1
|
Ruderman LV, Bayoumi T, Ten Noever de Brauw GV, Lan R, Nguyen JT, Pearle AD. Robotic-arm-assisted lateral unicompartmental knee arthroplasty leads to high implant survival and patient satisfaction at mean 10-year follow-up. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38738827 DOI: 10.1002/ksa.12237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 04/23/2024] [Accepted: 04/28/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND There is a lack of literature reporting on long-term outcomes following robotic-arm-assisted lateral unicompartmental knee arthroplasty (UKA). This study assessed the long-term survivorship, patient-reported satisfaction and pain scores following robotic-arm-assisted lateral UKA for lateral compartment osteoarthritis (OA). METHODS A single surgeon's database was reviewed to identify all patients who underwent robotic-arm-assisted lateral UKA with a cemented, fixed-bearing prosthesis prior to May 2015. Patients were contacted to determine implant survivorship, satisfaction and pain. Kaplan-Meier models were applied to analyse survival. RESULTS A total of 77 knees (70 patients) with a mean follow-up of 10.2 ± 1.5 years (range: 8.1-13.3) were included. Five knees were revised, corresponding to a 10-year survivorship of 96.1% and estimated survival time of 12.7 ± 0.3 years (95% confidence interval: 12.2-13.2) with all-cause revision as the endpoint. Unexplained pain (40.0%) and progression of OA (40.0%) in contralateral compartments were the most reported reasons for revision. Among patients without revision, 94.4% were either satisfied or very satisfied with their lateral UKA and the average pain score was 1.1. CONCLUSION Robotic-arm-assisted lateral UKA led to high implant survivorship and patient satisfaction, and low pain scores at long-term follow-up. Progression of OA in contralateral compartments and unexplained pain were the most frequent reasons for revision. These findings support the continued use of robotic-arm-assisted lateral UKA for lateral compartment OA; however, its clinical value over conventional techniques remains to be established in prospective comparative studies. LEVEL OF EVIDENCE Therapeutic Level IV.
Collapse
Affiliation(s)
- Lindsey V Ruderman
- Hospital for Special Surgery, Sports Medicine Institute, Weill Medical College of Cornell University, New York, New York, USA
| | - Tarik Bayoumi
- Hospital for Special Surgery, Sports Medicine Institute, Weill Medical College of Cornell University, New York, New York, USA
- Department of Orthopaedic Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Gaby V Ten Noever de Brauw
- Hospital for Special Surgery, Sports Medicine Institute, Weill Medical College of Cornell University, New York, New York, USA
- Department of Orthopaedic Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Ranqing Lan
- Biostatistics Core, Healthcare Research Institute, Hospital for Special Surgery, New York, New York, USA
| | - Joseph T Nguyen
- Biostatistics Core, Healthcare Research Institute, Hospital for Special Surgery, New York, New York, USA
| | - Andrew D Pearle
- Hospital for Special Surgery, Sports Medicine Institute, Weill Medical College of Cornell University, New York, New York, USA
| |
Collapse
|
2
|
Zhou H, Zhang Y, Agarwal A, Arnold G, Wang W. A preliminary study on analysis of lower limb energy during walking in the patients with knee replacement. Heliyon 2024; 10:e27960. [PMID: 38509893 PMCID: PMC10951602 DOI: 10.1016/j.heliyon.2024.e27960] [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: 09/21/2023] [Revised: 03/07/2024] [Accepted: 03/08/2024] [Indexed: 03/22/2024] Open
Abstract
Background Knee replacement surgeries are used to reduce pain and enhance functionality for individuals with knee arthritis. It is predicted that the annual volume of total knee replacement surgeries conducted in the US will surge by a substantial 673% by 2030. Though a lot of studies have done gait analysis on patients with knee replacement, little research is on energy changes in the lower limbs during gait. This study aimed to investigate the mechanical energy changes in the lower limbs for patients with total knee arthroplasty (TKA) and unicondylar knee arthroplasty (UKA), and ultimately to provide a specific tool to analyze limb energy during gait in clinical practice. Methods 10 TKA and 8 UKA patients were recruited for gait analysis. The control group consisted of 11 individuals without knee replacement surgery. Vicon motion capture system and Plug-in-Gait model were used to collect gait data to obtain marker coordinates and gait parameters. The kinetic energy, potential energy, and rotational energy for each segment in the lower limbs were calculated. The energies in the centre of pelvis were considered as the approximate to the centre of mass. The energy recovery coefficients were analysed for each segment during gait. SPSS was used to identify the differences between different groups. Results The results showed that during walking, the upper leg had the highest recovery coefficient, approximately 40%, followed by the foot at 10%, and the lowest recovery coefficient was observed in the lower leg, approximately 1-3%. However, the energy recovery coefficients at the centre of pelvis were significantly higher in the control group than the TKA and UKA groups by roughly 12%-15%. Conclusions The energy difference between the operative and non-operative sides is not significant regardless of the type of surgery. The TKA and UKA groups were more active in potential energy than control group. The upper leg has the highest recovery efficiency of kinetic and potential energy exchanges when walking. The control group used the energy for whole body is better than the patient groups. This study provides a new and useful way to analyze mechanical energy in the lower limbs during gait and could be applied in clinical practice.
Collapse
Affiliation(s)
- Haifei Zhou
- University Department of Orthopaedic and Trauma Surgery, Ninewells Hospital and Medical School, University of Dundee, Dundee, DD1 9SY, United Kingdom
| | - Yuying Zhang
- University Department of Orthopaedic and Trauma Surgery, Ninewells Hospital and Medical School, University of Dundee, Dundee, DD1 9SY, United Kingdom
| | - Archit Agarwal
- University Department of Orthopaedic and Trauma Surgery, Ninewells Hospital and Medical School, University of Dundee, Dundee, DD1 9SY, United Kingdom
- Department of Orthopedics, S P Wahi ONGC Hospital, Dehradun, 248003, India
| | - Graham Arnold
- University Department of Orthopaedic and Trauma Surgery, Ninewells Hospital and Medical School, University of Dundee, Dundee, DD1 9SY, United Kingdom
| | - Weijie Wang
- University Department of Orthopaedic and Trauma Surgery, Ninewells Hospital and Medical School, University of Dundee, Dundee, DD1 9SY, United Kingdom
| |
Collapse
|
3
|
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
|
4
|
D’Amario F, De Berardinis L, Zanon G, Qordja F, Vitale U, Gigante AP. First Italian Experience with the Oxinium Metal-Backed Fixed-Bearing Medial Journey II Unicompartmental Knee System: Promising Short-Term Outcomes of 145 Cases. J Clin Med 2024; 13:1303. [PMID: 38592148 PMCID: PMC10932057 DOI: 10.3390/jcm13051303] [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: 02/08/2024] [Revised: 02/21/2024] [Accepted: 02/23/2024] [Indexed: 04/10/2024] Open
Abstract
(1) Background: Unicompartmental knee arthroplasty (UKA) provides a viable alternative to total knee arthroplasty (TKA) in patients with isolated medial osteoarthritis (OA). From 2007 to 2021, 23% of all primary knee arthroplasties in Italy were UKAs. We retrospectively evaluated clinical outcomes and satisfaction in patients implanted with a new oxinium metal-backed fixed-bearing medial unicompartmental prosthesis at a 24-month follow-up. (2) Methods: From December 2020 to December 2021, 145 patients were treated by a single surgeon at a single institution using the hypoallergenic Journey II prosthesis. Clinical outcome measures included the Knee Society Knee Score (KSKS), Knee Society Function Score (KSFS), Oxford Knee Society (OKS) score, University of California Los Angeles Activity Score (UCLA), the Physical Component Summary (PCS), and the Mental Component Summary (MCS), and were calculated preoperatively and at 12 and 24 months. The Forgotten Joint Score-12 (FJS-12) was calculated at 12 and 24 months. Patient satisfaction was collected at 24 months. The scores were compared using the Friedman test. (3) Results: All clinical scores improved significantly from baseline to 24 months (p < 0.0001), except for the FJS-12, which from 12 to 24 months did not improve significantly (p = 0.041). Patient satisfaction was 9.32 ± 0.74 out of 10. No patient experienced complications or required revision surgery. (4) Conclusions: The Journey II unicompartmental prosthesis is a valuable treatment option for end-stage medial OA, improving knee function, providing pain relief, and ensuring high patient satisfaction at 24 months.
Collapse
Affiliation(s)
- Federico D’Amario
- Orthopedic Unit, Humanitas San Pio X, Via Francesco Nava, 31, 20159 Milano, Italy; (F.D.); (G.Z.)
| | - Luca De Berardinis
- Clinical Orthopedics, Department of Clinical and Molecular Sciences, School of Medicine, Università Politecnica delle Marche, Via Tronto, 10/a, 60126 Ancona, Italy; (F.Q.); (A.P.G.)
| | - Giacomo Zanon
- Orthopedic Unit, Humanitas San Pio X, Via Francesco Nava, 31, 20159 Milano, Italy; (F.D.); (G.Z.)
| | - Fjorela Qordja
- Clinical Orthopedics, Department of Clinical and Molecular Sciences, School of Medicine, Università Politecnica delle Marche, Via Tronto, 10/a, 60126 Ancona, Italy; (F.Q.); (A.P.G.)
| | - Umberto Vitale
- IRCCS Humanitas Research Hospital, Via Manzoni, 56, Rozzano, 20089 Milano, Italy;
| | - Antonio Pompilio Gigante
- Clinical Orthopedics, Department of Clinical and Molecular Sciences, School of Medicine, Università Politecnica delle Marche, Via Tronto, 10/a, 60126 Ancona, Italy; (F.Q.); (A.P.G.)
| |
Collapse
|
5
|
van Langeveld SJ, Janssen SJ, Koenraadt KLM, Elmans LHGJ, van Steenbergen LN, van Geenen RCI. Reduced 5-Year Risk for Revision of the Oxford UKA Using New Instrumentation versus Conventional Instrumentation: A Registry Study of 12,867 UKAs. J Knee Surg 2023; 36:1447-1453. [PMID: 36122694 DOI: 10.1055/a-1946-6892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Microplasty instrumentation was introduced for a more consistent surgical implantation technique, especially component alignment and tibial resection level, of the Oxford medial unicompartmental knee arthroplasty (UKA) and thereby aims to improve UKA survival. This study aimed to assess the 5-year risk for revision and reasons for revision of the Oxford medial UKA using the new instrumentation (Microplasty) with its predecessor, that is, conventional instrumentation (Phase 3). Data of all medial UKAs from the Dutch Arthroplasty Register (Landelijke Registratie Orthopedische Implantaten) between 2007 and 2019 were collected. Type of instrumentation was divided into new (Microplasty) and conventional instrumentation. Kaplan-Meier analysis was performed to calculate 5-year cumulative revision percentage with any reason for revision as end point. A multivariable Cox regression with outcome revision of UKA adjusted for age, gender, American Society of Anesthesiologists score, surgical history, and type of fixation was performed. Additionally, reasons for revision at 3-year were assessed and tested through Fisher's exact tests. A total of 12,867 Oxford medial UKAs, 8,170 using new and 4,697 using conventional instrumentation, were included. The 5-year revision percentage was 9.2% (95% confidence interval [CI]: 8.4-10.1%) for UKAs using the conventional and 6.1% (95% CI: 5.4-6.7%) for new instrumentation. The adjusted hazard ratio for revision at 5-year follow-up was 0.74 (95% CI: 0.63-0.87) in favor of UKAs using the new instrumentation. Malalignment was more frequently registered as reason for revision in UKAs using the conventional compared with the new instrumentation (16% versus 7.5%; p = 0.001). Our results show a reduced 5-year risk for revision of the medial Oxford UKAs using the new compared with the conventional instrumentation. This might be the result of a lower revision rate for malalignment in UKAs using the new instrumentation.
Collapse
Affiliation(s)
- Stephan J van Langeveld
- Department of Orthopaedic Surgery, FORCE (Foundation for Orthopaedic Research Care and Education), Amphia Hospital, Breda, The Netherlands
| | - Stein J Janssen
- Department of Orthopaedic Surgery, Academic Medical Center, Amsterdam Movement Sciences, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Koen L M Koenraadt
- Department of Orthopaedic Surgery, FORCE (Foundation for Orthopaedic Research Care and Education), Amphia Hospital, Breda, The Netherlands
| | - Leon H G J Elmans
- Department of Orthopaedic Surgery, FORCE (Foundation for Orthopaedic Research Care and Education), Amphia Hospital, Breda, The Netherlands
| | | | - Rutger C I van Geenen
- Department of Orthopaedic Surgery, FORCE (Foundation for Orthopaedic Research Care and Education), Amphia Hospital, Breda, The Netherlands
| |
Collapse
|
6
|
Abbasi‐Kesbi R, Fathi M, Najafi M, Nikfarjam A. Assessment of human gait after total knee arthroplasty by dynamic time warping algorithm. Healthc Technol Lett 2023; 10:73-79. [PMID: 37529411 PMCID: PMC10388232 DOI: 10.1049/htl2.12047] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 03/13/2023] [Accepted: 05/02/2023] [Indexed: 08/03/2023] Open
Abstract
Today, the elderly population is increasing, and there are many drawbacks for them, especially defects in their knee joints which lead to improper gait. To solve this problem, their knee joint can be replaced with knee arthroplasty. In this letter, level of improvement in the human gait before and after total knee arthroplasty (TKA) surgery is investigated using the dynamic time warping (DTW) algorithm. For this purpose, several volunteers who have problems with their knees are incorporated in a test before and after TKA surgery. Then, the data of gait analysis is collected and the data is compared with a reference using the DTW algorithm. The outcome results illustrate an improvement of 89%-97% by the proposed algorithm after TKA surgery. Therefore, patients can see improvement with high accuracy and very fast that result in more use this technique in TKR surgery.
Collapse
Affiliation(s)
- Reza Abbasi‐Kesbi
- MEMS & NEMS Department, Faculty of New Sciences and TechnologiesUniversity of TehranTehranIran
| | - Mohammad Fathi
- Department of Biomedical Engineering, Faculty of Medical Sciences and TechnologiesIslamic Azad University Science and Research BranchTehranIran
| | - Mohammad Najafi
- Department of Biomedical Engineering, Faculty of Medical Sciences and TechnologiesIslamic Azad University Science and Research BranchTehranIran
| | - Alireza Nikfarjam
- MEMS & NEMS Department, Faculty of New Sciences and TechnologiesUniversity of TehranTehranIran
| |
Collapse
|
7
|
Dong M, Fan H, Yang D, Sun X, Yan C, Feng Y. Comparison of spatiotemporal, kinematic, and kinetic gait characteristics in total and unicompartmental knee arthroplasty during level walking: A systematic review and meta-analysis. Gait Posture 2023; 104:58-69. [PMID: 37321113 DOI: 10.1016/j.gaitpost.2023.06.005] [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: 09/29/2022] [Revised: 03/26/2023] [Accepted: 06/05/2023] [Indexed: 06/17/2023]
Abstract
PURPOSE This meta-analysis was performed to compare the spatiotemporal, kinematic, and kinetic gait characteristics during level walking between total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA). METHODS An electronic database literature search was performed to screen clinical trials which were included the studies evaluating not only spatiotemporal, kinematic, and kinetic gait parameters, but also knee range of motion and knee score (Knee Society Score and Oxford Knee Score, i.e., KSS and OKS). The data analysis was performed using statistical software Stata 14.0 and Review Manager 5.4. RESULTS Thirteen studies (369 knees) that met the criteria were eventually included in this meta-analysis. The results revealed significant differences between UKA and TKA with regard to walking speed (P = 0.04), stride length (P = 0.02), maximum knee flexion at loading (P = 0.001), the 1st peak of vert-GRF (P = 0.006), the 1st valley of vert-GRF (P = 0.007), knee internal rotational moment (P = 0.04), knee extension (P < 0.00001), and KSS Function score (P = 0.05). In contrast, there were no statistical differences in the remaining spatiotemporal, kinematic, and kinetic gait parameters. CONCLUSION Medial UKA design is superior to TKA design with regard to walking speed, stride length, maximum knee flexion at loading, the 1st peak and the 1st valley of vert-GRF, knee internal rotational moment, knee extension, and KSS Function score. And it could provide a stronger basis for physicians to make clinical decisions.
Collapse
Affiliation(s)
- Mingjie Dong
- Department of Orthopaedics, the Second Clinical Medical College of Shanxi Medical University, 030000 Taiyuan, China
| | - Hao Fan
- Department of Orthopaedics, the Second Clinical Medical College of Shanxi Medical University, 030000 Taiyuan, China
| | - Dinglong Yang
- Department of Orthopaedics, the Second Clinical Medical College of Shanxi Medical University, 030000 Taiyuan, China
| | - Xiaoyu Sun
- Department of Orthopaedics, the Second Clinical Medical College of Shanxi Medical University, 030000 Taiyuan, China
| | - Chaochao Yan
- Department of Orthopaedics, the Second Clinical Medical College of Shanxi Medical University, 030000 Taiyuan, China
| | - Yi Feng
- Department of Orthopaedics, the Second Hospital of Shanxi Medical University, 030000 Taiyuan, China.
| |
Collapse
|
8
|
Zhang H, Chen Y, Jiang H, Yan W, Ouyang Y, Wang W, Liu Y, Zhou Y, Gu S, Wan H, He A, Mao Y, Liu W. Comparison of accuracy for hip-knee-ankle (HKA) angle by X-ray and knee motion analysis system and the relationships between HKA and gait posture. BMC Musculoskelet Disord 2023; 24:452. [PMID: 37270561 DOI: 10.1186/s12891-023-06437-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 04/18/2023] [Indexed: 06/05/2023] Open
Abstract
BACKGROUND The lower limb mechanical axis was used to assess the severity of knee osteoarthritis (KOA) with varus/valgus deformity and the accuracy of targeted lower limb alignment correction after operation by conventional X-rays. There are lots of parameters to assess the gait in elder patients such as velocity, stride length, step width and swing/stance ratio by knee joint movement analysis system. However, the correlation between the lower limb mechanical axis and gait parameters is not clear. This study is aimed at obtaining the accuracy of the lower limb mechanical axis by the knee joint movement analysis system and the correlation between the lower limb mechanical axis and gait parameters. METHODS We analysed 3D knee kinematics during ground gait of 99 patients with KOA and 80 patients 6 months after the operations with the vivo infrared navigation 3D portable knee joint movement analysis system (Opti-Knee®, Innomotion Inc, Shanghai, China). The HKA (Hip-Knee-Ankle) value was calculated and compared to X-ray findings. RESULTS HKA absolute variation after the operation was 0.83 ± 3.76°, which is lower than that before the operation (5.41 ± 6.20°, p = 0.001) and also lower than the entire cohort (3.36 ± 5.72). Throughout the cohort, a significant correlation with low coefficients (r = -0.19, p = 0.01) between HKA value and anterior-posterior displacement was found. In comparing the HKA values measured on the full-length alignment radiographs and 3D knee joint movement analysis system (Opti-Knee), there was a significant correlation with moderate to high coefficients (r = 0.784 to 0.976). The linear correlation analysis showed that there was a significant correlation between the values of HKA measured by X-ray and movement analysis system (R2 = 0.90, p < 0.01). CONCLUSIONS Data with equivalent results as HKA, the 6DOF of the knee and ground gait data could be provided by infrared navigation based 3D portable knee joint movement analysis system comparing with the conventional X-rays. There is no significant effect of HKA on the kinematics of the partial knee joint.
Collapse
Affiliation(s)
- Hui Zhang
- Department of Joint Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 222 West Huanhu Third Road, Pudong New Area, Shanghai, 201306, China
- College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, 10083, China
| | - Yanan Chen
- Department of Joint Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 222 West Huanhu Third Road, Pudong New Area, Shanghai, 201306, China
- College of Food Science and Technology, Shanghai Ocean University, No. 999, Hucheng Ring Road, Pudong New Area, Shanghai, 201306, China
| | - Huiquan Jiang
- Department of Joint Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 222 West Huanhu Third Road, Pudong New Area, Shanghai, 201306, China
- College of Fisheries and Life Science, Shanghai Ocean University, No. 999, Hucheng Ring Road, Pudong New Area, Shanghai, 201306, China
| | - Wenqing Yan
- College of Food Science and Technology, Shanghai Ocean University, No. 999, Hucheng Ring Road, Pudong New Area, Shanghai, 201306, China
| | - Yuanming Ouyang
- Department of Joint Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 222 West Huanhu Third Road, Pudong New Area, Shanghai, 201306, China
| | - Wei Wang
- Department of Joint Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 222 West Huanhu Third Road, Pudong New Area, Shanghai, 201306, China
| | - Yaru Liu
- Department of Joint Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 222 West Huanhu Third Road, Pudong New Area, Shanghai, 201306, China
- College of Food Science and Technology, Shanghai Ocean University, No. 999, Hucheng Ring Road, Pudong New Area, Shanghai, 201306, China
| | - Ying Zhou
- Department of Joint Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 222 West Huanhu Third Road, Pudong New Area, Shanghai, 201306, China
| | - Shiyi Gu
- Department of Joint Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 222 West Huanhu Third Road, Pudong New Area, Shanghai, 201306, China
| | - Hong Wan
- Department of Joint Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 222 West Huanhu Third Road, Pudong New Area, Shanghai, 201306, China
| | - Axiang He
- Department of Joint Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 222 West Huanhu Third Road, Pudong New Area, Shanghai, 201306, China.
| | - Yanjie Mao
- Department of Joint Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 222 West Huanhu Third Road, Pudong New Area, Shanghai, 201306, China.
| | - Wanjun Liu
- Department of Joint Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 222 West Huanhu Third Road, Pudong New Area, Shanghai, 201306, China.
| |
Collapse
|
9
|
Panzram B, Barbian F, Reiner T, Hariri M, Renkawitz T, Walker T. Clinical and Functional Results of Cementless Unicompartmental Knee Arthroplasty with a Minimum Follow Up of 5 Years-A Consecutive Cohort of 201 Patients. J Clin Med 2023; 12:jcm12041694. [PMID: 36836231 PMCID: PMC9966646 DOI: 10.3390/jcm12041694] [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: 01/14/2023] [Revised: 02/06/2023] [Accepted: 02/13/2023] [Indexed: 02/23/2023] Open
Abstract
The number of unicompartmental knee replacements (UKR) is increasing. Alongside various advantages, the revision rate of cemented UKR is higher compared to total knee arthroplasty (TKR). In contrast, cementless fixation shows reduced revision rates, compared to the cemented UKR. However, most of the recent literature is based on designer-dependent studies. In this retrospective, single-center cohort study, we investigated patients who underwent cementless Oxford UKR (OUKR) between 2012 and 2016 in our hospital with a minimum follow-up of five years. Clinical outcome was evaluated using the OKS, AKSS-O, AKSS-F, FFbH-OA, UCLA, SF-36, EQ-5D-3L, FJS, ROM, pain, and satisfaction measures. Survival analysis was performed with reoperation and revision as endpoints. We included 201 patients (216 knees) for clinical evaluation. All outcome parameters increased significantly from pre- to postoperative stages. The five-year survival rate was 96.1% for revision surgery and 94.9% for reoperation. The main reasons for revision were the progression of osteoarthritis, inlay dislocation, and tibial overstuffing. Two iatrogenic tibial fractures appeared. Cementless OUKR shows excellent clinical outcome and high survival rates after five years. The tibial plateau fracture in cementless UKR represents a serious complication and requires modification of the surgical technique.
Collapse
|
10
|
Stolarczyk A, Maciąg BM, Mostowy M, Maciąg GJ, Stępiński P, Szymczak J, Żarnovsky K, Świercz M, Oleksy Ł, Stolarczyk M. Comparison of Biomechanical Gait Parameters and Patient-Reported Outcome in Patients After Total Knee Arthroplasty With the Use of Fixed-Bearing Medial Pivot and Multi-radius Design Implants—Retrospective Matched-Cohort Study. Arthroplast Today 2022; 14:29-35. [PMID: 35128014 PMCID: PMC8799913 DOI: 10.1016/j.artd.2021.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 09/28/2021] [Accepted: 10/08/2021] [Indexed: 12/05/2022] Open
Abstract
Background Total knee arthroplasty (TKA) is considered to be highly successful in treatment of end-stage osteoarthritis. There are multiple implant designs available on the market, and it is difficult to point which one is the best. The aim of this study was to compare the clinical and functional outcomes and gait pattern after TKA with the use of fixed-bearing medial pivot (K-Mod) vs multi-radius design (NexGen) implants and to compare them to norms for healthy patients with no osteoarthritis or arthroplasty procedure in anamnesis. Methods A group of 30 patients who received the medial pivot (MP) TKA and 33 patients who received the posterior-stabilized (PS) TKA between May and August of 2018 were included. All surgeries were performed in the level III academic hospital by a single surgeon. Every patient was asked to fulfill the The Western Ontario and McMaster Universities Arthritis Index (WOMAC) questionnaire preoperatively and 2 years postoperatively. Standard X-ray, biomechanical gait analysis using a motion capture system, and statistical analysis were performed at 2 years postoperatively. Results A total of 28 patients from either MP cohort (93%) or PS (85%) matched-control cohort completed the whole assessment at the final follow-up. There were statistically significant differences in a few gait parameters such as shorter mean step length both in operated and healthy limb, lower mean gait velocity, and lower mean walking cadence than the norm in both MP and PS groups. As to the WOMAC score, there was statistically significant improvement in both groups comparing preoperative and postoperative outcomes. Nevertheless, in the MP group, there was a significantly higher score, indicating worse outcomes, in the stiffness part of the WOMAC score than in the PS group. No significant differences were found between groups during radiological evaluation. Conclusions There were satisfying and promising clinical, radiographic, and patient-reported outcomes in both MP and PS groups with very little difference in relation to norm values. However, both implants failed in fully restoring gait patterns similar to the healthy limb of the same patient.
Collapse
|
11
|
Magaldi RJ, Strecker SE, Nissen CW, Carangelo RJ, Grady-Benson J. Preoperative Factors to Assess Risk for Postoperative Urinary Retention in Total Joint Arthroplasty: A Retrospective Analysis. Arthroplast Today 2022; 13:181-187. [PMID: 35118181 PMCID: PMC8792390 DOI: 10.1016/j.artd.2021.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 09/21/2021] [Accepted: 10/11/2021] [Indexed: 11/18/2022] Open
Abstract
Background Methods Results Conclusions
Collapse
Affiliation(s)
- Robert James Magaldi
- New York Institute of Technology, College of Osteopathic Medicine, Old Westbury, NY, USA
- Orthopedics, Bone and Joint Institute, Hartford Hospital, Hartford, CT, USA
| | - Sara Elaine Strecker
- Orthopedics, Bone and Joint Institute, Hartford Hospital, Hartford, CT, USA
- Corresponding author. 31 Seymour Street, Suite 202, Hartford, CT 06106, USA. Tel.: +1 860-539-6283.
| | - Carl W. Nissen
- Orthopedics, Bone and Joint Institute, Hartford Hospital, Hartford, CT, USA
| | | | - John Grady-Benson
- Orthopedics, Bone and Joint Institute, Hartford Hospital, Hartford, CT, USA
| |
Collapse
|
12
|
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.
Collapse
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
| |
Collapse
|
13
|
Stoddart JC, Dandridge O, Garner A, Cobb J, van Arkel RJ. The compartmental distribution of knee osteoarthritis - a systematic review and meta-analysis. Osteoarthritis Cartilage 2021; 29:445-455. [PMID: 33253887 DOI: 10.1016/j.joca.2020.10.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 08/10/2020] [Accepted: 10/06/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES For a population with knee osteoarthritis (OA), determine: 1) the prevalence of single compartmental, bicompartmental and tricompartmental OA, 2) the prevalence of isolated medial tibiofemoral, lateral tibiofemoral, or patellofemoral OA, and combinations thereof. METHODS PubMed and Web of Science databases, and reference lists of identified studies, were searched to find studies which reported on the compartmental distribution and prevalence of knee OA. Two independent reviewers assessed studies against pre-defined inclusion criteria and prevalence data were extracted along with subject characteristics. The methodological quality of each included study was assessed. A random-effects model meta-analysis was performed for each OA category to estimate the relative prevalence of OA in the knee compartments amongst people with knee OA. RESULTS 16 studies (3,786 knees) met the inclusion criteria. High heterogeneity was measured. Normalised for knees with OA, estimated prevalence rates (95% CI) were: single compartmental 50% (31.5-58.3%), bicompartmental 33% (23.1-37.2%) and tricompartmental only 17% (8.8-24.8%). Isolated medial tibiofemoral OA, isolated patellofemoral OA, and combined medial tibiofemoral and patellofemoral OA were more common than tricompartmental disease, occurring in 27% (15.2-31.1%), 18% (9.9-22.7%) and 23% (14.1-27.3%) of people respectively. Single/bicompartmental patterns of disease involving the lateral tibiofemoral compartment were less common, summing to 15% (8.5-18.7%). CONCLUSION Three-quarters of people with knee OA do not have tricompartmental disease. This is not reflected in the frequency with which partial and combined partial knee arthroplasties are currently used. TRIAL REGISTRATION NUMBER PROSPERO systematic review protocol (CRD42019140345).
Collapse
Affiliation(s)
- J C Stoddart
- Biomechanics Group, Department of Mechanical Engineering, Imperial College London, London, UK.
| | - O Dandridge
- Biomechanics Group, Department of Mechanical Engineering, Imperial College London, London, UK.
| | - A Garner
- MSk Lab, Department of Surgery and Cancer, Imperial College London, London, UK; Health Education Kent, Surrey and Sussex Higher Surgical Training Programme, London, UK; Dunhill Medical Trust and Royal College of Surgeons of England Joint Research Fellowship, London, UK.
| | - J Cobb
- MSk Lab, Department of Surgery and Cancer, Imperial College London, London, UK.
| | - R J van Arkel
- Biomechanics Group, Department of Mechanical Engineering, Imperial College London, London, UK.
| |
Collapse
|
14
|
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.
Collapse
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
| |
Collapse
|