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Chirico M, Zanna L, Akkaya M, Carulli C, Civinini R, Innocenti M. The Traditional Intramedullary Axis Underestimates the Medial Tibial Slope Compared to Transmalleolar Sagittal Axis in Image-based Robotic-Assisted Unicompartimental Knee Arthroplasty. J Knee Surg 2024; 37:959-965. [PMID: 39084605 DOI: 10.1055/a-2376-6999] [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: 08/02/2024]
Abstract
The medial unicompartmental knee arthroplasty (mUKA) has been recognized as an excellent treatment for medial knee osteoarthritis. The posterior tibial slope (PTS) is measured radiographically with the intramedullary axis (IMA) to the tibial baseplate on the sagittal plane radiograph. However, in most computer-navigated or robotic mUKAs, the PTS is set from a transmalleolar axis (TMA).The PTS difference was evaluatedbetween the sagittal TMA and the sagittal IMA of patients undergoing a CT-based primary robotic-assisted mUKA.We retrospectively reviewed the preoperative computed tomography (CT) scans taken according to the MAKO system protocol (Stryker) of 67 patients undergoing mUKAs. We measured the angular difference between the IMA and the TMA in the sagittal plane.Using the TMA to set the PTS the estimation of the slope of the medial tibial plateau would increase by an average of 1.9 ± 3.2 degreescompared to the IMA. Furthermore, in nineknees, PTS was decreased.Tibial components implanted with the help of a CT scan-based preoperative planning MAKO will show an average of 1.9 degrees more than those measured on sagittal radiographs potentially of concern for knee kinematics. A universal language is needed to standardize the slope calculation and the respective reference axis used.
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Affiliation(s)
- Mattia Chirico
- Orthopaedic Clinic, University of Florence, Florence, Italy
| | - Luigi Zanna
- Orthopaedic Clinic, University of Florence, Florence, Italy
| | - Mustafa Akkaya
- Orthopaedic Clinic, University of Florence, Florence, Italy
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Schröter S, Klink J, Ihle C, Gueorguiev BG, Herbst M, Maiotti M, Histing T, Ahrend MD. Long-term Outcomes after Medial Open Wedge High Tibial Osteotomy - A Retrospective Study of 69 Patients. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2024; 162:465-473. [PMID: 37647923 DOI: 10.1055/a-2120-0993] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
High tibial osteotomy (HTO) is a widespread option to avoid or delay total knee arthroplasty (TKA). The present study aimed to assess the long-term survival rate and postoperative subjective knee function after isolated medial open wedge HTO in patients with symptomatic medial compartment knee osteoarthritis (OA) and varus malalignment.Sixty-nine patients (48.8 ± 6.7, 35-66 years; preoperative mechanical tibiofemoral angle [mTFA] -5.3 ± 3.4; -14.9-0.0° varus) treated with medial open wedge HTO using a TomoFix plate were included in this retrospective study, with a follow-up of at least 10 years (11.8 ± 1.0 years). The survival rate after HTO was calculated after 5 and 10 years. Subjective knee function was assessed using Hospital for Special Surgery (HSS), Oxford knee, Lequesne, and Lysholm scores.Thirty-three patients underwent conversion to TKA, on average, 7.0 ± 3.4 (1.3-13.7) years after HTO. Five- and ten-year survival rates were 84.1 and 60.9%, respectively. Patients without conversion to TKA showed a Lysholm score of 64.5 (35-92), Lequesne score of 7 (1-13), HSS score of 71 (56-86), and Oxford knee score of 38.5 (25-44) at the last follow-up (more than 10 years). Significantly higher scores were registered at the last follow-up compared to the preoperative state regarding the Lysholm score (preoperative: 43.5 [12-95]; follow-up: 64.5 [35-92]; p < 0.001). The HSS score (preoperative: 69.5 [43-93]; follow-up: 71 [56-86]; p = 0.6941) showed no statistically significant change during the 10-year follow-up period. The Lequesne score was significantly lower than the preoperative score (preoperative: 11.5 [0.5-22]; follow-up: 7 [1-13]; p < 0.001), indicating a lower handicap.The majority of patients with a valgus medial compartmental knee OA treated with HTO with fixation using the TomoFix plate can expect no conversion to TKA for more than 10 years. Furthermore, patients without conversion to TKA after 10 years still had a significantly higher subjective knee function than preoperatively. Further research is needed to identify risk factors for conversion to TKA. This helps to guide surgeons in selecting patients who will benefit most from HTO.
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Affiliation(s)
- Steffen Schröter
- Klinik für Unfall- und Wiederherstellungschirurgie, Diakonie Klinikum GmbH Jung-Stilling, Siegen, Germany
- Mitglied Osteotomie Komitee der Deutschen Kniegesellschaft
| | - Julian Klink
- Klinik für Unfall- und Wiederherstellungschirurgie, BG Unfallklinik Tübingen, Tübingen, Germany
| | - Christoph Ihle
- Klinik für Unfall- und Wiederherstellungschirurgie, BG Unfallklinik Tübingen, Tübingen, Germany
| | | | - Moritz Herbst
- Klinik für Unfall- und Wiederherstellungschirurgie, BG Unfallklinik Tübingen, Tübingen, Germany
| | - Marco Maiotti
- Orthopedics, Shoulder Unit Villa Stuart Clinic (Rome), Rome, Italy
| | - Tina Histing
- Klinik für Unfall- und Wiederherstellungschirurgie, BG Unfallklinik Tübingen, Tübingen, Germany
| | - Marc-Daniel Ahrend
- Klinik für Unfall- und Wiederherstellungschirurgie, BG Unfallklinik Tübingen, Tübingen, Germany
- Mitglied Osteotomie Komitee der Deutschen Kniegesellschaft
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Sangaletti R, Meschini C, Capece G, Montagna A, Andriollo L, Benazzo F, Rossi SMP. A morphometric medial compartment-specific unicompartmental knee system: 5 years follow up results from a pilot center. Knee 2024; 47:179-185. [PMID: 38401342 DOI: 10.1016/j.knee.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 01/04/2024] [Accepted: 02/07/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND Unicompartmental Knee Arthroplasty (UKA) is a valuable solution for the treatment of medial osteoarthritis of the knee. New implants feature designs for the elective substitution of a specific compartment. Aim of this study was to assess the survivorship and functional outcomes at minimum 4 years of the first 60 implanted patients in a pilot center of a new medial UKA as the evolution of a well performing long lasting fixed bearing implant. METHODS Between June 2017 and the end of 2018, 60 medial UKA were implanted in 58 patients. All patients were available for the last follow up and were analyzed prospectively. 37 were females and 21 were males with a mean age of 67 years (SD 10,71) and a mean of BMI 27.16 (SD 3.94) for the male population and of 26.73 (SD 4.05) for the female population. RESULTS At final follow up the mean Oxford Knee Score (OKS) was 44,02 (SD 3,1) and the mean Forgotten Joint Score (FJS) 78,6 (SD 7,9). The Knee Society Score (KSS) score was 95,2 for the "knee" score and 89.8 for the "function" score. No patients were revised. Kaplan-Meyer survival estimate showed a 100% survivorship at final follow up. No progressive radiolucent lines were found and no direct or indirect signs of polyethylene wear were registered on the final radiographs. CONCLUSIONS This new implant demonstrated promising clinical results with an excellent survival rate at short to midterm follow- up. Further follow up is needed to confirm this trend at longer term.
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Affiliation(s)
- Rudy Sangaletti
- Sezione di Chirurgia Protesica ad Indirizzo Robotico, Unità di Traumatologia dello Sport, U.O.C Ortopedia e Traumatologia, Fondazione Poliambulanza, Brescia, Italy
| | - Cesare Meschini
- Sezione di Chirurgia Protesica ad Indirizzo Robotico, Unità di Traumatologia dello Sport, U.O.C Ortopedia e Traumatologia, Fondazione Poliambulanza, Brescia, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giacomo Capece
- Sezione di Chirurgia Protesica ad Indirizzo Robotico, Unità di Traumatologia dello Sport, U.O.C Ortopedia e Traumatologia, Fondazione Poliambulanza, Brescia, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alice Montagna
- Sezione di Chirurgia Protesica ad Indirizzo Robotico, Unità di Traumatologia dello Sport, U.O.C Ortopedia e Traumatologia, Fondazione Poliambulanza, Brescia, Italy; Università degli studi di Pavia, Pavia, Italy
| | - Luca Andriollo
- Sezione di Chirurgia Protesica ad Indirizzo Robotico, Unità di Traumatologia dello Sport, U.O.C Ortopedia e Traumatologia, Fondazione Poliambulanza, Brescia, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Benazzo
- Sezione di Chirurgia Protesica ad Indirizzo Robotico, Unità di Traumatologia dello Sport, U.O.C Ortopedia e Traumatologia, Fondazione Poliambulanza, Brescia, Italy; IUSS Istituto Universitario di Studi Superiori, Pavia, Italy
| | - Stefano Marco Paolo Rossi
- Sezione di Chirurgia Protesica ad Indirizzo Robotico, Unità di Traumatologia dello Sport, U.O.C Ortopedia e Traumatologia, Fondazione Poliambulanza, Brescia, Italy.
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Scheele CB, Pietschmann MF, Wagner TC, Müller PE. [Functional outcomes and return to sports, work, and daily activities after revision UKA compared to primary UKA and TKA]. ORTHOPADIE (HEIDELBERG, GERMANY) 2024; 53:201-208. [PMID: 38349524 PMCID: PMC10896861 DOI: 10.1007/s00132-024-04472-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/30/2023] [Indexed: 02/27/2024]
Abstract
BACKGROUND Unicompartmental knee arthroplasty (UKA), in addition to total knee arthroplasty (TKA), has been shown to be effective in the surgical treatment of knee osteoarthritis with appropriate patient selection. In clinical studies, it has demonstrated superior functional results with lower complication rates. In clinical practice, these advantages must be weighed against the disadvantage of an increased revision rate, especially in younger patients with sports and work activities. OBJECTIVES The aim of this study was to compare the functional outcome as well as the time to return to daily activities, work, and sports after revision of UKA to TKA with those of primary UKA and primary TKA using a matched-pair analysis. MATERIALS AND METHODS The study was based on a matched-pair analysis at two defined time points, always comparing 28 patients who underwent either revision of a UKA to a TKA, primary UKA, or primary TKA. Patients completed the Oxford Knee Score, UCLA score, Knee Society score, and WOMAC score during standardized follow-up. In addition, postoperative patient satisfaction and return to activities of daily living, work, and sports were recorded in a standardized manner, and a clinical examination was performed. RESULTS The four functional scores studied showed a common trend in favor of UKA, followed by primary TKA and revision TKA. The differences between converted UKA and primary TKA were not significant. However, at 3.2 years after the last surgery, the results of the converted UKA were significantly lower than those of the primary UKA. Return to work and sports tended to occur the earliest after UKA, followed by TKA and the revision group. All groups showed a tendency to engage in low-impact sports. CONCLUSION The functional results of revised UKA were significantly inferior to those of primary UKA based on a 3-year follow-up. Return to work, sports, and activities of daily living tended to take longer after revision than after primary implantation of either a UKA or a TKA.
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Affiliation(s)
- Christian B Scheele
- Klink für Orthopädie und Unfallchirurgie, Muskuloskelettalen Universitätszentrum München (MUM), Ludwig-Maximilians-Universität, Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland.
- Klinik und Poliklinik für Orthopädie und Sportorthopädie, Klinikum rechts an der Isar der Technischen Universität München, Ismaninger Str. 22, 81675, München, Deutschland.
| | - Matthias F Pietschmann
- Klink für Orthopädie und Unfallchirurgie, Muskuloskelettalen Universitätszentrum München (MUM), Ludwig-Maximilians-Universität, Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland
| | - Thomas C Wagner
- Klink für Orthopädie und Unfallchirurgie, Muskuloskelettalen Universitätszentrum München (MUM), Ludwig-Maximilians-Universität, Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland
| | - Peter E Müller
- Klink für Orthopädie und Unfallchirurgie, Muskuloskelettalen Universitätszentrum München (MUM), Ludwig-Maximilians-Universität, Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland
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Pascual-Leone N, Sloan M, Shah VM, Sheth NP. Patients With Significant Medical Comorbidities May Benefit from Unicompartmental Knee Arthroplasty Over Total Knee Arthroplasty. J Knee Surg 2024; 37:79-83. [PMID: 36657464 DOI: 10.1055/s-0042-1760388] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Many studies have compared outcomes in total knee arthroplasty (TKA) versus unicompartmental knee arthroplasty (UKA); however, to the authors' knowledge, there is no study evaluating complication rates in patients with significant comorbidities. The purpose of this retrospective study was to compare the incidence of postoperative complications, readmission and reoperation rates, length of stay (LOS), and discharge location for patients with significant medical comorbidities undergoing TKA versus UKA. Using the NSQIP database from 2008 to 2018, patients were identified by CPT code (27447 or 27446) and admission diagnostic code of primary osteoarthritis and included in the study if they had an American Society of Anesthesia score greater than or equal to 3. Chi-square test was used to compare categorical variables and t-test for continuous variables. Multivariate regression was used to compare outcomes of interest between groups. A total of 167,054 patients were analyzed with 97.3% undergoing TKA. TKA patients had a greater overall complication rate than those undergoing UKA (p < 0.001). Readmission rates were approximately 1.5 times higher in TKA compared with UKA (p = 0.002), while no statistically significant difference was discovered in reoperation rates (p = 0.868). TKA was also associated with decreased rates of same day discharge, discharge within 24 hours of surgery, and discharge home (p < 0.001, <0.001, and <0.001, respectively). This study found an increase in complication rates, readmission rates, and LOS, along with a lower likelihood of discharge home when undergoing a TKA. These findings suggest that patients with significant medical comorbidities at baseline may benefit from UKA over TKA when anatomically indicated.
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Affiliation(s)
- Nicolas Pascual-Leone
- Department of Orthopaedic Surgery, Pennsylvania Hospital, Philadelphia, Pennsylvania
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Matthew Sloan
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Emerson Center for Specialty Care, Concord, Massachusetts
| | - Vivek M Shah
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Neil P Sheth
- Department of Orthopaedic Surgery, Pennsylvania Hospital, Philadelphia, Pennsylvania
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Cai J, Ma M, Zeng W, Luo S, Yuan F, Yin F. Computed tomography-based patient-specific cutting guides used for positioning of the femoral component of implants during unicompartmental knee arthroplasty: a cadaver study. BMC Surg 2023; 23:381. [PMID: 38114969 PMCID: PMC10729329 DOI: 10.1186/s12893-023-02272-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 11/20/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND To investigate whether patient-specific instrumentation (PSI) improves the femoral component positioning of implants during unicompartmental knee arthroplasty (UKA) using cadaver bone models. METHODS Fifty adult cadaveric femoral bone specimens collected from February 2016-2018, were randomized to receive medial UKA with a PSI guide (n = 25) or conventional instrumentation (CI) (n = 25). Standard anteroposterior and lateral view radiographs were obtained postoperatively to assess the coronal and sagittal positioning of the femoral prostheses, respectively. The osteotomy time was recorded to assess the convenience of PSI in guiding osteotomy. RESULTS Osteotomy time significantly shortened in the PSI group (3.12 ± 0.65 versus 4.33 ± 0.73 min, p < 0.001). There was a significant difference in the postoperative coronal alignment of the femoral component between the PSI and CI groups (varus/valgus angle: 1.43 ± 0.93° vs. 2.65 ± 1.50°, p = 0.001). The prevalence of outliers in coronal alignment was lower in the PSI than the CI group (2/25, 8% vs. 9/25, 36%). Sagittal posterior slope angle of the femoral component was significantly different between the two groups (8.80 ± 0.65° and 6.29 ± 1.88° in the CI and PSI groups, respectively, p < 0.001). The malalignment rate of the femoral component in the sagittal plane was 60% in the CI group, whereas no positioning deviation was observed in the PSI group. CONCLUSION This study used a cadaver model to support the fact that CT-based PSI shows an advantage over CI in optimizing implant positioning for UKAs.
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Affiliation(s)
- Junfeng Cai
- Department of joint surgery, Shanghai east hospital, Tongji university, school of medicine, Shanghai, 200120, China
| | - Min Ma
- Department of joint surgery, Shanghai east hospital, Tongji university, school of medicine, Shanghai, 200120, China
| | - Wen Zeng
- Department of joint surgery, Shanghai east hospital, Tongji university, school of medicine, Shanghai, 200120, China
| | - Shuling Luo
- Department of joint surgery, Shanghai east hospital, Tongji university, school of medicine, Shanghai, 200120, China
| | - Feng Yuan
- Department of joint surgery, Shanghai east hospital, Tongji university, school of medicine, Shanghai, 200120, China.
| | - Feng Yin
- Department of joint surgery, Shanghai east hospital, Tongji university, school of medicine, Shanghai, 200120, China.
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Rossi SMP, Sangaletti R, Nesta F, Matascioli L, Terragnoli F, Benazzo F. A well performing medial fixed bearing UKA with promising survivorship at 15 years. Arch Orthop Trauma Surg 2022; 143:2693-2699. [PMID: 35908099 DOI: 10.1007/s00402-022-04562-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 07/18/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Unicompartmental knee arthroplasty (UKA) accounts for 10% of knee arthroplasty procedures in Europe. Fixed bearing UKA designs have shown favorable survivorship in registries when compared with mobile bearings. This study analyses long-term follow-up of patients with a medial fixed bearing metal backed tibial UKA and reports 15 years survivorship and clinical outcomes. METHODS Data were collected prospectively for 148 medial unicompartmental fixed bearing metal backed UKAs implanted in 148 patients in two high volumes knee arthroplasty centers between January 2005 and December 2007. The indication was osteoarthritis in all but 2 patients. Patients' reported outcome scores were documented at last follow up. The mean patient age at time of surgery was 65 years. RESULTS At final follow up, outcome and survivorship data were collected for 124 medial fixed bearing UKAs. Thirteen patients underwent revision; average time to revision was 77 months (SD 35.31). The Kaplan-Meier analysis demonstrated a survivorship of 97.65% at 69 months and of 89,52%. at 120 months and 173 months of follow-up. When revisions for infection were excluded, the survivorship of the implant was 90.3% at the last of follow up. The mean OKS was 43.02 (SD 5.1) at the last follow-up, and the mean FJS was 77.6 (SD 6.9). CONCLUSION This Medial fixed bearing metal backed UKA demonstrates promising long-term survivorship and patient outcomes. It appears to be a suitable and reasonably lasting option for the treatment of medial compartment OA.
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Affiliation(s)
- Stefano Marco Paolo Rossi
- Sezione di Chirurgia Protesica ad Indirizzo Robotico, Unità di Traumatologia dello Sport, U.O.C Ortopedia e Traumatologia, Fondazione Poliambulanza, Via Bissolati 57, 25124, Brescia, Italy.
| | - Rudy Sangaletti
- Sezione di Chirurgia Protesica ad Indirizzo Robotico, Unità di Traumatologia dello Sport, U.O.C Ortopedia e Traumatologia, Fondazione Poliambulanza, Via Bissolati 57, 25124, Brescia, Italy
| | - Fabio Nesta
- U.O.C Ortopedia e Traumatologia, Fondazione Poliambulanza, Via Bissolati 57, Brescia, Italy
| | - Luca Matascioli
- U.O.C Ortopedia e Traumatologia, Fondazione Poliambulanza, Via Bissolati 57, Brescia, Italy
| | - Flavio Terragnoli
- U.O.C Ortopedia e Traumatologia, Fondazione Poliambulanza, Via Bissolati 57, Brescia, Italy
| | - Francesco Benazzo
- Sezione di Chirurgia Protesica ad Indirizzo Robotico, Unità di Traumatologia dello Sport, U.O.C Ortopedia e Traumatologia, Fondazione Poliambulanza, Via Bissolati 57, 25124, Brescia, Italy
- IUSS Istituto Universitario di Studi Superiori, Pavia, Italy
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A Comparative Study of Total Knee Arthroplasty and Unicondylar Knee Arthroplasty in the Treatment of Knee Osteoarthritis. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:7795801. [PMID: 35582233 PMCID: PMC9071932 DOI: 10.1155/2022/7795801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/23/2022] [Accepted: 04/21/2022] [Indexed: 11/18/2022]
Abstract
Objective To compare the clinical efficacy of total knee arthroplasty (TKA) and unicondylar knee arthroplasty (UKA) in the treatment of knee osteoarthritis (KOA). Methods A retrospective analysis was conducted on 30 patients admitted to the Department of Orthopaedics of Yijishan Hospital from 2020 to 2021. The patients were divided into UKA group (n = 15) and TKA group (control, n = 15). The intraoperative situation and postoperative clinical indicators of patients in the two groups were collected and compared, such as operation time, intraoperative blood loss, length of hospital stay, postoperative complications, and postoperative functional recovery. Postoperative functional recovery was investigated by the visual analogue pain scale (VAS), knee score scale (HSS), and knee range of motion (ROM) scores 5 days after surgery. Results Perioperative indexes in the UKA group were significantly lower than those in the TKA group, including operation time, intraoperative blood loss, first time going to the ground, and length of hospital stay. VAS, HSS, and ROM scores in the two groups were significantly improved after surgery compared with those before surgery. However, ROM scores in the UKA group were significantly better than in the TKA group. In terms of early postoperative complications, there was one case of venous thrombosis of lower limbs in the UKA group, while in the TKA group there was one case of delayed wound healing due to diabetes, and one case of deep infection. Conclusion Both UKA and TKA are very successful options for the treatment of KOA, but the use of UKA can promote the recovery of postoperative knee function, reduce postoperative complications, and achieve more satisfactory than expected results.
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Qutub A, Ghandurah A, Alzahrani A, Alghamdi A, Bakhsh TM. Functional results and survivorship after medial unicompartmental knee arthroplasty: a single center experience from Saudi Arabia. Ann Saudi Med 2021; 41:299-306. [PMID: 34618608 PMCID: PMC8497006 DOI: 10.5144/0256-4947.2021.299] [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] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Isolated involvement of the medial compartment of the knee in degenerative disease is encountered in about 25% of patients with gonarthrosis. We aim to show that in a well-selected group of such patients, medial unicompartmental knee arthroplasty (UKA) is a good option. OBJECTIVES Review the functional outcomes of patients undergoing UKA and determine the long-term survivorship of the implants and complications of the procedure. DESIGN Analytical retrospective chart review. SETTING Academic tertiary care medical center and tertiary care private hospital in the western region of Saudi Arabia. PATIENTS AND METHODS We selected patients who underwent medial UKAs by the same surgeon between December 1988 and December 2009. The life table approach and the Kaplan-Meier statistical method were used to estimate the survival rate (5-30 years) with revision as the endpoint. Functional outcome scores were determined according to the Knee Society Clinical Rating System. MAIN OUTCOME MEASURES Change in performance scores for pain, walking, and range of movement. Survivorship of the implants with removal of the implant as the endpoint; post-operative complications. SAMPLE SIZE 218 implants on 142 patients. RESULTS The survival rate of UKA was 94.7% at 10 years (95% CI 0.906-0.970), 80.9% at 20 years (95%CI 0.724-0.871), and 77.8% at 30 years (95%CI 0.669-0.855). The average grand total functional score increased from 61 (maximum 200) at 0 months to above 150 at ≥6 months. CONCLUSION UKA is a good option for isolated medial compartment gonarthrosis with excellent functional outcome and good survivorship in selected patients. LIMITATION Single center experience, retrospective. We lost 6.0% of patients during follow-up. Comparison with other treatment modalities is based on literature review and not on our own data. CONFLICT OF INTEREST None.
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Affiliation(s)
- Ammar Qutub
- From the Department of Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Amjad Ghandurah
- From the Department of Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Adel Alzahrani
- From the Department of Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ahmed Alghamdi
- From the Department of Orthopedic Surgery, East Jeddah General Hospital, Jeddah, Saudi Arabia
| | - Talal M Bakhsh
- From the Department of Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
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Austin MS, Ashley BS, Bedard NA, Bezwada HP, Hannon CP, Fillingham YA, Kolwadkar YV, Rees HW, Grosso MJ, Zeegen EN. What is the Level of Evidence Substantiating Commercial Payers' Coverage Policies for Total Joint Arthroplasty? J Arthroplasty 2021; 36:2665-2673.e8. [PMID: 33867209 DOI: 10.1016/j.arth.2021.03.036] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 03/08/2021] [Accepted: 03/14/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The prevalence of total joint arthroplasty (TJA) in the United States has drawn the attention of health care stakeholders. The payers have also used a variety of strategies to regulate the medical necessity of these procedures. The purpose of this study was to examine the level of evidence of the coverage policies being used by commercial payers in the United States. METHODS The references of the coverage policies of four commercial insurance companies were reviewed for type of document, level of evidence, applicability to a TJA population, and success of nonoperative treatment in patients with severe degenerative joint disease. RESULTS 282 documents were reviewed. 45.8% were primary journal articles, 14.2% were level I or II, 41.2% were applicable to patients who were candidates for TJA, and 9.9% discussed the success of nonoperative treatment in patients who would be candidates for TJA. CONCLUSION Most of the references cited by commercial payers are of a lower level of scientific evidence and not applicable to patients considered to be candidates for TJA. This is relatively uniform across the reviewed payers. The dearth of high-quality literature cited by commercial payers reflects the lack of evidence and difficulty in conducting high level studies on the outcomes of nonoperative versus operative treatment for patients with severe, symptomatic osteoarthritis. Patients, surgeons, and payers would all benefit from such studies and we encourage professional societies to strive toward that end through multicenter collaboration.
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Affiliation(s)
- Matthew S Austin
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Blair S Ashley
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Nicholas A Bedard
- Department of Orthopaedic Surgery, University of Iowa Hospitals & Clinics, Iowa City, IA
| | | | - Charles P Hannon
- Department of Orthopaedic Surgery, The Mayo Clinic, Ochester, MN
| | - Yale A Fillingham
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Yogesh V Kolwadkar
- Department of Orthopaedic Surgery, VA Central California Health Care System, Fresno, CA
| | - Harold W Rees
- Department of Orthopaedic Surgery, Loyola University Medical Center, Maywood, IL
| | - Matthew J Grosso
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA; Connecticut Joint Replacement Institute, Hartford, CT
| | - Erik N Zeegen
- Department of Orthopaedic Surgery, University of California Los Angeles, Santa Monica, CA
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11
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Ngarmukos S, Kim KI, Wongsak S, Chotanaphuti T, Inaba Y, Chen CF, Liu D. Asia-Pacific venous thromboembolism consensus in knee and hip arthroplasty and hip fracture surgery: Part 1. Diagnosis and risk factors. Knee Surg Relat Res 2021; 33:18. [PMID: 34147134 PMCID: PMC8214263 DOI: 10.1186/s43019-021-00099-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 04/04/2021] [Indexed: 12/11/2022] Open
Affiliation(s)
- Srihatach Ngarmukos
- Department of Orthopaedics, King Chulalongkorn Memorial Hospital and Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Kang-Il Kim
- Department of Orthopaedic Surgery, Center for Joint Diseases, Kyung Hee University Hospital at Gangdong, 892 Dongnam-ro, Gangdong-gu Seoul, Seoul, 134-727, Korea.
- Department of Orthopaedic Surgery, School of Medicine, Kyung Hee University, Seoul, Korea.
| | - Siwadol Wongsak
- Department of Orthopaedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Thanainit Chotanaphuti
- Department of Orthopaedics, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Yutaka Inaba
- Department of Orthopaedic Surgery, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan
| | - Cheng-Fong Chen
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - David Liu
- Gold Coast Centre for Bone & Joint Surgery, Gold Coast, Australia
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12
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Chen Z, Chen K, Yan Y, Feng J, Wang Y, Liu Z, Yang Q, He C. Effects of posterior tibial slope on the mid-term results of medial unicompartmental knee arthroplasty. ARTHROPLASTY 2021; 3:11. [PMID: 35236478 PMCID: PMC8796409 DOI: 10.1186/s42836-021-00070-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 01/21/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To evaluate the effect of medial posterior tibial slope (PTS) on mid-term postoperative range of motion (ROM) and functional improvement of the knee after medial unicompartmental knee arthroplasty (UKA). METHODS Medical records of 113 patients who had undergone 124 medial UKAs between April 2009 through April 2014 were reviewed retrospectively. The mean follow-up lasted 7.6 years (range, 6.2-11.2 years). Collected were demographic data, including gender, age, height, weight of the patients. Anteroposterior (AP) and lateral knee radiographs of the operated knees were available in all patients. The knee function was evaluated during office follow-up or hospital stay. Meanwhile, postoperative PTS, ROM, maximal knee flexion and Hospital for Special Surgery (HSS) knee score (pre-/postoperative) of the operated side were measured and assessed. According to the size of the PTS, patients were divided into 3 groups: group 1 (<4°), group 2 (4° ~ 7°) and group 3 (>7°). The association between PTS and the knee function was investigated. RESULTS In our cohort, the average PTS was 2.7° ± 0.6° in group 1, 5.6° ± 0.9° in group 2 and 8.7° ± 1.2° in group 3. Pairwise comparisons showed significant differences among them (p < 0.01). The average maximal flexion range of postoperative knees in each group was 112.4° ± 5.6°, 116.4° ± 7.2°, and 117.5° ± 6.1°, respectively, with significant difference found between group 1 and group 2 (p < 0.05), and between group 1 and group 3 (p < 0.05). However, the gender, age, and body mass index (BMI) did not differ between three groups and there was no significant difference between groups in terms of pre-/postoperative HSS scores or postoperative knee ROM. CONCLUSION A mid-term follow-up showed that an appropriate PTS (4° ~ 7°) can help improve the postoperative flexion of knee. On the other hand, too small a PTS could lead to limited postoperative knee flexion. Therefore, the PTS less than 4° should be avoided during medial UKA.
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Affiliation(s)
- Zhijie Chen
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025 People’s Republic of China
| | - Kaizhe Chen
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025 People’s Republic of China
| | - Yufei Yan
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025 People’s Republic of China
| | - Jianmin Feng
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025 People’s Republic of China
| | - Yi Wang
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025 People’s Republic of China
| | - Zhihong Liu
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025 People’s Republic of China
| | - Qingming Yang
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025 People’s Republic of China
| | - Chuan He
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025 People’s Republic of China
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13
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Nikose SS, Nikose D, Kekatpure AL, Jain S, Saoji K, Reddy SM. Impact of medial open-wedge high tibial osteotomy for medial compartment osteoarthritis of the knee. World J Orthop 2020; 11:606-614. [PMID: 33362996 PMCID: PMC7745488 DOI: 10.5312/wjo.v11.i12.606] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 08/31/2020] [Accepted: 10/23/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Most populations worldwide, who are used to squatting and sitting cross-legged for their activities of daily living, largely comprise the lower socioeconomic strata, thus making them candidates for exclusion for total knee arthroplasty. Proximal/high tibial osteotomy (HTO) is a preferred strategy for clinically symptomatic osteoarthritis (OA) with genu varum due to painful medial compartment OA which is not amenable to conservative measures. AIM To evaluate the outcomes of medial open-wedge HTO along with autologous bone grafting and buttress plate for the treatment of genu varum due to OA of the knee in a rural population of central India. METHODS A total of 65 knees in 56 patients with a mean age of 58.22 ± 5.63 years with genu varum due to intractable painful knee OA were treated with medial open-wedge HTO along with autologous bone grafting and buttress plate osteosynthesis from June 2015 to May 2018. The mean preoperative radiological angle of genu varum was 13.4°. Clinical outcomes were assessed by the range of movement, knee scores, pain scores, and functional scores. Radiographic studies were performed preoperatively and at regular intervals during the follow-up period. RESULTS All patients reported pain relief immediately after the osteotomy and during the long-term analysis covering between one to three years. The genu varum angle was overcorrected to approximately four degrees in all patients. There was a loss of reduction by approximately three degrees in all patients at around six weeks postoperatively. Preoperative knee movements were restored in all patients. No major perioperative complications were noted during surgery and postoperative follow-up and the clinical scores were significantly improved during the final analysis which revealed good pain relief. CONCLUSION Medial open-wedge HTO is a reliable, safe, practical, physiological, and feasible treatment for populations who are used to increased activity in their occupation and lifestyle and is associated with excellent short-term and long-term results for OA in genu varum knees.
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Affiliation(s)
- Sunil Sheshrao Nikose
- Department of Orthopedic and Trauma Surgery, Jawaharlal Nehru Medical College, Wardha 442001, Maharashtra, India
| | - Devashree Nikose
- General Doctor, NKP Salve Institute of Medical Sciences, Nagpur 440019, Maharashtra, India
| | - Aditya L Kekatpure
- Department of Orthopedic and Trauma Surgery, Jawaharlal Nehru Medical College, Wardha 442001, Maharashtra, India
| | - Shashank Jain
- Department of Orthopedic and Trauma Surgery, Jawaharlal Nehru Medical College, Wardha 442001, Maharashtra, India
| | - Kiran Saoji
- Department of Orthopedic and Trauma Surgery, Jawaharlal Nehru Medical College, Wardha 442001, Maharashtra, India
| | - Sridhar M Reddy
- Department of Orthopedic and Trauma Surgery, Jawaharlal Nehru Medical College, Wardha 442001, Maharashtra, India
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14
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Hutyra CA, Gonzalez JM, Yang JC, Johnson FR, Reed SD, Amendola A, Bolognesi MP, Berend KR, Berend ME, MacDonald SJ, Mather RC. Patient Preferences for Surgical Treatment of Knee Osteoarthritis: A Discrete-Choice Experiment Evaluating Total and Unicompartmental Knee Arthroplasty. J Bone Joint Surg Am 2020; 102:2022-2031. [PMID: 33027086 DOI: 10.2106/jbjs.20.00132] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Total knee arthroplasty (TKA) is a common treatment for end-stage knee osteoarthritis but is associated with increased complication rates compared with unicompartmental knee arthroplasty (UKA). UKA offers better functional outcomes but is associated with a higher risk of revision. The purpose of this study was to apply good-practice, stated-preference methods to quantify patient preferences for benefit-risk tradeoffs associated with arthroplasty treatments for end-stage knee osteoarthritis. METHODS A discrete-choice experiment was developed with the following attributes: chance of complications, functional ability, awareness of the knee implant, and chance of needing another operation within 10 years. Patients included those aged 40 to 80 years with knee osteoarthritis. A pivot design filtered respondents into 1 of 2 surveys on the basis of self-reported functional ability (good compared with fair or poor) as measured by the Oxford Knee Score. Treatment-preference data were collected, and relative attribute-importance weights were estimated. RESULTS Two hundred and fifty-eight completed survey instruments from 92 males and 164 females were analyzed, with 72 respondents in the good-function cohort and 186 in the fair/poor-function cohort. Patients placed the greatest value or relative importance on serious complications and rates of revision in both cohorts. Preference weights did not vary between cohorts for any attribute. In the good-function cohort, 42% of respondents chose TKA and 58% chose UKA. In the fair/poor-function cohort, 54% chose TKA and 46% chose UKA. CONCLUSIONS Patient preferences for various treatment attributes varied among patients in a knee osteoarthritis population. Complication and revision rates were the most important factors to patients, suggesting that physicians should focus on these areas when discussing treatments. The proportion of patients who chose UKA suggests that the current trend of increased UKA utilization is aligned with patient preferences. CLINICAL RELEVANCE Systematic elicitation of patient preferences for knee arthroplasty procedures, which lays out evidence-based risks and benefits of different treatments, indicates a larger subset of the knee osteoarthritis population may prefer UKA than would be suggested by the current rates of utilization of the procedure. Arthroplasty treatment should align with patient preferences and eligibility criteria to better deliver patient-centered care.
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Affiliation(s)
- Carolyn A Hutyra
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | | | - Jui-Chen Yang
- Pacific Economic Research, LLC, Bellevue, Washington
| | - F Reed Johnson
- Duke Clinical Research Institute, Durham, North Carolina
| | - Shelby D Reed
- Duke Clinical Research Institute, Durham, North Carolina
| | - Annunziato Amendola
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Michael P Bolognesi
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Keith R Berend
- Joint Implant Surgeons, Inc., New Albany, Ohio.,White Fence Surgical Suites, New Albany, Ohio.,Mount Carmel New Albany Surgical Hospital, New Albany, Ohio
| | | | - Steven J MacDonald
- Division of Orthopaedic Surgery, University Hospital, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Richard C Mather
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
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Jansen K, Beckert M, Deckard ER, Ziemba-Davis M, Meneghini RM. Satisfaction and Functional Outcomes in Unicompartmental Compared with Total Knee Arthroplasty: Radiographically Matched Cohort Analysis. JB JS Open Access 2020; 5:JBJSOA-D-20-00051. [PMID: 33299963 PMCID: PMC7722600 DOI: 10.2106/jbjs.oa.20.00051] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Unicompartmental and total knee arthroplasty (UKA and TKA) have demonstrated excellent mid- and long-term outcomes and have been compared in clinical series for decades; however, to our knowledge, no study has sufficiently matched UKA and TKA cohorts on preoperative osteoarthritis severity. The purpose of this study was to evaluate patient-reported outcomes of radiographically and demographically matched UKA and TKA cohorts.
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Affiliation(s)
- Kirsten Jansen
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Mitchell Beckert
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Evan R Deckard
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Mary Ziemba-Davis
- IU Health Hip & Knee Center, Indiana University Health Physicians, Fishers, Indiana
| | - R Michael Meneghini
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana.,IU Health Hip & Knee Center, Indiana University Health Physicians, Fishers, Indiana
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16
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Yapici F, Aykut US, Coskun M, Arslan MC, Merder-Coskun D, Kocabiyik A, Ulu E, Bayhan AI, Kaygusuz MA. Complications, Additional Surgery, and Joint Survival Analysis After Medial Open-Wedge High Tibial Osteotomy. Orthopedics 2020; 43:303-314. [PMID: 32931590 DOI: 10.3928/01477447-20200819-01] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 06/11/2019] [Indexed: 02/03/2023]
Abstract
The reported incidence of complications following medial open-wedge high tibial osteotomy (MOWHTO) varies. The authors sought to assess the complications, additional surgeries, and joint survival following MOWHTO in patients with isolated medial compartment arthrosis during a mean follow-up of 10 years. This retrospective study involved patients implanted with spacer plates, angle adjustable plates, or inverse L-type plates with wedges between 2000 and 2010. A total of 504 knees from 441 patients were examined. Mean age of the study population was 52.6±7.0 years, with 56 (11.1%) knees from men and 448 (88.9%) from women. The 10-year Kaplan-Meier joint survival rate was 94.8%. Overall complication rate for MOWHTO was 63.7%, with complications in 20.3% of treated knees requiring additional surgery. In this population, although the overall complication rate and the need for additional surgery were high, the need for additional surgery resulting from serious complications was low (2.6%). The high joint survival rate and low rate of additional surgery for serious complications indicate that MOWHTO can be safely applied in patients with isolated medial gonarthrosis. [Orthopedics. 2020;43(5):303-314.].
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17
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Lim JBT, Pang HN, Tay KJD, Chia SL, Lo NN, Yeo SJ. Clinical outcomes and patient satisfaction following revision of failed unicompartmental knee arthroplasty to total knee arthroplasty are as good as a primary total knee arthroplasty. Knee 2019; 26:847-852. [PMID: 31113700 DOI: 10.1016/j.knee.2019.04.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 04/01/2019] [Accepted: 04/18/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND With unicompartmental knee arthroplasty (UKA) being increasingly performed for medial compartment osteoarthritis (OA) of the knee, revision total knee arthroplasty (TKA) for failed UKA is expected to increase. Our primary aim is to evaluate patients in our tertiary institution who underwent revision of failed UKA to TKA to compare their pre-operative clinical scores (patient-reported outcome measures, PROMs) to those of primary TKA. METHODS Retrospective review of our institutional arthroplasty registry between 2001 and 2014 was performed. We identified 70 patients who underwent revision of UKA to TKA. The revision UKA to TKA patients was matched with 140 patients who underwent primary TKA for OA in terms of preoperative demographics, gender, age at time of surgery, body mass index (BMI), primary surgeon, and PROMs. Intra-operative data and postoperative complications or re-revision surgeries performed were reviewed. RESULTS In the revision UKA to TKA group, more stems, augments or constrained implants were used compared to primary TKA. A greater proportion of patients with metal-backed UKA revision to TKA required stems, augments or constrained implants as compared to all-polyethylene UKA revision to TKA, but not a significant proportion (P = 0.250). At two years postoperatively, there were no significant differences observed between the groups in terms of patient satisfaction and PROMs. CONCLUSIONS This study showed similar outcomes following revision of failed UKA to TKA and primary TKA. There were significant improvements in PROMs for revision UKA to TKA, which is comparable to that of primary TKA.
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Affiliation(s)
- Jason Beng Teck Lim
- Department of Orthopaedic Surgery, Singapore General Hospital, Republic of Singapore.
| | - Hee Nee Pang
- Department of Orthopaedic Surgery, Singapore General Hospital, Republic of Singapore
| | - Keng Jin Darren Tay
- Department of Orthopaedic Surgery, Singapore General Hospital, Republic of Singapore
| | - Shi-Lu Chia
- Department of Orthopaedic Surgery, Singapore General Hospital, Republic of Singapore
| | - Ngai Nung Lo
- Department of Orthopaedic Surgery, Singapore General Hospital, Republic of Singapore
| | - Seng Jin Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, Republic of Singapore
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18
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Kaplan LM, Siljander MP, Verner JJ, Baker KC, Gehrke CK, Salisbury MR, Baker EA. Analysis of Retrieved Unicompartmental Knee Implants and Tissue: Third-Body Wear as a Potential Contributor to Progression of Arthritis to Adjacent Compartments. Orthopedics 2019; 42:149-157. [PMID: 31099880 DOI: 10.3928/01477447-20190424-06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 04/03/2019] [Indexed: 02/03/2023]
Abstract
Unicompartmental knee arthroplasty (UKA) for the treatment of single-compartment osteoarthritis has been associated with polyethylene wear and progression of osteoarthritis into adjacent compartments, leading to revision. In this study, damage and clinical failure modes of retrieved UKA implants were investigated and protein expression profiles between articular cartilage adjacent to UKA and primary osteoarthritic cartilage were compared. Fifty retrieved UKA implants were analyzed for various damage. Records review and radiographic analysis were performed to collect clinical data and implant characteristics. Cartilage harvested from revision UKA and primary total knee arthroplasty surgeries was characterized with a proteome profiling array detecting levels of 36 different cytokines, chemokines, and acute phase inflammatory proteins. Progression of osteoarthritis (n=18, 36%) and component loosening (n=17, 34%) were the most common reasons for revision. Liners exhibited the highest frequency of damage modes. Progression of arthritis positively correlated with radiographic presence of extruded bone cement and burnishing of liner components. A protein-level profile between revision UKA and primary total knee arthroplasty cartilage showed 12 differentially expressed cytokines. Failure of UKA may be secondary to the effects of wear debris particulate migration into the adjacent compartment, suggesting an additional pathway of cartilage damage manifesting as traditional clinical symptoms. [Orthopedics. 2019; 42(3):149-157.].
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Law GW, Bin Abd Razak HR, Goh GSH, Wong KC, Chong HC, Lo NN, Yeo SJ. Diabetes mellitus does not negatively impact outcomes and satisfaction following unicompartmental knee arthroplasty in well-controlled disease. ASIA-PACIFIC JOURNAL OF SPORT MEDICINE ARTHROSCOPY REHABILITATION AND TECHNOLOGY 2019; 16:24-29. [PMID: 30984560 PMCID: PMC6445438 DOI: 10.1016/j.asmart.2018.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 12/13/2018] [Accepted: 12/18/2018] [Indexed: 11/29/2022]
Abstract
Background Unicompartmental knee arthroplasty (UKA) has gained popularity in recent years in view of its minimally invasive nature and proven benefits over the traditional total knee arthroplasty (TKA) in terms of superior knee range of motion and kinametics, faster recovery, lower blood loss, shorter hospital stay and ease of revision with the preservation of bone stock. With the increasing incidence of diabetes mellitus (DM) worldwide and an increased risk of deep infection, wound complications and early failure previously shown in diabetic patients undergoing TKA, it is prudent that we establish the impact of DM on the outcomes and complications of UKA given that there is little on the topic in the current literature. This is especially significant in Asia as Asia is home to more than 60% of the world's population of diabetic patients with estimates of more than 200 million people having the condition. Type 2 DM in particular, is an increasing epidemic with projections to increase by more than 150% between year 2000 and 2035. The purpose of this study is to evaluate the impact of diabetes mellitus on the outcomes and satisfaction of UKA at 2 years postoperatively. We hypothesize that diabetes mellitus does not affect the outcomes and satisfaction following UKA in Asians at 2 years postoperatively. Methods We conducted a retrospective review of prospectively collected registry data of 1075 UKAs performed in a multiethnic Asian population between 2006 and 2013 at our institution. Outcomes assessed included flexion range, Knee Society Score (KSS), Oxford Knee Score (OKS), Short-Form 36 (SF-36) and satisfaction scores. All patients with DM were identified and matched with patients without DM for age, gender and body mass index. Outcomes, satisfaction, complication and revision rates were then compared between the two groups up to 2 years postoperatively. Preoperative HbA1c was used to assess the patients’ blood glucose control in the DM group. Results A total of 104 patients (9.7%) had DM, close to the national prevalence (11.3%). At 2 years postoperatively, DM patients had better improvement in their SF-36 Mental Component Score (MCS) (p = 0.015) despite poorer preoperative scores (DM group = 70 ± 23, non-DM group = 77 ± 17, p = 0.013), and were in 1° more varus (p = 0.005) when compared to patients without DM. There was no significant difference in the proportion of patients achieving the minimal clinically important difference for knee-specific outcomes (DM:90%, non-DM:96%) or the satisfaction rates between the groups (DM:92%, non-DM:94%). Complication rates were similar (DM:5.8%, non-DM:4.8%). There were no venous thromboembolic events, deaths or revisions during the follow-up period in both groups. The mean preoperative HbA1c in our DM group was 6.6%. Conclusion In this matched-pair study of diabetic versus non-diabetic patients undergoing surgery for UKA, DM does not have a clinically significant negative impact on the outcomes and satisfaction following UKA in patients with well-controlled disease.
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Affiliation(s)
- Gin Way Law
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia Level 4, 169865, Singapore
| | | | - Graham Seow-Hng Goh
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia Level 4, 169865, Singapore
| | - Khai Cheong Wong
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia Level 4, 169865, Singapore
| | - Hwei Chi Chong
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia Level 4, 169865, Singapore
| | - Ngai Nung Lo
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia Level 4, 169865, Singapore
| | - Seng Jin Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia Level 4, 169865, Singapore
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20
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Liu CY, Li CD, Wang L, Ren S, Yu FB, Li JG, Ma JX, Ma XL. Function scores of different surgeries in the treatment of knee osteoarthritis: A PRISMA-compliant systematic review and network-meta analysis. Medicine (Baltimore) 2018; 97:e10828. [PMID: 29794771 PMCID: PMC6393067 DOI: 10.1097/md.0000000000010828] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 04/30/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Osteoarthritis (OA) is the third most common diagnosis made by general practitioners in older patients. The aim of this study was to compare the function scores of different surgeries in the treatment of knee osteoarthritis (KOA). METHODS Cohort studies about different surgical treatments for KOA were included with a comprehensive search in PubMed, Cochrane Library, and Embase. The standard mean difference (SMD) value was evaluated and the surface under the cumulative ranking (SUCRA) curve was drawn with a combination of direct and indirect evidence. A total of 265 eligible patients were enrolled and served as the nonoperative treatment group, osteotomy group, unicompartmental knee arthroplasty (UKA) group, total knee arthroplasty (TKA) group, and arthroscopic surgery group. Before surgery, 6 months after surgery, 1 year after surgery and 5 years after surgery, the hospital for special surgery (HSS) knee score, Lysholm score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, and American knee society score (KSS) were recorded. RESULTS A total of 9 cohort studies including 954 patients with KOA were finally enrolled into the study. The network-meta analysis revealed that osteotomy and UKA treatments showed a better efficacy on improving the function score. Our cohort study further confirmed that, a higher HSS knee score after 1 year and higher Lysholm score after 6 months and 1 year were observed in the osteotomy and UKA groups, while better HSS knee score and KSS after 6 months and 1 year were showed in the osteotomy and TKA groups. In the TKA group, Lysholm score and KSS were higher and WOMAC score was lower after 5 years than other groups. WOMAC score was lowest in the UKA group after 6 months, 1 year and 5 years of surgery. CONCLUSION These results provide evidence that function scores of patients with KOA were improved by osteotomy, UKA, TKA, and arthroscopic surgery. And osteotomy and UKA showed better short-term efficacy, while TKA appeared better long-term efficacy.
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Affiliation(s)
| | | | - Liang Wang
- Department of Bone Trauma, The Sixth People's Hospital of Ji’nan City, Ji’nan, PR China
| | - Shan Ren
- Department of Bone and Joint Surgery
| | - Fu-Bin Yu
- Department of Bone and Joint Surgery
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Wan FY, Yue JA, Guo WS, Ma LY, Yan R, Zhang QD, Cheng LM. Glycosaminoglycan Content of the Lateral Compartment Cartilage in Knees Conforming to the Indications for Oxford Medial Unicompartmental Knee Arthroplasty. Chin Med J (Engl) 2018; 131:194-199. [PMID: 29336368 PMCID: PMC5776850 DOI: 10.4103/0366-6999.222321] [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] [Indexed: 11/09/2022] Open
Abstract
Background: The quality of the lateral compartment cartilage is important to preoperative evaluation and prognostic prediction of unicompartmental knee arthroplasty (UKA). Delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) enables noninvasive assessment of glycosaminoglycan (GAG) content in cartilage. This study aimed to determine the GAG content of the lateral compartment cartilage in knees scheduled to undergo Oxford medial UKA. Methods: From December 2016 to May 2017, twenty patients (20 osteoarthritic knees) conforming to the indications for Oxford medial UKA were included as the osteoarthritis (OA) group, and 20 healthy volunteers (20 knees) paired by sex, knee side, age (±3 years), and body mass index (BMI) (±3 kg/m2) were included as the control group. The GAG contents of the weight-bearing femoral cartilage (wbFC), the posterior non-weight-bearing femoral cartilage (pFC), the lateral femoral cartilage (FC), and tibial cartilage (TC) were detected using dGEMRIC. The dGEMRIC indices (T1Gd) were calculated in the middle three consecutive slices of the lateral compartment. Paired t-tests were used to compare the T1Gd in each region of interest between the OA group and control group. Results: The average age and BMI in the two groups were similar. In the OA group, T1Gd of FC and TC was 386.7 ± 50.7 ms and 429.6 ± 59.9 ms, respectively. In the control group, T1Gd of FC and TC was 397.5 ± 52.3 ms and 448.6 ± 62.5 ms, respectively. The respective T1Gd of wbFC and pFC was 380.0 ± 47.8 ms and 391.0 ± 66.3 ms in the OA group and 400.3 ± 51.5 ms and 393.6 ± 57.9 ms in the control group. Although the T1Gd of wbFC and TC tended to be lower in the OA group than the control group, there was no significant difference between groups in the T1Gd in any of the analyzed cartilage regions (P value of wbFC, pFC, FC, and TC was 0.236, 0.857, 0.465, and 0.324, respectively). Conclusions: The GAG content of the lateral compartment cartilage in knees conforming to indications for Oxford medial UKA is similar with those of age- and BMI-matched participants without OA.
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Affiliation(s)
- Fu-Yin Wan
- Department of Bone and Joint Surgery, Peking University China-Japan Friendship School of Clinical Medicine, Beijing 100029, China
| | - Ju-An Yue
- Department of Bone and Joint, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Wan-Shou Guo
- Department of Bone and Joint Surgery, Peking University China-Japan Friendship School of Clinical Medicine; Department of Bone and Joint Surgery, China-Japan Friendship Hospital, Beijing 100029, China
| | - Lu-Yao Ma
- Department of Bone and Joint Surgery, Peking University China-Japan Friendship School of Clinical Medicine, Beijing 100029, China
| | - Ran Yan
- Department of Radiology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Qi-Dong Zhang
- Department of Bone and Joint Surgery, China-Japan Friendship Hospital, Beijing 100029, China
| | - Li-Ming Cheng
- Department of Bone and Joint Surgery, China-Japan Friendship Hospital, Beijing 100029, China
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Han SB, Kyung HS, Seo IW, Shin YS. Better clinical outcomes after unicompartmental knee arthroplasty when comparing with high tibial osteotomy. Medicine (Baltimore) 2017; 96:e9268. [PMID: 29390376 PMCID: PMC5815788 DOI: 10.1097/md.0000000000009268] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Both high tibial osteotomy (HTO) and unicompartmental knee arthroplasty (UKA) are well-established treatments for medial knee osteoarthritis (OA). However, it is unclear whether HTO or UKA leads to better clinical outcomes and lower complication rates. This meta-analysis compared the clinical outcomes and complications of HTO and UKA in patients with medial knee OA. METHODS All studies comparing the functional outcome, postoperative pain, revision rate to total knee arthroplasty (TKA), postoperative complications, postoperative velocity, and postoperative range of motion (ROM) as assessed with various measurement tools in patients with medial knee OA treated with HTO or UKA were included. RESULTS Sixteen studies were included in the meta-analysis. The proportion of patients who underwent revision to TKA (OR 1.56, 95% CI: 0.61-3.98; P = .35) did not differ significantly between HTO and UKA. In contrast, functional outcome (OR 0.47, 95% CI: 0.24 to 0.95; P = .04), postoperative pain (OR 0.28, 95% CI: 0.12 to 0.62; P = .002), postoperative complications (OR 2.48, 95% CI: 1.26 to 4.90; P = .009), postoperative velocity (95% CI: -0.11 to -0.00; P = .03), and postoperative ROM (95% CI: 2.02 to 15.23; P = .01) were significantly different between the 2 groups. CONCLUSIONS There were no significant differences in the revision rate to TKA between HTO and UKA. However, results from subgroup analyses suggested that opening-wedge HTO resulted in a lower revision rate to TKA than did UKA, whereas closing-wedge HTO resulted in a higher revision rate to TKA than did UKA. In addition, UKA resulted in significantly better functional outcomes and postoperative velocity, along with less postoperative pain, fewer postoperative complications, and lower postoperative ROM. Based on the findings of current meta-analysis, UKA appears to be as efficacious and safe as HTO in the treatment of medial knee OA.
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Affiliation(s)
- Seung-Beom Han
- Department of Orthopedic Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul
| | - Hee-Soo Kyung
- Department of Orthopedic Surgery, School of Medicine, Kyungpook National University, Daegu
| | - In-Wook Seo
- Department of Orthopedic Surgery, Veterans Health Service Medical Center, Seoul, Korea
| | - Young-Soo Shin
- Department of Orthopedic Surgery, Veterans Health Service Medical Center, Seoul, Korea
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Lakra A, Murtaugh T, Geller JA, Macaulay W, Shah RP. Simultaneous ipsilateral knee arthroscopy and unicondylar knee arthroplasty is effective for bicompartmental symptoms. J Orthop 2017; 14:507-511. [PMID: 28860683 DOI: 10.1016/j.jor.2017.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Accepted: 08/06/2017] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Patients with unicompartmental radiographic arthritis but bicompartmental symptoms pose a clinical challenge. Some surgeons may perceive it as a contraindication for unicondylar knee arthroplasty (UKA). We investigated patient outcomes 2 years after simultaneous ipsilateral arthroscopy and UKA as compared to a similar group of patients who had total knee replacement (TKA) for a similar clinical presentation. METHODS We identified 9 patients with simultaneous ipsilateral arthroscopy and UKA between 2004 and 2013, and 12 clinically similar patients treated with TKA. RESULTS At 1- and 2-years, SF-12 physical scores were significantly improved in the UKA-scope group than in the TKA group (47.2 vs 40.3, p = 0.042; 48.3 vs 32.6, p = 0.026). WOMAC pain score, WOMAC stiffness score, WOMAC function and KSFS were significantly improved in the UKA-scope group at 2 years as compared to the TKA group (98.7 vs 63.8, p = 0.030), (90.1 vs 43.8, p = 0.013), (92.3 vs 55.2, p = 0.027 and (92.3 vs 55.2, p = 0.027), respectively). Change in score from baseline for KSFS, SF-12 physical and WOMAC stiffness were significantly improved in the UKA-scope group at 2 years compared to TKA, (28.3 vs -5, p = 0.041), (13.6 vs 3.0, p = 0.026), (52.6 vs -6.3, p = 0.025), respectively. CONCLUSION This study shows that patients with isolated compartment radiographic disease but with bicompartmental symptoms can benefit from UKA and simultaneous arthroscopy. Further, TKA for isolated compartment radiographic disease in this limited series had poorer outcomes. We obtain MRI selectively when physical exam and radiographic findings suggest isolated arthritic disease in patients with bicompartmental symptoms.
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Affiliation(s)
- Akshay Lakra
- Center for Hip and Knee Replacement, Department of Orthopaedic Surgery, Columbia University at New York Presbyterian Hospital, 622 West 168th Street, PH 1155, New York, NY 10032, United States
| | - Taylor Murtaugh
- Center for Hip and Knee Replacement, Department of Orthopaedic Surgery, Columbia University at New York Presbyterian Hospital, 622 West 168th Street, PH 1155, New York, NY 10032, United States
| | - Jeffrey A Geller
- Center for Hip and Knee Replacement, Department of Orthopaedic Surgery, Columbia University at New York Presbyterian Hospital, 622 West 168th Street, PH 1155, New York, NY 10032, United States
| | - William Macaulay
- Center for Hip and Knee Replacement, Department of Orthopaedic Surgery, Columbia University at New York Presbyterian Hospital, 622 West 168th Street, PH 1155, New York, NY 10032, United States
| | - Roshan P Shah
- Center for Hip and Knee Replacement, Department of Orthopaedic Surgery, Columbia University at New York Presbyterian Hospital, 622 West 168th Street, PH 1155, New York, NY 10032, United States
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Postural Stability after Unicondylar Knee Arthroplasty and Patient-Specific Interpositional Knee Spacer. BIOMED RESEARCH INTERNATIONAL 2017; 2017:5836025. [PMID: 28785582 PMCID: PMC5530433 DOI: 10.1155/2017/5836025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 06/12/2017] [Indexed: 11/28/2022]
Abstract
Purpose and Hypothesis. Knee osteoarthritis results, inter alia, in decreased postural stability. After arthroplasty, postural stability recovers, but it is unclear whether this can be ascribed to a reduction of pain or to the preserving of receptor-rich intraarticular soft tissue and natural knee kinematics. The objective of this study was to evaluate whether an unicondylar knee arthroplasty provides better results regarding postural stability or a patient-specific knee spacer. Methods. In this comparative study, we assessed functional results and postural stability 16 months after 20 unicondylar knee arthroplasties (group A) and 20 patient-specific interpositional knee device implantations (group B). Patients were evaluated using the KSS and WOMAC score. Postural stability was analysed during single leg stance on a force platform (Biodex Balance System). Results. Concerning postural stability, range of motion (ROM), and KSS 16 months after the procedure, there were no significant differences between both groups. Conclusion. Successful treatment of knee osteoarthritis restores postural stability to the level of the contralateral side, regardless of the implant device.
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25
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Smith WB, Steinberg J, Scholtes S, Mcnamara IR. Medial compartment knee osteoarthritis: age-stratified cost-effectiveness of total knee arthroplasty, unicompartmental knee arthroplasty, and high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2017; 25:924-933. [PMID: 26520646 DOI: 10.1007/s00167-015-3821-3] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 09/25/2015] [Indexed: 12/01/2022]
Abstract
PURPOSE To compare the age-based cost-effectiveness of total knee arthroplasty (TKA), unicompartmental knee arthroplasty (UKA), and high tibial osteotomy (HTO) for the treatment of medial compartment knee osteoarthritis (MCOA). METHODS A Markov model was used to simulate theoretical cohorts of patients 40, 50, 60, and 70 years of age undergoing primary TKA, UKA, or HTO. Costs and outcomes associated with initial and subsequent interventions were estimated by following these virtual cohorts over a 10-year period. Revision and mortality rates, costs, and functional outcome data were estimated from a systematic review of the literature. Probabilistic analysis was conducted to accommodate these parameters' inherent uncertainty, and both discrete and probabilistic sensitivity analyses were utilized to assess the robustness of the model's outputs to changes in key variables. RESULTS HTO was most likely to be cost-effective in cohorts under 60, and UKA most likely in those 60 and over. Probabilistic results did not indicate one intervention to be significantly more cost-effective than another. The model was exquisitely sensitive to changes in utility (functional outcome), somewhat sensitive to changes in cost, and least sensitive to changes in 10-year revision risk. CONCLUSIONS HTO may be the most cost-effective option when treating MCOA in younger patients, while UKA may be preferred in older patients. Functional utility is the primary driver of the cost-effectiveness of these interventions. For the clinician, this study supports HTO as a competitive treatment option in young patient populations. It also validates each one of the three interventions considered as potentially optimal, depending heavily on patient preferences and functional utility derived over time.
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Affiliation(s)
| | | | | | - Iain R Mcnamara
- Norfolk and Norwich University Hospital NHS Foundation Trust, University of East Anglia, Colney Lane, Norwich, NR4 2UY, UK.
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26
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Krych AJ, Reardon P, Sousa P, Pareek A, Stuart M, Pagnano M. Unicompartmental Knee Arthroplasty Provides Higher Activity and Durability Than Valgus-Producing Proximal Tibial Osteotomy at 5 to 7 Years. J Bone Joint Surg Am 2017; 99:113-122. [PMID: 28099301 DOI: 10.2106/jbjs.15.01031] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The cases of patients with medial compartment osteoarthritis who were ≤55 years old and had a proximal tibial osteotomy (PTO) or medial unicompartmental knee arthroplasty (UKA) were compared. Outcomes included postoperative activity level, function, and survivorship free of revision to total knee arthroplasty. METHODS Between 1998 and 2013, data were available for 240 patients between 18 and 55 years old with medial compartment arthritis and varus malalignment who were treated either with PTO (57 patients) or with UKA (183 patients). The mean age was 42.7 years for the 57 patients (41 men and 16 women) in the PTO group versus 49.2 years for the 183 patients (82 men and 101 women) in the UKA group. The Tegner activity level and Lysholm knee scores were evaluated at 3 months and at 1, 2, and 5 years postoperatively as well as at the time of the final follow-up. The end point for survival was defined as revision to total knee arthroplasty. A Wilcoxon rank-sum test was used to evaluate the difference between the groups with respect to the Tegner and Lysholm scores at the respective follow-up intervals. Multivariate regression was used to assess potential confounders. RESULTS Preoperatively, the PTO and UKA groups had similar Tegner (3.0 ± 1.3 and 2.6 ± 0.09, respectively) and Lysholm scores (69.5 ± 7.3 and 71.6 ± 5.4). Postoperatively, the UKA group had significantly superior mean Tegner scores compared with the PTO group at 3 months (3.82 and 2.02, respectively), at 2 years (4.33 and 3.75), and at the time of the final follow-up (4.48 and 3.08), while the Lysholm scores were higher at 3 months (88.0 and 76.3) and at the final follow-up (90.0 and 80.2) (p < 0.01 for all). Multivariate analysis showed UKA to be an independent predictor of activity level at 3 months, 1 year, and 2 years, as well as at the final follow-up. The survivorship was 77% in the PTO group at an average of 7.2 years and 94% in the UKA group at an average of 5.8 years (p < 0.01). The average time to failure was 98 months (range, 38 to 169 months) in the PTO group and 42 months (range, 2 to 123 months) in the UKA group (p < 0.01). CONCLUSIONS In this comparative cohort study of young patients with isolated unicompartmental arthritis, those treated with UKA reached a higher level of activity early after surgery and it persisted at mid-term follow-up. The UKA group had earlier, but less frequent, revision to total knee arthroplasty. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Aaron J Krych
- 1Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota
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Denisov LN, Tsvetkova ES, Golubev GS, Bugrova OV, Dydykina IS, Dubikov AI, Menshikova LV, Peshekhonova LK, Rebrov AP, Torgashin AN, Trofimov EA, Yakupova SP, Zonova EV, Brewer O, Cooper C, Reginster J, Knyazeva LA. THE EUROPEAN SOCIETY FOR CLINICAL AND ECONOMIC ASPECTS OF OSTEOPOROSIS AND OSTEOARTHRITIS (ESCEO) ALGORITHM FOR THE MANAGEMENT OF KNEE OSTEOARTHRITIS IS APPLICABLE TO RUSSIAN CLINICAL PRACTICE: A CONSENSUS STATEMENT OF LEADING RUSSIAN AND ESCEO OSTEOARTHRITIS EXPERTS. ACTA ACUST UNITED AC 2017. [DOI: 10.14412/1995-4484-2016-641-653] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) treatment algorithm for the management of knee osteoarthritis (OA), published in December 2014, provides practical guidance for the prioritization of interventions. This current paper represents an assessment and endorsement of the algorithm by Russian experts in OA for use in Russian clinical practice, with the aim of providing easy-to-follow advice on how to establish a treatment flow in patients with knee OA, in support of the clinicians’ individualized assessment of the patient. Medications recommended by the ESCEO algorithm are available in Russia. In step 1, background maintenance therapy with symptomatic slow-acting drugs for osteoarthritis (SYSADOA) is advised, for which high-quality evidence is provided only for the formulations of patented crystalline glucosamine sulphate (pCGS) (Rottapharm/Meda) and prescription chondroitin sulfate. Paracetamol may be added for rescue analgesia only, due to limited efficacy and increasing safety signals. Topical non-steroidal anti-inflammatory drugs (NSAIDs) may provide additional symptomatic treatment with the same degree of efficacy as oral NSAIDs but without the systemic safety concerns. To be effective, topical NSAIDs must have high bioavailability, and among NSAIDs molecules like etofenamate have high absorption and bioavailability alongside evidence for accumulation in synovial tissues. Oral NSAIDs maintain a central role in step 2 advanced management of persistent symptoms. However, oral NSAIDs are highly heterogeneous in terms of gastrointestinal and cardiovascular safety profile, and patient stratification with careful treatment selection is advocated to maximize the risk: benefit ratio. Intra-articular hyaluronic acid as a next step provides sustained clinical benefit with effects lasting up to 6 months after a short-course of weekly injections. As a last step before surgery, the slow titration of sustained-release tramadol, a weak opioid, affords sustained analgesia with improved tolerability.
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Affiliation(s)
| | | | - G. Sh. Golubev
- Rostov State Medical University, Ministry of Health of Russia
| | - O. V. Bugrova
- Orenburg State Medical University, Ministry of Health of Russia
| | | | - A. I. Dubikov
- Pacific State Medical University, Ministry of Health of Russia
| | | | | | - A. P. Rebrov
- V.I. Razumovsky Saratov State Medical University, Ministry of Health of Russia
| | - A. N. Torgashin
- N.N. Priorov Central Research Institute of Traumatology and Orthopedics, Ministry of Health of Russia
| | - E. A. Trofimov
- I.I. Mechnikov North-Western State Medical University, Ministry of Health of Russia
| | - S. P. Yakupova
- Kazan State Medical University, Ministry of Health of Russia
| | - E. V. Zonova
- Railway Clinical Hospital at the Novosibirsk-Main Station, OAO «RZhD»
| | - O. Brewer
- Epidemiology, and Health Economics, Centre Hospitalier Universitaire in Sart-Tilman, Universite de Liege
| | - C. Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton
| | - J. Reginster
- NIHR Musculoskeletal Biomedical Research Unit, University of Oxford
| | - L. A. Knyazeva
- Kursk State Medical University, Ministry of Health of Russia
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Khamaisy S, Zuiderbaan HA, van der List JP, Nam D, Pearle AD. Medial unicompartmental knee arthroplasty improves congruence and restores joint space width of the lateral compartment. Knee 2016; 23:501-5. [PMID: 26994481 DOI: 10.1016/j.knee.2016.02.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 02/21/2016] [Accepted: 02/22/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Osteoarthritic progression of the lateral compartment remains a leading indication for medial unicompartmental knee arthroplasty (UKA) revision. Therefore, the purpose of this study was to evaluate the alterations of the lateral compartment congruence and joint space width (JSW) following medial UKA. METHODS Retrospectively, lateral compartment congruence and JSW were evaluated in 174 knees (74 females, 85 males, mean age 65.5years; SD±10.1) preoperatively and six weeks postoperatively, and compared to 41 healthy knees (26 men, 15 women, mean age 33.7years; SD±6.4). Congruence (CI) was calculated using validated software that evaluates the geometric relationship between surfaces and calculates a congruence index (CI). JSW was measured on three sides (inner, middle, outer) by subdividing the lateral compartment into four quarters. RESULTS The CI of the control group was 0.98 (SD±0.01). The preoperative CI was 0.88 (SD±0.01), which improved significantly to 0.93 (SD±0.03) postoperatively (p<0.001). In 82% of knees, CI improved after surgery, while in 18% it decreased. The preoperative significant JSW differences of the inner (p<0.001) and outer JSW (p<0.001) were absent postoperatively. CONCLUSION Our data suggests that a well-conducted medial UKA not only resurfaces the medial compartment but also improves congruence and restores the JSW of the lateral compartment.
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Affiliation(s)
- Saker Khamaisy
- Sports Medicine and Shoulder Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY, United States.
| | - Hendrik A Zuiderbaan
- Sports Medicine and Shoulder Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY, United States.
| | - Jelle P van der List
- Sports Medicine and Shoulder Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY, United States.
| | - Denis Nam
- Adult Reconstruction and Joint Replacement Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY, United States.
| | - Andrew D Pearle
- Sports Medicine and Shoulder Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY, United States.
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Iacono F, Raspugli GF, Akkawi I, Bruni D, Filardo G, Budeyri A, Bragonzoni L, Presti ML, Bonanzinga T, Marcacci M. Unicompartmental knee arthroplasty in patients over 75 years: a definitive solution? Arch Orthop Trauma Surg 2016; 136:117-123. [PMID: 26350386 DOI: 10.1007/s00402-015-2323-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Indexed: 12/28/2022]
Abstract
INTRODUCTION The purpose of this study was to perform a mid-long-term clinical and radiographic evaluation of the results obtained in patients older than 75 years treated with minimally invasive unicompartmental knee arthroplasty (UKA). The hypothesis was that UKA is a viable solution for the definitive treatment of localized disease in this age group, with good results and a low failure rate. METHODS An all-poly tibial component UKA was applied with a minimally invasive technique. Sixty-seven knees in patients with a minimum age of 75 years were evaluated at mean 9 years' follow-up. The Oxford knee score, Knee Society Score, WOMAC score, Visual Analogue Scale (VAS) for pain self-assessment and range of motion (ROM) were determined, as well as weight-bearing antero-posterior and laterolateral radiographs. RESULTS All clinical scores, as well as VAS and ROM, improved significantly at 9-year follow-up, and the outcome was considered good or excellent in 92.6% of the patients. Radiographic results showed that both tibial plateau angle and posterior tibial slope angles were maintained, whereas femoro-tibial angle was significantly changed at follow-up. Further analysis showed no significant correlation between clinical scores and body mass index, whereas the clinical outcome was correlated with the ROM obtained. Only two failures and one major post-operative complication were observed. CONCLUSIONS UKA is a viable option for treating unicompartmental knee osteoarthritis. With the proper indications and an accurate technique UKA may be indicated also in very elderly patients with reduced complications and morbidity, and excellent survivorship.
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Affiliation(s)
- Francesco Iacono
- 2 nd Orthopaedics and Traumatologic Clinic, Rizzoli Orthopaedic Institute, Via Pupilli 1, 40136, Bologna, Italy.
| | - Giovanni Francesco Raspugli
- 2 nd Orthopaedics and Traumatologic Clinic, Rizzoli Orthopaedic Institute, Via Pupilli 1, 40136, Bologna, Italy.
| | - Ibrahim Akkawi
- 2 nd Orthopaedics and Traumatologic Clinic, Rizzoli Orthopaedic Institute, Via Pupilli 1, 40136, Bologna, Italy.
| | - Danilo Bruni
- 2 nd Orthopaedics and Traumatologic Clinic, Rizzoli Orthopaedic Institute, Via Pupilli 1, 40136, Bologna, Italy.
| | - Giuseppe Filardo
- 2 nd Orthopaedics and Traumatologic Clinic, Rizzoli Orthopaedic Institute, Via Pupilli 1, 40136, Bologna, Italy.
| | - Aydin Budeyri
- Orthopaedics and Traumatology Department, SANKO University-Private Sani Konukoglu Hospital, Gaziantep, Turkey.
| | - Laura Bragonzoni
- Dipartimento di Scienze Biomediche e Neuromotorie-DIBINEM, Univeristà di Bologna, Bologna, Italy.
| | - Mirco Lo Presti
- 2 nd Orthopaedics and Traumatologic Clinic, Rizzoli Orthopaedic Institute, Via Pupilli 1, 40136, Bologna, Italy.
| | - Tommaso Bonanzinga
- 2 nd Orthopaedics and Traumatologic Clinic, Rizzoli Orthopaedic Institute, Via Pupilli 1, 40136, Bologna, Italy.
| | - Maurilio Marcacci
- 2 nd Orthopaedics and Traumatologic Clinic, Rizzoli Orthopaedic Institute, Via Pupilli 1, 40136, Bologna, Italy.
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Walker PS, Arno S, Borukhoy I, Bell CP. Characterising knee motion and laxity in a testing machine for application to total knee evaluation. J Biomech 2015; 48:3551-8. [DOI: 10.1016/j.jbiomech.2015.06.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 06/15/2015] [Accepted: 06/17/2015] [Indexed: 11/28/2022]
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Longo UG, Loppini M, Trovato U, Rizzello G, Maffulli N, Denaro V. No difference between unicompartmental versus total knee arthroplasty for the management of medial osteoarthtritis of the knee in the same patient: a systematic review and pooling data analysis. Br Med Bull 2015; 114:65-73. [PMID: 25743408 DOI: 10.1093/bmb/ldv009] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/31/2015] [Indexed: 01/09/2023]
Abstract
INTRODUCTION One-third of patients with knee osteoarthritis (OA) has involvement of only one compartment, especially the medial one. SOURCES OF DATA We performed a comprehensive search of studies comparing unicompartmental knee arthoplasty (UKA) and total knee arthroplasty (TKA) in the same patient on PubMed, OVID/Medline, Cochrane, CINAHL, Google scholar and Embase databases. AREAS OF AGREEMENT UKA is indicated in knee with medial OA, no flexion deformity, no joint instability and no varus deformity. AREAS OF CONTROVERSY Although high tibial osteotomy, UKA and TKA have been proposed to address medial OA of the knee, the best management is still controversial. GROWING POINTS Studies investigating surgical management of medial OA of the knee are increasingly frequent. AREAS TIMELY FOR DEVELOPING RESEARCH Large, multicentre, powered, randomized trials comparing UKA and TKA are needed to identify the best management for medial OA of the knee. Moreover, new score systems for satisfaction of the patient should be formulated.
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Affiliation(s)
- Umile Giuseppe Longo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, Trigoria, Rome 00128, Italy
| | - Mattia Loppini
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, Trigoria, Rome 00128, Italy
| | - Ugo Trovato
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, Trigoria, Rome 00128, Italy
| | - Giacomo Rizzello
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, Trigoria, Rome 00128, Italy
| | - Nicola Maffulli
- Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London E1 4DG, UK Department of Musculoskeletal Disorders, University of Salerno School of Medicine and Surgery, Via Salvador Allende, Baronissi, Salerno 84081, Salerno, Italy
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, Trigoria, Rome 00128, Italy
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Ghomrawi HM, Eggman AA, Pearle AD. Effect of age on cost-effectiveness of unicompartmental knee arthroplasty compared with total knee arthroplasty in the U.S. J Bone Joint Surg Am 2015; 97:396-402. [PMID: 25740030 PMCID: PMC4344593 DOI: 10.2106/jbjs.n.00169] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Trade-offs between upfront benefits and later risk of revision of unicompartmental knee arthroplasty compared with those of total knee arthroplasty are poorly understood. The purpose of our study was to compare the cost-effectiveness of unicompartmental knee arthroplasty with that of total knee arthroplasty across the age spectrum of patients undergoing knee replacement. METHODS Using a Markov decision analytic model, we compared unicompartmental knee arthroplasty with total knee arthroplasty with regard to lifetime costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs) from a societal perspective for patients undergoing surgery at forty-five, fifty-five, sixty-five, seventy-five, or eighty-five years of age. Transition probabilities were estimated from the literature; survival, from the Swedish Knee Arthroplasty Register; and costs, from the literature and the Healthcare Cost and Utilization Project (HCUP) database. Costs and QALYs were discounted at 3.0% annually. We conducted sensitivity analyses to test the robustness of model estimates and threshold analyses. RESULTS For patients sixty-five years of age and older, unicompartmental knee arthroplasty dominated total knee arthroplasty, with lower lifetime costs and higher QALYs. Unicompartmental knee arthroplasty was no longer cost-effective at a $100,000/QALY threshold when total knee arthroplasty rehabilitation costs were reduced by two-thirds or more for these older patients. Lifetime societal savings from utilizing unicompartmental knee arthroplasty in all older patients (sixty-five or older) in 2015 and 2020 were $56 to $336 million and $84 to $544 million, respectively. In the forty-five and fifty-five-year-old age cohorts, total knee arthroplasty had an ICER of $30,300/QALY and $63,000/QALY, respectively. Unicompartmental knee arthroplasty became cost-effective when its twenty-year revision rate dropped from 27.8% to 25.7% for the forty-five-year age group and from 27.9% to 26.7% for the fifty-five-year age group. CONCLUSIONS Unicompartmental knee arthroplasty is an economically attractive alternative in patients sixty-five years of age or older, and modest improvements in implant survivorship could make it a cost-effective alternative in younger patients.
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Affiliation(s)
- Hassan M. Ghomrawi
- Division of Comparative Effectiveness and Outcomes Research, Department of Healthcare Policy and Research, Weill Cornell Medical College, 425 East 61st Street, Suite 301, New York, NY 10065. E-mail address for H.M. Ghomrawi: . E-mail address for A.A. Eggman:
| | - Ashley A. Eggman
- Division of Comparative Effectiveness and Outcomes Research, Department of Healthcare Policy and Research, Weill Cornell Medical College, 425 East 61st Street, Suite 301, New York, NY 10065. E-mail address for H.M. Ghomrawi: . E-mail address for A.A. Eggman:
| | - Andrew D. Pearle
- Hospital for Special Surgery, 523 East 72nd Street, 7th Floor, New York, NY 10021. E-mail address:
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Barbadoro P, Ensini A, Leardini A, d'Amato M, Feliciangeli A, Timoncini A, Amadei F, Belvedere C, Giannini S. Tibial component alignment and risk of loosening in unicompartmental knee arthroplasty: a radiographic and radiostereometric study. Knee Surg Sports Traumatol Arthrosc 2014; 22:3157-62. [PMID: 24972998 DOI: 10.1007/s00167-014-3147-6] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 06/18/2014] [Indexed: 11/25/2022]
Abstract
PURPOSE Unicompartmental knee arthroplasty (UKA) has shown a higher rate of revision compared with total knee arthroplasty. The success of UKA depends on prosthesis component alignment, fixation and soft tissue integrity. The tibial cut is the crucial surgical step. The hypothesis of the present study is that tibial component malalignment is correlated with its risk of loosening in UKA. METHODS This study was performed in twenty-three patients undergoing primary cemented unicompartmental knee arthroplasties. Translations and rotations of the tibial component and the maximum total point motion (MTPM) were measured using radiostereometric analysis at 3, 6, 12 and 24 months. Standard radiological evaluations were also performed immediately before and after surgery. Varus/valgus and posterior slope of the tibial component and tibial-femoral axes were correlated with radiostereometric micro-motion. A survival analysis was also performed at an average of 5.9 years by contacting patients by phone. RESULTS Varus alignment of the tibial component was significantly correlated with MTPM, anterior tibial sinking, varus rotation and anterior and medial translations from radiostereometry. The posterior slope of the tibial component was correlated with external rotation. The survival rate at an average of 5.9 years was 89%. The two patients who underwent revision presented a tibial component varus angle of 10° for both. CONCLUSIONS There is correlation between varus orientation of the tibial component and MTPM from radiostereometry in unicompartmental knee arthroplasties. Particularly, a misalignment in varus larger than 5° could lead to risk of loosening the tibial component. LEVEL OF EVIDENCE Prognostic studies-retrospective study, Level II.
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Affiliation(s)
- P Barbadoro
- 1st Ortopaedic-Traumatologic Clinic, Istituto Ortopedico Rizzoli, University of Bologna, Via Pupilli 1, 40136, Bologna, Bo, Italy,
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Erfahrungen mit medialen monokondylären Prothesen mit mobilem Plateau. DER ORTHOPADE 2014; 43:905-12. [DOI: 10.1007/s00132-014-3010-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Bruyère O, Cooper C, Pelletier JP, Branco J, Luisa Brandi M, Guillemin F, Hochberg MC, Kanis JA, Kvien TK, Martel-Pelletier J, Rizzoli R, Silverman S, Reginster JY. An algorithm recommendation for the management of knee osteoarthritis in Europe and internationally: a report from a task force of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO). Semin Arthritis Rheum 2014; 44:253-63. [PMID: 24953861 DOI: 10.1016/j.semarthrit.2014.05.014] [Citation(s) in RCA: 309] [Impact Index Per Article: 28.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 04/24/2014] [Accepted: 05/09/2014] [Indexed: 01/11/2023]
Abstract
OBJECTIVES Existing practice guidelines for osteoarthritis (OA) analyze the evidence behind each proposed treatment but do not prioritize the interventions in a given sequence. The objective was to develop a treatment algorithm recommendation that is easier to interpret for the prescribing physician based on the available evidence and that is applicable in Europe and internationally. The knee was used as the model OA joint. METHODS ESCEO assembled a task force of 13 international experts (rheumatologists, clinical epidemiologists, and clinical scientists). Existing guidelines were reviewed; all interventions listed and recent evidence were retrieved using established databases. A first schematic flow chart with treatment prioritization was discussed in a 1-day meeting and shaped to the treatment algorithm. Fine-tuning occurred by electronic communication and three consultation rounds until consensus. RESULTS Basic principles consist of the need for a combined pharmacological and non-pharmacological treatment with a core set of initial measures, including information access/education, weight loss if overweight, and an appropriate exercise program. Four multimodal steps are then established. Step 1 consists of background therapy, either non-pharmacological (referral to a physical therapist for re-alignment treatment if needed and sequential introduction of further physical interventions initially and at any time thereafter) or pharmacological. The latter consists of chronic Symptomatic Slow-Acting Drugs for OA (e.g., prescription glucosamine sulfate and/or chondroitin sulfate) with paracetamol at-need; topical NSAIDs are added in the still symptomatic patient. Step 2 consists of the advanced pharmacological management in the persistent symptomatic patient and is centered on the use of oral COX-2 selective or non-selective NSAIDs, chosen based on concomitant risk factors, with intra-articular corticosteroids or hyaluronate for further symptom relief if insufficient. In Step 3, the last pharmacological attempts before surgery are represented by weak opioids and other central analgesics. Finally, Step 4 consists of end-stage disease management and surgery, with classical opioids as a difficult-to-manage alternative when surgery is contraindicated. CONCLUSIONS The proposed treatment algorithm may represent a new framework for the development of future guidelines for the management of OA, more easily accessible to physicians.
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Affiliation(s)
- Olivier Bruyère
- Support Unit in Epidemiology and Biostatistics, Department of Public Health, Epidemiology and Health Economics, University of Liège, CHU Sart Tilman, 4000 Liège, Belgium.
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK; NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK
| | - Jean-Pierre Pelletier
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Montreal, Quebec, Canada
| | - Jaime Branco
- CEDOC, Department of Rheumatology, Faculdade de Ciências Médicas, Universidade Nova de Lisboa/CHLO, EPE-Hospital Egas Moniz, Lisbon, Portugal
| | - Maria Luisa Brandi
- Department of Internal Medicine, University of Florence, Florence, Italy
| | | | - Marc C Hochberg
- Division of Rheumatology & Clinical Immunology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD; Geriatric Research, Education and Clinical Center, Baltimore, MD; Health Care System, Baltimore, MD
| | - John A Kanis
- WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
| | - Tore K Kvien
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Johanne Martel-Pelletier
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Montreal, Quebec, Canada
| | - René Rizzoli
- Service of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Stuart Silverman
- Cedars-Sinai Medical Center, Los Angeles, CA; OMC Clinical Research Center, Beverly Hills, CA
| | - Jean-Yves Reginster
- Support Unit in Epidemiology and Biostatistics, Department of Public Health, Epidemiology and Health Economics, University of Liège, CHU Sart Tilman, 4000 Liège, Belgium
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Bell SW, Stoddard J, Bennett C, London NJ. Accuracy and early outcomes in medial unicompartmental knee arthroplasty performed using patient specific instrumentation. Knee 2014; 21 Suppl 1:S33-6. [PMID: 25382366 DOI: 10.1016/s0968-0160(14)50007-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 08/15/2014] [Accepted: 08/20/2014] [Indexed: 02/02/2023]
Abstract
Unicompartmental knee arthroplasty (UKA) is a technically demanding procedure and poor implant positioning has been identified as a factor in early failure. The aim of this study was to evaluate the accuracy and clinical outcomes of the patient specific instrumentation implementation technique with a fixed bearing UKA. We carried out a prospective study of 41 patients (44 procedures) between December 2011 and April 2013. The preoperative planned sizes of implants used were accurate to within one implant size change in 96% of cases. The mean post-operative limb alignment was 3.8° varus. The Oxford Knee Scores (OKS) (0-48) improved from a mean preoperative score of 23.8 to 35.6 at six weeks and 44.5 at one year. The mean improvement in OKS from preoperative to one year was 20.7. The mean one year FJS (0-100) was 80.6. At a mean follow-up of 24 months there were no complications identified and there was a 100% survivorship. This technique may offer a particular advantage to surgeons who perform lower volumes of UKA with the potential to improve both clinical outcomes and implant survivorship in UKA to achieve greater consistency of results.
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Affiliation(s)
- Stuart W Bell
- Harrogate District Hospital, Lancaster Park Road, Harrogate, North Yorkshire, HG2 7SX, UK.
| | - James Stoddard
- Harrogate District Hospital, Lancaster Park Road, Harrogate, North Yorkshire, HG2 7SX, UK
| | - Caroline Bennett
- Harrogate District Hospital, Lancaster Park Road, Harrogate, North Yorkshire, HG2 7SX, UK
| | - Nicholas J London
- Harrogate District Hospital, Lancaster Park Road, Harrogate, North Yorkshire, HG2 7SX, UK
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Servien E, Merini A, Lustig S, Neyret P. Lateral uni-compartmental knee replacement: current concepts and future directions. Knee Surg Sports Traumatol Arthrosc 2013; 21:2501-8. [PMID: 23832173 DOI: 10.1007/s00167-013-2585-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Accepted: 06/24/2013] [Indexed: 11/26/2022]
Abstract
Uni-compartmental knee replacement (UKR) is an attractive surgical option for the treatment of single compartment femoro-tibial osteoarthritis. While UKR for medial compartment arthritis is a well-established procedure with an excellent track record, UKR for lateral compartment arthritis has seen more limited success and remains a challenging operation, even in the hands of experienced arthroplasty surgeons. Despite this, several studies have now reported satisfactory mid- and long-term results with lateral UKR in appropriately selected patients. A better understanding of the aetiology and biomechanics of lateral compartment arthritis, as well as an appreciation for the technical challenges unique to lateral UKR, are likely to lead to improved outcomes with this procedure. The purpose of this level 4 study is to highlight the current concepts surrounding lateral UKR, to review the current body of literature, and to explore future directions for improving the results of lateral UKR.
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Affiliation(s)
- E Servien
- Department of Orthopaedic Surgery, Hopital de la Croix-Rousse, Centre Albert Trillat, Lyon University, 103 Grande rue de la Croix-Rousse, 69004, Lyon, France,
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Becker R, Mauer C, Stärke C, Brosz M, Zantop T, Lohmann CH, Schulze M. Anteroposterior and rotational stability in fixed and mobile bearing unicondylar knee arthroplasty: a cadaveric study using the robotic force sensor system. Knee Surg Sports Traumatol Arthrosc 2013; 21:2427-32. [PMID: 22868351 DOI: 10.1007/s00167-012-2157-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2012] [Accepted: 07/25/2012] [Indexed: 12/22/2022]
Abstract
PURPOSE Different bearing designs in unicondylar knee arthroplasty (UKA) have been developed in order to influence the rate of polyethylene wear. Increased anteroposterior translation and rotation after UKA has been hypothesized due to changes in joint surface geometry. The mobile bearing design was expected to show increased anteroposterior translation compared to the fixed bearing and biconcave bearing design. METHODS Six human cadaver knees were used for the tests. Anteroposterior and rotational knee stability was analysed in 0°, 30°, 60°, 90° and 120° of knee flexion using a robotic testing system (KR 125, KUKA Robots Augsburg, Germany). Three forces and moments were measured in a Cartesian coordinate system with a resolution of 1.0 N and 0.1 Nm. RESULTS There was no difference between the native knees and the knees after UKA in AP translation and rotation in all knee flexion angles. The factor knee flexion angle had a significant impact on the anterior translation when the type of bearing was neglected (p ≤ 0.015). CONCLUSION This study shows that the natural knee stability in AP translation and rotation can be preserved in UKA. The preserved knee stability in different planes after UKA underlines the advantage of UKA when surgery is required in osteoarthritic changes of the medial compartment.
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Affiliation(s)
- Roland Becker
- Department of Orthopaedic and Trauma Surgery, City Hospital Brandenburg, Hochstrasse 26, 14770, Brandenburg, Havel, Germany,
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Ensini A, Barbadoro P, Leardini A, Catani F, Giannini S. Early migration of the cemented tibial component of unicompartmental knee arthroplasty: a radiostereometry study. Knee Surg Sports Traumatol Arthrosc 2013; 21:2474-9. [PMID: 22660971 DOI: 10.1007/s00167-012-2068-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2011] [Accepted: 05/14/2012] [Indexed: 11/26/2022]
Abstract
PURPOSE Unicompartmental knee arthroplasty has good clinical results but high revision rates. A unicompartmental knee arthroplasty design features an all-polyethylene and conforming tibial component, and we hypothesized that this may put at risk its fixation. Implant-to-bone micromotion was measured together with relevant clinical outcomes. METHODS The migration of the tibial component in twenty patients was measured at 3, 6, 12 and 24 months, using standard radiostereometry, along with the relevant clinical outcomes using the IKS scoring system. RESULTS The eighteen arthroplasties at 24 months were found successful, with very good functional (mean 87.7; SD 15.4) and knee scores (mean 94.8; SD 10.1). The means and the standard deviations of the maximum total point motion (MTPM) for the four follow-ups were, respectively, as small as 0.4 ± 0.1 mm, 0.6 ± 0.2 mm, 0.6 ± 0.3 mm and 0.7 ± 0.3 mm, an average over all patients but one. In this knee, these were 1.6, 2.1, 2.4 and 2.2 mm, therefore not at high risk of aseptic loosening according to the literature. Only one knee was found at this risk, having the MTPM from 12 to 24 months of 0.5 mm, and the component moving and sinking medially, and rising laterally. CONCLUSION At 2-year follow-up, a successful implant-to-bone fixation can be achieved in conforming all-polyethylene cemented tibial component together with excellent clinical outcomes.
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Affiliation(s)
- Andrea Ensini
- Department of Orthopaedic Surgery, Centro di Ricerca Codivilla-Putti, Istituto Ortopedico Rizzoli, University of Bologna, Via Di Barbiano 1/10, 40136, Bologna, Italy
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Hall MJ, Connell DA, Morris HG. Medium to long-term results of the UNIX uncemented unicompartmental knee replacement. Knee 2013; 20:328-31. [PMID: 23062658 DOI: 10.1016/j.knee.2012.09.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Revised: 09/11/2012] [Accepted: 09/14/2012] [Indexed: 02/02/2023]
Abstract
INTRODUCTION We report the first non-designer study of the Unix uncemented unicompartmental knee prosthesis. MATERIALS AND METHODS Eighty-five consecutive UKRs were carried out with sixty-five available for follow-up. Oxford Knee Scores, WOMAC questionnaire and radiological assessment were completed. RESULTS The mean Oxford Knee Score was thirty-eight and WOMAC Score was twenty. Overall Kaplan Meier survival estimate is 76% (95% confidence interval 60%-97%) at 12years and 88% (95% confidence interval 76-100%) with aseptic loosening as the endpoint. Radiographic assessment showed lysis in the tibia in 6% of patients with no lysis evident around the central fin. DISCUSSION Survivorship is comparable to other published series of UKRs. We suggest the central fin design is key to dissipating large forces throughout the proximal tibia, resulting in low levels of tibial loosening. Level of evidence IV.
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Affiliation(s)
- Matthew J Hall
- Dept. of Orthopaedics, Derriford Hospital, Derriford Road, Plymouth, Devon, PL 8 6DH, UK.
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Lateral unicompartmental knee replacements: early results from a District General Hospital. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2013; 24:987-91. [PMID: 23842661 DOI: 10.1007/s00590-013-1277-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 07/02/2013] [Indexed: 10/26/2022]
Abstract
Lateral unicompartment knee replacements are performed infrequently in the United Kingdom. This study evaluates the experience of two knee surgeons in a District General Hospital for all lateral unicompartmental arthroplasties performed between October 2007 and August 2011. Two different implants were used in this time period, the Oxford domed and the Zimmer fixed-bearing system. Twenty-seven procedures were completed in this time span (15 Oxford domed and 12 Zimmer fixed bearing), all of which once completed were followed up and 21 patients completed an Oxford knee score. Average Oxford knee scores were 36.6 (95 % CI 29.0-44.2) for the Oxford domed prosthesis and 28.6 (19.8-37.5) for the Zimmer fixed-bearing prosthesis (p = 0.15). One patient with an Oxford domed prosthesis required revision for bearing dislocation. The follow-up Oxford knee scores support the use of this technique as an alternative to total knee replacement but with no significant difference in functional outcome. Our results, however, may encourage a more cautious approach to the use of a mobile-bearing prosthesis in favour of a fixed-bearing prosthesis.
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Soininvaara TA, Harju KAL, Miettinen HJA, Kröger HPJ. Periprosthetic bone mineral density changes after unicondylar knee arthroplasty. Knee 2013; 20:120-7. [PMID: 23154036 DOI: 10.1016/j.knee.2012.10.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Revised: 10/08/2012] [Accepted: 10/09/2012] [Indexed: 02/02/2023]
Abstract
BACKGROUND Unicompartmental knee arthroplasty (UKA) has received renewed interest in the last decade. UKA involves minor injury to soft tissues, limited removal of bone and delicate preservation of knee anatomy and geometry. In theory, UKA provides an opportunity to restore post-surgical knee kinematics to near normal. HYPOTHESIS UKA leaves patellofemoral joint free to meet high mechanical forces with no stress-shielding and therefore might preserve bone mineral density (BMD). PATIENTS AND METHODS We studied 21 patients with osteoarthritis (OA), who had received medial compartment UKA at Kuopio University Hospital between October 1997 and September 2000. BMD was measured by dual-energy X-ray absorptiometry (DEXA), at baseline (within a week after surgery) and at intervals until 7 years. RESULTS DEXA results were reproducible. The highest rate of periprosthetic bone loss occurred during the first 3 months after UKA. The average loss in BMD was 4.4% (p = 0.039) in the femoral diaphysis and it ranged from 11.2% (p < 0.001) to 11.9% (p = 0.002) in the distal femoral metaphysis; however, BMD changes in these regions, from 2 years to 7 years, were nonsignificant. At the 1-year follow-up, the BMD of the medial tibial metaphysis had increased by 8.9% (p = 0.02), whereas those in the lateral tibial metaphysial (-2.4%) and diaphysial regions (-2.0%) did not change significantly. INTERPRETATIONS UKA did not preserve periprosthetic BMD in the distal femoral metaphysis, whereas BMD changes in the tibial metaphysis were minor, consistent with a mechanical balance between the medial and lateral tibial compartments. LEVEL OF EVIDENCE 2B: Prospective case control study.
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Bhandari M, Smith J, Miller LE, Block JE. Clinical and economic burden of revision knee arthroplasty. CLINICAL MEDICINE INSIGHTS-ARTHRITIS AND MUSCULOSKELETAL DISORDERS 2012; 5:89-94. [PMID: 23239930 PMCID: PMC3520180 DOI: 10.4137/cmamd.s10859] [Citation(s) in RCA: 147] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Surgery is indicated for symptomatic knee osteoarthritis (OA) when conservative measures are unsuccessful. High tibial osteotomy (HTO), unicompartmental knee arthroplasty (UKA), and total knee arthroplasty (TKA) are surgical options intended to relieve knee OA pain and dysfunction. The choice of surgical intervention is dependent on several factors such as disease location, patient age, comorbidities, and activity levels. Regardless of surgical treatment, complications such as infection, loosening or lysis, periprosthetic fracture, and postoperative pain are known risks and are indications for revision surgery. The clinical and economic implications for revision surgery are underappreciated. Over 55,000 revision surgeries were performed in 2010 in the US, with 48% of these revisions in patients under 65 years. Total costs associated with each revision TKA surgery have been estimated to be in excess of $49,000. The current annual economic burden of revision knee OA surgery is $2.7 billion for hospital charges alone. By 2030, assuming a 5-fold increase in the number of revision procedures, this economic burden will exceed $13 billion annually. It is appealing to envision a therapy that could delay or obviate the need for arthroplasty. From an actuarial standpoint, this would have the theoretical downstream effect of substantially reducing the number of revision procedures. Although no known therapies currently meet these criteria, such a breakthrough would have a tremendous impact in lessening the clinical and economic burden of knee OA revision surgery.
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Affiliation(s)
- Mohit Bhandari
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
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Martinez-Carranza N, Weidenhielm L, Crafoord J, Hedström M. Deviation between navigated and final 3-dimensional implant position in mini-invasive unicompartmental knee arthroplasty: a pilot study in 13 patients. Acta Orthop 2012; 83:625-8. [PMID: 23043273 PMCID: PMC3555452 DOI: 10.3109/17453674.2012.736840] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Unicompartmental knee arthroplasty (UKA) is an established method of treating isolated gonartrosis. Modern techniques such as computer-assisted surgery (CAS) and minimally invasive surgery (MIS) are attractive complementary methods to UKA. However, the positioning of the components remains a concern. Thus, we performed a prospective study to assess whether there was deviation between the navigated implant position and the final implant position. PATIENTS AND METHODS We performed UKA with MIS and CAS in 13 patients. By comparing intraoperative navigation data with postoperative computed tomography (CT) measurements, we calculated the deviation between the computer-assisted implant position and the final 3-D implant position of the femoral and tibial components. RESULTS The computer-assisted placement of the femoral and tibial component showed adequate position and consistent results regarding flexion-extension and varus-valgus. However, regarding rotation there was a large variation and 6 of 10 patients were outside the target range for both the femoral component and the tibial component. INTERPRETATION Difficulties in assessing anatomical landmarks with the CAS in combination with MIS might be a reason for the poor rotational alignment of the components.
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Affiliation(s)
- Nicolas Martinez-Carranza
- Department of Orthopaedics, Karolinska University Hospital,Institution of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institute
| | - Lars Weidenhielm
- Department of Orthopaedics, Karolinska University Hospital,Department of Molecular Medicine and Surgery, Karolinska Institute
| | - Joakim Crafoord
- Department of Radiology, Karolinska University Hospital, Stockholm, Sweden
| | - Margareta Hedström
- Department of Orthopaedics, Karolinska University Hospital,Institution of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institute
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Heyse TJ, Khefacha A, Peersman G, Cartier P. Survivorship of UKA in the middle-aged. Knee 2012; 19:585-91. [PMID: 21962908 DOI: 10.1016/j.knee.2011.09.002] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Revised: 09/03/2011] [Accepted: 09/05/2011] [Indexed: 02/02/2023]
Abstract
BACKGROUND Unicompartmental knee arthroplasty (UKA) is known to be a viable procedure allowing for preservation of the intact compartments and delivering excellent function at long-term follow-up. The primary purpose of this single-surgeon study was to analyse the survivorship of a fixed bearing UKA in patients younger than 60 years. METHODS From all UKAs implanted between 1993 and 2005 at the senior authors' centre, 223 patients <60 years at operation with a minimum follow-up of 5 years were identified including all-poly and metal-backed tibiae. They were evaluated applying the Knee Society Score (KSS) at latest follow-up. Survivorship was calculated using Kaplan-Meier analysis, which considered the following variables: gender, type of tibial implant, medial vs. lateral UKA, and age. RESULTS Average age at index operation was mean 53.7 (SD 5.8, range 30-60) years at a mean follow-up of 10.8 (SD 3.5, range 5-17) years. From the KSS, the knee score was 94.3 (SD 7.8) and the function score was 94.9 (SD 6.8). At latest follow-up, the implant survival rate was 94.3%. Survivorship for the entire cohort was 93.5% at 10 years (medial UKA 94.1% vs. lateral 91.8%), and 86.3% at 15 years (85.1% medial vs. 91.7% lateral) CONCLUSION In conclusion, excellent survival and function outcomes were noted in this subgroup of patients younger than 60 years. Revision rates were comparable to those studies in which UKA was performed on an elderly patient population. UKA can successfully be performed in patients younger than 60 years with appropriate patient selection.
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Affiliation(s)
- Thomas J Heyse
- Department of Orthopedics and Rheumatology, University Hospital Marburg, Germany.
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Abbasi-Bafghi H, Fallah-Yakhdani HR, Meijer OG, de Vet HCW, Bruijn SM, Yang LY, Knol DL, Van Royen BJ, van Dieën JH. The effects of knee arthroplasty on walking speed: a meta-analysis. BMC Musculoskelet Disord 2012; 13:66. [PMID: 22559793 PMCID: PMC3481434 DOI: 10.1186/1471-2474-13-66] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Accepted: 05/06/2012] [Indexed: 12/30/2022] Open
Abstract
Background Patients with knee osteoarthritis patients have problems with walking, and tend to walk slower. An important aim of knee arthroplasty is functional recovery, which should include a post-operative increase in walking speed. Still, there are several problems with measuring walking speed in groups of knee osteoarthritis patients. Nevertheless, test-retest reliability of walking speed measurements is high, and when the same investigators monitor the same subjects, it should be possible to assess the walking speed effects of knee arthroplasty. The present study reports a meta-analysis of these effects. Methods A total of 16 independent pre-post arthroplasty comparisons of walking speed were identified through MEDLINE, Web of Science, and PEDro, in 12 papers, involving 419 patients. Results For 0.5–5 months post-operatively, heterogeneity was too large to obtain a valid estimate of the overall effect-size. For 6–12 and 13–60 months post-operatively, heterogeneity was absent, low, or moderate (depending on estimated pre-post correlations). During these periods, subjects walked on average 0.8 standard-deviations faster than pre-operatively, which is a large effect. Meta-regression analysis revealed significant effects of time and time squared, suggesting initial improvement followed by decline. Conclusion This meta-analysis revealed a large effect of arthroplasty on walking speed 6–60 months post-operatively. For the first 0.5–5 months, heterogeneity of effect-sizes precluded a valid estimate of short-term effects. Hence, patients may expect a considerable improvement of their walking speed, which, however, may take several months to occur. Meta-regression analysis suggested a small decline from 13 months post-operatively onwards.
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Affiliation(s)
- Hamid Abbasi-Bafghi
- Research Institute MOVE, Faculty of Human Movement Sciences, VU University, Amsterdam, The Netherlands
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Lyons MC, MacDonald SJ, Somerville LE, Naudie DD, McCalden RW. Unicompartmental versus total knee arthroplasty database analysis: is there a winner? Clin Orthop Relat Res 2012; 470:84-90. [PMID: 22038173 PMCID: PMC3237994 DOI: 10.1007/s11999-011-2144-z] [Citation(s) in RCA: 201] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND TKA and unicompartmental knee arthroplasty (UKA) are both utilized to treat unicompartmental knee arthrosis. While some surgeons assume UKA provides better function than TKA, this assumption is based on greater final outcome scores rather than on change in scores and many patients with UKA have higher preoperative scores. QUESTIONS/PURPOSES We therefore asked whether TKA would demonstrate (1) better change in clinical outcome scores from preoperative to postoperative states and (2) better survivorship than UKA. METHODS We evaluated 4087 patients with 5606 TKAs and 179 patients with 279 UKAs performed between 1978 and 2009. Patients with TKA were older and heavier than patients with UKA (mean age, 68 versus 66 years; mean BMI, 32 versus 29). We compared preoperative, latest postoperative, and change in Knee Society Clinical Rating System (KSCRS), SF-12, and WOMAC scores. Minimum followup was 2 years (UKA: mean, 7 years; range, 2.0-23 years; TKA: mean, 6.5 years; range, 2.0-33 years). Preoperative outcome measure scores (WOMAC, SF-12, KSCRS) were higher in the UKA group. RESULTS Patients with UKA had higher postoperative KSCRS and SF-12 mental scores. Changes in score for all WOMAC domains were similar between groups. Total KSCRS changes in score were similar between groups, although patients with TKA had higher knee scores (49 versus 43) but lower function scores than UKA (21 versus 26). Cumulative revision rate was higher for UKA than for TKA (13% versus 7%). Kaplan-Meier survivorship at 5 and 10 years was 95% and 90%, respectively, for UKA and 98% and 95%, respectively, for TKA. CONCLUSIONS While patients with UKA had higher pre- and postoperative scores than patients with TKA, the changes in scores were similar in both groups and survival appeared higher in patients with TKA.
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Affiliation(s)
- Matthew C. Lyons
- Division of Orthopaedic Surgery, University of Western Ontario & London Health Sciences Centre, University Campus, 339 Windermere Road, London, ON N6A 5A5 Canada
| | - Steven J. MacDonald
- Division of Orthopaedic Surgery, University of Western Ontario & London Health Sciences Centre, University Campus, 339 Windermere Road, London, ON N6A 5A5 Canada
| | - Lyndsay E. Somerville
- Division of Orthopaedic Surgery, University of Western Ontario & London Health Sciences Centre, University Campus, 339 Windermere Road, London, ON N6A 5A5 Canada
| | - Douglas D. Naudie
- Division of Orthopaedic Surgery, University of Western Ontario & London Health Sciences Centre, University Campus, 339 Windermere Road, London, ON N6A 5A5 Canada
| | - Richard W. McCalden
- Division of Orthopaedic Surgery, University of Western Ontario & London Health Sciences Centre, University Campus, 339 Windermere Road, London, ON N6A 5A5 Canada
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Sikorski JM, Sikorska JZ. Relative risk of different operations for medial compartment osteoarthritis of the knee. Orthopedics 2011; 34:e847-54. [PMID: 22146200 DOI: 10.3928/01477447-20111021-04] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The relative risk of total knee arthroplasty (TKA), high tibial osteotomy (HTO), and medial unicompartment (UKA) replacement for medial compartment arthritis is presented. Risk is defined as the product of the probability of an event occurring and its consequence. To define consequence, 2 related scales of impact (1 systemic and 1 local) are suggested. The probability of a complication is derived from the incidence as found in the published literature and expressed as a decimal of 1. The cumulative risk is expressed as the sum of the risks of all individual complications. The overall impact of specific comorbidities has been calculated when their influence on the incidence of a particular complication is known. Of the 3 operations, TKA has the highest cumulative risk of systemic complications and HTO is the most likely to produce local technical problems. UKA is the safest of the procedures. The relative risk of TKA:HTO:UKA is 1.00:1.01:0.31. For TKA, the greatest additional risk is morbid obesity, which increases overall risk by 31% by virtue of a 7.8-fold increase in infection rate. Cardiorespiratory disease, diabetes mellitus, smoking, and cirrhosis of the liver increase cumulative risk by 20%, 17%, and 17%, respectively.The authors conclude that a quantitative assessment of operative risk is possible and useful. However, it depends on the availability of reliable complication incidence data.
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Khatri PJ, O'Connor AM, Dervin GF. Decision support needs of patients choosing between unicompartmental and total knee arthroplasty for advanced medial compartment osteoarthritis of the knee. J Arthroplasty 2011; 26:1343-9. [PMID: 21397451 DOI: 10.1016/j.arth.2010.12.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2010] [Accepted: 12/17/2010] [Indexed: 02/01/2023] Open
Abstract
Patients with isolated medial knee osteoarthritis are often candidates for both unicompartmental knee arthroplasty and total knee arthroplasty and must choose between these 2 options. We interviewed 20 such patients to describe their decision support needs and 14 knee arthroplasty surgeons to describe their requirements in supporting patients' decision making. Patients and surgeons both desired active patient participation in the decision. Of 14 surgeons, 13 identified a knowledgeable patient as the most important factor in facilitating decision making, but many worried about confusing patients from information overload. Patients, on the other hand, demonstrated poor knowledge of the advantages and disadvantages of each surgical option, and 17 of 20 desired supplemental educational resources. Thus, most patients choosing between unicompartmental knee arthroplasty and total knee arthroplasty would appreciate and benefit from a decision support intervention.
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Affiliation(s)
- Prateek J Khatri
- Department of Orthopaedic Surgery, Ottawa Hospital, Ottawa, Ontario, Canada
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Willis-Owen CA, Sarraf KM, Martin AE, Martin DK. Are current thrombo-embolic prophylaxis guidelines applicable to unicompartmental knee replacement? ACTA ACUST UNITED AC 2011; 93:1617-20. [DOI: 10.1302/0301-620x.93b12.27650] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Symptomatic and asymptomatic deep-vein thrombosis (DVT) is a common complication of knee replacement, with an incidence of up to 85% in the absence of prophylaxis. National guidelines for thromboprophylaxis in knee replacement are derived from total knee replacement (TKR) data. No guidelines exist specific to unicompartmental knee replacement (UKR). We investigated whether the type of knee arthroplasty (TKR or UKR) was related to the incidence of DVT and discuss the applicability of existing national guidelines for prophylaxis following UKR. Data were collected prospectively on 3449 knee replacements, including procedure type, tourniquet time, surgeon, patient age, use of drains and gender. These variables were related to the incidence of symptomatic DVT. The overall DVT rate was 1.6%. The only variable that had an association with DVT was operation type, with TKR having a higher incidence than UKR (2.2% versus 0.3%, p < 0.001). These data show that the incidence of DVT after UKR is both clinically and statistically significantly lower than that after TKR. TKR and UKR patients have different risk profiles for symptomatic DVT. The risk-benefit ratio for TKR that has been used to produce national guidelines may not be applicable to UKR. Further research is required to establish the most appropriate form of prophylaxis for UKR.
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Affiliation(s)
- C. A. Willis-Owen
- Queen Mary’s Hospital, Department
of Orthopaedic Surgery, Frognal Avenue, Sidcup, Kent
DA14 6LT, UK
| | - K. M. Sarraf
- Chelsea and Westminster Hospital, 369
Fulham Road, London SW10 9NH, UK
| | - A. E. Martin
- Sportsmed SA, 32
Payneham Road, Stepney, South
Australia 5069, Australia
| | - D. K. Martin
- Sportsmed SA, 32
Payneham Road, Stepney, South
Australia 5069, Australia
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