OA.
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Affiliation(s)
- Meichao Deng
- The Department of Orthopedic Surgery, Yongchuan Hospital, Chongqing Medical University, 439 Xuanhua Road, Yongchuan, Chongqing, China
| | - Yang Hu
- The Department of Orthopedic Surgery, Yongchuan Hospital, Chongqing Medical University, 439 Xuanhua Road, Yongchuan, Chongqing, China
| | - Zhongzu Zhang
- The Department of Orthopedic Surgery, Yongchuan Hospital, Chongqing Medical University, 439 Xuanhua Road, Yongchuan, Chongqing, China
| | - Hongjun Zhang
- The Department of Orthopedic Surgery, Yongchuan Hospital, Chongqing Medical University, 439 Xuanhua Road, Yongchuan, Chongqing, China
| | - Yiming Qu
- The Department of Orthopedic Surgery, Yongchuan Hospital, Chongqing Medical University, 439 Xuanhua Road, Yongchuan, Chongqing, China
| | - Gaohai Shao
- The Department of Orthopedic Surgery, Yongchuan Hospital, Chongqing Medical University, 439 Xuanhua Road, Yongchuan, Chongqing, China.
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Jansen K, Beckert M, Deckard ER, Ziemba-Davis M, Meneghini RM. Satisfaction and Functional Outcomes in Unicompartmental Compared with Total Knee Arthroplasty: Radiographically Matched Cohort Analysis. JB JS Open Access 2020; 5:JBJSOA-D-20-00051. [PMID: 33299963 PMCID: PMC7722600 DOI: 10.2106/jbjs.oa.20.00051] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Unicompartmental and total knee arthroplasty (UKA and TKA) have demonstrated excellent mid- and long-term outcomes and have been compared in clinical series for decades; however, to our knowledge, no study has sufficiently matched UKA and TKA cohorts on preoperative osteoarthritis severity. The purpose of this study was to evaluate patient-reported outcomes of radiographically and demographically matched UKA and TKA cohorts.
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Affiliation(s)
- Kirsten Jansen
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Mitchell Beckert
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Evan R Deckard
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Mary Ziemba-Davis
- IU Health Hip & Knee Center, Indiana University Health Physicians, Fishers, Indiana
| | - R Michael Meneghini
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana.,IU Health Hip & Knee Center, Indiana University Health Physicians, Fishers, Indiana
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Deng M, Hu Y, Zhang Z, Zhang H, Qu Y, Shao G. WITHDRAWN: Unicondylar knee replacement versus total knee replacement for the treatment of medial knee osteoarthritis: A systematic review and meta-analysis. J Orthop 2020. [DOI: 10.1016/j.jor.2020.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Kennedy JA, Mellon SJ, Lombardi AV, Berend KR, Hamilton TW, Murray DW. Candidacy for medial unicompartmental knee replacement declines with age. Orthop Traumatol Surg Res 2020; 106:443-447. [PMID: 32265176 DOI: 10.1016/j.otsr.2019.11.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 10/15/2019] [Accepted: 11/04/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND The effect of age on the percentage of primary knee replacements appropriate for unicompartmental replacement (UKR), defined as candidacy, is unknown. The aim was to determine the candidacy and outcome of UKR in different age groups. HYPOTHESIS Age is associated with candidacy for medial UKR. PATIENTS AND METHODS This cross-sectional study determined UKR candidacy from preoperative radiographs, including stress views, from 457 consecutive knee replacements (TKR or UKR) in a specialist joint replacement centre. Candidacy, estimated from radiographs and from usage, was determined for all knees and then stratified by age group<50, 50-60, 60-70, 70-80, and 80+. The outcome of UKR implanted in these groups was also assessed. To avoid overestimating, candidacy estimated by usage was used for the primary analysis. RESULTS Candidacy decreased with age (OR 0.98, p=0.008) and was 61% (CI 42-78), 52% (CI 43-61), 43% (CI 35-51), 41% (CI 31-52), and 36% (CI 22-52) respectively. Candidacy estimated by radiographs was slightly higher overall (49% compared to 46%) and in all age groups than candidacy estimated from usage. Neither functional outcome (p=0.47) nor implant survival (p=0.54) was affected by age. Overall 80% achieved good/excellent Knee Society objective scores, and the five-year implant survival was 99%. DISCUSSION There is a strong association of candidacy for UKR with age in that younger patients are more likely to be candidates (61% in those<50 and 36% in those 80+). Good outcomes can be expected in patients of all ages who are appropriate for UKR. LEVEL OF EVIDENCE IV, Prognostic cross-sectional study.
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Affiliation(s)
- James A Kennedy
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Oxford, UK, OX3 7LD.
| | - Stephen J Mellon
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Oxford, UK, OX3 7LD
| | | | | | - Thomas W Hamilton
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Oxford, UK, OX3 7LD
| | - David W Murray
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Oxford, UK, OX3 7LD; Nuffield Orthopaedic Centre, Oxford University Hospital NHS Foundation Trust, Windmill Road, Oxford, UK, OX3 7LD
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Kleeblad LJ, Strickland SM, Nwachukwu BU, Kerkhoffs GMMJ, Pearle AD. Satisfaction with return to sports after unicompartmental knee arthroplasty and what type of sports are patients doing. Knee 2020; 27:509-517. [PMID: 31926669 DOI: 10.1016/j.knee.2019.11.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 10/14/2019] [Accepted: 11/23/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE The present study provides insight into patient satisfaction with return to sports after unicompartmental knee arthroplasty (UKA) and to what type of activities patients return. This is important because indications for UKA have expanded and younger and more active patients undergo surgery currently. METHODS Patients who received a UKA were contacted between 12 and 24 months' post-surgery, receiving a questionnaire to evaluate postoperative satisfaction with return to sports, level of return, type of activities performed pre- and postoperatively, and (activity) outcome scores (NRS, UCLA, HAAS). Descriptive statistical analysis focused on the influence of patients' sex and age, and a regression model was fitted to assess the predictors for high satisfaction postoperatively. RESULTS One hundred and sixty-four patients (179 UKAs) with a mean age of 62.3 years responded at an average follow-up of 20.2 months. Preoperatively, 132 patients (81%) participated in sports, which increased to 147 patients (90%) after UKA. Analyzing outcomes for each knee individually, satisfaction with return to sports was recorded in 83% (149/179). Return to a higher or similar level was reported in 85.4% of the cases (117/137). Most common sports after UKA were cycling (45%), swimming (38%), and stationary cycling (27%). Overall, 93.9% of patients were able to return to low impact sports, 63.9% to intermediate and 32.7% to high impact sports. Regarding activity scores, preoperative NRS score improved from 6.40 ± 2.10 to 1.33 ± 1.73 postoperatively (p < .001). The mean preoperative UCLA score improved from 5.93 ± 2.19 to 6.78 ± 1.92 (p < .001) and HAAS score from 9.13 ± 3.55 to 11.08 ± 2.83 postoperatively (p < .001). Regression analyses showed that male sex, preoperative UCLA score and sports participation predicted high activity scores postoperatively. CONCLUSION The vast majority of patients undergoing medial UKA returned to sports postoperatively, of which over 80% was satisfied with their restoration of sports ability. Male patients, patients aged ≥70, and patients who participated in low-impact sports preoperatively achieved the highest satisfaction rates. Regarding type of sports, male patients and patients aged ≤55 were most likely to return to high and intermediate impact sports. This study may offer valuable information to help manage patients' expectations regarding their ability to return to sports based on demographics and type of preoperative sporting activities. LEVEL OF EVIDENCE Case series; Level of evidence IV.
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Affiliation(s)
- Laura J Kleeblad
- Department of Orthopaedic Surgery and Sports Medicine, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY, United States of America.
| | - Sabrina M Strickland
- Department of Orthopaedic Surgery and Sports Medicine, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY, United States of America
| | - Benedict U Nwachukwu
- Department of Orthopaedic Surgery and Sports Medicine, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY, United States of America
| | - Gino M M J Kerkhoffs
- Department of Orthopaedic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Andrew D Pearle
- Department of Orthopaedic Surgery and Sports Medicine, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY, United States of America
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Unicompartmental Knee Arthroplasty Provides Significantly Greater Improvement in Function than Total Knee Arthroplasty Despite Equivalent Satisfaction for Isolated Medial Compartment Osteoarthritis. J Arthroplasty 2019; 34:1611-1616. [PMID: 31031160 DOI: 10.1016/j.arth.2019.04.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 03/20/2019] [Accepted: 04/02/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND While some advocate for unicompartmental knee arthroplasty (UKA) for isolated medial compartment osteoarthritis (OA), others favor total knee arthroplasty (TKA). The purpose of this study was to compare the functional outcomes of UKA and TKA performed for patients with unicompartmental arthritis (OA). METHODS A study was performed on 133 patients that met strict criteria for UKA, but who underwent either medial UKA or TKA for isolated medial compartment OA based upon physician equipoise. The primary outcome-New Knee Society Score (KSS)-was assessed preoperatively and at 2 years postoperatively. A propensity score weighted regression was used to balance the groups on several key covariates, including age, gender, body mass index, and baseline KSS. RESULTS After propensity weighting, there were no significant differences between UKA and TKA in overall baseline KSS or KSS after 2 years postoperatively. While TKA patients had demonstrated a significantly greater improvement in the symptoms KSS subscale, UKA patients had a significantly greater improvement in the function subscale. Expectations were significantly more likely to be met after UKA, but there were no differences in patient satisfaction. CONCLUSION UKA and TKA are both highly successful options for treating patients with medial compartment OA, although functionality increased more, and expectations were more likely to be met, after UKA in this study. Given equivalent patient satisfaction after both TKA and UKA, surgeons should consider factors such as clinical experience, individual preference, cost of care, surgical risk, and recovery needs, when making treatment decisions regarding this clinical entity.
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Robinson PG, Clement ND, Hamilton D, Blyth MJG, Haddad FS, Patton JT. A systematic review of robotic-assisted unicompartmental knee arthroplasty: prosthesis design and type should be reported. Bone Joint J 2019; 101-B:838-847. [PMID: 31256672 DOI: 10.1302/0301-620x.101b7.bjj-2018-1317.r1] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Robotic-assisted unicompartmental knee arthroplasty (UKA) promises accurate implant placement with the potential of improved survival and functional outcomes. The aim of this study was to present the current evidence for robotic-assisted UKA and describe the outcome in terms of implant positioning, range of movement (ROM), function and survival, and the types of robot and implants that are currently used. MATERIALS AND METHODS A search of PubMed and Medline was performed in October 2018 in line with the Preferred Reporting Items for Systematic Review and Meta-Analysis statement. Search terms included "robotic", "knee", and "surgery". The criteria for inclusion was any study describing the use of robotic UKA and reporting implant positioning, ROM, function, and survival for clinical, cadaveric, or dry bone studies. RESULTS A total of 528 articles were initially identified from the databases and reference lists. Following full text screening, 38 studies that satisfied the inclusion criteria were included. In all, 20 studies reported on implant positioning, 18 on functional outcomes, 16 on survivorship, and six on ROM. The Mako (Stryker, Mahwah, New Jersey) robot was used in 32 studies (84%), the BlueBelt Navio (Blue Belt Technologies, Plymouth, Minnesota) in three (8%), the Sculptor RGA (Stanmore Implants, Borehamwood United Kingdom) in two (5%), and the Acrobot (The Acrobot Co. Ltd., London, United Kingdom) in one study (3%). The most commonly used implant was the Restoris MCK (Stryker). Nine studies (24%) did not report the implant that was used. The pooled survivorship at six years follow-up was 96%. However, when assessing survival according to implant design, survivorship of an inlay (all-polyethylene) tibial implant was 89%, whereas that of an onlay (metal-backed) implant was 97% at six years (odds ratio 3.66, 95% confidence interval 20.7 to 6.46, p < 0.001). CONCLUSION There is little description of the choice of implant when reporting robotic-assisted UKA, which is essential when assessing survivorship, in the literature. Implant positioning with robotic-assisted UKA is more accurate and more reproducible than that performed manually and may offer better functional outcomes, but whether this translates into improved implant survival in the mid- to longer-term remains to be seen. Cite this article: Bone Joint J 2019;101-B:838-847.
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Affiliation(s)
| | - N D Clement
- Department of Orthopaedics and Trauma, University of Edinburgh, Edinburgh, UK
| | - D Hamilton
- Department of Orthopaedics and Trauma, University of Edinburgh, Edinburgh, UK
| | - M J G Blyth
- Glasgow Royal Infirmary Orthopaedic Research Unit, Glasgow, UK
| | - Fares S Haddad
- University College London Hospitals, The Princess Grace Hospital, and The NIHR Biomedical Research Centre at UCLH, London, UK
| | - J T Patton
- Department of Orthopaedics and Trauma, University of Edinburgh, Edinburgh, UK
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Unicompartmental versus total knee arthroplasty for knee osteoarthritis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2018; 29:947-955. [PMID: 30535643 DOI: 10.1007/s00590-018-2358-9] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 12/03/2018] [Indexed: 01/22/2023]
Abstract
PURPOSE In the last couple of years, a significant amount of studies comparing the UKA and TKA for unicompartmental knee osteoarthritis have been published. However, there is a lack of recent meta-analysis comparing the two implants. Since the number of performed UKAs is currently increasing and the indications are obsolete, it becomes important to update current evidences and outcomes. With these premises, a meta-analysis of clinical trials comparing UKA versus TKA was conducted. METHODS In October 2018, the following databases were accessed: Cochrane Systematic Reviews, Scopus, PubMed and Google Scholar. According to the Oxford Center of Evidence-based Medicine, level of evidence articles I to III were included. Only studies reporting quantitative data concerning the outcomes of interest were included. For the statistical analysis and the methodological quality assessment, we referred to the Review Manager Software 5.3. Dichotomous data were analyzed through the Mantel-Haenszel statistical method with the odd ratio effect measure. For continuous data, the inverse variance statistical method was used with the mean difference effect measure. A confidence interval of 95% was considered for analysis. To evaluate study heterogeneity, both Chi-square and Higgins tests were performed. Values of P < 0.05 were considered statistically significant. RESULTS The overall methodological quality assessment was moderate. The risk of publication's bias was moderate. We enrolled in this study a total of 13,789 patients. The mean follow-up was 42.69 months. The UKA evidenced increased risk of revision's surgeries (OR 2.16, P > 0.0001). All the other scores of interest were in favor of the UKA: Oxford Knee Score, KSS Clinical, WOMAC overall and related subscales. The UKA also reported better functional outcomes: KSS Function, longer walking distance, improvement of the joint flexion and ROM. Moreover, in the UKA group have been reported a shorter length of stay, reduced estimated total blood loss and shorter surgical duration. CONCLUSION The main findings of this meta-analysis are that UKA reported a reduced survivorship but better clinical and functional performances compared to TKA. Furthermore, shorter surgical duration, lower total estimated blood loss and quicker hospitalization length were observed in the UKA cohort.
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Sun X, Su Z. A meta-analysis of unicompartmental knee arthroplasty revised to total knee arthroplasty versus primary total knee arthroplasty. J Orthop Surg Res 2018; 13:158. [PMID: 29929543 PMCID: PMC6013960 DOI: 10.1186/s13018-018-0859-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 06/08/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study was performed to compare the clinical outcomes of unicompartmental knee arthroplasty (UKA) revised to total knee arthroplasty (TKA) versus primary TKA. METHODS Relevant trials were identified via a search of the Cochrane Central Register of Controlled Trials and PubMed from inception to 17 June 2017. A meta-analysis was performed to compare postoperative outcomes between revised UKA and primary TKA with respect to the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, Knee Society Score (KSS), mean polyethylene thickness, hospital stay, revision rate, range of motion (ROM), and complications. RESULTS Five of 233 studies involving 536 adult patients (revised UKA group, n = 209; primary TKA group, n = 327) were eligible for inclusion in the meta-analysis. The primary TKA group had better WOMAC scores, KSS, and ROM than the revised UKA group (P < 0.05). Compared with primary TKA, revision of UKA to TKA required more augments, stems, and bone grafts and a thicker polyethylene component (P < 0.05). There were no significant differences between the two groups in the revision rate, hospital stay, or complications (P > 0.05). CONCLUSION Conversion of UKA to TKA is associated with poorer clinical outcomes than primary TKA. Furthermore, we believe that conversion of UKA to TKA is more complicated than performing primary TKA. Revision UKA often requires more augments, stems, and bone grafts and thicker polyethylene components than primary TKA. However, patients who undergo conversion of UKA to TKA have similar hospital stay, complications, and revision rate as patients who undergo primary TKA.
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Affiliation(s)
- Xuedong Sun
- Department of Orthopaedics, Weifang People's Hospital, no. 151 Guangwen Road, Weifang, 260041, China
| | - Zheng Su
- Department of Medical Oncology, Weifang People's Hospital, no. 151 Guangwen Road, Weifang, 260041, China.
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Medial Unicompartmental Knee Arthroplasty: Correlation Between Components’ Malalignment and Long-term Outcome in Obese Patients. Trauma Mon 2017. [DOI: 10.5812/traumamon.60096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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van der List JP, Kleeblad LJ, Zuiderbaan HA, Pearle AD. Mid-Term Outcomes of Metal-Backed Unicompartmental Knee Arthroplasty Show Superiority to All-Polyethylene Unicompartmental and Total Knee Arthroplasty. HSS J 2017; 13:232-240. [PMID: 28983215 PMCID: PMC5617820 DOI: 10.1007/s11420-017-9557-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 04/04/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Two commonly used tibial designs for unicompartmental knee arthroplasty (UKA) are all-polyethylene "inlay" and metal-backed "onlay" components. Biomechanical studies showed that the metal baseplate in onlay designs better distributes forces over the tibia but studies failed to show differences in functional outcomes between both designs at mid-term follow-up. Furthermore, no studies have compared both designs with total knee arthroplasty (TKA). QUESTIONS/PURPOSES The goal of this study was to compare outcomes of inlay UKA and onlay UKA at mid-term follow-up and compare these with TKA outcomes. METHODS In this retrospective study, 52 patients undergoing inlay medial UKA, 59 patients undergoing onlay medial UKA, and 59 patients undergoing TKA were included. Western Ontario and McMaster Universities Arthritis Index scores were collected preoperatively and at mean 5.1-year follow-up (range 4.0-7.0 years). RESULTS Preoperatively, no differences were observed in patient characteristics or outcome scores. At mid-term follow-up, patients undergoing onlay medial UKA reported significant better functional outcomes than those of inlay medial UKA (92.0 ± 10.4 vs. 82.4 ± 18.7, p = 0.010) and when compared to TKA (92.0 ± 10.4 vs. 79.6 ± 18.5, p < 0.001) while no significant differences between inlay medial UKA and TKA were noted. No significant differences in revision rates were found. CONCLUSION Functional outcomes following onlay metal-backed medial UKA were significantly better compared to inlay all-polyethylene medial UKA and to TKA. Based on the results of this study and on biomechanical and survivorship studies in the literature, we recommended using metal-backed onlay tibial components for unicompartmental knee arthroplasty.
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Affiliation(s)
- Jelle P. van der List
- Computer Assisted Surgery Center, Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
- Weill Cornell Medical College, New York, NY 10065 USA
| | - Laura J. Kleeblad
- Computer Assisted Surgery Center, Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
- Weill Cornell Medical College, New York, NY 10065 USA
| | | | - Andrew D. Pearle
- Computer Assisted Surgery Center, Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
- Weill Cornell Medical College, New York, NY 10065 USA
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