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Scott RD. Unicompartmental Knee Arthroplasty: Lessons Learned After 50 Years of Experience. J Arthroplasty 2024; 39:1901-1903. [PMID: 38697318 DOI: 10.1016/j.arth.2024.04.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2024] Open
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Favroul C, Batailler C, Thouvenin C, Shatrov J, Neyret P, Servien E, Lustig S. Long-term functional success and robust implant survival in lateral unicompartmental knee arthroplasty: A case series with a mean follow-up of twenty two and a half years. INTERNATIONAL ORTHOPAEDICS 2024; 48:1761-1769. [PMID: 38743298 DOI: 10.1007/s00264-024-06215-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 05/07/2024] [Indexed: 05/16/2024]
Abstract
PURPOSE Lateral unicompartmental knee arthroplasty (UKA) is an accepted treatment option in cases of end-stage lateral osteoarthritis. While lateral UKA has many proposed advantages compared to total knee arthroplasty, its technical challenges and relatively small number of cases make this an uncommon procedure. The aim of this study was to report the survivorship and functional outcomes beyond 20 years of follow-up of isolated UKA. METHODS Between January 1988 and October 2003, 54 lateral UKAs were performed in a single center. The fitted prosthesis was a fixed plate and cemented polyethylene (PE). All patients had isolated lateral tibiofemoral osteoarthritis, including five open meniscectomies, three arthroscopies, and three open reductions of lateral tibial plateau fractures. Patients with a minimum of 20 years of follow-up were included in the final analysis. RESULTS Of the 54 UKA, 22 died before reaching the minimum follow-up period and four were lost to follow-up. Twenty-eight were included in the final analysis. Among them, 21 patients remained alive and an additional seven were deceased after 20 years. The mean age at the last follow-up was 84.8 ± 11.9 years with a mean follow-up duration of 22.5 ± 2.1 years. Of the 28 knees, eight underwent revision surgery (5 for the progression of osteoarthritis; 2 for aseptic loosening; 1 for PE wear). Kaplan-Meier survival analysis revealed a survival rate at 20 and 25 years of 72.3% (CI 59.1; 88.6). The average time to revision was 14.9 ± 4.9 years. At the last follow-up, the mean function Knee Society Score (KSS) was 41.5 ± 32.9 and the mean objective KSS score was 79.4 ± 9.7. In the unrevised population, 94.7% of patients (n = 18) reported being satisfied or very satisfied with the surgery. CONCLUSION Lateral UKA remains a viable treatment option for patients with isolated lateral tibiofemoral osteoarthritis, providing satisfactory 20-year implant survivorship and high patient satisfaction.
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Affiliation(s)
- Clément Favroul
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon North University Hospital, 103 Grande Rue de La Croix-Rousse, 69004, Lyon, France.
| | - Cécile Batailler
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon North University Hospital, 103 Grande Rue de La Croix-Rousse, 69004, Lyon, France
- Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406, 69622, Lyon, France
| | - Clara Thouvenin
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon North University Hospital, 103 Grande Rue de La Croix-Rousse, 69004, Lyon, France
| | - Jobe Shatrov
- Sydney Orthopedic Research Institute, University of Notre Dame Australia, Hornsby and Ku-Ring Hospital, Sydney, Australia
| | | | - Elvire Servien
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon North University Hospital, 103 Grande Rue de La Croix-Rousse, 69004, Lyon, France
- LIBM-EA 7424, Interuniversity Laboratory of Biology of Mobility, Claude Bernard Lyon 1 University, Lyon, France
| | - Sébastien Lustig
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon North University Hospital, 103 Grande Rue de La Croix-Rousse, 69004, Lyon, France
- Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406, 69622, Lyon, France
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Hiranaka T. Advantages and limitations of mobile-bearing unicompartmental knee arthroplasty: an overview of the literature. Expert Rev Med Devices 2024; 21:587-600. [PMID: 38873929 DOI: 10.1080/17434440.2024.2367002] [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: 08/20/2023] [Accepted: 06/07/2024] [Indexed: 06/15/2024]
Abstract
INTRODUCTION Interest in unicompartmental knee arthroplasty (UKA) has recently grown. Mobile bearing UKA, in which the bearing is not fixed but rather perfectly conforms with femoral and tibial components and moves completely passively between the femoral and tibial implant, has now been used for approximately half a century. AREAS COVERED Alongside the recognized advantages of UKA, the mobile-bearing variant benefits from an extremely low rate of polyethylene wear and tolerable minor malalignment. Revision rates for UKA have been reported to exceed those of total knee arthroplasty, but long-term survival rates and outcomes from mobile-bearing UKA have been found to be satisfactory. In addition to the lateral osteoarthritis and loosening, which are main complications of UKA, bearing dislocation is a specific complication of mobile bearing UKA. Fractures and valgus subsidence are more prevalent than in the cementless UKA. While these continue to be features to be addressed, they have been partially solved. EXPERT OPINION Given the manifold benefits of UKA, its application could be extended to a larger patient population. Successful outcomes rely on careful patient selection and the surgeon's extensive familiarity with the procedure. Looking ahead, the incorporation of robotic surgery, already a feature of some fixed-bearing UKAs, might shape the future trajectory of mobile-bearing UKA.
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Affiliation(s)
- Takafumi Hiranaka
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Takatsuki, Osaka, Japan
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Magruder ML, McClure T, Marchand K, Mont MA, Marchand RC. Robotic-arm-assisted conversion of unicompartmental knee arthroplasty to total knee arthroplasty. J Orthop 2024; 52:119-123. [PMID: 39035220 PMCID: PMC11258387 DOI: 10.1016/j.jor.2024.03.024] [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: 03/11/2024] [Accepted: 03/13/2024] [Indexed: 07/23/2024] Open
Abstract
Introduction The purpose of this study was to describe a novel robotic-arm-assisted UKA to TKA conversion technique and evaluate the patient reported and clinical outcomes in these patients. Methods A retrospective review between 2017 and 2022 was conducted of patients that underwent robotic-arm-assisted UKA to TKA conversion. Charts were reviewed for patient demographics, indications for conversion from UKA to TKA, operative technique, implants used, postoperative complications, and patient-reported outcome measures (PROMs). The surgical technique resembles that of primary TKA, with the major exception of registering the robotic arm with retained UKA implants and removing the implants only when verification is complete. There were 44 robotic-arm-assisted UKAs in 41 patients were included in the study. Indications for UKA conversion to TKA included: 33 patients who had osteoarthritis progression (75%), 7 aseptic loosening (16%), 2 unspecified pain (4.5%), 1 polyethylene wear (2.3%), and 1 prosthetic joint infection (2.3%). Uncemented cruciate-retaining (CR) implants were used in 38 of the 44 robotic-arm-assisted TKAs (86.5%). The other six utilized cemented implants: four CR femurs (9.1%), six tibial baseplates (13.6%), four tibial stems (9.1%), and four medial tibial augments (9.1%). Results The PROMs significantly improved at 1-year follow-up, with the average KOOS JR score increasing from 48.1 to 68.7 (P < 0.001), and the r-WOMAC score decreasing from 25.7 to 10.6 (P = 0.003). Two patients developed prosthetic joint infections (4.5%), one developed aseptic loosening of the femoral component (2.3%), and one developed a superficial surgical site infection requiring superficial irrigation and debridement (2.3%). Overall survivorship was 93.18% at 1.8 years, and aseptic survivorship was 97.73%. Conclusion Robotic-arm-assisted UKA to TKA conversion exhibited improved patient-reported outcomes and low revision and complication rates. Improved implant placement achieved with robotic-arm-assistance may improve the functional and clinical outcomes following these surgeries.
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Affiliation(s)
- Matthew L. Magruder
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
| | - Tanner McClure
- Ortho Rhode Island, Department of Orthopaedic Surgery, Warwick, RI, USA
| | - Kevin Marchand
- Ortho Rhode Island, Department of Orthopaedic Surgery, Warwick, RI, USA
| | - Michael A. Mont
- The Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD, USA
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Zgouridou A, Kenanidis E, Potoupnis M, Tsiridis E. Global mapping of institutional and hospital-based (Level II-IV) arthroplasty registries: a scoping review. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1219-1251. [PMID: 37768398 PMCID: PMC10858160 DOI: 10.1007/s00590-023-03691-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 08/13/2023] [Indexed: 09/29/2023]
Abstract
PURPOSE Four joint arthroplasty registries (JARs) levels exist based on the recorded data type. Level I JARs are national registries that record primary data. Hospital or institutional JARs (Level II-IV) document further data (patient-reported outcomes, demographic, radiographic). A worldwide list of Level II-IV JARs must be created to effectively assess and categorize these data. METHODS Our study is a systematic scoping review that followed the PRISMA guidelines and included 648 studies. Based on their publications, the study aimed to map the existing Level II-IV JARs worldwide. The secondary aim was to record their lifetime, publications' number and frequency and recognise differences with national JARs. RESULTS One hundred five Level II-IV JARs were identified. Forty-eight hospital-based, 45 institutional, and 12 regional JARs. Fifty JARs were found in America, 39 in Europe, nine in Asia, six in Oceania and one in Africa. They have published 485 cohorts, 91 case-series, 49 case-control, nine cross-sectional studies, eight registry protocols and six randomized trials. Most cohort studies were retrospective. Twenty-three per cent of papers studied patient-reported outcomes, 21.45% surgical complications, 13.73% postoperative clinical and 5.25% radiographic outcomes, and 11.88% were survival analyses. Forty-four JARs have published only one paper. Level I JARs primarily publish implant revision risk annual reports, while Level IV JARs collect comprehensive data to conduct retrospective cohort studies. CONCLUSIONS This is the first study mapping all Level II-IV JARs worldwide. Most JARs are found in Europe and America, reporting on retrospective cohorts, but only a few report on studies systematically.
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Affiliation(s)
- Aikaterini Zgouridou
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece
| | - Eustathios Kenanidis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece.
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece.
| | - Michael Potoupnis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece
| | - Eleftherios Tsiridis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece
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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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Ji S, Huang Y, Zhou Y, Wang C, Wang X, Ma C, Jiang X. Pre-operative predictive factors of residual varus on the mechanical axis after Oxford unicompartmental knee arthroplasty. Front Surg 2023; 9:1054351. [PMID: 36700020 PMCID: PMC9869032 DOI: 10.3389/fsurg.2022.1054351] [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] [Received: 09/26/2022] [Accepted: 12/08/2022] [Indexed: 01/12/2023] Open
Abstract
Background Residual varus after Oxford unicompartmental knee arthroplasty (UKA) happens frequently. This study aims to evaluate the pre-operative contributing factors of residual varus. Methods A total of 1,002 knees (880 patients, 201 patients were male, and 679 were female) underwent Oxford UKA in the Orthopedic Surgery Department of the Beijing Jishuitan Hospital from March 2018 to April 2021. The mean age of the patient was 64.7 ± 7.7 years. To assess residual varus, the full-length lower extremity is placed upright for EOS imaging, with the knee fully extended. The angle of post-operative residual varus was measured as described by Noyes et al. Of the knees studied, they were either categorized into an under-corrected group (post-operative Noyes angle >5°) or a corrected group (post-operative Noyes angle ≤5°). Age, gender, body mass index (BMI), range of motion (ROM), Clinical American Knee Society Score (Clinical AKSS), and Function American Knee Society Score (Function AKSS) were compared. The following additional parameters were measured: pre-operative Noyes angle, lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), the posterior slope of the proximal tibia angle (PPTA), joint line converge angle (JLCA), and fixed flexion deformity (FFD). Results There was no statistically significant difference between the two groups in regards to gender (p = 0.428), surgical leg (p = 0.937), age (p = 0.851), BMI (p = 0.064), pre-operative Clinical AKSS (p = 0.206) and Function AKSS (p = 0.100). However, pre-operative ROM statistically differed between the two groups (p < 0.001). The contributing factors of post-operative residual varus were determined to be the following parameters: pre-operative MPTA (p < 0.001, OR = 4.522, 95% CI: 2.927-6.984), pre-operative Noyes (p < 0.001, OR = 3.262, 95% CI: 1.802-5.907) and pre-operative FFD (p = 0.007, OR = 1.862, 95% CI: 1.182-2.934). The effects of pre-operative LDFA (p = 0.146), JLCA (p = 0.942), and pre-operative PPTA (p = 0.899) on the post-operative mechanical axis did not show statistical significance. Conclusions Patients with severe pre-operative varus, particularly varus deformity mainly from the tibial side or pre-operative FFD, are more prone to get extremity mechanical axis residual varus after UKA with Oxford.
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Affiliation(s)
- Songjie Ji
- Department of Orthopedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China,Correspondence: Songjie Ji Xu Jiang
| | - Ye Huang
- Department of Orthopedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China
| | - Yixin Zhou
- Department of Orthopedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China
| | - Chao Wang
- Department of Statistics, Beijing Research Institute of Traumatology and Orthopedics, Beijing, China
| | - Xiaokai Wang
- Department of Radiology, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China
| | - Chaoyi Ma
- Department of Radiology, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China
| | - Xu Jiang
- Department of Orthopedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China,Correspondence: Songjie Ji Xu Jiang
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The compartmental approach to revision of partial knee arthroplasty results in nearer-normal gait and improved patient reported outcomes compared to total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2023; 31:1143-1152. [PMID: 34415369 PMCID: PMC9957906 DOI: 10.1007/s00167-021-06691-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 07/30/2021] [Indexed: 12/25/2022]
Abstract
PURPOSE This study investigated the gait and patient reported outcome measures of subjects converted from a partial knee arthroplasty to combined partial knee arthroplasty, using a compartmental approach. Healthy subjects and primary total knee arthroplasty patients were used as control groups. METHODS Twenty-three patients converted from partial to combined partial knee arthroplasty were measured on the instrumented treadmill at top walking speeds, using standard gait metrics. Data were compared to healthy controls (n = 22) and primary posterior cruciate-retaining total knee arthroplasty subjects (n = 23) where surgery were performed for one or two-compartment osteoarthritis. Groups were matched for age, sex and body mass index. At the time of gait analysis, combined partial knee arthroplasty subjects were median 17 months post-revision surgery (range 4-81 months) while the total knee arthroplasty group was median 16 months post-surgery (range 6-150 months). Oxford Knee Scores and EuroQol-5D 5L scores were recorded at the time of treadmill assessment, and results analysed by question and domain. RESULTS Subjects revised from partial to combined partial knee arthroplasty walked 16% faster than total knee arthroplasty (mean top walking speed 6.4 ± 0.8 km/h, vs. 5.5 ± 0.7 km/h p = 0.003), demonstrating nearer-normal weight-acceptance rate (p < 0.001), maximum weight-acceptance force (p < 0.006), mid-stance force (p < 0.03), contact time (p < 0.02), double support time (p < 0.009), step length (p = 0.003) and stride length (p = 0.051) compared to primary total knee arthroplasty. Combined partial knee arthroplasty subjects had a median Oxford Knee Score of 43 (interquartile range 39-47) vs. 38 (interquartile range 32-41, p < 0.02) and reported a median EQ-5D 0.94 (interquartile range 0.87-1.0) vs. 0.84 (interquartile range 0.80-0.89, p = 0.006). CONCLUSION This study finds that a compartmental approach to native compartment degeneration following partial knee arthroplasty results in nearer-normal gait and improved patient satisfaction compared to total knee arthroplasty. LEVEL OF EVIDENCE III.
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Saylık M, Yenigul AE, Atıcı T. Outcome of mobile and fixed unicompartmental knee arthroplasty and risk factors for revision. J Int Med Res 2022; 50:3000605221115383. [PMID: 36000161 PMCID: PMC9421233 DOI: 10.1177/03000605221115383] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Objectives In this study, we aimed to evaluate the outcomes of patients undergoing
unilateral knee arthroplasty (UKA) and to analyze risk factors that may lead
to revision in patients who undergo UKA. Methods We included patients who underwent mobile or fixed UKA owing to
osteoarthritis and who had at least 24 months of follow-up in the
postoperative period. We recorded information on patient age, sex, side,
body mass (kg/m2), follow-up duration, Knee Society Score,
Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain,
WOMAC function, WOMAC stiffness, mechanical axle angle, femoral component
compliance, tibial component compliance, accumulated experience of the
surgeon, and revision status. Results In total, we evaluated 131 knees in 118 patients. 50 (38%) who underwent
mobile UKA and 81 (62%) who underwent fixed UKA. The effect of obesity on
mobile and fixed UKA revision was significant. The likelihood of revision
decreased with greater experience of the surgeon performing UKA. Conclusion Our study showed that the clinical results of mobile and fixed UKA procedures
are similar. We also revealed that obesity poses a risk for revision in both
fixed and mobile UKA, and the revision rate decreases with increased
experience of the surgeon.
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Affiliation(s)
- Murat Saylık
- İstinye University/Medikalpark Bursa Hospital Turkey, Bursa, Turkey
| | - Ali Erkan Yenigul
- Department of Orthopedics and Traumatology, Uludağ University School of Medicine, Bursa, Turkey
| | - Teoman Atıcı
- Department of Orthopedics and Traumatology, Uludağ University School of Medicine, Bursa, Turkey
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Sabah SA, Hedge EA, Abram SGF, Alvand A, Price AJ, Hopewell S. Patient-reported outcome measures following revision knee replacement: a review of PROM instrument utilisation and measurement properties using the COSMIN checklist. BMJ Open 2021; 11:e046169. [PMID: 34675009 PMCID: PMC8532560 DOI: 10.1136/bmjopen-2020-046169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 08/24/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To identify: (1) patient-reported outcome measures (PROMs) used to evaluate symptoms, health status or quality of life following discretionary revision (or re-revision) knee joint replacement, and (2) validated joint-specific PROMs, their measurement properties and quality of evidence. DESIGN (1) Scoping review; (2) systematic review following the COnsensus-based Standards for selection of health status Measurement INstruments (COSMIN) checklist. DATA SOURCES MEDLINE, Embase, AMED and PsycINFO were searched from inception to 1 July 2020 using the Oxford PROM filter unlimited by publication date or language. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Studies reporting on the development, validation or outcome of a joint-specific PROM for revision knee joint replacement were included. RESULTS 51 studies reported PROM outcomes using eight joint-specific PROMs. 27 out of 51 studies (52.9%) were published within the last 5 years. PROM development was rated 'inadequate' for each of the eight PROMs studied. Validation studies were available for only three joint-specific PROMs: Knee Injury and Osteoarthritis Outcome Score (KOOS), Lower Extremity Activity Scale (LEAS) and Western Ontario and McMaster Universities Arthritis Index (WOMAC). 25 out of 27 (92.6%) measurement properties were rated insufficient, indeterminate or not assessed. The quality of supporting evidence was mostly low or very low. Each of the validated PROMs was rated 'B' (potential for recommendation but require further evaluation). CONCLUSION Joint-specific PROMs are increasingly used to report outcomes following revision knee joint replacement, but these instruments have insufficient evidence for their validity. Future research should be directed toward understanding the measurement properties of these instruments in order to inform clinical trials and observational studies evaluating the outcomes from joint-specific PROMs.
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Affiliation(s)
- Shiraz A Sabah
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Elizabeth A Hedge
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Simon G F Abram
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Abtin Alvand
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Andrew J Price
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Sally Hopewell
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Pumilia CA, Schroeder L, Sarpong NO, Martin G. Patient Satisfaction, Functional Outcomes, and Implant Survivorship in Patients Undergoing Customized Unicompartmental Knee Arthroplasty. J Pers Med 2021; 11:753. [PMID: 34442397 PMCID: PMC8401135 DOI: 10.3390/jpm11080753] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/21/2021] [Accepted: 07/29/2021] [Indexed: 12/16/2022] Open
Abstract
Customized unicompartmental knee arthroplasty (C-UKA) utilizes implants manufactured on an individual patient basis, derived from pre-operative computed tomography images in an effort to more closely approximate the natural anatomy of the knee. The outcomes from 349 medial and lateral fixed-bearing C-UKA were reviewed. Implant survivorship analysis was conducted via retrospective chart review, and follow-up analysis was conducted via a single postoperative phone call or email. The rate of follow-up was 69% (242 knees). The average age at surgery was 71.1 years and the average body mass index was 28.8 kg/m2. Seven revision arthroplasties (2.1%) had knowingly been performed at an average of 1.9 years postoperatively (range: 0.1-3.9 years), resulting in an implant survivorship of 97.9% at an average follow-up of 4.2 years (range: 0.1-8.7) and 97.9% at an average of 4.8 years (range: 2.0-8.7) when knees with less than two years of follow-up were excluded. The reasons for revision were implant loosening (one knee), infection (two knees), progression of osteoarthritis (two knees), and unknown reasons (two knees). The average KOOS, JR. interval score was 84 (SD: 14.4). Of those able to be contacted for follow-up analysis, 67% were "very satisfied," 26% were "satisfied," 4% were "neutral," 2% were "dissatisfied," and 1% were "very dissatisfied." When asked if the knee felt "natural," 60% responded with "always," 35% responded with "sometimes," and 5% responded with "never." After analyzing a large cohort of C-UKA, we found favorable rates of survivorship, satisfaction, and patient-reported functional outcomes.
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Affiliation(s)
| | - Lennart Schroeder
- Department of General, Trauma and Reconstructive Surgery, University Hospital, Ludwig Maximilians University, 81377 Munich, Germany;
| | - Nana O. Sarpong
- Columbia University Medical Center, Department of Orthopedic Surgery, New York—Presbyterian Hospital, Columbia University, New York, NY 10032, USA;
| | - Gregory Martin
- Department of Orthopedic Surgery, Personalized Orthopaedics of the Palm Beaches, Boynton Beach, FL 33437, USA;
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Tan MWP, Ng SWL, Chen JY, Liow MHL, Lo NN, Yeo SJ. Long-Term Functional Outcomes and Quality of Life at Minimum 10-Year Follow-Up After Fixed-Bearing Unicompartmental Knee Arthroplasty and Total Knee Arthroplasty for Isolated Medial Compartment Osteoarthritis. J Arthroplasty 2021; 36:1269-1276. [PMID: 33243585 DOI: 10.1016/j.arth.2020.10.049] [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: 07/10/2020] [Revised: 10/07/2020] [Accepted: 10/26/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The aim of this study is to compare the long-term functional outcome and quality of life between total knee arthroplasty (TKA) and fixed-bearing unicompartmental knee arthroplasty (UKA) for the treatment of isolated medial compartment osteoarthritis. METHODS Between 2000 and 2008, a total of 218 patients underwent primary UKA at our tertiary hospital. A TKA group was matched through 1:1 propensity score matching and adjusted for age, gender, body mass index, preoperative knee flexion, and function scores. All patients had medial compartment osteoarthritis. The patients were assessed with the range of motion, Knee Society Knee Score and Knee Society Function Score, Oxford Knee Score, Short Form-36 physical component score (PCS) and mental component score preoperatively, at 6 months, 2 years, and 10 years. Patients' satisfaction, expectation fulfillment, and minimal clinically important difference were analyzed. RESULTS There were no differences in baseline characteristics between groups after propensity score matching (P > .05). UKA had greater knee flexion at all time points. Although the Knee Society Function Score was superior in UKA by 5.5, 3, and 4.3 points at 6 months, 2 years, and 10 years, respectively (P < .001), these differences did not exceed the minimal clinically important difference (Knee Society Knee Score 6.1). There were no significant differences in the Oxford Knee Score and Short Form-36 physical component score/mental component score. At 10 years, similar proportions of UKA and TKA were satisfied (90.8% vs 89.9%, P = .44) and had expectation fulfillment (89.4% vs 88.5%, P = .46). Between 2 and 10 years, all function scores deteriorated significantly for both groups (P < .01). CONCLUSION UKA and TKA are excellent treatment modalities for isolated medial compartment osteoarthritis, with similar functional outcomes, quality of life, and satisfaction at 10 years.
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Affiliation(s)
- Marcus Wei Ping Tan
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore Level 4, Academia, Singapore 169856, Singapore
| | - Stacy Wei Ling Ng
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore Level 4, Academia, Singapore 169856, Singapore
| | - Jerry Yongqiang Chen
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore Level 4, Academia, Singapore 169856, Singapore
| | - Ming Han Lincoln Liow
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore Level 4, Academia, Singapore 169856, Singapore
| | - Ngai Nung Lo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore Level 4, Academia, Singapore 169856, Singapore
| | - Seng Jin Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore Level 4, Academia, Singapore 169856, Singapore
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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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Garner A, Dandridge O, Amis AA, Cobb JP, van Arkel RJ. The extensor efficiency of unicompartmental, bicompartmental, and total knee arthroplasty. Bone Joint Res 2021; 10:1-9. [PMID: 33380175 PMCID: PMC7845459 DOI: 10.1302/2046-3758.101.bjr-2020-0248.r1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Aims Unicompartmental knee arthroplasty (UKA) and bicompartmental knee arthroplasty (BCA) have been associated with improved functional outcomes compared to total knee arthroplasty (TKA) in suitable patients, although the reason is poorly understood. The aim of this study was to measure how the different arthroplasties affect knee extensor function. Methods Extensor function was measured for 16 cadaveric knees and then retested following the different arthroplasties. Eight knees underwent medial UKA then BCA, then posterior-cruciate retaining TKA, and eight underwent the lateral equivalents then TKA. Extensor efficiency was calculated for ranges of knee flexion associated with common activities of daily living. Data were analyzed with repeated measures analysis of variance (α = 0.05). Results Compared to native, there were no reductions in either extension moment or efficiency following UKA. Conversion to BCA resulted in a small decrease in extension moment between 70° and 90° flexion (p < 0.05), but when examined in the context of daily activity ranges of flexion, extensor efficiency was largely unaffected. Following TKA, large decreases in extension moment were measured at low knee flexion angles (p < 0.05), resulting in 12% to 43% reductions in extensor efficiency for the daily activity ranges. Conclusion This cadaveric study found that TKA resulted in inferior extensor function compared to UKA and BCA. This may, in part, help explain the reported differences in function and satisfaction differences between partial and total knee arthroplasty. Cite this article: Bone Joint Res 2021;10(1):1–9.
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Affiliation(s)
- Amy Garner
- MSk Lab, Sir Michael Uren Biomedical Engineering Research Hub, Imperial College London, London, UK.,Biomechanics Group, Mechanical Engineering Department, Imperial College London, London, UK.,Royal College of Surgeons of England and Dunhill Medical Trust Clinical Research Fellowship, Royal College of Surgeons of England, London, UK.,Health Education Kent, Surrey and Sussex, London, UK
| | - Oliver Dandridge
- Biomechanics Group, Mechanical Engineering Department, Imperial College London, London, UK
| | - Andrew A Amis
- Biomechanics Group, Mechanical Engineering Department, Imperial College London, London, UK
| | - Justin P Cobb
- MSk Lab, Sir Michael Uren Biomedical Engineering Research Hub, Imperial College London, London, UK
| | - Richard J van Arkel
- Biomechanics Group, Mechanical Engineering Department, Imperial College London, London, UK
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Sun XW, Lu FF, Zou K, Hong M, Zhang QD, Guo WS. Does new instrument for Oxford unicompartmental knee arthroplasty improve short-term clinical outcome and component alignment? A meta-analysis. J Orthop Surg Res 2020; 15:386. [PMID: 32894147 PMCID: PMC7487934 DOI: 10.1186/s13018-020-01926-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 08/24/2020] [Indexed: 11/10/2022] Open
Abstract
Background The Microplasty (MP) instrumentation designed for the Phase III Oxford mobile-bearing unicompartmental knee arthroplasty (UKA) system is considered a better option to achieve more accurate component positioning and alignment. In the present study, we focused on short-term clinical and radiological outcomes to determine whether the MP instrumentation can reduce the short-term revision rate and occurrence of outliers of metallic components. Methods The literature in PubMed, Embase, the Cochrane Library, and Web of Science was searched up to May 2020. Studies were scrutinized by two independent authors, and the revision rate, complication spectrum, and radiological assessment with outlier rates were specifically analyzed. RevMan 5.3 was used for the statistical analysis. Results Seven studies were included in the meta-analysis. Four studies reported both clinical and radiological outcomes, two reported only radiological outcomes, and one reported only clinical outcomes. The pooled analysis showed that the revision rate in the MP instrumentation group was 0.866 per 100 component years, while that in the control group was 1.124 (odds ratio, 0.77; p < 0.05). The subgroup analysis of the bearing dislocation rate showed a significantly greater reduction in the Korean population than in the populations of other countries (p < 0.05). The radiological assessment showed that the alignment of the femoral component was significantly improved (p < 0.05), while that of the tibial component was not (p > 0.05). Conclusion The newly developed MP instrumentation for Oxford UKA significantly reduced the revision rate of this treatment. The positioning of the femoral component was also proven to be better by radiological assessments.
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Affiliation(s)
- Xiao Wei Sun
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.,Department of Orthopaedic Surgery, China-Japan Friendship Hospital, No. 2 Yinghuadong Road, Chaoyang District, Beijing, 100029, China
| | - Fei Fan Lu
- China-Japan Friendship School of Clinical Medicine, Peking University, Beijing, China
| | - Kun Zou
- Beijing University of Chinese Medicine, Beijing, China
| | - Mao Hong
- Beijing University of Chinese Medicine, Beijing, China
| | - Qi Dong Zhang
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, No. 2 Yinghuadong Road, Chaoyang District, Beijing, 100029, China
| | - Wan Shou Guo
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China. .,Department of Orthopaedic Surgery, China-Japan Friendship Hospital, No. 2 Yinghuadong Road, Chaoyang District, Beijing, 100029, China.
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Smith T. Avoiding 'Fake News' in orthopaedic research - measuring the right outcomes and their interpretation. Knee 2019; 26:811-812. [PMID: 31327511 DOI: 10.1016/j.knee.2019.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 06/25/2019] [Indexed: 02/02/2023]
Affiliation(s)
- Toby Smith
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford.
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