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Andriollo L, Benazzo F, Cinelli V, Sangaletti R, Velluto C, Rossi SMP. The use of an imageless robotic system in revision of unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2025; 33:1792-1803. [PMID: 39740128 PMCID: PMC12022834 DOI: 10.1002/ksa.12574] [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: 09/30/2024] [Revised: 12/12/2024] [Accepted: 12/13/2024] [Indexed: 01/02/2025]
Abstract
PURPOSE The application of robotics in revision arthroplasty particularly from unicompartmental knee arthroplasty (UKA) to total knee arthroplasty (TKA), is underexplored. The purpose of this study is to describe the surgical technique of an imageless robotic system used in the revision of UKA to TKA and to evaluate short- to mid-term outcomes. METHODS This prospective study includes 35 patients treated from May 2020 to July 2023. Demographic data of the patients were gathered and the reasons for needing revision surgery were assessed. All patients were clinically evaluated preoperatively and at the final follow-up of 31.3 ± 12.1 months, using the Western Ontario and McMaster Universities Arthritis Index (WOMAC), Oxford Knee Score (OKS), Forgotten Joint Score (FJS-12), Numerical Rating Scale (NRS) and range of motion (ROM). Additionally, a radiographic evaluation was performed, and implant survival was assessed by analyzing complications at final follow-up. RESULTS In 88.6% of the patients, a primary Posterior Stabilized (PS) or Constrained Posterior Stabilized prosthetic implant was used, with 11.4% of patients requiring a varus-valgus constraint implant. In 71.4% of the cases, a thinnest size liner of 10 mm was used. The use of the robotic system was never aborted for any reason. At final follow-up, the implant survival rate was 97.14%. Average OKS increased from 31.4 ± 9.4 to 41.5 ± 4.3, FJS-12 from 47.3 ± 19.3 to 80.7 ± 8.9; WOMAC at final follow-up was 17.8 ± 8.7, from 53.5 ± 21.3 preoperatively. Analyzing ROM, NRS and patient-reported outcome measures, there were significant differences in each parameter between prerevision surgery and final follow-up. CONCLUSIONS This study highlights that in a cohort of patients undergoing robotic-assisted conversion from UKA to TKA, the use of an imageless procedure incorporating intraoperative bone morphing and alignment based on a functional philosophy has proven to be safe and has yielded excellent clinical and radiographic outcomes. LEVEL OF EVIDENCE Level II, prospective cohort study.
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Affiliation(s)
- Luca Andriollo
- Sezione di Chirurgia Protesica ad Indirizzo Robotico, Unità di Traumatologia Dello Sport, UOC Ortopedia e TraumatologiaBresciaItaly
- Università Cattolica del Sacro CuoreRomaItaly
- Artificial Intelligence CenterAlma Mater Europaea UniversityViennaAustria
| | - Francesco Benazzo
- Sezione di Chirurgia Protesica ad Indirizzo Robotico, Unità di Traumatologia Dello Sport, UOC Ortopedia e TraumatologiaBresciaItaly
- IUSS Istituto Universitario di Studi SuperioriPaviaItaly
| | - Virgina Cinelli
- Sezione di Chirurgia Protesica ad Indirizzo Robotico, Unità di Traumatologia Dello Sport, UOC Ortopedia e TraumatologiaBresciaItaly
- Università Cattolica del Sacro CuoreRomaItaly
| | - Rudy Sangaletti
- Sezione di Chirurgia Protesica ad Indirizzo Robotico, Unità di Traumatologia Dello Sport, UOC Ortopedia e TraumatologiaBresciaItaly
| | - Calogero Velluto
- Sezione di Chirurgia Protesica ad Indirizzo Robotico, Unità di Traumatologia Dello Sport, UOC Ortopedia e TraumatologiaBresciaItaly
- Università Cattolica del Sacro CuoreRomaItaly
| | - Stefano Marco Paolo Rossi
- Sezione di Chirurgia Protesica ad Indirizzo Robotico, Unità di Traumatologia Dello Sport, UOC Ortopedia e TraumatologiaBresciaItaly
- IUSS Istituto Universitario di Studi SuperioriPaviaItaly
- Department of Life Science, Health, and Health ProfessionsUniversità degli Studi Link, Link Campus UniversityRomaItaly
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Christiner T, Chidlow C, Smith S. Revision of unicompartmental knee replacement can achieve equivalent outcomes to primary total knee replacement when revised for confirmed pathology. Knee 2025; 55:118-125. [PMID: 40286440 DOI: 10.1016/j.knee.2025.04.006] [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: 11/24/2024] [Revised: 02/24/2025] [Accepted: 04/06/2025] [Indexed: 04/29/2025]
Abstract
INTRODUCTION There is conflicting evidence regarding outcomes following revision of Unicompartmental Knee Replacement (UKR) to Total Knee Replacement (TKR). We hypothesise that a UKR can be successfully revised to a TKR with equivalent outcomes to primary TKR when revised for a well-defined revision diagnosis such as progression of arthritis. METHODS From 2011 to 2023, the records of a surgeon were reviewed to identify patients who underwent revision of a UKR. Data collected included indications for revision, implant details, oxford knee scores (OKS) and survivorship. The OKS of the revision group was compared with a group of primary TKRs. RESULTS A total of 21 revision UKR to TKR were included in the study. Primary Cruciate Retaining implants were used in all but 1 revision (Posterior Stabilised) with tibial sided augments or a stem required in 4. Survivorship of the revision UKRs was 95.2% at a mean of 4.37 years post-operatively. Mean OKS for the group was 37.65 with an improvement of 19.65 (p = 0.0001). Patients revised for a well-defined indication had 6-month mean OKS of 41.29, comparable to the primary TKR mean OKS of 39.5 (p = 0.535). Patients revised without confirmed pathology had mean 6-month OKS of 29.17 which was significantly worse than the remaining revision UKRs and primary TKRs (p = 0.001). CONCLUSION When a UKR is revised for a well-defined revision indication, patients can expect equivalent outcomes to primary TKR. This study also confirms that in most instances, a UKR can be successfully revised utilising primary implants with good midterm survivorship.
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Affiliation(s)
- Thomas Christiner
- Dr Simon Smith, 44 Forrest Avenue, Bunbury, WA 6230, Australia; St John of God Hospital Bunbury, 700 Robertson Road, College Grove, WA 6230, Australia; Bunbury Regional Hospital, Bussell Highway, Bunbury, WA 6230, Australia.
| | - Caitlin Chidlow
- Dr Simon Smith, 44 Forrest Avenue, Bunbury, WA 6230, Australia; St John of God Hospital Bunbury, 700 Robertson Road, College Grove, WA 6230, Australia; Bunbury Regional Hospital, Bussell Highway, Bunbury, WA 6230, Australia
| | - Simon Smith
- Dr Simon Smith, 44 Forrest Avenue, Bunbury, WA 6230, Australia; St John of God Hospital Bunbury, 700 Robertson Road, College Grove, WA 6230, Australia; Bunbury Regional Hospital, Bussell Highway, Bunbury, WA 6230, Australia
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Bockholt S, Gosheger G, Moellenbeck B, Schneider KN, Schwarze J, Theil C. Revision of medial unicompartmental knee arthroplasty-Not as uncomplicated as one thought? Analysis of survival and re-revisions from a single centre. J Exp Orthop 2025; 12:e70250. [PMID: 40256667 PMCID: PMC12007015 DOI: 10.1002/jeo2.70250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2025] [Revised: 03/06/2025] [Accepted: 03/07/2025] [Indexed: 04/22/2025] Open
Abstract
Purpose Medial unicompartmental knee arthroplasty (UKA) is a treatment option for medial knee osteoarthritis, with an increase in surgeries over the last few years. However, the results of revision total knee arthroplasty (TKA) after a UKA vary greatly. The purpose of the study was to examine the survival after revision TKA of a failed UKA. Methods This is a retrospective single-centre analysis that includes 35 revision TKA procedures after the failed UKA performed from 2004 to 2019. The median follow-up after revision TKA was 39 months (interquartile range [IQR]: 32-52). The indication for revision of the UKA was aseptic loosening in 49% of patients (17/35). We evaluated demographic factors, reason for revision and revision implant used with descriptive statistics. Implant survival analysis with a focus on re-revision-free survival and potential re-revisions was performed using Kaplan-Meier survival curves. Differences in survival were analyzed using the log-rank test. p Value was set at 0.05. Results Forty per cent (14/35) of revision implants were posterior stabilized revision TKA, followed by 34% (12/35) of condylar constrained designs and 23% of rotating hinged TKA (8/35). Only one patient was revised to a cruciate retaining primary implant (3%). The re-revision-free survival after revision TKA amounted to 94% (95% confidence interval [CI]: 91%-100%) after 1 year, 80% (95% CI: 67%-93%) after 2 years and 74% (95% CI: 56%-90%) at 5 years. Twenty-three per cent of patients (8/35) underwent re-revision after the initial UKA revision after a median time period of 21 months (IQR: 12-24). The reasons for repeat revision were tibial aseptic loosening in 9% of patients (3/35), periprosthetic joint infection (PJI) in 9% of patients (3/35) and instability in 5% (2/35). Rotating hinge knee implants showed reduced survivorship. Conclusions Revision of medial UKA is associated with an increased use of more elaborate and complex revision implants. There is a substantial risk of repeat revision, with aseptic tibial loosening and PJI being the main reasons for the failure of this series. Level of Evidence Level III.
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Affiliation(s)
- Sebastian Bockholt
- Department of Orthopedics and Tumor OrthopedicsMuenster University HospitalMuensterGermany
| | - Georg Gosheger
- Department of Orthopedics and Tumor OrthopedicsMuenster University HospitalMuensterGermany
| | - Burkhard Moellenbeck
- Department of Orthopedics and Tumor OrthopedicsMuenster University HospitalMuensterGermany
| | | | - Jan Schwarze
- Department of Orthopedics and Tumor OrthopedicsMuenster University HospitalMuensterGermany
| | - Christoph Theil
- Department of Orthopedics and Tumor OrthopedicsMuenster University HospitalMuensterGermany
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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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Ibach MJ, Torney O, Halder AM, Schrednitzki D, Lohmann CH, Meißner N. Minimal changes in patella height after aseptic revision from unicompartmental to total knee arthroplasty. Arch Orthop Trauma Surg 2025; 145:181. [PMID: 40072626 DOI: 10.1007/s00402-025-05799-8] [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: 01/04/2025] [Accepted: 02/28/2025] [Indexed: 03/14/2025]
Abstract
INTRODUCTION If revision of a unicompartmental knee arthroplasty (UKA) is required, converting it to a total knee arthroplasty (TKA) remains the favored approach. However, worse functional outcomes after revision from UKA to TKA are reported compared to primary TKAs. One potential driver may be a decline in patella height, limiting knee flexion, and increasing patellofemoral stress. Therefore, the aim of this study was to assess whether the patella height changes after revision from UKA to TKA. METHODS We retrospectively analyzed 128 aseptic UKA to TKA revisions between 2015 and 2022 at a single medical center. True lateral radiographs were obtained before revision (T1), one week after revision (T2), and at the last follow-up (T3). Two orthopedic surgeons independently measured the modified Insall-Salvati ratio (mISR) at each time point. The mean age was 67 years, 67% were female, and the mean BMI was 32 kg/m². The mean follow-up was 1.5 years. RESULTS The mean mISR was 1.59 ± 0.3 at T1, and 1.58 ± 0.2 at T2, respectively, with no significant difference between T1 and T2 (p = 0.72). At T3 the mean mISR was 1.52 ± 0.2, with no significant difference to T2 (p = 0.57). Overall, 24 patients (19%) experienced a patellar tendon shortening of ≥ 10%. For T3 measurements obtained beyond 6 months postoperatively the mISR decreased by 3% compared to T2 (p = 0.03). CONCLUSIONS While a subset of patients with revision UKA to TKA demonstrated notable patellar tendon shortening over time, the overall cohort did not show a clinically meaningful change. Although a statistically significant 3% decrease in the mISR emerged beyond six months, this subtle difference fell below the predefined ≥ 10% threshold. These findings suggest that while minor changes can occur, their clinical relevance remains uncertain, underscoring the need for further long-term investigation. LEVEL OF EVIDENCE III.
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Raja HM, Wesemann L, Charters MA, North WT. The Conversion of Unicompartmental Knee Arthroplasty to Total Knee Arthroplasty with Non-CT-Based Robotic Assistance: A Novel Surgical Technique and Case Series. J Knee Surg 2025; 38:141-147. [PMID: 39317202 DOI: 10.1055/a-2421-5496] [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: 09/26/2024]
Abstract
Robotic-assisted devices help provide precise component positioning in conversion of unicompartmental knee arthroplasty (UKA) to total knee arthroplasty (TKA). A few studies offer surgical techniques for computed tomography (CT) based robotic-assisted conversion of UKA to TKA; however, no studies to date detail this procedure utilizing a non-CT-based robotic-assisted device. This article introduces a novel technique employing a non-CT-based robotic-assisted device (ROSA Knee System, Zimmer Biomet, Warsaw, IN) for converting UKA to TKA with a focus on its efficacy in gap balancing. We present three patients (ages 46-66 years) who were evaluated for conversion of UKA to TKA for aseptic loosening, stress fracture, and progressive osteoarthritis. Each patient underwent robotic-assisted conversion to TKA. Postoperative assessments at 6 months revealed improved pain, function, and radiographic stability. Preoperative planning included biplanar long leg radiographs to determine the anatomic and mechanical axis of the leg. After arthrotomy with a standard medial parapatellar approach, infrared reflectors were pinned into the femur and tibia, followed by topographical mapping of the knee with the UKA in situ. The intraoperative software was utilized to evaluate flexion and extension balancing and plan bony resections. Then, the robotic arm guided placement of the femoral and tibial guide pins and the UKA components were removed. After bony resection of the distal femur and proximal tibia, the intraoperative software was used to reassess the extension gap, and plan posterior condylar resection to have the flexion gap match the extension gap. The use of a non-CT-based robotic-assisted device in conversion of UKA to TKA is a novel technique and a good option for surgeons familiar with robotic-assisted arthroplasty, resulting in excellent outcomes at 6 months.
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Affiliation(s)
- Hamza M Raja
- Department of Orthopaedic Surgery, Henry Ford Hospital System, Detroit, Michigan
| | - Luke Wesemann
- Department of Orthopaedic Surgery, Henry Ford Hospital System, Detroit, Michigan
| | - Michael A Charters
- Department of Orthopaedic Surgery, Henry Ford Hospital System, Detroit, Michigan
| | - W Trevor North
- Department of Orthopaedic Surgery, Henry Ford Hospital System, Detroit, Michigan
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Jones GG, Campi S, von Knoch F, Lunebourg A, London N, Barrett D, Argenson JN. Indications for the addition of a patellofemoral joint arthroplasty following a previous unicondylar knee arthroplasty- a literature review and Delphi consensus. Arch Orthop Trauma Surg 2025; 145:120. [PMID: 39797997 PMCID: PMC11724779 DOI: 10.1007/s00402-024-05738-z] [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: 09/20/2024] [Accepted: 12/16/2024] [Indexed: 01/13/2025]
Abstract
INTRODUCTION The aim of this study was to establish an international consensus statement on the indications for the addition of a patellofemoral joint arthroplasty (PFJA) in patients with a unicondylar knee arthroplasty (UKA) and symptomatic progression of patellofemoral compartment osteoarthritis. MATERIALS AND METHODS A systematic review of the literature was conducted, and the results used to inform the development of a statement by an expert working group. This was then evaluated and modified, using a Delphi process, by members of the European Knee Society (EKS). RESULTS Forty-nine (round one) and forty-two (round two) EKS members took part in the Delphi process, with 83% agreement on the resulting consensus statement that the indications for this procedure are: (1) a well-functioning UKA in a satisfied patient with secondary osteoarthritis progression in the patellofemoral compartment (2), symptomatic patellofemoral compartment osteoarthritis with full thickness cartilage loss affecting the lateral facet of the patellofemoral joint (3), functional ligaments, including the anterior cruciate ligament (ACL) (4), a lateral tibiofemoral compartment with no cartilage damage greater than Ahlback Grade 1 (5), knee flexion ≥ 100° and extension loss ≤ 5° and (6) older patients with increased medical co-morbidities. CONCLUSIONS The simple addition of a PFJA to patients with an existing UKA and progression of patellofemoral compartment osteoarthritis is an attractive option. This EKS Delphi-derived consensus statement, which reached a strong consensus, can be used by clinicians to identify patients suitable for this procedure.
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Affiliation(s)
| | - Stefano Campi
- Campus Bio Medico University Hospital, Rome, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | | | | | - Nick London
- Yorkshire Knee Clinic, Leeds, UK
- Leeds Beckett University, Leeds, UK
| | - David Barrett
- King Edward VII Hospital, Windsor, UK
- School of Engineering Science, University of Southampton, Southampton, UK
| | - Jean-Noel Argenson
- Institute for Locomotion, Aix-Marseille University, Marseille, France
- CNRS 5, St. Marguerite Hospital, Marseille, France
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Forlenza EM, Burnett RA, Acuña AJ, Levine BR, Gililland JM, Della Valle CJ. Revision Unicompartmental Knee Arthroplasty: Worse than a Primary, but Better than a Revision Total Knee Arthroplasty. J Arthroplasty 2025:S0883-5403(24)01336-6. [PMID: 39755220 DOI: 10.1016/j.arth.2024.12.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2024] [Revised: 12/22/2024] [Accepted: 12/30/2024] [Indexed: 01/06/2025] Open
Abstract
BACKGROUND Revision of a unicompartmental to a total knee arthroplasty (TKA) is often compared to primary TKA with regard to its technical difficulty and complication rates. We sought to compare medical and surgical complications following revision unicompartmental knee arthroplasty (UKA) to those following primary TKA and aseptic revision TKA. METHODS A national administrative claims database was queried for patients undergoing revision UKA between 2010 and 2019. Patients undergoing revision of a UKA were matched to patients undergoing primary TKA and aseptic revision TKA based on age, sex, Elixhauser Comorbidity Index, payer status, and a history of obesity, osteoporosis, tobacco use, and alcohol use disorder. Revision-free survivorship as well as 2-year and 90-day complication rates were compared. Multivariable logistic regression analysis was performed to determine the independent risk of medical and surgical complications. RESULTS A total of 3,924 matched primary TKAs, revision of a failed UKA, and aseptic revision TKA patients were included. Overall survivorship was 96.9% (95% confidence interval [CI] 95.9 to 97.8) for primary TKA, 93.4% (95% CI 92.1 to 94.8) for revision UKA, and 89.8% (95% CI 88.2 to 91.5) for aseptic revision TKA at 2-year follow-up (P < 0.001). At two years, revision UKA patients had higher rates of aseptic loosening (2.2 versus 0.8%, P = 0.004), instability (2.4 versus 0.8%, P = 0.002), and mechanical failures (3.0 versus 1.5%, P = 0.012) than primary TKA patients. The 90-day complication rates were comparable between primary TKA and revision UKA patients (all P > 0.05); the risk of reoperation, acute kidney injury, wound dehiscence, hematoma, and transfusion were all higher in the revision TKA than in the revision UKA cohort (all P < 0.05). CONCLUSIONS Revision-free survivorship and arthroplasty-related complications at two years following revision UKA are lower than that for primary TKA, but higher than that for aseptic revision TKA, whereas medical complications are similar to those following primary TKA.
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Affiliation(s)
- Enrico M Forlenza
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Robert A Burnett
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois; Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah
| | - Alexander J Acuña
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Brett R Levine
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Jeremy M Gililland
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah
| | - Craig J Della Valle
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
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Buchalter DB, Ast MP. Avoiding complications in medial unicompartmental knee arthroplasty. J ISAKOS 2024; 9:100331. [PMID: 39401700 DOI: 10.1016/j.jisako.2024.100331] [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: 09/22/2024] [Accepted: 09/25/2024] [Indexed: 11/18/2024]
Abstract
Medial unicompartmental knee arthroplasty (mUKA) is a highly effective treatment for the management of isolated osteoarthritis in the medial compartment. While favorable long-term survivorship is seen in most series, the long-term rate of revision after mUKAs remains higher than that for total knee arthroplasty. Poor indications and poor surgical technique are often responsible for mUKA failure. Understanding why these complications occur and how to avoid them will optimize clinical outcomes, reduce revision rates, and lead to lower healthcare costs. This review will discuss the five most common causes of mUKA failure including progression of arthritis, aseptic loosening, bearing dislocation, periprosthetic fracture, and polyethylene wear and how to avoid them with proper patient selection and meticulous surgical technique.
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Affiliation(s)
- Daniel B Buchalter
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021, USA.
| | - Michael P Ast
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021, USA.
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Sanghvi PA, Burkhart RJ, Belt NG, Nedder VJ, Saleh A, Kaelber DC, Mistovich RJ. Epidemiological Trends and Outcomes of Unicompartmental Knee Arthroplasty Among 104 Million Patients in the United States. J Arthroplasty 2024; 39:2942-2948. [PMID: 38914143 DOI: 10.1016/j.arth.2024.06.048] [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: 02/19/2024] [Revised: 06/17/2024] [Accepted: 06/19/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND Unicompartmental knee arthroplasty (UKA) is an alternative to total knee arthroplasty (TKA) for localized osteoarthritis. Recent advancements in UKA implant design and expanding patient criteria may have increased its utilization. However, few studies have examined the use of UKA in the United States. Thus, this study assessed the current and projected future trends of UKA and robotic UKA in the United States through 2035, along with postoperative outcomes. METHODS A collaborative healthcare research network was queried to identify patients who had undergone UKA. Primary outcomes measured included prevalence (P), incidence proportion (IP), and incidence rate (IR) from 2012 to 2022. Chi-squared analyses were done to compare outcomes across categorical data. Regression modeling was performed to project UKA to the year 2035. Statistical significance was held at P < .05 for all analyses. RESULTS In 2022, 1,662 UKAs were performed within the network, a 590% increase from 2012 (241 performed). The IP increased on an average annual basis by 41.8%, the IR by 50%, and the P by 51.3%. A year following UKA, conversion to TKA was the most common orthopaedic complication (39.9%). As of 2022, there were 68 robotic UKAs performed, a 518% increase from the 11 performed in 2012. Regression analysis for UKA through 2035 showed that IP will be 0.04%, IR will be 1.75 × 10-6 cases/person-day, and P will be 0.3%. CONCLUSIONS These findings are consistent with prior studies indicating a higher utilization of UKA over the past decade. Reported complications were not uncommon, as nearly 40% of patients required a conversion to a TKA. Further research is needed to optimally identify criteria for appropriate patients and determine the benefits robotic UKA may provide, specifically reducing the risk of conversion to a TKA.
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Affiliation(s)
- Parshva A Sanghvi
- Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Robert J Burkhart
- Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Nicholas G Belt
- Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Victoria J Nedder
- Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Anas Saleh
- The MetroHealth System, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - David C Kaelber
- The MetroHealth System, Case Western Reserve University School of Medicine, Cleveland, Ohio; The Center for Clinical Informatics Research and Education, The MetroHealth System, Cleveland, Ohio
| | - R Justin Mistovich
- Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio; The MetroHealth System, Case Western Reserve University School of Medicine, Cleveland, Ohio
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Scheele CB, Pietschmann MF, Wagner TC, Müller PE. Conversion of UKA to TKA using identical standard implants-How does it compare to primary UKA, primary TKA and revision TKA? ARTHROPLASTY 2024; 6:48. [PMID: 39223613 PMCID: PMC11370294 DOI: 10.1186/s42836-024-00267-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 06/17/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND UKA is a well-established treatment option for anteromedial osteoarthritis of the knee, resulting in superior functional outcomes but also higher revision rates than TKA. This study aimed to compare the outcomes of UKA, TKA, UKA converted to TKA using identical standard implants and revised TKA to support clinical decision-making. METHODS In this study, we retrospectively examined 116 patients who underwent UKA, 77 patients who received TKA, 28 patients whose UKA was converted to TKA using identical standard implants, and 21 patients who had a one-stage revision of TKA. The mean age at operation was 66.5 years (39-90 years), with a mean BMI of 28.8 kg/m2 (17.4-58.8) and a mean follow-up period of four years (0.9-9.9 years). We assessed various PROMs, including Oxford Knee Score, UCLA score, KSS score, and a modified WOMAC-Score as well as patient satisfaction and ability to resume daily activities, work, and sports. RESULTS The highest patient satisfaction was seen in the UKA. All scores were significantly higher for UKA than for TKA, converted UKA, and revised TKA. None of the scores showed a significant inferiority of converted UKA to TKA. In the case of revision, two scores showed significantly better results for converted UKA than for revised TKA. CONCLUSIONS Our results indicated that patients initially treated with UKA did not have significantly worse functional outcomes after conversion to TKA, given the use of identical standard implants. This highlights the effectiveness of UKA as a therapeutic option with outcomes superior to those of primary TKA and the importance of a bone-sparing procedure. Conversely, revision TKA is linked to poorer functional outcomes compared to both primary arthroplasties.
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Affiliation(s)
- Christian B Scheele
- Department of Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, Großhadern Campus, Ludwig Maximilians University, Marchioninistr. 15, Munich, 81377, Germany.
- Department of Orthopedics and Sports Orthopedics, Klinikum Rechts Der Isar, Technical University Munich, Ismaninger Str. 22, Munich, 81675, Germany.
| | - Matthias F Pietschmann
- Department of Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, Großhadern Campus, Ludwig Maximilians University, Marchioninistr. 15, Munich, 81377, Germany
| | - Thomas C Wagner
- Department of Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, Großhadern Campus, Ludwig Maximilians University, Marchioninistr. 15, Munich, 81377, Germany
| | - Peter E Müller
- Department of Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, Großhadern Campus, Ludwig Maximilians University, Marchioninistr. 15, Munich, 81377, Germany
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12
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Dal Fabbro G, Grassi A, Agostinone P, Lucidi GA, Fajury R, Ravindra A, Zaffagnini S. High survivorship rate and good clinical outcomes after high tibial osteotomy in patients with radiological advanced medial knee osteoarthritis: a systematic review. Arch Orthop Trauma Surg 2024; 144:3977-3988. [PMID: 38430233 PMCID: PMC11564305 DOI: 10.1007/s00402-024-05254-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 02/17/2024] [Indexed: 03/03/2024]
Abstract
INTRODUCTION The role of valgus producing high tibial osteotomy (HTO) for the treatment of advanced knee osteoarthritis (OA) is still controversial. The aim of the current systematic review was to assess survivorship and patient-reported outcomes (PROMs) of high tibial osteotomy in patients with radiological advanced medial knee OA. METHODS A systematic search of PubMed, Cochrane and EMBASE database was performed in July 2023 in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines. Inclusion and exclusion criteria were applied to identify studies investigating the survivorship rate and PROMs of valgus-producing high tibial osteotomy in patients with advanced knee OA at x-ray assessment in the medial compartment at minimum-two-years follow up. Advanced radiological OA was defined as Kellgren Lawrence (K-L) ≥ 3 or Ahlbäch ≥ 2. Survivorship was defined as percentage of patients free of total knee arthroplasty (TKA) at follow-up. Clinical interpretation of provided PROMs were performed according to minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) target values reported in literature. Survivorship data and PROMs scores were extracted, and studies were stratified based on selected study features. The quality of included studies was assessed with modified Coleman score. RESULTS A total of 18 studies, totalling 1296 knees with a mean age between 46.9 and 67 years old, were included. Average survivorship was of 74.6% (range 60 - 98.1%) at 10-years follow up. The subjective scoring systems showed good results according to MCID and PASS, and postoperative improvements were partially maintained until final follow-up. CONCLUSION HTO is worth considering as treatment choice even in patients affected by radiological advanced medial knee osteoarthritis. Long term survivorship and good patient reported clinical outcomes could be expected in this population. LEVEL OF EVIDENCE IV; systematic review of level III-IV studies.
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Affiliation(s)
- Giacomo Dal Fabbro
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, Bologna, 40136, Italy.
- Università di Bologna, Dipartimento di Scienze Biomediche e Neuromotorie DIBINEM, Bologna, Italy.
| | - Alberto Grassi
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, Bologna, 40136, Italy
| | - Piero Agostinone
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, Bologna, 40136, Italy
| | - Gian Andrea Lucidi
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, Bologna, 40136, Italy
| | - Raschid Fajury
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, Bologna, 40136, Italy
| | - Abhijit Ravindra
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, Bologna, 40136, Italy
| | - Stefano Zaffagnini
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, Bologna, 40136, Italy
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13
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Roche M, Vakharia RM, Law T, Rodriguez HC, Mekkawy KL, Sodhi N, Dubin JA, Hameed D, Mont MA. Excellent 10-Year survivorship of robotic-arm-assisted unicompartmental knee arthroplasty. J Orthop 2024; 55:32-37. [PMID: 38638114 PMCID: PMC11021903 DOI: 10.1016/j.jor.2024.02.044] [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: 02/20/2024] [Accepted: 02/24/2024] [Indexed: 04/20/2024] Open
Abstract
Introduction Robotic-arm-assisted unicompartmental knee arthroplasty (UKA) is an excellent solution for patients suffering from single-compartment knee arthritis. While outcomes tend to be favorable for UKAs, revision operations, commonly due to component malpositioning and malalignment resulting in accelerated wear, are a major concern. Intraoperative technologies, such as robotic assistance, can help better ensure that implants are positioned based on a patient's specific anatomy and mechanical physiology. However, long-term survivorship and patient-reported satisfaction with robotic-assisted UKAs are limited. Therefore, the purpose of this study was to assess the 10-year outcomes of patients who underwent robotic-arm-assisted unicompartmental knee arthroplasty. Specifically, we evaluated: 1) 10-year survivorships; 2) patient satisfaction scores; and 3) re-operations. Methods From a single surgeon and single institution, 185 patients who had a mean age of 65 years (range, 39 to 92) and a mean body mass index of 31.6 (range, 22.4 to 39) at a mean of 10 years follow-up were evaluated (range, 9 to 11). For all patients, the same robotic-assistive device was utilized intraoperatively, and all patients underwent standardized physical therapy and received standardized pain control management. Then 10-year survivorships with Kaplan-Meir curves, patient satisfaction evaluations with a 5-point Likert scale, and re-operations were assessed as primary outcomes. Results Overall implant survivorship was 99%, with only two patients requiring revision surgery. There was one patient who was converted to a total knee arthroplasty, while the other patient underwent polyethylene exchange at 5 weeks for an acute infection with successful implant retention. Overall, 97% of the patients were satisfied with their postoperative outcomes, with 81% of patients reporting being very satisfied. There were two other patients who required arthroscopic intervention: one to remove a cement loose body, the other to remove adhered scar from the fat pad and the anterior cruciate ligament. Conclusion This study is one of the first to provide longer-term (mean 10-year) survivorship and patient-reported satisfaction outcomes for robotic-assisted UKA patients. These data show strong support for utilizing this surgical technique, as nearly all patients maintained their original prostheses and reported being satisfied after a mean of 10 years. Therefore, based on these results, we recommend the use of robotic assistance when performing UKAs.
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Affiliation(s)
- Martin Roche
- Department of Orthopaedic Surgery, Hospital for Special Surgery Florida, West Palm Beach, FL, United States
| | - Rushabh M. Vakharia
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, United States
| | - Tsun Law
- Holy Cross Hospital, Orthopaedic Research Institute, Ft. Lauderdale, FL, 33308, United States
| | | | - Kevin L. Mekkawy
- Larkin Community Hospital, South Miami, FL, 33143, United States
| | - Nipun Sodhi
- Department of Orthopaedic Surgery, North Shore University Hospital, Northwell Health, New York, NY, United States
| | - Jeremy A. Dubin
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopaedics, Baltimore, MD, United States
| | - Daniel Hameed
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopaedics, Baltimore, MD, United States
| | - Michael A. Mont
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopaedics, Baltimore, MD, United States
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Favroul C, Batailler C, Thouvenin C, Shatrov J, Neyret P, Servien E, Lustig S. Long-term functional success and robust implant survival in lateral unicompartmental knee arthroplasty: A case series with a mean follow-up of twenty two and a half years. INTERNATIONAL ORTHOPAEDICS 2024; 48:1761-1769. [PMID: 38743298 DOI: 10.1007/s00264-024-06215-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 05/07/2024] [Indexed: 05/16/2024]
Abstract
PURPOSE Lateral unicompartmental knee arthroplasty (UKA) is an accepted treatment option in cases of end-stage lateral osteoarthritis. While lateral UKA has many proposed advantages compared to total knee arthroplasty, its technical challenges and relatively small number of cases make this an uncommon procedure. The aim of this study was to report the survivorship and functional outcomes beyond 20 years of follow-up of isolated UKA. METHODS Between January 1988 and October 2003, 54 lateral UKAs were performed in a single center. The fitted prosthesis was a fixed plate and cemented polyethylene (PE). All patients had isolated lateral tibiofemoral osteoarthritis, including five open meniscectomies, three arthroscopies, and three open reductions of lateral tibial plateau fractures. Patients with a minimum of 20 years of follow-up were included in the final analysis. RESULTS Of the 54 UKA, 22 died before reaching the minimum follow-up period and four were lost to follow-up. Twenty-eight were included in the final analysis. Among them, 21 patients remained alive and an additional seven were deceased after 20 years. The mean age at the last follow-up was 84.8 ± 11.9 years with a mean follow-up duration of 22.5 ± 2.1 years. Of the 28 knees, eight underwent revision surgery (5 for the progression of osteoarthritis; 2 for aseptic loosening; 1 for PE wear). Kaplan-Meier survival analysis revealed a survival rate at 20 and 25 years of 72.3% (CI 59.1; 88.6). The average time to revision was 14.9 ± 4.9 years. At the last follow-up, the mean function Knee Society Score (KSS) was 41.5 ± 32.9 and the mean objective KSS score was 79.4 ± 9.7. In the unrevised population, 94.7% of patients (n = 18) reported being satisfied or very satisfied with the surgery. CONCLUSION Lateral UKA remains a viable treatment option for patients with isolated lateral tibiofemoral osteoarthritis, providing satisfactory 20-year implant survivorship and high patient satisfaction.
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Affiliation(s)
- Clément Favroul
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon North University Hospital, 103 Grande Rue de La Croix-Rousse, 69004, Lyon, France.
| | - Cécile Batailler
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon North University Hospital, 103 Grande Rue de La Croix-Rousse, 69004, Lyon, France
- Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406, 69622, Lyon, France
| | - Clara Thouvenin
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon North University Hospital, 103 Grande Rue de La Croix-Rousse, 69004, Lyon, France
| | - Jobe Shatrov
- Sydney Orthopedic Research Institute, University of Notre Dame Australia, Hornsby and Ku-Ring Hospital, Sydney, Australia
| | | | - Elvire Servien
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon North University Hospital, 103 Grande Rue de La Croix-Rousse, 69004, Lyon, France
- LIBM-EA 7424, Interuniversity Laboratory of Biology of Mobility, Claude Bernard Lyon 1 University, Lyon, France
| | - Sébastien Lustig
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon North University Hospital, 103 Grande Rue de La Croix-Rousse, 69004, Lyon, France
- Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406, 69622, Lyon, France
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15
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Albishi W, AbuDujain NM, Aldhahri M, Alzeer M. Unicompartmental knee replacement: controversies and technical considerations. ARTHROPLASTY 2024; 6:21. [PMID: 38693586 PMCID: PMC11064323 DOI: 10.1186/s42836-024-00242-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 02/20/2024] [Indexed: 05/03/2024] Open
Abstract
BACKGROUND Unicompartmental knee replacement (UKR) is one of the effective interventions for the treatment of symptomatic knee osteoarthritis. Moreover, it has multiple advantages over total knee arthroplasty (TKA), including reduced intraoperative blood loss, decreased risk of transfusion, and faster recovery. This study aimed to discuss critical technical considerations regarding UKR and some of the controversies and updates. METHODS We conducted a review to provide an overview of the controversies and technical considerations about UKR in several aspects. Only peer-reviewed articles were included, up to December 2023 using PubMed, Google Scholar, ERIC, and Cochrane database for systematic reviews databases. RESULT UKR is associated with superior patient-reported clinical and functional outcomes, as well as shorter hospital stays, fewer postoperative complications, and revealed favorable outcomes in patients' return to sport. The choice between mobile- and fixed-bearing prostheses depends, in part, on the surgeon's preference. The mobile-bearing UKR is a less constrained prosthesis and can potentially result in less wear, but it is more technically demanding. While no significant difference between mobile-bearing versus fixed-bearing prostheses, cementless is superior to cemented design. Furthermore, UKR can be a good alternative for high tibial osteotomy (HTO) and still can be considered after a failed HTO. Lastly, recent reviews have shown a revision rate comparable to that of TKA. This is probably influenced by Improved comprehension of the best indications, patient selection criteria, as well as of the design, materials, and technological advances. CONCLUSION UKR treatment for unicompartmental knee osteoarthritis is secure and effective. Based on clinical and functional outcomes, decreased morbidity and mortality, and cost-effectiveness, long-term studies suggest that UKR is superior to TKA. Further investigation in this area is warranted.
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Affiliation(s)
- Waleed Albishi
- Department of Orthopedic Surgery, College of Medicine, King Saud University, Riyadh, 11362, Saudi Arabia
| | - Nasser M AbuDujain
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, 2925, Saudi Arabia.
| | - Mohammed Aldhahri
- Department of Orthopedic Surgery, College of Medicine, King Saud University, Riyadh, 11362, Saudi Arabia
| | - Meshari Alzeer
- College of Medicine, King Saud University, Riyadh, 11362, Saudi Arabia
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16
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Theus-Steinmann C, Lustig S, Calliess T. [Evolving indications for partial knee replacement : New aspects]. ORTHOPADIE (HEIDELBERG, GERMANY) 2024; 53:238-245. [PMID: 38498206 DOI: 10.1007/s00132-024-04484-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/12/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND Partial knee replacement has proven to be an effective therapy for advanced unicompartmental arthrosis of the knee. Despite continuous advancements in implants and surgical techniques over the past decades, the global preference for total knee arthroplasty still persists for historical reasons. OBJECTIVES This report aims to illuminate advantages and disadvantages of partial knee replacement considering long-term results, the evolution of indication criteria over recent decades and new aspects in patient selection with potential improvements through emerging technologies. MATERIAL AND METHODS The analysis involves the examination of long-term results from clinical studies and registry data, highlighting the risk factors for potential failures and their influence on the development of indication criteria. RESULTS Present-day long-term results demonstrate excellent prosthetic survival, aligning with outcomes from total knee arthroplasty. New perspectives for expanding indication criteria are discussed, including the possible application of partial knee replacement in cases of severe varus deformity > 15°, anterior cruciate ligament insufficiency, young active patients, anterior knee pain, and/or patellofemoral arthritis, as well as mild radiographic arthritis with degenerative medial meniscus root tear and meniscal extrusion. DISCUSSION Indication criteria have consistently expanded in recent years, taking into account modern insights, and the application of advanced technologies can enhance precision and minimize surgical errors. Furthermore, this report emphasizes that revision rates are not the sole criterion for success and underscores the necessity for a comprehensive examination of clinical results.
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Affiliation(s)
- Carlo Theus-Steinmann
- articon Spezialpraxis für Gelenkchirurgie, Berner Prothetikzentrum Salem-Spital, Schänzlistrasse 39, 3013, Bern, Schweiz.
| | - Sébastien Lustig
- Centre Albert Trillat, Hôpital de la Croix-Rousse, 103 Grande Rue de la Croix Rousse, 69004, Lyon, Frankreich
| | - Tilman Calliess
- articon Spezialpraxis für Gelenkchirurgie, Berner Prothetikzentrum Salem-Spital, Schänzlistrasse 39, 3013, Bern, Schweiz
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17
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Zhao JL, Jin X, Huang HT, Yang WY, Li JH, Luo MH, Liu J, Pan JK. Analysis of the causes of primary revision after unicompartmental knee arthroplasty: A case series. World J Clin Cases 2024; 12:1560-1568. [PMID: 38576738 PMCID: PMC10989437 DOI: 10.12998/wjcc.v12.i9.1560] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 02/02/2024] [Accepted: 02/26/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Unicompartmental knee arthroplasty (UKA) has great advantages in the treatment of unicompartmental knee osteoarthritis, but its revision rate is higher than that of total knee arthroplasty. AIM To summarize and analyse the causes of revision after UKA. METHODS This is a retrospective case series study in which the reasons for the first revision after UKA are summarized. We analysed the clinical symptoms, medical histories, laboratory test results, imaging examination results and treatment processes of the patients who underwent revision and summarized the reasons for primary revision after UKA. RESULTS A total of 13 patients, including 3 males and 10 females, underwent revision surgery after UKA. The average age of the included patients was 67.62 years. The prosthesis was used for 3 d to 72 months. The main reasons for revision after UKA were improper suturing of the surgical opening (1 patient), osteophytes (2 patients), intra-articular loose bodies (2 patients), tibial prosthesis loosening (2 patients), rheumatoid arthritis (1 patient), gasket dislocation (3 patients), anterior cruciate ligament injury (1 patient), and medial collateral ligament injury with residual bone cement (1 patient). CONCLUSION The causes of primary revision after UKA were gasket dislocation, osteophytes, intra-articular loose bodies and tibial prosthesis loosening. Avoidance of these factors may greatly reduce the rate of revision after UKA, improve patient satisfaction and reduce medical burden.
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Affiliation(s)
- Jin-Long Zhao
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China
| | - Xiao Jin
- Department of Chinese Medicine, The First Affiliated Hospital, Jinan University, Guangzhou 510630, Guangdong Province, China
| | - He-Tao Huang
- The Second School of Clinical Medical Sciences, Guangzhou University of Chinese Medicine, Guangdong Academy of Traditional Chinese Medicine, Guangzhou 510405, Guangdong Province, China
| | - Wei-Yi Yang
- The Second Affiliated Hospital, Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou 510120, Guangdong Province, China
| | - Jia-Hui Li
- The Affiliated TCM Hospital, Guangzhou Medical University, Guangzhou 510405, Guangdong Province, China
| | - Ming-Hui Luo
- The Second Affiliated Hospital, Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou 510120, Guangdong Province, China
| | - Jun Liu
- The Research Team on Bone and Joint Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou 510405, Guangdong Province, China
| | - Jian-Ke Pan
- The Second Affiliated Hospital, Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou 510120, Guangdong Province, China
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Fu T, Ren S, Nie Y. THE EFFECTS OF DRAINAGE TUBE ON PAIN AND FUNCTIONAL RECOVERY AFTER UNICOMPARTMENTAL KNEE ARTHROPLASTY. ACTA ORTOPEDICA BRASILEIRA 2024; 32:e266853. [PMID: 38532868 PMCID: PMC10962064 DOI: 10.1590/1413-785220243201e266853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 07/06/2023] [Indexed: 03/28/2024]
Abstract
Objective The objective of this study was to evaluate the impact of drainage tube placement on postoperative pain, recovery, and opioid consumption within a 72-hour period following unicompartmental knee arthroplasty (UKA). Methods Patients with medial knee osteoarthritis who underwent UKA from January 2019 to August 2020 were enrolled in the study and divided into two groups based on whether they received a drain postoperatively. Results The drainage group had significantly lower VAS scores on day 1, day 2, and day 3, in addition to significantly smaller changes in the circumference of the knee joint within 3 days postoperatively (P <0.05). The ROM in the drainage group significantly increased at 3 days and 1 month post-surgery, with a statistically significant difference in morphine consumption between the two groups at 3 days (P<0.05). The incidence of postoperative nausea and vomiting (5 cases) and wound bleeding (1 case) was lower in the drainage group compared to the non-drainage group (P<0.05). Conclusions The placement of a drainage tube in UKA may reduce the swelling of knee joint and pain, which not only reduces the use of Opioid but also facilitates early functional activities of the knee joint. Level of Evidence III; Retrospective Comparative Study.
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Affiliation(s)
- Ting Fu
- Fuyang People's Hospital, Fuyang, Anhui, China
| | - Shuzhen Ren
- Fuyang Second People's Hospital, Fuyang, Anhui, China
| | - Yu Nie
- Fuyang People's Hospital, Fuyang, Anhui, China
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Zgouridou A, Kenanidis E, Potoupnis M, Tsiridis E. Global mapping of institutional and hospital-based (Level II-IV) arthroplasty registries: a scoping review. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1219-1251. [PMID: 37768398 PMCID: PMC10858160 DOI: 10.1007/s00590-023-03691-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 08/13/2023] [Indexed: 09/29/2023]
Abstract
PURPOSE Four joint arthroplasty registries (JARs) levels exist based on the recorded data type. Level I JARs are national registries that record primary data. Hospital or institutional JARs (Level II-IV) document further data (patient-reported outcomes, demographic, radiographic). A worldwide list of Level II-IV JARs must be created to effectively assess and categorize these data. METHODS Our study is a systematic scoping review that followed the PRISMA guidelines and included 648 studies. Based on their publications, the study aimed to map the existing Level II-IV JARs worldwide. The secondary aim was to record their lifetime, publications' number and frequency and recognise differences with national JARs. RESULTS One hundred five Level II-IV JARs were identified. Forty-eight hospital-based, 45 institutional, and 12 regional JARs. Fifty JARs were found in America, 39 in Europe, nine in Asia, six in Oceania and one in Africa. They have published 485 cohorts, 91 case-series, 49 case-control, nine cross-sectional studies, eight registry protocols and six randomized trials. Most cohort studies were retrospective. Twenty-three per cent of papers studied patient-reported outcomes, 21.45% surgical complications, 13.73% postoperative clinical and 5.25% radiographic outcomes, and 11.88% were survival analyses. Forty-four JARs have published only one paper. Level I JARs primarily publish implant revision risk annual reports, while Level IV JARs collect comprehensive data to conduct retrospective cohort studies. CONCLUSIONS This is the first study mapping all Level II-IV JARs worldwide. Most JARs are found in Europe and America, reporting on retrospective cohorts, but only a few report on studies systematically.
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Affiliation(s)
- Aikaterini Zgouridou
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece
| | - Eustathios Kenanidis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece.
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece.
| | - Michael Potoupnis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece
| | - Eleftherios Tsiridis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece
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Montilla FJ, Payo-Ollero J, Serrano-Toledano D, Del Río-Arteaga M, Ribera J, Muela R. Unicompartmental knee arthroplasties: does the type of tibial component selected influence implant survival? Arch Orthop Trauma Surg 2024; 144:347-355. [PMID: 37743356 DOI: 10.1007/s00402-023-05055-x] [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: 03/27/2023] [Accepted: 09/02/2023] [Indexed: 09/26/2023]
Abstract
INTRODUCTION Few information has been published on the survival of unicompartmental knee arthroplasty (UKA) and fixed-bearing tibial components. The aim of this study is to analyze if UKA survival varies according to UKA model used and to analyze the possible risk factors for UKA revision. MATERIALS AND METHODS A retrospective study analyzing 301 UKAs (ACCURIS, all-polyethylene tibial component, 152; Triathlon PKR, metal-backed tibial component, 149) was performed. Demographic parameters as well as implant survival and cause of prosthetic revision were analyzed. The Kaplan-Meier survival analysis, the log-rank test and the Cox multiple regression were used for the analysis. RESULTS Average follow-up was 8.1 ± 3.08-years. Average age was 68.1 ± 8.6-years; 70.4% of subjects were women. The ACCURIS UKA group had a UKA revision rate higher compared to the Triathlon PKR group (16/152, 10.6% vs 5/149, 3.4%, respectively; p < 0.001). The main cause of prosthetic revision was aseptic loosening (5/21, 23.8%). All aseptic loosening cases and tibial component collapse were reported with the ACCURIS UKA group. Overall UKA survival was 98.01% (95% CI 95.62-99.1) at 1-year, 94.27% (95% CI 90.95-96.4) at 5-years and 92.38% (95% CI 88.48-94.99) at 10-years' follow-up. There were no differences in the Kaplan-Meier survival curves regarding operated side or affected tibiofemoral compartment (log-rank test = 0.614 and 0.763, respectively). However, Kaplan-Meier survival curve according to UKA model used was different (log-rank test = 0.033). The metal-backed component appeared to be a protector factor for UKA revision when adjusted for age, sex, operated side, and affected tibiofemoral compartment (Hazard Ratio 0.32, p = 0.031). CONCLUSION Fixed-bearing UKAs showed excellent mid- and long-term survival rates. Aseptic loosening is the main cause of implant failure. PKR group (metal-backed component) seem to be a protector factor to UKA revision when it was compared with ACCURIS UKA group (all-polyethylene tibial component).
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Affiliation(s)
- Francisco Javier Montilla
- Clínica COT, C/ Juan Ramón Jiménez 29, 41011, Seville, Spain
- Orthopedics and Trauma Surgery Department, Viamed Santa Ángela de la Cruz Hospital, Av. de Jerez, 59, 41014, Seville, Spain
| | - Jesús Payo-Ollero
- Clínica COT, C/ Juan Ramón Jiménez 29, 41011, Seville, Spain.
- Orthopedics and Trauma Surgery Department, Viamed Santa Ángela de la Cruz Hospital, Av. de Jerez, 59, 41014, Seville, Spain.
| | - David Serrano-Toledano
- Clínica COT, C/ Juan Ramón Jiménez 29, 41011, Seville, Spain
- Orthopedics and Trauma Surgery Department, Viamed Santa Ángela de la Cruz Hospital, Av. de Jerez, 59, 41014, Seville, Spain
| | - Marta Del Río-Arteaga
- Clínica COT, C/ Juan Ramón Jiménez 29, 41011, Seville, Spain
- Orthopedics and Trauma Surgery Department, Viamed Santa Ángela de la Cruz Hospital, Av. de Jerez, 59, 41014, Seville, Spain
| | - Juan Ribera
- Clínica COT, C/ Juan Ramón Jiménez 29, 41011, Seville, Spain
- Orthopedics and Trauma Surgery Department, Viamed Santa Ángela de la Cruz Hospital, Av. de Jerez, 59, 41014, Seville, Spain
| | - Rafael Muela
- Clínica COT, C/ Juan Ramón Jiménez 29, 41011, Seville, Spain
- Orthopedics and Trauma Surgery Department, Viamed Santa Ángela de la Cruz Hospital, Av. de Jerez, 59, 41014, Seville, Spain
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Toro G, Braile A, Conza G, De Cicco A, Abu Mukh A, Placella G, Salini V. Unicompartimental knee arthroplasty metallosis treated with uni-on-uni revision: A case report. World J Orthop 2023; 14:889-896. [PMID: 38173807 PMCID: PMC10758592 DOI: 10.5312/wjo.v14.i12.889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/15/2023] [Accepted: 11/09/2023] [Indexed: 12/15/2023] Open
Abstract
BACKGROUND Metallosis is the result of metallic wear debris in the soft tissues and is associated to both local and systemic inflammatory response. Metallosis has been reported after total hip and total knee arthroplasty (TKA), but rarely after a unicompartimental knee arthroplasty (UKA). In the context of UKA metallosis, surgeons often opt for revision using a TKA. However, in this paper, the authors successfully treated UKA revising the metal back only. CASE SUMMARY Prior to treat our patient we conducted a literature research through which we identified eleven cases of metallosis after UKA, ten (90.9%) were treated revising using though a TKA. Only one case was managed through a uni-on-uni revision, reporting high knee function. Our patient complained worsening pain and function after a snap occurred at 16 mo after UKA implantation. At 18 mo following surgical debridment and uni-on-uni revision surgery, our patient exhibited a relevant improvement in Oxford Knee Score and a reduction of metal ion levels in the blood. CONCLUSION Our study highlights that in case of metallosis after UKA, the treatment may be based on surgical debridement and just revising the mobilized components.
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Affiliation(s)
- Giuseppe Toro
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Naples 80138, Italy
| | - Adriano Braile
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Naples 80138, Italy
| | - Gianluca Conza
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Naples 80138, Italy
| | - Annalisa De Cicco
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Naples 80138, Italy
| | - Assala Abu Mukh
- Department of Orthopaedics and Traumatology, San Raffaele Hospital, Milan 20132, Italy
| | - Giacomo Placella
- Department of Orthopaedics and Traumatology, San Raffaele Hospital, Milan 20132, Italy
| | - Vincenzo Salini
- Department of Orthopaedics and Traumatology, San Raffaele Hospital, Milan 20132, Italy
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22
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Sabah SA, Hedge EA, von Fritsch L, Xu J, Rajasekaran RB, Hamilton TW, Shearman AD, Alvand A, Beard DJ, Hopewell S, Price AJ. Patient-relevant outcomes following elective, aseptic revision knee arthroplasty: a systematic review. Syst Rev 2023; 12:133. [PMID: 37528486 PMCID: PMC10394899 DOI: 10.1186/s13643-023-02290-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/17/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND The aim of this systematic review was to summarise the evidence for the clinical effectiveness of revision knee arthroplasty (rKA) compared to non-operative treatment for the management of patients with elective, aseptic causes for a failed knee arthroplasty. METHODS MEDLINE, Embase, AMED and PsychINFO were searched from inception to 1st December 2020 for studies on patients considering elective, aseptic rKA. Patient-relevant outcomes (PROs) were defined as implant survivorship, joint function, quality of life (QoL), complications and hospital admission impact. RESULTS No studies compared elective, aseptic rKA to non-operative management. Forty uncontrolled studies reported on PROs following elective, aseptic rKA (434434 rKA). Pooled estimates for implant survivorship were: 95.5% (95% CI 93.2-97.7%) at 1 year [seven studies (5524 rKA)], 90.8% (95% CI 87.6-94.0%) at 5 years [13 studies (5754 rKA)], 87.4% (95% CI 81.7-93.1%) at 10 years [nine studies (2188 rKA)], and 83.2% (95% CI 76.7-89.7%) at 15 years [two studies (452 rKA)]. Twelve studies (2382 rKA) reported joint function and/or QoL: all found large improvements from baseline to follow-up. Mortality rates were low (0.16% to 2% within 1 year) [four studies (353064 rKA)]. Post-operative complications were common (9.1 to 37.2% at 90 days). CONCLUSION Higher-quality evidence is needed to support patients with decision-making in elective, aseptic rKA. This should include studies comparing operative and non-operative management. Implant survivorship following elective, aseptic rKA was ~ 96% at 1 year, ~ 91% at 5 years and ~ 87% at 10 years. Early complications were common after elective, aseptic rKA and the rates summarised here can be shared with patients during informed consent. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020196922.
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Affiliation(s)
- Shiraz A Sabah
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, England.
- Nuffield Orthopaedic Centre, Oxford, England.
| | - Elizabeth A Hedge
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, England
| | - Lennart von Fritsch
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, England
| | - Joshua Xu
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, England
| | - Raja Bhaskara Rajasekaran
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, England
- Nuffield Orthopaedic Centre, Oxford, England
| | - Thomas W Hamilton
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, England
- Nuffield Orthopaedic Centre, Oxford, England
| | | | - Abtin Alvand
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, England
- Nuffield Orthopaedic Centre, Oxford, England
| | - David J Beard
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, England
| | - Sally Hopewell
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, England
- Centre for Statistics in Medicine, University of Oxford, Oxford, England
| | - Andrew J Price
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, England
- Nuffield Orthopaedic Centre, Oxford, England
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Inclan PM, Barrack RL, Matava MJ. Popliteus Avulsion Fracture After Unicompartmental Arthroplasty: A Case Report. JBJS Case Connect 2023; 13:01709767-202303000-00003. [PMID: 36608173 DOI: 10.2106/jbjs.cc.22.00477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
CASE An active 64-year-old patient presented with new-onset lateral knee pain 42 days after an uncomplicated medial unicompartmental knee arthroplasty (UKA). Magnetic resonance imaging and diagnostic injection of local anesthetic identified an avulsion fracture of the popliteus tendon as the source of discomfort. Repair of the tendon to its native footprint was performed with suture anchor fixation. The patient was pain-free and returned to work without restrictions at 12 weeks. CONCLUSION We identify a unique cause of knee pain after UKA-avulsion of the popliteus tendon. Successful management of this condition included anatomic repair of the tendon with suture anchor fixation.
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Affiliation(s)
- Paul M Inclan
- Department of Orthopaedic Surgery, Washington University in St. Louis, Chesterfield, MO
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Marquina Moraleda V, Gastaldi G, Fuentes S, Colomina R, Jover P, Hernández L. Prótesis unicompartimental de rodilla. Resultados clínico-radiográficos y análisis de la supervivencia del implante. REVISTA DE LA ASOCIACIÓN ARGENTINA DE ORTOPEDIA Y TRAUMATOLOGÍA 2022. [DOI: 10.15417/issn.1852-7434.2022.87.6.1540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Objetivo: Evaluar los resultados clínicos y radiográficos en pacientes sometidos a artroplastia unicompartimental de rodilla, así como la tasa de complicaciones y la supervivencia del implante.
Materiales y Métodos: Estudio descriptivo retrospectivo de 68 pacientes consecutivos (70 rodillas) sometidos a artroplastia unicompartimental de rodilla entre 2013 y 2020, con un seguimiento medio de 57.7 meses (rango 24-105) y una media de la edad de 61 años (rango 34-79). El 46,5% eran hombres. El índice demasa corporal medio era de 29,9 (rango 20-39). El diagnóstico más frecuente fue la artrosis del compartimento femorotibial medial con un varo <7°. Los resultados se evaluaron con la escala analógica visual para dolor y el Knee Society Score (KSS). Se evaluó la incidencia de complicaciones y la tasa de supervivencia del implante.
Resultados: La disminución media en la escala analógica visual para dolor fue de 4,4 ± 1,9. Las puntuaciones medias posoperatorias en las escalas funcional y clínica del KSS fueron de 77,4 ± 13,7 y 70,2 ± 17,7, respectivamente. La tasa de complicaciones posquirúrgicas fue del 7% (5 casos). La tasa de reintervención quirúrgica fue del 15,5% (11 pacientes): nueve casos por persistencia del dolor, uno por rigidez articular y otro por aflojamiento aséptico.
Conclusiones: La artroplastia unicompartimental de rodilla es una opción terapéutica eficaz para pacientescon gonartrosis unicompartimental de rodilla; se logran buenos resultados clínicos con una aceptable tasa de complicaciones; sin embargo, la tasa de revisión del implante es considerable.
Nivel de Evidencia: IV
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Cochrane NH, Kim B, Seyler TM, Bolognesi MP, Wellman SS, Ryan SP. Accelerated discharge after aseptic revision knee arthroplasty is not associated with early readmission and reoperation. Bone Joint J 2022; 104-B:1323-1328. [DOI: 10.1302/0301-620x.104b12.bjj-2022-0372.r2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Aims In the last decade, perioperative advancements have expanded the use of outpatient primary total knee arthroplasty (TKA). Despite this, there remains limited data on expedited discharge after revision TKA. This study compared 30-day readmissions and reoperations in patients undergoing revision TKA with a hospital stay greater or less than 24 hours. The authors hypothesized that expedited discharge in select patients would not be associated with increased 30-day readmissions and reoperations. Methods Aseptic revision TKAs in the National Surgical Quality Improvement Program database were reviewed from 2013 to 2020. TKAs were stratified by length of hospital stay (greater or less than 24 hours). Patient demographic details, medical comorbidities, American Society of Anesthesiologists (ASA) grade, operating time, components revised, 30-day readmissions, and reoperations were compared. Multivariate analysis evaluated predictors of discharge prior to 24 hours, 30-day readmission, and reoperation. Results Of 21,610 aseptic revision TKAs evaluated, 530 were discharged within 24 hours. Short-stay patients were younger (63.1 years (49 to 78) vs 65.1 years (18 to 94)), with lower BMI (32.3 kg/m2 (17 to 47) vs 33.6 kg/m2 (19 to 54) and lower ASA grades. Diabetes, chronic obstructive pulmonary disease, hypertension, and cancer were all associated with a hospital stay over 24 hours. Single component revisions (56.8% (n = 301) vs 32.4% (n = 6,823)), and shorter mean operating time (89.7 minutes (25 to 275) vs 130.2 minutes (30 to 517)) were associated with accelerated discharge. Accelerated discharge was not associated with 30-day readmission and reoperation. Conclusion Accelerated discharge after revision TKA did not increase short-term complications, readmissions, or reoperations. Further efforts to decrease hospital stays in this setting should be evaluated. Cite this article: Bone Joint J 2022;104-B(12):1323–1328.
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Affiliation(s)
- Niall H. Cochrane
- Department of Orthopaedic Surgery, Duke University Health System, Durham, North Carolina, USA
| | - Billy Kim
- Department of Orthopaedic Surgery, Duke University Health System, Durham, North Carolina, USA
| | - Thorsten M. Seyler
- Department of Orthopaedic Surgery, Duke University Health System, Durham, North Carolina, USA
| | - Michael P. Bolognesi
- Department of Orthopaedic Surgery, Duke University Health System, Durham, North Carolina, USA
| | - Samuel S. Wellman
- Department of Orthopaedic Surgery, Duke University Health System, Durham, North Carolina, USA
| | - Sean P. Ryan
- Department of Orthopaedic Surgery, Duke University Health System, Durham, North Carolina, USA
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Cao Z, Liu Y, Yang M, Zhang Z, Kong X, Chai W. Effects of Surgeon Handedness on the Outcomes of Unicompartmental Knee Arthroplasty: A Single Center's Experience. Orthop Surg 2022; 14:3293-3299. [PMID: 36281639 PMCID: PMC9732585 DOI: 10.1111/os.13549] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 09/03/2022] [Accepted: 09/13/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Surgeon handedness has been widely discussed in operative surgery, and could cause clinical discrepancy. However, few studies have reported the effect of handedness on unicompartmental knee arthroplasty (UKA). Based on our clinical observation and case analysis, we aimed to find out the effects of surgeon handedness on UKA. METHODS We retrospectively studied 94 UKA procedures performed by one right-handed surgeon from January 2017 to December 2018 at a single medical center. The cases were divided into two groups by operation side (49 L-UKAs and 45 R-UKAs). Preoperative demographic data were collected. Imaging parameters (femorotibial and hip-knee-ankle angles and tibial-plateau retroversion) and joint function scores (Knee Society Score [KSS] and Oxford Knee Score [OKS]) were recorded. Patients were followed up regularly and Forgotten Joint Score (FJS) was calculated at the last follow-up. All data were compared between the two groups with independent-samples t-test, and paired t-test was used for intragroup comparisons. RESULTS The average follow-up was 26.7 ± 3.2 months. The average patient age was 63.5 ± 9.0 years and the average body mass index was 26.89 ± 3.43 kg/m2 . There was no significant group difference in any preoperative characteristic. Both the KSS and OKS improved significantly after surgery (p < 0.05). No significant group difference was found between the KSS or OKS at any follow-up visit. The varus or valgus of tibial component was 3.57 ± 1.42° on the left side and 3.19 ± 1.56° on the right side (p = 0.45). The varus or valgus of femoral component was 7.81 ± 2.43° in patients undergoing L-UKA and 7.05 ± 2.90° in those undergoing R-UKA (p = 0.04). No statistical differences were found in outliers of component orientation on both sides. The femorotibial and hip-knee-ankle angles improved significantly in both groups, and there was no significant group difference in either lower limb alignment or tibial-plateau retroversion. The complication rate was 8.16% (4/49) in the L-UKA group and 6.67% (3/45) in the R-UKA group. There was no correlation between prosthesis orientation and early joint function score. CONCLUSIONS Surgeon handedness may cause a worse prosthetic orientation on femoral side during surgeon's non-dominant UKA, and surgeons should be cautious of bone resection and prosthesis implantation. However, radiographic difference did not bring variations on short-term clinical outcomes or lower limb alignment.
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Affiliation(s)
- Zheng Cao
- Senior Department of OrthopedicsThe Fourth Medical Center of PLA General HospitalBeijingChina,Medical School of Nankai UniversityTianjinChina
| | - Yubo Liu
- Senior Department of OrthopedicsThe Fourth Medical Center of PLA General HospitalBeijingChina,Medical School of Nankai UniversityTianjinChina
| | - Minzhi Yang
- Senior Department of OrthopedicsThe Fourth Medical Center of PLA General HospitalBeijingChina,National Clinical Research Center for Orthopedics, Sports Medical and RehabilitationBeijingChina
| | - Zhuo Zhang
- Senior Department of OrthopedicsThe Fourth Medical Center of PLA General HospitalBeijingChina,National Clinical Research Center for Orthopedics, Sports Medical and RehabilitationBeijingChina
| | - Xiangpeng Kong
- Senior Department of OrthopedicsThe Fourth Medical Center of PLA General HospitalBeijingChina,National Clinical Research Center for Orthopedics, Sports Medical and RehabilitationBeijingChina
| | - Wei Chai
- Senior Department of OrthopedicsThe Fourth Medical Center of PLA General HospitalBeijingChina,National Clinical Research Center for Orthopedics, Sports Medical and RehabilitationBeijingChina
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Annapareddy A, Daultani D, Mulpur P, Khanna V, Sankineani SR, Eachempati KK, Reddy AVG. High Prevalence of Isolated Antero-medial Osteoarthritis (AMOA) in Indian Patients Undergoing Primary Total Knee Arthroplasty. Indian J Orthop 2022; 56:1774-1781. [PMID: 36187578 PMCID: PMC9485309 DOI: 10.1007/s43465-022-00710-8] [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: 06/01/2022] [Accepted: 07/21/2022] [Indexed: 02/04/2023]
Abstract
Background Isolated antero-medial osteoarthritis (AMOA) of the knee is a distinct pattern of arthritis. Medial arthritis of the knee in select patients can be managed with uni-compartmental arthroplasty (UKA), with studies showing shorter hospital stay, faster rehabilitation and reduced medical complications in the post-operative period compared to TKA. However, the prevalence of AMOA in Indian patients with osteoarthritis of the knee is unknown. The aim of this study was to evaluate the prevalence of AMOA in patients undergoing primary TKA for OA. Methods This was a prospective evaluation of 2518 knees in 1936 patients who were selected for primary TKA. Pre-operative radiographs were screened based on the Oxford UKA Radiological decision aid and diagnosis of AMOA was established. All 2518 knees underwent primary total knee arthroplasty and cases of AMOA were confirmed intra-operatively based on ACL integrity, lateral compartment wear and medial compartment wear pattern. Cases with AMOA arthritic wear pattern were considered amenable for UKA if radiographs showed intact lateral joint space, intra-operatively those with intact and functional ACL, acceptable patellofemoral wear (Outerbridge I-II). Results We report a prevalence of 46.94% of AMOA, who were amenable for UKA. Obese patients were more likely to have a damaged or non-functional ACL and more likely to have a high degree of wear, not amenable for UKA (p < 0.05). Non-functional ACL was associated with higher prevalence of posterior extension of arthritic wear. Conclusion This study demonstrated a high prevalence (46.94%) of antero-medial osteoarthritis (AMOA), amenable for UKA. Patient selection is important for improving outcomes after TKA or UKA. Future studies are warranted to compare outcomes of both UKA and TKA in patients with isolated AMOA of the knee.
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Affiliation(s)
- Adarsh Annapareddy
- Sunshine Bone and Joint Institute, Sunshine Hospitals, PG Road, Ramgopalpet, Secunderabad, Hyderabad, Telangana 500003 India
| | - Deepesh Daultani
- Sunshine Bone and Joint Institute, Sunshine Hospitals, PG Road, Ramgopalpet, Secunderabad, Hyderabad, Telangana 500003 India
| | - Praharsha Mulpur
- Sunshine Bone and Joint Institute, Sunshine Hospitals, PG Road, Ramgopalpet, Secunderabad, Hyderabad, Telangana 500003 India
| | - Vishesh Khanna
- Sunshine Bone and Joint Institute, Sunshine Hospitals, PG Road, Ramgopalpet, Secunderabad, Hyderabad, Telangana 500003 India
| | | | | | - A. V. Gurava Reddy
- Sunshine Bone and Joint Institute, Sunshine Hospitals, PG Road, Ramgopalpet, Secunderabad, Hyderabad, Telangana 500003 India
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Haffar A, Krueger CA, Marullo M, Banerjee S, Dobelle E, Argenson JN, Sprenzel JF, Berger RA, Romagnoli S, Lonner JH. Staged BiCompartmental Knee Arthroplasty has Greater Functional Improvement, but Equivalent Midterm Survivorship, as Revision TKA for Progressive Osteoarthritis After Partial Knee Arthroplasty. J Arthroplasty 2022; 37:1260-1265. [PMID: 35227809 DOI: 10.1016/j.arth.2022.02.084] [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: 11/10/2021] [Revised: 02/11/2022] [Accepted: 02/19/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Progressive arthritis in the unresurfaced compartments of the knee is one failure mode after partial knee arthroplasty (PKA). While progressive arthritis after PKA is typically treated with revision to TKA (rTKA), staged bicompartmental knee arthroplasty (sBiKA) -the addition of another PKA - is an alternative. This study compared outcomes of sBiKA and rTKA for progressive arthritis after PKA. METHODS A retrospective comparative study of non-consecutive cases at four institutions were performed in patients with an intact PKA, without loosening or wear, who underwent sBiKA (n = 27) or rTKA (n = 30), for progressive osteoarthritis. Outcomes studied were new Knee Society Function and Objective Scores (KSSF, KSSO), KOOS, Jr., ROM, operative times, length of stay, complication rates and the need for reoperations. RESULTS Mean time to conversion was 7.4 ± 6 years for sBiKA and 9.7 ± 8 for rTKA, P = .178. Patient demographics and pre-operative outcomes were similar among cohorts. At an average of 5.7 ± 3 (sBiKA) and 3.2 ± 2 years (rTKA), KOOS, Jr. significantly improved, P < .001, by an equivalent amount. Post-operative KSSO and KSSF were significantly higher in the sBiKA cohort, respectively, (90.4 ± 10 vs 72.1 ± 20, P < .001) and (80.3 ± 18 vs 67.1 ± 19, P = .011). sBiKA patients had significantly greater improvement in KSSO (30.7 ± 33 vs 5.2 ± 18, P = .003). One sBiKA patient underwent reoperation for continued pain. CONCLUSION SBiKA has equivalent survivorship, but greater improvement in functional outcomes as rTKA at short to midterm follow-up. Given the shorter operative times and length of stay, sBiKA is a safe and cost-effective alternative to rTKA for progressive osteoarthritis following PKA. Nevertheless, further follow-up is necessary to determine whether sBiKA is a durable option.
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Affiliation(s)
- Amer Haffar
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Chad A Krueger
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Matteo Marullo
- Joint Replacement Department, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Samik Banerjee
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Emile Dobelle
- Department of Orthopedics and Traumatology, Institute for Locomotion, St. Marguerite Hospital, Marseille, France
| | - Jean N Argenson
- Department of Orthopedics and Traumatology, Institute for Locomotion, St. Marguerite Hospital, Marseille, France
| | - Jenny F Sprenzel
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | - Richard A Berger
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | - Sergio Romagnoli
- Joint Replacement Department, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Jess H Lonner
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
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Shen G, Shen D, Fang Y, Li X, Cui L, Wei B, Wu L. Clinical Outcomes of Revision Total Knee Arthroplasty after High Tibial Osteotomy and Unicompartmental Knee Arthroplasty: A Systematic Review and Meta-Analysis. Orthop Surg 2022; 14:1549-1557. [PMID: 35611758 PMCID: PMC9363736 DOI: 10.1111/os.13311] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 04/09/2022] [Accepted: 04/19/2022] [Indexed: 12/01/2022] Open
Abstract
As more high tibial osteotomy (HTO) and unicompartmental knee arthroplasty (UKA) are performed, orthopaedic surgeons realize that more HTO and UKA failures will require revision to total knee arthroplasty (TKA) in the future. To systematically evaluate the clinical outcomes of TKA after HTO and TKA after UKA, the Embase, PubMed, Ovid, Web of Science, and Cochrane Library databases were searched for studies investigating revision TKA after HTO and UKA published up to June 2021. RevMan version 5.3 was used to perform the meta‐analysis. The revision TKA after HTO and revision TKA after UKA groups were compared in terms of operative time, range of motion (ROM), knee score, postoperative complications, postoperative infection, revision, and revision implants used. Nine studies were ultimately included in the meta‐analysis. Results revealed that the knee score for the revision TKA after HTO group was better than that of the revision TKA after UKA group (MD 4.50 [95% CI 0.80–8.20]; p = 0.02). The revision TKA after HTO group had a lower revision rate (OR 0.65 [95% CI 0.55–0.78]; p < 0.00001) and fewer revision implants used (OR 0.11 [95% CI 0.05–0.23]; p < 0.00001). There were no statistical differences in operation time (MD ‐2.00 [95% CI −11.22 to 7.21]; p = 0.67), ROM (MD ‐0.04 [95% CI ‐3.69–3.61]; p = 0.98), postoperative complications (OR 1.41 [95% CI 0.77–2.60]; p = 0.27), or postoperative infections (OR 0.89 [95% CI 0.61–1.29]; p = 0.53). To conclude, the revision rate of revision TKA after UKA was greater, and more revision implants were required. It is important for orthopaedic surgeons to preserve bone during primary UKA.
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Affiliation(s)
- Gaobo Shen
- The Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, China.,Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Danhong Shen
- Nanjing University of Science and Technology, Nanjing, China
| | - Yuan Fang
- The Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, China
| | - Xuefei Li
- The Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, China
| | - Longkang Cui
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Bing Wei
- The Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, China
| | - Lianguo Wu
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
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Imageless robotic-assisted revision arthroplasty from UKA to TKA : Surgical technique and case-control study compared with primary robotic TKA. DER ORTHOPADE 2021; 50:1018-1025. [PMID: 34714372 PMCID: PMC8642254 DOI: 10.1007/s00132-021-04182-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/30/2021] [Indexed: 11/12/2022]
Abstract
Background and objective It is evident from the national joint registries that numbers of revision knee arthroplasty operations are rising. The aim of this article is to introduce a new robotic-assisted approach in UKA to TKA revision arthroplasty and investigate the alignment accuracy, implant component use and surgery time and to compare it to primary robotic-assisted TKA arthroplasty. Methods This retrospective, case-control study included patients undergoing image-less robotic-assisted revision arthroplasty from UKA to TKA (n = 20) and patients undergoing image-less robotic-assisted primary TKA (control group, n = 20) from 11/2018 to 07/2020. The control group was matched based on the BMI and natural alignment. Comparison of groups was based on postoperative alignment, outlier rate, tibial insert size, lateral bone resection depth, incision-to-wound closure time. All surgeries were performed by a single senior surgeon using the same bi-cruciate stabilizing TKA system. Statistical analysis consisted of parametric t‑testing and Fisher’s exact test with a level of significance of p < 0.05. Results The two groups showed no differences in mean BMI, natural alignment (p > 0.05) and mean overall limb alignment. No outlier was found for OLA and slope analysis. The smallest insert size (9 mm) was used in 70% of the cases in the revision group (n = 14) and in 90% of the cases in the primary group (n = 18, p = 0.24), distal femoral and tibial resection depth showed no statistical difference (p > 0.05). The incision to wound closure time was longer in the revision group but showed no significant difference. Conclusion Image-less robotic-assisted revision arthroplasty from UKA to TKA showed a comparable surgery time, and alignment accuracy in comparison to primary robotic-assisted TKA. Comparable bone preservation and subsequent tibial insert size use was observed for both groups.
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Ramamurti P, Fassihi SC, Stake S, Stadecker M, Whiting Z, Thakkar SC. Conversion Total Knee Arthroplasty. JBJS Rev 2021; 9:01874474-202109000-00007. [PMID: 34812774 DOI: 10.2106/jbjs.rvw.20.00198] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Conversion total knee arthroplasty (TKA) represents a heterogeneous group of procedures and most commonly includes TKA performed after ligamentous reconstruction, periarticular open reduction and internal fixation (ORIF), high tibial osteotomy (HTO), and unicompartmental knee arthroplasty (UKA). » Relative to patients undergoing primary TKA, patients undergoing conversion TKA often have longer operative times and higher surgical complexity, which may translate into higher postoperative complication rates. » There is mixed evidence on implant survivorship and patient-reported outcome measures when comparing conversion TKA and primary TKA, with some studies noting no differences between the procedures and others finding decreased survivorship and outcome scores for conversion TKA. » By gaining an improved understanding of the unique challenges facing patients undergoing conversion TKA, clinicians may better set patient expectations, make intraoperative adjustments, and guide postoperative care.
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Affiliation(s)
- Pradip Ramamurti
- Department of Orthopaedic Surgery, George Washington University, Washington, DC
| | - Safa C Fassihi
- Department of Orthopaedic Surgery, George Washington University, Washington, DC
| | - Seth Stake
- Department of Orthopaedic Surgery, George Washington University, Washington, DC
| | - Monica Stadecker
- Department of Orthopaedic Surgery, George Washington University, Washington, DC
| | - Zachariah Whiting
- Department of Orthopaedic Surgery, George Washington University, Washington, DC
| | - Savyasachi C Thakkar
- Adult Reconstruction Division, Department of Orthopaedic Surgery, Johns Hopkins University, Columbia, Maryland
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Contemporary Knee Osteotomy in the United States: High Tibial Osteotomy and Distal Femoral Osteotomy Have Comparable Complication Rates despite Differing Demographic Profiles. J Knee Surg 2021; 34:816-821. [PMID: 31777032 DOI: 10.1055/s-0039-3400742] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Knee osteotomies show efficacy in slowing knee osteoarthritis progression and delaying the need for total knee arthroplasty in younger patients. Despite evolutions in indications, techniques, and hardware that have improved outcomes, longitudinal trends demonstrate a decline in high tibial osteotomy (HTO) and distal femoral osteotomy (DFO) use. Unfortunately, knowledge of the current usage and complications associated with HTO and DFO is limited. The purpose of this study was to compare the preoperative demographics and early complication rates of HTO and DFO. We analyzed the HTOs and DFOs performed between 2006 and 2017 using the ACS-NSQIP (American College of Surgeons National Surgical Quality Improvement Program) database. We compared both groups for preoperative patient demographics (sex, age, race, body mass index [BMI]) and health status variables including functional scores, ASA (American Society of Anesthesiologists) scores, smoking status, and other comorbidities. Emergency and elective status of the patient case, length of hospital stay, operation time, and 30-day postoperative complications were also analyzed. After the exclusion criteria were applied, 321 HTO and 295 DFO patients were included in the final analysis. The HTO group had higher proportions of younger (p < 0.001) and male (p < 0.001) patients with higher BMI (p = 0.007). Racial profiles were similar between the two groups (p = 0.575). Preoperatively, those in the HTO group had more functional independence, better physical status scores, and fewer chronic conditions (p < 0.05). There were no statistically significant differences between HTO and DFO in operative time, postoperative complications, readmission, and reoperation. HTO patients, however, had shorter hospital stays (p < 0.001). Although there are differences in preoperative and operative characteristics of HTO and DFO, early postoperative complications are similar for both groups. Therefore, HTO and DFO can be considered safe and effective treatment options for younger patients with symptomatic unicompartmental knee osteoarthritis.
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Tille E, Beyer F, Auerbach K, Tinius M, Lützner J. Better short-term function after unicompartmental compared to total knee arthroplasty. BMC Musculoskelet Disord 2021; 22:326. [PMID: 33810795 PMCID: PMC8019176 DOI: 10.1186/s12891-021-04185-w] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 03/22/2021] [Indexed: 11/24/2022] Open
Abstract
Background Unicompartmental knee arthroplasty (UKA) is an established treatment option for patients with unicompartmental osteoarthritis (OA). However, strict patient selection is crucial for its success. The proposed advantages include nearly natural knee kinematics, faster rehabilitation and better functional outcomes. Despite the aforementioned facts and it’s proven cost-effectiveness, there are still hesitations for the use of UKA as an alternative to total knee arthroplasty (TKA). Key objectives of this study were therefore to assess clinical and patient-reported outcome (PRO) as well as patient’s satisfaction after medial UKA in comparison to TKA. Methods To assess the outcome after UKA we conducted a prospective multi-center study. 116 patients with unicompartmental OA and indication for UKA were included. Overall 54 females and 62 males with an average age of 62.7 years (±9.8) and an average body mass index (BMI) of 29.2 (± 3.7) were recruited. Clinical results and PRO were assessed using the Knee Society Score (KSS). Follow-ups took place 3 months, 1 and 2 years after surgery including clinical examination, radiographs, assessment of PRO and adverse events. Pain and satisfaction was evaluated using a visual analog scale (VAS, 0 (worst) to 10 (best)). For comparison with TKA a propensity score matched-pair analysis was performed to eliminate confounders. Matching criteria were gender, patient’s age, BMI and comorbidities. A total of 116 matched-pairs were analysed. Results There was no revision in the UKA group until 2 years after surgery. Revision rates were higher in the TKA group (0.6%). Preoperative KSS-Scores were higher within the UKA cohort (p < 0.001). After surgical treatment, PROMs displayed a significant improvement (p < 0,001) in both cohorts. Regarding the Knee-Score (Pain, Alignment, ROM) we observed no differences between cohorts after 12 months. The Function-Score demonstrated significantly better results in the UKA cohort (UKA vs. TKA 95 vs 80, p < 0.001). Patient satisfaction was also higher in UKA patients (UKA vs TKA 9.0 vs 8.8, p = 0.019). Conclusion Patients of both cohorts showed high satisfaction after knee arthroplasty. UKA resulted in higher function scores compared to TKA without increased revision rate during short-term follow-up. Therefore, UKA is a good treatment option for unicompartmental OA. Trial registration Clinicaltrials.gov, NCT04598568. Registered 22 October 2020 - Retrospectively registered.
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Affiliation(s)
- Eric Tille
- University Center for Orthopaedic, Trauma- and Plastic Surgery, University Medicine Carl Gustav Carus Dresden, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
| | - Franziska Beyer
- University Center for Orthopaedic, Trauma- and Plastic Surgery, University Medicine Carl Gustav Carus Dresden, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Kai Auerbach
- Arthromed Praxisklinik Chemnitz, Chemnitz, Germany
| | | | - Jörg Lützner
- University Center for Orthopaedic, Trauma- and Plastic Surgery, University Medicine Carl Gustav Carus Dresden, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany
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Tan MWP, Ng SWL, Chen JY, Liow MHL, Lo NN, Yeo SJ. Long-Term Functional Outcomes and Quality of Life at Minimum 10-Year Follow-Up After Fixed-Bearing Unicompartmental Knee Arthroplasty and Total Knee Arthroplasty for Isolated Medial Compartment Osteoarthritis. J Arthroplasty 2021; 36:1269-1276. [PMID: 33243585 DOI: 10.1016/j.arth.2020.10.049] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 10/07/2020] [Accepted: 10/26/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The aim of this study is to compare the long-term functional outcome and quality of life between total knee arthroplasty (TKA) and fixed-bearing unicompartmental knee arthroplasty (UKA) for the treatment of isolated medial compartment osteoarthritis. METHODS Between 2000 and 2008, a total of 218 patients underwent primary UKA at our tertiary hospital. A TKA group was matched through 1:1 propensity score matching and adjusted for age, gender, body mass index, preoperative knee flexion, and function scores. All patients had medial compartment osteoarthritis. The patients were assessed with the range of motion, Knee Society Knee Score and Knee Society Function Score, Oxford Knee Score, Short Form-36 physical component score (PCS) and mental component score preoperatively, at 6 months, 2 years, and 10 years. Patients' satisfaction, expectation fulfillment, and minimal clinically important difference were analyzed. RESULTS There were no differences in baseline characteristics between groups after propensity score matching (P > .05). UKA had greater knee flexion at all time points. Although the Knee Society Function Score was superior in UKA by 5.5, 3, and 4.3 points at 6 months, 2 years, and 10 years, respectively (P < .001), these differences did not exceed the minimal clinically important difference (Knee Society Knee Score 6.1). There were no significant differences in the Oxford Knee Score and Short Form-36 physical component score/mental component score. At 10 years, similar proportions of UKA and TKA were satisfied (90.8% vs 89.9%, P = .44) and had expectation fulfillment (89.4% vs 88.5%, P = .46). Between 2 and 10 years, all function scores deteriorated significantly for both groups (P < .01). CONCLUSION UKA and TKA are excellent treatment modalities for isolated medial compartment osteoarthritis, with similar functional outcomes, quality of life, and satisfaction at 10 years.
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Affiliation(s)
- Marcus Wei Ping Tan
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore Level 4, Academia, Singapore 169856, Singapore
| | - Stacy Wei Ling Ng
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore Level 4, Academia, Singapore 169856, Singapore
| | - Jerry Yongqiang Chen
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore Level 4, Academia, Singapore 169856, Singapore
| | - Ming Han Lincoln Liow
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore Level 4, Academia, Singapore 169856, Singapore
| | - Ngai Nung Lo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore Level 4, Academia, Singapore 169856, Singapore
| | - Seng Jin Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore Level 4, Academia, Singapore 169856, Singapore
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Nandra R, Rajgor H, Winkworth C, Aslam N. Regional five-year clinical outcomes of 289 consecutive cementless oxford uni-compartmental knee replacements at a non-inventor centre. J Clin Orthop Trauma 2021; 17:176-181. [PMID: 33854945 PMCID: PMC8039718 DOI: 10.1016/j.jcot.2021.03.012] [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] [Received: 12/11/2020] [Accepted: 03/16/2021] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Uncemented unicompartmental knee replacement offers a minimally invasive approach, faster rehabilitation and good levels of function, supported by evidence reporting low intra-operative fracture rate and mid-term stability with no implant migration at 5-years. Our aim was to examine the clinical outcomes in 289 consecutive Oxford unicompartmental knee arthroplasties (257 patients), five years post-operatively. METHODS A retrospective study of patients treated between 2008 and 2014 in a non-inventor centre by a single surgeon was performed. Patients with anteromedial bone on bone uni-compartmental arthritis were included. Oxford Knee Scores (OKSs) at last follow-up were recorded, intra-operative complications reported with commentary on revision cases. RESULTS Mean age of patients was 66 years (SD 9.6, 45-88 years). 122 (42%) patients were female and 135 (58%) were male. Patient in our study were ASA 1 (36%), ASA 2 (62%) and ASA 3 (01%). There were no intra-operative complications, particularly tibia fractures during impaction. The average oxford knee score was 40.1 (n = 232, Range 06 to 48, SD 8.46) at an average 6 years and 3 months from surgery, including revised patients. Six patients had their prosthesis revised within five-years of the index surgery. Five-year cumulative implant survival rate was 97.8% (95% CI 97.62 to 97.98, SE 0.09). Indications for revision were: lateral side wear (n = 1); dislocated spacer (n = 4); instability and spacer subluxation (n = 1). Thirteen patients died within five years of surgery Five-year cumulative survival rate was 94.9% (95% CI 94.87 to 94.925, SE 0.013). CONCLUSION The proportion of patients requiring revision at five-years is lower than that generally reported for UKR. These findings add support for the use of the cementless oxford UKR outside the design centre.
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Patients Receiving a Primary Unicompartmental Knee Replacement Have a Higher Risk of Revision but a Lower Risk of Mortality Than Predicted Had They Received a Total Knee Replacement: Data From the National Joint Registry for England, Wales, Northern Ireland, and the Isle of Man. J Arthroplasty 2021; 36:471-477.e6. [PMID: 33011013 DOI: 10.1016/j.arth.2020.08.063] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/27/2020] [Accepted: 08/30/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND To determine unicompartmental (UKR) and total knee replacement (TKR) revision rates, compare UKR revision rates with what they would have been had they received TKR instead, and assess subsequent re-revision and 90-day mortality rates. METHODS Using National Joint Registry data, we estimated UKR and TKR revision and mortality rates. Flexible parametric survival modeling (FPM) was used to model failure in TKR and make estimates for UKR. Kaplan-Meier estimates were used to compare cumulative re-revision for revised UKRs and TKRs. RESULTS Ten-year UKR revision rates were 2.5 times higher than expected from TKR, equivalent to 70 excess revisions/1000 cases within 10 years (5861 excess revisions in this cohort). Revision rates were 2.5 times higher for the highest quartile volume UKR surgeons compared to the same quartile for TKR and 3.9 times higher for the lowest quartiles respectively. Re-revision rates of revised TKRs (10 years = 17.5%, 95% confidence interval [CI] 16.4-18.7) were similar to revised UKRs (15.2%, 95% CI 13.4-17.1) and higher than revision rates following primary TKR (3.3%, 95% CI 3.1-3.5). Ninety-day mortality rates were lower after UKR compared with TKR (0.08% vs 0.33%) and lower than predicted had UKR patients received a TKR (0.18%), equivalent to 1 fewer death per 1000 cases. CONCLUSION UKR revision rates were substantially higher than TKR even when demographics and caseload differences were accounted for; however, fewer deaths occur after UKR. This should be considered when forming treatment guidelines and commissioning services. Re-revision rates were similar between revised UKRs and TKRs, but considerably higher than for primary TKR, therefore UKR cannot be considered an intermediate procedure.
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Sun X, Liu P, Lu F, Wang W, Guo W, Zhang Q. Bearing dislocation of mobile bearing unicompartmental knee arthroplasty in East Asian countries: a systematic review with meta-analysis. J Orthop Surg Res 2021; 16:28. [PMID: 33413535 PMCID: PMC7791981 DOI: 10.1186/s13018-020-02190-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 12/28/2020] [Indexed: 11/25/2022] Open
Abstract
Background Bearing dislocation is a common postoperative complication of mobile-bearing unicompartmental knee arthroplasty, and East Asian patients tend to be at higher risk. However, whether this high dislocation rate is common in all East Asian populations remains unclear. This meta-analysis was performed to explore this issue and describe various features of dislocation in East Asians, including the onset time, dislocation direction, and re-dislocation rate. Methods The literature was searched in PubMed, Embase, Ovid, and Cochrane Library up to May 2020. Studies were scrutinized by two independent authors, and the bearing dislocation rate, onset time, direction, and re-dislocation rate were specifically analyzed. RevMan 5.3 was used for the statistical analysis. Results Seven case series from Korea, China, and Japan were included. The pooled analysis showed that the total dislocation rate was 2.37%, while the subgroup analysis showed that the dislocation rate in Korea and other countries was 4.50% and 0.74%, respectively (P < 0.01). Another subgroup analysis of the onset time showed a significant difference before and after the first 5 years postoperatively (P < 0.01). Anterior and posterior dislocations were more frequent than medial and lateral dislocations (P < 0.01). The average re-dislocation rate was 32.45%, which was approximately seven times higher than the primary dislocation rate (P < 0.01). Conclusion Our meta-analysis demonstrated that Korea had a higher bearing dislocation rate among East Asian countries, especially in the first 5 years after primary UKA. Anterior and posterior dislocations were common. The most important finding is that the re-dislocation rate can be much higher than the initial dislocation rate.
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Affiliation(s)
- Xiaowei Sun
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.,Department of Orthopaedic Surgery, China-Japan Friendship Hospital, No. 2, Yinghuadong Road, Chaoyang District, Beijing, 100029, China
| | - Pei Liu
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, No. 2, Yinghuadong Road, Chaoyang District, Beijing, 100029, China.,Beijing University of Chinese Medicine, Beijing, China
| | - Feifan Lu
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, No. 2, Yinghuadong Road, Chaoyang District, Beijing, 100029, China.,China-Japan Friendship School of Clinical Medicine, Peking University, Beijing, 100029, China
| | - Weiguo Wang
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, No. 2, Yinghuadong Road, Chaoyang District, Beijing, 100029, China
| | - Wanshou Guo
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.,Department of Orthopaedic Surgery, China-Japan Friendship Hospital, No. 2, Yinghuadong Road, Chaoyang District, Beijing, 100029, China
| | - Qidong Zhang
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, No. 2, Yinghuadong Road, Chaoyang District, Beijing, 100029, China.
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Garner A, Dandridge O, Amis AA, Cobb JP, van Arkel RJ. The extensor efficiency of unicompartmental, bicompartmental, and total knee arthroplasty. Bone Joint Res 2021; 10:1-9. [PMID: 33380175 PMCID: PMC7845459 DOI: 10.1302/2046-3758.101.bjr-2020-0248.r1] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Aims Unicompartmental knee arthroplasty (UKA) and bicompartmental knee arthroplasty (BCA) have been associated with improved functional outcomes compared to total knee arthroplasty (TKA) in suitable patients, although the reason is poorly understood. The aim of this study was to measure how the different arthroplasties affect knee extensor function. Methods Extensor function was measured for 16 cadaveric knees and then retested following the different arthroplasties. Eight knees underwent medial UKA then BCA, then posterior-cruciate retaining TKA, and eight underwent the lateral equivalents then TKA. Extensor efficiency was calculated for ranges of knee flexion associated with common activities of daily living. Data were analyzed with repeated measures analysis of variance (α = 0.05). Results Compared to native, there were no reductions in either extension moment or efficiency following UKA. Conversion to BCA resulted in a small decrease in extension moment between 70° and 90° flexion (p < 0.05), but when examined in the context of daily activity ranges of flexion, extensor efficiency was largely unaffected. Following TKA, large decreases in extension moment were measured at low knee flexion angles (p < 0.05), resulting in 12% to 43% reductions in extensor efficiency for the daily activity ranges. Conclusion This cadaveric study found that TKA resulted in inferior extensor function compared to UKA and BCA. This may, in part, help explain the reported differences in function and satisfaction differences between partial and total knee arthroplasty. Cite this article: Bone Joint Res 2021;10(1):1–9.
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Affiliation(s)
- Amy Garner
- MSk Lab, Sir Michael Uren Biomedical Engineering Research Hub, Imperial College London, London, UK.,Biomechanics Group, Mechanical Engineering Department, Imperial College London, London, UK.,Royal College of Surgeons of England and Dunhill Medical Trust Clinical Research Fellowship, Royal College of Surgeons of England, London, UK.,Health Education Kent, Surrey and Sussex, London, UK
| | - Oliver Dandridge
- Biomechanics Group, Mechanical Engineering Department, Imperial College London, London, UK
| | - Andrew A Amis
- Biomechanics Group, Mechanical Engineering Department, Imperial College London, London, UK
| | - Justin P Cobb
- MSk Lab, Sir Michael Uren Biomedical Engineering Research Hub, Imperial College London, London, UK
| | - Richard J van Arkel
- Biomechanics Group, Mechanical Engineering Department, Imperial College London, London, UK
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Yun AG, Qutami M, Chen CHM, Pasko KBD. Management of failed UKA to TKA: conventional versus robotic-assisted conversion technique. Knee Surg Relat Res 2020; 32:38. [PMID: 32727605 PMCID: PMC7389376 DOI: 10.1186/s43019-020-00056-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/02/2020] [Indexed: 11/13/2022] Open
Abstract
Background Failure of unicompartmental knee arthroplasty (UKA) is a distressing and technically challenging complication. Conventional conversion techniques (CCT) with rods and jigs have produced varying results. A robotic-assisted conversion technique (RCT) is an unexplored, though possibly advantageous, alternative. We compare our reconstructive outcomes between conventional and robotic methods in the management of failed UKA. Methods Thirty-four patients with a failed UKA were retrospectively reviewed. Patients underwent conversion total knee arthroplasty (TKA) with either a CCT or RCT. Seventeen patients were included in each group. All procedures were done by a single surgeon at a single institution, with a mean time to follow-up of 3.6 years (range, 1 to 12). The primary outcome measures were the need for augments and polyethylene thickness. Secondary outcome measures were complications, need for revision, estimated blood loss (EBL), length of stay, and operative time. Results The mean polyethylene thickness was 12 mm (range, 9 to 15) in the CCT group and 10 mm (range, 9 to 14) in the RCT groups, with no statistical difference between the two groups (P = 0.07). A statistically significant difference, however, was present in the use of augments. In the CCT group, five out of 17 knees required augments, whereas none of the 17 knees in the RCT group required augments (P = 0.04). Procedurally, robotic-assisted surgery progressed uneventfully, even with metal artifact noted on the preoperative computerized tomography (CT) scans. Computer mapping of the residual bone surface after implant removal was a helpful guide in minimizing resection depth. No further revisions or reoperations were performed in either group. Conclusions Robotic-assisted conversion TKA is technically feasible and potentially advantageous. In the absence of normal anatomic landmarks to guide conventional methods, the preoperative CT scans were unexpectedly helpful in establishing mechanical alignment and resection depth. In this limited series, RCT does not seem to be inferior to CCT. Further investigation of outcomes is warranted.
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Affiliation(s)
- Andrew G Yun
- Orthopedic Surgery, Center for Hip and Knee Replacement, Providence Saint John's Health Center, 2121 Santa Monica Blvd, Santa Monica, CA, 90404, USA
| | - Marilena Qutami
- Orthopedic Surgery, Center for Hip and Knee Replacement, Providence Saint John's Health Center, 2121 Santa Monica Blvd, Santa Monica, CA, 90404, USA
| | - Chang-Hwa Mary Chen
- Department of Surgery, Providence Saint John's Health Center, 2121 Santa Monica Blvd, Santa Monica, CA, 90404, USA
| | - Kory B Dylan Pasko
- Orthopedic Surgery, Center for Hip and Knee Replacement, Providence Saint John's Health Center, 2121 Santa Monica Blvd, Santa Monica, CA, 90404, USA.
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40
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Johnson WB, Engh CA, Parks NL, Hamilton WG, Ho PH, Fricka KB. A lower threshold for revision of aseptic unicompartmental vs total knee arthroplasty. Bone Joint J 2020; 102-B:91-95. [PMID: 32475288 DOI: 10.1302/0301-620x.102b6.bjj-2019-1538.r1] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS It has been hypothesized that a unicompartmental knee arthroplasty (UKA) is more likely to be revised than a total knee arthroplasty (TKA) because conversion surgery to a primary TKA is a less complicated procedure. The purpose of this study was to determine if there is a lower threshold for revising a UKA compared with TKA based on Oxford Knee Scores (OKSs) and range of movement (ROM) at the time of revision. METHODS We retrospectively reviewed 619 aseptic revision cases performed between December 1998 and October 2018. This included 138 UKAs that underwent conversion to TKA and 481 initial TKA revisions. Age, body mass index (BMI), time in situ, OKS, and ROM were available for all patients. RESULTS There were no differences between the two groups based on demographics or time to revision. The top reasons for aseptic TKA revision were loosening in 212 (44%), instability in 88 (18%), and wear in 69 (14%). UKA revision diagnoses were primarily for loosening in 50 (36%), progression of osteoarthritis (OA) in 50 (36%), and wear in 17 (12%). Out of a maximum 48 points, the mean OKS of the UKAs before revision was 23 (SD 9.3), which was significantly higher than the TKAs at 19.2 (SD 9.8; p < 0.001). UKA patients scored statistically better on nine of the 12 individual OKS questions. The UKA cases also had a larger pre-revision mean ROM (114°, SD 14.3°) than TKAs (98°, SD 25°) ; p < 0.001). CONCLUSION At revision, the mean UKA OKSs and ROM were significantly better than those of TKA cases. This study suggests that at our institution there is a difference in preoperative OKS between UKA and TKA at the time of revision, demonstrating a revision bias. Cite this article: Bone Joint J 2020;102-B(6 Supple A):91-95.
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Affiliation(s)
| | - C Anderson Engh
- Anderson Orthopaedic Research Institute, Alexandria, Virginia, USA
| | - Nancy L Parks
- Anderson Orthopaedic Research Institute, Alexandria, Virginia, USA
| | | | - P Henry Ho
- Anderson Orthopaedic Research Institute, Alexandria, Virginia, USA
| | - Kevin B Fricka
- Anderson Orthopaedic Research Institute, Alexandria, Virginia, USA
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The Feasibility of Outpatient Revision Total Knee Arthroplasty in Selected Case Scenarios. J Arthroplasty 2020; 35:S92-S96. [PMID: 32139191 DOI: 10.1016/j.arth.2020.02.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 02/05/2020] [Accepted: 02/10/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND As total knee arthroplasty (TKA) continues moving to the outpatient arena, the demand for revision surgery will subsequently increase which draws into question the feasibility for some revision scenarios as an outpatient. The purpose of this study is to report on the safety of outpatient revision knee arthroplasty. METHODS From June 2013 through December 2018, 102 patients (106 knees) underwent revision knee arthroplasty at a free-standing ambulatory surgery center. Mean patient age was 58.0 years, and 43% of patients were male. Procedures included the following: 45 cases of unicompartmental arthroplasty to TKA, 54 TKA revisions, and 52 cases involved a full exchange of components. RESULTS Ninety-three patients (88%) were discharged the same day without incident, none required transfer to acute facility, and 13 required overnight stay with 4 of these for convenience and 9 for medical reasons. There were no major complications within the first 48 hours postoperative. One patient required readmission for treatment of ileus 11 days postoperative. There were no other readmissions, no subsequent surgeries, and no deaths within 90 days. One or more major comorbidities were present in 66 patients. CONCLUSION Outpatient revision knee arthroplasty was found to be safe in carefully selected patients and case scenarios. Presence of medical comorbidities was not associated with risk of complications. The paradigm changes of patient education, medical optimization, and a multimodal program to mitigate the risk of blood loss and reduce need for narcotics facilitates performing some revision arthroplasties safely in an outpatient setting.
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Lo Presti M, Costa GG, Grassi A, Agrò G, Cialdella S, Vasco C, Neri MP, Cucurnia I, Zaffagnini S. Bearing thickness of unicompartmental knee arthroplasty is a reliable predictor of tibial bone loss during revision to total knee arthroplasty. Orthop Traumatol Surg Res 2020; 106:429-434. [PMID: 32253136 DOI: 10.1016/j.otsr.2019.12.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 12/09/2019] [Accepted: 12/17/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND Bone defects during revision procedures for failed UKA represent a challenge even for the most experienced surgeons; therefore, an accurate preoperative planning remains essential to prevent dramatic scenarios in the surgical theatre. HYPOTHESIS Our hypothesis is that bearing thickness used in original UKA represents a reliable predictor of severe tibial bone loss, requiring a metallic augment or constrained implant, during revision to TKA. PATIENTS AND METHODS Forty-two patients who underwent a total knee arthroplasty from failed UKA were identified from our institutional database and evaluated clinically using the Knee Society Score (KSS). A multivariate logistic regression analysis was performed using the presence of tibial augments or the need of varus-valgus constrained (VVC) prosthesis as depend variables, and patients' gender, age at revision procedure, side (medial or lateral), UKA tibial tray (all-polyethylene or metal back), bearing thickness (composite thicknesses of the metal-backed tray and insert or all-polyethylene tibial component ≤8mm or more than 8mm) and cause of failed UKA as independent variables. RESULTS A posterior-stabilized prosthesis was used in 27 cases (64.3%). An augment was necessary in 12 patients (28.6%). Initial bearing thickness greater than 8mm was associated with greater likelihood of a VVC implant (OR=11.78, 95% CI, 1.6583 to 83.6484, p=0.0137) and a tibial augment (OR=9.59, 95% CI, 1.327 to 69.395, p=0.0251). Tibial tray design, patients' gender or age during revision surgery, side or cause of failure were not associated to increased risk of augmentation or constrained implants. DISCUSSION Surgeons should be aware of the particular challenges that the conversion of a UKA to a TKA presents and be prepared to address them intraoperatively, with particular care to proper bone loss manage. Satisfying results can be achieved at mid-to-long term follow-up, if these procedures are planned accurately, and a precise analysis of failed UKA components, in particular bearing thickness, represents a helpful support in this context. LEVEL OF EVIDENCE IV, retrospective case series.
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Affiliation(s)
- Mirco Lo Presti
- II Orthopaedic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano n. 1/10, 40136, Bologna, Italy
| | - Giuseppe Gianluca Costa
- II Orthopaedic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano n. 1/10, 40136, Bologna, Italy.
| | - Alberto Grassi
- II Orthopaedic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano n. 1/10, 40136, Bologna, Italy
| | - Giuseppe Agrò
- II Orthopaedic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano n. 1/10, 40136, Bologna, Italy
| | - Sergio Cialdella
- II Orthopaedic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano n. 1/10, 40136, Bologna, Italy
| | - Cosimo Vasco
- II Orthopaedic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano n. 1/10, 40136, Bologna, Italy
| | - Maria Pia Neri
- II Orthopaedic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano n. 1/10, 40136, Bologna, Italy
| | - Ilaria Cucurnia
- II Orthopaedic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano n. 1/10, 40136, Bologna, Italy
| | - Stefano Zaffagnini
- II Orthopaedic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano n. 1/10, 40136, Bologna, Italy
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Crawford DA, Berend KR, Thienpont E. Unicompartmental Knee Arthroplasty: US and Global Perspectives. Orthop Clin North Am 2020; 51:147-159. [PMID: 32138853 DOI: 10.1016/j.ocl.2019.11.010] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Unicompartmental knee arthroplasty (UKA) is a treatment option for anteromedial osteoarthritis. Compared with total knee arthroplasty (TKA), UKA offers improved knee range of motion, functional recovery and decreased medical complications. Revision rates continue to be higher with UKA compared with TKA. With current UKA implants, there is no significant difference in mobile bearing or fixed bearing, or between cemented and cementless implants. Enabling technology, such as robotic-assisted surgery, has demonstrated improvements in component positioning, but no long-term difference in survival compared with traditional manual instruments.
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Affiliation(s)
- David A Crawford
- JIS Orthopedics, 7277 Smith's Mill Road, Suite 200, New Albany, OH 43054, USA.
| | - Keith R Berend
- JIS Orthopedics, 7277 Smith's Mill Road, Suite 200, New Albany, OH 43054, USA
| | - Emmanuel Thienpont
- Cliniques universitaires Saint Luc, Avenue Hippocrate 10, Brussels 1200, Belgium
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吴 东, 杨 敏, 曹 正, 孔 祥, 王 毅, 郭 人, 柴 伟. [Research progress in unicompartmental knee arthroplasty]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:145-150. [PMID: 32030942 PMCID: PMC8171978 DOI: 10.7507/1002-1892.201906085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 11/24/2019] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To summarize the clinical application and research progress in unicompartmental knee arthroplasty (UKA). METHODS The literature related to UKA in recent years was reviewed and the emerging indications, implant options, comparisons between other surgical techniques, and recent advances were summarized. RESULTS Clinical studies show that UKA has many advantages, such as less trauma, faster recovery, and fewer postoperative complications. At present, the operative indication has been expanded. The body mass index more than 25 kg/m 2, less than 60 years old, patellofemoral arthritis, and anterior cruciate ligament dysfunction are no longer considered as contraindications. The prosthesis type in UKA should be selected according to the patient's condition. In recent years, the robot-assisted UKA can effectively improve the effectiveness, improve patient satisfaction, and reduce postoperative complications. CONCLUSION With the development of surgical techniques, designs of prosthesis, and the robotic technology, UKA would be further applicated. As more long-term data on UKA become available, it will further guide clinicians in counseling patients on whether UKA should be performed.
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Affiliation(s)
- 东 吴
- 中国人民解放军总医院第一医学中心骨科（北京 100853）Department of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing, 100853, P.R.China
| | - 敏之 杨
- 中国人民解放军总医院第一医学中心骨科（北京 100853）Department of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing, 100853, P.R.China
- 南开大学医学院（天津 300071）Medicine School of Nankai University, Tianjin, 300071, P.R.China
| | - 正 曹
- 中国人民解放军总医院第一医学中心骨科（北京 100853）Department of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing, 100853, P.R.China
- 南开大学医学院（天津 300071）Medicine School of Nankai University, Tianjin, 300071, P.R.China
| | - 祥朋 孔
- 中国人民解放军总医院第一医学中心骨科（北京 100853）Department of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing, 100853, P.R.China
| | - 毅 王
- 中国人民解放军总医院第一医学中心骨科（北京 100853）Department of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing, 100853, P.R.China
| | - 人文 郭
- 中国人民解放军总医院第一医学中心骨科（北京 100853）Department of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing, 100853, P.R.China
| | - 伟 柴
- 中国人民解放军总医院第一医学中心骨科（北京 100853）Department of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing, 100853, P.R.China
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El-Galaly A, Kappel A, Nielsen PT, Jensen SL. Revision Risk for Total Knee Arthroplasty Converted from Medial Unicompartmental Knee Arthroplasty: Comparison with Primary and Revision Arthroplasties, Based on Mid-Term Results from the Danish Knee Arthroplasty Registry. J Bone Joint Surg Am 2019; 101:1999-2006. [PMID: 31764362 DOI: 10.2106/jbjs.18.01468] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Medial unicompartmental knee arthroplasties (UKAs) have good clinical outcomes but implant survival is inferior to that of total knee arthroplasties (TKAs). Conversion to a TKA is a reliable option when UKA fails. However, there is controversy regarding these conversions. The aim of this study was to analyze the survival of TKAs converted from UKAs when compared with both primary and revision TKAs. METHODS On the basis of registrations in the Danish Knee Arthroplasty Registry from 1997 to 2017, 1,012 TKAs converted from UKAs were compared with 73,819 primary TKAs and 2,572 revision TKAs. The primary outcome was the risk of revision. Secondarily, the study analyzed the influence of different implants, the indication for the UKA conversion, and surgical volume on the survival of TKA converted from UKA. Third, the study compared the indications for revision. RESULTS The converted UKAs were mainly mobile-bearing (85%) and, at the time of conversion, the patients were younger (mean [standard deviation], 66 ± 10 years) and more were Charnley class A (55%) compared with patients with primary TKA (70 ± 9 years and 35% class A) or revision TKA (70 ± 10 years and 42% class A) (all p < 0.001). The survival of TKAs converted from UKAs was comparable with that of revision TKAs (p = 0.42) and significantly inferior to the survival of primary TKAs (p < 0.001). This relationship was unaffected by differences between the groups, with an adjusted hazard ratio of 0.94 (95% confidence interval [CI]: 0.74 to 1.19) compared with revision TKAs and 3.00 (95% CI: 2.47 to 3.66) compared with primary TKAs. The survival of TKA converted from UKA was unaffected by differences in the conversion implants (all p ≥ 0.47), experience with revision surgery (all p ≥ 0.06), and the indications for the UKA-to-TKA conversion (all p ≥ 0.27). Instability (26%) and unexplained pain (13%) were more frequent indications for revisions of TKA converted from UKA (p < 0.001). CONCLUSIONS TKA converted from medial UKA has a 3-fold higher risk of revision when compared with primary TKA. The implant survival resembled that of revision TKA but with a higher prevalence of unexplained pain and instability. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Anders El-Galaly
- Orthopaedic Research Unit, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Andreas Kappel
- Orthopaedic Research Unit, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | - Steen Lund Jensen
- Orthopaedic Research Unit, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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