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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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Bougaud E, Canovas F, Hamoui M, Dagneaux L. Combined structural allograft and tantalum cone to manage segmental metaphyseal tibial bone defect in revision knee arthroplasty. Orthop Traumatol Surg Res 2023; 109:103606. [PMID: 36963661 DOI: 10.1016/j.otsr.2023.103606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 01/20/2023] [Accepted: 02/06/2023] [Indexed: 03/26/2023]
Abstract
Tibial bone defect remains a challenge in revision knee arthroplasty. The present innovative technique combines structural allograft and tantalum metaphyseal cone for treatment of AORI stage 2A and 2B (uncontained peripheral metaphyseal) tibial defect. The aim is to reconstitute bone stock and enhance allograft osseointegration, while limiting stress to the allograft by implanting the metaphyseal cone through the allograft and the original bone. LEVEL OF EVIDENCE: V (expert opinion).
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Affiliation(s)
- Elias Bougaud
- Department of Orthopaedic Surgery, Lower Limb Surgery Unit, Lapeyronie University Hospital, Montpellier University, 371, avenue Gaston-Giraud, 34295 Montpellier cedex 05, France.
| | - François Canovas
- Department of Orthopaedic Surgery, Lower Limb Surgery Unit, Lapeyronie University Hospital, Montpellier University, 371, avenue Gaston-Giraud, 34295 Montpellier cedex 05, France.
| | - Mazen Hamoui
- Department of Orthopaedic Surgery, Lower Limb Surgery Unit, Lapeyronie University Hospital, Montpellier University, 371, avenue Gaston-Giraud, 34295 Montpellier cedex 05, France.
| | - Louis Dagneaux
- Department of Orthopaedic Surgery, Lower Limb Surgery Unit, Lapeyronie University Hospital, Montpellier University, 371, avenue Gaston-Giraud, 34295 Montpellier cedex 05, France.
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Liebensteiner MC, Ruzicka A, Hinz M, Leitner H, Harrasser A, Dammerer D, Krismer M. The clinical outcome of total knee arthroplasty is compromised by a previously implanted medial unicondylar knee arthroplasty. Arch Orthop Trauma Surg 2023; 143:4331-4337. [PMID: 36933071 PMCID: PMC10293435 DOI: 10.1007/s00402-023-04829-7] [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: 11/30/2021] [Accepted: 02/28/2023] [Indexed: 03/19/2023]
Abstract
OBJECTIVE To investigate the clinical outcome of patients that underwent conversion of a medial unicondylar knee arthroplasty (UKA) to a total knee arthroplasty (TKA) and to compare that outcome to patients that underwent primary TKA. It was hypothesized that those groups would significantly differ in terms of knee score outcome and implant survival. METHODS A retrospective-comparative study was conducted utilizing data from the Federal state's arthroplasty registry. Included were patients from our department that undergone a conversion of a medial UKA to a TKA (UKA-TKA group). The Western Ontario and MacMaster Universities Osteoarthritis Index (WOMAC) from preoperative and 1-year postoperative was used. Moreover, the implant survival was analyzed. RESULTS In the UKA-TKA group, there were 51 cases (age 67 ± 10, 74% women), and in the TKA group, there were 2247 cases (age 69 ± 9, 66% women). The one-year postoperative WOMAC total score was 33 in the UKA-TKA group und 21 in the TKA group (p < 0.001). Similarly, the WOMAC pain, WOMAC stiffness, and WOMAC function scores were significantly worse in the UKA-TKA. After 5 years, the survival rates were 82% and 95% (p = 0.001). The 10-years prosthesis survival was 74% and 91% in the UKA-TKA and TKA groups, respectively (p < 0.001). CONCLUSIONS Based on our findings it is concluded that patients who received a TKA after UKA have inferior results than those that directly receive a TKA. This is true for both patient-reported knee outcome and prosthesis survival. Converting UKA to TKA should not be seen as an easy operation, but should rather be done by surgeons with considerable experience in both primary and revision knee arthroplasty.
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Affiliation(s)
- M C Liebensteiner
- Department for Orthopaedic Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - A Ruzicka
- Department for Orthopaedic Surgery, Medical University Innsbruck, Innsbruck, Austria.
| | - M Hinz
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - H Leitner
- Department of Clinical Epidemiology, Tyrolean Federal Institute for Integrated Care, Tirol Kliniken GmbH, Innsbruck, Austria
| | - A Harrasser
- Department of Clinical Epidemiology, Tyrolean Federal Institute for Integrated Care, Tirol Kliniken GmbH, Innsbruck, Austria
| | - D Dammerer
- Department of Orthopaedics and Traumatology, University Hospital Krems, Krems, Austria
| | - M Krismer
- Department for Orthopaedic Surgery, Medical University Innsbruck, Innsbruck, Austria
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Byttebier P, Dhont T, Pintelon S, Rajgopal A, Burssens A, Victor J. Comparison of Different Strategies in Revision Arthroplasty of the Knee with Severe Bone Loss: A Systematic Review and Meta-Analysis of Clinical Outcomes. J Arthroplasty 2022; 37:S371-S381.e4. [PMID: 35271982 DOI: 10.1016/j.arth.2022.02.103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND In revision total knee arthroplasty large bone lesions can jeopardize correct implant orientation and fixation. Different strategies have been proposed to tackle this issue. The purpose of this review and meta-analysis is to evaluate the midterm clinical and survivorship results of porous cones and porous-coated sleeves compared to morselized and structural grafts. METHODS We performed a systematic review of the literature on the different strategies targeting moderate to large metaphyseal bone defects. The literature was evaluated for methodological quality. We analyzed results on survivorship using logistic regression correcting for follow-up time and number of knees. We compared these results using forest plots for early and midterm follow-up. Clinical outcome was evaluated by comparing standardized mean difference of patient-related outcome measures. RESULTS A total of 77 articles analyzing 4,391 knees were included. The logistic regression curve showed a nonsignificant odds ratio (OR) at 10 years of 0.91 (95% confidence interval [CI] 0.699-1.192, P = .49) for failure comparing all porous implants with all grafting procedures. The available clinical reports show a bigger standardized mean difference increase for tantalum cones (OR 3.04, 95% CI 1.71-4.37) than for porous sleeves (OR 1.72, 95% CI 0.88-2.57). CONCLUSION Our analysis shows that the size and quality of the literature on metaphyseal bone defects is progressively improving. Porous implants are effective in tackling metaphyseal bone defects showing good survivorship outcome at midterm follow-up. In younger patients with less constrained prosthetic implants, surgeons might still consider the use of grafts without risking worse outcomes.
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Affiliation(s)
- Paul Byttebier
- Department of Orthopaedics and Trauma Surgery, UZ Gent, Medical University of Ghent, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Thibaut Dhont
- Department of Orthopaedics and Trauma Surgery, UZ Gent, Medical University of Ghent, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Sam Pintelon
- Department of Orthopaedics and Trauma Surgery, UZ Gent, Medical University of Ghent, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Ashok Rajgopal
- Institute of Musculoskeletal Disorders and Orthopaedics, Medanta- The Medicity Hospital Gurugram, Haryana, India
| | - Arne Burssens
- Department of Orthopaedics and Trauma Surgery, UZ Gent, Medical University of Ghent, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Jan Victor
- Department of Orthopaedics and Trauma Surgery, UZ Gent, Medical University of Ghent, Corneel Heymanslaan 10, 9000 Ghent, Belgium
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Suwankomonkul P, Arirachakaran A, Kongtharvonskul J. Short-term improvement of patellofemoral pain in medial unicompartmental knee arthroplasty with patellar denervation: a prospective comparative study. Musculoskelet Surg 2020; 106:75-82. [PMID: 32743756 DOI: 10.1007/s12306-020-00675-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 07/25/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Medial osteoarthritis (OA) knees with symptomatic patellofemoral (PF) arthritis were not recommended for UKA in the past. However, UKA has shown good clinical results in patients with medial OA knee with symptomatic PF arthritis. On the contrary, this procedure is not recommended for patients with severe PF OA. Patella denervation (PD) by circumferential electrocautery can reduce the severity and incidence of anterior knee pain in TKA. However, to the best of our knowledge, there are no studies reporting anterior knee pain and complications of medial UKA with PD in severe PF OA. OBJECTIVE We have conducted a prospective comparative study to assess the short-term results of anterior knee pain and complications after medial UKA with PD or without PD in medial compartment arthritis and severe PF arthritis patients. MATERIAL AND METHODS This prospective comparative study was conducted from January 2018-September 2019 at Pranungkaew Hospital, Nonthaburi, Thailand. A total of 66 patients with medial compartment and severe patellofemoral arthritis were allocated to UKA with or without patella denervation. The primary outcomes were Kujala anterior knee pain scale and complications measured at 6 months after the surgery. RESULTS Sixty-six patients (37 patients undergoing UKA with PD and 27 patients undergoing UKA without PD) of medial compartment and severe lateral facet patellofemoral arthritis (62 female, 4 male; mean age 60.16 (5.03) years; 17 PF grade III, 49 PF grade IV) were included in this study. The mean preoperative Kujala scores were 54.96 (range 30-80) (SD 2.59) in the no-PD group (group I) and 47.77 (range 27-75) (1.62) in the PD group (group II), respectively (p value = 0.009). All baseline characteristics were also comparable between treatment groups except the preoperative Kujala score. The mean final value of Kujala score was 70.22 (range 50-96) (2.40) in the no-PD group (group I) and 80.10 (range 60-95) (SD 1.50) in the PD group (group II), respectively (p value < 0.001). The mean difference of Kujala score was statistically significantly higher by 9.88 (4.48, 15.28) points in the PD group when compared to the no-PD group. There were no complications in both groups after surgery. CONCLUSIONS Patellar denervation seems to provide short-term benefits improving the Kujala score in patients with PF OA undergoing UKA. LEVEL OF EVIDENCE III. Trial Registration ClinicalTrials.gov: NCT03676179.
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Affiliation(s)
- P Suwankomonkul
- Orthopedics Department, Pranungkraw General Hospital, Nonthaburi, Thailand
| | - A Arirachakaran
- Orthopedics Department, Bumrungrad International Hospital, Bangkok, Thailand
| | - J Kongtharvonskul
- Orthopedic Department, Payathai 3 Hospital, Bangkok, Thailand.
- Department for Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Bangkok, Thailand.
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Lo Presti M, Costa GG, Grassi A, Agrò G, Cialdella S, Vasco C, Neri MP, Cucurnia I, Zaffagnini S. Bearing thickness of unicompartmental knee arthroplasty is a reliable predictor of tibial bone loss during revision to total knee arthroplasty. Orthop Traumatol Surg Res 2020; 106:429-434. [PMID: 32253136 DOI: 10.1016/j.otsr.2019.12.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 12/09/2019] [Accepted: 12/17/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND Bone defects during revision procedures for failed UKA represent a challenge even for the most experienced surgeons; therefore, an accurate preoperative planning remains essential to prevent dramatic scenarios in the surgical theatre. HYPOTHESIS Our hypothesis is that bearing thickness used in original UKA represents a reliable predictor of severe tibial bone loss, requiring a metallic augment or constrained implant, during revision to TKA. PATIENTS AND METHODS Forty-two patients who underwent a total knee arthroplasty from failed UKA were identified from our institutional database and evaluated clinically using the Knee Society Score (KSS). A multivariate logistic regression analysis was performed using the presence of tibial augments or the need of varus-valgus constrained (VVC) prosthesis as depend variables, and patients' gender, age at revision procedure, side (medial or lateral), UKA tibial tray (all-polyethylene or metal back), bearing thickness (composite thicknesses of the metal-backed tray and insert or all-polyethylene tibial component ≤8mm or more than 8mm) and cause of failed UKA as independent variables. RESULTS A posterior-stabilized prosthesis was used in 27 cases (64.3%). An augment was necessary in 12 patients (28.6%). Initial bearing thickness greater than 8mm was associated with greater likelihood of a VVC implant (OR=11.78, 95% CI, 1.6583 to 83.6484, p=0.0137) and a tibial augment (OR=9.59, 95% CI, 1.327 to 69.395, p=0.0251). Tibial tray design, patients' gender or age during revision surgery, side or cause of failure were not associated to increased risk of augmentation or constrained implants. DISCUSSION Surgeons should be aware of the particular challenges that the conversion of a UKA to a TKA presents and be prepared to address them intraoperatively, with particular care to proper bone loss manage. Satisfying results can be achieved at mid-to-long term follow-up, if these procedures are planned accurately, and a precise analysis of failed UKA components, in particular bearing thickness, represents a helpful support in this context. LEVEL OF EVIDENCE IV, retrospective case series.
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Affiliation(s)
- Mirco Lo Presti
- II Orthopaedic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano n. 1/10, 40136, Bologna, Italy
| | - Giuseppe Gianluca Costa
- II Orthopaedic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano n. 1/10, 40136, Bologna, Italy.
| | - Alberto Grassi
- II Orthopaedic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano n. 1/10, 40136, Bologna, Italy
| | - Giuseppe Agrò
- II Orthopaedic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano n. 1/10, 40136, Bologna, Italy
| | - Sergio Cialdella
- II Orthopaedic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano n. 1/10, 40136, Bologna, Italy
| | - Cosimo Vasco
- II Orthopaedic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano n. 1/10, 40136, Bologna, Italy
| | - Maria Pia Neri
- II Orthopaedic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano n. 1/10, 40136, Bologna, Italy
| | - Ilaria Cucurnia
- II Orthopaedic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano n. 1/10, 40136, Bologna, Italy
| | - Stefano Zaffagnini
- II Orthopaedic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano n. 1/10, 40136, Bologna, Italy
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Abstract
Supplemental Digital Content is available in the text Background: Previously, the authors modified the surgical technique to preserve tibial bone mass for Oxford unicompartmental knee arthroplasty (UKA). The purpose of this study was to determine the clinical outcomes and values of this modified technique. Methods: Clinical data of 34 consecutive patients who underwent the unilateral modified UKA technique (modified group, 34 knees) were retrospectively analyzed. To compare the outcome, a match-paired control group (conventional group, 34 knees) of an equal number of patients using the conventional technique system in the same period were selected and matched with respect to diagnosis, age, pre-operative range of motion (ROM), and radiological grade of knee arthrosis. Clinical outcomes including knee Hospital for Special Surgery (HSS) score, ROM, and complications were compared between the two groups. Post-operative radiographic assessments included hip-knee-ankle angle (HKA), joint line change, implant position, and alignment. Results: The mean follow-up time was 38.2 ± 6.3 months. There was no difference in baseline between the two groups. The amount of proximal tibial bone cut in the modified group was significantly less than that of the conventional group (4.7 ± 1.1 mm vs. 6.7 ± 1.3 mm, t = 6.45, P < 0.001). Joint line was elevated by 2.1 ± 1.0 mm in the modified group compared with –0.5 ± 1.7 mm in the conventional group (t = –7.46, P < 0.001). No significant differences were observed between the two groups after UKA with respect to HSS score, VAS score, ROM, and HKA. Additionally, the accuracy of the post-operative implant position and alignment was similar in both groups. As for implant size, the tibial implant size in the modified group was larger than that in the conventional group (χ2 = 4.95, P = 0.035). Conclusions: The modified technique for tibial bone sparing was comparable with the conventional technique in terms of clinical outcomes and radiographic assessments. It can preserve tibial bone mass and achieve a larger cement surface on the tibial side.
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Scheele CB, Pietschmann MF, Schröder C, Lenze F, Grupp TM, Müller PE. Effect of bone density and cement morphology on biomechanical stability of tibial unicompartmental knee arthroplasty. Knee 2020; 27:587-597. [PMID: 32024609 DOI: 10.1016/j.knee.2020.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 10/08/2019] [Accepted: 01/21/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Unicompartmental knee arthroplasty (UKA) offers good long-term survivorship and superior kinematics and function compared with total knee arthroplasty (TKA). However, revision rates are higher with aseptic loosening representing a major cause. Biomechanical stability depends on cement penetration. The goal of this study was to analyze the influence of cement morphology and bone density on primary stability of tibial UKA under physiological loading conditions in human tibiae. METHODS Thirty-six tibial trays were implanted in fresh-frozen human cadaver knees and tested for primary stability using dynamic compression-shear testing. Prior to implantation, bone density had been quantified for all 18 tibiae. Postoperatively, cement penetration has been assessed on frontal cuts based on eight predefined parameters. The influence of bone density and cement morphology on biomechanical stability was determined using correlation and linear regression analysis. RESULTS Mean failure load was 2691 ± 832.9 N, mean total cement thickness was 2.04 ± 0.37 mm, mean cement penetration was 1.54 ± 0.33 mm and mean trabecular bone mineral density (BMD) was 107.1 ± 29.3 mg/ml. There was no significant correlation between failure load and cement morphology (P > .05). Failure load was significantly positive correlated with trabecular BMD (r = 0.843; P < .0001) and cortical BMD (r = 0.432; P = .0136). CONCLUSIONS Simulating physiological loading conditions, the failure load of tibial UKA is linearly dependent on the trabecular BMD. The observed parameters of cementation morphology seem capable of preventing failure at the bone-cement interface before inherent bone stability is reached. Further research is required to assess the usefulness of a preoperative assessment of bone quality for patient selection in UKA.
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Affiliation(s)
- Christian B Scheele
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Munich, Germany; Technical University Munich, Klinikum rechts der Isar, Department of Orthopedics and Sports Orthopedics, Munich, Germany.
| | - Matthias F Pietschmann
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Munich, Germany
| | - Christian Schröder
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Munich, Germany
| | - Florian Lenze
- Technical University Munich, Klinikum rechts der Isar, Department of Orthopedics and Sports Orthopedics, Munich, Germany
| | - Thomas M Grupp
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Munich, Germany; Aesculap AG Research & Development, Tuttlingen, Germany
| | - Peter E Müller
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Munich, Germany
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Deroche E, Batailler C, Lording T, Neyret P, Servien E, Lustig S. High Survival Rate and Very Low Wear of Lateral Unicompartmental Arthroplasty at Long Term: A Case Series of 54 Cases at a Mean Follow-Up of 17 Years. J Arthroplasty 2019; 34:1097-1104. [PMID: 30777626 DOI: 10.1016/j.arth.2019.01.053] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 12/23/2018] [Accepted: 01/22/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Survivorship of lateral unicompartmental knee arthroplasty (UKA) has progressively improved. However, there are few studies describing long-term results, and no study reports on polyethylene (PE) wear in lateral unicompartmental arthroplasty. The aims of this study are to determine the survival rate of lateral UKA with a fixed, all-PE bearing, and the PE wear of the tibial implant at a minimum of 15 years follow-up. METHODS From January 1988 to October 2003, we performed 54 lateral UKAs in 52 patients. All patients had isolated lateral osteoarthritis (OA). The mean age at the index procedure was 65.4 ± 11 years. Thirty-nine UKAs were available for follow-up (30 alive and 9 dead after 15 years). Twelve patients had died before 15 years and 3 patients were lost to follow-up. The mean follow-up was 17.9 years (range, 15-23 years). RESULTS At the final follow-up, 8 knees of 39 (20.5%) had a surgical revision. The cumulative survival rate was 82.1% at 15 years and 79.4% at 20 years. The main reason of revision was progression of OA (87.5%), followed by aseptic loosening of the tibial component (12.5%). With a mean follow-up of 17.9 years, the mean PE wear was 0.061 mm/y. There was no radiographic loosening in the surviving implants and no revisions for wear. The mean functional International Knee Society score was 66.5 ± 26.8, with a mean objective score of 84.4 points ± 13.2. In the population without revision, 90.5% were satisfied or very satisfied at the latest follow-up. CONCLUSION Lateral UKA with a fixed, all-PE tibial bearing and a femoral resurfacing implant presents a high survivorship at long term, with very low PE wear.
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Affiliation(s)
- Etienne Deroche
- Orthopedic Surgery Department, Croix-Rousse Hospital, Lyon, France
| | - Cécile Batailler
- Orthopedic Surgery Department, Croix-Rousse Hospital, Lyon, France
| | | | - Philippe Neyret
- Orthopedic Surgery Department, Croix-Rousse Hospital, Lyon, France
| | - Elvire Servien
- Orthopedic Surgery Department, Croix-Rousse Hospital, Lyon, France
| | - Sébastien Lustig
- Orthopedic Surgery Department, Croix-Rousse Hospital, Lyon, France
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Jonas SC, Jermin P, Howells N, Porteous A, Murray J, Robinson J. Outcome of revision UKR to TKR when compared to a matched group of TKR of same total arthroplasty lifespan. Knee 2019; 26:400-404. [PMID: 30792107 DOI: 10.1016/j.knee.2018.12.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 11/04/2018] [Accepted: 12/14/2018] [Indexed: 02/02/2023]
Abstract
AIM To compare outcomes of revision uni-compartmental knee replacement (UKR) with a defined revision cause with a matched group of primary total knee replacements (TKR). BACKGROUND UKR accounts for 8.7% of knee arthroplasty in the UK each year. It has better functional outcome than total knee replacement for isolated single compartment arthritis but can result in complex surgery when revision is required. This is feared to result in poorer patient reported outcomes when compared to primary TKR. We aim to compare the clinical results of revised UKR with primary TKR, taking into account the survival length of the UKR. PATIENTS AND METHODS Forty-five patients (27 female) were retrospectively identified from our arthroplasty database that had undergone revision from UKR to TKR (1999-2014) and had a minimum of two years of follow-up post-revision. These patients were then matched with regards to age at primary procedure, sex, BMI and total arthroplasty life (UKR + Revision TKR) up to point of follow-up. RESULTS In the UKR revision group (mean arthroplasty life 8.6 years) the mean Oxford knee score (OKS) was 31.8. In the primary knee group (mean arthroplasty life 8.4 years) the mean OKS was 32.8. This difference was not statistically significant. Fifteen out of 45 patients undergoing revision surgery required stemmed components. CONCLUSION UKR provides comparable clinical outcome even after revision surgery to TKR as primary TKRs and should be considered in all patients meeting the selection criteria. Revision is complex and revision components should be available.
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Affiliation(s)
- Sam C Jonas
- Avon Orthopaedic Centre, United Kingdom of Great Britain and Northern Ireland.
| | - Paul Jermin
- Avon Orthopaedic Centre, United Kingdom of Great Britain and Northern Ireland
| | - Nick Howells
- Avon Orthopaedic Centre, United Kingdom of Great Britain and Northern Ireland
| | - Andrew Porteous
- Avon Orthopaedic Centre, United Kingdom of Great Britain and Northern Ireland
| | - James Murray
- Avon Orthopaedic Centre, United Kingdom of Great Britain and Northern Ireland
| | - James Robinson
- Avon Orthopaedic Centre, United Kingdom of Great Britain and Northern Ireland
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Lee JK, Kim HJ, Park JO, Yang JH. Inferior outcome of revision of unicompartmental knee arthroplasty to total knee arthroplasty compared with primary total knee arthroplasty: systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2018; 26:3403-3418. [PMID: 29589049 DOI: 10.1007/s00167-018-4909-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 03/20/2018] [Indexed: 01/14/2023]
Abstract
PURPOSE The purpose of this study was to compare the revision of unicompartmental knee arthroplasty (UKA) to total knee arthroplasty (TKA) with primary TKA through a review of previously published studies. The hypothesis was that the revised UKA group would need additional operative procedures, including the use of stems and augments, resulting in poorer clinical outcomes than those of the primary TKA group. METHODS A literature search of online register databases was performed to identify clinical trials that compared revised UKA to TKA with primary TKA. An electronic literature search was performed using the Medline, Embase, Cochrane Library, Web of Science, and Scopus databases. No language or date restrictions were applied. RESULTS A total of 2034 articles were identified from a keyword search, of which 11 studies were determined as eligible. They were all retrospective comparative studies. The revised UKA to TKA group had longer operation times resulting from additional procedures such as bone grafting and use of stems and augments, higher reoperation rates, and worse postoperative clinical outcomes based on the Western Ontario and McMaster Universities Osteoarthritis Index and Oxford Knee Score than the primary TKA group, with the differences being statistically significant. CONCLUSION UKA should not be considered an alternative procedure to TKA. LEVEL OF EVIDENCE Therapeutic Level III.
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Affiliation(s)
- Jin Kyu Lee
- Department of Orthopaedic Surgery, Hanyang University Hospital, Seoul, South Korea
| | - Hyun Jung Kim
- Department of Preventive Medicine, College of Medicine, Korea University, Seoul, South Korea
| | - Jae Ok Park
- Medical Library, Veterans Health Service Medical Center, Seoul, South Korea
| | - Jae-Hyuk Yang
- Department of Orthopedic Surgery, Hanyang University Guri Hospital, 153, Gyeongchunro, Guri, Gyeonggi-Do, 11923, South Korea.
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Innocenti B, Fekete G, Pianigiani S. Biomechanical Analysis of Augments in Revision Total Knee Arthroplasty. J Biomech Eng 2018; 140:2694847. [PMID: 30098138 DOI: 10.1115/1.4040966] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Indexed: 11/08/2022]
Abstract
Augments are a common solution for treating bone loss in revision total knee arthroplasty and industry is providing to surgeons several options, in terms of material, thickness and shapes. Actually, while the choice of the shape and the thickness is mainly dictated by the bone defect, no proper guidelines are currently available to select the optimal material for a specific clinical situation. Nevertheless, different materials could induce different bone responses and, later, potentially compromise implant stability and performances. Therefore, in this study, a biomechanical analysis is performed by means of finite element modelling about existing features for augment designs. Based upon a review of available products at present, the following augments features were analyzed: position (distal/proximal and posterior), thickness (5, 10 and 15 mm) and material (bone cement, porous and solid metal). For all analyzed configurations, bone stresses were investigated in different regions and compared among all configurations and the control model for which no augments were used. Results show that the use of any kind of augment usually induces a change in bone stresses, especially in the region close to the bone cut. The porous metal presents result very close to cement ones; thus it could be considered as a good alternative for defects of any size. Solid metal has the least satisfying results inducing the highest changes in bone stress. The results of this study demonstrate that material stiffness of the augment should be as close as possible to bone properties for allowing the best implant performances.
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Affiliation(s)
- Bernardo Innocenti
- BEAMS Department, Université Libre De Bruxelles, Av. F. Roosevelt, 50 CP165/56, 1050 Bruxelles, Belgium
| | - Gusztáv Fekete
- Savaria Institute of Technology, Faculty of Informatics, Eötvös Loránd University, Károlyi Gáspár 4, 9700 Szombathely, Hungary
| | - Silvia Pianigiani
- BEAMS Department, Université Libre De Bruxelles, Av. F. Roosevelt, 50 CP165/56, 1050 Bruxelles, Belgium
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Sun X, Su Z. A meta-analysis of unicompartmental knee arthroplasty revised to total knee arthroplasty versus primary total knee arthroplasty. J Orthop Surg Res 2018; 13:158. [PMID: 29929543 PMCID: PMC6013960 DOI: 10.1186/s13018-018-0859-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 06/08/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study was performed to compare the clinical outcomes of unicompartmental knee arthroplasty (UKA) revised to total knee arthroplasty (TKA) versus primary TKA. METHODS Relevant trials were identified via a search of the Cochrane Central Register of Controlled Trials and PubMed from inception to 17 June 2017. A meta-analysis was performed to compare postoperative outcomes between revised UKA and primary TKA with respect to the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, Knee Society Score (KSS), mean polyethylene thickness, hospital stay, revision rate, range of motion (ROM), and complications. RESULTS Five of 233 studies involving 536 adult patients (revised UKA group, n = 209; primary TKA group, n = 327) were eligible for inclusion in the meta-analysis. The primary TKA group had better WOMAC scores, KSS, and ROM than the revised UKA group (P < 0.05). Compared with primary TKA, revision of UKA to TKA required more augments, stems, and bone grafts and a thicker polyethylene component (P < 0.05). There were no significant differences between the two groups in the revision rate, hospital stay, or complications (P > 0.05). CONCLUSION Conversion of UKA to TKA is associated with poorer clinical outcomes than primary TKA. Furthermore, we believe that conversion of UKA to TKA is more complicated than performing primary TKA. Revision UKA often requires more augments, stems, and bone grafts and thicker polyethylene components than primary TKA. However, patients who undergo conversion of UKA to TKA have similar hospital stay, complications, and revision rate as patients who undergo primary TKA.
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Affiliation(s)
- Xuedong Sun
- Department of Orthopaedics, Weifang People's Hospital, no. 151 Guangwen Road, Weifang, 260041, China
| | - Zheng Su
- Department of Medical Oncology, Weifang People's Hospital, no. 151 Guangwen Road, Weifang, 260041, China.
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Laterale Schlittenprothese. ARTHROSKOPIE 2017. [DOI: 10.1007/s00142-017-0160-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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The influence of different sets of surgical instrumentation in Oxford UKA on bearing size and component position. Arch Orthop Trauma Surg 2017; 137:895-902. [PMID: 28439701 DOI: 10.1007/s00402-017-2702-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Indexed: 02/09/2023]
Abstract
INTRODUCTION The Oxford unicompartmental knee arthroplasty (OUKA) has been proven to be an effective treatment for anteromedial osteoarthritis of the knee joint. New instrumentation has been introduced to improve the reproducibility of implant positioning and to minimize bone loss during tibial resection (Oxford Microplasty; Zimmer Biomet, Warsaw, Indiana, USA). METHODS To assess the effect of the new instrumentation, we retrospectively evaluated the postoperative radiographs and surgical records of 300 OUKAs in three consecutive cohorts of patients. The first cohort consists of the first 100 minimal invasive implantations of the OUKA using the conventional phase III instrumentation, the second cohort consists of the 100 most recent minimal invasive OUKA with the conventional phase III instrumentation and the third cohort consists of the first 100 minimal invasive OUKA using the new Oxford Microplasty instrumentation. RESULTS Mean bearing thickness was statistically significant and lower in OUKA with use of the updated instrumentation than with the conventional instrumentation (p = 0.01 and p = 0.04). Additionally, statistically significant and more femoral components were aligned within the accepted range of tolerance in both the coronal and the sagittal plane with use of the updated instrumentation compared to the conventional phase III instrumentation in group A (p = 0.029 and p = 0.038) and in the sagittal plane with use of the updated instrumentation compared to the conventional phase III instrumentation in group B (p = 0.002). CONCLUSION The new modified instrumentation seems to be an effective tool to reduce the risk of malalignment of the femoral component in the coronal and in the sagittal plane compared to the conventional phase III instrumentation. Furthermore, the instrumentation is also effective in determining an adequate level of tibial resection and thus avoiding unnecessary bone loss.
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Cerciello S, Morris BJ, Lustig S, Visonà E, Cerciello G, Corona K, Neyret P. Lateral tibial plateau autograft in revision surgery for failed medial unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2017; 25:773-778. [PMID: 25906913 DOI: 10.1007/s00167-015-3610-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Accepted: 04/16/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE Revision surgery for failed unicompartmental knee arthroplasty (UKA) with bone loss is challenging. Several options are available including cement augmentation, metal augmentation, and bone grafting. The aim of the present study was to describe a surgical technique for lateral tibial plateau autografting and report mid-term outcomes. METHODS Eleven consecutive patients (median age 69.5 years) affected by posteromedial tibial plateau collapse after medial UKA were enrolled in the present study. The delay between UKA and revision surgery was 21 months (range 15-36 months). All patients were revised with a cemented posterior-stabilized implant, with a tibial stem. Medial tibial plateau bone loss was treated with an autologous lateral tibial plateau bone graft secured with two absorbable screws. All patients were evaluated with the Oxford Knee Score (OKS), visual analogue scale for pain (VAS), and complete radiographic evaluation. RESULTS At a median follow-up of 60 months (range 36-84 months), the OKS improved from 21.5 (range 16-26) to 34.5 (range 30-40) (p < 0.01) and the median VAS score improved from 8.0 (range 5-9) to 5.5 (range 3-7) (p < 0.01). No intraoperative complications were recorded. Partial reabsorption of the graft was observed in two cases at final follow-up. CONCLUSION Lateral tibial plateau bone autograft is an alternative to metal wedge or cement augments in the treatment of medial plateau collapse after UKA. Primary fixation of the tibial plateau autograft can be achieved with absorbable screws and a tibial-stemmed implant. Further comparative studies with a larger series may be helpful to draw definitive conclusions. LEVEL OF EVIDENCE Case series, Level IV.
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Affiliation(s)
- Simone Cerciello
- Albert Trillat Center, Lyon North University Hospital, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France.
| | - Brent Joseph Morris
- Lexington Clinic Orthopedics - Sports Medicine Center, The Shoulder Center of Kentucky, Lexington, KY, USA
| | - Sebastien Lustig
- Albert Trillat Center, Lyon North University Hospital, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France
| | | | | | - Katia Corona
- Science for Health Department, Molise University, Campobasso, Italy
| | - Philippe Neyret
- Albert Trillat Center, Lyon North University Hospital, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France
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Computerised navigation of unicondylar knee prostheses: from primary implantation to revision to total knee arthroplasty. INTERNATIONAL ORTHOPAEDICS 2016; 41:293-299. [PMID: 27680750 DOI: 10.1007/s00264-016-3293-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 09/11/2016] [Indexed: 10/20/2022]
Abstract
AIM Computerized navigation of unicondylar knee arthroplasties (UKA) is not a widespread technique. The lifespan of a UKA depends on the quality of its implantation. We know that overcorrection leads to a rapid extension of the osteoarthritis to the opposite side of the knee and undercorrection to a rapid loosening or wear of the prosthesis. Because of these difficulties and following a long experience with navigation of total knee arthroplasties (TKA) and osteotomies around the knee, we began using navigation for revisions to TKA in 2003 and for UKAs in 2008. The aim of this work is to present, firstly, the axial alignment of 79 medial and 19 lateral computer-assisted UKAs and, secondly, the axial alignment of 23 computer-assisted UKA revisions to TKA. METHODS In all the cases we used the Orthopilot® device (BBraun-Aesculap, Tuttlingen, Germany), which is a non image-based navigation system. RESULTS For medial prostheses, the main objective was to obtain a post-operative HKA angle of 177° ± 2°, i.e. an under correction of 1-5°. This objective was met in 88.5 % of the cases. For lateral prostheses, the main objective was to achieve a post-operative HKA angle of 183° ± 2°, i.e. also an under correction of 1-5°. This objective was met in 84 % of the cases (3 cases at 186° and no cases of over correction). Regarding UKA revisions, the main objective was to ensure an HKA angle of 180° ± 3°. This was met in 92.4 % of the cases. CONCLUSION As for TKA and osteotomies, computerized navigation of UKAs and UKA revisions allows the pre-operative goal to be met easily.
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Midterm results after unicompartmental knee replacement with all-polyethylene tibial component: a single surgeon experience. Arch Orthop Trauma Surg 2016; 136:1303-1307. [PMID: 27443168 DOI: 10.1007/s00402-016-2515-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Indexed: 10/21/2022]
Abstract
PURPOSE The aim of this study was to determine the survival rate, the causes of failure, and the functional outcomes of an all-polyethylene tibial unicompartmental knee prosthesis. METHODS One hundred (100) nonselected, consecutive patients indicated for unicompartmental knee replacement for isolated medial knee compartment osteoarthritis by a single surgeon at a single institution from 2000 to 2004 were included in this study. Data was collected retrospectively at final follow-up from the hospital electronic database, including progress notes, demographic information, Hospital for Special Surgery (HSS) Knee Score, details on the surgical procedure, reoperations/revisions, and mortality. A survival analysis was performed to estimate the probability of survival over time. RESULTS The survival probability of the all-polyethylene UKA implant was 95.4 % after a mean follow-up of 8 years, which is comparable to reports from studies using metal-backed modular designs for UKA. The causes of failure were progression of arthritis in adjacent compartments (2 %) and loosening of the tibial component (2 %). The mean preoperative HSS knee score improved from 36.6 ± 14.3 to 76.6 ± 21.6 at latest follow-up (p < 0.0001). CONCLUSIONS In summary, an all-polyethylene tibial component has equivalent survivorship to modular designs. Implant selection does not seem to have great influence on the outcome, but rather the success depends on appropriate indications and surgical technique.
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20
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van der List JP, Zuiderbaan HA, Pearle AD. Why Do Medial Unicompartmental Knee Arthroplasties Fail Today? J Arthroplasty 2016; 31:1016-21. [PMID: 26725134 DOI: 10.1016/j.arth.2015.11.030] [Citation(s) in RCA: 173] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 11/05/2015] [Accepted: 11/25/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Failure rates are higher in medial unicompartmental knee arthroplasty (UKA) than total knee arthroplasty. To improve these failure rates, it is important to understand why medial UKA fail. Because individual studies lack power to show failure modes, a systematic review was performed to assess medial UKA failure modes. Furthermore, we compared cohort studies with registry-based studies, early with midterm and late failures and fixed-bearing with mobile-bearing implants. METHODS Databases of PubMed, EMBASE, and Cochrane and annual registries were searched for medial UKA failures. Studies were included when they reported >25 failures or when they reported early (<5 years), midterm (5-10 years), or late failures (>10 years). RESULTS Thirty-seven cohort studies (4 level II studies and 33 level III studies) and 2 registry-based studies were included. A total of 3967 overall failures, 388 time-dependent failures, and 1305 implant design failures were identified. Aseptic loosening (36%) and osteoarthritis (OA) progression (20%) were the most common failure modes. Aseptic loosening (26%) was most common early failure mode, whereas OA progression was more commonly seen in midterm and late failures (38% and 40%, respectively). Polyethylene wear (12%) and instability (12%) were more common in fixed-bearing implants, whereas pain (14%) and bearing dislocation (11%) were more common in mobile-bearing implants. CONCLUSION This level III systematic review identified aseptic loosening and OA progression as the major failure modes. Aseptic loosening was the main failure mode in early years and mobile-bearing implants, whereas OA progression caused most failures in late years and fixed-bearing implants.
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Affiliation(s)
- Jelle P van der List
- Department of Orthopaedic Surgery, Sports Medicine and Shoulder Service, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York
| | - Hendrik A Zuiderbaan
- Department of Orthopaedic Surgery, Sports Medicine and Shoulder Service, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York
| | - Andrew D Pearle
- Department of Orthopaedic Surgery, Sports Medicine and Shoulder Service, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York
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Pongcharoen B, Reutiwarangkoon C. The comparison of anterior knee pain in severe and non severe arthritis of the lateral facet of the patella following a mobile bearing unicompartmental knee arthroplasty. SPRINGERPLUS 2016; 5:202. [PMID: 27026898 PMCID: PMC4769708 DOI: 10.1186/s40064-016-1914-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 02/17/2016] [Indexed: 01/30/2023]
Abstract
In the past, medial osteoarthritis (OA) knee with symptomatic patellofemoral (PF) arthritis has not been recommended for a unicompartmental knee arthroplasty (UKA). However, recent studies have reported that UKA has shown good results in patients with medial OA of the knee, including those with PF arthritis. The purpose of this study is to compare the results between patients with medial OA knees; those with severe arthritis of the lateral facet of the patella and patients without severe arthritis of the lateral facet of the patella following mobile bearing UKA. We have prospectively evaluated 104 patients (114 knees) who had undergone an Oxford mobile bearing UKA. The mean follow-up was 19.05 months (range 12.30–29.70 months). The patients were divided into two groups: group I consisted of eighty patients (88 knees) who did not have severe arthritis of the lateral facet (Outerbridge grade 0–2) and group II had twenty-four patients (26 knees) who had severe arthritis of the lateral facet (Outerbridge grade 3, 4). We recorded the incidence of anterior knee pain, knee scores, pain scores, and functional scores in comparison of the two groups. The visual analog scale (VAS) and incidence of post-operative anterior knee pain had not shown any significant differences. The VAS for post-operative anterior knee pain was 0.11 (SD 0.56, range 0–3 point) versus 0.12 (SD 0.59, range 0–3 point) for group I and group II patients, respectively (P = 0.98). The incidence of post-operative anterior knee pain was 4.5 versus 3.8 % for group I and group II patients, respectively (P = 0.88). The pain scores and functional scores had not exhibited any differences. However, the knee scores of patients with severe arthritis of the lateral facet of the patella was worse than those seen in patients without severe arthritis of the lateral facet of the patella with a statistical significance. It was scored as 96.78 (SD 4.56, range 85–100) versus 94.43 (SD 4.50, range 81–100) for group I and group II patients, respectively (P = 0.02). Anterior knee pain, pain scores, and functional scores were not different between the two groups following a medial Oxford UKA. However, the knee scores of patients with severe arthritis of the lateral facet were worse than those in patients without severe arthritis of the lateral facet of the patella.
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Affiliation(s)
- Boonchana Pongcharoen
- Department of Orthopaedic Surgery, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Chaivet Reutiwarangkoon
- Department of Orthopaedic Surgery, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
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Abstract
Unicompartmental arthroplasty is an efficient and approved treatment option of unicompartmental arthritis of the knee, being performed with increasing frequency worldwide. Compared to total knee replacement, there are several advantages such as faster recovery, lower blood loss, better functional outcome and lower infection rates. However, higher revision rates are a frequent argument against the use of unicompartmental arthroplasty. The following article gives an overview of failure mechanisms and strategies for revision arthroplasty. This article is based on a selective literature review including PubMed and relevant print media. Our own clinical experience is considered as well.
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Labruyère C, Zeller V, Lhotellier L, Desplaces N, Léonard P, Mamoudy P, Marmor S. Chronic infection of unicompartmental knee arthroplasty: one-stage conversion to total knee arthroplasty. Orthop Traumatol Surg Res 2015; 101:553-7. [PMID: 26164543 DOI: 10.1016/j.otsr.2015.04.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 04/13/2015] [Accepted: 04/22/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND The main reasons for revision of unicompartmental knee arthroplasty (UKA) are loosening, wear, extension of osteoarthritis to another compartment, and infection. There have been no studies of the management of infected UKA, whose incidence varies from 0.2% to 1%. Our objective was to describe infection-related and mechanical outcomes of chronic UKA infection managed by one-stage conversion to total knee arthroplasty (TKA). PATIENTS AND METHODS Consecutive patients with chronic UKA infection managed by one-stage conversion to TKA between January 2003 and December 2010 were included in a retrospective single-center study. All patients also received appropriate dual antibiotic therapy intravenously for 6 weeks then orally for 6 additional weeks. RESULTS During the study period, among 233 cases of infected knee arthroplasty managed at our center, 9 met the study inclusion criteria. The UKA was medial in 6 patients, lateral in 2, and patellofemoral in 1. Median age was 67 years (range, 36-83 years) and median infection duration was 9months. In 5 patients, previous treatment with synovectomy, joint lavage, and antibiotics had failed. The following bacteria were identified: oxacillin-susceptible Staphylococci, n=6 (S. epidermidis, n=4; S. capitis, n=1; and S. lugdunensis, n=1); nutritionally deficient Streptococcus, n=1; Enterococcus durans, n=1; and Escherichia coli, n=1. Median follow-up was 60 months (range, 36-96 months). No patient experienced recurrent infection or required revision surgery for infection. No medical complications limiting the use of appropriate antibiotic therapy were recorded. The mean preoperative knee and function scores were 60 and 50, respectively; corresponding mean postoperative values were 75 and 65, respectively. DISCUSSION UKA infection involves both the prosthesis and the native cartilage, neither of which can be treated conservatively in chronic forms. After identification of the causative organism, synovectomy and joint excision followed by same-stage TKA and combined with appropriate antibiotic therapy for 3 months is effective. LEVEL OF EVIDENCE IV, retrospective cohort study.
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Affiliation(s)
- C Labruyère
- Centre de référence en infection ostéoarticulaire, Groupe Hospitalier Diaconesses Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France
| | - V Zeller
- Centre de référence en infection ostéoarticulaire, Groupe Hospitalier Diaconesses Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France
| | - L Lhotellier
- Centre de référence en infection ostéoarticulaire, Groupe Hospitalier Diaconesses Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France
| | - N Desplaces
- Centre de référence en infection ostéoarticulaire, Groupe Hospitalier Diaconesses Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France
| | - P Léonard
- Centre de référence en infection ostéoarticulaire, Groupe Hospitalier Diaconesses Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France
| | - P Mamoudy
- Centre de référence en infection ostéoarticulaire, Groupe Hospitalier Diaconesses Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France
| | - S Marmor
- Centre de référence en infection ostéoarticulaire, Groupe Hospitalier Diaconesses Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France.
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Computer navigation for revision of unicompartmental knee replacements to total knee replacements: the results of a case–control study of forty six knees comparing computer navigated and conventional surgery. INTERNATIONAL ORTHOPAEDICS 2015; 39:1779-84. [DOI: 10.1007/s00264-015-2838-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Accepted: 05/25/2015] [Indexed: 10/23/2022]
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Suter B, Testa E, Stämpfli P, Konala P, Rasch H, Friederich NF, Hirschmann MT. A novel standardized algorithm using SPECT/CT evaluating unhappy patients after unicondylar knee arthroplasty--a combined analysis of tracer uptake distribution and component position. BMC Med Imaging 2015; 15:11. [PMID: 25886040 PMCID: PMC4376158 DOI: 10.1186/s12880-015-0053-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 03/04/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The introduction of a standardized SPECT/CT algorithm including a localization scheme, which allows accurate identification of specific patterns and thresholds of SPECT/CT tracer uptake, could lead to a better understanding of the bone remodeling and specific failure modes of unicondylar knee arthroplasty (UKA). The purpose of the present study was to introduce a novel standardized SPECT/CT algorithm for patients after UKA and evaluate its clinical applicability, usefulness and inter- and intra-observer reliability. METHODS Tc-HDP-SPECT/CT images of consecutive patients (median age 65, range 48-84 years) with 21 knees after UKA were prospectively evaluated. The tracer activity on SPECT/CT was localized using a specific standardized UKA localization scheme. For tracer uptake analysis (intensity and anatomical distribution pattern) a 3D volumetric quantification method was used. The maximum intensity values were recorded for each anatomical area. In addition, ratios between the respective value in the measured area and the background tracer activity were calculated. The femoral and tibial component position (varus-valgus, flexion-extension, internal and external rotation) was determined in 3D-CT. The inter- and intraobserver reliability of the localization scheme, grading of the tracer activity and component measurements were determined by calculating the intraclass correlation coefficients (ICC). RESULTS The localization scheme, grading of the tracer activity and component measurements showed high inter- and intra-observer reliabilities for all regions (tibia, femur and patella). For measurement of component position there was strong agreement between the readings of the two observers; the ICC for the orientation of the femoral component was 0.73-1.00 (intra-observer reliability) and 0.91-1.00 (inter-observer reliability). The ICC for the orientation of the tibial component was 0.75-1.00 (intra-observer reliability) and 0.77-1.00 (inter-observer reliability). CONCLUSIONS The SPECT/CT algorithm presented combining the mechanical information on UKA component position, alignment and metabolic data is highly reliable and proved to be a valuable, consistent and useful tool for analysing postoperative knees after UKA. Using this standardized approach in clinical studies might be helpful in establishing the diagnosis in patients with pain after UKA.
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Affiliation(s)
- Basil Suter
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laifen), CH-4101, Bruderholz, Switzerland.
| | - Enrique Testa
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laifen), CH-4101, Bruderholz, Switzerland.
| | - Patrick Stämpfli
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laifen), CH-4101, Bruderholz, Switzerland.
| | | | - Helmut Rasch
- Institute for Radiology and Nuclear Medicine, Kantonsspital Baselland, Bruderholz, CH-4101, Switzerland.
| | - Niklaus F Friederich
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laifen), CH-4101, Bruderholz, Switzerland.
| | - Michael T Hirschmann
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laifen), CH-4101, Bruderholz, Switzerland.
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UKA can be safely revised to primary knee arthroplasty by using an autologous bone plate from the proximal lateral tibia. J Arthroplasty 2014; 29:1991-5. [PMID: 25007728 DOI: 10.1016/j.arth.2014.05.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 05/06/2014] [Accepted: 05/22/2014] [Indexed: 02/01/2023] Open
Abstract
The bone-preservation by UKA in medial osteoarthritis constitutes only an advantage if in the case of revision an unconstrained TKA can be implanted. The aim of this study was to evaluate a revision technique using an autologous bone slice from the lateral to the medial proximal tibia. We report on 17 patients with a mean follow up of 3.1years. Patient's satisfaction and pain, WOMAC- and Oxford-Knee-Score, radiological and clinical knee symptoms/function were assessed. No loosening, wear or implant subsidence could be detected during the follow up. In comparison with results after primary TKA in the literature we found our clinical results to be within the range. The study demonstrates that thismethod is safe and produces good midterm results.
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Aldinger PR, Walker T, Gotterbarm T. Erfahrungen mit lateralen unikondylären Prothesen. DER ORTHOPADE 2014; 43:913-22. [DOI: 10.1007/s00132-014-3021-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Citak M, Dersch K, Kamath AF, Haasper C, Gehrke T, Kendoff D. Common causes of failed unicompartmental knee arthroplasty: a single-centre analysis of four hundred and seventy one cases. INTERNATIONAL ORTHOPAEDICS 2014; 38:961-5. [PMID: 24402555 PMCID: PMC3997760 DOI: 10.1007/s00264-013-2263-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 12/15/2013] [Indexed: 10/25/2022]
Abstract
PURPOSE We performed this retrospective study to determine the main causes for early and late failures of unicompartmental knee arthroplasty (UKA). METHODS Between January 2000 and March 2012, all patients treated for a failed medial UKA in the authors' institution were retrospectively reviewed. A total of 471 patients were identified, and causes of failure were analysed based on the medical records and radiographs at the time of revision. RESULTS The cohort included 161 males and 310 females, with a mean age of 67.7 years (range, 42-91 years; SD = 10.1) at the time of revision. The mean time from index arthroplasty to revision surgery was 6.1 years (range, 0.1-27.9 years; SD = 5.6). A total of 254 cases (53.9 %) failed within five years after primary implantation, and 108 cases (22.9 %) failed after ten years. The major reason for failure was the development of other compartment arthritis (39.5 %), followed by aseptic loosening (25.4 %). CONCLUSIONS Of importance, the mean time to failure after UKA was 6.1 years, with more than 50 % of failures occurring within the first five years postoperatively.
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Affiliation(s)
- Mustafa Citak
- Department of Orthopaedic Surgery, Helios Endo-Kinik Hamburg, Hamburg, Germany,
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Mozella ADP, Borges Gonçalves F, Osterno Vasconcelos J, de Araújo Barros Cobra HA. Revision of unicompartmental knee arthroplasty: implants used and causes of failure. Rev Bras Ortop 2014; 49:154-9. [PMID: 26229792 PMCID: PMC4511742 DOI: 10.1016/j.rboe.2014.03.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 04/09/2013] [Indexed: 11/29/2022] Open
Abstract
Objective to determine the causes of unicondylar knee arthroplasty failures, as well as identify the implants used and the need of bone grafting in patients undergoing revision UKA in Center of Knee Surgery at the Instituto Nacional de Traumatologia e Ortopedia (INTO) in the period between January 1990 and January 2013. Methods a retrospective analysis of the medical documentation and imaging, determining the cause of failure of UKA and the time of its occurrence, as well as prosthetic components implanted during the review and the need for bone grafting. Results in this study, 27 UKA failures in 26 patients were included. Collapse of one or more components was the main cause of failure, occurring in 33% of patients. Aseptic failure was identified in 30% of cases, progression of osteoarthrosis in 15%, infection and pain 7% each, and osteolysis and polyethylene failure in 4% each. Early failure occurred in 41% of all revisions of UKA and late failure in 59%. 23 patients have undergone revision of UK. Conclusion in 35% of revisions the use of bone grafting was needed in tibial area; in 3 cases we needed allograft from Tissue Bank. We did not use metal increase in any of the revision. In one patient we used implant constraint for instability.
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Affiliation(s)
- Alan de Paula Mozella
- Knee Surgery Center, Instituto Nacional de Traumatologia e Ortopedia (Into), Rio de Janeiro, RJ, Brazil
| | - Felipe Borges Gonçalves
- Knee Surgery Center, Instituto Nacional de Traumatologia e Ortopedia (Into), Rio de Janeiro, RJ, Brazil
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Mozella ADP, Borges Gonçalves F, Osterno Vasconcelos J, de Araújo Barros Cobra HA. Revisão de artroplastia unicompartimental de joelho: implantes usados e causas de falha. Rev Bras Ortop 2014. [DOI: 10.1016/j.rbo.2014.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Is unicompartmental-to-unicompartmental revision knee arthroplasty a reliable option? Case-control study. Orthop Traumatol Surg Res 2014; 100:141-5. [PMID: 24373806 DOI: 10.1016/j.otsr.2013.10.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2013] [Accepted: 10/25/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND In selected patients with failed unicompartmental knee arthroplasty (UKA), revision UKA is a reliable option and may even provide lower morbidity rates and better functional outcomes compared to revision total knee arthroplasty. MATERIAL AND METHODS In a multicentre retrospective study of 425 knees requiring revision surgery after UKA, 36 knees were managed with revision UKA. RESULTS Of the 36 knees, 3 (8.33%) required iterative revision surgery, for aseptic loosening. After a mean follow-up of 8.3 years, the mean IKS knee and function scores were high (93.81/100 and 90.77/100, respectively). DISCUSSION In carefully selected patients, UKA-to-UKA revision performed according to a rigorous operative technique deserves a role in the surgical strategy for failed UKA. LEVEL OF EVIDENCE III, multicentre retrospective case-control study.
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Ollivier M, Abdel MP, Parratte S, Argenson JN. Lateral unicondylar knee arthroplasty (UKA): contemporary indications, surgical technique, and results. INTERNATIONAL ORTHOPAEDICS 2013; 38:449-55. [PMID: 24337799 DOI: 10.1007/s00264-013-2222-9] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Accepted: 11/19/2013] [Indexed: 12/01/2022]
Abstract
Unicompartmental femoro-tibial osteoarthritis usually affects the medial compartment of the knee, but in 10%, the lateral compartment is primarily involved. Femoral osteotomy is attractive to avoid TKA in younger patients with low-grade unicompartmental osteoarthritis and a valgus deformity. However, only limited functional results can be expected for patients with Ahlback grade 2 or greater osteoarthritis. Moreover, because of previous skin incisions and hardware removal, TKA after femoral osteotomy remains a complex procedure with poor functional results. Unicompartmental knee arthroplasty for both the medial and the lateral compartments has been performed since the 1970s. In a patient with involvement of only one compartment, a medial or a lateral UKA can provide a quicker recovery and enhanced function when compared to TKA. In addition, it preserves bone stock and can be "easily" revised by a TKA. Technical improvements, combined with strict patient selection, have resulted in ten year survivorships greater than 90%. However, lateral UKA is technically more challenging than medial UKA due to the lower number of indications, as well as the functional anatomy of the lateral compartment. The goals of this article are to present up-to-date information concerning indications, patients' selection, surgical technique and results of lateral compartment UKA.
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Affiliation(s)
- Matthieu Ollivier
- Department of Orthopedic Surgery, Institute for Locomotion, Aix-Marseille University, 270 Boulevard Sainte Marguerite, BP 29, 13274, Marseille, France
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Manzotti A, Chemello C, Pullen C, Cerveri P, Confalonieri N. An uncommon cause of cemented unicompartmental knee arthroplasty failure: fracture of metallic components. Knee Surg Sports Traumatol Arthrosc 2013; 21:2518-2522. [PMID: 22638637 DOI: 10.1007/s00167-012-2062-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2012] [Accepted: 05/11/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE Despite good overall clinical results, unicompartmental knee replacements (UKR) are not without their problems and failures have been reported. The most common causes of UKR failure are component loosening, poor patient selection, poor surgical technique, polyethylene wear and progression of arthritis in other compartments. The purpose of this study is to present a series of atraumatic fractures of metallic components in a UKR treated in a single orthopaedic centre. METHOD Since 1999, 121 failed unicompartmental knee arthroplasties have been referred to our centre. In six of these, atraumatic breakage of a metal component in the cemented UKR was seen and included in this study. Pre-operative alignment, BMI and implant longevity were documented. The femoral implant failed in 4 patients and the tibial implant in a further 2. RESULTS All the femoral implant fractures occurred within 3 years of UKR surgery (mean: 22.2 months, SD: 10.6 months). Tibial implant breakage occurred at a mean of 8.5 years (SD: 2.4 months) following UKR. All patients were treated with conversion to a navigated total knee replacement. A primary total knee arthroplasty was used in all cases with one patient requiring a tibial component incorporating a wedge and stem following breakage of the original UKR tibial implant. CONCLUSION Fracture of the metallic components is a potential cause of failure of unicompartmental knee arthroplasty. In our experience, the incidence of this complication was 4.9 % of all UKR failures. Patients with a BMI greater than 30 and a progressive deterioration in limb alignment were at greater risk.
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Affiliation(s)
- Alfonso Manzotti
- Ist Orthopedic Department, C.T.O. Hospital, Via Bignami 1, 20100, Milan, Italy,
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Rouanet T, Combes A, Migaud H, Pasquier G. Do bone loss and reconstruction procedures differ at revision of cemented unicompartmental knee prostheses according to the use of metal-back or all-polyethylene tibial component? Orthop Traumatol Surg Res 2013; 99:687-92. [PMID: 23810395 DOI: 10.1016/j.otsr.2013.03.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 02/16/2013] [Accepted: 03/14/2013] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Results of unicompartmental knee arthroplasty (UKA) revision are known but the severity of bone loss and the need for reconstruction are not detailed for different tibial implants. HYPOTHESIS Metal-backing UKA revision exposes the patient to more severe tibial bone loss and requires more substantial reconstruction procedures than cemented polyethylene UKA revision. MATERIALS AND METHODS This retrospective series of 23 revisions of UKA to total knee arthroplasty (TKA) compared 11 all-polyethylene UKAs with 12 metal-backing UKAs. Factors that contributed to failure were aseptic loosening (n=12) and osteoarthritis evolution (n=11). Both groups were similar regarding the demographic and clinical features. We reported bone loss and the reconstruction procedure to fill it according to the initially used tibial implant. The results were evaluated with the IKS score to a follow-up of 37 months (range, 24-67 months). RESULTS There were more tibial segmental bone loss (10 versus 3) and more metal wedges (8/12 versus 2/11) in metal-backing UKA revision (P<0.05). Tibial stems were more often used in metal-backing UKA revision (12/12 versus 7/11) (P=0.04). The results of TKA at follow-up did not differ according to whether the revised tibial implant was all polyethylene (IKS=155 [range, 107-195]) or metal-back (IKS=155 [range, 127-172]). DISCUSSION This study suggests that metal-backing UKA revision exposes the patient to more severe tibial bone loss requiring more substantial reconstruction. These results must be confirmed on a larger population, but surgeons should be alerted to this kind of revision surgery, which warrants having available a revision knee prothesis. LEVEL OF EVIDENCE Level III, case-control study.
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Affiliation(s)
- T Rouanet
- Université Lille Nord de France, 59000 Lille, France; Services d'orthopédie, département universitaire de chirurgie orthopédique, université Lille 2, hôpital Salengro, CHRU de Lille, place de Verdun, 59037 Lille cedex, France.
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Saragaglia D, Bonnin M, Dejour D, Deschamps G, Chol C, Chabert B, Refaie R, the French Society of Hip and Knee. Results of a French multicentre retrospective experience with four hundred and eighteen failed unicondylar knee arthroplasties. INTERNATIONAL ORTHOPAEDICS 2013; 37:1273-8. [PMID: 23715952 PMCID: PMC3685668 DOI: 10.1007/s00264-013-1915-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Accepted: 04/23/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE By means of a multicentre retrospective study based on the failure of 418 aseptic unicondylar knee arthroplasties (UKA) our aims were to present the different types of revision procedure used in failed UKAs, to establish a clear operative strategy for each type of revision and to better define the indications for each type of revision. METHODS Aseptic loosening was the principal cause of failure (n = 184, 44%) of which 99 cases were isolated tibial loosening (23.5 % of the whole series and 54% of all loosening), 25 were isolated femoral loosening (six and 13.6%) and 60 were both femoral and tibial loosening (14.3 and 32.6%). The next most common causes of failure were progression of arthritis (n = 56, 13.4%), polyethylene wear (n = 53, 12.7%), implant positioning errors (n = 26), technical difficulties (n = six) and implant failure (n = 16, 3.8% of cases). Data collection was performed online using OrthoWave software (Aria, Bruay Labuissiere, France), which allows collection of all details of the primary and revision surgery to be recorded. RESULTS A total of 426 revisions were performed; 371 patients underwent revision to a total knee arthroplasty (TKA) (87%), 33 patients (7.7%) were revised to an ipsilateral UKA, 11 (2.6%) patients underwent contralateral UKA (ten) or patellofemoral arthroplasty (one) and 11 patients (2.6%) underwent revision without any change in implants. CONCLUSIONS Before considering a revision procedure it is important to establish a definite cause of failure in order to select the most appropriate revision strategy. Revision to a TKA is by far the most common strategy for revision of failed UKA but by no means the only available option. Partial revisions either to an alternative ipsilateral UKA or contralateral UKA are viable less invasive techniques, which in carefully selected patients and in experienced hands warrant consideration.
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Affiliation(s)
- Dominique Saragaglia
- />Clinique Universitaire de Chirurgie Orthopédique et de Traumatologie du Sport, CHU de Grenoble, Hôpital Sud, Avenue de Kimberley, BP 338, 38434 Échirolles cedex, France
| | - Michel Bonnin
- />Centre Orthopédique Santy, 24 avenue Paul Santy, 69008 Lyon, France
| | - David Dejour
- />Lyon-Ortho-Clinic, Clinique Sauvegarde, 8 Avenue Ben Gourion, 69009 Lyon, France
| | - Gérard Deschamps
- />Centre Orthopédique Médico chirurgical, 2 rue du Pressoir, 71640 Dracy-le-Fort, France
| | - Christophe Chol
- />Centre Orthopédique Médico chirurgical, 2 rue du Pressoir, 71640 Dracy-le-Fort, France
| | - Benoit Chabert
- />Clinique Universitaire de Chirurgie Orthopédique et de Traumatologie du Sport, CHU de Grenoble, Hôpital Sud, Avenue de Kimberley, BP 338, 38434 Échirolles cedex, France
| | - Ramsay Refaie
- />Department of Trauma and Orthopaedics, Wansbeck Hospital, Northumberland, UK
| | - the French Society of Hip and Knee
- />Clinique Universitaire de Chirurgie Orthopédique et de Traumatologie du Sport, CHU de Grenoble, Hôpital Sud, Avenue de Kimberley, BP 338, 38434 Échirolles cedex, France
- />Centre Orthopédique Santy, 24 avenue Paul Santy, 69008 Lyon, France
- />Lyon-Ortho-Clinic, Clinique Sauvegarde, 8 Avenue Ben Gourion, 69009 Lyon, France
- />Centre Orthopédique Médico chirurgical, 2 rue du Pressoir, 71640 Dracy-le-Fort, France
- />Department of Trauma and Orthopaedics, Wansbeck Hospital, Northumberland, UK
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Kerens B, Boonen B, Schotanus M, Kort N. Patient-specific guide for revision of medial unicondylar knee arthroplasty to total knee arthroplasty: beneficial first results of a new operating technique performed on 10 patients. Acta Orthop 2013; 84:165-9. [PMID: 23496649 PMCID: PMC3639337 DOI: 10.3109/17453674.2013.785908] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Unicompartmental to total knee arthroplasty revision surgery can be technically demanding. Joint line restoration, rotation, and augmentations can cause difficulties. We describe a new technique in which single-way fitting guides serve to position the knee system cutting blocks. METHOD Preoperatively, images of the distal femur and proximal tibia are taken using CT scanning. These images are used to create a patient-specific guide that fits in one single position on the contours of the bone and the prosthesis in situ. The guides are fixed with pins and then removed. The pins determine the position of the cutting blocks. 10 consecutive revisions were performed using this technique. RESULTS All guides fitted well. 7 of 10 femoral prostheses were within the desired AP and sagittal angle ± 3°. However, 1 proximal tibia did not have enough bone stock on the medial plateau for adequate fixation of the guide, so conversion to intramedular referencing was performed. This was to be expected after the preoperative planning. All tibial components were within the desired AP angle ± 3° and 7 of 10 were within the desired sagittal angle. Hip-knee-ankle angle was within 0 ± 3° in 8 of 10 cases. INTERPRETATION This new technique makes preoperative planning and execution of this plan during surgery less demanding. Problems such as the need for augmentations can be predicted at the preoperative planning. The instrumentation must be redesigned in order to make this technique work in cases where there is minimal bone stock present.
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Affiliation(s)
- Bart Kerens
- Department of Orthopaedic Surgery, Maastricht University Medical Centre, Maastricht
| | - Bert Boonen
- Department of Orthopaedic Surgery, Orbis Medisch Centrum, Sittard, the Netherlands.
| | - Martijn Schotanus
- Department of Orthopaedic Surgery, Orbis Medisch Centrum, Sittard, the Netherlands.
| | - Nanne Kort
- Department of Orthopaedic Surgery, Orbis Medisch Centrum, Sittard, the Netherlands.
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Matharu G, Robb C, Baloch K, Pynsent P. The Oxford medial unicompartmental knee replacement: survival and the affect of age and gender. Knee 2012; 19:913-7. [PMID: 22480781 DOI: 10.1016/j.knee.2012.03.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Revised: 03/09/2012] [Accepted: 03/09/2012] [Indexed: 02/02/2023]
Abstract
STUDY AIMS To determine the survival and functional outcome for the phase 3 Oxford unicompartmental knee replacement (UKR) performed at a single independent centre and to assess whether age and gender affect survival. PATIENTS AND METHODS Between 2000 and 2008, 459 consecutive Oxford UKRs were implanted in 392 patients using a minimally invasive technique. RESULTS Mean age of patients was 63.0 years and 53% were female. Mean follow-up was 4.4 years (range 0.5-11.2 years). No patient was lost to follow-up and 411 (90%) knees had a minimum follow-up of 2 years. Twenty knees (4.4%) have undergone revision to total knee replacement at a mean time of 3.2 years. Aseptic component loosening (n=11) accounted for most failures. Cumulative survival was 94.4% at 5 years (95% confidence interval 90.9-97.0) and 93.0% at 8 years (95% confidence interval 84.8-96.2). The median postoperative Oxford knee score was 31.2% (interquartile range 12.2%-52.1%) at latest follow-up. Age and gender had no statistically significant affect on UKR survival. CONCLUSIONS This large independent series demonstrates good medium-term survival and functional outcome can be achieved with the phase 3 Oxford UKR in appropriately selected patients. Age and gender should not be considered contraindications for performing Oxford UKR.
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Affiliation(s)
- Gulraj Matharu
- Royal Orthopaedic Hospital, Northfield, Birmingham, B31 2AP United Kingdom.
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Pietschmann MF, Wohlleb L, Weber P, Schmidutz F, Ficklscherer A, Gülecyüz MF, Safi E, Niethammer TR, Jansson V, Müller PE. Sports activities after medial unicompartmental knee arthroplasty Oxford III-what can we expect? INTERNATIONAL ORTHOPAEDICS 2012. [PMID: 23180099 DOI: 10.1007/s00264-012-1710-7] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE Excellent long-term results have been reported for implantation of unicompartmental knee arthroplasty (UKA). In many patients the desire for improvement in function often includes an aspiration to return to sports. The purpose of our study was to evaluate physical activities after medial Oxford-III (Biomet) UKA surgery. METHODS Patients' physical activity before and after the surgery was assessed using a self reporting questionnaire. We used the Oxford knee scoring system (OKS), the WOMAC-, the Knee society- (KSS) and the UCLA-score to assess postoperative knee function. The mean follow-up was 4.2 years. The female-to-male ratio was 1.3:1. The mean age at surgery was 65.3 years. RESULTS Of the 131 patients studied 78 participated in some kind of sports before surgery (mean age 64.4 years), while 53 patients did not perform any sports (mean age 66.5 years) (p > 0.05). At follow-up the patients in the active group were significantly younger than the patients in the inactive group (p < 0.05). The majority of patients (80.1 %) returned to their level of sports activity after UKA surgery. Six patients took up sports after surgery while 15 patients stopped their sports. Among the active patients we found a shift from high- towards low-impact sports. The active patients had significantly higher scores for the OKS, KSS, WOMAC and UCLA score. The complication rate was comparable in both groups. CONCLUSION Our study demonstrates that a high degree of patient satisfaction in terms of sports activity can be achieved using the Oxford-III UKA for medial osteoarthritis.
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Chatain F, Denjean S, Delalande JL, Chavane H, Bejui-Hugues J, Guyen O. Computer-navigated revision total knee arthroplasty for failed unicompartmental knee arthroplasty. Orthop Traumatol Surg Res 2012; 98:720-7. [PMID: 22939772 DOI: 10.1016/j.otsr.2012.02.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2012] [Revised: 02/14/2012] [Accepted: 02/28/2012] [Indexed: 02/02/2023]
Abstract
The most frequent technical difficulty encountered at unicompartmental knee arthroplasty (UKA) revision to total knee arthroplasty (TKA) is filling in all bone defects. These bone defects can render difficult components positioning, mechanical axis restitution, and ligament balance assessment, which are the three most important parameters for successful TKA. We describe a computer-assisted technique which makes it possible to control these three parameters before removal of the implants that have caused the bone defects. Our study is based on a series of 20 cases, with a minimum follow-up of 2 years. The anatomical and clinical results were very satisfying and comparable to results of primary TKA. We recommend this computer-navigated technique, which is as simple as a primary TKA procedure.
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Affiliation(s)
- F Chatain
- Alps Private Hospital - Belledonne Private Hospital, 8, place Paul-Mistral, 38000 Grenoble, France.
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Chou DTS, Swamy GN, Lewis JR, Badhe NP. Revision of failed unicompartmental knee replacement to total knee replacement. Knee 2012; 19:356-9. [PMID: 21636281 DOI: 10.1016/j.knee.2011.05.002] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2011] [Revised: 05/02/2011] [Accepted: 05/05/2011] [Indexed: 02/02/2023]
Abstract
Recent reports suggest good outcome results following unicompartmental knee replacement (UKR). However, a number of authors have commented on the problem of osseous defects requiring technically difficult revision surgery. We reviewed clinical outcomes following revision total knee replacement (TKR) for failed UKR and analysed the reasons for failure and the technical aspects of the revision surgery. Between 2001 and 2010 our institute performed 132 UKR's out of which 33 required revision to TKR during a period 6 years. Demographics, details and indications for primary and revision surgery, the revised prosthesis including augments, technical difficulties and complications were noted. Patient outcome assessment was based on the Oxford knee score (OKS). Survival analysis for the UKR prosthesis was calculated using Kaplan-Meier Survival curves. Reasons for revision included aseptic loosening, persistent pain, dislocated meniscus, mal-alignment and other compartment osteoarthritis. Median time to revision was 19 months (range 2-159). Using revision as the end-point the survival proportion at 5-years was 69%. 18 revisions required additional intra-operative constructs including stemmed implants, wedge augmentation or bone graft. The mean 1 year post-operative OKS was 29 compared to 39 for primary TKR during the same period (p<0.001). Aseptic loosening was the commonest mode of failure. UKR survivorship at a non-specialist institute is considerably lower than at originating centres. Two thirds of the revisions were technically difficult and required additional constructs. The clinical outcome after revision surgery was inferior to that of primary TKR. The role of UKR needs to be more clearly defined.
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Affiliation(s)
- Daud T S Chou
- ST3 Trauma and Orthopaedics, Queens Medical Centre, Nottingham University Hospital, United Kingdom.
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Siddiqui NA, Ahmad ZM. Revision of unicondylar to total knee arthroplasty: a systematic review. Open Orthop J 2012; 6:268-75. [PMID: 22905072 PMCID: PMC3420035 DOI: 10.2174/1874325001206010268] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Revised: 02/28/2012] [Accepted: 03/10/2012] [Indexed: 12/04/2022] Open
Abstract
Isolated unicompartmental osteoarthritis in the young patient is a difficult problem to treat; they may be too young to consider total knee arthroplasty due to difficulties with inevitable future revision. Unicompartmental knee arthroplasty is one possible solution as it is perceived by some as being a smaller surgical insult than total knee arthroplasty, with easier revision to total knee arthroplasty than a revision total knee arthroplasty. A total knee arthroplasty performed as a revision unicondylar knee arthroplasty is thought by some authors to have equivalent functional outcomes to a primary total knee replacement. However, there have been several studies suggesting that revision is not as simple as suggested, and that function is not as good as primary total knee arthroplasty. We performed a systematic review of the literature regarding outcomes after revision of a unicondylar knee arthroplasty. Although there are many studies proposing selective use of the unicondylar knee arthroplasty, there are a number of studies highlighting difficulties with revision and poorer outcomes, and, therefore, the unicondylar knee arthroplasty cannot be considered a small procedure that will 'buy time' for the patient, and have results equal to a primary knee arthroplasty when revised. Further controlled studies, ideally randomised, are required before final conclusions can be drawn.
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Affiliation(s)
- Nashat A Siddiqui
- Department of Trauma and Orthopaedics, Princess Alexandra Hospital, Brisbane, Queensland, QLD 4102, Australia
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Qiu YY, Yan CH, Chiu KY, Ng FY. Review article: Treatments for bone loss in revision total knee arthroplasty. J Orthop Surg (Hong Kong) 2012; 20:78-86. [PMID: 22535817 DOI: 10.1177/230949901202000116] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Bone deficiency hinders implant alignment and stabilisation of the bone-implant interface in revision total knee arthroplasty (TKA). Treatments for bone defects include bone cement, bone cement with screw reinforcement, metal augments, impaction bone grafts, structural allografts, and tantalum, depending on the location and size of the defects. Small defects are usually treated with cement, cement plus screws, or impaction allograft bone. Large defects are repaired with structural allografts or metal augments. Recent developments involve the use of highly porous osteoconductive tantalum. We reviewed the pros and cons of each method for bone defect management in revision TKA.
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Affiliation(s)
- Yi Yan Qiu
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong
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Confalonieri N, Manzotti A, Chemello C, Cerveri P. Computer-assisted revision of failed unicompartmental knee arthroplasty. Orthopedics 2010; 33:52-7. [PMID: 20954631 DOI: 10.3928/01477447-20100510-51] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The authors performed a matched-paired study comparing 22 computer-assisted surgery (CAS)-unicompartmental knee replacement (UKR) revisions with a similar group of knee replacement revisions performed conventionally. The aim of the study was to assess differences in implants used in the revision, surgical time, limb alignment, joint line restoration, and procedure costs. In the conventional group, there was a higher percentage of posterior stabilized (PS) and condylar constrained knee (CCK) implants, as well as a higher percentage of augmentations/stems/offsets. There were no statistically significant differences in postoperative mechanical axis, surgical time, or hospital stay. There were fewer outliers and better joint line restoration in the CAS group. More blood transfusions were performed in the conventional group, and costs were higher in this group as well.
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Affiliation(s)
- Norberto Confalonieri
- 1st Orthopedic Department, C.T.O. Hospital, Instituti Clinici di Istituti Clinici de Perfezionamento, Milan, Italy
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Maduekwe UI, Zywiel MG, Bonutti PM, Johnson AJ, Delanois RE, Mont MA. Scientific evidence for the use of modern unicompartmental knee arthroplasty. Expert Rev Med Devices 2010; 7:219-39. [PMID: 20214428 DOI: 10.1586/erd.09.65] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Unicompartmental knee arthroplasty as a surgical treatment for monocompartmental knee arthritis remains a controversial procedure with questions surrounding the benefits and survivorship of the procedure versus osteotomies or total knee arthroplasties. The authors, by examining the complete body of literature for scientific evidence concerning the procedure, will describe the history of usage of these prostheses, their rationale for usage, modern devices and their results, and why they may have advantages as a treatment modality for monocompartmental knee arthritis. Outcomes of current unicompartmental designs will be presented and evaluated to determine which aspects of the design and patient selection technique are associated with success or failure. Commonly asked questions regarding the use of these devices will be addressed. The authors will also describe some potential modifications that might affect the use of these components in the future, including minimally invasive procedures and robotics, and how these devices may change over the next 5 years.
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Affiliation(s)
- Uma I Maduekwe
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215, USA
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John J, Mauffrey C, May P. Unicompartmental knee replacements with Miller-Galante prosthesis: two to 16-year follow-up of a single surgeon series. INTERNATIONAL ORTHOPAEDICS 2010; 35:507-13. [PMID: 20419454 DOI: 10.1007/s00264-010-1006-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Revised: 02/13/2010] [Accepted: 03/15/2010] [Indexed: 11/26/2022]
Abstract
We report the outcome of 94 Miller-Galante unicompartmental knee replacements done by a single surgeon over 16 years in a district general hospital in the UK. Patellofemoral arthritis was considered a contraindication only if symptomatic and confirmed on radiography and surgery. Deformity when present was correctable. The mean age at surgery was 66.54 years. The mean follow-up was 10.8 years (2-16 years). The mean Bristol knee score was 43.1 (28-50); 86% of the patients had good or excellent scores. The average range of flexion was 110.6° (80-130°); 89% of the knees had an appropriate alignment. Using revision as the endpoint, outcome for every knee was established. The survival rate for medial unicompartmental knee replacements was 94% at ten years and 87% at 15 years. Although the survival rate for the lateral unicompartmental knee replacement was 97% at five years, it dropped to 41% at eight years. Lateral unicompartmental knee replacements formed only 9.6% of all the replacements in this series. The results for medial unicompartmental knee replacements are similar to reports by other authors for similar and mobile bearing designs. Unicompartmental knee replacement results in a more kinematic knee and produces good functional results.
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Affiliation(s)
- Joby John
- Department of Trauma and Orthopaedics, Royal Derby Hospital, Derby City, UK.
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Whittaker JP, Naudie DDR, McAuley JP, McCalden RW, MacDonald SJ, Bourne RB. Does bearing design influence midterm survivorship of unicompartmental arthroplasty? Clin Orthop Relat Res 2010; 468:73-81. [PMID: 19597898 PMCID: PMC2795843 DOI: 10.1007/s11999-009-0975-7] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2009] [Accepted: 06/24/2009] [Indexed: 01/31/2023]
Abstract
UNLABELLED Medial unicompartmental arthroplasties (UKA) are available with mobile- and fixed-bearing designs, with the advantages of one bearing over another unproven. We questioned whether the bearing design influenced clinical outcome, survivorship, the reason for revision, or the timing of failures. We retrospectively reviewed 179 patients (229 knees) who had medial unicompartmental knee arthroplasties between 1990 and 2007; of these 79 knees had a mobile-bearing design and 150 knees a fixed-bearing design. Patients with mobile-bearing UKA had a minimum followup of 1 year (mean, 3.6 years; range, 1-11.3 years); those with fixed-bearing UKA a minimum followup of 1 year (mean, 8.1 years; range, 1-17.8 years). Patients were evaluated with clinical outcome scores and radiographically using the Knee Society rating system. Seven of 79 (9%) mobile-bearing knees underwent revision at a mean of 2.6 years, and 22 of 150 (15%) fixed-bearing knees underwent revision at a mean of 6.9 years. The 5-year cumulative survival rates were 88% (SE +/- 0.47, 95% CI 0.7229-1) and 96% (SE +/- 0.16, 95% CI 0.93-0.9979) for the mobile- and fixed-bearing designs respectively using the endpoint of revision surgery. We observed no differences in the indications or complexity of revision surgery between the groups and none in midterm survivorship. LEVEL OF EVIDENCE Level III, comparative study. See Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
| | - Douglas D. R. Naudie
- Division of Orthopaedic Surgery, London Health Sciences Centre, University Campus, University of Western Ontario, London, ON Canada
| | - James P. McAuley
- Division of Orthopaedic Surgery, London Health Sciences Centre, University Campus, University of Western Ontario, London, ON Canada
| | - Richard W. McCalden
- Division of Orthopaedic Surgery, London Health Sciences Centre, University Campus, University of Western Ontario, London, ON Canada
| | - Steven J. MacDonald
- Division of Orthopaedic Surgery, London Health Sciences Centre, University Campus, University of Western Ontario, London, ON Canada
| | - Robert B. Bourne
- Division of Orthopaedic Surgery, London Health Sciences Centre, University Campus, University of Western Ontario, London, ON Canada
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Clarius M, Hauck C, Seeger JB, Pritsch M, Merle C, Aldinger PR. Correlation of positioning and clinical results in Oxford UKA. INTERNATIONAL ORTHOPAEDICS 2009; 34:1145-51. [PMID: 19813012 DOI: 10.1007/s00264-009-0881-3] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2009] [Revised: 09/14/2009] [Accepted: 09/14/2009] [Indexed: 12/22/2022]
Abstract
In a prospective clinical study, 59 patients with anteromedial osteoarthritis of the knee (61 knee joints) underwent minimally invasive medial Oxford unicompartmental arthroplasty phase 3. Clinical and radiographic examinations of 56 knees were carried out at five (4-7) years. American Knee Society (AKS) scores improved from mean 45.5 (20-80) points (knee score) and 55 (15-100) points (function score) before surgery to 90 (30-100) points in both scores after surgery. The position of each implant was determined on screened radiographs using an image intensifier. The implant position was analysed according to the Oxford X-ray rating system. We evaluated nine measures, and there was no detectable correlation between implant position and clinical result. However, long-term studies are needed before it is possible to elaborate an evidence-based guideline on positioning.
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Berend KR, George J, Lombardi AV. Unicompartmental knee arthroplasty to total knee arthroplasty conversion: assuring a primary outcome. Orthopedics 2009; 32:orthopedics.42853. [PMID: 19751000 DOI: 10.3928/01477447-20090728-32] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Converting unicompartmental knee arthroplasty (UKA) to total knee arthroplasty can be difficult, and specialized techniques are needed. Issues include bone loss, joint-line, sizing, and rotation. Determining the complexity of conversion preoperatively helps predict the need for augmentation, grafting, stems, or constraint. We examined insert thickness, augmentation, stem use, and effect of failure mode on complexity of UKA conversion. Fifty cases (1997-2007) were reviewed: 9 implants (18%) were modular fixed-bearing, 4 (8%) were metal-backed nonmodular fixed-bearing, 8 (16%) were resurfacing onlay, 10 (20%) were all-polyethylene step-cut, and 19 (38%) were mobile bearing designs; 5 knees (10%) failed due to infection, 5 (10%) due to wear and/or instability, 10 (20%) for pain or progression of arthritis, 8 (16%) for tibial fracture or severe subsidence, and 22 (44%) due to loosening of either one or both components. Complexity was evaluated using analysis of variance and chi-squared 2-by-k test (80% power; 95% confidence interval). Insert thickness was no different between implants (P=.23) or failure modes (P=.27). Stemmed component use was most frequent with nonmodular components (50%), all-polyethylene step-cut implants (44%), and modular fixed-bearing implants (33%; P=.40). Stem use was highest in tibial fracture (86%; P=.002). Augment use was highest among all-polyethylene step-cut implants (all-polyethylene, 56%; metal-backed, 50%; modular fixed-bearing, 33%; P=.01). Augmentation use was highest in fracture (86%) and infection (67%), with a significant difference noted between failure modes (P=.003). Failure of nonmodular all-polyethylene step-cut devices was more complex than resurfacing or mobile bearing. Failure mode was predictive of complexity. Reestablishing the joint-line, ligamentous balance, and durable fixation are critical to assuring a primary outcome.
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Affiliation(s)
- Keith R Berend
- Joint Implant Surgeons Inc., 7277 Smith's Mill Road, New Albany, OH 43054, USA
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Järvenpää J, Kettunen J, Miettinen H, Kröger H. The clinical outcome of revision knee replacement after unicompartmental knee arthroplasty versus primary total knee arthroplasty: 8-17 years follow-up study of 49 patients. INTERNATIONAL ORTHOPAEDICS 2009; 34:649-53. [PMID: 19471929 DOI: 10.1007/s00264-009-0811-4] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2009] [Revised: 05/06/2009] [Accepted: 05/08/2009] [Indexed: 10/20/2022]
Abstract
When unicompartmental knee arthroplasty (UKA) failure occurs, a revision procedure to total knee arthroplasty (TKA) is often necessary. We compared the long-term results of this procedure to primary TKA and evaluated whether they are clinically comparable. Twenty-one patients underwent UKA conversion to TKA between 1991 and 2000. The results of these patients were compared to the group of 28 primary TKA patients with the same age, sex and operation time point. The long-term outcomes were evaluated using clinical and radiological analysis. The mean follow-up period of the patients was 10.5 years. The UKA revision patients were more dissatisfied, as measured by the WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) scale (0-100 mm) compared to the primary TKA patients (pain 18.1/7.8; p = 0.014; stiffness 25.7/14.4, p = 0.024; physical function 19.0/14.8, p = 0.62). Two patients were revised twice in the UKA revision group. There was one revision in the primary TKA group (p = 0.39). Improvement in range of motion (ROM) was better in the TKA patients compared to the UKA revision patients (8.2 degrees /-2.6 degrees , p = 0.0001). We suggest that UKA conversion to TKA is associated with poorer clinical outcome as compared to primary TKA.
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Affiliation(s)
- Jaakko Järvenpää
- Faculty of Medicine, Bone and Cartilage Unit, University of Kuopio, Kuopio, Finland.
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