Return to Sport After Unicompartmental Knee Arthroplasty: A Systematic Review and Meta-analysis

Evaluation of Functional Outcomes, Survivorship and Complications of Hypoallergenic Fixed-Bearing Medial and Lateral Unicompartmental Knee Arthroplasty: A Minimum 2-Year Follow-Up

Background: Unicompartmental knee arthroplasty (UKA) is a viable treatment option for patients with isolated knee osteoarthritis. This study evaluated the clinical outcomes of the JII UK (Smith & Nephew, Memphis, TN, USA) hypoallergenic, fixed-bearing UKA implant in a medium cohort of patients undergoing both medial and lateral procedures with a short-term follow-up. Methods: A retrospective review was conducted on 257 consecutive patients who underwent primary UKA using the JII UK implant between December 2020 and December 2022. Clinical outcomes were assessed using the Knee Society Score (KSS), Knee Society Function Score (KSFS), Oxford Knee Score (OKS), UCLA Activity Score, Forgotten Joint Score (FJS-12), and satisfaction. Survivorship analysis was performed, and complications were recorded. Results: At the 2-year follow-up, the implant survival rate was 99.61%. Statistical significant improvements were observed in all clinical scores, with high patient satisfaction. The mean UCLA Activity Score increased from 4.53 preoperatively to 7.3 at 24 months. Conclusions: This study demonstrates promising short-term clinical outcomes for the hypoallergenic fixed-bearing medial and lateral UKA implant, with high patient satisfaction and a low complication rate. Further studies with longer follow-up periods are warranted to confirm these findings.

Comparison of the EQ-5D-3L and EQ-5D-5L instruments in patients undergoing unicompartmental knee arthroplasty

Purpose

The purpose of this investigation is to assess and contrast the effectiveness of the two EuroQol five dimensions questionnaire (EQ-5D) versions-EQ-5D-3L and EQ-5D-5L-in assessing one-year quality of life outcomes for patients with knee osteoarthritis (KOA) undergoing unicompartmental knee arthroplasty (UKA).

Material and method

From the medical records at the Honghui Hospital, Xi'an Jiaotong University, 402 individuals aged 50 and above, who were one-year post-operation, were selected to fill out survey questionnaires during their return hospital visits. Of these, 231 respondents (57.5%) completed the questionnaire; 228 completed both versions, and 56 completed the EQ-5D retest questionnaire. The assessment included missing data, ceiling effects, informativity and discriminatory power, as well as response consistency, redistribution properties, and inconsistency. Reliability and validity were also evaluated.

Results

The results indicate that the EQ-5D-5L surpasses the EQ-5D-3L in construct validity, informativity, detection precision, and discriminatory power. Consistency reliability is also better in the EQ-5D-5L than in the EQ-5D-3L. Both instrument versions maintained reliable levels of test-retest reliability.

Conclusion

In patients with KOA undergoing UKA, the EQ-5D-5L has proven superior in measurement capabilities when compared with the EQ-5D-3L one-year post-operation. Thus, it is advised to utilize the EQ-5D-5L for ongoing assessments of quality of life in this specific group of patients.

Inferior short-term survivorship and patient outcomes for cementless compared to hybrid fixation with a cemented femoral implant in a novel blade-anchored medial unicompartmental knee arthroplasty design: An analysis of 132 cases

PURPOSE

For younger, more active patients, a cementless unicompartmental knee arthroplasty (UKA) might be more advantageous than cemented fixation. Therefore, this study aimed to compare implant survivorship and patient-reported outcome measures (PROMs) between cementless and hybrid fixation (cemented femur and cementless tibial fixation) in a novel tibial blade-anchored, medial UKA design.

METHODS

Two surgeon's registries were reviewed for patients who underwent primary cementless or hybrid medial UKA for medial osteoarthritis between 2019 and 2022. Patients were included if implant survivorship and one-year postoperative PROMs (UCLA-activity score, Oxford Knee Score (OKS), Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS-JR), pain (VAS) and satisfaction) were registered. Variables were compared using independent two-sample t-tests or the Chi-square test. Survival rates were determined using the Kaplan-Meier models and compared using the Log-rank test.

RESULTS

A total of 132 knees were included (cementless 58.3%; cemented 41.7%; mean follow-up 3.1 ± 0.6 years). Three-year all-cause revision survival rate was significantly superior for the hybrid fixation (hybrid: 100%; cementless 88.5%[84.7%-92.3%], p = 0.026). However, the difference in three-year conversion rate to total knee arthroplasty (TKA) did not reach statistical significance. The one-year postoperative OKS (hybrid: 42.9 ± 4.8; cementless: 39.8 ± 6.4, p = 0.003) and KOOS-JR (hybrid:81.5 ± 13.7; cementless: 74.4 ± 12.1, p = 0.002) were significantly superior for the hybrid fixation. Three-year conversion rate to TKA and two-year postoperative PROMs did not significantly differ.

CONCLUSION

The cementless medial UKA demonstrated a significantly inferior short-term all-cause survival rate and inferior postoperative one-year OKS and KOOS-JR compared to the hybrid medial UKA design with a cemented femoral component.

Return to Sports After Unicompartmental Knee Arthroplasty

Knee osteoarthritis (OA) is a widespread and potentially debilitating condition that can interfere with the growing demand for a healthy and active lifestyle. In people under the age of 55 years, the prevalence of OA is expected to increase substantially in the coming decades. High tibial osteotomy and cartilage repair operations have been used to treat OA in young, active individuals; however, these procedures require lengthy rehabilitation periods and result in poor return to preoperative levels of activity that make them unsuitable for the young, active patient. Unicompartmental knee arthroplasty (UKA) is a less invasive treatment alternative, especially for younger, active, middle-aged persons with a desire to return to sporting activities. UKA yields successful return to activities with excellent functional outcomes and mid- to long-term survivorship. This article will review the ability of patients to return to sports after UKA, the type and nature of the sporting activities, as well as the timing to return to these sports.

Patient satisfaction following unicompartmental knee arthroplasty: Current concepts

Unicompartmental knee arthroplasty (UKA) has gained progressive popularity in recent decades, currently comprising approximately 10% of knee arthroplasties in the United States. Nonetheless, UKA has not yet solidified its position as the superior treatment for isolated compartment osteoarthritis, as initially reported implant survivorship was subpar, leading to hesitation in its utilization and stricter patient indications compared to total knee arthroplasty. Patient satisfaction following knee arthroplasty has emerged as a critical metric to gauge patient acceptance and contentment with surgical interventions. Currently, a variety of UKA types exist, differing in bearing design, fixation techniques such as cementless or cemented fixation, and robotic-assisted systems, each with its own merits and drawbacks. Multiple studies have demonstrated the contributions of these innovations to improve clinical outcomes and implant survivorship. However, the abundance of studies has made it challenging to establish a clear overview. This paper provides an overview of the current concepts of UKA, evaluating various aspects of UKA referencing to patient satisfaction and providing a recap of its historical development. Available research demonstrated no significantly universal superior variant of UKA.

Cemented versus cementless unicompartmental knee arthroplasty

Unicompartmental knee arthroplasty (UKA) offers a more conservative treatment than total knee arthroplasty when osteoarthritis affects only one tibiofemoral knee compartment. Cemented UKA has become the gold standard due to its good functional outcomes and low revision rates. The most common reasons for revision with cemented UKA include aseptic loss, unexplained pain, and radiolucent lines. Cementless UKA, which adds a porous coating of titanium and hydroxyapatite as well as an additional peg on the femoral component, has been shown to reduce the prevalence of radiolucencies compared to cemented UKAs. National registry data have demonstrated comparable functional outcomes and improved revision rates with cementless UKA. This review aims to summarize various advancements in unicompartmental prostheses, and to highlight how the conceptual advantages of the cementless model lead to superior implant survivorship and functional outcomes.

High return to sport rate in patients undergoing image-based robotic arm assisted unicompartmental knee arthroplasty

INTRODUCTION

This study was aimed to assess the return to sport (RTS) rate in patients who underwent CT-based robotic-assisted unicompartmental knee arthroplasty (RA-UKA) and to evaluate the clinical performance and the assocition between patients' sport activity levels and Patient Reported Outcome Measures after surgery.

MATERIALS AND METHODS

This retrospective study included 218 patients undergoing medial RA-UKA with fixed-bearing implants, performed at a single center between 2014 and 2019. Patients were allocated into two groups based on sport's practice and were administered the University of California, Los Angeles (UCLA) activity scale, Forgotten Joint Score-12 (FJS-12), Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS-JR) and the 5-Level Likert Scale.

RESULTS

A total of 136 patients were included for assessment. The overall RTS rate after surgery was 93.1%. Six subjects who did not practice sport preoperatively, were able to start sport activities after surgery and all patients performing sports preoperatively, returned to same activity level. The mean UCLA and FJS-12 scores in the group of patients practicing sports were significantly higher than in the no-sport group (p < 0.001 and p < 0.05, respectively). Patients who practiced sports were more likely to attain higher FJS-12 and UCLA scores than those who were not performing physical activity.

CONCLUSIONS

Patients undergoing RA-UKA showed a 93.1% RTS rate after surgery. Differences were detected in terms of postoperative UCLA and FJS-12 scores between patients who performed and who did not practice sport activities after surgery. High levels of postoperative UCLA scores were associated with higher KOOS-JR and patients' satisfaction.

Unicompartmental knee replacement: controversies and technical considerations

BACKGROUND

Unicompartmental knee replacement (UKR) is one of the effective interventions for the treatment of symptomatic knee osteoarthritis. Moreover, it has multiple advantages over total knee arthroplasty (TKA), including reduced intraoperative blood loss, decreased risk of transfusion, and faster recovery. This study aimed to discuss critical technical considerations regarding UKR and some of the controversies and updates.

METHODS

We conducted a review to provide an overview of the controversies and technical considerations about UKR in several aspects. Only peer-reviewed articles were included, up to December 2023 using PubMed, Google Scholar, ERIC, and Cochrane database for systematic reviews databases.

RESULT

UKR is associated with superior patient-reported clinical and functional outcomes, as well as shorter hospital stays, fewer postoperative complications, and revealed favorable outcomes in patients' return to sport. The choice between mobile- and fixed-bearing prostheses depends, in part, on the surgeon's preference. The mobile-bearing UKR is a less constrained prosthesis and can potentially result in less wear, but it is more technically demanding. While no significant difference between mobile-bearing versus fixed-bearing prostheses, cementless is superior to cemented design. Furthermore, UKR can be a good alternative for high tibial osteotomy (HTO) and still can be considered after a failed HTO. Lastly, recent reviews have shown a revision rate comparable to that of TKA. This is probably influenced by Improved comprehension of the best indications, patient selection criteria, as well as of the design, materials, and technological advances.

CONCLUSION

UKR treatment for unicompartmental knee osteoarthritis is secure and effective. Based on clinical and functional outcomes, decreased morbidity and mortality, and cost-effectiveness, long-term studies suggest that UKR is superior to TKA. Further investigation in this area is warranted.

Impacts of Knee Arthroplasty on Activity Level and Knee Function in Young Patients: A Systematic Review

The annual demand for knee arthroplasty has been steadily rising, particularly in younger patients. The primary objective of this systematic review was to determine the impact of knee arthroplasties on knee function and activity levels in young (≤55 years) patients. A PubMed search from inception (1977) to March 2022 to identify eligible studies produced 640 peer-reviewed studies for consideration. A total of 18 studies including 4,186 knee arthroplasties in 3,200 patients (mean patient age at the time of surgery: 47.4 years, range: 18-55 years) were ultimately included for analysis. Mean final follow-up (FFU) duration was 5.8 years (range: 2-25.1 years). Mean FFU improvement in Knee Society Clinical Score was 48.0 (1,625 knees, range: 20.9-69.0), Knee Society Function Score was 37.4 (1,284 knees, range: 20-65). Mean FFU for the Tegner and Lysholm activity scale was 2.8 (4 studies, 548 knees, range: 0.7-4.2); University of California Los Angeles Physical Activity Questionnaire score was 2.8 (3 studies, 387 knees, range: 1.2-5); lower extremity activity scale was 1.84 (529 knees). The available evidence suggest that young patients typically realize sustained improvements in knee function compared to preoperative levels; however, these improvements do not typically translate into a return to desired activity levels or quality of life, and this patient population should expect a higher and earlier risk for revision than their older counterparts. Further research, including robust registry data, is needed to establish evidence-based indications, expectations, and prognoses for outcomes after knee arthroplasty in young and active patients.

Return to Sport After Hip and Knee Arthroplasty: Counseling the Patient on Resuming an Active Lifestyle

PURPOSEOF REVIEW

The purpose of this review is to summarize the available literature on the epidemiology, biomechanics, clinical outcomes, and complications of return to sport after TJA, as well as provide guidelines for patients' safe return to athletic activity.

RECENT FINDINGS

As volume and indications for total joint arthroplasty (TJA) expand, arthroplasty candidates today are demographically younger, more physically active, and have higher expectations for postoperative function. Many TJA patients wish to resume sports activity that may theoretically place their reconstruction under more biomechanical stress and risk for early wear or failure. Recommendations for postoperative patient activity following TJA have historically largely been surgeon-dependent and in the context of evolving prosthetic design and surgical techniques. We endorse a three-tiered framework for return to sporting activities: (1) low-impact sports are generally recommended, (2) intermediate-impact sports are generally recommended with experience, and (3) high-impact sports are generally not recommended though activity-specific joint decisions between patient and surgeon can be made.

The Effects of Periarticular Injection Cocktail in Postoperative Analgesia after Bilateral Unicompartmental Knee Arthroplasty

Objective

This study was conducted to compare postoperative pain and functional recovery in bilateral unicompartmental knee arthroplasty (UKA) and unilateral UKA after cocktail therapy.

Methods

A total of 240 patients who received unilateral UKA and bilateral UKA in our orthopedic department from February 2019 to April 2020 were collected. The general clinical data was recorded and compared between the two groups of subjects, and the time of postoperative landing was recorded separately for both groups. A visual analogue scale (VAS) was used to record the patients' pain at 1, 7, and 14 days postoperatively, as well as the range of motion of the affected limb at 1, 7, 14 days, and 3 months postoperatively and the hospital for special surgery (HSS) knee score of the knee at 1 month postoperatively.

Results

After cocktail injection analgesia, unilateral patients with knee surgery got off the ground and walked significantly earlier than patients with bilateral surgery, while there was no significant difference between the two groups in terms of pain at 1, 7, and 14 days after surgery, range of motion of the affected limb at 1, 7, 14 days, and 3 months after surgery, and knee HSS score at 1 month after surgery.

Conclusion

Periarticular cocktail injection significantly reduces postoperative pain in patients, and bilateral UKA surgery can be used as satisfactory as unilateral UKA in clinical practice.