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Liu C, Ge J, Jiang Y, Wang W, Zhang Q, Guo W. Preoperative valgus-corrected hip-knee-ankle angle and medial meniscal extrusion are useful for evaluating postoperative alignment in mobile-bearing UKA. Heliyon 2023; 9:e22234. [PMID: 38058632 PMCID: PMC10696016 DOI: 10.1016/j.heliyon.2023.e22234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 10/31/2023] [Accepted: 11/07/2023] [Indexed: 12/08/2023] Open
Abstract
Purpose The purposes of the study were to analyze the correlation between preoperative variables (valgus corrected hip-knee-ankle angle (vcHKA), medial osteophyte areas of the tibia and femur, and medial meniscus extrusion (MME)) and the postoperative alignment in mobile-bearing unicompartmental knee arthroplasty (UKA). Methods This study enrolled 109 patients (118 knees) who underwent mobile-bearing UKA between January 1, 2019 and January 1, 2023, retrospectively. Radiographic parameters, including the HKA, hip-knee-shaft angle (HKS), and valgus-corrected femorotibial angle (vcFTA), were measured using preoperative radiographs. The vcHKA was calculated as vcFTA - HKS. The medial osteophyte areas of the tibia and femur and MME were measured using knee magnetic resonance imaging (MRI). Simple and multiple linear regression analyses, univariate and multivariate logistic regression analyses, and receiver operating characteristic (ROC) curves were performed. Results In total, 109 patients (118 knees) were enrolled in this study. In the multiple linear regression analysis, vcHKA (β = 0.732, 95 % confidence interval (95%CI) = 0.582 to 0.881; p < 0.001) and MME (β = 0.203, 95%CI = 0.001 to 0.405; p = 0.049) were positively correlated with postoperative HKA, and postoperative HKA was modeled according to the following equation: 45.420 + (0.732° * vcHKA) + (0.203 mm × MME). In the multivariate logistic regression analysis, vcHKA (odds ratio (OR) = 2.007, 95 % CI = 1.433 to 2.810, p < 0.001) was associated with postoperative valgus malalignment independently. In the ROC curve, vcHKA (cutoff value: 180°) was predictive of postoperative valgus malalignment, with an accuracy (95%CI) of 0.862 (0.780-0.944). Conclusion Overcorrection of a varus knee under valgus stress radiograph (VSR) and excessive MME on preoperative MRI increase the possibility of overcorrection of postoperative alignment in mobile-bearing UKA.
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Affiliation(s)
- Changquan Liu
- China-Japan Friendship Hospital (Institute of Clinical Medical Sciences), Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Juncheng Ge
- Department of Orthopaedic Surgery, Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
| | - Yankun Jiang
- Department of Orthopaedic Surgery, Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
| | - Weiguo Wang
- China-Japan Friendship Hospital (Institute of Clinical Medical Sciences), Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Qidong Zhang
- China-Japan Friendship Hospital (Institute of Clinical Medical Sciences), Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Wanshou Guo
- China-Japan Friendship Hospital (Institute of Clinical Medical Sciences), Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, China
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Ge J, Hernigou P, Guo W, Zhang N, Liu C, Zhang Q. Minimally invasive small incision surgical technique for unicompartmental knee arthroplasty. INTERNATIONAL ORTHOPAEDICS 2023; 47:2717-2725. [PMID: 37542540 DOI: 10.1007/s00264-023-05908-5] [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: 06/29/2023] [Accepted: 07/20/2023] [Indexed: 08/07/2023]
Abstract
PURPOSE It is always a challenge for orthopaedic surgeons to minimise surgical incisions while ensuring excellent surgical results. We propose the minimally invasive small incision (MISI) technique and an extramedullary positioning technique in the unicompartmental knee arthroplasty (UKA) surgery. This study aimed to clarify the early postoperative clinical outcomes and component alignment between MISI and conventional minimally invasive surgical (MIS) techniques. METHODS We prospectively enrolled 60 patients who underwent MISI-UKA and 60 patients who underwent MIS-UKA as controls. Clinical parameters include the time of straight leg raising, postoperative walking time with walker assistance, hospital stay, Numerical Rating Scale (NRS) pain score and Knee Society Score (KSS). The postoperative components and lower extremity alignment were compared between the two groups with radiographic image measurement. RESULTS The MISI group obtained a smaller incision during knee extension (P < 0.001) but a longer tourniquet usage time than the MIS group. The MISI group lost less blood (P < 0.001). The MISI group achieved straight leg raising and walking with aid earlier after surgery, with a shorter hospital stay than the MIS group (P < 0.001). Range of motion (ROM), NRS and KSS scores revealed no significant difference between the two groups in six months postoperative follow-up (P > 0.05). Radiographic measurement results between the two groups revealed no statistical difference (P > 0.05) CONCLUSION: The MISI-UKA could achieve faster earlier recovery after surgery and shorter hospital stays without compromising the principles of proper prosthesis position and limb alignment compared with the conventional MIS-UKA.
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Affiliation(s)
- Juncheng Ge
- Department of Orthopaedic Surgery, Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Philippe Hernigou
- Department of Orthopaedic Surgery, University Paris East (UPEC), Hôpital Henri Mondor, Creteil, France.
| | - Wanshou Guo
- Department of Orthopaedic Surgery, Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China.
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, China.
| | - Nianfei Zhang
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Changquan Liu
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, China
- China-Japan Friendship Hospital (Institute of Clinical Medical Sciences), Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Qidong Zhang
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, China
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Sun X, Lu F, Guo W, Cheng L, Wang W, Zhang Q. Trajectory of bearing movement during Oxford mobile-bearing unicompartmental knee arthroplasty using a kinematic alignment technique. Chin Med J (Engl) 2023; 136:613-615. [PMID: 36806284 PMCID: PMC10106227 DOI: 10.1097/cm9.0000000000002052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Indexed: 02/22/2023] Open
Affiliation(s)
- Xiaowei Sun
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing 100029, China
| | - Feifan Lu
- Department of Orthopedic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Wanshou Guo
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing 100029, China
| | - Liming Cheng
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing 100029, China
| | - Weiguo Wang
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing 100029, China
| | - Qidong Zhang
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing 100029, China
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Gap balance difference of unicompartmental knee arthroplasty between hanging leg and supine leg position: a prospective cohort study. INTERNATIONAL ORTHOPAEDICS 2023; 47:745-753. [PMID: 36629852 DOI: 10.1007/s00264-022-05680-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 12/20/2022] [Indexed: 01/12/2023]
Abstract
PURPOSE Gap balance is critical in Oxford unicompartmental knee arthroplasty (OUKA) surgery; the effect of lower limb positioning on gap balance judgements has not been reported. There are two mean operative positions for OUKA patients, the hanging leg (HL) and the supine leg (SL) position. This study aimed to investigate the gap balance achieved by current UKA surgical techniques by using a force sensor, to compare the differences in gap balance between the two different positions, and to test whether the difference in gap balance leads to different outcomes in terms of component alignment and early post-operative clinical outcomes. METHODS This prospective study included 97 knees (76 patients), who underwent OUKA from June 1, 2020, to July 31, 2021, of which 67 knees underwent UKA in the supine leg position and the other 30 in the hanging leg position. When the operator was satisfied with the gap balance, the contact forces between the trial and the spacer block were measured at 90° of knee flexion (flexion gap) and 20° of knee flexion (extension gap) using a pre-developed matrix flexible force sensor. X-rays were reviewed three to five days after surgery. Knee Society Scores (KSS) were obtained at the six month follow-up. RESULTS Compared to the HL group, the contact force at the flexion gap was higher in the SL group: 55.15N (SD 43.36N) vs. 34.25N (SD 27.56N) (p < 0.05), whereas in the extension gap, there was no significant difference, 90.19 N (SD 43.36N) in the SL group and 86.72N (SD 43.08N) in the HL group (ns.). The contact force was greater in the extension gap than in the flexion gap in both groups (p < 0.01). The gap balance difference in the HL group was 52.46N (SD 31.33N), which was greater than that of the SL group at 35.03N (SD 19.50N) (p < 0.05). There were no significant differences in component alignment or lower limb mechanical alignment between the two groups. There was no significant difference in pre-operative and post-operative KSS between the two groups, while post-operative KSS was significantly higher in both groups compared to the pre-operative period. CONCLUSION The intra-operative contact forces between the flexion and extension gaps differed in the two groups; the hanging leg position appeared to produce a greater difference in the judgement of gap balance than the supine leg position, but this difference did not adversely affect the alignment of the component or the early post-operative clinical outcome.
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D'Ambrosi R, da Silva MJDSV, Moura JLM, Mariani I, Serrao LD, Di Feo F, Ursino N. Radiographic and Clinical Evolution of the Oxford Unicompartmental Knee Arthroplasty. J Knee Surg 2023; 36:246-253. [PMID: 34520561 DOI: 10.1055/s-0041-1731718] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The aim of the study is to evaluate whether the use of the new instrumentation Microplasty (MP) improves component positioning and the reliability of the surgical technique, reducing the implant outliers from the recommended range and providing a more accurate resection, while avoiding insufficient or excessive tibial resection and clinical scores. We prospectively analyzed clinical and radiographic outcomes of three consecutive cohorts for a total of 227 implants at a minimum follow-up of 36 months. The first cohort consisted of 67 Oxford unicompartmental knee arthroplasty (OUKA), using the phase III (Ph-III). The second cohort consisted of 136 OUKA, with the MP instrumentation. The third cohort consisted of 24 hypoallergenic OUKA, using the MP instrumentation (TiNbN). Postoperative alignment of the knee in the coronal and sagittal plane was measured using radiographs. No clinical differences were found among the three groups (p > 0.05). A significant difference was found on the slope between Ph-III and MP (p = 0.0005). Moreover, a significant difference was found in tibial angle and in tibial slope in arthroplasty with femoral size small (S), compared with size medium (M) or large (Ly) (tibia varus/valugs angle: p = 0.0484; tibial slope: p = 0.04). Similar results were found between small (AA, A, B) tibial size and large (C, D, E, F) tibial size for tibial varus/valgus (p = 0.03) angle and tibial slope (p = 0.003). A significant difference was found between Ph-III and MP in tibial slope in patients with body mass index (BMI) ≥25 kg/m2 (p = 0.0003). A positive correlation was noted between the femoral and tibial sizes and the tibial angle and the slope, and a negative correlation between weight and the tibial slope; furthermore, a positive correlation was found between Oxford knee score and radiographic angles. The MP instrumentation seems to be effective in determining the tibial cut and, particularly, improving the tibial slope, compared with Ph-III. The tibial slope is directly affected by the weight and measurements of the components, regardless of the instruments or the number of pegs, while clinical outcomes are correlated with implant position. This prospective comparative study reflects level of evidence II.
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Affiliation(s)
| | - Manuel J de S V da Silva
- Trofa Saúde Hospital Braga Centro, Braga, Portugal; ICVS/3B's, PT Government Associated Laboratory, Braga/Guimarães, Portugal; School of Medicine, Minho University, Braga, Portugal; Clinical Academic Center-Braga (2CA-Braga), Braga, Portugal
| | - João L M Moura
- Senhora da Oliveira Hospital, Guimarães, Portugal; Trofa Saúde Hospital Braga Centro, Braga, Portugal
| | - Ilaria Mariani
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
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Wen P, Zhang Q, Sun X, Zhang B, Ma T, Zhang Y. Exploring the relationship between bearing extrusion and postoperative persistent pain in Oxford unicompartmental knee arthroplasty: A trajectory measurement study. Front Bioeng Biotechnol 2022; 10:965009. [PMID: 36246383 PMCID: PMC9557290 DOI: 10.3389/fbioe.2022.965009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 09/08/2022] [Indexed: 11/16/2022] Open
Abstract
Objective: The aim of the study is to explore the relationship between the extrusion of the meniscus bearing and postoperative persistent pain of Oxford unicompartmental knee arthroplasty. Methods: Patients undertaking Oxford UKA from January 2019 to June 2020 were retrospectively analyzed. Intraoperatively, the displacement and movement trajectory of the meniscus bearing was recorded by the specially designed gridding mold of the tibial component. The k-means clustering analysis was applied based on the incidence of postoperative persistent knee pain and the bearing extrusion distance. The intraoperative meniscus bearing movement trajectories were analyzed between the two groups and the patients’ clinical outcomes and radiographic assessments. Results: The k-means clustering analysis indicated that the extrusion of the bearing of 5 mm was the grouping standard. There were 27 patients with 30 knees in the extrusion group and 58 patients with 68 knees in the non-extrusion group. The proportion of optimal bearing movement trajectories in the extrusion group was significantly lower than that in the non-extrusion group (p < 0.05). Postoperative persistent knee pain occurred in six cases (6.1%), with four and two cases in the extrusion and non-extrusion groups, respectively. The incidence of postoperative persistent knee pain in the extrusion group was higher than that of the non-extrusion group (p < 0.05). Radiographic assessment showed that the continuity of the femoral and tibial components in the extrusion group was greater than that in the non-extrusion group (p < 0.05). However, there were no differences in pre- and postoperative HKAA, the varus/valgus degree of both femoral and tibial components, and the flexion/extension angles of the femoral component, and the tibial slope also showed no statistical difference (p > 0.05). Conclusion: For Oxford mobile-bearing UKA, the extrusion of meniscus bearing over 5 mm may increase the incidence of postoperative persistent knee pain, while the improvement of the bearing movement trajectory can effectively reduce this complication.
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Affiliation(s)
- Pengfei Wen
- Department of Joint Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
| | - Qidong Zhang
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Xiaowei Sun
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Binfei Zhang
- Department of Joint Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
| | - Tao Ma
- Department of Joint Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
| | - Yumin Zhang
- Department of Joint Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
- *Correspondence: Yumin Zhang,
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Kim TK, Mittal A, Meshram P, Kim WH, Choi SM. Evidence-based surgical technique for medial unicompartmental knee arthroplasty. Knee Surg Relat Res 2021; 33:2. [PMID: 33413698 PMCID: PMC7792201 DOI: 10.1186/s43019-020-00084-x] [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] [Received: 09/11/2020] [Accepted: 11/26/2020] [Indexed: 01/04/2023] Open
Abstract
Unicompartmental knee arthroplasty (UKA) is a successful treatment modality in selected patients having advanced, single-compartment osteoarthritis of the knee. The bone and ligament preservation leading to shorter recovery periods, better functional outcomes, lower perioperative complication rates, and easier revision, if needed, are proposed as some of the advantages of UKA over total knee arthroplasty (TKA). Despite several advantages, UKA is reported to have higher failure rates as compared to TKA. The prosthesis failure of UKA is directly correlated to intraoperative technique-related factors like malpositioning of components and the inability to replicate the target-limb alignment as per preoperative planning. An evidence-based surgical technique for UKA may help surgeons to avoid the intraoperative technique-related errors. The purpose of this paper is to describe a stepwise surgical technique for the fixed-bearing medial UKA.
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Affiliation(s)
- Tae Kyun Kim
- TK Orthopedic Institution, 55 Dongpangyo-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13535, Republic of Korea.
| | - Anurag Mittal
- TK Orthopedic Institution, 55 Dongpangyo-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13535, Republic of Korea
| | - Prashant Meshram
- Department of Orthopaedics, Johns Hopkins Medical Institute, 2360 West Joppa Road, Suite 306, Baltimore, MD, 21093, USA
| | - Woo Hyun Kim
- TK Orthopedic Institution, 55 Dongpangyo-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13535, Republic of Korea
| | - Sang Min Choi
- TK Orthopedic Institution, 55 Dongpangyo-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13535, Republic of Korea
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