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Mori Y, Tarasawa K, Tanaka H, Kamimura M, Harada K, Mori N, Fushimi K, Aizawa T, Fujimori K. Thromboembolic and infectious complication risks in TKA and UKA: evidence from a Japanese nationwide cohort. Knee Surg Relat Res 2025; 37:19. [PMID: 40341061 PMCID: PMC12063263 DOI: 10.1186/s43019-025-00273-6] [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: 01/09/2025] [Accepted: 04/23/2025] [Indexed: 05/10/2025] Open
Abstract
INTRODUCTION Total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA) are widely used to treat knee osteoarthritis. TKA significantly contributes to long-term pain relief and joint function improvement, while UKA offers faster recovery and reduced early complications. However, TKA and UKA complication risks, aside from conditions such as deep vein thrombosis, have not been thoroughly investigated. This study compares the in-hospital complication risks of TKA and UKA using a nationwide Japanese database. METHODS A retrospective cohort study was conducted using data from the Japanese Diagnosis Procedure Combination (DPC) database, spanning from April 2016 to March 2023. A total of 259,319 knee arthroplasty cases (TKA: 228,595; UKA: 30,724) were analyzed. Propensity score matching (1:1) was used to adjust for age, sex, comorbidities, and surgical factors, resulting in 30,591 matched pairs. Multivariable logistic regression analyses assessed the risks of complications, including deep vein thrombosis, pulmonary embolism, and surgical site infections. RESULTS Deep vein thrombosis is frequently observed as a complication with a high incidence rate. Even after propensity score matching, the incidence remained significantly higher in the TKA group (8.8%) compared with the UKA group (6.1%) (p < 0.0001). TKA was associated with significantly higher risks of deep vein thrombosis (odds ratio (OR): 1.467, 95% confidence interval (CI) 1.380-1.560, p < 0.0001), pulmonary embolism (OR: 1.709, 95% CI 1.182-2.470, p = 0.0044), and surgical site infection (OR: 1.512, 95% CI 1.277-1.790, p < 0.0001) compared with UKA. UKA showed lower risks of cognitive dysfunction, pneumonia, transfusion requirements, and shorter hospital stays. However, patients who underwent UKA had a higher risk of periprosthetic fractures. CONCLUSIONS This study highlights the distinct risk profiles of TKA and UKA, emphasizing the need for tailored surgical decision-making. UKA offers advantages in reducing complications for specific patient populations. Strengthening prophylactic measures is crucial for effectively managing thromboembolic and infectious complications in patients undergoing TKA.
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Affiliation(s)
- Yu Mori
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-Machi, Aoba-Ku, Sendai, Miyagi, 980-8574, Japan.
| | - Kunio Tarasawa
- Department of Health Administration and Policy, Tohoku University Graduate School of Medicine, 2-1 Seiryo-Machi, Aoba-Ku, Sendai, Miyagi, 980-8574, Japan
| | - Hidetatsu Tanaka
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-Machi, Aoba-Ku, Sendai, Miyagi, 980-8574, Japan
| | - Masayuki Kamimura
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-Machi, Aoba-Ku, Sendai, Miyagi, 980-8574, Japan
| | - Kento Harada
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-Machi, Aoba-Ku, Sendai, Miyagi, 980-8574, Japan
| | - Naoko Mori
- Department of Radiology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine and Dental Sciences, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8519, Japan
| | - Toshimi Aizawa
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-Machi, Aoba-Ku, Sendai, Miyagi, 980-8574, Japan
| | - Kenji Fujimori
- Department of Health Administration and Policy, Tohoku University Graduate School of Medicine, 2-1 Seiryo-Machi, Aoba-Ku, Sendai, Miyagi, 980-8574, Japan
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Yan Z, Chen M, Li D, Cai Z, Sun H, Ma S, Ma R, Xu J. Investigation of risk factors for anterior knee pain following unicompartmental knee arthroplasty: A case-control study. J Orthop 2025; 62:175-181. [PMID: 40241857 PMCID: PMC11999342 DOI: 10.1016/j.jor.2025.03.057] [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: 03/09/2025] [Accepted: 03/26/2025] [Indexed: 04/18/2025] Open
Abstract
Objective The objective of this study is to identify and analyze the risk factors associated with anterior knee pain (AKP) following unicompartmental knee arthroplasty (UKA) and to investigate the underlying mechanisms that contribute to this postoperative complication. Methods This case-control study encompassed 30 knees from 24 patients who underwent medial fixed-platform UKA for knee osteoarthritis between 2018 and 2022. Participants were categorized into two groups based on the presence or absence of postoperative AKP. Clinical and imaging data were collected. Logistic regression analysis was utilized to determine independent risk factors for AKP. Results Among the 30 knees assessed, 7 (23.3 %) exhibited AKP postoperatively, while 23 (76.7 %) did not report such pain. An analysis of imaging parameters revealed significant differences between the two groups regarding postoperative patellar tilt angle, trochlear groove angle, progression of medial patellofemoral arthritis, and postoperative medial tilt of the patella. Logistic regression analysis identified the progression of medial patellofemoral arthritis as an independent risk factor for the occurrence of AKP. Additionally, an increased patellar tilt angle was identified as a protective factor, whereas postoperative medial tilt of the patella was recognized as a risk factor. Conclusion The progression of medial patellofemoral arthritis is identified as an independent risk factor for AKP following fixed-platform UKA. The development of this condition may be influenced by postoperative patellar tilt and trochlear groove angle. These findings underscore the necessity for optimal implant positioning and effective soft tissue management during UKA to mitigate postoperative complications.
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Affiliation(s)
- Ziyou Yan
- Department of Joint Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, Guangdong, China
- Department of Joint Surgery, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518033, Guangdong, China
| | - Meiyi Chen
- Department of Joint Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, Guangdong, China
| | - Deng Li
- Department of Joint Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, Guangdong, China
| | - Zhiqing Cai
- Department of Joint Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, Guangdong, China
| | - Hao Sun
- Department of Joint Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, Guangdong, China
| | - Shuqiang Ma
- Department of Joint Surgery, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518033, Guangdong, China
| | - Ruofan Ma
- Department of Joint Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, Guangdong, China
| | - Jie Xu
- Department of Joint Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, Guangdong, China
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Wignadasan W, Fontalis A, Shaeir M, Haddad FS. Beyond the surface: anterior cruciate ligament assessment in knee osteoarthritis. Bone Joint Res 2025; 14:93-96. [PMID: 39912706 PMCID: PMC11803638 DOI: 10.1302/2046-3758.142.bjr-2024-0313.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2025] Open
Affiliation(s)
- Warran Wignadasan
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK
| | - Andreas Fontalis
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK
- Department of Orthopaedic Surgery, The Princess Grace Hospital, London, UK
| | - Mohammed Shaeir
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK
- Department of Orthopaedic Surgery, The Princess Grace Hospital, London, UK
| | - Fares S. Haddad
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK
- Department of Orthopaedic Surgery, The Princess Grace Hospital, London, UK
- The Bone & Joint Journal, London, UK
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Foissey C, Batailler C, Fontalis A, Servien E, Lustig S. Long-term outcomes in unicompartmental knee arthroplasty: Survivorship of medial versus lateral unicompartmental knee arthroplasty. J ISAKOS 2024; 9:100329. [PMID: 39413926 DOI: 10.1016/j.jisako.2024.100329] [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: 10/18/2024]
Abstract
Unicompartmental knee arthroplasties (UKAs) currently represent an important portion of knee arthroplasty procedures and their usage is on an upward trend. Despite offering better functional outcomes and a quicker recovery compared with total knee arthroplasties (TKAs), UKAs are often scrutinized for their longevity. This article provides an in-depth examination of the technical nuances and survival rates of medial versus lateral UKAs, drawing on recent advances and findings in the field. This manuscript thoroughly evaluates the comparability of patient populations undergoing medial and lateral UKAs, considering their anatomical, biomechanical, and demographic differences. It delves into the specific technical challenges associated with each type and systematically assesses the factors that influence failure, including the intricacies of implant design and patient-specific variables. Despite relevant anatomical and biomechanical contrasts between medial and lateral UKAs, the recent literature points to comparable survival rates. The prevalence of early failures within the initial five years after operation underscores the criticality of precise patient selection and refined surgical techniques. The paper succinctly summarizes the pivotal literature and provides essential guidance for optimizing UKA survivorship. It underscores the importance of meticulous patient selection and precise surgical techniques, alongside the identification and mitigation of potential pitfalls that impact outcomes. Finally, robotic technology in UKA has considerably enhanced the precision and reproducibility, representing a viable solution to effectively meet and achieve the recommended technical objectives.
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Affiliation(s)
- Constant Foissey
- Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, FIFA Medical Center of Excellence, Lyon, France.
| | - Cécile Batailler
- Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, FIFA Medical Center of Excellence, Lyon, France
| | - Andreas Fontalis
- Department of Trauma and Orthopaedics Surgery, University College Hospital, London, United Kingdom; Division of Surgery and Interventional Science, University College London, London, United Kingdom
| | - Elvire Servien
- Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, FIFA Medical Center of Excellence, Lyon, France; EA 7424, Interuniversity Laboratory of Human Movement Science, Université Lyon 1, Lyon, France
| | - Sébastien Lustig
- Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, FIFA Medical Center of Excellence, Lyon, France; Université de Lyon, Université Claude Bernard Lyon 1, IFSTTAR, LBMC UMR_T9406, 69622 Lyon, France
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Fricka KB, Strait AV, Ho H, Hopper RH, McAsey CJ. Early Outcome of a Contemporary Unicondylar Knee System. Cureus 2024; 16:e74596. [PMID: 39606132 PMCID: PMC11602105 DOI: 10.7759/cureus.74596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2024] [Indexed: 11/29/2024] Open
Abstract
INTRODUCTION In 2019, a new fixed-bearing implant for unicondylar knee arthroplasty (UKA) was introduced that incorporated a round-on-flat design featuring an Oxinium femoral component coupled with a highly crosslinked polyethylene bearing surface. Compared to prior implants, the design featured smaller size increments coupled with medial and lateral-specific tibial baseplates. The objective of this study is to describe our institution's early experience with this UKA implant system by evaluating survivorship, reasons for revision, and patient-reported outcome measures (PROMs). METHODS The 944 UKAs that comprise the study population, including 814 medial and 130 lateral joint replacements, were performed by six surgeons from September 2019 through the end of December 2023. All UKA components were cemented, the mean age at surgery was 67.1±10.0 years, 57% (537/944) of the UKAs were performed among women, and the mean body mass index was 30.3±6.2 kg/m2. Outcome measures included Kaplan-Meier survivorship using reoperation for any reason as an endpoint, reasons for reoperation, range of motion, and PROMs that were collected preoperatively and postoperatively at 4 weeks, 4 months, 1 year, and 2 years. RESULTS Using reoperation for any reason as an endpoint, 1-year survivorship was 99.3% (95% CI, 98.7 to 99.9%) and 2-year survivorship was 98.2% (95% CI, 96.9 to 99.5%). There were nine reoperations among the 944 UKAs, including three for infection, two for tibial loosening, one for femoral loosening, one for progression of arthritis, one for patellar instability, and one for recurrent hemarthrosis. The mean time to reoperation was 0.82±0.68 years and all were performed among medial UKAs. Range of motion increased from 117±8 degrees preoperatively to 122±6 degrees at 1-year follow-up. PROMs, including the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR) and the Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health Physical score, demonstrated progressive increases from the preoperative assessment through 2-year follow-up. For UKAs with preoperative and 2-year KOOS JR scores, the mean change was 31±17. CONCLUSION As new implants and technologies are introduced, documenting the early outcome from high volume centers can offer valuable insights to validate the effectiveness of implant systems before they are adopted by the broader orthopedic community. This study demonstrates encouraging early outcome data associated with a contemporary UKA system based on survivorship and PROMs. At this early stage, there are no implant-related concerns but obtaining additional follow-up will be important to quantify how revisions and PROMs evolve over time.
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Affiliation(s)
- Kevin B Fricka
- Orthopaedics, Anderson Orthopaedic Clinic, Arlington, USA
| | - Alexander V Strait
- Adult Hip and Knee Replacement, Anderson Orthopaedic Research Institute, Alexandria, USA
| | - Henry Ho
- Adult Hip and Knee Replacement, Anderson Orthopaedic Research Institute, Alexandria, USA
| | - Robert H Hopper
- Adult Hip and Knee Replacement, Anderson Orthopaedic Research Institute, Alexandria, USA
| | - Craig J McAsey
- Orthopaedics, Anderson Orthopaedic Clinic, Arlington, USA
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Liu L, Li J, Wang Y, Li X, Han P, Li X. Cemented versus cementless Oxford unicompartmental knee arthroplasty for the treatment of medial knee osteoarthritis: an updated systematic review and meta-analysis. Arch Orthop Trauma Surg 2024; 144:4391-4403. [PMID: 39294529 DOI: 10.1007/s00402-024-05539-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 09/03/2024] [Indexed: 09/20/2024]
Abstract
OBJECTIVE This meta-analysis sought to compare the efficacy of cemented versus cementless Oxford unicompartmental knee arthroplasty(UKA) for the treatment of medial knee osteoarthritis. METHODS A comprehensive search of the following databases was conducted: Pubmed, The Cochrane Library, China National Knowledge Infrastructure (CNKI), Embase, the Web of Science, and MEDLINE. The objective was to identify literature comparing cemented versus cementless Oxford unicompartmental knee arthroplasty for the treatment of medial knee osteoarthritis. Duplicate literature, low-quality literature, literature with incompatible observations, and literature for which the full text was not available were excluded. Two independent researchers employed the Cochrane Risk Assessment Tool and the Newcastle-Ottawa Scale (NOS) to evaluate the quality of the included literature. The data then were extracted and subsequently meta-analyzed using RevMan 5.4. RESULTS A total of 12 papers were included in the analysis, encompassing a cumulative of 2558 cumulative cases. Of these, 1258 were cemented and 1300 were cementless. A meta-analysis was conducted to compare the outcomes of cemented versus cementless Oxford UKA. The Oxford UKA group exhibited a significantly longer surgery time than the cementless Oxford UKA group [mean difference (MD) = 9.91, 95% confidence interval (CI) (7.64,12.17)]. Additionally, the cemented Oxford UKA group demonstrated a significantly lower knee OKS score compared to the cementless Oxford UKA group. The mean difference (MD) was - 1.58 (95% CI: -2.30, -0.86), indicating a significantly lower score for the cemented Oxford UKA group. Similarly, the mean difference (MD) was - 1.8 for the knee KSS clinical score, indicating a significantly lower score for the cemented Oxford UKA group. The results demonstrated that the knee KSS functional score was significantly lower in the cemented Oxford UKA group than in the cementless Oxford UKA group [MD=-1.72, 95% CI (-3.26, -0.37)]. 95% CI (-3.27,-0.17)], the cemented Oxford UKA group exhibited a significantly higher incidence of radiolucent lines around the prosthesis than the cementless Oxford UKA group [ratio of ratios (OR) = 3.62, 95% CI (1.08,12.13)]. The revision rate was significantly higher in the cemented Oxford UKA group than in the cementless Oxford UKA group [OR = 2.22, 95% CI (1.40,3.53)]. However, no significant difference was observed between the two groups in terms of reoperation rate, five-year prosthesis survival rate, and complication rate. CONCLUSIONS The findings indicated that, in comparison to cemented Oxford UKA, cementless Oxford UKA resulted in a reduction in surgical time, an improvement in knee OKS score, KSS clinical score, and KSS functional score, and a decrease in the incidence of periprosthetic radiolucent lines and the rate of revisions.
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Affiliation(s)
- Lun Liu
- Department of Orthopaedics, The Second People's Hospital of Changzhi City, No. 83, Heping West Street, Changzhi, Shanxi, 046000, China
- Graduate School, The First Clinical College of Changzhi Medical College, No. 161, Jiefang East Street, Changzhi, Shanxi, 046000, China
| | - Juebei Li
- Graduate School, Huazhong University of Science and Technology, No.13, Hangkong Road, Wuhan, Hubei, 430000, China
| | - Yunlu Wang
- Department of Orthopaedics, The Second People's Hospital of Changzhi City, No. 83, Heping West Street, Changzhi, Shanxi, 046000, China
- Graduate School, The First Clinical College of Changzhi Medical College, No. 161, Jiefang East Street, Changzhi, Shanxi, 046000, China
| | - Xiyong Li
- Graduate School, The First Clinical College of Changzhi Medical College, No. 161, Jiefang East Street, Changzhi, Shanxi, 046000, China
- Department of Orthopaedics, Heping Hospital Affiliated To Changzhi Medical College, No. 110, Yan'an South Road, Changzhi, Shanxi, 046000, China
| | - Pengfei Han
- Department of Orthopaedics, Heping Hospital Affiliated To Changzhi Medical College, No. 110, Yan'an South Road, Changzhi, Shanxi, 046000, China.
| | - Xiaodong Li
- Department of Orthopaedics, The Second People's Hospital of Changzhi City, No. 83, Heping West Street, Changzhi, Shanxi, 046000, China.
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Hu H, Li P, Liu Z, Lv H, Yang X, Liu P. Comparative long-term outcomes of unicompartmental and total knee arthroplasty in knee osteoarthritis patients: a systematic review and meta-analysis. Front Surg 2024; 11:1405025. [PMID: 39233767 PMCID: PMC11371575 DOI: 10.3389/fsurg.2024.1405025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 08/06/2024] [Indexed: 09/06/2024] Open
Abstract
Background Long-term outcomes for knee osteoarthritis patients undergoing unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA) remain inconclusive. Objectives This study aims to evaluate the long-term outcomes over five years, including Knee Society Pain Scores (KSPS), Knee Society Scores (KSS), Knee Society Function Scores (KSFS), range of motion (ROM), and survival rates-of UKA vs. TKA in knee osteoarthritis patients. Design Systematic review using data from randomized controlled and cohort trials, and world databases. Data sources Researchers searched Medline, Embase, Cochrane Controlled Register of Trials, and ClinicalTrials.gov from January 1990 to March 2024. Eligibility criteria for selecting studies The researchers selected studies based on adult participants with knee osteoarthritis. Eligible studies compare UKA and TKA reports on clinical or surgical outcomes, including KSPS, KSS, KSFS, ROM and survival rates, over 5 years. The researchers excluded the studies fewer than five years, or if English text was unavailable. Results Researchers categorized twenty-nine eligible studies into three groups: five randomized controlled trials, 11 registries and database studies, and 13 cohort studies. The analysis revealed that neither TKA nor UKA definitively outperformed the other in terms of pain (SMD (95% CI): -0.06 [-0.41, 0.28], I 2 = 90%) and KSS scores (SMD (95% CI): -0.07 [-0.23, 0.008], I 2 = 81%) over a period of five years. However, KSFS (SMD (95% CI): -0.30 [-0.43, -0.17], I 2 = 74%) and ROM (SMD (95% CI): -0.78 [-1.11, -0.46], I 2 = 92%) tended to favor UKA, and survival rate favor TKA at 5 or over 5-year follow-up periods. Conclusions UKA shows a trend towards better outcomes in KSFS and ROM, alongside a more favorable survival rate in TKA at the five-year and beyond follow-up periods. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=517835, PROSPERO (CRD42024517835).
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Affiliation(s)
- Hai Hu
- Department of Bone Injuries, Hanan Branch of the Second Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine, Harbin, China
| | - Pengfei Li
- Department of Bone Injuries, Hanan Branch of the Second Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine, Harbin, China
| | - Zelin Liu
- Department of Medical Services Division, The Second Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine, Harbin, China
| | - Hang Lv
- Department of Bone Injuries, Hanan Branch of the Second Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine, Harbin, China
| | - Xiangjun Yang
- Department of Bone Injuries, Hanan Branch of the Second Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine, Harbin, China
| | - Peiran Liu
- Department of Bone Injuries, Hanan Branch of the Second Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine, Harbin, China
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Cozzarelli NF, Khan IA, Arshi A, Sherman MB, Lonner JH, Fillingham YA. Return to Sport After Unicompartmental Knee Arthroplasty and Patello-Femoral Arthroplasty. J Arthroplasty 2024; 39:1988-1995.e5. [PMID: 38367903 DOI: 10.1016/j.arth.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 01/24/2024] [Accepted: 02/05/2024] [Indexed: 02/19/2024] Open
Abstract
BACKGROUND Data on sports/physical activity participation following unicompartmental knee arthroplasty (UKA) and patello-femoral arthroplasty (PFA) is variable and limited. The purpose of this study was to assess participations, outcomes, and limitations in sports following UKA and PFA. METHODS Patients who underwent UKA and PFA at a single institution from 2015 to 2020 were surveyed on sports participation before and after surgery. Data was correlated with perioperative patient characteristics and outcome scores. Among 776 patients surveyed, 356 (50%) patients responded. Of respondents, 296 (83.1%) underwent UKA, 44 (12.6%) underwent PFA, and 16 (4.5%) underwent both UKA/PFA. RESULTS Activity participation rates were 86.5, 77.3, and 87.5% five years prior, and 70.9, 61.4, and 75% at one year prior to UKA, PFA, and UKA/PFA, respectively. Return to sports rates were 81.6, 64.7, and 62.3% at mean 4.6 years postoperatively, respectively. The most common activities were recreational walking, swimming, cycling, and golf. Patients returned to a similar participation level for low-impact activities, whereas participation decreased for intermediate- and high-impact activities. Patients participating in activities had higher postoperative Knee Injury and Osteoarthritis Outcome Score Joint Replacement (P < .001), 12-Item Short Form Physical Component Score (P = .045) and Mental Component Score (P = .012). Activity restrictions were reported among 25, 36.4, and 25% of UKA, PFA, and UKA/PFA patients, respectively, and were more commonly self-imposed than surgeon-directed. CONCLUSIONS Though UKA patients' postoperative sports participation may improve compared to one year preoperatively, participation for patients surgically treated for isolated osteoarthritis is decreased compared to 5 years preoperatively and varies among patient subsets.
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Affiliation(s)
- Nicholas F Cozzarelli
- Department of Orthopedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Irfan A Khan
- Department of Orthopedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Armin Arshi
- Department of Orthopedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania; Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Matthew B Sherman
- Department of Orthopedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jess H Lonner
- Department of Orthopedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Yale A Fillingham
- Department of Orthopedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
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Song K, Qi L, Mu Z, Sun H, Zhai S, Liu D, Li S, Luo Y, Liu P. Health-related quality of life after total knee arthroplasty and unicompartmental knee arthroplasty for unicompartmental osteoarthritis: A systematic review and meta-analysis. J Orthop Surg (Hong Kong) 2024; 32:10225536241256245. [PMID: 38763777 DOI: 10.1177/10225536241256245] [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] [Indexed: 05/21/2024] Open
Abstract
BACKGROUND While previous research has demonstrated potential advantages of unicompartmental knee arthroplasty (UKA) over total knee arthroplasty (TKA), particularly in terms of clinical outcomes such as function and pain relief, the specific impact on health-related quality of life (HRQOL) remains unclear. This systematic review and meta-analysis aim to address this gap by comparing HRQOL outcomes between UKA and TKA, providing valuable insights for clinical decision-making. METHODS We conducted a literature search in the PubMed, Embase, Cochrane Controlled Register of Trials (CENTRAL), and Web of Science databases up to July 15, 2023. Eligible studies assessed HRQOL using EQ-5D, SF-36, or SF-12 and were assessed for methodological quality using the Newcastle-Ottawa Scale (NOS). RESULTS Seven eligible studies were included, comprising a total of 64,585 patients with 35,809 undergoing TKA and 28,776 undergoing UKA. Patient age ranged from 52.0 to 67.7 years with an average BMI ranging from 27.2 to 31.0 kg/m2. Follow-up periods ranged from 6 months to 10 years. Five studies (63,829 patients) that evaluated HRQOL using EQ-5D showed significantly better outcomes for UKA compared to TKA (MD -0.04, 95% CI -0.05 to -0.02). Two studies (756 patients) that evaluated HRQOL using SF-36 showed no significant difference between TKA and UKA. Five studies (63,286 patients) that evaluated functional outcomes using Oxford Knee Score (OKS) showed significantly better functional scores for UKA compared to TKA (MD -1.29, 95% CI -1.86 to -0.72). Four studies (24,570 patients) that reported patient satisfaction showed no statistically significant difference between TKA and UKA (MD 0.97, 95% CI 0.90 to 1.05). Further subgroup analysis did not affect the conclusions. CONCLUSIONS Our meta-analysis suggests that UKA is associated with better HRQOL and knee function, as well as similar patient satisfaction, compared to TKA for patients with unicompartmental osteoarthritis.
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Affiliation(s)
- Ke Song
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, PR China
- Qilu Hospital of Shandong University Dezhou Hospital (Dezhou People's Hospital), Dezhou, PR China
| | - Liping Qi
- Qilu Hospital of Shandong University Dezhou Hospital (Dezhou People's Hospital), Dezhou, PR China
| | - Zongyou Mu
- Qilu Hospital of Shandong University Dezhou Hospital (Dezhou People's Hospital), Dezhou, PR China
| | - Houyi Sun
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, PR China
| | - Shenhao Zhai
- Qilu Hospital of Shandong University Dezhou Hospital (Dezhou People's Hospital), Dezhou, PR China
| | - Dehua Liu
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, PR China
| | - Shihao Li
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, PR China
| | - Yange Luo
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, PR China
| | - Peilai Liu
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, PR China
- Qilu Hospital of Shandong University Dezhou Hospital (Dezhou People's Hospital), Dezhou, PR China
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10
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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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Kılıçarslan K, Naldöven ÖF, Veizi E, Güven Ş, Çepni Ş, Fırat A. C-Reactive Protein and Erythrocyte Sedimentation Rates after Total and Unicompartmental Knee Arthroplasty-Less Implant Equals Quicker Normalization. J Long Term Eff Med Implants 2024; 34:49-55. [PMID: 38842232 DOI: 10.1615/jlongtermeffmedimplants.2023050965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
Postoperative follow up after total or unicondylar knee arthroplasty (UKA) includes C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) to scan for and possibly diagnose a periprosthetic joint infection (PJI). The aim of this study was to describe the postoperative changes in CRP and ESR values after UKA and compare them with values obtained after TKA. Patients operated on between 2020 and 2022 were eligible for this retrospective study. Inclusion criteria were patients with at least 4 postoperative visits associated with blood test screening for PJI, aged > 45, with uneventful follow-up for the first 90 days. Exclusion criteria were a history of chronic inflammatory disease, revision for any reason, and readmission for any reason. Blood samples were collected on the 3rd, 15th, and 30th postoperative days and once between the 45th and the 90th day. The mean and peak values were compared between the two groups. The study included 277 patients (243 TKAs and 34 UKAs). Mean age was significantly lower in the UKA group (67.2 ± 7.5 vs. 60.0 ± 5.9). On the 3rd and the 15th postoperative day, the UKA patients had significantly lower ESR and CRP levels. The levels normalized after the first month. While the TKA patients showed higher values, the trend normalized after the 30th day. CRP and ESR values rose significantly after TKA and persisted up to the 15th day postoperatively. CRP and ESR values normalized faster in patients undergoing UKA. Patients > 65 had higher CRP and ESR values during their routine follow-ups.
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Affiliation(s)
| | - Ömer Faruk Naldöven
- Department of Orthopedics and Traumatology, Ankara City Hospital, 06000 Ankara, Turkey
| | - Enejd Veizi
- Department of Orthopedics and Traumatology, Ankara City Hospital, 06000 Ankara, Turkey
| | - Şahan Güven
- Department of Orthopedics and Traumatology, Ankara City Hospital, 06000 Ankara, Turkey
| | - Şahin Çepni
- Department of Orthopedics and Traumatology, Ankara City Hospital, 06000 Ankara, Turkey
| | - Ahmet Fırat
- Department of Orthopedics and Traumatology, Ankara City Hospital, 06000 Ankara, Turkey
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12
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Hoveidaei AH, Esmaeili S, Ghaseminejad-Raeini A, Pirahesh SK, Hoveidaei A, Sandiford NA, Lahner N, Citak M. Patient satisfaction following robotic unicompartmental knee arthroplasty: A systematic review and meta-analysis. Technol Health Care 2024; 32:3625-3634. [PMID: 38073355 DOI: 10.3233/thc-231216] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2024]
Abstract
BACKGROUND Unicompartmental knee arthroplasty (UKA) is a viable alternative to total knee arthroplasty (TKA) for osteoarthritis patients with single-compartment involvement, with advantages including accelerated recovery, reduced pain, and improved function. Robotic-assisted UKA (rUKA) is a promising development that ensures precise implant positioning and limb alignment. However, concerns about complications remain. OBJECTIVE This study looks at patient satisfaction as a key metric for determining the efficacy of rUKA versus manual UKA (mUKA). METHODS The search strategy for this study followed PRISMA. Using precise keywords, PubMed, Scopus, Web of Science, and the Cochrane library were searched. English articles were searched until August 2, 2023. Selection criteria included mUKA and rUKA patient satisfaction studies. The NOS scale evaluated study quality. Meta-analysis was done with R and heterogeneity analysis. RESULTS This systematic review examined 5 studies with 1060 UKAs (532 robotic-assisted and 528 manual). Variable satisfaction assessment methods were used. Three studies found no difference in patient satisfaction after robotic-assisted UKA, but two found a higher satisfaction. Meta-analysis showed robotic-assisted UKA improved patient satisfaction (OR = 1.72 [1.25-2.37]). Overall, most studies showed low risk of bias, except one with higher bias. CONCLUSION This review suggests that robotic assistance may enhance patient satisfaction in UKA procedures.
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Affiliation(s)
- Amir Human Hoveidaei
- International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD, USA
| | - Sina Esmaeili
- Sina University Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Armin Hoveidaei
- Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Nemandra A Sandiford
- Joint Reconstruction Unit, Southland Teaching Hospital, Invercargill, New Zealand
| | - Nina Lahner
- Ruhr University Bochum, Hautarztpraxis Lahner, Düsseldorf, Germany
| | - Mustafa Citak
- Department of Orthopaedic Surgery, ENDO-Klinik Hamburg, Hamburg, Germany
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13
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Cai J, Ma M, Zeng W, Luo S, Yuan F, Yin F. Computed tomography-based patient-specific cutting guides used for positioning of the femoral component of implants during unicompartmental knee arthroplasty: a cadaver study. BMC Surg 2023; 23:381. [PMID: 38114969 PMCID: PMC10729329 DOI: 10.1186/s12893-023-02272-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 11/20/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND To investigate whether patient-specific instrumentation (PSI) improves the femoral component positioning of implants during unicompartmental knee arthroplasty (UKA) using cadaver bone models. METHODS Fifty adult cadaveric femoral bone specimens collected from February 2016-2018, were randomized to receive medial UKA with a PSI guide (n = 25) or conventional instrumentation (CI) (n = 25). Standard anteroposterior and lateral view radiographs were obtained postoperatively to assess the coronal and sagittal positioning of the femoral prostheses, respectively. The osteotomy time was recorded to assess the convenience of PSI in guiding osteotomy. RESULTS Osteotomy time significantly shortened in the PSI group (3.12 ± 0.65 versus 4.33 ± 0.73 min, p < 0.001). There was a significant difference in the postoperative coronal alignment of the femoral component between the PSI and CI groups (varus/valgus angle: 1.43 ± 0.93° vs. 2.65 ± 1.50°, p = 0.001). The prevalence of outliers in coronal alignment was lower in the PSI than the CI group (2/25, 8% vs. 9/25, 36%). Sagittal posterior slope angle of the femoral component was significantly different between the two groups (8.80 ± 0.65° and 6.29 ± 1.88° in the CI and PSI groups, respectively, p < 0.001). The malalignment rate of the femoral component in the sagittal plane was 60% in the CI group, whereas no positioning deviation was observed in the PSI group. CONCLUSION This study used a cadaver model to support the fact that CT-based PSI shows an advantage over CI in optimizing implant positioning for UKAs.
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Affiliation(s)
- Junfeng Cai
- Department of joint surgery, Shanghai east hospital, Tongji university, school of medicine, Shanghai, 200120, China
| | - Min Ma
- Department of joint surgery, Shanghai east hospital, Tongji university, school of medicine, Shanghai, 200120, China
| | - Wen Zeng
- Department of joint surgery, Shanghai east hospital, Tongji university, school of medicine, Shanghai, 200120, China
| | - Shuling Luo
- Department of joint surgery, Shanghai east hospital, Tongji university, school of medicine, Shanghai, 200120, China
| | - Feng Yuan
- Department of joint surgery, Shanghai east hospital, Tongji university, school of medicine, Shanghai, 200120, China.
| | - Feng Yin
- Department of joint surgery, Shanghai east hospital, Tongji university, school of medicine, Shanghai, 200120, China.
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Ge J, Hernigou P, Guo W, Zhang N, Liu C, Zhang Q. Minimally invasive small incision surgical technique for unicompartmental knee arthroplasty. INTERNATIONAL ORTHOPAEDICS 2023; 47:2717-2725. [PMID: 37542540 DOI: 10.1007/s00264-023-05908-5] [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: 06/29/2023] [Accepted: 07/20/2023] [Indexed: 08/07/2023]
Abstract
PURPOSE It is always a challenge for orthopaedic surgeons to minimise surgical incisions while ensuring excellent surgical results. We propose the minimally invasive small incision (MISI) technique and an extramedullary positioning technique in the unicompartmental knee arthroplasty (UKA) surgery. This study aimed to clarify the early postoperative clinical outcomes and component alignment between MISI and conventional minimally invasive surgical (MIS) techniques. METHODS We prospectively enrolled 60 patients who underwent MISI-UKA and 60 patients who underwent MIS-UKA as controls. Clinical parameters include the time of straight leg raising, postoperative walking time with walker assistance, hospital stay, Numerical Rating Scale (NRS) pain score and Knee Society Score (KSS). The postoperative components and lower extremity alignment were compared between the two groups with radiographic image measurement. RESULTS The MISI group obtained a smaller incision during knee extension (P < 0.001) but a longer tourniquet usage time than the MIS group. The MISI group lost less blood (P < 0.001). The MISI group achieved straight leg raising and walking with aid earlier after surgery, with a shorter hospital stay than the MIS group (P < 0.001). Range of motion (ROM), NRS and KSS scores revealed no significant difference between the two groups in six months postoperative follow-up (P > 0.05). Radiographic measurement results between the two groups revealed no statistical difference (P > 0.05) CONCLUSION: The MISI-UKA could achieve faster earlier recovery after surgery and shorter hospital stays without compromising the principles of proper prosthesis position and limb alignment compared with the conventional MIS-UKA.
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Affiliation(s)
- Juncheng Ge
- Department of Orthopaedic Surgery, Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Philippe Hernigou
- Department of Orthopaedic Surgery, University Paris East (UPEC), Hôpital Henri Mondor, Creteil, France.
| | - Wanshou Guo
- Department of Orthopaedic Surgery, Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China.
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, China.
| | - Nianfei Zhang
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Changquan Liu
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, China
- China-Japan Friendship Hospital (Institute of Clinical Medical Sciences), Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Qidong Zhang
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, China
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Foissey C, Batailler C, Vahabi A, Fontalis A, Servien E, Lustig S. Combination of a High Residual Varus and Joint-Line Lowering Strongly Increases the Risk of Early Implant Failure in Medial Unicompartmental Knee Arthroplasty. J Arthroplasty 2023; 38:2275-2281. [PMID: 37271228 DOI: 10.1016/j.arth.2023.05.055] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 05/18/2023] [Accepted: 05/20/2023] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND Outliers in implant positioning, malalignment, and joint line height change are risk factors for unicompartmental knee arthroplasty (UKA) failure. However, their relationships and patterns in large datasets remain unexplored. This study assessed medial UKA survival in a large cohort and explored associated risk factors. METHODS This was a retrospective cohort study on medial UKA patients (2011 to 2019). Radiological outcomes included tibial implant positioning in the coronal plane, posterior tibial slope, residual knee deformity, and joint line restitution. Survival rate at last follow-up was recorded. Multinomial logistic regression analyzed risk factors, incorporating demographic and univariate analysis data. RESULTS Three hundred and sixty-six knees met inclusion criteria, with 10 lost to follow-up (2.7%). Mean follow-up was 61.3 months [24.1 to 135.1]. 5- and 10-year implant survival rates were 92% ± 1.6 and 88.4% ± 3.8, respectively. Multivariate analysis identified post-operative hip-knee-ankle angle (HKA) ≤ 175° (OR = 5.30 [1.64 to 17.13], P = .005) and joint line lowering ≥2 mm (OR = 8.86 [2.06 to 38.06]) as significant risk factors for tibial implant failure. Their combination carried a significantly high risk of failure (OR = 10.3 [3.1 to 34.3]). Post-operative HKA < 175° was common in knees with pre-operative HKA < 172°. CONCLUSION This study reports encouraging 5- and 10-year survival outcomes for medial UKA. Tibial loosening was the main reason for revision. Patients with joint line lowering ≥ 2 mm and post-operative HKA ≤ 175° were at high risk of tibial implant failure. Surgeons should carefully restore the joint line in cases of pre-operative HKA < 172°.
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Affiliation(s)
- Constant Foissey
- Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, FIFA Medical Center of Excellence, Lyon, France
| | - Cécile Batailler
- Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, FIFA Medical Center of Excellence, Lyon, France
| | - Arman Vahabi
- Department of Orthopaedics and Traumatology, Ege University, Izmir, Turkey
| | - Andreas Fontalis
- Department of Trauma and Orthopaedics Surgery, University College Hospital, London, United Kingdom; Division of Surgery and Interventional Science, University College London, London, United Kingdom
| | - Elvire Servien
- Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, FIFA Medical Center of Excellence, Lyon, France; EA 7424, Interuniversity Laboratory of Human Movement Science, Université Lyon 1, Lyon, France
| | - Sébastien Lustig
- Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, FIFA Medical Center of Excellence, Lyon, France; Université Claude Bernard Lyon 1, IFSTTAR, LBMC UMR_T9406, Université de Lyon, Lyon, France
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16
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Zhu X, Xu H, Wang L, Zhang H, Chen H, Wang J, Zhang H. Impact of lateral meniscus injury detected by preoperative magnetic resonance imaging on midterm results after unicompartmental knee arthroplasty. Knee 2023; 44:227-235. [PMID: 37677873 DOI: 10.1016/j.knee.2023.08.014] [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: 03/09/2023] [Revised: 08/11/2023] [Accepted: 08/16/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND The significance of lateral meniscus injury and its impact on success rates with medial unicompartmental knee arthroplasty (UKA) is still debated among scholars. This study aims to investigate whether preoperative magnetic resonance imaging (MRI) findings of lateral meniscus injury influence midterm outcomes following UKA. METHODS This study recruited 104 patients who underwent medial mobile-bearing UKA. Based on the extent of lateral meniscus injury indicated by the preoperative MRI and Stoller's classification system, patients were divided into two groups: the normal group (grade 0), and the lateral meniscus injury group (grade 3). Further, preoperative demographic and clinical outcome data (Hospital for Special Surgery score, lateral knee pain, squatting, and knee extension ability) were compared at least 2 years postoperatively. RESULTS No statistically significant difference in knee function or clinical outcome was found between the normal group (n = 59) and the lateral meniscus injury group (n = 45). During the 39.2 months (range: 24-64 months), no patient required any reoperation or revision procedures. CONCLUSION In summary, the presence of lateral meniscus injury as determined by preoperative MRI does not affect the midterm results after UKA. Without additional treatment for lateral meniscus injury, UKA can yield desired outcomes regardless of the presence of lateral meniscus injury on preoperative MRI.
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Affiliation(s)
- Xunpeng Zhu
- Department of Orthopaedics, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, PR China
| | - Hui Xu
- Department of Orthopaedics, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, PR China
| | - Lin Wang
- Department of Orthopaedics, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, PR China
| | - Haigang Zhang
- Department of Orthopaedics, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, PR China
| | - Hongwei Chen
- Department of Orthopaedics, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, PR China
| | - Jun Wang
- Department of Orthopaedics, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, PR China
| | - Hui Zhang
- Department of Orthopaedics, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, PR China.
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Better accuracy and implant survival in medial imageless robotic-assisted unicompartmental knee arthroplasty compared to conventional unicompartmental knee arthroplasty: two- to eleven-year follow-up of three hundred fifty-six consecutive knees. INTERNATIONAL ORTHOPAEDICS 2023; 47:533-541. [PMID: 36434294 DOI: 10.1007/s00264-022-05640-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 10/30/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE Implant malpositioning, joint line (JL) lowering, and malalignment have been identified as risk factors for implant failure in unicompartmental knee arthroplasty (UKA). The aims of this study were to compare the accuracy of implant positioning in robotic-assisted UKA versus conventional UKA in a large cohort and examine the correlation with implant survival at mid-term follow-up. METHODS This retrospective study included 356 medial UKAs from 2011 to 2019. The radiological measurements performed were coronal positioning of tibial implant according to Cartier angle (Δ Cartier), posterior tibial slope (PTS), residual hip-knee-ankle (HKA), and JL restoration. Outliers were defined as follows: post-operative HKA < 175° or > 180°, Δ Cartier > 3° or < - 3°, JL change ≥ 2 mm, and PTS < 2° or > 8°. The survival probability was reported at the last follow-up. RESULTS Out of the 356 knees included, 159 underwent conventional UKA (44.5%) and 197 (55.5%) robotic-assisted UKA. The mean follow-up was 61.3 months ± 24.0. Robotic UKA was associated with better accuracy compared to conventional UKA in relation to HKA (67% vs 56%, p = 0.023), JL restoration (70% vs 44%, p < 0.0001), PTS (83% vs 55%, p < 0.0001), and tibial varus restoration (65% vs 55%, p = 0.049). Implant survival in the robotic group was found to be superior at the last follow-up (96.4% versus 87.3% at 9 years, p = 0.004). CONCLUSION Robotic assistance in patients undergoing medial UKA was associated with better accuracy compared to conventional UKA with respect to tibial implant positioning, post-operative limb alignment, and JL restoration. This was translated in improved survival at mid-term follow-up favouring the robotic group.
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Zanirato A, Cavagnaro L, Chiarlone F, Quarto E, Formica M. Periprosthetic joint infection in unicompartmental knee arthroplasty: treatment options and outcomes. What is the current evidence in literature? Arch Orthop Trauma Surg 2023; 143:1031-1039. [PMID: 35303146 PMCID: PMC9925597 DOI: 10.1007/s00402-022-04414-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 03/04/2022] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Periprosthetic joint infections (PJI) following unicompartmental knee arthroplasties (UKAs) will increase. The aim of this review is to evaluate current evidence regarding treatment options, complications, clinical and radiological outcomes of PJI management in UKAs. METHODS A systematic review of English literature was performed. Retrospective and prospective studies providing treatment options, complications, clinical and radiological outcomes of PJI following UKAs were included. PJI type, treatment, survival rate with no reoperation for infection and survival rate with no reoperation for any cause were evaluated. RESULTS Eleven articles were included. Three studies focusing on PJI following UKA (45 cases) report a survival rate with no reoperation for infection of 68.9% and a survival rate with no reoperation for any cause of 48.9%. Eight articles concerning UKA failure modes (28 cases) overestimate survival rate with no reoperation for infection (88.9%) and survival rate with no reoperation for any cause (88.9%) (p < 0.05). DAIR reports a rate of infection eradication failure ranging from 43.8 to 100%. 1SE allows for a survival rate with no reoperation for infection of 100%. 2SE reports a rate of infection eradication failure ranging from 0 to 12.5%. A high rate of early aseptic reoperation is reported, despite infection eradication (20% in DAIR; 28.5% in 2SE). CONCLUSIONS Treatment strategy is determined by symptom timing, PJI type (acute vs chronic), causative organism, patient's comorbidities. A longer duration of PJI or severe host and extremity status seems to require 2SE or 1SE. Patients who have a shorter duration of PJI could receive DAIR.
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Affiliation(s)
- Andrea Zanirato
- IRCCS Ospedale Policlinico San Martino-Clinica Ortopedica, Largo Rosanna Benzi 10, 16132, Genova, GE, Italy.
- DISC Dipartimento Di Scienze Chirurgiche e Diagnostiche Integrate, Viale Benedetto XV 6, 16132, Genova, GE, Italy.
| | - Luca Cavagnaro
- Joint Replacement Unit, Ortopedia e Traumatologia 2--Ospedale Santa Corona, Viale 25 Aprile, 38, 17027, Pietra Ligure, SV, Italy
| | - Francesco Chiarlone
- Joint Replacement Unit, Ortopedia e Traumatologia 2--Ospedale Santa Corona, Viale 25 Aprile, 38, 17027, Pietra Ligure, SV, Italy
| | - Emanuele Quarto
- IRCCS Ospedale Policlinico San Martino-Clinica Ortopedica, Largo Rosanna Benzi 10, 16132, Genova, GE, Italy
- DISC Dipartimento Di Scienze Chirurgiche e Diagnostiche Integrate, Viale Benedetto XV 6, 16132, Genova, GE, Italy
| | - Matteo Formica
- IRCCS Ospedale Policlinico San Martino-Clinica Ortopedica, Largo Rosanna Benzi 10, 16132, Genova, GE, Italy
- DISC Dipartimento Di Scienze Chirurgiche e Diagnostiche Integrate, Viale Benedetto XV 6, 16132, Genova, GE, Italy
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Ji S, Huang Y, Zhou Y, Wang C, Wang X, Ma C, Jiang X. Pre-operative predictive factors of residual varus on the mechanical axis after Oxford unicompartmental knee arthroplasty. Front Surg 2023; 9:1054351. [PMID: 36700020 PMCID: PMC9869032 DOI: 10.3389/fsurg.2022.1054351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 12/08/2022] [Indexed: 01/12/2023] Open
Abstract
Background Residual varus after Oxford unicompartmental knee arthroplasty (UKA) happens frequently. This study aims to evaluate the pre-operative contributing factors of residual varus. Methods A total of 1,002 knees (880 patients, 201 patients were male, and 679 were female) underwent Oxford UKA in the Orthopedic Surgery Department of the Beijing Jishuitan Hospital from March 2018 to April 2021. The mean age of the patient was 64.7 ± 7.7 years. To assess residual varus, the full-length lower extremity is placed upright for EOS imaging, with the knee fully extended. The angle of post-operative residual varus was measured as described by Noyes et al. Of the knees studied, they were either categorized into an under-corrected group (post-operative Noyes angle >5°) or a corrected group (post-operative Noyes angle ≤5°). Age, gender, body mass index (BMI), range of motion (ROM), Clinical American Knee Society Score (Clinical AKSS), and Function American Knee Society Score (Function AKSS) were compared. The following additional parameters were measured: pre-operative Noyes angle, lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), the posterior slope of the proximal tibia angle (PPTA), joint line converge angle (JLCA), and fixed flexion deformity (FFD). Results There was no statistically significant difference between the two groups in regards to gender (p = 0.428), surgical leg (p = 0.937), age (p = 0.851), BMI (p = 0.064), pre-operative Clinical AKSS (p = 0.206) and Function AKSS (p = 0.100). However, pre-operative ROM statistically differed between the two groups (p < 0.001). The contributing factors of post-operative residual varus were determined to be the following parameters: pre-operative MPTA (p < 0.001, OR = 4.522, 95% CI: 2.927-6.984), pre-operative Noyes (p < 0.001, OR = 3.262, 95% CI: 1.802-5.907) and pre-operative FFD (p = 0.007, OR = 1.862, 95% CI: 1.182-2.934). The effects of pre-operative LDFA (p = 0.146), JLCA (p = 0.942), and pre-operative PPTA (p = 0.899) on the post-operative mechanical axis did not show statistical significance. Conclusions Patients with severe pre-operative varus, particularly varus deformity mainly from the tibial side or pre-operative FFD, are more prone to get extremity mechanical axis residual varus after UKA with Oxford.
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Affiliation(s)
- Songjie Ji
- Department of Orthopedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China,Correspondence: Songjie Ji Xu Jiang
| | - Ye Huang
- Department of Orthopedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China
| | - Yixin Zhou
- Department of Orthopedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China
| | - Chao Wang
- Department of Statistics, Beijing Research Institute of Traumatology and Orthopedics, Beijing, China
| | - Xiaokai Wang
- Department of Radiology, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China
| | - Chaoyi Ma
- Department of Radiology, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China
| | - Xu Jiang
- Department of Orthopedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China,Correspondence: Songjie Ji Xu Jiang
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20
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Annapareddy A, Mulpur P, Prakash M, Suhas Masilamani AB, Eachempati KK, Gurava Reddy AV. Partial versus total knee arthroplasty for isolated antero-medial osteoarthritis - An analysis of PROMs and satisfaction. SICOT J 2023; 9:11. [PMID: 37094284 PMCID: PMC10125017 DOI: 10.1051/sicotj/2023006] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 03/12/2023] [Indexed: 04/26/2023] Open
Abstract
AIM This study aimed to compare the patient-reported functional outcomes and patient satisfaction after medial Unicompartmental Knee Arthroplasty (UKA) versus Total Knee Arthroplasty (TKA), performed for anteromedial osteoarthritis (AMOA) of the knee in patients from an Indian population, at a minimum 3-year follow-up. METHODS This is a prospective matched cohort study (1:2 ratio). One hundred and one UKA cases were matched to 206 TKA cases by propensity score matching for age, body mass index (BMI), gender distribution, and the Charlson Comorbidity Index (CCI). The primary outcome (Oxford knee score, OKS) was assessed at a 3-year follow-up, along with secondary outcomes (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC] Score, Forgotten Joint Score (FJS), Anterior Knee Pain (Kujala) score, patient satisfaction, and revision rate at the final follow-up). RESULTS The UKA group was superior to the TKA group in patient-reported functional outcomes based on the OKS (p = 0.004). Using the FJS score, UKA was more likely to be a forgotten joint compared to TKA (p < 0.001). However, differences in the OKS and FJS did not meet the reported minimal clinically important difference (MCID) thresholds. Quality of life (EuroQol-5D VAS scale) was found to be significantly higher in the UKA group (p < 0.001). Patients in the UKA group were more likely to be very satisfied (75.2%) versus the TKA group (62.1%, p = 0.023). CONCLUSION For AMOA, UKA was associated with improved patient satisfaction compared to TKA. Although patient-reported outcome measures were statistically in favour of UKA over TKA, the differences were not clinically significant. Multicenter and randomized studies comparing the two procedures are warranted. EVIDENCE Level-II Therapeutic.
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Affiliation(s)
- Adarsh Annapareddy
- Consultant Orthopaedic and Joint Replacement Surgeon, Sunshine Bone and Joint Institute, KIMS-Sunshine Hospitals, 500003 Hyderabad, India
| | - Praharsha Mulpur
- Consultant Orthopaedic and Joint Replacement Surgeon, Sunshine Bone and Joint Institute, KIMS-Sunshine Hospitals, 500003 Hyderabad, India
| | - Mrinal Prakash
- Research Fellow, Joint Replacement Surgery, Sunshine Bone and Joint Institute, KIMS-Sunshine Hospitals, 500003 Hyderabad, India
| | - A B Suhas Masilamani
- Consultant Orthopaedic and Joint Replacement Surgeon, Sunshine Bone and Joint Institute, KIMS-Sunshine Hospitals, 500003 Hyderabad, India
| | - Krishna Kiran Eachempati
- Consultant Orthopaedic and Joint Replacement Surgeon, Department of Orthopaedics, Medicover Hospitals, 524002 Hyderabad, India
| | - A V Gurava Reddy
- Consultant Orthopaedic and Joint Replacement Surgeon, Sunshine Bone and Joint Institute, KIMS-Sunshine Hospitals, 500003 Hyderabad, India
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21
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Foo WYX, Liow MHL, Chen JY, Tay DKJ, Lo NN, Yeo SJ. All-polyethylene unicompartmental knee arthroplasty is associated with increased risks of poorer knee society knee score and lower satisfaction in obese patients. Arch Orthop Trauma Surg 2022; 142:3977-3985. [PMID: 35094135 DOI: 10.1007/s00402-021-04325-w] [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: 02/26/2021] [Accepted: 12/19/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Although metal-backed tibial component (MB) is biomechanically superior to all-polyethylene (AP) implants in fixed-bearing unicompartmental knee arthroplasty (UKA), recent studies have shown comparable functional outcomes between the two. However, no study has examined this comparison in obese patients (BMI ≥ 30 kg/m2). We investigated whether functional outcomes between the two implants differ among obese patients, and whether the extent of obesity influences these outcomes. PATIENTS AND METHODS Four hundred twenty-two UKA implants from 347 obese patients were reviewed retrospectively. Patients were assessed using the Knee Society Knee Score (KSKS) and Function Score (KSFS), the original Oxford Knee Score (OKS), and SF-36 Physical Component Summary (PCS) and Mental Component Summary (MCS). Minimal clinically important difference (MCID) attainment was recorded. Patients' fulfillment of expectations and satisfaction with the surgery outcome was also graded. Patients were further divided into lower obesity (BMI 30-34.9 kg/m2) and higher obesity (BMI ≥ 35 kg/m2) to examine effect modification. RESULTS There were no differences in functional outcomes and quality-of-life scores, MCID attainment of functional scores, as well as satisfaction and expectation fulfillment between AP and MB. Among higher obesity patients, AP was associated with a poorer KSKS (p = 0.031) and lower proportion of satisfaction fulfillment (p = 0.041) 2 years postoperatively compared to MB. CONCLUSION We found no differences in functional and quality-of-life outcomes between fixed-bearing AP and MB tibial components among obese patients who underwent UKA. However, among higher obesity patients (BMI ≥ 35 kg/m2), patients with AP tibial component were associated with lower KSKS score and a lower proportion of attaining satisfaction fulfillment 2 years postoperatively.
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Affiliation(s)
| | - Ming Han Lincoln Liow
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, Singapore, 169865, Singapore
| | - Jerry Yongqiang Chen
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, Singapore, 169865, Singapore
| | - Darren Keng Jin Tay
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, Singapore, 169865, Singapore
| | - Ngai Nung Lo
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, Singapore, 169865, Singapore
| | - Seng Jin Yeo
- Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore.,Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, Singapore, 169865, Singapore
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22
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Plancher KD, Matheny LM, Briggs KK, Petterson SC. Reliability and Validity of the Knee Injury and Osteoarthritis Outcome Score in Patients Undergoing Unicompartmental Knee Arthroplasty. J Arthroplasty 2022; 37:1998-2003.e1. [PMID: 35487406 DOI: 10.1016/j.arth.2022.04.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 04/12/2022] [Accepted: 04/19/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The Knee Injury and Osteoarthritis Outcome Score (KOOS) was developed to document outcomes from knee injury, including the impact of osteoarthritis on knee function. The purpose of this study is to determine the reliability and validity of the KOOS subscales for evaluating outcomes following unicompartmental knee arthroplasty (UKA). METHODS KOOS Pain, Activities of Daily Living (ADL), Sport, Symptoms, and Quality of Life (QoL) scores collected from 172 patients who underwent UKA were used in the analysis. KOOS subscales were tested for reliability and validity of scores through a Rasch model analysis. RESULTS KOOS Sport, KOOS ADL, and KOOS QoL had good evidence of reliability with acceptable person reliability, person separation, and item reliability. For overall scale functioning, KOOS Pain, Symptoms, and ADL all had 1 question that did not have an acceptable value for infit or outfit mean square value. Questions in KOOS Sport and QoL all had acceptable values. There was a positive, linear relationship between the Short-Form 12 Physical Component Summary and the KOOS subscales which indicated good evidence of convergent validity. These associations were also seen when the cohort was separated in medial and lateral UKA. CONCLUSION Two of the 5 KOOS subscales (KOOS Sport and KOOS QoL) were considered adequate in measuring outcomes, as well as reliability. The KOOS ADL had borderline values; however, it had adequate infit and outfit values. The KOOS Pain and Symptom score performed poorly in this analysis. For documenting outcomes following UKA, this study supports the use of KOOS ADL, Sport, and QoL.
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Affiliation(s)
- Kevin D Plancher
- Department of Orthopaedic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York; Department of Orthopaedic Surgery, Weill Cornell Medical College, New York, New York; Plancher Orthopaedics & Sports Medicine, New York, New York; Orthopaedic Foundation, Stamford, Connecticut
| | - Lauren M Matheny
- School of Data Science and Analytics, Kennesaw State University, Atlanta, Georgia
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23
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Lonner JH, Seidenstein AD, Charters MA, North WT, Cafferky NL, Durbhakula SM, Kamath AF. Improved accuracy and reproducibility of a novel CT-free robotic surgical assistant for medial unicompartmental knee arthroplasty compared to conventional instrumentation: a cadaveric study. Knee Surg Sports Traumatol Arthrosc 2022; 30:2759-2767. [PMID: 34120210 DOI: 10.1007/s00167-021-06626-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 06/07/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Alignment errors in medial unicompartmental knee arthroplasty (UKA) predispose to premature implant loosening and polyethylene wear. The purpose of this study was to determine whether a novel CT-free robotic surgical assistant improves the accuracy and reproducibility of bone resections in UKA compared to conventional manual instrumentation. METHODS Sixty matched cadaveric limbs received medial UKA with either the ROSA® Partial Knee System or conventional instrumentation. Fifteen board-certified orthopaedic surgeons with no prior experience with this robotic application performed the procedures with the same implant system. Bone resection angles in the coronal, sagittal and transverse planes were determined using optical navigation while resection depth was obtained using calliper measurements. Group comparison was performed using Student's t test (mean absolute error), F test (variance) and Fisher's exact test (% within a value), with significance at p < 0.05. RESULTS Compared to conventional instrumentation, the accuracy of bone resections with CT-free robotic assistance was significantly improved for all bone resection parameters (p < 0.05), other than distal femoral resection depth, which did not differ significantly. Moreover, the variance was significantly lower (i.e. fewer chances of outliers) for five of seven parameters in the robotic group (p < 0.05). All values in the robotic group had a higher percentage of cases within 2° and 3° of the intraoperative plan. No re-cuts of the proximal tibia were required in the robotic group compared with 40% of cases in the conventional group. CONCLUSION The ROSA® Partial Knee System was significantly more accurate, with fewer outliers, compared to conventional instrumentation. The data reported in our current study are comparable to other semiautonomous robotic devices and support the use of this robotic technology for medial UKA. LEVEL OF EVIDENCE Cadaveric study, Level V.
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Affiliation(s)
- Jess H Lonner
- Rothman Orthopaedic Institute, 925 Chestnut St, Philadelphia, PA, 19107, USA. .,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, 19107, USA.
| | - Ari D Seidenstein
- Rothman Orthopaedics, Montvale, NJ, 07645, USA.,Hackensack Meridian School of Medicine, Nutley, NJ, 07110, USA
| | | | | | | | | | - Atul F Kamath
- Orthopaedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, OH, 44113, USA
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24
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A Comparative Study of Total Knee Arthroplasty and Unicondylar Knee Arthroplasty in the Treatment of Knee Osteoarthritis. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:7795801. [PMID: 35582233 PMCID: PMC9071932 DOI: 10.1155/2022/7795801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/23/2022] [Accepted: 04/21/2022] [Indexed: 11/18/2022]
Abstract
Objective To compare the clinical efficacy of total knee arthroplasty (TKA) and unicondylar knee arthroplasty (UKA) in the treatment of knee osteoarthritis (KOA). Methods A retrospective analysis was conducted on 30 patients admitted to the Department of Orthopaedics of Yijishan Hospital from 2020 to 2021. The patients were divided into UKA group (n = 15) and TKA group (control, n = 15). The intraoperative situation and postoperative clinical indicators of patients in the two groups were collected and compared, such as operation time, intraoperative blood loss, length of hospital stay, postoperative complications, and postoperative functional recovery. Postoperative functional recovery was investigated by the visual analogue pain scale (VAS), knee score scale (HSS), and knee range of motion (ROM) scores 5 days after surgery. Results Perioperative indexes in the UKA group were significantly lower than those in the TKA group, including operation time, intraoperative blood loss, first time going to the ground, and length of hospital stay. VAS, HSS, and ROM scores in the two groups were significantly improved after surgery compared with those before surgery. However, ROM scores in the UKA group were significantly better than in the TKA group. In terms of early postoperative complications, there was one case of venous thrombosis of lower limbs in the UKA group, while in the TKA group there was one case of delayed wound healing due to diabetes, and one case of deep infection. Conclusion Both UKA and TKA are very successful options for the treatment of KOA, but the use of UKA can promote the recovery of postoperative knee function, reduce postoperative complications, and achieve more satisfactory than expected results.
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25
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Total knee arthroplasty versus unicompartmental knee arthroplasty in management of anteromedial knee osteoarthritis: a randomized clinical trial. CURRENT ORTHOPAEDIC PRACTICE 2022. [DOI: 10.1097/bco.0000000000001128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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26
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Bull D, Mannan A, Ansari J, Mason K, London E, Müller JH, London N. Medial/central PF arthritis and functionally stable ACL deficiency do not compromise outcomes of fixed-bearing medial UKA. Knee 2022; 35:8-15. [PMID: 35152155 DOI: 10.1016/j.knee.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 12/16/2021] [Accepted: 01/06/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND There is limited published data assessing functional scores and patient satisfaction following unicompartmental knee arthroplasty (UKA) in patients with patellofemoral (PF) arthritis or anterior cruciate ligament (ACL) deficiency. The purpose of this study was to determine whether medial/central PF arthritis or functionally stable ACL deficiency compromise outcomes of fixed-bearing medial UKA at a minimum follow-up of 2 years. The hypothesis was that equivalent outcomes can be achieved in patients with substantial medial/central PF arthritis or with functionally stable ACL deficiency. METHODS The authors studied a consecutive series of 229 patients (240 knees) at 36.9 ± 6.3 months after receiving fixed-bearing medial UKA. Patients completed pre- and post-operative (2 years) clinical outcome questionnaires for Oxford Knee Score (OKS), EQ-5D, Knee injury and Osteoarthritis Outcome Score Physical Function Short Form (KOOS-PS), University of California, Los Angeles (UCLA) activity score, and Forgotten Joint Score (FJS). Multivariable analyses were performed to determine associations between clinical scores, patient demographics, PF arthritis and functionally stable ACL deficiency. RESULTS Of the 240 knees, 125 (54%) had substantial medial/central PF arthritis and 21 (9%) functionally stable ACL deficiency. Multivariable analyses revealed no association between outcomes and medial/central PF arthritis, but knees with functionally stable ACL deficiency were associated with better KOOS-PS (β = 8.99, p = 0.012). CONCLUSION Fixed-bearing medial UKA grants satisfactory outcomes at 2 years even in knees with substantial medial/central PF arthritis or functionally stable ACL deficiency. Longer-term prospective studies with larger cohorts are needed to confirm these promising findings regarding outcomes in patients traditionally contraindicated for medial UKA.
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Affiliation(s)
- Damian Bull
- Harrogate and District Foundation Trust, North Yorkshire, England
| | - Ashim Mannan
- Leeds Beckett University School of Sport, Leeds, England
| | - Juned Ansari
- Harrogate and District Foundation Trust, North Yorkshire, England
| | | | | | | | | | - Nick London
- Harrogate and District Foundation Trust, North Yorkshire, England; Wexham Park Hospital, Slough, England
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27
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Haffar A, Ali R, Mehta N, Patel A, Fricka KB, Della Valle CJ, Gerlinger TL, Krueger CA, Lonner JH. Prior Anterior Cruciate Ligament Reconstruction Does Not Compromise the Functional Outcomes of Medial Unicompartmental Knee Arthroplasty Although Revision for Progressive Arthritis May Occur Earlier. J Arthroplasty 2022; 37:238-242. [PMID: 34699914 DOI: 10.1016/j.arth.2021.10.008] [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: 07/21/2021] [Revised: 10/07/2021] [Accepted: 10/17/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Anterior cruciate ligament (ACL) deficiency is commonly considered a contraindication for unicompartmental knee arthroplasty (UKA). The purpose of this study is to compare the outcomes of UKA after prior ACL reconstruction (rACL cohort) to UKA with an intact native ACL (nACL cohort). METHODS Forty-five patients from 3 institutions who underwent medial UKA after prior rACL were matched by age, gender, preoperative function scores, and body mass index to 90 patients who underwent UKA with an intact nACL. Primary outcomes were Knee Injury and Osteoarthritis Outcome Score for Joint Replacement, Oxford Knee Scores, Knee Society Functional Scores, and Kellgren-Lawrence scores in the unresurfaced, lateral tibiofemoral compartment. Secondary outcomes were postoperative complications and the need for revision to TKA. RESULTS At a mean of 3.6 years, all PROMs improved significantly with no differences identified between groups. The incidence of revision TKA was similar between cohorts (P = 1.00); however, the mean time to revision for progressive osteoarthritis was 4.0 years in the nACL group and 2.2 years in the rACL group. Twenty percent of rACL patients had a postoperative complication compared to 8% in the nACL group. Despite presenting with a similar degree of lateral arthritis, a greater percentage of patients developed Kellgren-Lawrence scores of ≥3 in the rACL cohort (9%) than in the nACL cohort (0%). CONCLUSION A previously reconstructed ACL does not appear to compromise the short-term functional outcomes of UKA; however, there is a higher rate of minor complications and progression of lateral compartment arthritis, which should be considered with patients in the shared decision process.
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Affiliation(s)
- Amer Haffar
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Raheel Ali
- Anderson Orthopaedic Research Institute, Alexandria, VA; Inova Mount Vernon Hospital Joint Replacement Center, Alexandria, VA
| | - Nabil Mehta
- Midwest Orthopaedics at Rush, Rush Univesity Medical Center, Chicago, IL
| | - Arpan Patel
- Midwest Orthopaedics at Rush, Rush Univesity Medical Center, Chicago, IL
| | - Kevin B Fricka
- Anderson Orthopaedic Research Institute, Alexandria, VA; Inova Mount Vernon Hospital Joint Replacement Center, Alexandria, VA
| | | | - Tad L Gerlinger
- Midwest Orthopaedics at Rush, Rush Univesity Medical Center, Chicago, IL
| | - Chad A Krueger
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Jess H Lonner
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
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Cavagnaro L, Chiarlone F, Mosconi L, Zanirato A, Formica M, Burastero G. Two-stage revision for periprosthetic joint infection in unicompartmental knee arthroplasty: clinical and radiological results. Arch Orthop Trauma Surg 2022; 142:2031-2038. [PMID: 35589980 PMCID: PMC9296397 DOI: 10.1007/s00402-022-04464-8] [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: 10/11/2021] [Accepted: 04/24/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Unicompartmental knee arthroplasty (UKA) has an infection rate of 0.1-0.8%. Despite the wide amount of literature about septic total knee arthroplasty management, few data are available for UKA infection treatment. The aim is to present the clinical and radiological outcomes along with complication rates of a series of septic UKA treated with two-stage exchange. METHODS We retrospectively reviewed 16 patient treated with staged UKA revision for infection between June 2015 and September 2019 in a single bone infection unit. The main demographic and surgical data were recorded. Clinical scores (VAS, KSS, OKS, postoperative ROM), radiological parameters (osseointegration, loosening and radiolucencies) and complications were reported. The mean follow-up was 33.5 ± 6.9 months. RESULTS Mean age at surgery was 68.5 ± 9.1. All but two were medial UKA. The mean number of previous surgeries was 2.9 ± 1.9. The mean ROM, VAS, KSS and OKS of the entire population improved significantly (p < 0.01). Radiological analysis did not show any migration or implant loosening. Ten constrained condylar and six posterior stabilized prosthesis were finally implanted. One intraoperative pathogen isolation was recorded and managed with suppressive therapy and good final outcome. The implant survivorship free from infection was 100% at the final follow-up. The overall survival rate for any reason of revision was 100% CONCLUSION: According to our results, staged revision represents a reliable ad effective option in delayed and late UKA infections. This technique provides optimal clinical and radiological results with acceptable complication rates. To the best of our knowledge, this represent the widest case series on infected UKA managed with two-stage exchange.
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Affiliation(s)
- Luca Cavagnaro
- Joint Replacement Unit/Bone Infection Unit, Ospedale Santa Corona, Via XXV Aprile 38, 17027 Pietra Ligure, SV Italy
| | - Francesco Chiarlone
- Joint Replacement Unit/Bone Infection Unit, Ospedale Santa Corona, Via XXV Aprile 38, 17027 Pietra Ligure, SV Italy
| | - Lorenzo Mosconi
- Joint Replacement Unit/Bone Infection Unit, Ospedale Santa Corona, Via XXV Aprile 38, 17027 Pietra Ligure, SV Italy
| | - Andrea Zanirato
- Orthopaedic Department, Policlinico San Martino Largo, Rosanna Benzi 10, 16132 Genoa, GE Italy
| | - Matteo Formica
- Orthopaedic Department, Policlinico San Martino Largo, Rosanna Benzi 10, 16132 Genoa, GE Italy
| | - Giorgio Burastero
- Joint Replacement Unit, Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milan, MI Italy
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Maqbool M, Fekadu G, Jiang X, Bekele F, Tolossa T, Turi E, Fetensa G, Fanta K. An up to date on clinical prospects and management of osteoarthritis. Ann Med Surg (Lond) 2021; 72:103077. [PMID: 34868573 PMCID: PMC8626656 DOI: 10.1016/j.amsu.2021.103077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 11/14/2021] [Accepted: 11/16/2021] [Indexed: 12/19/2022] Open
Abstract
The rising prevalence of osteoarthritis (OA) in the general population has necessitated the development of novel treatment options. It is critical to recognize the joint as a separate entity participating in degenerative processes, as well as the multifaceted nature of OA. OA is incurable because there is currently no medication that can stop or reverse cartilage or bone loss. As this point of view has attracted attention, more research is being directed toward determining how the various joint components are impacted and how they contribute to OA pathogenesis. Over the next few years, several prospective therapies focusing on inflammation, cartilage metabolism, subchondral bone remodelling, cellular senescence, and the peripheral nociceptive pathway are predicted to transform the OA therapy landscape. Stem cell therapies and the use of various biomaterials to target articular cartilage (AC) and osteochondral tissues are now being investigated in considerable detail. Currently, laboratory-made cartilage tissues are on the verge of being used in clinical settings. This review focuses on the update of clinical prospects and management of osteoarthritis, as well as future possibilities for the treatment of OA.
Osteoarthritis (OA) is a general term that incorporates several different joint diseases. The exact pathophysiology of OA remains unclear. OA is incurable because there is currently no medication that can stop or reverse cartilage or bone loss. Nonsteroidal anti-inflammatory drugs are the most frequently prescribed medications to alleviate arthritic discomfort. Stem cell therapies to target articular cartilage and osteochondral tissues are now under investigation.
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Affiliation(s)
- Mudasir Maqbool
- Department of Pharmaceutical Sciences, University of Kashmir, Hazratbal Srinagar, 190006, Jammu and Kashmir, India
| | - Ginenus Fekadu
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T, Hong Kong.,School of Pharmacy, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Xinchan Jiang
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T, Hong Kong
| | - Firomsa Bekele
- Department of Pharmacy, College of Health Science, Mettu University, Mettu, Ethiopia
| | - Tadesse Tolossa
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Ebisa Turi
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Getahun Fetensa
- School of Nursing and Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Korinan Fanta
- School of Pharmacy, Institute of Health Science, Jimma University, Jimma, Ethiopia
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Wu LP, Mayr HO, Zhang X, Huang YQ, Chen YZ, Li YM. Knee Scores of Patients with Non-Lateral Compartmental Knee Osteoarthritis Undergoing Mobile, Fixed-Bearing Unicompartmental Knee and Total Knee Arthroplasties: A Randomized Controlled Trial. Orthop Surg 2021; 14:73-87. [PMID: 34870364 PMCID: PMC8755879 DOI: 10.1111/os.13111] [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: 11/10/2020] [Revised: 04/21/2021] [Accepted: 05/26/2021] [Indexed: 11/29/2022] Open
Abstract
Objective To evaluate knee scores and clinical efficacies of patients with non‐lateral unicompartmental knee osteoarthritis (OA) who randomly underwent mobile‐bearing (MB) unicompartmental knee arthroplasty (UKA), fixed‐bearing (FB) UKA, and total knee arthroplasty (TKA). Methods From September 2015 to February 2017, a prospective, randomized, parallel, single‐center trial of 180 patients (78 males and 102 females; 63.3 ± 6.9 years) with non‐lateral compartmental knee OA was performed in the first author‐affiliated hospital. The patients were randomly divided into three groups (each group included 60 patients) and received medial cemented Oxford phase 3 MB UKA, medial cemented Link FB UKA, or cemented DePuy Sigma PFC TKA, respectively. A similar perioperative management and fast‐track surgery program was carried out for all patients. The knee scores at 3‐year follow‐up after operation and clinical efficacies of these three groups of patients were recorded, investigated, and compared. Results Primarily, compared to the TKA group, the UKA groups (MB UKA and FB UKA) had shorter operative time (median 63.2 < 67.1 min), less bleeding (8.6 < 30.0 mL), earlier resumption of walking without crutches (3.0 < 8.0 days) and walking up and down the stairs (5.0 < 10.0 days) (P < 0.001), higher FJS scores (78.0 > 74.5) (P = 0.007), better results in all knee scores (except VAS and KSS function scores) (P < 0.05), and a larger maximum flexion angle of the knee at the 3‐year follow‐up (123.0° > 96.0°) (P = 0.001). Secondarily, compared to the TKA group, the MB UKA group showed better results in the Western Ontario and McMaster Universities index (WOMAC) stiffness (83.6 > 79.6), WOMAC total (86.3 > 83.2), Oxford knee score (OKS) (20.0 < 23.0), Forgotten Joint Score (FJS) (78.5 > 74.5), and a larger maximum flexion angle of the knee (123.0 > 96.0) (P < 0.05). Moreover, the FB UKA group showed higher Hospital for Special Surgery Knee Score (HSS) (91.0 > 88.5), WOMAC stiffness (84.3 > 79.6), WOMAC function (85.2 > 81.7), WOMAC total scores (87.6 > 83.2), and a larger maximum flexion angle of the knee (119.0° > 96.0°) than the TKA group (P < 0.05). Overall, there was no significant difference in all knee scores and maximum flexion angles of the knee for the MB UKA and FB UKA groups (P > 0.05). There was one case with original bearing dislocation in MB UKA group. One patient with displacement of the femoral component caused by a fall injury, and another patient, who lost his life in a car accident, were involved in the FB UKA group. There was an infection case and an intermuscular vein thrombosis case in TKA group. Conclusion UKA showed more advantages than TKA; however, there was no significant difference between the MB UKA and FB UKA groups for treatment of non‐lateral compartmental knee OA.
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Affiliation(s)
- Li-Ping Wu
- Department of Orthopedic Surgery, Jiangmen Central Hospital (Affiliated Jiangmen Hospital of Sun Yat-Sen University), Jiangmen, China
| | - Hermann O Mayr
- Department of Orthopedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Xing Zhang
- Clinical Experimental Center, Jiangmen Central Hospital (Affiliated Jiangmen Hospital of Sun Yat-Sen University), Jiangmen, China
| | - Yuan-Qiao Huang
- Department of Orthopedic Surgery, Jiangmen Central Hospital (Affiliated Jiangmen Hospital of Sun Yat-Sen University), Jiangmen, China
| | - Yuan-Zhuang Chen
- Department of Orthopedic Surgery, Jiangmen Central Hospital (Affiliated Jiangmen Hospital of Sun Yat-Sen University), Jiangmen, China
| | - Yu-Ming Li
- Department of Orthopedic Surgery, Jiangmen Central Hospital (Affiliated Jiangmen Hospital of Sun Yat-Sen University), Jiangmen, China
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Hur ES, Serino J, Bohl DD, Della Valle CJ, Gerlinger TL. Fewer Adverse Events Following Outpatient Compared with Inpatient Unicompartmental Knee Arthroplasty. J Bone Joint Surg Am 2021; 103:2096-2104. [PMID: 34398841 DOI: 10.2106/jbjs.20.02157] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Unicompartmental knee arthroplasty (UKA) is a common procedure for unicompartmental knee arthritis, often resulting in pain relief and improved function. The demand for total knee arthroplasty in the U.S. is projected to grow 85% between 2014 and 2030, and the volume of UKA procedures is growing 3 to 6 times faster than that of total knee arthroplasty. The purpose of the present study was to examine the safety of outpatient and inpatient UKA and to investigate changes over time as outpatient procedures were performed more frequently. METHODS Patients who underwent UKA from 2005 to 2018 as part of the National Surgical Quality Improvement Program were identified. Patients were divided into an early cohort (5,555 patients from 2005 to 2015) and late cohort (5,627 patients from 2016 to 2018). Outpatient status was defined as discharge on the day of surgery. Adverse events within 30 days postoperatively were compared, with adjustment for baseline characteristics with use of standard multivariate regression and propensity-score-matching techniques. RESULTS Among the 5,555 cases in the early cohort, the rate of surgical-site infection was lower for inpatient (0.84%) compared with outpatient UKA (1.69%; adjusted relative risk [RR] for inpatient, 0.5; 95% confidence interval [CI], 0.2 to 1.0; p = 0.045); no other significant differences were identified. Among the 5,627 cases in the late cohort, inpatient UKA had higher rates of any complication (2.53% compared with 0.95% for outpatient UKA; adjusted RR for inpatient, 2.5; 95% CI, 1.4 to 4.3; p = 0.001) and readmission (1.81% compared with 0.88% for outpatient UKA; adjusted RR for inpatient, 2.0; 95% CI, 1.1 to 3.5; p = 0.023). In the propensity-score-matched comparison for the late cohort, inpatient UKA had a higher rate of any complication (RR for inpatient, 2.0; 95% CI, 1.0 to 4.0; p = 0.049) and return to the operating room (RR for inpatient, 4.3; 95% CI, 1.4 to 12.6; p = 0.009). Although the rate of readmission was almost twice as high among inpatients (1.67% compared with 0.84% for outpatients; RR for inpatient, 2.0; 95% CI, 1.0 to 4.1; p = 0.059), this difference did not reach significance with the sample size studied. There was a significant reduction in the overall rate of complications over time (3.44% in the early cohort compared with 2.11% in the late cohort; adjusted RR for late cohort, 0.7; 95% CI, 0.5 to 0.8; p = 0.001), with a more than fourfold reduction among outpatients (3.95% in the early cohort compared with 0.95% in the late cohort; adjusted RR for late cohort, 0.3; 95% CI, 0.1 to 0.5; p < 0.001). CONCLUSIONS Outpatient UKA was associated with a lower risk of complications compared with inpatient UKA when contemporary data are examined. We identified a dramatic reduction in complications across the early and late cohorts, suggesting an improvement in quality over time, with the largest improvements seen among outpatients. This shift may represent changes in patient selection or improvements in perioperative protocols. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Edward S Hur
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
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Joint awareness after unicompartmental and total knee arthroplasty: Which feels more natural? JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2021. [DOI: 10.1177/22104917211056944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background/Purpose The purpose of this study was to compare the joint awareness and knee function after unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA) for the management of isolated medial compartment osteoarthritis. Methods Patients who underwent UKA or TKA at our institution for isolated medial compartment osteoarthritis from 2015 to 2020 with a minimum follow-up of 1 year were screened. 116 eligible patients were invited and 94 volunteer patients participated. All patients were evaluated with The Forgotten Joint Score-12 and Lysholm Knee Scale. Results Average follow-up period was 29.13±15.48 months for UKA and 31.66±2.91 months for TKA groups ( p=0.292). FJS-12 of the UKA group was significantly higher than that of the TKA group (79.74±15.06 and 63.25±19.86, respectively; p=0.024). The Lysholm Knee Scale score was also significantly higher in the UKA group compared with the TKA group (92.94±8.74 and 78.34±14.99, respectively; p = 0.002). Conclusion Our findings suggest that patients who underwent UKA were less aware of their artificial joints and had better knee function compared to patients who underwent TKA for medial osteoarthritis of the knee.
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Tripathy SK, Varghese P, Srinivasan A, Goyal T, Purudappa PP, Sen RK, Chandrappa MH. Joint awareness after unicompartmental knee arthroplasty and total knee arthroplasty: a systematic review and meta-analysis of cohort studies. Knee Surg Sports Traumatol Arthrosc 2021; 29:3478-3487. [PMID: 33078218 DOI: 10.1007/s00167-020-06327-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 10/06/2020] [Indexed: 02/05/2023]
Abstract
PURPOSE The purpose of this systematic review and meta-analysis is to evaluate the joint awareness after unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA). It was hypothesized that patients with UKA could better forget about their artificial joint in comparison to TKA. METHODS A search of major literature databases and bibliographic details revealed 105 studies evaluating forgotten joint score in UKA and TKA. Seven studies found eligible for this review were assessed for risk of bias and quality of evidence using the Newcastle-Ottawa Scale. The forgotten joint score (FJS-12) was assessed at 6 months, 1 year, and 2 years. RESULTS The mean FJS-12 at 2 years was 82.35 in the UKA group and 74.05 in the TKA group. Forest plot analysis of five studies (n = 930 patients) revealed a mean difference of 7.65 (95% CI: 3.72, 11.57, p = 0.0001; I2 = 89% with p < 0.0001) in FJS-12 at 2 years. Further sensitivity analysis lowered I2 heterogeneity to 31% after exclusion of the study by Blevin et al. (MD 5.88, 95%CI: 3.10, 8.66, p < 0.0001). A similar trend of differences in FJS-12 between the groups was observed at 6 months (MD 32.49, 95% CI: 17.55, 47.43, p < 0.0001) and at 1 year (MD 25.62, 95% CI: 4.26, 46.98, p = 0.02). CONCLUSIONS UKA patients can better forget about their artificial joint compared to TKA patients. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Sujit Kumar Tripathy
- Department of Orthopedics, All India Institute of Medical Sciences, Bhubaneswar, 751019, India.
| | - Paulson Varghese
- Department of Orthopedics, All India Institute of Medical Sciences, Bhubaneswar, 751019, India
| | - Anand Srinivasan
- Department of Pharmacology, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Tarun Goyal
- Department of Orthopedics, All India Institute of Medical Sciences, Bathinda, India
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Goh GS, Zeng GJ, Chen JY, Lo NN, Yeo SJ, Liow MHL. Preoperative Flexion Contracture Does Not Compromise the Outcomes and Survivorship of Medial Fixed Bearing Unicompartmental Knee Arthroplasty. J Arthroplasty 2021; 36:3406-3412. [PMID: 34090691 DOI: 10.1016/j.arth.2021.05.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/06/2021] [Accepted: 05/12/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Despite the expanding indications for unicompartmental knee arthroplasty (UKA), the classic indication that limits flexion contracture to <5° in fixed bearing UKA excludes most patients with arthritic knees and has not been challenged in modern literature. This study compared the clinical outcomes between patients with severe flexion contracture and controls undergoing UKA. METHODS Eighty seven medial fixed bearing UKAs performed in patients with severe (≥15°) flexion contracture were matched 1:1 with 87 controls without flexion or recurvatum deformity (-5°<extension<5°) using propensity scores to control for age, sex, BMI, Charlson comorbidity index, ASA class, and baseline patient-reported outcome measures (PROMs). Perioperative outcomes were recorded. Range of motion, Knee Society Score, Oxford Knee Score, SF-36, and patient satisfaction were assessed at 6 months and 2 years. Survivorship was recorded at mean 11.5 ± 3.2 years. RESULTS Preoperative knee extension in the control and contracture groups was 0.9° ± 1.9° and 18.0° ± 3.5° (P < .001), respectively, whereas flexion was 122.8° ± 27.9° and 120.6° ± 13.6° (P = .502). The contracture group had poorer Knee Society functional (P = .023) and SF-36 physical score (P = .010) at 6 months. However, there was no difference in PROMs at 2 years. A similar proportion achieved the minimal clinically important difference for each PROM and was satisfied with surgery. Range of motion remained poorer in the contracture group and a higher percentage had residual contractures (P < .001). Ten-year survivorship was 94% and 97% in the control and contracture groups, respectively (P = .145). CONCLUSION Although patients with severe flexion contractures had a poorer range of motion and postoperatively, these patients attained comparable PROMs, satisfaction rates, and mid-term survivorship after UKA. LEVEL OF EVIDENCE III, therapeutic study.
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Affiliation(s)
- Graham S Goh
- Department of Orthopaedic Surgery, Singapore General Hospital
| | - Gerald J Zeng
- Department of Orthopaedic Surgery, Singapore General Hospital
| | - Jerry Y Chen
- Department of Orthopaedic Surgery, Singapore General Hospital
| | - Ngai-Nung Lo
- Department of Orthopaedic Surgery, Singapore General Hospital
| | - Seng-Jin Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital
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Robotic Assistance in Unicompartmental Knee Arthroplasty Results in Superior Early Functional Recovery and Is More Likely to Meet Patient Expectations. Adv Orthop 2021; 2021:4770960. [PMID: 34336292 PMCID: PMC8298171 DOI: 10.1155/2021/4770960] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 07/02/2021] [Indexed: 11/17/2022] Open
Abstract
Robotic technology has reduced the errors of implant alignment in unicompartmental knee arthroplasty (UKA), but its impact on functional recovery after UKA is poorly defined. The purpose of this study was to compare early functional recovery, pain levels, and satisfaction in UKA performed with either robotic assistance or conventional methods. A retrospective analysis was performed on 89 matched consecutive patients who underwent outpatient UKA by a single physician using either conventional instruments (n = 39) or robotic methods (n = 50), with otherwise identical perioperative protocols. Outcomes studied included Lower Extremity Functional Score (LEFS), new Knee Society Score (KSS), Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS-JR.), VR/SF-12, Visual Analog Scale (VAS) pain scores, and perioperative opioid consumption. Patients in the robotic cohort had superior early functional outcomes, with greater LEFS (conventional = 23; robotic = 31) at 1 week post-op (p=0.015) and KOOS-JR (conventional = 74; robotic = 81) at up to 6 months post-op (p=0.037); these two values remained statistically significant after mixed-model regression analysis (p=0.010; p=0.023), respectively. At 1 year post-op, expectations were more likely to be met in those who received robotic assistance (p=0.06). No differences were reported with respect to postoperative opioid usage (p=0.320), reoperations (p=1.00), and complications (p=0.628). Robotic-assisted UKA resulted in more rapid recovery and less early postoperative pain and were more likely to meet expectations than conventional UKA, although functional differences equilibrated by 1 year postoperatively. Further follow-up is necessary to determine if implant durability is impacted by robotics.
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Pumilia CA, Schroeder L, Sarpong NO, Martin G. Patient Satisfaction, Functional Outcomes, and Implant Survivorship in Patients Undergoing Customized Unicompartmental Knee Arthroplasty. J Pers Med 2021; 11:753. [PMID: 34442397 PMCID: PMC8401135 DOI: 10.3390/jpm11080753] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/21/2021] [Accepted: 07/29/2021] [Indexed: 12/16/2022] Open
Abstract
Customized unicompartmental knee arthroplasty (C-UKA) utilizes implants manufactured on an individual patient basis, derived from pre-operative computed tomography images in an effort to more closely approximate the natural anatomy of the knee. The outcomes from 349 medial and lateral fixed-bearing C-UKA were reviewed. Implant survivorship analysis was conducted via retrospective chart review, and follow-up analysis was conducted via a single postoperative phone call or email. The rate of follow-up was 69% (242 knees). The average age at surgery was 71.1 years and the average body mass index was 28.8 kg/m2. Seven revision arthroplasties (2.1%) had knowingly been performed at an average of 1.9 years postoperatively (range: 0.1-3.9 years), resulting in an implant survivorship of 97.9% at an average follow-up of 4.2 years (range: 0.1-8.7) and 97.9% at an average of 4.8 years (range: 2.0-8.7) when knees with less than two years of follow-up were excluded. The reasons for revision were implant loosening (one knee), infection (two knees), progression of osteoarthritis (two knees), and unknown reasons (two knees). The average KOOS, JR. interval score was 84 (SD: 14.4). Of those able to be contacted for follow-up analysis, 67% were "very satisfied," 26% were "satisfied," 4% were "neutral," 2% were "dissatisfied," and 1% were "very dissatisfied." When asked if the knee felt "natural," 60% responded with "always," 35% responded with "sometimes," and 5% responded with "never." After analyzing a large cohort of C-UKA, we found favorable rates of survivorship, satisfaction, and patient-reported functional outcomes.
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Affiliation(s)
| | - Lennart Schroeder
- Department of General, Trauma and Reconstructive Surgery, University Hospital, Ludwig Maximilians University, 81377 Munich, Germany;
| | - Nana O. Sarpong
- Columbia University Medical Center, Department of Orthopedic Surgery, New York—Presbyterian Hospital, Columbia University, New York, NY 10032, USA;
| | - Gregory Martin
- Department of Orthopedic Surgery, Personalized Orthopaedics of the Palm Beaches, Boynton Beach, FL 33437, USA;
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Burnett Iii RA, Yang J, Courtney PM, Terhune EB, Hannon CP, Della Valle CJ. Costs of unicompartmental compared with total knee arthroplasty : a matched cohort study over ten years. Bone Joint J 2021; 103-B:23-31. [PMID: 34053283 DOI: 10.1302/0301-620x.103b6.bjj-2020-2259.r1] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The aim of this study was to compare ten-year longitudinal healthcare costs and revision rates for patients undergoing unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA). METHODS The Humana database was used to compare 2,383 patients undergoing UKA between 2007 and 2009, who were matched 1:1 from a cohort of 63,036 patients undergoing primary TKA based on age, sex, and Elixhauser Comorbidity Index. Medical and surgical complications were tracked longitudinally for one year following surgery. Rates of revision surgery and cumulative mean healthcare costs were recorded for this period of time and compared between the cohorts. RESULTS Patients undergoing TKA had significantly higher rates of manipulation under anaesthesia (3.9% vs 0.9%; p < 0.001), deep vein thrombosis (5.0% vs 3.1%; p < 0.001), pulmonary embolism (1.5% vs 0.8%; p = 0.001), and renal failure (4.2% vs 2.2%; p < 0.001). Revision rates, however, were significantly higher for UKA at five years (6.0% vs 4.2%; p = 0.007) and ten years postoperatively (6.5% vs 4.4%; p = 0.002). Longitudinal-related healthcare costs for patients undergoing TKA were greater than for those undergoing UKA at one year ($24,771 vs $22,071; p < 0.001) and five years following surgery ($26,549 vs $25,730; p < 0.001); however, the mean costs of TKA were comparable to UKA at ten years ($26,877 vs $26,891; p = 0.425). CONCLUSION Despite higher revision rates, patients undergoing UKA had lower mean healthcare costs than those undergoing TKA up to ten years following the procedure, at which time costs were comparable. In the era of value-based care, surgeons and policymakers should be aware of the costs involved with these procedures. UKA was associated with fewer complications at one year postoperatively but higher revision rates at five and ten years. While UKA was significantly less costly than TKA at one and five years, costs at ten years were comparable with a mean difference of only $14. Lowering the risk of revision surgery should be targeted as a source of cost savings for both UKA and TKA as the mean related healthcare costs were 2.5-fold higher in patients requiring revision surgery. Cite this article: Bone Joint J 2021;103-B(6 Supple A):23-31.
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Affiliation(s)
- Robert A Burnett Iii
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - JaeWon Yang
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - P Maxwell Courtney
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA
| | - E Bailey Terhune
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Charles P Hannon
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Craig J Della Valle
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
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Baryeh K, Maillot C, Gummaraju A, Rivière C. Disappointing Relationship between Functional Performance and Patient Satisfaction of UKA Patients: A Cross Sectional Study. Orthop Traumatol Surg Res 2021; 107:102865. [PMID: 33636415 DOI: 10.1016/j.otsr.2021.102865] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 07/08/2020] [Accepted: 07/20/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Following a Unicompartmental knee arthroplasty (UKA) satisfaction is often conflated with functional outcome. Recent studies have shown that satisfaction is not linked to functional outcome. The research questions were: (1) what is the relationship between satisfaction and functional performance and quality of life (absolute and gain values) after UKA? And (2) what is the level of satisfaction, function, and quality of life after UKA? HYPOTHESIS There is a poor relationship between functional performance and patient satisfaction following UKA. METHODS This was a retrospective study using a locally held arthroplasty register to identify patients who had undergone UKA between 2004 and 2017. Patient reported outcome measures (PROMs) were collected prospectively and included EQ-5D, Oxford Knee Score (OKS) and satisfaction score (based on a visual analogue score with 0 being worst and 100 being best). Patients with a complete set of pre-operative and 2-year post-operative outcome scores were included. Patients who subsequently underwent revision surgery were excluded. 1638 patients were identified, of which 896 were eligible for inclusion. The average age was 66.7 years old, with 46.3% of patients being female. RESULTS There was a moderate to strong correlation between the absolute or relative values for OKS and the patient satisfaction following UKA (r=0.705 and r=0.522, respectively). The average pre-operative scores improved from a median of 23 (IQR 18-28) to 43 (IQR 35-46) (p<0.001) and from a median of 0.62 (IQR 0.186-0.691) to 0.85 (IQR 0.691 - 1) (p<0.001) for OKS and EQ-5D, respectively. In terms of satisfaction with outcome, 82.6% of patients were very satisfied and 4.4% were dissatisfied (scoring ≥80% and <50%, respectively). At 2 years, the PASS was met or surpassed by 73.1% and 54.9% (OKS and EQ-5D, respectively). The MCID was met or surpassed by 93% and 78% (OKS and EQ-5D, respectively). DISCUSSION/CONCLUSION UKA is a successful procedure generating high levels of patient function and satisfaction. Because patients' OKS and EQ-5D scores may be influenced by comorbidities, those scores are of disappointing predictive value in estimating patient satisfaction, and therefore should not be used as a surrogate to determine the success of the UKA procedure. LEVEL OF EVIDENCE III; Restrospective cohort study.
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Affiliation(s)
- Kwaku Baryeh
- South West London Elective Orthopaedic Centre, Dorking Road, Epsom, KT18 7EG, UK.
| | - Cedric Maillot
- Service de Chirurgie Orthopedique et Traumatologique Bichat-Beaujon, Assistance Publique Hospitaux de Paris universite Sorbonne Paris Cite, France
| | - Advaith Gummaraju
- South West London Elective Orthopaedic Centre, Dorking Road, Epsom, KT18 7EG, UK
| | - Charles Rivière
- South West London Elective Orthopaedic Centre, Dorking Road, Epsom, KT18 7EG, UK; The MSK Lab, Imperial College London, Charing Cross Hospital, Charing Cross Campus, W6 8RF London, UK; Centre de l'Arthrose - Clinique de Sport, 4, rue Georges Negrevergne, 33700 Mérignac, France
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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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Cregar WM, Goodloe JB, Lu Y, Gerlinger TL. Increased Operative Time Impacts Rates of Short-Term Complications After Unicompartmental Knee Arthroplasty. J Arthroplasty 2021; 36:488-494. [PMID: 32921548 DOI: 10.1016/j.arth.2020.08.032] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/13/2020] [Accepted: 08/17/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Previous evidence has demonstrated an exacerbating effect of increased operative time on short-term complications in total joint arthroplasty. While the same relationship may be expected for unicompartmental knee arthroplasty (UKA), supporting evidence remains sparse. The purpose of this study is to determine the impact of operative time on short-term complication rates after UKA and determine a critical threshold in operative times after which complications may increase. METHODS The American College of Surgeons National Surgical Quality Improvement Project was queried from 2007 to 2018 to identify 11,633 UKA procedures that were included in the final analysis. The effect of operative time on complications within 30 days was evaluated using multivariate logistic regression models. Receiver operating characteristics curves and spline regression models were used to identify critical thresholds in operative time that increase the likelihood of short-term complications. RESULTS Longer operative times (in minutes) were associated with higher rates of surgical site infection (90.4 ± 26.7 vs 84.8 ± 25.5, P = .003), blood transfusions (94.9 ± 28.6 vs 84.9 ± 25.5, P = .007), as well as reoperation rates (90.8 ± 27.9 vs 84.9 ± 25.5, P = .01), extended hospital length of stay (93.4 ± 29.8 vs 84.5 ± 25.2, P < .001), and mortality (110.4 ± 35.5 vs 84.9 ± 25.5, P = .008). Following multivariate logistic regression, operative time was found to independently predict increased surgical site infection, blood transfusion, myocardial infarction, extended length of stay, and mortality (odds ratio: 1.09 - 1.45, CI: 1.01 - 1.91, all P values <0.02). Receiver operating characteristics curves found an increase in mortality risk during the 30-day postoperative period after 88.5 minutes of operative time, a finding supported by spline regression plots. CONCLUSION The present study found a positive correlation between increased operative times and short-term postoperative complication rates after UKA. Despite a statistically significant association with increasing operative time, odds ratios of reported complications are relatively low.
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Affiliation(s)
- William M Cregar
- Division of Orthopaedics, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - J Brett Goodloe
- Department of Orthopaedic Surgery and Physical Rehabilitation, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Yining Lu
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Tad L Gerlinger
- Division of Orthopaedics, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
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Deng M, Hu Y, Zhang Z, Zhang H, Qu Y, Shao G. Unicondylar knee replacement versus total knee replacement for the treatment of medial knee osteoarthritis: a systematic review and meta-analysis. Arch Orthop Trauma Surg 2021; 141:1361-1372. [PMID: 33512583 PMCID: PMC8295078 DOI: 10.1007/s00402-021-03790-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 01/11/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Since the optimal surgery for isolated medial knee osteoarthritis (OA) is unclear, this study aimed at comparing the effectiveness of unicondylar knee replacement (UKR) with total knee replacement (TKR) for simple medial knee OA. METHODS Literature searches of PubMed, Embase, Web of Science, and the Cochrane Library were searched up to 1th April 2020. Only studies comparing UKR with TKR for isolated medial knee OA were included. Data collection and extraction, quality assessment, and data analyses were performed according to the Cochrane standards. RESULTS A total of 13 articles with 1888 patients were included, among which, 944 and 944 underwent UKR and TKR, respectively. The analyzed postoperative outcomes were mostly within 5 years of follow-up. The meta-analysis showed that UKR improved knee general function (P < 0.00001) and health (P = 0.02), moreover, reduced post-operative pain (P = 0.01) and complications (P < 0.05) more than TKR. There were no significant differences in postoperative revision (P = 0.252), high-activity arthroplasty score (HAAS) (P = 0.307) and Oxford knee score (OKS) (P = 0.15) between the two techniques. CONCLUSIONS The patients of UKR could achieve better clinical results than that of TKR, moreover, there were negligible differences between the two techniques in postoperative revision in the early and mid-term follow-up and surgeons should be aware of the important reasons for revision of UKR. Thus, UKR instead of TKR should be performed in patients with late-stage isolated medial knee OA.
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Affiliation(s)
- Meichao Deng
- The Department of Orthopedic Surgery, Yongchuan Hospital, Chongqing Medical University, 439 Xuanhua Road, Yongchuan, Chongqing, China
| | - Yang Hu
- The Department of Orthopedic Surgery, Yongchuan Hospital, Chongqing Medical University, 439 Xuanhua Road, Yongchuan, Chongqing, China
| | - Zhongzu Zhang
- The Department of Orthopedic Surgery, Yongchuan Hospital, Chongqing Medical University, 439 Xuanhua Road, Yongchuan, Chongqing, China
| | - Hongjun Zhang
- The Department of Orthopedic Surgery, Yongchuan Hospital, Chongqing Medical University, 439 Xuanhua Road, Yongchuan, Chongqing, China
| | - Yiming Qu
- The Department of Orthopedic Surgery, Yongchuan Hospital, Chongqing Medical University, 439 Xuanhua Road, Yongchuan, Chongqing, China
| | - Gaohai Shao
- The Department of Orthopedic Surgery, Yongchuan Hospital, Chongqing Medical University, 439 Xuanhua Road, Yongchuan, Chongqing, China.
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Goh GS, Zeng GJ, Chen JY, Lo NN, Yeo SJ, Liow MHL. Ten-Year Results of Unicompartmental Knee Arthroplasty in Patients With Psychological Distress. J Arthroplasty 2020; 35:2830-2836.e1. [PMID: 32475784 DOI: 10.1016/j.arth.2020.05.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 04/18/2020] [Accepted: 05/04/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Although the influence of psychological distress on the outcomes of total knee arthroplasty has been described extensively, its effect on unicompartmental knee arthroplasty (UKA) is poorly defined. Furthermore, most studies in arthroplasty literature had short follow-ups of ≤1 year. We investigated the influence of psychological distress on long-term patient-reported outcomes and analyzed the change in mental health after UKA in a cohort with minimum 10 years of follow-up. METHODS Prospectively collected data of 269 patients undergoing UKA in 2004-2007 were reviewed. Patients were stratified into those with psychological distress (36-item Short-Form health survey [SF-36] Mental Component Summary [MCS] <50, n = 111) and those without (SF-36 MCS ≥50, n = 158). Clinical outcomes were obtained preoperatively, at 2 years, and 10 years. Multiple regression was used to control for age, gender, body mass index, Charlson Comorbidity Index, American Society of Anesthesiologists class, and baseline scores. The rate of expectation fulfillment and satisfaction was compared. RESULTS Psychologically distressed patients had poorer Knee Society Knee Score, Function Score, Oxford Knee Score, and SF-36 Physical Component Summary preoperatively, at 2 years, and 10 years. However, an equal proportion in each group attained the minimal clinically important difference for each score. Distressed patients had a comparable rate of satisfaction (91% vs 95%, P = .136) but lower fulfillment of expectations (89% vs 95%, P = .048). The percentage of distressed patients declined from 41% to 35% at follow-up. The mean SF-36 MCS improved by 6.9 points. CONCLUSION Although psychologically distressed patients had relatively greater pain and poorer function preoperatively and up to 10 years after UKA, a similar proportion of them experienced a clinically meaningful improvement in patient-reported outcomes.
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Affiliation(s)
- Graham S Goh
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Gerald J Zeng
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Jerry Y Chen
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Ngai-Nung Lo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Seng-Jin Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
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Sun XW, Lu FF, Zou K, Hong M, Zhang QD, Guo WS. Does new instrument for Oxford unicompartmental knee arthroplasty improve short-term clinical outcome and component alignment? A meta-analysis. J Orthop Surg Res 2020; 15:386. [PMID: 32894147 PMCID: PMC7487934 DOI: 10.1186/s13018-020-01926-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 08/24/2020] [Indexed: 11/10/2022] Open
Abstract
Background The Microplasty (MP) instrumentation designed for the Phase III Oxford mobile-bearing unicompartmental knee arthroplasty (UKA) system is considered a better option to achieve more accurate component positioning and alignment. In the present study, we focused on short-term clinical and radiological outcomes to determine whether the MP instrumentation can reduce the short-term revision rate and occurrence of outliers of metallic components. Methods The literature in PubMed, Embase, the Cochrane Library, and Web of Science was searched up to May 2020. Studies were scrutinized by two independent authors, and the revision rate, complication spectrum, and radiological assessment with outlier rates were specifically analyzed. RevMan 5.3 was used for the statistical analysis. Results Seven studies were included in the meta-analysis. Four studies reported both clinical and radiological outcomes, two reported only radiological outcomes, and one reported only clinical outcomes. The pooled analysis showed that the revision rate in the MP instrumentation group was 0.866 per 100 component years, while that in the control group was 1.124 (odds ratio, 0.77; p < 0.05). The subgroup analysis of the bearing dislocation rate showed a significantly greater reduction in the Korean population than in the populations of other countries (p < 0.05). The radiological assessment showed that the alignment of the femoral component was significantly improved (p < 0.05), while that of the tibial component was not (p > 0.05). Conclusion The newly developed MP instrumentation for Oxford UKA significantly reduced the revision rate of this treatment. The positioning of the femoral component was also proven to be better by radiological assessments.
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Affiliation(s)
- Xiao Wei 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
| | - Fei Fan Lu
- China-Japan Friendship School of Clinical Medicine, Peking University, Beijing, China
| | - Kun Zou
- Beijing University of Chinese Medicine, Beijing, China
| | - Mao Hong
- Beijing University of Chinese Medicine, Beijing, China
| | - Qi Dong Zhang
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, No. 2 Yinghuadong Road, Chaoyang District, Beijing, 100029, China
| | - Wan Shou 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.
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Houskamp DJ, Tompane T, Barlow BT. What Is the Critical Tibial Resection Depth During Unicompartmental Knee Arthroplasty? A Biomechanical Study of Fracture Risk. J Arthroplasty 2020; 35:2244-2248. [PMID: 32362480 DOI: 10.1016/j.arth.2020.04.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 03/26/2020] [Accepted: 04/02/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Fracture after medial unicompartmental knee arthroplasty (UKA) is a rare complication. Biomechanical studies evaluating association between depth of resection and maximum load to failure are lacking. The purpose of this study is to establish the relationship between depth of resection of the medial tibial plateau and mean maximum load to failure. METHODS Medial tibial resections were performed from 2 to 10 mm in 25 standardized fourth-generation Sawbones composite tibias (Sawbones, Vashon Island, Washington). A metal-backed tibial component with a 9-mm polyethylene bearing was used (Stryker PKR). Tibias were mounted on a biomechanical testing apparatus (MTESTQuattro) and axially loaded cyclically 10 times per cycle and incrementally increased until failure occurred. RESULTS Load to failure was recorded in 25 proximal tibia model samples after medial UKA using sequential resections from 2 to 10 mm. Analysis of variance testing identified significant differences in mean maximum load to failure between groups (P = .0003). Analysis of regression models revealed a statistically significant fit of a quadratic model (R2 = 0.59, P = .0001). The inflection point of this quadratic curve was identified at 5.82 mm, indicating that the maximum load to failure across experimental models in this study began to decline beyond a resection depth of 5.82 mm. CONCLUSION In this biomechanical model, medial tibial resections beyond 5.82 mm produced a significantly lower mean load to failure using a quadratic curve model. Resections from 2 to 6 mm showed no significant differences in mean load to failure. Identification of the tibial resection depth at which the mean load to failure significantly decreases is clinically relevant as this depth may increase the risk of periprosthetic fracture after a medial UKA.
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Lu Y, Cregar WM, Goodloe JB, Khazi Z, Forsythe B, Gerlinger TL. General Anesthesia Leads to Increased Adverse Events Compared With Spinal Anesthesia in Patients Undergoing Unicompartmental Knee Arthroplasty. J Arthroplasty 2020; 35:2002-2008. [PMID: 32247674 DOI: 10.1016/j.arth.2020.03.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 02/21/2020] [Accepted: 03/05/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The volume of unicompartmental knee arthroplasty (UKA) has increased dramatically in recent years with good reported long-term outcomes. UKA can be performed under general or neuraxial (ie, spinal) anesthesia; however, little is known as to whether there is a difference in outcomes based on anesthesia type. The purpose of the present study is to compare perioperative outcomes between anesthesia types for patients undergoing primary elective UKA. METHODS Patients who underwent primary elective UKA from 2007 to 2017 were identified from the American College of Surgeons-National Surgical Quality Improvement Program Database. Operating room times, length of stay (LOS), 30-day adverse events, and readmission rates were compared between patients who received general anesthesia and those who received spinal anesthesia. Propensity-adjusted multivariate analysis was used to control for selection bias and baseline patient characteristics. RESULTS A total of 8639 patients underwent UKA and met the inclusion criteria for this study. Of these, 4728 patients (54.7%) received general anesthesia and 3911 patients (45.3%) received spinal anesthesia. On propensity-adjusted multivariate analyses, general anesthesia was associated with increased operative time (P < .001) and the occurrence of any severe adverse event (odds ratio [OR], 1.39; 95% confidence interval [95% CI], 1.04-1.84; P = .024). In addition, general anesthesia was associated with higher rates of deep venous thrombosis (OR, 2.26; 95% CI, 1.11-4.6; P = .024) and superficial surgical site infection (OR, 1.04; 95% CI, 0.6-1.81; P < .001). Finally, general anesthesia was also associated with a reduced likelihood of discharge to home (OR, 0.72; 95% CI, 0.59-0.88; P < .001). No difference existed in postoperative hospital LOS or readmission rates among cohorts. CONCLUSION General anesthesia was associated with an increased rate of adverse events and increased operating room times as well as a reduced likelihood of discharge to home. There was no difference in hospital LOS or postoperative readmission rates between anesthesia types.
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Affiliation(s)
- Yining Lu
- Division of Orthopaedics, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL
| | - William M Cregar
- Division of Orthopaedics, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL
| | - J Brett Goodloe
- Department of Orthopaedic Surgery and Physical Rehabilitation, Medical University of South Carolina, Charleston, SC
| | - Zain Khazi
- Department of Orthopaedic Surgery and Rehabilitation, Iowa University Hospitals and Clinics, Iowa City, IA
| | - Brian Forsythe
- Division of Orthopaedics, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL
| | - Tad L Gerlinger
- Division of Orthopaedics, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL
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Deng M, Hu Y, Zhang Z, Zhang H, Qu Y, Shao G. WITHDRAWN: Unicondylar knee replacement versus total knee replacement for the treatment of medial knee osteoarthritis: A systematic review and meta-analysis. J Orthop 2020. [DOI: 10.1016/j.jor.2020.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Chalmers BP, Kapadia M, Chiu YF, Henry MW, Miller AO, Carli AV. Treatment and Outcome of Periprosthetic Joint Infection in Unicompartmental Knee Arthroplasty. J Arthroplasty 2020; 35:1917-1923. [PMID: 32173618 DOI: 10.1016/j.arth.2020.02.036] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 02/05/2020] [Accepted: 02/17/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Periprosthetic joint infection (PJI) after unicompartmental knee arthroplasty (UKA) is a devastating but poorly understood complication, with a paucity of published data regarding treatment and outcomes. This study analyzes the largest cohort of UKA PJIs to date comparing treatment outcome, septic and aseptic reoperation rates, and risk factors for treatment failure. METHODS Twenty-one UKAs in 21 patients treated for PJI, as defined by Musculoskeletal Infection Society criteria, were retrospectively reviewed. Minimum and mean follow-up was 1 and 3.5 years, respectively. Fourteen (67%) patients had acute postoperative PJIs. Surgical treatment included 16 debridement, antibiotics, and implant retentions (DAIRs) (76%), 4 two-stage revisions (19%), and 1 one-stage revision (5%). Twenty (95%) PJIs were culture positive with Staphylococcus species identified in 15 cases (71%). RESULTS Survivorship free from reoperation for infection at 1 year was 76% (95% confidence interval, 58%-93%). Overall survival from all-cause reoperation was 57% (95% confidence interval, 27%-87%) at 5 years. Two additional patients (10%) underwent aseptic revision total knee arthroplasty for lateral compartment degeneration 1 year after DAIR and tibial aseptic loosening 2.5 years after 2-stage revision. All patients who initially failed PJI UKA treatment presented with acute postoperative PJIs (5 of 14; 36%). CONCLUSION Survivorship free from persistent PJI at 1 year is low at 76% but is consistent with similar reports of DAIRs for total knee arthroplasties. Furthermore, there is low survivorship free from all-cause reoperation of 71% and 57% at 2 and 5 years, respectively. Surgeons should be aware of these poorer outcomes and consider treating UKA PJI early and aggressively.
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Affiliation(s)
- Brian P Chalmers
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY
| | - Milan Kapadia
- Department of Medicine, Infectious Disease, Hospital for Special Surgery, New York, NY
| | - Yu-Fen Chiu
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY
| | - Michael W Henry
- Department of Medicine, Infectious Disease, Hospital for Special Surgery, New York, NY
| | - Andy O Miller
- Department of Medicine, Infectious Disease, Hospital for Special Surgery, New York, NY
| | - Alberto V Carli
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY
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Bosch LC, Bala A, Denduluri SK, Maloney WJ, Huddleston JI, Goodman SB, Amanatullah DF. Reimbursement and Complications in Outpatient vs Inpatient Unicompartmental Arthroplasty. J Arthroplasty 2020; 35:S86-S91. [PMID: 32220483 DOI: 10.1016/j.arth.2020.02.063] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 02/26/2020] [Accepted: 02/26/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Increasing utilization of unicompartmental knee arthroplasty (UKA) has driven a greater push for outpatient treatment and cost containment in the setting of bundled payments. The purpose of this study is to evaluate utilization trends of inpatient vs outpatient UKA, index episode and 90-day reimbursement, and any differences in medical or surgical complications. METHODS The PearlDiver database was employed to identify all inpatient and outpatient UKAs performed between 2007 and 2016 with 2-year follow-up. Patients were matched by age, gender, and Elixhauser Comorbidity Index. We tracked index procedure and global period reimbursement, 90-day medical and surgical complications, and 2-year surgical complications. RESULTS The reimbursement and utilization cohort included 3181 outpatient and 5490 inpatient UKAs. Outpatient UKA and overall utilization of UKA increased over the study period. Mean index reimbursement of inpatient UKA was $2486.16 higher per procedure (P < .001) while mean global period reimbursement was $2782.13 higher per inpatient procedure (P < .001). Ninety-day medical complications including postoperative anemia (P < .001), transfusion (P = .024), and arrhythmia (P = .004) were more common with inpatient UKAs, whereas surgical wound complications (P = .001) and operative debridement (P = .028) were more common among outpatient UKAs. Outpatient UKA was not associated with an increased risk of periprosthetic joint infection (P > .05), aseptic loosening (P > .05), or revision surgery (P > .05) when compared to inpatient UKA. CONCLUSION Outpatient UKA utilization is increasing and is associated with decreased reimbursement compared to inpatient UKA without increased risk of major medical complications, although it is associated with increased risk of wound complication and need for operative debridement at 90 days.
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Affiliation(s)
- Liam C Bosch
- Department of Orthopaedic Surgery, Stanford Hospital and Clinics, Stanford, CA
| | - Abiram Bala
- Department of Orthopaedic Surgery, Stanford Hospital and Clinics, Stanford, CA
| | - Sahitya K Denduluri
- Department of Orthopaedic Surgery, Stanford Hospital and Clinics, Stanford, CA
| | - William J Maloney
- Department of Orthopaedic Surgery, Stanford Hospital and Clinics, Stanford, CA
| | - James I Huddleston
- Department of Orthopaedic Surgery, Stanford Hospital and Clinics, Stanford, CA
| | - Stuart B Goodman
- Department of Orthopaedic Surgery, Stanford Hospital and Clinics, Stanford, CA
| | - Derek F Amanatullah
- Department of Orthopaedic Surgery, Stanford Hospital and Clinics, Stanford, CA
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