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Za P, Papalia GF, Cardile U, Gregori P, Vasta S, Franceschetti E, Campi S, Papalia R. Cementless unicompartmental knee arthroplasty is safe and effective at a minimum follow-up of 4.2 years: A systematic review. J Exp Orthop 2025; 12:e70253. [PMID: 40337672 PMCID: PMC12056710 DOI: 10.1002/jeo2.70253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2025] [Revised: 03/22/2025] [Accepted: 03/26/2025] [Indexed: 05/09/2025] Open
Abstract
Purpose Cemented unicompartmental knee arthroplasty (UKA) is a widely used procedure in the treatment of anteromedial and lateral knee osteoarthritis. However, several advantages are reported for cementless UKA, such as improved osseointegration, reduced cement-related costs and complications. The aim of this study was to analyse clinical outcomes, survival, complications, failures and revision rate of cementless UKA. Methods A systematic review was performed on 31 May 2024, on PubMed, Cochrane Library and Scopus. We included randomised clinical trials and prospective and retrospective studies reporting clinical outcomes, implant survival, complications, failures and revision rates of cementless UKA. The following data were extracted: study design, type of implant, number of patients and knees, follow-up, age, sex, pre-operative and post-operative clinical outcomes, reoperations and revisions with causes of failure and overall survival. Results Fifteen studies were included, involving 3475 patients and 3641 UKA (2568 cementless UKA and 854 cemented UKA). The mean patients' age was 66 years. The mean follow-up was 6.5 years. The Oxford Knee Score improved from 17.8 preoperatively to 40.3 post-operatively in cementless UKA. Knee Society Score improved from 118.2 preoperatively to 168.6 post-operatively in cementless UKA. The reoperation rate was 3.85% for cementless UKA and 9% for cemented UKA. The most common causes of revision were osteoarthritis progression (1.4%), aseptic loosening (0.8%), bearing dislocation and unexplained pain (0.7%). The overall survival of cementless UKA was 96.2% and 93.6% at 5 and 10 years, respectively. Conclusion Cementless UKA is a viable alternative to cemented UKAs with a low failure rate, without a lower clinical benefit at a minimum follow-up of 4.2 years. Level of Evidence Level III, systematic review of studies.
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Affiliation(s)
- Pierangelo Za
- Department of Orthopaedic and Trauma SurgeryUniversità Campus Bio‐Medico di RomaRomaItaly
- Research Unit of Orthopaedic and Trauma SurgeryFondazione Policlinico Universitario Campus Bio‐MedicoRomaItaly
| | - Giuseppe Francesco Papalia
- Department of Orthopaedic and Trauma SurgeryUniversità Campus Bio‐Medico di RomaRomaItaly
- Research Unit of Orthopaedic and Trauma SurgeryFondazione Policlinico Universitario Campus Bio‐MedicoRomaItaly
- Oncological Orthopaedics DepartmentIFO – IRCCS Regina Elena National Cancer InstituteRomeItaly
| | - Umberto Cardile
- Department of Orthopaedic and Trauma SurgeryUniversità Campus Bio‐Medico di RomaRomaItaly
- Research Unit of Orthopaedic and Trauma SurgeryFondazione Policlinico Universitario Campus Bio‐MedicoRomaItaly
| | - Pietro Gregori
- Department of Orthopaedic and Trauma SurgeryUniversità Campus Bio‐Medico di RomaRomaItaly
- Research Unit of Orthopaedic and Trauma SurgeryFondazione Policlinico Universitario Campus Bio‐MedicoRomaItaly
| | - Sebastiano Vasta
- Department of Orthopaedic and Trauma SurgeryUniversità Campus Bio‐Medico di RomaRomaItaly
- Research Unit of Orthopaedic and Trauma SurgeryFondazione Policlinico Universitario Campus Bio‐MedicoRomaItaly
| | - Edoardo Franceschetti
- Department of Orthopaedic and Trauma SurgeryUniversità Campus Bio‐Medico di RomaRomaItaly
- Research Unit of Orthopaedic and Trauma SurgeryFondazione Policlinico Universitario Campus Bio‐MedicoRomaItaly
| | - Stefano Campi
- Department of Orthopaedic and Trauma SurgeryUniversità Campus Bio‐Medico di RomaRomaItaly
- Research Unit of Orthopaedic and Trauma SurgeryFondazione Policlinico Universitario Campus Bio‐MedicoRomaItaly
| | - Rocco Papalia
- Department of Orthopaedic and Trauma SurgeryUniversità Campus Bio‐Medico di RomaRomaItaly
- Research Unit of Orthopaedic and Trauma SurgeryFondazione Policlinico Universitario Campus Bio‐MedicoRomaItaly
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Saitoh A, Hiranaka T, Okamoto K, Fujishiro T, Koide M, Suda Y, Tanaka A, Arimoto A. Hybrid Fixation Achieves Similar or Slightly Better Results Compared With All Cemented Fixation in Oxford Unicompartmental Knee Arthroplasty at the Short-Term Follow-Up. Cureus 2025; 17:e81533. [PMID: 40314040 PMCID: PMC12043381 DOI: 10.7759/cureus.81533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2025] [Indexed: 05/03/2025] Open
Abstract
Introduction Cementless Oxford unicompartmental knee arthroplasty (OUKA) has been shown to have less frequent radiolucent lines and equivalent or even better results than those of cemented OUKA. However, tibial fractures are more frequent in cementless OUKA than in cemented OUKA, especially in Asian countries. A hybrid option, with a cementless femur and cemented tibia, may, therefore, be a good compromise. This study compares the clinical results of hybrid OUKA with those of fully cemented OUKA. Materials and methods This retrospective study included 108 consecutive unicompartmental knee arthroplasties implanted between September 2016 and September 2018 in our hospital. Cases were divided into two groups: those using cemented fixation and those using hybrid fixation OUKAs. Pre- and postoperative knee range of motion (ROM), operation time, pre-and postoperative Oxford knee score (OKS), and complications were compared between the groups two years after OUKA was performed. Results There was no significant difference in pre- and postoperative ROM, operation time, and OKS performed unilateral OUKA, but mean OKS was higher in the hybrid group than in the cemented group performed bilateral OUKA (p<0.01). Both groups included one revision to total knee arthroplasty each. There was no statistically significant difference in the rate of revision (p=0.723). Conclusions Better clinical outcomes were achieved in the hybrid fixation group than in the cemented fixation group, with an equivalent rate of complication. Longer follow-up periods are needed to confirm the benefits of hybrid fixation in OUKA over time.
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Affiliation(s)
- Akira Saitoh
- Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Takatsuki, JPN
| | - Takafumi Hiranaka
- Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Takatsuki, JPN
| | - Koji Okamoto
- Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, takatsuki, JPN
| | - Takaaki Fujishiro
- Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Takatsuki, JPN
| | - Motoki Koide
- Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Takatsuki, JPN
| | - Yoshihito Suda
- Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Takatsuki, JPN
| | - Atsuki Tanaka
- Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Takatsuki, JPN
| | - Akihiko Arimoto
- Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Takatsuki, JPN
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Ten Noever de Brauw GV, Vossen RJM, Bayoumi T, Sierevelt IN, Burger JA, Pearle AD, Kerkhoffs GMMJ, Spekenbrink-Spooren A, Zuiderbaan HA. Distinct age-related modes of failure in cemented and cementless Oxford medial unicompartmental knee arthroplasty : results from 25,762 patients in the Dutch Arthroplasty Register. Bone Joint J 2025; 107-B:329-336. [PMID: 40020722 DOI: 10.1302/0301-620x.107b3.bjj-2024-0512.r2] [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: 03/03/2025]
Abstract
Aims The primary objective of this study was to compare short-term implant survival between cemented and cementless fixation for the mobile-bearing Oxford medial unicompartmental knee arthroplasty (UKA) across various age groups. The secondary objectives were to compare modes of failure and to evaluate patient-reported outcomes. Methods A total of 25,762 patients, comprising 8,022 cemented (31.1%) and 17,740 cementless (68.9%) medial UKA cases, were included from the Dutch Arthroplasty Register. Patient stratification was performed based on age: < 50 years, 50 to 59 years, 60 to 69 years, and ≥ 70 years. Survival rates and hazard ratios were calculated. Modes of failure were described and postoperative change in baseline for the Oxford Knee Score and numerical rating scale for pain at six and 12 months' follow-up were compared. Results The 2.5-year implant survival rate of cementless UKA was significantly higher compared to cemented UKA in patients aged younger than 60 years (age < 50 years: 95.9% (95% CI 93.8 to 97.3) vs 90.9% (95% CI 87.0 to 93.7); p = 0.007; and 50 to 59 years: 95.6% (95% CI 94.9 to 96.3) vs 94.0% (95% CI 92.8 to 95.0); p = 0.009). Cemented UKA exhibited significantly higher revision rates for tibial loosening (age < 50 and 60 to 69 years), while cementless UKA was associated with higher revision rates for periprosthetic fractures (age ≥ 60 years). Patient-reported outcomes were similar between both fixation techniques, irrespective of age. Conclusion Cementless fixation resulted in superior short-term implant survival compared to cemented fixation among younger patients undergoing Oxford mobile-bearing medial UKA. Distinct failure patterns between fixation techniques emerged across various age groups, with revisions for tibial loosening being associated with cemented UKA in younger patients, while revisions for periprosthetic fractures were specifically identified among elderly patients undergoing cementless UKA.
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Affiliation(s)
- Gaby V Ten Noever de Brauw
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Computer Assisted Surgery Center & Sports Medicine, Weill Medical College of Cornell University, New York City, New York, USA
- Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Roderick J M Vossen
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Computer Assisted Surgery Center & Sports Medicine, Weill Medical College of Cornell University, New York City, New York, USA
- Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Tarik Bayoumi
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Computer Assisted Surgery Center & Sports Medicine, Weill Medical College of Cornell University, New York City, New York, USA
- Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Inger N Sierevelt
- Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- Orthopaedic Department, Spaarne Gasthuis Academy, Hoofddorp, Netherlands
- Orthopaedic Department, Xpert Clinics, Leiderdorp, Netherlands
| | - Joost A Burger
- Charité-Universitatsmedizin Berlin, Corporate Member of Freie Universität and Humboldt Universität, Berlin, Germany
| | - Andrew D Pearle
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Computer Assisted Surgery Center & Sports Medicine, Weill Medical College of Cornell University, New York City, New York, USA
| | - Gino M M J Kerkhoffs
- Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Movement Sciences, Sports, Amsterdam, Netherlands
| | - Anneke Spekenbrink-Spooren
- Dutch Arthroplasty Register (Landelijke Registratie Orthopedische Implantaten), 's-Hertogenbosch, Netherlands
| | - Hendrik A Zuiderbaan
- Department of Orthopaedic Surgery, Medical Clinic Velsen, Velsen-Noord, Netherlands
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Yang H, Marras D, Clary CW, Zumbrunn T, List R, Ferguson SJ, Rullkoetter PJ. Impact of Surgical Alignment, Bone Properties, Anterior-Posterior Translation, and Implant Design Factors on Fixation in Cementless Unicompartmental Knee Arthroplasty. J Biomech Eng 2025; 147:011007. [PMID: 39445747 DOI: 10.1115/1.4066969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Accepted: 10/15/2024] [Indexed: 10/25/2024]
Abstract
Micromotion exceeding 150 μm at the implant-bone interface may prevent bone formation and limit fixation after cementless knee arthroplasty. Understanding the critical parameters impacting micromotion is required for optimal implant design and clinical performance. However, few studies have focused on unicompartmental knee arthroplasty (UKA). This study assessed the impacts of alignment, surgical, and design factors on implant-bone micromotions for a novel cementless UKA design during a series of simulated daily activities. Three finite element models that were validated for predicting micromotion of cementless total knee arthroplasty (TKA) were loaded with design-specific kinematics/loading to simulate gait (GT), deep knee bending (DKB), and stair descent (SD). The implant-bone micromotion and the porous surface area ideal for bone ingrowth were estimated and compared to quantify the impact of each factor. Overall, the peak tray-bone micromotions were consistently found at the lateral aspect of the tibial baseplate and were consistently higher than the femoral micromotions. The femoral micromotion was insensitive to almost all the factors studied, and the porous area favorable for bone ingrowth was no less than 93%. For a medial uni, implanting the tray 1 mm medially or the femoral component 1 mm laterally reduced the tibial micromotion by 19.3% and 26.3%, respectively. Differences in tray-bone micromotion due to bone moduli were up to 59.8%. A 5 mm more posterior femoral translation increased the tray-bone micromotion by 35.8%. The presence of the tray keel prevented the spread of the micromotion and increased the overall porous surface area, but also increased peak micromotion. The tray peg and the femoral anterior peg had little impact on the micromotion of their respective implants. In conclusion, centralizing the load transfer to minimize tibial tray applied moment and optimizing the fixation features to minimize micromotion are consistent themes for improving cementless fixation in UKA. Perturbation of femoral-bone alignment may be preferred as it would not create under/overhang on the tibia.
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Affiliation(s)
- Huizhou Yang
- Center for Orthopaedic Biomechanics, University of Denver, Room 434, 2155 E. Wesley Avenue, Denver, CO 80208
| | - Daniele Marras
- Center for Orthopaedic Biomechanics, University of Denver, Denver, CO 80208
| | - Chadd W Clary
- Center for Orthopaedic Biomechanics, University of Denver, Denver, CO 80208
| | - Thomas Zumbrunn
- Institute for Biomechanics, ETH Zurich, Hönggerbergring 64, HPP O14, Zurich 8093, Switzerland
- ETH Zurich
| | - Renate List
- Institute for Biomechanics, ETH Zurich, Hönggerbergring 64, HPP O14, Zurich 8093, Switzerland; Human Performance Lab, Schulthess Clinic, Zurich 8008, Switzerland
- ETH Zurich
| | - Stephen J Ferguson
- Institute for Biomechanics, ETH Zurich, Hönggerbergring 64, HPP O14, Zurich 8093, Switzerland
| | - Paul J Rullkoetter
- Center for Orthopaedic Biomechanics, University of Denver, Room 427, 2155 E. Wesley Avenue, Denver, CO 80208
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Karayiannis P, Cassidy R, Dobie I, Beverland D. Long term follow up of 257 consecutive cementless Oxford medial compartment knee arthroplasties at a non-designer centre. Knee 2024; 49:201-209. [PMID: 39043015 DOI: 10.1016/j.knee.2024.07.001] [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: 03/06/2024] [Revised: 06/04/2024] [Accepted: 07/02/2024] [Indexed: 07/25/2024]
Abstract
AIMS This study aimed to review the survivorship, indication for revision and patient reported outcomes for 257 consecutive Oxford cementless unicompartmental knee arthroplasties (OUKA's) in 238 patients at 12-14 years post-operatively. METHODS Patients underwent surgery between April 2008 and October 2010 by two non-design surgeons including their learning curve. The 5-year clinical and radiological outcomes have already been reported. Oxford knee scores (OKS) were recorded at 1, 5 and 12-14 years with delayed review a result of the COVID-19 pandemic. Revision indication and imaging were reviewed. RESULTS Revision was required in 28 OUKA's (10.9%) with a 10-year cumulative survival of 93.0%, reducing to 78.8% at 14 years. 59 patients had died prior to this review and 24 were not contactable. Those not contactable had electronic records reviewed to ensure they did not have a revision elsewhere. Half of the revisions were for progression of lateral compartment arthritis (14/28). Four of 6 cases with a full revision for polyethylene wear may have benefited from a bearing exchange instead. OKSs in non-revised patients were good (median score 38, IQR 30-44) with no significant deterioration noted from 5 to 12-14 years. CONCLUSIONS Cementless OUKA in this series had a long-term survival rate comparable to other OUKA's outside of the designer centre. OKSs remain good for those patients not revised. Progression of lateral compartment arthritis was the primary reason for revision with no revisions for component loosening or bearing spinout. Ideally UKA patients who experience problems should be under the care of revisions surgeons who perform UKA. Improving patient selection and understanding of the pathophysiology of lateral disease progression, remain crucial to improve the long-term survivorship of OUKA.
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Affiliation(s)
- Paul Karayiannis
- Musgrave Park Hospital, Stockman's Lane, Belfast BT9 7JB, Northern Ireland, United Kingdom.
| | - Roslyn Cassidy
- Musgrave Park Hospital, Stockman's Lane, Belfast BT9 7JB, Northern Ireland, United Kingdom.
| | - Ian Dobie
- Musgrave Park Hospital, Stockman's Lane, Belfast BT9 7JB, Northern Ireland, United Kingdom.
| | - David Beverland
- Primary Joint Unit, Musgrave Park Hospital, Stockman's Lane, Belfast BT97JB, Northern Ireland, United Kingdom.
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Hiranaka T. Advantages and limitations of mobile-bearing unicompartmental knee arthroplasty: an overview of the literature. Expert Rev Med Devices 2024; 21:587-600. [PMID: 38873929 DOI: 10.1080/17434440.2024.2367002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 06/07/2024] [Indexed: 06/15/2024]
Abstract
INTRODUCTION Interest in unicompartmental knee arthroplasty (UKA) has recently grown. Mobile bearing UKA, in which the bearing is not fixed but rather perfectly conforms with femoral and tibial components and moves completely passively between the femoral and tibial implant, has now been used for approximately half a century. AREAS COVERED Alongside the recognized advantages of UKA, the mobile-bearing variant benefits from an extremely low rate of polyethylene wear and tolerable minor malalignment. Revision rates for UKA have been reported to exceed those of total knee arthroplasty, but long-term survival rates and outcomes from mobile-bearing UKA have been found to be satisfactory. In addition to the lateral osteoarthritis and loosening, which are main complications of UKA, bearing dislocation is a specific complication of mobile bearing UKA. Fractures and valgus subsidence are more prevalent than in the cementless UKA. While these continue to be features to be addressed, they have been partially solved. EXPERT OPINION Given the manifold benefits of UKA, its application could be extended to a larger patient population. Successful outcomes rely on careful patient selection and the surgeon's extensive familiarity with the procedure. Looking ahead, the incorporation of robotic surgery, already a feature of some fixed-bearing UKAs, might shape the future trajectory of mobile-bearing UKA.
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Affiliation(s)
- Takafumi Hiranaka
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Takatsuki, Osaka, Japan
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MacAulay A, Rahman A, Marks L, Murray DW, Mellon SJ. A finite element model for investigating the influence of keel design and position on unicompartmental knee replacement cementless tibial component fixation. Med Eng Phys 2024; 125:104119. [PMID: 38508799 DOI: 10.1016/j.medengphy.2024.104119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 11/07/2023] [Accepted: 02/14/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVES The cementless Oxford Unicompartmental Knee Replacement (OUKR) tibial component relies on an interference fit to achieve initial fixation. The behaviour at the implant-bone interface is not fully understood and hence modelling of implants using Finite Element (FE) software is challenging. With a goal of exploring alternative implant designs with lower fracture risk and adequate fixation, this study aims to investigate whether optimisation of FE model parameters could accurately reproduce experimental results of a pull-out test which assesses fixation. MATERIALS AND METHODS Finite element models of implants with three methods of fixation (standard keel, small keel, and peg) in a bone analogue foam block were created, in which implants were modelled using an analytical rigid definition and the foam block was modelled as a homogenous linear isotropic material. The total interference and elastic slip were varied in these models and optimised by comparing simulated and experimental results of pull-out tests for two (standard and peg) implant geometries. Then the optimised interference and elastic slip were validated by comparing simulated and experimental data of a third (small keel) implant geometry. RESULTS The optimisation of parameters established an interference of 0.16 mm and an elastic slip of 0.20 mm as most suitable for modelling the experimental force-displacement plots during pull-out. This combination of parameters accurately reproduced the experimental results of the small keel geometry. The maximum pull-out forces from the FE models were consistent with experimental data for each implant design. CONCLUSIONS This study shows that experimental pull-out tests can be accurately modelled using adjusted interference values and non-linear friction and outlines a method for determining these parameters. This study demonstrates that complex problems in modelling implant behaviour can be addressed with relatively simple models. This can potentially lead to the development of implants with reduced risk of failure.
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Affiliation(s)
- Alexander MacAulay
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), Oxford Orthopaedic Engineering Centre (OOEC), University of Oxford, Botnar Research Centre, Oxford, United Kingdom.
| | - Azmi Rahman
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), Oxford Orthopaedic Engineering Centre (OOEC), University of Oxford, Botnar Research Centre, Oxford, United Kingdom
| | - Laurence Marks
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), Oxford Orthopaedic Engineering Centre (OOEC), University of Oxford, Botnar Research Centre, Oxford, United Kingdom
| | - David W Murray
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), Oxford Orthopaedic Engineering Centre (OOEC), University of Oxford, Botnar Research Centre, Oxford, United Kingdom
| | - Stephen J Mellon
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), Oxford Orthopaedic Engineering Centre (OOEC), University of Oxford, Botnar Research Centre, Oxford, United Kingdom
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Kılıçarslan K, Naldöven ÖF, Veizi E, Güven Ş, Çepni Ş, Fırat A. C-Reactive Protein and Erythrocyte Sedimentation Rates after Total and Unicompartmental Knee Arthroplasty-Less Implant Equals Quicker Normalization. J Long Term Eff Med Implants 2024; 34:49-55. [PMID: 38842232 DOI: 10.1615/jlongtermeffmedimplants.2023050965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
Postoperative follow up after total or unicondylar knee arthroplasty (UKA) includes C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) to scan for and possibly diagnose a periprosthetic joint infection (PJI). The aim of this study was to describe the postoperative changes in CRP and ESR values after UKA and compare them with values obtained after TKA. Patients operated on between 2020 and 2022 were eligible for this retrospective study. Inclusion criteria were patients with at least 4 postoperative visits associated with blood test screening for PJI, aged > 45, with uneventful follow-up for the first 90 days. Exclusion criteria were a history of chronic inflammatory disease, revision for any reason, and readmission for any reason. Blood samples were collected on the 3rd, 15th, and 30th postoperative days and once between the 45th and the 90th day. The mean and peak values were compared between the two groups. The study included 277 patients (243 TKAs and 34 UKAs). Mean age was significantly lower in the UKA group (67.2 ± 7.5 vs. 60.0 ± 5.9). On the 3rd and the 15th postoperative day, the UKA patients had significantly lower ESR and CRP levels. The levels normalized after the first month. While the TKA patients showed higher values, the trend normalized after the 30th day. CRP and ESR values rose significantly after TKA and persisted up to the 15th day postoperatively. CRP and ESR values normalized faster in patients undergoing UKA. Patients > 65 had higher CRP and ESR values during their routine follow-ups.
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Affiliation(s)
| | - Ömer Faruk Naldöven
- Department of Orthopedics and Traumatology, Ankara City Hospital, 06000 Ankara, Turkey
| | - Enejd Veizi
- Department of Orthopedics and Traumatology, Ankara City Hospital, 06000 Ankara, Turkey
| | - Şahan Güven
- Department of Orthopedics and Traumatology, Ankara City Hospital, 06000 Ankara, Turkey
| | - Şahin Çepni
- Department of Orthopedics and Traumatology, Ankara City Hospital, 06000 Ankara, Turkey
| | - Ahmet Fırat
- Department of Orthopedics and Traumatology, Ankara City Hospital, 06000 Ankara, Turkey
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Rahman A, Martin B, Jenkins C, Mohammad H, Barker K, Dodd C, Jackson W, Price A, Mellon S, Murray DW. Less pain reported 5 years after cementless compared to cemented unicompartmental knee replacement: an analysis of pain, neuropathy, and co-morbidity scores. Knee Surg Sports Traumatol Arthrosc 2023; 31:5180-5189. [PMID: 37776359 PMCID: PMC10598111 DOI: 10.1007/s00167-023-07589-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 09/11/2023] [Indexed: 10/02/2023]
Abstract
PURPOSE To compare patient-reported pain scores and assess the influence of neuropathy and co-morbidity, on knee pain following cemented and cementless medial unicompartmental knee replacement (UKR) 5 years after surgery. METHOD In this longitudinal study, 262 cemented and 262 cementless Oxford UKR performed for the same indications and with the same techniques were recruited. Patients were reviewed at five years, evaluating patient-reported pain and association with clinical outcomes. Intermittent and Constant Osteoarthritis Pain (ICOAP), PainDETECT (PD), Charnley score, Oxford Knee Score (OKS) and American Knee Society Score (AKSS) were compared. RESULTS In both cohorts, intermittent pain was more common than constant pain (47% vs 21%). Cementless knees reported significantly less pain than cemented (ICOAP-Total 5/100 vs 11/100, p < 0.0001). A greater proportion of cementless knees experienced no pain at all (ICOAP = 0/100, 61% vs 43%, p < 0.0001) and 75% fewer experienced severe or extreme pain. Pain sub-scores in PD, OKS and AKSS follow this trend. Pain was unlikely to be neuropathic (PD positive: 5.26%), but patients reporting high levels of 'strongest' pain were three times more likely to be neuropathic. Patients with co-morbidities (Charnley C) experienced greater pain than those without (Charnley A+B) across all knee-specific scores, despite scores being knee specific. CONCLUSION Both cemented and cementless UKR in this study had substantially less pain than that reported in literature following TKR. Cementless UKR had significantly less pain than cemented UKR in all scores. Two-thirds of patients with a cementless UKR had no pain at all at 5 years, and pain experienced was most likely to be mild and intermittent with no patients in severe or extreme pain. Patients with cementless UKR that had higher levels of pain were more likely to have co-morbidity or evidence or neuropathic pain. It is unclear why cementless UKR have less pain than cemented; further study is necessary.
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Affiliation(s)
- Azmi Rahman
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
| | - Benjamin Martin
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Cathy Jenkins
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Hasan Mohammad
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Karen Barker
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Christopher Dodd
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - William Jackson
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Andrew Price
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Stephen Mellon
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - David W Murray
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Mancino F, Malahias MA, Loucas R, Ryan L, Kostretzis L, Tornberg H, Gu A, Nikolaou VS, Togninalli D, Alexiades MM. Cementless versus cemented unicompartmental knee arthroplasty: a systematic review of comparative studies. Musculoskelet Surg 2023; 107:255-267. [PMID: 36689086 DOI: 10.1007/s12306-023-00773-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 01/08/2023] [Indexed: 01/24/2023]
Abstract
There are still some controversies regarding the clinical use of cementless UKAs. The aim of this systematic review was to determine whether cementless medial UKA leads to similar outcomes compared to cemented medial UKA. This search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews guidelines (PRISMA). The random effects model with 95% confidence interval (CI) was applied to the analysis. The I2 statistic was used to assess study heterogeneity. Six studies were eligible for inclusion (4784 UKAs, 4776 patients): 2947 cemented UKAs (61.6%) and 1837 cementless UKAs (38.4%). The overall mean follow-up was 4.9 years. The all-cause reoperation rate was 11.3% (80 of 706) at mean 5.7-year follow-up for cemented UKA and 6.9% (57 of 824) at mean 4.1-year follow-up for the cementless. The overall revision rate was 10.2% (303 of 2947) for the cemented and 5.8% (108 of 1837) for the cementless. Aseptic loosening was the most frequent reason of revision (2.3% cemented vs 0.5% cementless). The overall rate of radiolucent lines (RLL) was 28.3% (63 of 223) in the cemented cohort and 11.1% in the cementless (26 of 234). All the studies reported improved functional outcomes. Cementless UKA provides at least equivalent if not better results compared to cemented UKA. Despite the use of cemented UKA outnumber cementless fixation, available data shows that cementless UKA had a reduced midterm revision rate, while providing similar functional outcomes.
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Affiliation(s)
- F Mancino
- Department of Orthopaedic, The Orthopaedic Research Foundation of Western Australia (ORFWA), Fiona Stanley Hospital, Perth, Australia.
| | - M A Malahias
- School of Medicine - Frankfurt, European University Cyprus, Im Vogelsgesang 3, Frankfurt am Main, 60488, Germany
- Department of Orthopedics and Traumatology, Clinica ARS Medica, Via Grumo 16, 6929, Gravesano, Ticino, Switzerland
| | - R Loucas
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - L Ryan
- Department of Orthopedic Surgery, George Washington School of Medicine and Health Sciences, 2300 M St NW, Washington DC, 20037, USA
| | - L Kostretzis
- Hôpital Maisonneuve-Rosemont, CanadaCooper, 5415 Boulevard de L'Assomption, Montréal, QC, H1T 2M4, Canada
| | - H Tornberg
- Medical School of Rowan University, 401 Broadway, Camden, NJ, 08103, USA
| | - A Gu
- Department of Orthopedic Surgery, George Washington School of Medicine and Health Sciences, 2300 M St NW, Washington DC, 20037, USA
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, 535 E 70Th St, New York, 10021, USA
| | - V S Nikolaou
- 2nd Orthopaedic Department, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - D Togninalli
- Department of Orthopedics and Traumatology, Clinica ARS Medica, Via Grumo 16, 6929, Gravesano, Ticino, Switzerland
| | - M M Alexiades
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, 535 E 70th St, New York, 10021, USA
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11
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Gibbons JP, Cassidy RS, Bryce L, Napier RJ, Bloch BV, Beverland DE. Is Cementless Total Knee Arthroplasty Safe in Women Over 75 Y of Age? J Arthroplasty 2023; 38:691-699. [PMID: 36272510 DOI: 10.1016/j.arth.2022.10.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 10/11/2022] [Accepted: 10/13/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Cementless total knee arthroplasty (TKA) is the subject of renewed interest. Previous concerns about survivorship have been addressed and there is an appeal in terms of biological fixation and surgical efficiency. However, even surgeon advocates have concerns about the risk of marked subsidence when using this technology in older patients at risk for osteoporosis. METHODS This was a retrospective analysis of 1,000 consecutive fully cementless mobile bearing TKAs performed at a single institution on women over 75 years of age who had postoperative and 1-year x-rays. The primary outcome was the incidence of subsidence. RESULTS There were three asymptomatic cases with definite subsidence and change in alignment. In a fourth symptomatic case, the femoral component subsided into varus and the tibia into valgus, thus maintaining alignment which facilitated nonoperative treatment in a 92-year-old. Overall, at 1 year, there were two- liner revisions for infection without recurrence. Five patients had further surgery, of which three were washouts and two were for periprosthetic fractures sustained postoperatively within 1 year. Seven patients had further anesthesia, of which five were manipulations and two were nonrecurrent closed reductions for spinouts. CONCLUSION Cementless TKA did not have a high risk of subsidence in this at-risk population. In the hands of experienced surgeons, these procedures can be used safely irrespective of bone quality.
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Affiliation(s)
- John P Gibbons
- Orthopaedic Outcomes Unit, Musgrave Park Hospital, Belfast, Northern Ireland
| | - Roslyn S Cassidy
- Orthopaedic Outcomes Unit, Musgrave Park Hospital, Belfast, Northern Ireland
| | - Leeann Bryce
- Orthopaedic Outcomes Unit, Musgrave Park Hospital, Belfast, Northern Ireland
| | - Richard J Napier
- Orthopaedic Outcomes Unit, Musgrave Park Hospital, Belfast, Northern Ireland
| | - Benjamin V Bloch
- Nottingham Elective Orthopaedic Services, City Hospital Campus, Nottingham University Hospitals NHS Trust, Nottingham, England
| | - David E Beverland
- Orthopaedic Outcomes Unit, Musgrave Park Hospital, Belfast, Northern Ireland
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12
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Puvanendran A, Jaibaji M, Volpin A, Konan S. Survivorship, clinical outcomes and indications for revision in uncemented unicompartmental knee arthroplasty: systematic review. Acta Orthop Belg 2023; 89:83-95. [PMID: 37294990 DOI: 10.52628/89.1.9873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Modern uncemented unicompartmental knee arthroplasty (UKA) relies on the mechanics of the implant design and a biological bond at the bone-implant interface to create a secure fixation of its components. The aim of this systematic review was to determine implant survivorship, clinical outcomes and indications for revision in uncemented UKAs. A search strategy was employed using keywords related to UKAs and uncemented fixation to identify suitable studies. Both prospective and retrospective studies with a minimum of two year mean follow-up were included. Data was gathered on study design, implant type, patient demographics, survivorship, clinical outcome scores and the indications for revision. Methodological quality was assessed using a ten-point risk of bias scoring tool. Eighteen studies were included in the final review. The mean follow-up of studies ranged between 2-11 years. The primary outcome of survival demonstrated 5 year survivorship ranged between 91.7-100.0% and 10-year survivorship between 91.0-97.5%. Clinical and functional outcome scores were found to be excellent in the majority of studies with the remaining reporting good results. Revisions represented 2.7% of the total operations performed. There were 145 revisions with an overall revision rate of 0.8 per 100 observed component years. Osteoarthritis disease progression (30.2%) and bearing dislocations (23.8%) were the most common causes of implant failure. This review finds uncemented UKAs demonstrate comparable survivorship, clinical outcomes and safety profile to cemented UKAs to consider this fixation a suitable alternative in clinical use.
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13
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Panzram B, Barbian F, Reiner T, Hariri M, Renkawitz T, Walker T. Clinical and Functional Results of Cementless Unicompartmental Knee Arthroplasty with a Minimum Follow Up of 5 Years-A Consecutive Cohort of 201 Patients. J Clin Med 2023; 12:jcm12041694. [PMID: 36836231 PMCID: PMC9966646 DOI: 10.3390/jcm12041694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 02/06/2023] [Accepted: 02/13/2023] [Indexed: 02/23/2023] Open
Abstract
The number of unicompartmental knee replacements (UKR) is increasing. Alongside various advantages, the revision rate of cemented UKR is higher compared to total knee arthroplasty (TKR). In contrast, cementless fixation shows reduced revision rates, compared to the cemented UKR. However, most of the recent literature is based on designer-dependent studies. In this retrospective, single-center cohort study, we investigated patients who underwent cementless Oxford UKR (OUKR) between 2012 and 2016 in our hospital with a minimum follow-up of five years. Clinical outcome was evaluated using the OKS, AKSS-O, AKSS-F, FFbH-OA, UCLA, SF-36, EQ-5D-3L, FJS, ROM, pain, and satisfaction measures. Survival analysis was performed with reoperation and revision as endpoints. We included 201 patients (216 knees) for clinical evaluation. All outcome parameters increased significantly from pre- to postoperative stages. The five-year survival rate was 96.1% for revision surgery and 94.9% for reoperation. The main reasons for revision were the progression of osteoarthritis, inlay dislocation, and tibial overstuffing. Two iatrogenic tibial fractures appeared. Cementless OUKR shows excellent clinical outcome and high survival rates after five years. The tibial plateau fracture in cementless UKR represents a serious complication and requires modification of the surgical technique.
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14
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Crawford DA, Rutledge-Jukes H, Alexander JS, Lombardi AV, Berend KR. 15-Year Follow-Up of Mobile Bearing Medial Unicompartmental Knee Arthroplasty. J Arthroplasty 2023:S0883-5403(23)00045-1. [PMID: 36708937 DOI: 10.1016/j.arth.2023.01.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 01/16/2023] [Accepted: 01/20/2023] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Medial unicompartmental knee arthroplasty (UKA) is a successful treatment for antero-medial osteoarthritis. However, there are few published studies on the long-term survival of this procedure. The purpose of this study was to review the 15-year minimum outcomes and survival of a mobile-bearing medial UKA. METHODS A retrospective review was performed between July 2004 and December 2006 of all patients who underwent a medial UKA eligible for a minimum of 15-year follow-up. The initial query revealed 299 patients (349 knees). One hundred-seventeen patients died or were lost to follow-up, leaving 182 patients (219 knees) for analyses. Clinical outcomes and survivorship were analyzed. RESULTS There were 59 implant-related reoperations which occurred at a mean of 10 years (range, 0 to 16 years). The most common reasons for reoperation were arthritic progression (9.1%) and aseptic loosening (9.1%). The 10-year survival with revision to TKA was 89% (95% confidence interval: 86% to 92.4%), and the 15-year survival was 84.1% (95% confidence interval: 80.3% to 88%). There were no statistically significant differences in survival between sex, body mass index, and age. Patients who were not revised had statistically significant improvements in knee range of motion and Knee Society scores. CONCLUSIONS This study found similar long-term survival of a medial mobile-bearing UKA to published total knee arthroplasty outcomes. The implant evaluated in this study has undergone subsequent improvements in instrumentation and design. Further analyses should be performed on the long-term outcomes of the current implant platform.
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15
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Grabherr M, Dimitriou D, Schraknepper J, Helmy N, Flury A. Hybrid fixation of unicompartmental knee arthroplasty shows equivalent short-term implant survivorship and clinical scores compared to standard fixation techniques. Arch Orthop Trauma Surg 2022:10.1007/s00402-022-04710-z. [PMID: 36459235 DOI: 10.1007/s00402-022-04710-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 11/22/2022] [Indexed: 12/04/2022]
Abstract
INTRODUCTION There is a paucity of data regarding hybrid-fixated unicompartmental knee arthroplasty (UKA), and no study directly compared all three available fixation techniques (cementless, cemented, and hybrid). The hypothesis was that hybrid fixation might have a lower incidence of radiolucent lines (RLL) than cemented UKA, with equivalent outcomes to uncemented UKA. MATERIALS AND METHODS A total of 104 UKA with a minimal follow-up of 1 year were retrospectively included, of which 40 were cemented, 41 cementless, and 23 hybrid prostheses. The functional outcomes scores included the Oxford Knee (OKS), Subjective Knee (SKS), and Forgotten Joint scores (FJS). RLLs, subsidence, and component positioning were assessed on radiographs. RESULTS At a mean follow-up of 28 months, the survival rate was 95% for cemented UKA and 100% for the cementless and hybrid UKA (n.s.), respectively. Postoperative FJS (93 vs. 82 points, p = 0.007) and SKS (4.7 vs. 4.1 points, p = 0.001) were better in cementless than cemented UKA, with hybrid-fixated UKA in between the two (90 and 4.4 points, n.s.). Improvement of OKS preoperatively to postoperatively did not differ between the groups (n.s.). RLLs were more frequent in cemented (23%) compared to cementless (5%, p = 0.021) and hybrid UKA (9%, n.s.). With an incidence of 12%, subsidence occurred more commonly in cementless UKA compared to cemented (5%) and hybrid (0%) (n.s.) UKA. CONCLUSION Hybrid fixation achieves equivalent results to standard UKA fixation techniques regarding implant survival and functional and radiological outcomes. Therefore, the hybrid fixation technique seems to be a valuable alternative as it combines the advantages of cemented tibial components with those of uncemented femoral components. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Michael Grabherr
- Orthopaedic and Traumatology Department, Bürgerspital Solothurn, Schöngrünstrasse 38, 4500, Solothurn, Switzerland.
| | - Dimitris Dimitriou
- Orthopaedic and Traumatology Department, Bürgerspital Solothurn, Schöngrünstrasse 38, 4500, Solothurn, Switzerland.,Orthopaedic Department, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Johannes Schraknepper
- Orthopaedic and Traumatology Department, Bürgerspital Solothurn, Schöngrünstrasse 38, 4500, Solothurn, Switzerland
| | - Näder Helmy
- Orthopaedic and Traumatology Department, Bürgerspital Solothurn, Schöngrünstrasse 38, 4500, Solothurn, Switzerland
| | - Andreas Flury
- Orthopaedic and Traumatology Department, Bürgerspital Solothurn, Schöngrünstrasse 38, 4500, Solothurn, Switzerland.,Orthopaedic Department, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
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16
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Gopinath R, DePalma BJ, Costales T, Chapman DM, Dalury DF. The natural history of radiolucencies following cemented unicompartmental knee arthroplasty at 7 years. Knee 2022; 39:203-208. [PMID: 36215922 DOI: 10.1016/j.knee.2022.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 07/15/2022] [Accepted: 09/18/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Radiolucent lines (RLLs) following unicompartmental knee arthroplasty (UKA) can be concerning as aseptic loosening remains a cause of failure in UKA. The aim of our study was to report on the history of RLLs surrounding the components in a cemented medial compartment fixed-bearing UKA as well as the long-term functional outcomes in this group of patients. MATERIAL AND METHODS In this retrospective consecutive case-series, twenty-eight patients (37 knees) were treated with medial, fixed-bearing cemented unicompartmental knee arthroplasty. At average final follow-up of 7.1 years, 36 knees were available for review. Radiographs were taken at six weeks, one year, and final follow up. RLLs were measured using a novel modification to the Knee Society scoring (KSS) system. RESULTS At six-weeks, we identified RLLs in 26 tibias and two femurs out of 37 total knees. At one-year, four additional tibias and both femurs showed some progression of their radiolucencies but were < 2 mm total. At final follow-up, 31 of the 36 tibias (86.1%) and five of the 36 femurs (13.9%) had any RLLs. On the tibial side, RLLs were most common in medial/lateral and anterior/posterior aspects of the tibial tray with few found centrally. On the femoral side, the posterior femoral cut accounted for the most RLLs of any zone at all time points. KSS averaged 93.8 at final follow-up and none of the patients required revision surgery. CONCLUSION RLLs are common following cemented, fixed-bearing UKA. Many seem to progress slowly up to one year but not thereafter. There does not appear to be any association between the presence of these radiolucencies and long-term follow-up function in this group of patients.
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Affiliation(s)
- Rohan Gopinath
- Department of Orthopaedic Surgery, University of Maryland Medical Center, 110 South Paca Street 6th Floor Suite 300, Baltimore, MD 21201, United States
| | - Brian J DePalma
- Department of Orthopaedic Surgery, University of Maryland Medical Center, 110 South Paca Street 6th Floor Suite 300, Baltimore, MD 21201, United States
| | - Timothy Costales
- Department of Orthopaedic Surgery, University of Maryland Medical Center, 110 South Paca Street 6th Floor Suite 300, Baltimore, MD 21201, United States
| | - Danielle M Chapman
- Orthopaedic Institute at University of Maryland St. Joseph's Medical Center, 7601 Osler Dr., Towson, MD 21204, United States
| | - David F Dalury
- Orthopaedic Institute at University of Maryland St. Joseph's Medical Center, 7601 Osler Dr., Towson, MD 21204, United States.
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17
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Leenders AM, Kort NP, Koenraadt KLM, van Geenen RCI, Most J, Kerens B, Boonen B, Schotanus MGM. Patient-specific instruments do not show advantage over conventional instruments in unicompartmental knee arthroplasty at 2 year follow-up: a prospective, two-centre, randomised, double-blind, controlled trial. Knee Surg Sports Traumatol Arthrosc 2022; 30:918-927. [PMID: 33570699 DOI: 10.1007/s00167-021-06471-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 01/21/2021] [Indexed: 01/24/2023]
Abstract
PURPOSE The aim of this two-centre RCT was to compare pre- and post-operative radiological, clinical and functional outcomes between patient-specific instrumentation (PSI) and conventional instrumented (CI) unicompartmental knee arthroplasty (UKA). It was hypothesised that both alignment methods would have comparable post-operative radiological, clinical and functional outcomes. METHODS One hundred and twenty patients were included, and randomly allocated to the PSI or the CI group. Outcome measures were peri-operative outcomes (operation time, length of hospital stay and intra-operative changes of implant size) and post-operative radiological outcomes including the alignment of the tibial and femoral component in the sagittal and frontal plane and the hip-knee-ankle-axis (HKA-axis), rate of adverse events (AEs) and patient-reported outcome measures (PROMs) pre-operatively and at 3, 12 and 24 months post-operatively. RESULTS There was a statistically significant difference (p < 0.05) in alignment of the femoral component in the frontal plane in favour of the CI method. No statistically significant differences were found for the peri-operative data or in the functional outcome at 2-year follow-up. In the PSI group, the approved implant size of the femoral component was correct in 98.2% of the cases and the tibial component was correct in 60.7% of the cases. There was a comparable rate of AEs: 5.1% in the CI and 5.4% in the PSI group. CONCLUSION The PSI method did not show an advantage over CI in regard of positioning of the components, nor did it show an improvement in clinical or functional outcome. We conclude that the possible advantages of PSI do not outweigh the costs of the MRI scan and the manufacturing of the PSI. LEVEL OF EVIDENCE Randomised controlled trial, level I.
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Affiliation(s)
- Alexandra M Leenders
- Department of Orthopaedics, Zuyderland Medical Centre, Dr. H. van der Hoffplein 1, 6162 BG, Sittard-Geleen, The Netherlands. .,Department of Orthopaedics, VieCuri Medical Centre, Tegelseweg 210, 5912 BL, Venlo, The Netherlands.
| | - Nanne P Kort
- CortoClinics, Steeg 6E, 5482 WN, Schijndel, The Netherlands
| | - Koen L M Koenraadt
- Department of Orthopaedics, Amphia Hospital, Molengracht 21, 4814 CK, Breda, The Netherlands
| | - Rutger C I van Geenen
- Department of Orthopaedics, Amphia Hospital, Molengracht 21, 4814 CK, Breda, The Netherlands
| | - Jasper Most
- Department of Orthopaedics, Zuyderland Medical Centre, Dr. H. van der Hoffplein 1, 6162 BG, Sittard-Geleen, The Netherlands
| | - Bart Kerens
- Department of Orthopaedics, AZ Sint-Maarten, Liersesteenweg 435, 2800, Mechelen, Belgium
| | - Bert Boonen
- Department of Orthopaedics, Zuyderland Medical Centre, Dr. H. van der Hoffplein 1, 6162 BG, Sittard-Geleen, The Netherlands
| | - Martijn G M Schotanus
- Department of Orthopaedics, Zuyderland Medical Centre, Dr. H. van der Hoffplein 1, 6162 BG, Sittard-Geleen, The Netherlands.,School of Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre, Universiteitssingel 40, 6229 ER, Maastricht, The Netherlands
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18
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Good mid- to long-term results of the cemented oxford phase 3 unicompartmental knee arthroplasty in a non-designer centre. Knee Surg Sports Traumatol Arthrosc 2022; 30:3215-3219. [PMID: 34251470 PMCID: PMC9418077 DOI: 10.1007/s00167-021-06665-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 07/04/2021] [Indexed: 11/02/2022]
Abstract
PURPOSE Unicompartmental knee arthroplasty (UKA) provides patients with an alternative treatment to TKA in isolated medial compartment osteoarthritis providing better functional outcomes and faster recovery in the short term. Our aim was to quantify revision rates, predictors of revision, mortality rate and functionality of the Oxford Phase 3 UKA in a non-designer institution. METHODS This was a retrospective review of prospectively collected regional registry data. All Oxford Phase 3 UKAs performed for medial tibio-femoral osteoarthritis of the knee joint were included from a single academic institution between the period of January 1st 2006 and December 30th 2009. Kaplan-Meier survivorship curves adjusting for loss to follow-up and deceased patients were generated. Primary outcome variables included all-cause and aseptic revision. Secondary outcome variables included functional outcome scores. Patients were reviewed at 6 months, 2 years, 5 years, 10 years and 15 years. RESULTS A total of 64 cemented Oxford phase 3 UKAs were performed between January 2006 and November 2009. Fifteen-year follow-up data were available for 51 patients, of these 12 required revision. Survival rates, adjusting for patients that were either lost to follow-up or deceased, were 87.5% at 5 years, 81.4% at 10 years and 76.4% at 15 years. The overall aseptic revision rate at the time of review was 18.75% (n = 12). The only significant predictor of postoperative WOMAC score at 15 years was the preoperative WOMAC score (p = 0.03). CONCLUSION The Oxford Phase 3 UKA for medial tibio-femoral arthritis has promising outcomes at 15-year follow-up with a survival rate of 76.4% in a non-designer centre. LEVEL OF EVIDENCE III.
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19
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Martin B, Rahman A, Jenkins C, Mohammad H, Barker K, Dodd C, Jackson W, Price A, Mellon S, Murray D. Comparison of five-year clinical outcomes of 524 cemented and cementless medial unicompartmental knee replacements. Knee 2022; 34:89-97. [PMID: 34883332 DOI: 10.1016/j.knee.2021.08.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 07/08/2021] [Accepted: 08/13/2021] [Indexed: 02/02/2023]
Abstract
AIM To compare the outcomes of cemented and cementless Unicompartmental Knee Replacements (UKR) at 5 years after surgery. METHODS 262 cemented and 262 cementless medial mobile-bearing UKR, implanted by four high-volume surgeons using identical indications and surgical techniques, were reviewed by independent physiotherapists at 5 years. Survival, Oxford Knee Score (OKS), American Knee Society Score (AKSS), and EQ-5D-5L were assessed. The cementless cohort was mainly implanted after the cemented. Each cohort was divided into early and late sub-groups and compared, to assess if any differences were due to progressive improvement in surgical practice over time. RESULTS There were no significant differences between the cohorts for demographics, pre-operative scores, and 5-year revision (0.8%), re-operation (1.5%), and complication rates (5%). The cementless cohort had significantly better 5-year OKS (43v41, p = 0.008), AKSS-Objective (94v90, p = 0.049) and EQ-5D-5L (0.81v0.87, p = 0.0001). Pain sub-scores within OKS, AKSS, and EQ-5D-5L were also significantly better in the cementless cohort, and the differences were proportionally much greater and more significant than differences in their respective overall scores. There was no significant improvement in scores between the early and late subgroups of the cohorts, whereas the 'early-cementless' cohort had significantly better scores than the contemporaneously implanted 'late-cemented' cohort. This suggests that differences found were due to implant type, instead of improved surgical practice over time. CONCLUSION Cementless UKR is associated with better clinical outcomes than cemented UKR, which is primarily due to improved pain relief. Both cemented and cementless UKR are safe with low reoperation and complication rates, and a 5-year survival of 99%.
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Affiliation(s)
- Benjamin Martin
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Azmi Rahman
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom.
| | - Cathy Jenkins
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Hasan Mohammad
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Karen Barker
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Christopher Dodd
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - William Jackson
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Andrew Price
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Stephen Mellon
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - David Murray
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
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20
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Beckers L, Dandois F, Ooms D, Berger P, Van Laere K, Scheys L, Vandenneucker H. Assessment of in vivo bone activity patterns in medial mobile-bearing unicompartmental knee arthroplasty : a prospective SPECT/CT study. Bone Joint J 2022; 104-B:34-44. [PMID: 34969270 DOI: 10.1302/0301-620x.104b1.bjj-2021-0121.r2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
AIMS Higher osteoblastic bone activity is expected in aseptic loosening and painful unicompartmental knee arthroplasty (UKA). However, insights into normal bone activity patterns after medial UKAs are lacking. The aim of this study was to identify the evolution in bone activity pattern in well-functioning medial mobile-bearing UKAs. METHODS In total, 34 patients (13 female, 21 male; mean age 62 years (41 to 79); BMI 29.7 kg/m2 (23.6 to 42.1)) with 38 medial Oxford partial UKAs (20 left, 18 right; 19 cementless, 14 cemented, and five hybrid) were prospectively followed with sequential 99mTc-hydroxymethane diphosphonate single photon emission CT (SPECT)/CT preoperatively, and at one and two years postoperatively. Changes in mean osteoblastic activity were investigated using a tracer localization scheme with volumes of interest (VOIs), reported by normalized mean tracer values. A SPECT/CT registration platform additionally explored cortical tracer evolution in zones of interest identified by previous experimental research. RESULTS Significant reduction of tracer activity from the preoperative situation was found in femoral and anteromedial tibial VOIs adjacent to the UKA components. Temporarily increased osteoblastic bone activity was observed in VOIs comprising the UKA keel structure at one year postoperatively compared to the preoperative activity. Persistent higher tracer uptake was found in the posterior tibial cortex at final follow-up. Multivariate analysis showed no statistical difference in osteoblastic bone activity underneath cemented or cementless components. CONCLUSION Well-functioning medial mobile-bearing UKAs showed distinct changes in patterns of normalized bone tracer activity in the different VOIs adjacent to the prosthetic components, regardless of their type of fixation. Compared to the preoperative situation, persistent high bone activity was found underneath the keel and the posterior tibial cortex at final follow-up, with significant reduced activity only being identified in femoral and anteromedial tibial VOIs. Cite this article: Bone Joint J 2022;104-B(1):34-44.
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Affiliation(s)
- Lucas Beckers
- KULeuven/University Hospitals Leuven, Institute for Orthopaedic Research and Training (IORT), Leuven, Belgium
| | - Félix Dandois
- KULeuven/University Hospitals Leuven, Institute for Orthopaedic Research and Training (IORT), Leuven, Belgium
| | - Dirk Ooms
- Department of Nuclear Medicine and Molecular Imaging, Katholieke Universiteit Leuven Universitaire Ziekenhuizen Leuven, Leuven, Belgium.,Department of Nuclear Medicine, OLV Ziekenhuis Campus Aalst, Aalst, Belgium
| | - Pieter Berger
- KULeuven/University Hospitals Leuven, Institute for Orthopaedic Research and Training (IORT), Leuven, Belgium
| | - Koen Van Laere
- Department of Nuclear Medicine and Molecular Imaging, Katholieke Universiteit Leuven Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | - Lennart Scheys
- KULeuven/University Hospitals Leuven, Institute for Orthopaedic Research and Training (IORT), Leuven, Belgium
| | - Hilde Vandenneucker
- KULeuven/University Hospitals Leuven, Institute for Orthopaedic Research and Training (IORT), Leuven, Belgium
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21
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Patel KT, Lewis TL, Gill P, Chatterton M. The patient perspective, experience and satisfaction of day case unicompartmental knee arthroplasty: A short-term mixed-methods study. Knee 2021; 33:378-385. [PMID: 34775281 DOI: 10.1016/j.knee.2021.10.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 07/04/2021] [Accepted: 10/13/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Day case unicompartmental knee arthroplasty (UKA) is increasingly being performed worldwide. When performed in the appropriate patient, day case UKA has been demonstrated to be safe, cost effective and improve resource allocation. Limited evidence highlights increased patient satisfaction of day case UKA when compared with inpatient UKA. A detailed study of the patient perspective, experience and satisfaction following day case UKA has not been described before. METHODS A retrospective case series review of 21 consecutive patients (19 unilateral, 2 bilateral) undergoing day case UKA in an elective orthopaedic centre was undertaken. A qualitative and quantitative patient assessment of the day case UKA experience was administered. A five-point Likert scale satisfaction questionnaire, Oxford Knee Score (OKS) and open-ended interview was undertaken. The qualitative responses underwent thematic analysis. RESULTS One hundred percent of patients expressed satisfaction (76.2% completely satisfied, 33.8% moderately satisfied) with day case UKA. The majority of patients (90.5%) reported that if they had to undergo UKA again they would prefer a day case over an inpatient procedure. Patients consider surgical outcome, physiotherapy provision, discharge planning, postoperative medications and follow up as key aspects of day case UKA care. One patient was re-admitted following discharge. CONCLUSIONS The present study demonstrates a high level of patient satisfaction with day case UKA. The results reported herein are subject to the study limitations of sample size, recall bias and inclusion criteria. We recommend that the themes identified by patients are addressed through a multidisciplinary approach with well-defined clinical pathways for a high-quality patient-centred experience.
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Affiliation(s)
- K T Patel
- Department of Trauma and Orthopaedic Surgery, Princess Royal University Hospital, King's College NHS Foundation Trust, Farnborough Common, Orpington, UK.
| | - T L Lewis
- Department of Trauma and Orthopaedic Surgery, Princess Royal University Hospital, King's College NHS Foundation Trust, Farnborough Common, Orpington, UK
| | - P Gill
- Department of Trauma and Orthopaedic Surgery, Princess Royal University Hospital, King's College NHS Foundation Trust, Farnborough Common, Orpington, UK
| | - M Chatterton
- Department of Trauma and Orthopaedic Surgery, Princess Royal University Hospital, King's College NHS Foundation Trust, Farnborough Common, Orpington, UK
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22
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Xue L, Xue H, Wen T, Guan M, Yang T, Ma T, Tu Y. Assessment of radiolucent lines in patients with lateral unicompartmental knee arthroplasty and the relationship between these lines and the outcome. INTERNATIONAL ORTHOPAEDICS 2021; 45:2017-2023. [PMID: 34173848 DOI: 10.1007/s00264-021-05115-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 06/14/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To assess the radiolucent lines (RLLs) around both tibial and femoral components in patients following lateral unicompartmental knee arthroplasty (UKA). METHODS We performed a retrospective review of the records of a consecutive series of patients who had undergone lateral UKA. The RLLs were assessed with standard anteroposterior and lateral radiographs post-operatively. The patient-reported outcome measures included the Hospital for Special Surgery (HSS) score and Oxford knee score (OKS). The femoral component position (FCP) and femoral-tibial angle (FTA) were also recorded. RESULTS A total of 198 UKAs that had appropriate radiographs and outcome scores were reviewed with a median follow-up of 33 (range, 12-71) months. The results suggested that 69 cases (34.8%) had RLLs on the standard radiographs. The incidence rates of femoral and tibial physiological RLLs were 11.6% (23/198) and 26% (52/198), respectively, of which 3% (6/198) concerned both components. All RLLs were considered "physiologic lines" that developed within one year after surgery. There were no significant differences among the types of RLLs in any of the outcome measures. No differences in FCP (P = .359) or FTA (P = .111) at the last follow-up were seen. CONCLUSIONS It was found that one-third of UKAs had RLLs on radiographs following lateral UKA. All RLLs developed within one year after surgery. As a clinical consequence, the development of RLLs does not affect the short-term outcomes after lateral UKA.
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Affiliation(s)
- Long Xue
- Department of Orthopaedics, Yangpu Hospital Affiliated to Tongji University School of Medicine, 450 Tengyue Road, Shanghai, 200090, China
| | - Huaming Xue
- Department of Orthopaedics, Yangpu Hospital Affiliated to Tongji University School of Medicine, 450 Tengyue Road, Shanghai, 200090, China
| | - Tao Wen
- Department of Orthopaedics, Yangpu Hospital Affiliated to Tongji University School of Medicine, 450 Tengyue Road, Shanghai, 200090, China
| | - Mengying Guan
- Department of Orthopaedics, Yangpu Hospital Affiliated to Tongji University School of Medicine, 450 Tengyue Road, Shanghai, 200090, China
| | - Tao Yang
- Department of Orthopaedics, Yangpu Hospital Affiliated to Tongji University School of Medicine, 450 Tengyue Road, Shanghai, 200090, China
| | - Tong Ma
- Department of Orthopaedics, Yangpu Hospital Affiliated to Tongji University School of Medicine, 450 Tengyue Road, Shanghai, 200090, China
| | - Yihui Tu
- Department of Orthopaedics, Yangpu Hospital Affiliated to Tongji University School of Medicine, 450 Tengyue Road, Shanghai, 200090, China.
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Ma J, Yan Y, Wang W, Wang B, Yue D, Guo W. Lower early revision rates after uncemented Oxford Unicompartmental Knee Arthroplasty (UKA) than cemented Oxford UKA: A meta-analysis. Orthop Traumatol Surg Res 2021; 107:102802. [PMID: 33429085 DOI: 10.1016/j.otsr.2021.102802] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/22/2020] [Accepted: 08/18/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND UKA has been proved to offer good results in treating patients with unicompartmental knee osteoarthritis (OA). However, there is still a controversy about the better fixation mode in UKA procedure between cemented and uncemented prosthesis. Therefore, this meta-analysis was conducted to compare clinical and radiological outcomes of cemented versus uncemented Oxford UKA. HYPOTHESIS The study surmised that uncemented Oxford UKA was associated with shorter operation time, higher function scores, lower revision rate and less radiolucency than cemented Oxford UKA. METHODS A meta-analysis to compare postoperative outcomes between cemented and uncemented Oxford UKA wsa conducted. The primary outcomes included Oxford knee score (OKS), revision rate, and incidence of radiolucency. The secondary outcomes included operation time, knee society score (KSS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), range of motion (ROM). PubMed, Embase, Web of Science, the Cochrane Library and China national knowledge infrastructure were searched until April, 2020 to identify studies for including. Relevant data were analyzed using RevMan v5.3. RESULTS We identified nine studies involving 901 patients meeting our inclusion criteria. No significant difference of OKS was found in both groups. Compared with cemented group, uncemented Oxford UKA group was associated with lower revision rate (95% CI: 0.90 to 3.73; OR=1.83) and less radiolucent lines (95% CI: 0.79 to 9.52; OR=2.75) after following up for at least 2years. The operation time was significantly shorter by 10.12minutes (95% CI: p<0.00001) in the uncemented group when compared against the cemented group. The KSS, WOMAC, ROM were not significantly different between two groups. CONCLUSIONS Uncemented Oxford UKA had lower revision rate, shorter operation time and less radiolucent lines than cemented Oxford UKA did. There is still need for more long follow-up clinical trials with high evidence level to determine which method of fixation is of preferable for Oxford UKA in the future. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Jinhui Ma
- Department of Orthopaedic Surgery, Center for Osteonecrosis and Joint Preserving & Reconstruction, China-Japan Friendship Hospital, 2 Yinghuadong Road, Chaoyang District, Beijing 100029, China
| | - Yan Yan
- Department of Orthopaedic Surgery, Peking University China-Japan Friendship School of Clinical Medicine, Beijing 100029, China
| | - Weiguo Wang
- Department of Orthopaedic Surgery, Center for Osteonecrosis and Joint Preserving & Reconstruction, China-Japan Friendship Hospital, 2 Yinghuadong Road, Chaoyang District, Beijing 100029, China
| | - Bailiang Wang
- Department of Orthopaedic Surgery, Center for Osteonecrosis and Joint Preserving & Reconstruction, China-Japan Friendship Hospital, 2 Yinghuadong Road, Chaoyang District, Beijing 100029, China.
| | - Debo Yue
- Department of Orthopaedic Surgery, Center for Osteonecrosis and Joint Preserving & Reconstruction, China-Japan Friendship Hospital, 2 Yinghuadong Road, Chaoyang District, Beijing 100029, China
| | - Wanshou Guo
- Department of Orthopaedic Surgery, Center for Osteonecrosis and Joint Preserving & Reconstruction, China-Japan Friendship Hospital, 2 Yinghuadong Road, Chaoyang District, Beijing 100029, China
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24
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Belsey J, Yasen SK, Jobson S, Faulkner J, Wilson AJ. Return to Physical Activity After High Tibial Osteotomy or Unicompartmental Knee Arthroplasty: A Systematic Review and Pooling Data Analysis. Am J Sports Med 2021; 49:1372-1380. [PMID: 32960075 PMCID: PMC8020302 DOI: 10.1177/0363546520948861] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 05/22/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND The 2 most common definitive surgical interventions currently performed for the treatment of medial osteoarthritis of the knee are medial opening wedge high tibial osteotomy (HTO) and medial unicompartmental knee arthroplasty (UKA). Research exists to suggest that physically active patients may be suitably indicated for either procedure despite HTO being historically indicated in active patients and UKA being more appropriate for sedentary individuals. PURPOSE To help consolidate the current indications for both procedures regarding physical activity and to ensure that they are based on the best information presently available. STUDY DESIGN Systematic review. METHODS A search of the literature via the MEDLINE, Embase, and PubMed databases was conducted independently by 2 reviewers in accordance with the PRISMA (Preferred Reporting Items for Systematic Meta-Analyses) guidelines. Studies that reported patient physical activity levels with the Tegner activity score were eligible for inclusion. Patient demographics, operative variables, and patient-reported outcome scores were abstracted from the included studies. RESULTS Thirteen eligible studies were included, consisting of 401 knees that received HTO (399 patients) and 1622 that received UKA (1400 patients). The patients' mean age at surgery was 48.4 years for the HTO group and 60.6 years for the UKA group. Mean follow-up was 46.6 months (HTO) and 53.4 months (UKA). All outcome scores demonstrated an equal or improved score for activity and knee function regardless of the operation performed. Operative variables during HTO had a larger effect on outcome than during UKA. CONCLUSION Patients who underwent HTO were more physically active pre- and postoperatively, but patients undergoing UKA experienced an overall greater increase in their physical activity levels and knee function according to Tegner and Lysholm scores. Activity after HTO may be influenced by operative factors such as the implant used and the decision to include a graft material in the osteotomy gap, although this requires further research. Some studies found that patients were able to return to physical activity postoperatively despite having an age or body mass index that would traditionally be a relative contraindication for HTO or UKA.
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Affiliation(s)
| | - Sam K. Yasen
- Hampshire Hospitals NHS Foundation
Trust, Basingstoke, UK
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25
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Beckmann J, Hirschmann MT, Matziolis G, Holz J, V Eisenhart-Rothe R, Becher C. [Recommendations for unicondylar knee replacement in the course of time : A current inventory]. DER ORTHOPADE 2021; 50:104-111. [PMID: 33346867 DOI: 10.1007/s00132-020-04054-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND A higher patient satisfaction stands in contrast to higher revision rates of unicondylar knee joint endoprosthetics (UKE) compared to total knee joint endoprosthetics (TKE). Furthermore, old "dogmas" regarding indications and contraindications persist, which is still reflected in the significantly different case numbers. AIM The aim of this article is to provide an overview of the current literature regarding 1. indication and contraindication (BMI, age, sport, arthrosis of other compartments, ligament status) and 2. the "eternal rival" fixed or mobile bearing for UKE. RESULTS The choice of the right patient remains essential, even if all the old "dogmas" of contraindications have been relativized or even outdated. Arthroses of the contralateral (in medial UKE correspondingly lateral) compartment and advanced arthroses of the lateral patella facet remain the only persistent contraindications. In contrast, a high BMI, age, chondrocalcinosis, medial patella facet and a defective (but particularly functionally stable) ACL are not contraindications; however, severe obesity is responsible for a significantly higher complication rate and probably a higher rate of loosening. Rather, the experience and thus the number of UKEs of the individual surgeon is decisive for the outcome, to which the discussion about mobile or fixed inlays must also be completely subordinated. CONCLUSION The indications for UKE can, therefore, be extended with a clear conscience on the basis of literature, and the current 1:10 UKE:TKE ratio in Germany can be shifted significantly.
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Affiliation(s)
- J Beckmann
- Sportklinik Stuttgart, Taubenheimstr. 8, 70372, Stuttgart, Deutschland.
| | | | - G Matziolis
- Waldkliniken Eisenberg, Eisenberg, Deutschland
| | - J Holz
- OrthoCentrum Hamburg, Hamburg, Deutschland
| | - R V Eisenhart-Rothe
- Klinikum rechts der Isar der Technischen Universität München, München, Deutschland
| | - C Becher
- IZO - Internationales Zentrum für Orthopädie, ATOS Klinik Heidelberg, Heidelberg, Deutschland
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26
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Gupta V, Kejriwal R, Frampton C. Revision Following Cemented and Uncemented Oxford-III Primary Medial Unicompartmental Knee Replacements: A 19-Year Analysis from the New Zealand Joint Registry. J Bone Joint Surg Am 2020; 102:1777-1783. [PMID: 33086344 DOI: 10.2106/jbjs.19.01443] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Oxford-III unicompartmental knee replacements (UKRs) are among the most commonly used prostheses to treat isolated medial compartment osteoarthritis (OA). However, the best mode of implant fixation for primary UKRs remains a source of debate. The hypothesis of this study was that the biologically superior fixation of uncemented Oxford-III primary UKRs would translate into a lower revision rate when compared with cemented Oxford-III primary UKRs used to treat isolated medial compartment OA. METHODS Data on all Oxford-III primary UKRs (n = 8,733) completed for isolated medial compartment OA from January 2000 to December 2018 were obtained from the New Zealand Joint Registry (NZJR). Revision rates were documented for each fixation type and analyzed for associations with patient sex and age at surgery. A multivariate Cox proportional-hazards analysis was completed to determine if type of fixation was an independent risk factor for revision of Oxford-III UKRs. RESULTS Statistical analysis revealed a >1.8-fold greater revision risk for cemented Oxford-III UKRs compared with uncemented Oxford-III UKRs (p = 0.001) when considered independently of other risk factors. Furthermore, compared with uncemented fixation, cemented fixation was associated with a 2.9-fold (p < 0.001) increase in revision risk for women <65 years old and a 1.7-fold (p = 0.008) increase in revision risk for men 55 to 74 years old. There was no significant difference in the risk of revision between fixation methods for women ≥65 years old and men ≥75 years old. CONCLUSIONS We found that the type of fixation was an independent risk factor for revision of Oxford-III UKRs used in the treatment of isolated medial compartment OA. Uncemented Oxford-III primary UKRs had superior implant survivorship in women <65 years old and men 55 to 74 years old. Age and sex are important factors to consider when determining the type of fixation for Oxford-III primary UKRs used to treat isolated medial compartment OA. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Vikesh Gupta
- Department of Orthopaedic Surgery, Whangarei Base Hospital, Whangarei, New Zealand
| | - Ritwik Kejriwal
- Department of Orthopaedic Surgery, Taranaki Base Hospital, New Plymouth, New Zealand
| | - Chris Frampton
- Department of Medicine, The University of Otago, Christchurch, New Zealand
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Mittal A, Meshram P, Kim WH, Kim TK. Unicompartmental knee arthroplasty, an enigma, and the ten enigmas of medial UKA. J Orthop Traumatol 2020; 21:15. [PMID: 32876817 PMCID: PMC7468046 DOI: 10.1186/s10195-020-00551-x] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 07/22/2020] [Indexed: 12/17/2022] Open
Abstract
Unicompartmental knee arthroplasty (UKA) is a bone- and ligament-sparing alternative to total knee arthroplasty in the patients with end-stage single-compartment degeneration of the knee. Despite being a successful procedure, the multiple advantages of UKA do not correlate with its usage, most likely due to the concerns regarding prosthesis survivability, patient selection, ideal bearing design, and judicious use of advanced technology among many others. Therefore, the purpose of this study is to review and summarize the debated literature and discuss the controversies as “Ten Enigmas of UKA.”
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Affiliation(s)
- Anurag Mittal
- TK Orthopedic Surgery, 55 Dongpangyo-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13535, Republic of Korea
| | - Prashant Meshram
- Department of Orthopaedics, Johns Hopkins Medical Institute, 2360 West Joppa Road, Suite 306, Baltimore, MD, 21093, USA
| | - Woo Hyun Kim
- TK Orthopedic Surgery, 55 Dongpangyo-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13535, Republic of Korea
| | - Tae Kyun Kim
- TK Orthopedic Surgery, 55 Dongpangyo-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13535, Republic of Korea.
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28
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Kagan R, Anderson MB, Bailey T, Hofmann AA, Pelt CE. Ten-Year Survivorship, Patient-Reported Outcomes, and Satisfaction of a Fixed-Bearing Unicompartmental Knee Arthroplasty. Arthroplast Today 2020; 6:267-273. [PMID: 32577476 PMCID: PMC7303483 DOI: 10.1016/j.artd.2020.02.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 02/20/2020] [Accepted: 02/23/2020] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND We sought to determine the 10-year survivorship and reasons for revision for a fixed-bearing unicompartmental knee arthroplasty (UKA) design. In addition, we report on patient-reported outcomes and satisfaction and compare results of medial vs lateral compartment UKA and cemented vs cementless UKA with the same design. METHODS We performed a retrospective cohort study on a single-surgeon case series using a single fixed-bearing UKA design in 158 consecutive patients who underwent 177 UKA procedures between July 2000 and December 2010. Cases missing follow-up within the last year, clinically or via telephone, were excluded (n = 17, 10%). A cumulative incidence competing risk model was used to evaluate the cumulative incidence of failure. RESULTS Cumulative incidence of revision at a mean follow-up of 10 years was 13%. The majority of revisions (43%, 10/23) were for aseptic tibial component loosening, followed by progression of osteoarthritis (5/23, 22%). All Patient Reported Outcomes Measurement Information System measures demonstrated mean T-scores within one standard deviation from the US population norm. The mean Knee Injury and Osteoarthritis Outcome Score for Joint Replacement was 96.9 (range, 40-100). The mean pain score was 3.8 (range, 0-8). Eighty-six percent of patients were satisfied with the UKA. CONCLUSIONS At 10-year follow-up, the most common causes for revision were aseptic tibial loosening and adjacent compartment knee arthroplasty, and similar results were found for medial vs lateral compartment and for cemented vs cementless UKA. Surgeons should consider these findings for future UKA designs, and this represents the first study reporting on survivorship and outcomes of this specific UKA design.
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Affiliation(s)
- Ryland Kagan
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR, USA
| | - Mike B. Anderson
- Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Travis Bailey
- Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | | | - Christopher E. Pelt
- Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, UT, USA
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29
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Panzram B, Mandery M, Reiner T, Gotterbarm T, Schiltenwolf M, Merle C. Cementless Oxford Medial Unicompartmental Knee Replacement-Clinical and Radiological Results of 228 Knees with a Minimum 2-Year Follow-Up. J Clin Med 2020; 9:jcm9051476. [PMID: 32423118 PMCID: PMC7290835 DOI: 10.3390/jcm9051476] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/06/2020] [Accepted: 05/11/2020] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Studies show several advantages of unicompartmental knee replacement (UKR) over total knee replacements (TKR), whereas registry based revision rates of UKR are significantly higher than for TKA. Registry data report lower revision rates for cementless UKR compared to cemented UKR. The aim of this study was to assess clinical and radiological results of cementless Oxford UKR (OUKR) in an independent cohort. (2) Methods: This retrospective cohort study examines a consecutive series of 228 cementless OUKR. Clinical outcome was measured using functional scores (Oxford Knee Score (OKS), American Knee Society Score (AKSS), Hannover Functional Ability Questionnaire for Osteoarthritis (FFbH-OA), range of motion (ROM)), pain and satisfaction. Radiographs were analyzed regarding the incidence of radiolucent lines (RL), implant positioning, and their possible impact on clinical outcome. (3) Results: At a mean follow-up of 37.1 months, the two and three year revision free survival-rates were 97.5% and 96.9%. Reasons for revision surgery were progression of osteoarthritis, inlay dislocation and pain. All clinical outcome scores showed a significant improvement from pre- to postoperative. The incidence of RL around the implant was highest within the first year postoperatively (36%), and decreased (5%) within the second year. Their presence was not correlated with inferior clinical outcome. Implant positioning showed no influence on clinical outcome. (4) Conclusion: Cementless OUKR showed excellent clinical outcome and survival rates, with reliable osteointegration. Neither the incidence of radiolucent lines nor implant positioning were associated with inferior clinical outcome.
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Mohammad HR, Kennedy JA, Mellon SJ, Judge A, Dodd CA, Murray DW. Ten-year clinical and radiographic results of 1000 cementless Oxford unicompartmental knee replacements. Knee Surg Sports Traumatol Arthrosc 2020; 28:1479-1487. [PMID: 31209540 PMCID: PMC7176592 DOI: 10.1007/s00167-019-05544-w] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 05/16/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE Unicompartmental knee replacement (UKR) has substantial benefits over total knee replacement (TKR) but has higher revision rates. The cementless Oxford UKR was introduced to address this but there are concerns about fixation and tibial plateau fractures. The first long-term study of the device with clinical and radiographic outcomes is reported. METHODS The first 1000 medial cementless Oxford UKR were prospectively identified and followed up by independent physiotherapists. Survival was calculated using the endpoints reoperation, revision, revision to TKR, major revision requiring revision TKR components and patient mortality. The Oxford Knee Score (OKS), Tegner Activity Score and American Knee Society Score (AKSS) were recorded and radiographs analysed. RESULTS The ten year survival was 96.6% (CI 94.8-97.8), 97.5% (CI 95.7-98.5), 98.9% (CI 97.7-99.4) and 99.6% (CI 98.8-99.9) using reoperation, revision, revision to TKR and major revision as the endpoint, respectively. Commonest causes for revision were bearing dislocation (n = 7, 0.7%), disease progression (n = 4, 0.4%) and pain (n = 2, 0.2%). There was one lateral tibial plateau fracture and one femoral component loosening. At 10 years, the mean OKS was 41.2 (SD 9.8), Tegner 2.8 (SD 1.3), AKSS-O 89.1 (SD 13.0) and AKSS-F 80.4 (SD 14.6). There were no pathological radiolucencies or complete radiolucent lines. There were no implant-related deaths. CONCLUSIONS The cementless Oxford UKR is a safe procedure with excellent long-term clinical results. Our results suggest that reliable fixation was achieved with only one (0.1%) revision for loosening (femoral), no radiographic evidence of loosening in the remaining cases and no fractures related to implantation. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Hasan R. Mohammad
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK ,Oxford University Hospitals NHS Foundation Trust, Nuffield Orthopaedic Centre, Oxford, UK
| | - James A. Kennedy
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK ,Oxford University Hospitals NHS Foundation Trust, Nuffield Orthopaedic Centre, Oxford, UK
| | - Stephen J. Mellon
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Andrew Judge
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Christopher A. Dodd
- Oxford University Hospitals NHS Foundation Trust, Nuffield Orthopaedic Centre, Oxford, UK
| | - David W. Murray
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK ,Oxford University Hospitals NHS Foundation Trust, Nuffield Orthopaedic Centre, Oxford, UK
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Karaca S, Erdem MN, Oztermeli A, Bal E, Gogus A, Hamzaoglu A. Clinical and Radiological Results of Oxford Phase-3 Medial Unicompartmental Knee Arthroplasty. Cureus 2019; 11:e6070. [PMID: 31832288 PMCID: PMC6892577 DOI: 10.7759/cureus.6070] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Purpose The aim of this retrospective study was to investigate the effectiveness of medial unicompartmental knee arthroplasty (UKA) by showing the results of the radiological and clinical outcomes of the patients. Materials and methods Seventy-two knees of 54 patients who underwent UKA between September 2005 and March 2011 for medial knee arthritis with a minimum follow-up of six months were evaluated. Range of motion (ROM), Hospital for Special Surgery (HSS) knee score, Knee Society Score (KSS), and Oxford Knee Score (OKS) were investigated both preoperatively and postoperatively. On the other hand, Oxford radiographic evaluation criteria were used to evaluate prostheses radiologically at the final follow-up. Results The average age was 53.4 years (47 to 79 years). The average follow-up time was 39.8 months (8 to 72 months). There was a significant difference between preoperative and postoperative ROM, HSS, and OKS (p<0.05). Radiologically, there was no sign of arthritis on the unoperated side of the knee or failure of prosthesis detected. Before the operation, the average clinical KSS was 63.2 and improved to 91.4 after the operation. In addition, the average functional KSS was 54.9 before the operation and improved to 86.5 after the operation. The average knee flexion degree was 109.1 before the operation and there was an improvement to 123.6 degrees after the operation. Before the operation, the average HSS score was 67.5 (range, 52 to 75) and improved to 89.9 (range, 85 to 100) at the final control examination. Conclusion This study supports the use of Oxford Phase 3 UKA, which has excellent clinical and radiological results in patients with medial knee arthritis.
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Affiliation(s)
- Sinan Karaca
- Orthopaedics and Traumatology, Sehit Prof. Dr. Ilhan Varank Sancaktepe Education and Research Hospital, Istanbul, TUR
| | - Mehmet N Erdem
- Orthopaedics and Traumatology, Isik University, Istanbul, TUR
| | - Ahmet Oztermeli
- Orthopaedics and Traumatology, Gebze Fatih Government Hospital, Izmit, TUR
| | - Emre Bal
- Orthopaedics and Traumatology, Uskudar Goverment Hospital, Istanbul, TUR
| | - Abdullah Gogus
- Orthopaedics and Traumatology, Istanbul Florence Nightingale Hospital, Istanbul, TUR
| | - Azmi Hamzaoglu
- Orthopaedics and Traumatology, Istanbul Florence Nightingale Hospital, Istanbul, TUR
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Knifsund J, Reito A, Haapakoski J, Niinimäki T, Eskelinen A, Leskinen J, Puhto AP, Kettunen J, Manninen M, Mäkelä KT. Short-term survival of cementless Oxford unicondylar knee arthroplasty based on the Finnish Arthroplasty Register. Knee 2019; 26:768-773. [PMID: 30929792 DOI: 10.1016/j.knee.2019.03.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 01/18/2019] [Accepted: 03/08/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Cementless unicondylar knee arthroplasty (UKA) was introduced to secure long-term fixation and reduce the risk of revision. Experience with cementless UKA fixation is limited. METHODS The short-term survival (up to five years) of cementless Oxford UKA was assessed using data from the Finish Arthroplasty Register and was compared with that of cemented Oxford 3 UKA and total knee arthroplasty (TKA). Datawere obtained, from the Finnish Arthroplasty Register, on 1076 cementless Oxford UKAs and 2279 cemented Oxford 3 UKAs performed for primary osteoarthritis in 2005-2015. The Kaplan-Meier method, with revision for any reason as the endpoint, was used to assess the survival of these two UKA groups, and the results were compared with that of 65,563 cemented TKAs treated for primary osteoarthritis over the same period. The risk of revision of both Oxford prostheses was compared using Cox regression model, with adjustment for age and sex, with the cemented TKA group as reference. RESULTS The three-year survival was 93.7% for the cementless Oxford, 92.2% for the cemented Oxford 3, and 97.3% for the cemented TKA. The corresponding figures at five years were 92.3%, 88.9%, and 96.6%, respectively. The revision rate for both the cementless Oxford and the cemented Oxford 3 was significantly increased when compared with the cemented TKA (P < 0.001). CONCLUSIONS The survival of the cementless Oxford method was higher than that of the cemented Oxford 3 in the short term. The overall survival of Oxford UKA was poor in comparison with contemporary TKAs.
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Affiliation(s)
- Jani Knifsund
- Department of Orthopaedics and Traumatology, Turku University Hospital, Turku, Finland.
| | - Aleksi Reito
- Coxa Hospital for Joint Replacement, Tampere, Finland
| | | | - Tuukka Niinimäki
- Department of Orthopaedics and Traumatology, Oulu University Hospital, Oulu, Finland
| | | | - Jarkko Leskinen
- Department of Orthopaedics and Traumatology, Helsinki University Hospital, Helsinki, Finland
| | - Ari-Pekka Puhto
- Department of Orthopaedics and Traumatology, Oulu University Hospital, Oulu, Finland
| | - Jukka Kettunen
- Department of Orthopaedics and Traumatology, Kuopio University Hospital, Kuopio, Finland
| | | | - Keijo T Mäkelä
- Department of Orthopaedics and Traumatology, Turku University Hospital, Turku, Finland
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Horsager K, Madsen F, Odgaard A, Fink Jepsen C, Rømer L, Kristensen PW, Kaptein BL, Søballe K, Stilling M. Similar polyethylene wear between cemented and cementless Oxford medial UKA: a 5-year follow-up randomized controlled trial on 79 patients using radiostereometry. Acta Orthop 2019; 90:67-73. [PMID: 30526183 PMCID: PMC6366473 DOI: 10.1080/17453674.2018.1543757] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Hydroxyapatite (HA)-coated implants have been associated with high polyethylene wear in hip arthroplasties. HA coating as a promoter of wear in knee arthroplasties has not been investigated. We compared the wear-rate of the polyethylene bearing for cemented and cementless HA-coated Oxford medial unicondylar knee arthroplasties (UKA). Secondarily, we investigated whether wear-rates were influenced by overhang or impingement of the bearing. Patients and methods - 80 patients (mean age 64 years), treatment-blinded, were randomized to 1 of 3 Oxford medial UKA versions: cemented with double-pegged or single-pegged femoral component or cementless HA-coated with double-pegged femoral component (ratios 1:1:1). We compared wear between the cemented (n = 55) and cementless group (n = 25) (ratio 2:1). Wear, impingement, and overhang were quantified between surgery and 5-year follow-up using radiostereometry. Clinical outcome was evaluated with the Oxford Knee Score. Results - The mean wear-rate for patients without bearing overhang was 0.04 mm/year (95% CI 0.02-0.07) for the cemented group and 0.05 mm/year (CI 0.02-0.08) for the cementless group. The mean difference in wear was 0.008 mm/year (CI -0.04 to 0.03). No impingement was identified. Half of the patients had medial bearing overhang, mean 2.5 mm (1-5). Wear increased by 0.014 mm/year for each mm increment in overhang. The mean Oxford Knee Score was 39 for the cementless group and 38 for the cemented group at the 5-year follow-up. Interpretation - The wear-rates were similar for the 2 fixation methods, which supports further use of the cementless Oxford medial UKA. However, a caveat is a relatively large 95% CI of the mean difference in wear-rate. Component size and position is important as half of the patients presented with an additional increase in wear-rate due to medial bearing overhang.
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Affiliation(s)
- Kristian Horsager
- Department of Clinical Institute, Aarhus University, Aarhus, Denmark
| | - Frank Madsen
- Department of Orthopedics, Aarhus University Hospital, Aarhus, Denmark
| | - Anders Odgaard
- Department of Orthopaedics, Herlev-Gentofte Hospital, Copenhagen University Hospital, Hellerup, Denmark
| | - Claus Fink Jepsen
- Department of Orthopedics, Aarhus University Hospital, Aarhus, Denmark
| | - Lone Rømer
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Bart L Kaptein
- Department of Orthopedic Surgery, Biomechanics and Imaging Group, Leiden University Medical Center, Leiden, Netherlands
| | - Kjeld Søballe
- Department of Clinical Institute, Aarhus University, Aarhus, Denmark
| | - Maiken Stilling
- Department of Clinical Institute, Aarhus University, Aarhus, Denmark
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Campi S, Pandit H, Hooper G, Snell D, Jenkins C, Dodd CAF, Maxwell R, Murray DW. Ten-year survival and seven-year functional results of cementless Oxford unicompartmental knee replacement: A prospective consecutive series of our first 1000 cases. Knee 2018; 25:1231-1237. [PMID: 30150067 DOI: 10.1016/j.knee.2018.07.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Revised: 06/11/2018] [Accepted: 07/17/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Cementless fixation is an alternative to cemented unicompartmental knee replacement (UKR), with several advantages over cementation. This study reports the ten-year survival and seven-year clinical outcome of cementless Oxford unicompartmental knee replacement (OUKR). METHODS This prospective study describes the clinical outcome and survival of the first 1000 consecutive cementless medial OUKRs implanted at two centres for recommended indications. RESULTS The 10-year survival was 97% (CI 95%: 92-100%), with 25 knees being revised. The commonest reason for revision was progression of arthritis laterally, which occurred in nine knees, followed by primary dislocation of the bearing, which occurred in six knees. There were two dislocations secondary to trauma and a ruptured ACL, and two tibial plateau fractures. Although there were no definite cases of aseptic loosening, two early revisions were related to tibial fixation: one for pain and a radiolucent line and one for incomplete seating of the component with a radiolucent line. There were four revisions for pain, but the cause of the pain was uncertain: in one there was tibial overhang and in two there was patellofemoral degeneration, which possibly contributed to the pain. There were no deep infections. The mean OKS improved from 23 (SD 8) to 42 (SD 7) at a mean follow-up of 7.0 years (p < 0.001). There was no significant difference in survival or clinical outcome between the designer and independent centre. CONCLUSIONS The cementless OUKR is a safe and reproducible procedure with excellent 10-year survival and clinical results in the hands of both designer and independent surgeons.
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Affiliation(s)
- S Campi
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, United Kingdom.
| | - H Pandit
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, United Kingdom
| | - G Hooper
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand
| | - D Snell
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand
| | - C Jenkins
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - C A F Dodd
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - R Maxwell
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand
| | - D W Murray
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, United Kingdom; Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
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Eckert JA, Jaeger S, Klotz MC, Schwarze M, Bitsch RG. Can intraoperative measurement of bone quality help in decision making for cementless unicompartmental knee arthroplasty? Knee 2018; 25:609-616. [PMID: 29792279 DOI: 10.1016/j.knee.2018.03.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 01/14/2018] [Accepted: 03/12/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND In uncemented total hip arthroplasty (THA), low bone mineral density (BMD) is associated with aseptic loosening. BMD is usually assessed via dual-energy X-ray absorptiometry (DXA) or quantitative computed tomography, which takes time and exposes patients to radiation. Due to its low risk profile, intraoperative measurement of the trabecular stability might be a useful alternative to DXA. METHODS In 24 human femora, BMD was analysed using DXA at the femoral necks and the knees. Performing the standard Oxford Unicompartmental Knee Arthroplasty (OUKA) implantation procedure, a wingblade (DensiProbe) coupled to a torque probe was used to evaluate the trabecular peak torque. The standard procedure was modified: before the completion of the central peg drill hole, the DensiProbe was inserted into the pre-drilled hole and then turned until a loss of resistance was achieved. The obtained data was then correlated with BMD at the femoral neck as well as the knee. RESULTS In all tested regions, a higher peak torque was observed in correlation with a higher BMD. CONCLUSIONS As demonstrated, the DensiProbe can be a helpful tool to assess the bone quality intraoperatively in OUKA. It can be a valuable decision guidance when faced with choosing between a cemented and a cementless implant. Due to the fact that the central peg hole of the OUKA can be used for the procedure, no additional risk for the patient exists, while the additional work for the surgeon is minimal.
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Affiliation(s)
- Johannes A Eckert
- Laboratory of Biomechanics and Implant Research, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany
| | - Sebastian Jaeger
- Laboratory of Biomechanics and Implant Research, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany
| | - Matthias C Klotz
- Laboratory of Biomechanics and Implant Research, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany
| | - Martin Schwarze
- Laboratory of Biomechanics and Implant Research, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany
| | - Rudi G Bitsch
- Laboratory of Biomechanics and Implant Research, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany.
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Kamenaga T, Hiranaka T, Hida Y, Fujishiro T, Okamoto K. Unicompartmental knee arthroplasty for spontaneous osteonecrosis of the medial tibial plateau. Knee 2018; 25:715-721. [PMID: 29776813 DOI: 10.1016/j.knee.2018.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 04/10/2018] [Accepted: 04/17/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND There have been very few reports on isolated medial tibial plateau osteonecrosis, and the condition has not been clearly described. Unicompartmental knee arthroplasty (UKA) may be an appropriate treatment method for this condition. The aims of this study were to report our experience of using mobile-bearing knee implants for osteonecrosis of the medial tibial plateau and to discuss the etiology and treatment of this type of osteonecrosis. METHODS This study included six consecutive patients with isolated medial tibial plateau osteonecrosis treated with an Oxford mobile-bearing knee implant. The average age was 71.0 years. We preoperatively graded the tibial necrosis lesion using radiographic findings. We also assessed the area and size of necrosis, extent of the surrounding high-density area, and the presence of any meniscal lesions by preoperative magnetic resonance imaging (MRI), and pre- and postoperative Oxford Knee Scores (OKS) were evaluated. RESULTS MRI findings revealed that all patients had meniscal lesions in addition to a necrotic lesion. All patients significantly improved in their OKS. No knees required revision for either infection or loosening. CONCLUSIONS The etiology of these cases of necrosis is still unclear, but the current study suggested an association with medial meniscal lesions. The results of the study were promising, showing a good short-term clinical outcome of Oxford mobile-bearing UKA for this type of osteonecrosis.
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Affiliation(s)
- Tomoyuki Kamenaga
- Department of Orthopedic Surgery and Joint Surgery Center, Takatsuki General Hospital, Takatsuki, Osaka, Japan
| | - Takafumi Hiranaka
- Department of Orthopedic Surgery and Joint Surgery Center, Takatsuki General Hospital, Takatsuki, Osaka, Japan.
| | - Yuichi Hida
- Department of Orthopedic Surgery and Joint Surgery Center, Takatsuki General Hospital, Takatsuki, Osaka, Japan
| | - Takaaki Fujishiro
- Department of Orthopedic Surgery and Joint Surgery Center, Takatsuki General Hospital, Takatsuki, Osaka, Japan
| | - Koji Okamoto
- Department of Orthopedic Surgery and Joint Surgery Center, Takatsuki General Hospital, Takatsuki, Osaka, Japan
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Campi S, Pandit HG, Oosthuizen CR. The Oxford Medial Unicompartmental Knee Arthroplasty: The South African Experience. J Arthroplasty 2018; 33:1727-1731. [PMID: 29610011 DOI: 10.1016/j.arth.2018.01.035] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 01/13/2018] [Accepted: 01/22/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The Oxford unicompartmental knee arthroplasty (OUKA) is a successful treatment for endstage, symptomatic anteromedial osteoarthritis. This study reports the results of a cohort of consecutive cemented and cementless medial OUKAs from an independent center and aims to answer the following questions: what is the survival of OUKA in the hands of a nondesigner surgeon? Are there any differences in the survival of cementless and cemented OUKA? Are the failure modes any different with the cementless and cemented OUKA? METHODS One thousand one hundred twenty consecutive OUKAs were implanted in a single center for the recommended indications. Patients were prospectively identified and followed up. Survival was calculated with revision as the end point. RESULTS There were 522 cemented and 598 cementless implants. The mean follow-up was 8.3 years for cemented implants (range 0.5-17, standard deviation [SD] 2.9) and 2.7 years (range 0.5-7, SD 1.8) for cementless implants. The Oxford knee score improved from a preoperative mean of 22 (SD 8.1) to 40 (SD 7.9) at the last follow-up (P < .001). There were 59 failures requiring revision surgery, with a 5.3% cumulative revision rate. The most common reason for failure was progression of osteoarthritis in the lateral compartment, occurred in 26 cases (2.3%). The cumulative 10-year survival was 91% (95% confidence interval 87.3-95.2). CONCLUSION The results of this prospective, consecutive case series from the African continent demonstrated that excellent results are achievable with the OUKA in independent centers if the correct indications and surgical technique are used.
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Affiliation(s)
- Stefano Campi
- Department of Orthopaedics, Campus Bio-Medico University of Rome, Rome, Italy
| | - Hemant G Pandit
- Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), Chapel Allerton Hospital, University of Leeds, United Kingdom
| | - Christiaan R Oosthuizen
- University of the Witwatersrand (WITS), Division of Orthopaedic Surgery, Johannesburg, South Africa
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Panzram B, Bertlich I, Reiner T, Walker T, Hagmann S, Gotterbarm T. Cementless unicompartmental knee replacement allows early return to normal activity. BMC Musculoskelet Disord 2018; 19:18. [PMID: 29343231 PMCID: PMC5773134 DOI: 10.1186/s12891-017-1883-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 11/29/2017] [Indexed: 01/31/2023] Open
Abstract
Background Physical activity and regular participation in recreational sports gain importance in patients’ lifestyle after knee arthroplasty. Cementless unicompartimental Knee replacement with the Oxford System has been introduced into clinical routine. Currently there is no data reporting on the physical activity, return to sports rate and quality of live after medial cementless Oxford Unicompartimental Knee Replacement (OUKR). Methods This retrospective cohort study reports on the functional outcome of the first 27 consecutive patients (30 knees) that were consecutively treated with a cementless medial OUKR between 2007 and 2009 in our hospital. Physical activity and quality of life were measured using the Tegner-Score, the UCLA-Activity Score, the Schulthess Clinical Activity Questionnaire and the SF-36 Score. The patients’ satisfaction with the outcome was measured using a visual analogue scale. Results Mean age at surgery was 62.5 years. Patients showed a rapid recovery with 17 out of 27 patients returning to sports within 3 months, 24 within 6 months after surgery. The Return-to-activity-rate was 100%. 10 out of 27 patients showed a high activity level (UCLA ≥7 points) with a mean postoperative UCLA-Score of 6.1 points. Conclusions Patients recover rapidly after cementless OUKR with a return to sports rate of 100% and patients are able to participate in high impact sports disciplines.
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Affiliation(s)
- Benjamin Panzram
- Clinic of Orthopaedic and Trauma Surgery, University of Heidelberg, Schlierbacher Landstr. 200a, 69118, Heidelberg, Germany
| | - Ines Bertlich
- Clinic of Orthopaedic and Trauma Surgery, University of Heidelberg, Schlierbacher Landstr. 200a, 69118, Heidelberg, Germany
| | - Tobias Reiner
- Clinic of Orthopaedic and Trauma Surgery, University of Heidelberg, Schlierbacher Landstr. 200a, 69118, Heidelberg, Germany
| | - Tilman Walker
- Clinic of Orthopaedic and Trauma Surgery, University of Heidelberg, Schlierbacher Landstr. 200a, 69118, Heidelberg, Germany
| | - Sébastien Hagmann
- Clinic of Orthopaedic and Trauma Surgery, University of Heidelberg, Schlierbacher Landstr. 200a, 69118, Heidelberg, Germany
| | - Tobias Gotterbarm
- Clinic of Orthopaedic and Trauma Surgery, University of Heidelberg, Schlierbacher Landstr. 200a, 69118, Heidelberg, Germany.
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Results with nine years mean follow up on one hundred and three KAPS® uni knee arthroplasties: eighty six medial and seventeen lateral. INTERNATIONAL ORTHOPAEDICS 2017; 42:1061-1066. [DOI: 10.1007/s00264-017-3717-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Accepted: 12/03/2017] [Indexed: 10/18/2022]
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Kleeblad LJ, van der List JP, Zuiderbaan HA, Pearle AD. Regional Femoral and Tibial Radiolucency in Cemented Unicompartmental Knee Arthroplasty and the Relationship to Functional Outcomes. J Arthroplasty 2017; 32:3345-3351. [PMID: 28697861 DOI: 10.1016/j.arth.2017.06.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 06/08/2017] [Accepted: 06/12/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Femoral and tibial radiolucent lines (RLL) after unicompartmental knee arthroplasty (UKA) can be categorized in physiological and pathological radiolucencies. Although physiological tibial radiolucency is assessed extensively in literature, studies reporting femoral radiolucency are lacking. Therefore, a retrospective study was performed to assess physiological femoral RLL and its relationship to short-term functional outcomes. METHODS A total of 352 patients were included who underwent robotic-assisted medial UKA surgery and received a fixed-bearing metal-backed cemented medial UKA. Radiographic follow-up consisted of standard anteroposterior and lateral radiographs. Functional outcomes, using the Western Ontario and McMaster Universities Arthritis Index questionnaire, of patients with RLL were compared with a matched cohort, based on gender, age, and body mass index. RESULTS In this cohort, 101 patients (28.8%) had physiological regional radiolucency around the femoral (10.3%) and/or tibial (25.3%) components, of which 6.8% concerned both components. Tibial RLL were more frequently seen compared with femoral RLL (P < .001). Our data suggest that the time of onset of femoral radiolucency develops later (1.36 years) than tibial radiolucency (1.00 years, P = .02). No difference in short-term functional outcomes was found between the RLL group and the matched cohort group without radiolucency. CONCLUSION This study acknowledges that tibial and femoral physiological radiolucencies may develop after cemented medial UKA. Furthermore, this was the first study showing that physiological femoral RLL occur later than tibial RLL. Prospective studies with longer follow-up and larger numbers are necessary to compare radiolucency in different UKA designs and the relationship to outcomes.
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Affiliation(s)
- Laura J Kleeblad
- Department of Orthopaedic Surgery, Sports Medicine and Shoulder Service, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York
| | - Jelle P van der List
- Department of Orthopaedic Surgery, Sports Medicine and Shoulder Service, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York
| | | | - Andrew D Pearle
- Department of Orthopaedic Surgery, Sports Medicine and Shoulder Service, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York
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Stempin R, Kaczmarek W, Stempin K, Dutka J. Midterm Results of Cementless and Cemented Unicondylar Knee Arthroplasty with Mobile Meniscal Bearing: A Prospective Cohort Study. Open Orthop J 2017; 11:1173-1178. [PMID: 29290853 PMCID: PMC5721307 DOI: 10.2174/1874325001711011173] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 08/20/2017] [Accepted: 09/12/2017] [Indexed: 11/30/2022] Open
Abstract
Background: Cemented unicompartmental knee arthroplasty (UKA) yields good clinical outcome but common revision reasons are loosening and pain. Cementless UKA may reduce the revision rate. Objective: The current study was designed to assess clinical and radiographic outcome of cemented and cementless UKA, using bone quality as determined by the Bone Hardness Test (BHT) as selection criterion for cementless implantation. Methods: In this prospective comparative cohort study we analyzed 50 cementless and 29 Oxford consecutive UKA cases. Patients with sufficient bone quality were eligible for cementless UKA. Bone quality was assessed with the BHT, which consisted of exercising pressure with the thumb on the bone surface created after resection of the tibia. Results: The average surgical times were 62.5 ± 12.6 and 78 ± 16 minutes in the cementless and the cemented group, respectively (p < 0.01). The average thickness of the polyethylene insert was 4.3 ± 1.2 (range, 3 – 9) and 3.7 ± 0.8 (range, 3 – 6) mm, respectively (p = 0.02). Both types of implants yielded excellent clinical and functional results. At an average follow-up time of seven years, we found non-significant differences between clinical results of cementless versus cemented implants. Conclusion: Shorter surgical time makes cementless implantation more attractive to surgeons when considering UKA options for their patients. The average thickness of the polyethylene insert in cementless group was 0.6 mm thinner than in the cemented group. The BHT is a simple and useful test to assess whether patients are eligible for cementless UKA.
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Affiliation(s)
- Radosław Stempin
- Department of Orthopedic Surgery Promienista Clinic, Poznan, Poland
| | | | - Kacper Stempin
- Department of Orthopedic & Trauma Surgery Westallgäu Clinic, Wangen, Germany
| | - Julian Dutka
- Department of Orthopedic& Trauma Surgery S. Zeromski Memorial Hospital Cracow, Poland
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Cementless Oxford medial unicompartimental knee replacement: an independent series with a 5-year-follow-up. Arch Orthop Trauma Surg 2017; 137:1011-1017. [PMID: 28439705 DOI: 10.1007/s00402-017-2696-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Indexed: 10/19/2022]
Abstract
PURPOSE Cemented unicompartmental knee replacement (UKR) has proven excellent long-term survival rates and functional scores in Price et al. (Clin Orthop Relat Res 435:171-180, 2005), Price and Svard (Clin Orthop Relat Res 469(1):174-179, 2011) and Murray et al. (Bone Joint Surg Br 80(6):983-989, 1998). The main causes for revision, aseptic loosening and pain of unknown origin might be addressed by cementless UKR in Liddle et al. (Bone Joint J 95-B(2):181-187, 2013), Pandit et al. (J Bone Joint Surg Am 95(15):1365-1372, 2013), National Joint Registry for England, Wales and Northern Ireland: 10th Annual Report 2013 ( http://www.njrcentre.org.uk/njrcentre/Portals/0/Documents/England/Reports/10th_annual_report/NJR%2010th%20Annual%20Report%202013%20B.pdf , 2013), Swedish Knee Arthroplasty Register: Annual Report 2013 ( http://www.myknee.se/pdf/SKAR2013_Eng.pdf , 2013). METHODS This single-centre retrospective cohort study reports the 5-year follow-up results of our first 30 consecutively implanted cementless Oxford UKR (OUKR). Clinical outcome was measured using the OKS, AKSS, range of movement and level of pain (visual analogue scale). The results were compared to cemented OUKR in a matched-pair analysis. RESULTS Implant survival was 89.7%. One revision each was performed due to tibial fracture, progression of osteoarthritis (OA) and inlay dislocation. The 5-year survival rate of the cementless group was 89.7% and of the cemented group 94.1%. Both groups showed excellent postoperative clinical scores. CONCLUSIONS Cementless fixation shows good survival rates and clinical outcome compared to cemented fixation.
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Horsager K, Kaptein BL, Rømer L, Jørgensen PB, Stilling M. Dynamic RSA for the evaluation of inducible micromotion of Oxford UKA during step-up and step-down motion. Acta Orthop 2017; 88:275-281. [PMID: 28067099 PMCID: PMC5434595 DOI: 10.1080/17453674.2016.1274592] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Implant inducible micromotions have been suggested to reflect the quality of the fixation interface. We investigated the usability of dynamic RSA for evaluation of inducible micromotions of the Oxford Unicompartmental Knee Arthroplasty (UKA) tibial component, and evaluated factors that have been suggested to compromise the fixation, such as fixation method, component alignment, and radiolucent lines (RLLs). Patients and methods - 15 patients (12 men) with a mean age of 69 (55-86) years, with an Oxford UKA (7 cemented), were studied after a mean time in situ of 4.4 (3.6-5.1) years. 4 had tibial RLLs. Each patient was recorded with dynamic RSA (10 frames/second) during a step-up/step-down motion. Inducible micromotions were calculated for the tibial component with respect to the tibia bone. Postoperative component alignment was measured with model-based RSA and RLLs were measured on screened radiographs. Results - All tibial components showed inducible micromotions as a function of the step-cycle motion with a mean subsidence of up to -0.06 mm (95% CI: -0.10 to -0.03). Tibial component inducible micromotions were similar for cemented fixation and cementless fixation. Patients with tibial RLLs had 0.5° (95% CI: 0.18-0.81) greater inducible medio-lateral tilt of the tibial component. There was a correlation between postoperative posterior slope of the tibial plateau and inducible anterior-posterior tilt. Interpretation - All patients had inducible micromotions of the tibial component during step-cycle motion. RLLs and a high posterior slope increased the magnitude of inducible micromotions. This suggests that dynamic RSA is a valuable clinical tool for the evaluation of functional implant fixation.
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Affiliation(s)
- Kristian Horsager
- Department of Orthopedics, Aarhus University Hospital, Aarhus, Denmark;,Correspondence:
| | - Bart L Kaptein
- Department of Orthopedic Surgery, Biomechanics and Imaging Group, Leiden University Medical Center, Leiden, the Netherlands
| | - Lone Rømer
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Peter B Jørgensen
- Department of Orthopedics, Aarhus University Hospital, Aarhus, Denmark
| | - Maiken Stilling
- Department of Orthopedics, Aarhus University Hospital, Aarhus, Denmark
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Pandit HG, Campi S, Hamilton TW, Dada OD, Pollalis S, Jenkins C, Dodd CAF, Murray DW. Five-year experience of cementless Oxford unicompartmental knee replacement. Knee Surg Sports Traumatol Arthrosc 2017; 25:694-702. [PMID: 26611902 DOI: 10.1007/s00167-015-3879-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 11/11/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE Cementless unicompartmental knee replacement (UKR) was introduced to address some of the problems that can occur following cemented UKR. The aim of this study was to report the 5-year experience of the first 512 medial cementless Oxford UKR implanted by two surgeons for the recommended indications. METHODS The first consecutive 512 cementless Phase 3 Oxford UKRs implanted by two surgeons for the recommended indications between June 2004 and October 2013 were prospectively identified and followed up independently. All the procedures were carried out through a minimally invasive approach without eversion or dislocation of the patella. Patients were assessed clinically pre-operatively and at 1, 2, 5, 7 and 10 years after surgery with functional outcome scores and radiographs. RESULTS There were eight reoperations of which six were revisions giving a 5-year survival of 98 % (95 % CI 94-100 %). At a mean follow-up of 3.4 years (1.0-10.2), the mean OKS was 43 (SD 7), AKSS (objective) was 81 (SD 13), and AKSS (functional) was 86 (SD 17). The first 120 cases had a minimum follow-up of 5 years (mean 5.9; range 5-10.2). In these patients, the mean OKS was 41 (SD 8), AKSS (objective) was 81 (SD 14), and AKSS (functional) was 82 (SD 18). There were no femoral radiolucencies and no complete tibial radiolucencies. 11 % of tibial components had partial radiolucent lines; the remaining 89 % had no radiolucencies. CONCLUSION The clinical results are as good as or better than those previously reported for cemented fixation. The radiographic results are better with secure bony attachment to the implants in every case. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- H G Pandit
- Nuffield Orthopaedic Centre, Windmill Road, Oxford, UK.,Nuffield Department for Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Windmill Road, Oxford, UK
| | - S Campi
- Nuffield Department for Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Windmill Road, Oxford, UK
| | - T W Hamilton
- Nuffield Department for Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Windmill Road, Oxford, UK.
| | - O D Dada
- Nuffield Orthopaedic Centre, Windmill Road, Oxford, UK
| | - S Pollalis
- Nuffield Orthopaedic Centre, Windmill Road, Oxford, UK
| | - C Jenkins
- Nuffield Orthopaedic Centre, Windmill Road, Oxford, UK
| | - C A F Dodd
- Nuffield Orthopaedic Centre, Windmill Road, Oxford, UK
| | - D W Murray
- Nuffield Orthopaedic Centre, Windmill Road, Oxford, UK.,Nuffield Department for Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Windmill Road, Oxford, UK
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Campi S, Pandit HG, Dodd CAF, Murray DW. Cementless fixation in medial unicompartmental knee arthroplasty: a systematic review. Knee Surg Sports Traumatol Arthrosc 2017; 25:736-745. [PMID: 27436195 DOI: 10.1007/s00167-016-4244-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 07/06/2016] [Indexed: 02/06/2023]
Abstract
PURPOSE The aim of this study was to evaluate clinical outcome, failures, implant survival, and complications encountered with cementless fixation in unicompartmental knee arthroplasty (UKA). METHODS A systematic review of the literature on cementless fixation in UKA was performed according to the PRISMA guidelines. The following database was comprehensively searched: PubMed, Cochrane, Medline, CINAHL, Embase, and Google Scholar. The keywords "unicompartmental", "unicondylar", "partial knee arthroplasty", and "UKA" were combined with each of the keyword "uncemented", "cementless" and "survival", "complications", and "outcome". The following data were extracted: demographics, clinical outcome, details of failures and revisions, cumulative survival, and complications encountered. The risk of bias of each study was estimated with the MINORS score and a further scoring system based on the presence of the primary outcomes. RESULTS From a cohort of 63 studies identified using the above methodology, 10 papers (1199 knees) were included in the final review. The mean follow-up ranged from 2 to 11 years (median 5 years). The 5-year survival ranged from 90 to 99 % and the 10-year survival from 92 to 97 %. There were 48 revisions with an overall revision rate of 0.8 per 100 observed component-years. The most common cause of failure was progression of osteoarthritis in the retained compartment (0.9 %). The cumulative incidence of complications and revisions was comparable to that reported in similar studies on cemented UKAs. The advantages of cementless fixation include faster surgical time, avoidance of cementation errors, and lower incidence of radiolucent lines. CONCLUSIONS Cementless fixation is a safe and effective alternative to cementation in medial UKA. Clinical outcome, failures, reoperation rate, and survival are similar to those reported for cemented implants with lower incidence of radiolucent lines. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- S Campi
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK. .,Nuffield Orthopaedic Centre, Oxford University Hospital, NHS Foundation Trust, Oxford, UK.
| | - H G Pandit
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,Nuffield Orthopaedic Centre, Oxford University Hospital, NHS Foundation Trust, Oxford, UK
| | - C A F Dodd
- Nuffield Orthopaedic Centre, Oxford University Hospital, NHS Foundation Trust, Oxford, UK
| | - D W Murray
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,Nuffield Orthopaedic Centre, Oxford University Hospital, NHS Foundation Trust, Oxford, UK
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Kerens B, Schotanus MGM, Boonen B, Boog P, Emans PJ, Lacroix H, Kort NP. Cementless versus cemented Oxford unicompartmental knee arthroplasty: early results of a non-designer user group. Knee Surg Sports Traumatol Arthrosc 2017; 25:703-709. [PMID: 27161197 DOI: 10.1007/s00167-016-4149-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 04/26/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE Although fewer tibial radiolucent lines are observed in cementless Oxford unicompartmental knee arthroplasty (UKA) compared with cemented Oxford UKA, an independent comparative study on this topic is lacking. METHODS In this multicentre retrospective study, a cohort of 60 consecutive cases of cementless Oxford UKA is compared with a cohort of 60 consecutive cases of cemented Oxford UKA. Radiolucent lines, survival, perioperative data and clinical results were compared. RESULTS No complete tibial radiolucent lines were observed in either group. Seventeen per cent of partial tibial radiolucent lines were observed in the cementless group versus 21 % in the cemented group (n.s.). The percentage of tibial radiolucent zones was 4 versus 9 %, respectively (p = 0.036). Survival rates were 90 % at 34 months for the cementless group and 84 % at 54 months for the cemented group (n.s.). Mean operation time was 10 min shorter in the cementless group (p < 0.001), and clinical results were not significantly different. CONCLUSIONS Although no significant differences in radiolucent lines were found between both groups, they appear to be more common in the cemented group. This confirms previous results from reports by prosthesis designers. The presence of radiolucent lines after cemented Oxford UKA does not correlate with clinical outcome or survival. LEVEL OF EVIDENCE III.
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Affiliation(s)
- B Kerens
- AZ St Maarten, Leopoldstraat 2, Mechelen, Belgium.
| | | | - B Boonen
- Zuyderland Medical Centre, Sittard-Geleen, The Netherlands
| | - P Boog
- Elkerliek Ziekenhuis, Helmond, The Netherlands
| | - P J Emans
- Maastricht University Medical Centre, Maastricht, The Netherlands
| | - H Lacroix
- Elkerliek Ziekenhuis, Helmond, The Netherlands
| | - N P Kort
- Zuyderland Medical Centre, Sittard-Geleen, The Netherlands
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Goshima K, Sawaguchi T, Sakagoshi D, Shigemoto K, Hatsuchi Y, Akahane M. Age does not affect the clinical and radiological outcomes after open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2017; 25:918-923. [PMID: 26531184 DOI: 10.1007/s00167-015-3847-6] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 10/27/2015] [Indexed: 01/29/2023]
Abstract
PURPOSE Open-wedge high tibial osteotomy (OWHTO) is a well-established procedure in the management of medial compartment osteoarthritis and osteonecrosis of the medial femoral condyle. Several studies have evaluated factors that negatively influence outcomes. However, few reports have investigated the effect of age on HTO outcome. We evaluated the influence of the age on the outcome after HTO. METHODS The TomoFix® plate was used to perform 60 consecutive OWHTOs. Twenty-six knees in 23 patients >65 years old (mean age at surgery 68.7 ± 2.9 years; range 65-75 years, group A) were compared with 34 knees in 27 patients <65 years old (mean age at surgery 56.2 ± 7.5 years; range 38-64 years, group B) with respect to the clinical and radiological outcomes after HTO. The clinical evaluation included the Japanese Orthopedic Association Knee Score (JOA score), Oxford Knee Score (OKS) and complications after surgery. RESULTS There were no statistical differences in the background factors between the two groups. Postoperatively, the mean JOA score showed a significant improvement in both groups. The mean OKS after surgery was 41.6 ± 5.9 in group A and 41.4 ± 5.9 in group B. There were no statistical differences in the postoperative knee alignment and clinical outcomes between the two groups. CONCLUSION OWHTO using the rigid long plate was an effective procedure independent of patient's age. The results showed that age did not influence the clinical and radiological outcomes after OWHTO.
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Affiliation(s)
- Kenichi Goshima
- Department of Orthopedic Surgery and Joint Reconstructive Surgery, Toyama Municipal Hospital, 2-1 Imaizumi Hokubu-machi, Toyama, 939-8511, Japan.
| | - Takeshi Sawaguchi
- Department of Orthopedic Surgery and Joint Reconstructive Surgery, Toyama Municipal Hospital, 2-1 Imaizumi Hokubu-machi, Toyama, 939-8511, Japan
| | - Daigo Sakagoshi
- Department of Orthopedic Surgery and Joint Reconstructive Surgery, Toyama Municipal Hospital, 2-1 Imaizumi Hokubu-machi, Toyama, 939-8511, Japan
| | - Kenji Shigemoto
- Department of Orthopedic Surgery and Joint Reconstructive Surgery, Toyama Municipal Hospital, 2-1 Imaizumi Hokubu-machi, Toyama, 939-8511, Japan
| | - Yu Hatsuchi
- Department of Orthopedic Surgery and Joint Reconstructive Surgery, Toyama Municipal Hospital, 2-1 Imaizumi Hokubu-machi, Toyama, 939-8511, Japan
| | - Mika Akahane
- Department of Orthopedic Surgery and Joint Reconstructive Surgery, Toyama Municipal Hospital, 2-1 Imaizumi Hokubu-machi, Toyama, 939-8511, Japan
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Lisowski LA, Meijer LI, van den Bekerom MPJ, Pilot P, Lisowski AE. Ten- to 15-year results of the Oxford Phase III mobile unicompartmental knee arthroplasty: a prospective study from a non-designer group. Bone Joint J 2017; 98 B:41-47. [PMID: 27694515 PMCID: PMC5047134 DOI: 10.1302/0301-620x.98b10.bjj-2016-0474.r1] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Accepted: 07/19/2016] [Indexed: 11/28/2022]
Abstract
Aims The interest in unicompartmental knee arthroplasty (UKA) for
medial osteoarthritis has increased rapidly but the long-term follow-up
of the Oxford UKAs has yet to be analysed in non-designer centres.
We have examined our ten- to 15-year clinical and radiological follow-up
data for the Oxford Phase III UKAs. Patients and Methods Between January 1999 and January 2005 a total of 138 consecutive
Oxford Phase III arthroplasties were performed by a single surgeon
in 129 patients for medial compartment osteoarthritis (71 right
and 67 left knees, mean age 72.0 years (47 to 91), mean body mass
index 28.2 (20.7 to 52.2)). Both clinical data and radiographs were
prospectively recorded and obtained at intervals. Of the 129 patients,
32 patients (32 knees) died, ten patients (12 knees) were not able
to take part in the final clinical and radiological assessment due
to physical and mental conditions, but via telephone interview it
was confirmed that none of these ten patients (12 knees) had a revision
of the knee arthroplasty. One patient (two knees) was lost to follow-up. Results The mean follow-up was 11.7 years (10 to 15). A total of 11 knees
(8%) were revised. The survival at 15 years with revision for any
reason as the endpoint was 90.6% (95% confidence interval (CI) 85.2
to 96.0) and revision related to the prosthesis was 99.3% (95% CI
97.9 to 100). The mean total Knee Society Score was 47 (0 to 80)
pre-operatively and 81 (30 to 100) at latest follow-up. The mean
Oxford Knee Score was 19 (12 to 40) pre-operatively and 42 (28 to 55)
at final follow-up. Radiolucency beneath the tibial component occurred
in 22 of 81 prostheses (27.2%) without evidence of loosening. Conclusion This study supports the use of UKA in medial compartment osteoarthritis
with excellent long-term functional and radiological outcomes with
an excellent 15-year survival rate. Cite this article: Bone Joint J 2016;98-B(10
Suppl B):41–7.
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Affiliation(s)
- L A Lisowski
- BovenIJ Hospital, Statenjachtstraat 1, 1034 CS Amsterdam, The Netherlands
| | - L I Meijer
- BovenIJ Hospital, Statenjachtstraat 1, 1034 CS Amsterdam, The Netherlands
| | | | - P Pilot
- Reinier de Graaf Gasthuis, Reinier de Graafweg 5, 2625 AD, Delft, The Netherlands
| | - A E Lisowski
- Reinaert Kliniek, Brouwerseweg 100 C 02, 6216 EG, Maastricht, The Netherlands
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Panzram B, Bertlich I, Reiner T, Walker T, Hagmann S, Weber MA, Gotterbarm T. Results after Cementless Medial Oxford Unicompartmental Knee Replacement - Incidence of Radiolucent Lines. PLoS One 2017; 12:e0170324. [PMID: 28103308 PMCID: PMC5245886 DOI: 10.1371/journal.pone.0170324] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 01/03/2017] [Indexed: 11/19/2022] Open
Abstract
PURPOSE Tibial radiolucent lines (RL) are commonly seen in cemented unicompartmental knee replacement (UKR). In the postoperative course, they can be misinterpreted as signs of loosening, thus leading to unnecessary revision. Since 2004, a cementless OUKR is available. First studies and registry data have shown equally good clinical results of cementless OUKR compared to the cemented version and a significantly reduced incidence of RL in cementless implants. METHODS This single-centre retrospective cohort study includes the first 30 UKR (27 patients) implanted between 2007 and 2009 with a mean follow-up of 5 years. Clinical outcome was evaluated using the OKS, AKS, range of movement (ROM) and level of pain (VAS). Standard radiologic evaluation was performed at three months, one and five years after surgery. The results five years after implantation were compared to a group of 27 cemented Oxford UKR (OUKR) in a matched-pair-analysis. RESULTS Tibial RL were seen in 10 implants three months after operation, which significantly decreased to five after one year and to three after five years (p = 0.02). RL did not have a significant influence on revision (p = 1.0) or clinical outcome after five years. RL were always partial, never progressive and strictly limited to the tibia. There was no significant difference in the incidence of tibial RL five years after implantation between cemented and cementless implants (cemented: 4, cementless: 3, p = 1.0). CONCLUSIONS After cementless implantation RL were limited to the tibia, partial and never progressive. During short term follow-up the incidence of RL decreased significantly. RL seem to have no influence on clinical outcome and revision.
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Affiliation(s)
- Benjamin Panzram
- Clinic of Orthopedic and Trauma Surgery, University of Heidelberg, Heidelberg, Germany
| | - Ines Bertlich
- Clinic of Orthopedic and Trauma Surgery, University of Heidelberg, Heidelberg, Germany
| | - Tobias Reiner
- Clinic of Orthopedic and Trauma Surgery, University of Heidelberg, Heidelberg, Germany
| | - Tilman Walker
- Clinic of Orthopedic and Trauma Surgery, University of Heidelberg, Heidelberg, Germany
| | - Sébastien Hagmann
- Clinic of Orthopedic and Trauma Surgery, University of Heidelberg, Heidelberg, Germany
| | - Marc-André Weber
- Clinic of Diagnostic and Interventional Radiology, University of Heidelberg, Heidelberg, Germany
| | - Tobias Gotterbarm
- Clinic of Orthopedic and Trauma Surgery, University of Heidelberg, Heidelberg, Germany
- * E-mail:
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50
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Kleeblad LJ, Zuiderbaan HA, Hooper GJ, Pearle AD. Unicompartmental knee arthroplasty: state of the art. J ISAKOS 2017. [DOI: 10.1136/jisakos-2016-000102] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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