1
|
Stoddart JC, Garner A, Tuncer M, Amis AA, Cobb J, van Arkel RJ. Load transfer in bone after partial, multi-compartmental, and total knee arthroplasty. Front Bioeng Biotechnol 2024; 12:1274496. [PMID: 38524193 PMCID: PMC10957574 DOI: 10.3389/fbioe.2024.1274496] [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: 08/08/2023] [Accepted: 01/24/2024] [Indexed: 03/26/2024] Open
Abstract
Introduction: Arthroplasty-associated bone loss remains a clinical problem: stiff metallic implants disrupt load transfer to bone and, hence, its remodeling stimulus. The aim of this research was to analyze how load transfer to bone is affected by different forms of knee arthroplasty: isolated partial knee arthroplasty (PKA), compartmental arthroplasty [combined partial knee arthroplasty (CPKA), two or more PKAs in the same knee], and total knee arthroplasty (TKA). Methods: An experimentally validated subject-specific finite element model was analyzed native and with medial unicondylar, lateral unicondylar, patellofemoral, bi-unicondylar, medial bicompartmental, lateral bicompartmental, tricompartmental, and total knee arthroplasty. Three load cases were simulated for each: gait, stair ascent, and sit-to-stand. Strain shielding and overstraining were calculated from the differences between the native and implanted states. Results: For gait, the TKA femoral component led to mean strain shielding (30%) more than three times higher than that of PKA (4%-7%) and CPKA (5%-8%). Overstraining was predicted in the proximal tibia (TKA 21%; PKA/CPKA 0%-6%). The variance in the distribution for TKA was an order of magnitude greater than for PKA/CPKA, indicating less physiological load transfer. Only the TKA-implanted femur was sensitive to the load case: for stair ascent and gait, almost the entire distal femur was strain-shielded, whereas during sit-to-stand, the posterior femoral condyles were overstrained. Discussion: TKA requires more bone resection than PKA and CPKA. These finite element analyses suggest that a longer-term benefit for bone is probable as partial and multi-compartmental knee procedures lead to more natural load transfer compared to TKA. High-flexion activity following TKA may be protective of posterior condyle bone resorption, which may help explain why bone loss affects some patients more than others. The male and female bone models used for this research are provided open access to facilitate future research elsewhere.
Collapse
Affiliation(s)
- Jennifer C. Stoddart
- Biomechanics Group, Department of Mechanical Engineering, Imperial College London, London, United Kingdom
| | - Amy Garner
- Msk Lab, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- Dunhill Medical Trust and Royal College of Surgeons of England Joint Research Fellowship, London, United Kingdom
- Nuffield Orthopaedic Centre, Oxford Universities NHS Trust, Oxford, United Kingdom
| | | | - Andrew A. Amis
- Biomechanics Group, Department of Mechanical Engineering, Imperial College London, London, United Kingdom
| | - Justin Cobb
- Msk Lab, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Richard J. van Arkel
- Biomechanics Group, Department of Mechanical Engineering, Imperial College London, London, United Kingdom
| |
Collapse
|
2
|
Akkawi I, Draghetti M, Zmerly H. Outcome of simultaneous bi-unicompartmental knee arthroplasty: a systematic review. ACTA BIO-MEDICA : ATENEI PARMENSIS 2023; 94:e2023240. [PMID: 38054676 PMCID: PMC10734244 DOI: 10.23750/abm.v94i6.15006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 08/25/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND AND AIM Simultaneous medial and lateral tibiofemoral osteoarthritis (OA) could be treated with bi-unicompartmental knee arthroplasty (Bi-UKA) as an alternative to total knee arthroplasty (TKA). The present systematic review aims to assess if simultaneous Bi-UKA is a feasible option for treating medial and lateral tibiofemoral OA. MATERIALS AND METHODS A comprehensive search of PubMed, MEDLINE, Cochrane Library, and Google Scholar was performed to find studies that reported on the outcome of simultaneous Bi-UKA for both medial and lateral tibiofemoral OA. RESULTS Seven studies were considered eligible for inclusion in the present systematic review. Intraoperative fractures occurred 8 times. Overall, there were 22 revisions of the prosthetic components for any reason with a survival rate that ranged from 83 to 100%. Of these, 16 revisions were for the aseptic loosening of the prosthetic components. Out of 302 surgeries, three were revised due to symptomatic OA progression in the patello-femoral joint. All clinical scores improved at the latest follow-up compared to preoperative values. Moreover, there were no differences in clinical scores of Bi-UKA compared to unicompartmental knee arthroplasty (UKA), or medial UKA plus patello-femoral prosthesis. Whereas, compared to TKA, Bi-UKA patients had comparable or superior scores. Finally, the Bi-UKA group had a significantly shorter hospital stay compared to the TKA group. CONCLUSIONS The use of simultaneous Bi-UKA is a valid option to address bicompartmental knee OA in selected patients with low intraoperative fracture rate, low revision rate, satisfactory clinical outcome, and fast recovery.
Collapse
Affiliation(s)
| | - Maurizio Draghetti
- Orthopaedics and Traumatology Unit, Villa Erbosa Hospital, Bologna, Italy.
| | - Hassan Zmerly
- Orthopaedics and Traumatology Unit, Villa Erbosa Hospital, Bologna, Italy.
| |
Collapse
|
3
|
Lazzara JT, Arthur LW, Jenkins C, Dodd CAF, Mellon SJ, Murray DW. Fixed lateral unicompartmental knee replacement is a reliable treatment for lateral compartment osteoarthritis after mobile-bearing medial unicompartmental replacement. Knee Surg Sports Traumatol Arthrosc 2023; 31:5407-5412. [PMID: 37768357 PMCID: PMC10719134 DOI: 10.1007/s00167-023-07573-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/03/2023] [Indexed: 09/29/2023]
Abstract
PURPOSE Lateral osteoarthritis following medial unicompartmental knee replacement (UKR) is usually treated with total knee replacement, however, lateral UKR is a less invasive option that preserves a well-functioning medial UKR. This study aimed to determine the 5-year outcome of the cemented Fixed Lateral Oxford UKR (FLO) when used for the treatment of severe lateral disease after medial Oxford unicompartmental knee replacement. METHODS Forty-four knees with lateral bone-on-bone osteoarthritis (n = 43) and avascular necrosis (n = 1) treated with the FLO following medial Oxford UKR were followed up prospectively. The Oxford Knee Score (OKS) and Tegner Activity Score (TAS) were collected pre- and post-operatively. Life-table analysis was used to determine survival rates. RESULTS The mean patient age at the time of FLO surgery was 74.4 years with a mean time of 12.1 years between the primary medial UKR and the conversion to a bi-UKR with a FLO. Mean follow-up of the FLO was 3.5 years. After FLO no intra-operative or medical complications, re-admissions, or mortality occurred. There was one reoperation in which a bearing was exchanged for a medial bearing dislocation. There were no revisions of the FLO, so the FLO survival rate at 5 years was 100% (24 at risk). The mean pre-operative OKS was 22, which significantly (p < 0.0001) improved to a mean of 42, 42, and 40 at 1, 2, and 5 years, respectively. The median TAS had a non-significant improvement from 2.5 (Range 0-8) pre-operatively to 2 (Range 1-6) at 5 years postoperatively. CONCLUSION The FLO is a reliable treatment for lateral osteoarthritis following medial UKR. At 5 years there was a 100% survival of the FLO with a mean OKS of 40. LEVEL OF EVIDENCE IV, Prospective Case Series.
Collapse
Affiliation(s)
- Joseph T Lazzara
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Lachlan W Arthur
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK.
| | - Cathy Jenkins
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Christopher A F Dodd
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Stephen J Mellon
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - David W Murray
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| |
Collapse
|
4
|
Parente A, Medetti M, Basile G, Parente F. One-Stage Tricompartmental Hypoallergenic UKA for Tricompartmental Osteoarthritis: A Case Report. Healthcare (Basel) 2023; 11:2999. [PMID: 37998491 PMCID: PMC10671051 DOI: 10.3390/healthcare11222999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/14/2023] [Accepted: 11/17/2023] [Indexed: 11/25/2023] Open
Abstract
Osteoarthritis (OA) is a degenerative and progressive joint disease. When all three compartments are involved, end-stage OA is treated with a total knee arthroplasty (TKA). Unicompartmental knee arthroplasty (UKA) is a primary treatment for isolated osteoarthritis. UKA has a quicker recovery time than TKA, as well as less morbidity and more tissue sparing. At the time of surgery, 17% of patients have a tricompartmental disease and most patients with a Kellegren-Lawrence grade >3 have an intact anterior cruciate ligament (ACL). Conventional TKA sacrifices the ACL. Patients with concurrent medial and lateral osteoarthritis and a functional ACL may receive a primary bi-unicondylar arthroplasty. Combined partial knee arthroplasty (CPKA) is an established practice either in bicompartmental femoro-tibial OA or in OA progression after UKA, with the addition of another UKA. A conversion of a lateral UKA to a tricompartmental joint replacement has been reported in the literature. In our case report, we describe a one-stage hypoallergenic tricompartmental UKA, with improved clinical score and no sign of early failure at the last follow-up.
Collapse
Affiliation(s)
- Andrea Parente
- Hip and Knee Replacement Department, IRCCS Orthopedic Institute Galeazzi, 20161 Milan, Italy; (A.P.)
| | - Marta Medetti
- Hip and Knee Replacement Department, IRCCS Orthopedic Institute Galeazzi, 20161 Milan, Italy; (A.P.)
| | - Giuseppe Basile
- Legal Medicine Unit, IRCCS Orthopedic Institute Galeazzi, 20161 Milan, Italy;
| | - Franco Parente
- Hip and Knee Replacement Department, IRCCS Orthopedic Institute Galeazzi, 20161 Milan, Italy; (A.P.)
| |
Collapse
|
5
|
Indelli PF, Giuntoli M, Zepeda K, Ghirardelli S, Valtanen RS, Iannotti F. Native knee kinematics is not reproduced after sensor guided cruciates substituting total knee arthroplasty. J Exp Orthop 2023; 10:17. [PMID: 36786878 PMCID: PMC9929011 DOI: 10.1186/s40634-023-00567-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 01/11/2023] [Indexed: 02/15/2023] Open
Abstract
PURPOSE Gait analysis was used to evaluate knee kinematics in patients who underwent successful primary total knee arthroplasty (TKA) using two modern bi-cruciate substituting designs. The knee joint was balanced intraoperatively using real-time sensor technology, developed to provide dynamic feedback regarding stability and tibiofemoral load. The authors hypothesized that major differences exist in gait parameters between healthy controls and post-TKA patients. METHODS Ten patients who underwent successful TKA using bi-cruciate substituting designs were evaluated at a minimum of 9 months postoperatively using three-dimensional knee kinematic analysis; a multi-camera optoelectronic system and a force platform were used. Sensor-extracted kinematic data included knee flexion angle at heel-strike (KFH), peak midstance knee flexion angle (MSKFA), maximum and minimum knee adduction angle (KAA) and knee rotational angle at heel-strike. Multiple gait analysis data from the study group were compared to a group of ten healthy controls who were matched by age, sex and BMI. Clinical outcome in the TKA group was also measured using the Knee injury and Osteoarthritis Outcome Score (KOOS). RESULTS Clinically, at final follow-up, a statistically significant difference in pain, general symptoms, and activities of daily living was seen between the groups. From a gait analysis standpoint, TKA patients had significantly less rotation at heel strike (p = 0.04), lower late stance peak extension moments (p = 0.02), and less Knee Adduction Angle excursion during swing phase (p = 0.04) compared to the control group. No statistically significant difference was observed for knee flexion angle at heel strike, knee adduction moment, or peak knee flexion moment between the groups. CONCLUSIONS Modern bi-cruciate substituting TKA designs failed to reproduce normal knee kinematics. The lack of full knee extension during the stance phase, absence of the "screw-home mechanism" typical of an ACL functioning knee, and the reduced fluctuation in knee adduction angle during the swing phase still represent major proprioceptive and muscular recruitment differences between normal and replaced knees.
Collapse
Affiliation(s)
- Pier Francesco Indelli
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford and the Palo Alto Veterans Affairs Health Care System (PAVAHCS), Palo Alto, USA. .,Department of Orthopaedic Surgery, Stanford University School of Medicine, 450 Broadway, Redwood City, CA, 94063, USA.
| | - Michele Giuntoli
- grid.5395.a0000 0004 1757 3729Department of Orthopaedic and Trauma Surgery, University of Pisa, Pisa, Italy
| | - Karlos Zepeda
- grid.430773.40000 0000 8530 6973Touro College of Osteopathic Medicine, New York, USA
| | | | - Rosa Susanna Valtanen
- grid.168010.e0000000419368956Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford and the Palo Alto Veterans Affairs Health Care System (PAVAHCS), Palo Alto, USA
| | - Ferdinando Iannotti
- Department of Orthopaedic and Trauma Surgery, San Paolo Hospital, Civitavecchia, Italy
| |
Collapse
|
6
|
Hiranaka T, Fujishiro T, Koide M, Okamoto K. Kinematic Alignment Bi-unicompartmental Knee Arthroplasty With Oxford Partial Knees: A Technical Note. Cureus 2022; 14:e28556. [PMID: 36059371 PMCID: PMC9423885 DOI: 10.7759/cureus.28556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2022] [Indexed: 11/25/2022] Open
Abstract
Bi-unicompartmental knee arthroplasty (BiUKA) is an alternative to total knee arthroplasty for selected patients. Although it is thought to be technically demanding, the technique has not been previously described in detail. Kinematic alignment (KA) implantation and bone cuts parallel to the native joint line would be beneficial to ensure optimal mechanical loading. Here, we detail a technique for KA-BiUKA using the Oxford partial knees. The joint line is identified using the spoon of the microplasty instrumentation system with/without the accessory spoons. The tibia is cut parallel with the joint line using a side-slidable ankle yoke so that the inclination of the cutting block is parallel with the spoon surface. After defining the horizontal bone-cutting lines, the predominantly affected condyle is operated upon, followed by the lesser affected condyle. Although custom-made devices are required, the technique is useful and reproducible in the performance of KA-BiUKA with the Oxford partial knees.
Collapse
|
7
|
Stoddart JC, Garner A, Tuncer M, Cobb JP, van Arkel RJ. The risk of tibial eminence avulsion fracture with bi-unicondylar knee arthroplasty : a finite element analysis. Bone Joint Res 2022; 11:575-584. [PMID: 35920206 PMCID: PMC9396920 DOI: 10.1302/2046-3758.118.bjr-2021-0533.r1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIMS The aim of this study was to determine the risk of tibial eminence avulsion intraoperatively for bi-unicondylar knee arthroplasty (Bi-UKA), with consideration of the effect of implant positioning, overstuffing, and sex, compared to the risk for isolated medial unicondylar knee arthroplasty (UKA-M) and bicruciate-retaining total knee arthroplasty (BCR-TKA). METHODS Two experimentally validated finite element models of tibia were implanted with UKA-M, Bi-UKA, and BCR-TKA. Intraoperative loads were applied through the condyles, anterior cruciate ligament (ACL), medial collateral ligament (MCL), and lateral collateral ligament (LCL), and the risk of fracture (ROF) was evaluated in the spine as the ratio of the 95th percentile maximum principal elastic strains over the tensile yield strain of proximal tibial bone. RESULTS Peak tensile strains occurred on the anterior portion of the medial sagittal cut in all simulations. Lateral translation of the medial implant in Bi-UKA had the largest increase in ROF of any of the implant positions (43%). Overstuffing the joint by 2 mm had a much larger effect, resulting in a six-fold increase in ROF. Bi-UKA had ~10% increased ROF compared to UKA-M for both the male and female models, although the smaller, less dense female model had a 1.4 times greater ROF compared to the male model. Removal of anterior bone akin to BCR-TKA doubled ROF compared to Bi-UKA. CONCLUSION Tibial eminence avulsion fracture has a similar risk associated with Bi-UKA to UKA-M. The risk is higher for smaller and less dense tibiae. To minimize risk, it is most important to avoid overstuffing the joint, followed by correctly positioning the medial implant, taking care not to narrow the bone island anteriorly.Cite this article: Bone Joint Res 2022;11(8):575-584.
Collapse
Affiliation(s)
- Jennifer C Stoddart
- Biomechanics Group, Department of Mechanical Engineering, Imperial College London, London, UK
| | - Amy Garner
- MSk Lab, Department of Surgery and Cancer, Imperial College London, London, UK.,Dunhill Medical Trust and Royal College of Surgeons of England Joint Research Fellowship, London, UK.,Health Education Kent, Surrey and Sussex Higher Surgical Training Programme, London, UK
| | | | - Justin P Cobb
- MSk Lab, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Richard J van Arkel
- Biomechanics Group, Department of Mechanical Engineering, Imperial College London, London, UK
| |
Collapse
|
8
|
Affiliation(s)
- Vishal Rajput
- University College London Hospitals, London, UK.,The Princess Grace Hospital, London, UK
| | - Fares S Haddad
- University College London Hospitals, London, UK.,The Princess Grace Hospital, London, UK.,The NIHR Biomedical Research Centre at UCLH, London, UK.,The Bone & Joint Journal , London, UK
| |
Collapse
|