Articles de revues : « Unicompartmental Knee Replacement (UKR) »

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Kennedy, J. A., E. Burn, H. R. Mohammad, S. J. Mellon, A. Judge et D. W. Murray. « Lifetime revision risk for medial unicompartmental knee replacement is lower than expected ». Knee Surgery, Sports Traumatology, Arthroscopy 28, n^o 12 (12 février 2020) : 3935–41. http://dx.doi.org/10.1007/s00167-020-05863-3.

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Abstract Purpose Unicompartmental knee replacement (UKR) is widely considered to be a pre-total knee replacement (TKR) particularly in the young. The implication of this is that it is sensible to do a UKR, even though it will be revised at some stage, as it will delay the need for a TKR. The chance of a UKR being revised during a patient’s life time has not previously been calculated. The aim of this study was to estimate this lifetime revision risks for patients of different ages undergoing UKR. Methods Calculations were based on data from a designer series of 1000 medial Oxford UKR with mean 10-year follow up. These UKR were implanted for the recommended indications using the recommended surgical technique. Parametric survival models were developed for patients of different ages based on observed data, and were extrapolated using a Markov model to estimate lifetime revision risk. Results The estimated lifetime revision risk reduced with increasing age at surgery. Lifetime revision risk at age 55 was 15% (95% CI 12–19), at 65 it was 11% (8–13), at 75 it was 7% (5–9), and at 85 it was 4% (3–5). Conclusion Provided UKR is used appropriately, the lifetime revision risk is markedly lower than expected. UKR should be considered to be a definitive knee replacement rather than a Pre-TKR even in the young. These lifetime estimates, alongside established benefits for UKR in speed of recovery, morbidity, mortality and function, can be discussed with appropriate patients when considering whether to implant a UKR or TKR. Level of evidence III.

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Yu, Hiu-Kiu, Bruce Yan-Ho Tang, Hok-Leung Wong, Sumire Sasaki et Tai-Fong Wong. « Better immediate and early postoperative outcomes of unicompartmental knee replacement comparing with total knee replacement : A matched cohort of patients with medial knee osteoarthritis ». Journal of Orthopaedics, Trauma and Rehabilitation 28 (janvier 2021) : 221049172110569. http://dx.doi.org/10.1177/22104917211056951.

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Introduction: This study compared the immediate and early postoperative outcomes of medial compartment knee osteoarthritis patients receiving unicompartmental knee replacement (UKR) with a matched cohort of total knee replacement (TKR). Methods: 26 UKR patients were matched with 26 TKR patients based on age, body mass index, pre-operative radiographic severity, range of motion (ROM), Knee Society score (KSS) and Feller patella score. Immediate postoperative outcomes were reflected by postoperative pain, blood loss, length of stay and the number of physiotherapy sessions attended. Early postoperative outcomes (ROM and KSS) were measured at 3 months and 1 year post-operatively. Results: UKR patients had less hemoglobin drop (UKR: 1.2 g/dL, TKR: 1.6 g/dL, p = 0.04), shorter length of stay (UKR: 4.3 days, TKR: 6.0 days, p < 0.001) and required less physiotherapy sessions for recovery (UKR: 6.9 sessions, TKR: 9.3 sessions, p < 0.05). There were no statistically significant differences in early post-operative pain score and postoperative analgesia use ( p > 0.05) between the two groups. Patients receiving UKR had significantly higher post-operative KSS (UKR: 155.9, TKR: 142.4, p = 0.005) and ROM (UKR: 115.8o, TKR: 98.8o, p < 0.001) at 3 months. The KSS and ROM of UKR group at 3 months was better than TKR group at 1-year follow-up. Conclusion: In patients with medial knee osteoarthritis, UKR showed less postoperative analgesic use and blood loss, shorter length of stay, shorter course of rehabilitation and faster recovery with better early KSS and ROM than TKR. Follow up is necessary for comparison in long term outcome and survivorship between the two groups.

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Ventura, Alberto, Claudio Legnani, Clara Terzaghi, Vittorio Macchi et Enrico Borgo. « Unicompartmental Knee Replacement Combined to Anterior Cruciate Ligament Reconstruction : Midterm Results ». Journal of Knee Surgery 33, n^o 11 (3 juillet 2019) : 1152–56. http://dx.doi.org/10.1055/s-0039-1692647.

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AbstractA study was conducted to retrospectively evaluate the outcomes of combined medial unicompartmental knee replacement (UKR) and anterior cruciate ligament (ACL) reconstruction. The hypothesis was that this procedure would lead to satisfying results in patients affected by medial osteoarthritis and ACL insufficiency. Fourteen patients with ACL deficiency and concomitant medial compartment symptomatic osteoarthritis were treated from 2006 to 2010. Twelve of them were followed-up for an average time of 7.8 year (range: 6–10 years). Assessment included Knee Osteoarthritis Outcome score (KOOS), Oxford Knee score (OKS), American Knee Society scores (AKSS), Western Ontario and McMaster (WOMAC) index of osteoarthritis, Tegner's activity level, objective examination including instrumented laxity test with KT-1000 arthrometer, and standard X-rays. KOOS score, OKS, WOMAC index, and the AKSS improved significantly at follow-up (p < 0.001). There was no clinical evidence of instability in any of the knees as evaluated with clinical and instrumented laxity testing (p < 0.001). No pathologic radiolucent lines were observed around the components. In one patient, a total knee prosthesis was implanted due to the progression of signs of osteoarthritis in the lateral compartment 3 years after primary surgery. UKR combined with ACL reconstruction is an effective therapeutic option for the treatment of combined medial unicompartmental knee osteoarthritis and ACL deficiency and confirms subjective and objective clinical improvement up to 8 years after surgery. This study reflects level IV evidence.

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Hariri, Mustafa, Merlin Hagemann, Paul Mick, Julian Deisenhofer, Benjamin Panzram, Moritz Innmann, Tobias Reiner, Tobias Renkawitz et Tilman Walker. « Physical Activity of Young Patients Following Minimally Invasive Lateral Unicompartmental Knee Replacement ». Journal of Clinical Medicine 12, n^o 2 (12 janvier 2023) : 635. http://dx.doi.org/10.3390/jcm12020635.

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Unicompartmental knee replacement (UKR) has increased in popularity in recent years, especially in young patients with high demands on their athletic ability. To date, there are no data available on the physical activity of young patients following lateral UKR. The aim of this study was to demonstrate return-to-activity rate and sporting activity of patients aged 60 years or younger following lateral UKR with a fixed-bearing (FB) prosthesis. Thirty-seven patients aged 60 years or younger after lateral FB-UKR were included. Sporting activities were assessed using the University of California Los Angeles activity scale (UCLA) and the Tegner activity score (TAS). Clinical outcome was measured using the Oxford Knee Score (OKS), range of motion (ROM) and visual analogue scale (VAS). The mean follow-up (FU) was 3.1 ± 1.5 years and the mean age at surgery was 52.8 ± 3.1 years. The return-to-activity rate was 87.5% and 49% of patients were highly active postoperatively as defined by an UCLA score of 7 or higher. All clinical parameters increased significantly postoperatively. We demonstrated a high return-to-activity rate with nearly half of the patients achieving high activity levels. Longer FU periods are necessary to evaluate the effect of activity on implant survival.

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Rajani, Amyn M., Kareena Rajani, Urvil A. Shah, Anmol RS Mittal, Rahul Sheth et Meenakshi Punamiya. « Pseudoaneurysm of the Lateral Genicular Artery Following Unicompartmental knee Arthroplasty : A Rare Case Report ». Journal of Orthopaedic Case Reports 12, n^o 8 (2022) : 57–60. http://dx.doi.org/10.13107/jocr.2022.v12.i08.2964.

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Introduction: Unicondylar knee replacement is a minimally invasive technique of surface replacement of the knee joint. Very little literature is available regarding vascular complications in patients who undergo this procedure due to their extremely rare nature. Case Report: This first-of-its-kind report describes a case of pseudoaneurysm of the lateral genicular artery of the right knee in a hypertensive, 65-year-old man, following a single sitting bilateral unicompartmental knee replacement (UKR). With no involvement of the lateral compartment in UKR, we suspect an underlying mechanical element as the cause of the pseudoaneurysm. Patient presented with swelling and pain in the right knee for the first time at 8-month postoperatively, and after aspiration of the hemarthrosis, had two events of recurrence with increasing frequency. Dynamic magnetic resonance angiography confirmed the diagnosis and the patient underwent angiography-guided embolization of the lateral genicular artery using polyvinyl alcohol particles, with no recurrence in over a year since then. Conclusion: Pseudoaneurysm of the lateral genicular artery is a possible cause of recurrent hemarthrosis even after unicondylar knee replacement and requires a high degree of suspicion for its timely diagnosis and management.

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Panzram, Benjamin, Mira Mandery, Tobias Reiner, Tobias Gotterbarm, Marcus Schiltenwolf et Christian Merle. « Cementless Oxford Medial Unicompartmental Knee Replacement—Clinical and Radiological Results of 228 Knees with a Minimum 2-Year Follow-Up ». Journal of Clinical Medicine 9, n^o 5 (14 mai 2020) : 1476. http://dx.doi.org/10.3390/jcm9051476.

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(1) Background: Studies show several advantages of unicompartmental knee replacement (UKR) over total knee replacements (TKR), whereas registry based revision rates of UKR are significantly higher than for TKA. Registry data report lower revision rates for cementless UKR compared to cemented UKR. The aim of this study was to assess clinical and radiological results of cementless Oxford UKR (OUKR) in an independent cohort. (2) Methods: This retrospective cohort study examines a consecutive series of 228 cementless OUKR. Clinical outcome was measured using functional scores (Oxford Knee Score (OKS), American Knee Society Score (AKSS), Hannover Functional Ability Questionnaire for Osteoarthritis (FFbH-OA), range of motion (ROM)), pain and satisfaction. Radiographs were analyzed regarding the incidence of radiolucent lines (RL), implant positioning, and their possible impact on clinical outcome. (3) Results: At a mean follow-up of 37.1 months, the two and three year revision free survival-rates were 97.5% and 96.9%. Reasons for revision surgery were progression of osteoarthritis, inlay dislocation and pain. All clinical outcome scores showed a significant improvement from pre- to postoperative. The incidence of RL around the implant was highest within the first year postoperatively (36%), and decreased (5%) within the second year. Their presence was not correlated with inferior clinical outcome. Implant positioning showed no influence on clinical outcome. (4) Conclusion: Cementless OUKR showed excellent clinical outcome and survival rates, with reliable osteointegration. Neither the incidence of radiolucent lines nor implant positioning were associated with inferior clinical outcome.

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Daly, D., et R. Maxwell. « TEN YEARS OF COMBINED ACL RECONSTRUCTION AND UNICOMPARTMENTAL KNEE ARTHROPLASTIES ». Orthopaedic Proceedings 105-B, SUPP_2 (février 2023) : 60. http://dx.doi.org/10.1302/1358-992x.2023.2.060.

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The purpose of this study is to assess the long term results of combined ACL reconstruction and unicompartmental knee replacements (UKR). These patients have been selected for this combined operation due to their combination of instability symptoms from an absent ACL and unicompartmental arthritis.Retrospective review of 44 combined UKR and ACL reconstruction by a single surgeon. Surgeries included both medial and lateral UKR combined with either revision ACL reconstruction or primary ACL reconstruction. Patient reported outcomes were obtained preoperatively, at one year, 5 years and 10 years. Revision rate was followed up over 13 years for a mean of 7.4 years post-surgery.The average Oxford score at one year was 43 with an average increase from pre-operation to 1 year post operation of 15. For the 7 patients with 10 year follow up average oxford score was 42 at 1 year, 43 at 5 years and 45 at 10 years.There were 5 reoperations. 2 for revision to total knee arthroplasty and 1 for an exchange of bearing due to wear. The other 2 were the addition of another UKR. For those requiring reoperation the average time was 8 years.Younger more active patients presenting with ACL deficiency causing instability and unicompartmental arthritis are a difficult group to manage. Combining UKR and ACL reconstruction has scant evidence in regard to long term follow up but is a viable option for this select group. This paper has one of the largest cohorts with a reasonable follow up averaging 7.4 years and a revision rate of 11 percent.Combined unilateral knee replacements and ACL reconstruction can be a successful operation for patients with ACL rupture causing instability and unicompartmental arthritis.

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Tang, Bruce Yan Ho, Chi Nok Cheung, Hon For Tsui et Hok Leung Wong. « Early promising result of bicompartmental knee replacement in middle-aged patients ». Journal of Orthopaedics, Trauma and Rehabilitation 26, n^o 2 (13 juin 2019) : 85–88. http://dx.doi.org/10.1177/2210491719848758.

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Introduction: Partial knee replacement (PKR) is one of the treatment options in middle-aged patients with less extensive knee osteoarthritis, with unicompartmental knee replacement (UKR) most commonly done for medial osteoarthritis. There are numerous advantages like bone/ligament preserving and faster recovery. However, the indications of UKR remain controversial, as most patients have some patellofemoral joint (PFJ) osteoarthritis. We performed modular bicruciate-retaining bicompartmental knee replacement (BKR) in this group of patients and compared the outcome with total knee replacement (TKR). Materials and Methods: From 2016 to 2017, 14 BKR were performed in patients with medial and PFJ osteoarthritis. They were retrospectively compared with 14 TKR performed in patients with similar age and severity. The incision length, operative time, blood loss (in terms of hemoglobin drop), and length of stay were recorded. Pre- and postoperative range of motion and Knee Society knee score at 1-year follow-up were compared. Results: The mean incision length for BKR was shorter than TKR (130.1 vs. 185.1 mm), but the mean operative time was also longer (152.6 vs. 88.1 min). There was also less mean hemoglobin drop (1.8 vs. 2.6 g/dL) and shorter length of stay (7.4 vs. 9.2 days). The mean postoperative function score is better in BKR group (90.4 vs. 77.5), and the mean postoperative knee score (87.2 vs 88.9) and flexion (115.7° vs. 111.4°) were similar for both groups. Discussion: In selected patients, BKR is a good alternative to TKR. It preserves advantages of UKR while also tackle the PFJ which is the most controversial aspect of UKR. The early clinical outcome in our study is promising. However, there is a learning curve. Longer follow-up is necessary to study on the performance and survivorship as compared with UKR and TKR.

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Spinelli, M., S. Affatato, M. K. Harman et J. D. DesJardins. « Bi-unicondylar knee prosthesis functional assessment utilizing force-control wear testing ». Proceedings of the Institution of Mechanical Engineers, Part H : Journal of Engineering in Medicine 224, n^o 7 (28 décembre 2009) : 813–21. http://dx.doi.org/10.1243/09544119jeim726.

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Recent in vivo studies have identified variations in knee prosthesis function depending on prosthesis geometry, kinematic conditions, and the absence/presence of soft-tissue constraints after knee replacement surgery. In particular, unicondylar knee replacements (UKR) are highly sensitive to such variations. However, rigorous descriptions of UKR function through experimental simulation studies, performed under physiological force-controlled conditions, are lacking. The current study evaluated the long-term functional performance of a widely used fixed-bearing unicompartmental knee replacement, mounted in a bi-unicondylar configuration (Bi-UKR), utilizing a force-controlled knee simulator during a simulated (ISO 14243) walking cycle. The wear behaviour, the femoral—tibial kinematics, and the incurred damage scars were analysed. The wear rates for the medial and the lateral compartments were 10.27 ± 1.83 mg/million cycles and 4.49 ± 0.53 mg/million cycles, respectively. Although constant-input force-controlled loading conditions were maintained throughout the simulation, femoral—tibial contact point kinematics decreased by 65 to 68 per cent for average anterior/posterior travel and by 58 to 74 per cent for average medial/lateral travel with increasing cycling time up to 2 million cycles. There were no significant differences in damage area or damage extent between the medial and the lateral compartments. Focal damage scars representing the working region of the femoral component on the articular surface extended over a range of 16—21 mm in the anterior—posterior direction. Kinematics on the shear plane showed slight variations with increasing cycling time, and the platform exhibited medial pivoting over the entire test. These measures provide valuable experimental insight into the effect of the prosthesis design on wear, kinematics, and working area. These functional assessments of Bi-UKR under force-controlled knee joint wear simulation show that accumulated changes in the UKR articular conformity manifested as altered kinematics both for anterior/posterior translations and internal/external rotations.

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Mowbray, J., C. Frampton, R. Maxwell et G. Hooper. « SIXTEEN-YEAR SURVIVAL AND FUNCTIONAL RESULTS OF THE CEMENTLESS OXFORD UNICOMPARTMENTAL KNEE REPLACEMENT ». Orthopaedic Proceedings 105-B, SUPP_2 (février 2023) : 95. http://dx.doi.org/10.1302/1358-992x.2023.2.095.

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Cementless fixation is an alternative to cemented unicompartmental knee replacement (UKR), with several advantages over cementation. This study reports on the 15-year survival and 10-year clinical outcomes of the cementless Oxford unicompartmental knee replacement (OUKR).This prospective study describes the clinical outcomes and survival of first 693 consecutive cementless medial OUKRs implanted in New Zealand.The sixteen-year survival was 89.2%, with forty-six knees being revised. The commonest reason for revision was progression of arthritis, which occurred in twenty-three knees, followed by primary dislocation of the bearing, which occurred in nine knees. There were two bearing dislocations secondary to trauma and a ruptured ACL, and two tibial plateau fractures. There were four revisions for polyethylene wear. There were four revisions for aseptic tibial loosening, and one revision for impingement secondary to overhang of the tibial component. There was only one revision for deep infection and one revision where the indication was not stated. The mean OKS improved from 23.3 (7.4 SD) to 40.59 (SD 6.8) at a mean follow-up of sixteen years.In conclusion, the cementless OUKR is a safe and reproducible procedure with excellent sixteen-year survival and clinical outcomes.

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Campbell, T., L. Hill, H. Wong, D. Dow, O. Stevenson, M. L. Tay, J. T. Munro, S. Young et A. P. Monk. « THE USE OF MRI IN PREOPERATIVE PLANNING FOR MEDIAL UNICOMPARTMENTAL KNEE ARTHROPLASTY ». Orthopaedic Proceedings 105-B, SUPP_3 (février 2023) : 102. http://dx.doi.org/10.1302/1358-992x.2023.3.102.

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Contemporary indications for unicompartmental knee replacement (UKR) include bone on bone radiographic changes in the medial compartment with relatively preserved lateral and patellofemoral compartments. The role of MRI in identifying candidates for UKR is commonplace. The aim of this study was to assess the relationship between radiographic and MRI pre-operative grade and outcome following UKR.A retrospective analysis of medial UKR patients from 2017 to 2021. Inclusion criteria were medial UKR for osteoarthritis with pre-operative and post-operative Oxford Knee Scores (OKS), pre-operative radiographs and MRI.89 patients were included. Whilst all patients had grade 4 ICRS scores on MRI, 36/89 patients had grade 3 KL radiographic scores in the medial compartment, 50/89 had grade 4 KL scores on the medial compartment. Grade 3 KL with grade 4 IRCS medial compartment patients had a mean OKS change of 17.22 (Sd 9.190) meanwhile Grade 4 KL had a mean change of 17.54 (SD 9.001), with no statistical difference in the OKS change score following UKR between these two groups (p=0.873). Medial bone oedema was present in all but one patient. Whilst lateral compartment MRI ICRS scores ranged from 1 to 4 there was no association with MRI score of the lateral compartment and subsequent change in oxford score (P value 0.458). Patellofemoral Compartment (PFC) MRI ICRS ranged from 0 to 4. There was no association between PFC ICRS score and subsequent change in oxford knee score (P value .276)Radiographs may under report severity of some medial sided knee osteoarthritis. We conclude that in patients with grade 3 KL score that would normally not be considered for UKR, pre-operative MRI might identify grade 4 ICRS scores and this subset of patients have equivalent outcomes to patients with radiographic Grade 4 KL medial compartment osteoarthritis.

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Legnani, Claudio, Andrea Parente, Franco Parente et Alberto Ventura. « Medial unicompartmental knee replacement is a viable treatment option after failed high tibial osteotomy : a systematic review ». EFORT Open Reviews 7, n^o 8 (1 août 2022) : 569–75. http://dx.doi.org/10.1530/eor-21-0133.

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Purpose It is debatable whether or not previous high tibial osteotomy (HTO) has negative effects on the results of subsequent medial unicompartmental knee replacement (UKR). The purpose of this study is to report, through a systematic review of the literature, the outcomes of medial UKR after failed HTO. It was hypothesized that this procedure would be safe and effective in providing satisfactory postoperative functional outcomes. Methods A systematic review was performed by searching Pubmed/MEDLINE, Embase and CINAHL. Only studies in English pertaining to all levels of evidence reporting on subjects undergoing UKR following HTO were considered. Review articles and expert opinion or editorial pieces were excluded. Outcomes of interest included indications, surgical technique and associated procedures, type of prosthesis, clinical and functional outcomes, rate of complications, revision surgery and failure rate. Results Overall, six studies met all the inclusion criteria for this review. All were published between 2006 and 2021. The search resulted in one prospective comparative study, four retrospective comparative cohort studies, and one retrospective cohort study. Average follow-up periods ranged from 1 to 13 years. From these studies, 115 patients (117 knees) were identified. Overall, most studies reported satisfying postoperative clinical and functional outcomes. Implant survivorship ranged from 66 to 97.6%. In 15 patients, revision surgery was performed due to persistent pain. Conclusions Medial UKR performed after failed HTO appears as a feasible procedure providing satisfying outcomes and limited complications in most cases. Further prospective comparative studies reporting long-term outcomes are needed, as high-level studies on this topic are lacking.

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Asma, Ali, Mehmet Erduran et Musa Eymir. « An Unusual Presentation of Insert Dislocation and MCL Rupture in Unicompartmental Knee Replacement with 2 Years Postoperative Results : Does It Functional ? » Case Reports in Orthopedics 2019 (14 mai 2019) : 1–5. http://dx.doi.org/10.1155/2019/2634738.

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According to our knowledge, there is no prior article that reports functional results of medial collateral ligament (MCL) primary repair and insert change after MCL rupture and mobile-bearing dislocation as a late complication of unicompartmental knee replacement (UKR). Firstly, 63-year-old woman was treated with UKR due to anteromedial knee osteoarthritis of the right knee joint. 1 year after UKR surgery, she suffered from MCL rupture and mobile-bearing dislocation because of falls while getting on a public bus, and therefore, secondly, she was operated with MCL primary repair and mobile-bearing change and followed up for 2 years. The patient was evaluated regarding functional capacity, pain intensity, range of motion (RoM), and quality of life. Our case showed an improvement in the functional level and the other outcomes (pain intensity and quality of life) at postoperative 2nd year when compared to the preoperative period. The wellbeing of our case in about the postop 2nd year functional capacity and also other outcomes after revision surgery prompted us to continue to this surgery approach in the surgical management of similar cases that may arise thereafter.

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Hefny, Mamdouh H., Nick A. Smith et Jon Waite. « Cemented Lateral Unicompartmental Knee Replacement : A retrospective single centre independent series ». Journal of Orthopaedics, Trauma and Rehabilitation 29, n^o 1 (3 mars 2022) : 221049172210758. http://dx.doi.org/10.1177/22104917221075822.

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Background Unicompartmental knee replacement (UKR) has functional and economic benefits when compared with total knee replacement, however it is technically demanding and may be associated with higher failure rates. The primary aim of this independent series study was to evaluate the survival of lateral UKRs implanted in our institution and their clinical outcomes. The secondary outcome was to compare the results of mobile and fixed-bearing prostheses. Methods This is a retrospective series study of 183 cemented lateral UKRs implanted in 170 patients, for advanced isolated lateral compartment arthritis, under the care of two senior surgeons. Fixed or mobile-bearing prostheses were used according to the surgeon's preference. Kaplan Meier analysis was used to evaluate prosthesis survival with the endpoint being revision for any reason. A subgroup analysis of survival was also done for each bearing type. Functional outcomes were evaluated using the Oxford knee score (OKS) at final follow-up. Results This series included 103 Fixed-bearing and 80 mobile-bearing prostheses. Median follow-up was 6.9 years. 9 knees required revision. The commonest reason for revision was progression of arthritis to the medial compartment. Dislocation was the commonest cause of revision in the mobile-bearing group. Survival at 10 years was 91.9% with no significant difference ( p = 0.083) between bearing types (fixed-bearing 93.8% and mobile-bearing 90.6%). The OKS were comparable in both groups, the mean OKS was 44/48. Conclusion Good survival and functional outcomes can be achieved using cemented lateral UKRs with both bearing types. There was a trend towards superior outcomes in the fixed-bearing group.

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Panzram, Benjamin, Frederik Barbian, Tobias Reiner, Mustafa Hariri, Tobias Renkawitz et Tilman Walker. « Clinical and Functional Results of Cementless Unicompartmental Knee Arthroplasty with a Minimum Follow Up of 5 Years—A Consecutive Cohort of 201 Patients ». Journal of Clinical Medicine 12, n^o 4 (20 février 2023) : 1694. http://dx.doi.org/10.3390/jcm12041694.

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The number of unicompartmental knee replacements (UKR) is increasing. Alongside various advantages, the revision rate of cemented UKR is higher compared to total knee arthroplasty (TKR). In contrast, cementless fixation shows reduced revision rates, compared to the cemented UKR. However, most of the recent literature is based on designer-dependent studies. In this retrospective, single-center cohort study, we investigated patients who underwent cementless Oxford UKR (OUKR) between 2012 and 2016 in our hospital with a minimum follow-up of five years. Clinical outcome was evaluated using the OKS, AKSS-O, AKSS-F, FFbH-OA, UCLA, SF-36, EQ-5D-3L, FJS, ROM, pain, and satisfaction measures. Survival analysis was performed with reoperation and revision as endpoints. We included 201 patients (216 knees) for clinical evaluation. All outcome parameters increased significantly from pre- to postoperative stages. The five-year survival rate was 96.1% for revision surgery and 94.9% for reoperation. The main reasons for revision were the progression of osteoarthritis, inlay dislocation, and tibial overstuffing. Two iatrogenic tibial fractures appeared. Cementless OUKR shows excellent clinical outcome and high survival rates after five years. The tibial plateau fracture in cementless UKR represents a serious complication and requires modification of the surgical technique.

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Fowler, Timothy J., Alex L. Aquilina, Ashley W. Blom, Adrian Sayers et Michael R. Whitehouse. « Association between surgeon grade and implant survival following hip and knee replacement : a systematic review and meta-analysis ». BMJ Open 11, n^o 11 (novembre 2021) : e047882. http://dx.doi.org/10.1136/bmjopen-2020-047882.

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ObjectiveTo investigate the association between surgeon grade (trainee vs consultant) and implant survival following primary hip and knee replacement.DesignA systematic review and meta-analysis of observational studies.Data sourcesMEDLINE and Embase from inception to 6 October 2021.SettingUnits performing primary hip and/or knee replacements since 1990.ParticipantsAdult patients undergoing either a primary hip or knee replacement, predominantly for osteoarthritis.InterventionWhether the surgeon recorded as performing the procedure was a trainee or not.Primary and secondary outcome measuresThe primary outcome was net implant survival reported as a Kaplan-Meier survival estimate. The secondary outcome was crude revision rate. Both outcomes were reported according to surgeon grade.ResultsNine cohort studies capturing 4066 total hip replacements (THRs), 936 total knee replacements (TKRs) and 1357 unicompartmental knee replacements (UKRs) were included (5 THR studies, 2 TKR studies and 2 UKR studies). The pooled net implant survival estimates for THRs at 5 years were 97.9% (95% CI 96.6% to 99.2%) for trainees and 98.1% (95% CI 97.1% to 99.2%) for consultants. The relative risk of revision of THRs at 5 and 10 years was 0.88 (95% CI 0.46 to 1.70) and 0.68 (95% CI 0.37 to 1.26), respectively. For TKRs, the net implant survival estimates at 10 years were 96.2% (95% CI 94.0% to 98.4%) for trainees and 95.1% (95% CI 93.0% to 97.2%) for consultants. We report a narrative summary of UKR outcomes.ConclusionsThere is no strong evidence in the existing literature that trainee surgeons have worse outcomes compared with consultants, in terms of the net survival or crude revision rate of hip and knee replacements at 5–10 years follow-up. These findings are limited by the quality of the existing published data and are applicable to countries with established orthopaedic training programmes.PROSPERO registration numberCRD42019150494.

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Kennedy, James A., Jeya Palan, Stephen J. Mellon, Colin Esler, Chris A. F. Dodd, Hemant G. Pandit et David W. Murray. « Most unicompartmental knee replacement revisions could be avoided : a radiographic evaluation of revised Oxford knees in the National Joint Registry ». Knee Surgery, Sports Traumatology, Arthroscopy 28, n^o 12 (10 février 2020) : 3926–34. http://dx.doi.org/10.1007/s00167-020-05861-5.

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Abstract Purpose The purpose of this study was to understand why the revision rate of unicompartmental knee replacement (UKR) in the National Joint Registry (NJR) is so high. Using radiographs, the appropriateness of patient selection for primary surgery, surgical technique, and indications for revision were determined. In addition, the alignment of the radiographs was assessed. Methods Oxford UKR registered with the NJR between 2006 and 2010 and subsequently revised were identified by the NJR. A blinded review was undertaken of pre-primary, post-primary, and pre-revision anteroposterior and lateral radiographs of a sample of 107 cases from multiple centres. Results The recommended indications were satisfied in 70%, with 29% not demonstrating bone-on-bone arthritis. Major technical errors, likely leading to revision, were seen in 6%. Pre-revision radiographs were malaligned and, therefore, difficult to interpret in 53%. No reason for revision was seen in 67%. Reasons for revision included lateral compartment arthritis (10%), tibial loosening (7%), bearing dislocation (7%), infection (6%), femoral loosening (3%), and peri-prosthetic fracture (2%, one femoral, one tibial). Conclusions Only 20% of the revised UKR were implanted for the recommended indications, using appropriate surgical technique and had a mechanical problem necessitating revision. One-third of primary surgeries were undertaken in patients with early arthritis, which is contraindicated. Two-thirds were presumably revised for unexplained pain, which is not advised as it tends not to help the pain. This study suggests that variable and inappropriate indications for primary and revision surgery are responsible for the high rates of revision seen in registries. Level of evidence III, Therapeutic study.

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Vashisht, Arun, Gaurav Menwal et Rachit Bhatnagar. « A clinico-radiological evaluation of functional outcome of proximal fibular osteotomy for medial compartment knee osteoarthritis : a new emerging technique ». International Journal of Research in Orthopaedics 6, n^o 3 (22 avril 2020) : 515. http://dx.doi.org/10.18203/issn.2455-4510.intjresorthop20201725.

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Background: The medial compartmental osteoarthritis (OA) knee is initially treated conservatively followed by lateral close/open medial wedge high tibial osteotomy (HTO), or by unicompartmental or total knee replacement (UKR/TKR). Though HTO and UKR/TKR yield good results but are technically more demanding and are fraught with risk of complications, moreover replacement may not be the treatment of choice for younger patients. The objective of this study was to evaluate the efficacy of proximal fibular osteotomy (PFO), a minimally invasive procedure minus risks associated with HTO/TKR.Methods: Thirty-eight patients, 15 males and 23 females with a mean age of 54.46 years (range, 35 to 80 years) underwent PFO for OA knee and were followed for a mean period of 8.63 months (range 6 to 12 months).Results: After PFO all patients experienced immediate significant relief in medial knee pain with improved walking distance. Postoperatively, all patients showed radiological improvement in femorotibial angle (FTA), medial/lateral joint space ratio.Conclusions: PFO is safe, minimally invasive technique with minimal complications. It gives immediate relief of medial knee pain with improved function of joint.

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Mohammad, Hasan R., Andrew Judge et David W. Murray. « A matched comparison of cementless unicompartmental and total knee replacement outcomes based on the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man ». Acta Orthopaedica 93 (24 mai 2022) : 478–87. http://dx.doi.org/10.2340/17453674.2022.2743.

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Background and purpose: The main treatments for severe medial compartment knee arthritis are unicompartmental (UKR) and total knee replacement (TKR). UKRs have higher revision rates, particularly for aseptic loosening, therefore the cementless version was introduced. We compared the outcomes of matched cementless UKRs and TKRs.Patients and methods: The National Joint Registry was linked to the English Hospital Episode Statistics and Patient Reported Outcome Measures (PROMs) databases. 10,552 cementless UKRs and 10,552 TKRs were propensity matched and regression analysis used to compare revision/reoperation risks. 6-month PROMs were compared. UKR results were stratified by surgeon caseload into low- (< 10 UKRs/year), medium- (10 to < 30 UKRs/year), and high-volume (≥ 30 UKRs/year).Results: 8-year cementless UKR revision survival for the 3 respective caseloads were 90% (95% CI 87–93), 93% (CI 91–95), and 96% (CI 94–97). 8-year reoperation survivals were 76% (CI 71–80), 81% (CI 78–85), and 84% (CI 82–86) respectively. For TKR the 8-year implant survivals for revision and reoperation were 96% (CI 95–97) and 81% (CI 80–83). The HRs for the 3 caseload groups compared with TKR for revision were 2.0 (CI 1.3–2.9), 2.0 (CI 1.6–2.7), and 1.0 (CI 0.8–1.3) and for reoperation were 1.2 (CI 1.0–1.4), 0.9 (CI 0.8–1.0), and 0.6 (CI 0.5–0.7). 6-month Oxford Knee Score (OKS) (39 vs. 37) and EQ-5D (0.80 vs. 0.77) were higher (p < 0.001) for the cementless UKR.Interpretation: Cementless UKRs have higher revision and reoperation rates than TKR for low-volume UKR surgeons, similar reoperation but higher revision rates for mid-volume surgeons, and lower reoperation and similar revision rates for high-volume surgeons. Cementless UKR also had better PROMs.

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Koh, Yong-Gon, Hyoung-Taek Hong et Kyoung-Tak Kang. « Biomechanical Effect of UHMWPE and CFR-PEEK Insert on Tibial Component in Unicompartmental Knee Replacement in Different Varus and Valgus Alignments ». Materials 12, n^o 20 (14 octobre 2019) : 3345. http://dx.doi.org/10.3390/ma12203345.

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The current study aims to analyze the biomechanical effects of ultra-high molecular weight polyethylene (UHMWPE) and carbon-fiber-reinforced polyetheretherketone (CFR-PEEK) inserts, in varus/valgus alignment, for a tibial component, from 9° varus to 9° valgus, in unicompartmental knee replacement (UKR). The effects on bone stress, collateral ligament force, and contact stress on other compartments were evaluated under gait cycle conditions, by using a validated finite element model. In the UHMWPE model, the von Mises’ stress on the cortical bone region significantly increased as the tibial tray was in valgus >6°, which might increase the risk of residual pain, and when in valgus >3° for CFR-PEEK. The contact stress on other UHMWPE compartments decreased in valgus and increased in varus, as compared to the neutral position. In CFR-PEEK, it increased in valgus and decreased in varus. The forces on medial collateral ligaments increased in valgus, when compared to the neutral position in UHMWPE and CFR-PEEK. The results indicate that UKR with UHMWPE showed positive biomechanical outputs under neutral and 3° varus conditions. UKR with CFR-PEEK showed positive biomechanical outputs for up to 6° varus alignments. The valgus alignment should be avoided.

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Gregor, R. H., G. J. Hooper et C. M. A. Frampton. « FIVE- AND TEN-YEAR FOLLOW-UP OF UNICOMPARTMENTAL KNEE ARTHROPLASTIES IN OBESE PATIENTS ». Orthopaedic Proceedings 105-B, SUPP_3 (février 2023) : 53. http://dx.doi.org/10.1302/1358-992x.2023.3.053.

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Due to shorter hospital stays and faster patient rehabilitation Unicompartmental Knee Replacements (UKR) are now considered more cost effective than Total Knee Joint Replacements (TKJR). Obesity however, has long been thought of as a relative contraindication to UKR due to an unproven theoretical concern of early loosening.This study is a retrospective review of patient reported outcome scores and revision rates of all UKR with recorded BMI performed by the Canterbury District Health Board (CDHB) from January 2011 and September 2021. Patient reported outcome scores were taken preoperatively, at 6 months, 1 year, 5 years and 10 years post operatively. These included WOMAC, Oxford, HAAS, UCLA, WHOQOL, normality, pain and patient satisfaction. 873 patients had functional scores recorded at 5 years and 164 patients had scores recorded at 10 years. Further sub-group analysis was performed based on patient BMI of <25, 25-30, 30-35 and >35. Revision data was available for 2377 UKRs performed in Christchurch during this period.Both obese (BMI >30) and non-obese (BMI <30) patients had significantly improved post-operative scores compared to preoperative. Pre-operatively obese patients had significantly lower functional scores except for pain and UCLA. All functional scores were lower in obese patients at 5 years but this did not meet minimum clinical difference. At 10 years, there was significantly lower HAAS, satisfaction and WOMAC scores for obese patients but no difference in Oxford, normality, WHOQOL, UCLA and pain scores. There was no significant difference in the improvement from pre-operative scores between obese and non-obese patients. All cause revision rate for obese patients at 10 years was 0.69 per 100 observed component years compared to 0.76 in non-obese. This was not statistically significant.Our study proves that UKR is an excellent option in obese patients with post-operative improvement in functional scores and 10 year survivorship equivalent to non-obese patients.

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Plate, Johannes F., Ali Mofidi, Sandeep Mannava, Beth P. Smith, Jason E. Lang, Gary G. Poehling, Michael A. Conditt et Riyaz H. Jinnah. « Achieving Accurate Ligament Balancing Using Robotic-Assisted Unicompartmental Knee Arthroplasty ». Advances in Orthopedics 2013 (2013) : 1–6. http://dx.doi.org/10.1155/2013/837167.

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Unicompartmental knee arthroplasty (UKA) allows replacement of a single compartment in patients with limited disease. However, UKA is technically challenging and relies on accurate component positioning and restoration of natural knee kinematics. This study examined the accuracy of dynamic, real-time ligament balancing using a robotic-assisted UKA system. Surgical data obtained from the computer system were prospectively collected from 51 patients (52 knees) undergoing robotic-assisted medial UKA by a single surgeon. Dynamic ligament balancing of the knee was obtained under valgus stress prior to component implantation and then compared to final ligament balance with the components in place. Ligament balancing was accurate up to 0.53 mm compared to the preoperative plan, with 83% of cases within 1 mm at 0°, 30°, 60°, 90°, and 110° of flexion. Ligamentous laxity of1.31±0.13 mm at 30° of flexion was corrected successfully to0.78±0.17 mm (P<0.05). Robotic-assisted UKA allows accurate and precise reproduction of a surgical balance plan using dynamic, real-time soft-tissue balancing to help restore natural knee kinematics, potentially improving implant survival and functional outcomes.

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He, Yong, Lianbo Xiao, Weitao Zhai, Maximilian F. Kasparek, Guilin Ouyang et Friedrich Boettner. « What Percentage of Patients is a Candidate for Unicompartmental Knee Replacement at a Chinese Arthroplasty Center ? » Open Orthopaedics Journal 12, n^o 1 (30 janvier 2018) : 17–23. http://dx.doi.org/10.2174/1874325001812010017.

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Background:Data on indication of Unicompartmental Knee Arthroplasty (UKA) in the Asian population are currently not available. The current paper evaluates patients undergoing knee replacement at a Chinese Orthopaedic Specialty Hospital to report the percentage of patients who meet radiographic and clinical indication criteria for UKA.Methods:Over a one-year period 463 consecutive patients (515 knees) underwent primary knee replacement surgery. Clinical data were recorded and preoperative radiographs were assessed. Patients were classified as suitable candidates for UKA based on the degree of deformity, preoperative ROM and radiographic appearance of osteoarthritis. The different indication criteria for body weight and extend of patellofemoral osteoarthritis as reported by Kozinn and Scott as well as the Oxford Group were applied.Results:160 knees (31%) were excluded because of inflammatory and posttraumatic arthritis. 55 knees had to be excluded because of incomplete radiographs. Of the remaining 300 knees with osteoarthritis, 241 knees were excluded because of extend of deformity (n=156), decreased range of motion (n=119), advanced patellofemoral arthritis with bone loss (n=11) and AP instability (n=1). Of the remaining 63 knees, 54 knees (18%) met the modified Oxford criteria for mobile UKA and only 25 knees (8%) met the Scott and Kozinn criteria for fixed UKA.Conclusion:The current paper suggests that in comparison to Caucasian population, only a smaller percentage of patients at a Chinese Orthopaedic Specialty Hospital meet the indication criteria for UKA. Therefore, it might make sense to concentrate UKA surgeries in high volume centers.

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Vasso, Michele, Katia Corona, Rocco D'Apolito, Giuseppe Mazzitelli et Alfredo Panni. « Unicompartmental Knee Arthroplasty : Modes of Failure and Conversion to Total Knee Arthroplasty ». Joints 05, n^o 01 (mars 2017) : 044–50. http://dx.doi.org/10.1055/s-0037-1601414.

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AbstractDespite the excellent success rates of the modern unicompartmental knee arthroplasty (UKA), results of knee replacement registries still shows a relatively high revision and failure rate for UKA, especially when compared with traditional total knee arthroplasty (TKA). Bearing dislocation continues to be advocated as the predominant mechanism of failure in mobile UKA, whereas polyethylene wear and aseptic loosening remains the main cause of failure of fixed UKA. Degeneration of the unreplaced compartments has been reported in both mobile and fixed designs. When the revision is required, most of failed UKAs are converted to TKAs. Surgical challenges of the UKA revision, and outcomes of UKA converted to TKA are still debated in literature.

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Hou, Yingzhou, Shaohua Wang et Aiguo Wang. « Effect of unicompartmental knee arthroplasty and high tibial osteotomy with tomofix internal fixation in the treatment of unicompartmental knee osteoarthritis ». Orthopaedic Journal of Sports Medicine 8, n^o 9_suppl7 (1 septembre 2020) : 2325967120S0054. http://dx.doi.org/10.1177/2325967120s00541.

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Introduction: Knee osteoarthritis is a common degenerative disease in the elderly clinically. Cartilage damage, osteophyte formation, joint space narrowing and bone exposure are the main pathological changes, mainly manifested as joint cartilage degeneration [1]. Since the knee joint load of normal people is mainly conducted through the medial side of the knee joint, it is easy to cause degeneration of the medial compartment and then narrow the joint space, which leads to the medial deviation of the lower limb line and the varus deformity of the knee joint. For patients aged 55-65 years with unilateral ventricular osteoarthritis of the knee, the current surgical methods are mostly high tibial osteotomy (HTO) or unicomartmental knee arthroplasty (UKA)[2,3]. HTO always thought to improve lower limb power line to correct deformities, effectively relieve pain and improve function, is an effective method for treatment of osteoarthritis knee inside, high cut bone is typically used in younger patients and patients from physical activity, can effectively reduce the load and delay of knee joint cartilage lesion replacement time, while UKA is more suitable for old age is not active, activity, and patients needs more intense in terms of pain relief. Hypotheses: To investigate the clinical effect of unicompartmental knee arthroplasty (UKA) and high tibial osteotomy (HTO) with tomofix internal fixation in the treatment of unicompartmental knee osteoarthritis. Methods: 60 patients with unicompartmental knee osteoarthritis and varus deformity of the knee joint were randomly divided into two groups: the UKA group (30 cases) and the HTO group (30 cases). The average follow-up time was 6 months, Scores preoperative and postoperative knee joint function, postoperative complications and postoperative pain satisfaction were compared. Results: The scores of HSS, VAS, femorotibial angle(FTA) and active range of motion(ROM) were 82.6 ± 12.9, 1.9 ± 0.8,173.2 ± 1.4,135.2 ± 1.6 in the group of unicompartmental knee arthroplasty (UKA);The scores of HSS, VAS(Visual Analogue Score), femorotibial angle(FTA) and active range of motion(ROM) after tomofix internal fixation used in the group of high tibial osteotomy (HTO)were 81.9 ± 14.3, 1.8 ± 0.9, 174.5 ± 1.8 and 121.1 ± 2.7 . There was no significant difference between the UKA group and HTO group in the scores of HSS, VAS and femorotibial angle(FTA) (P > 0.05). The active range of motion(ROM) of the HTO group was better than that of UKA group (P < 0.05). Conclusion: Both unicompartmental knee arthroplasty (UKA) and high tibial osteotomy (HTO) with tomofix internal fixation can improve the knee joint function and symptoms in the treatment of medial compartment osteoarthritis, but the active range of motion(ROM) in HTO group is better than UKA group.

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Malhotra, Rajesh, Sahil Gaba, Vijay Kumar, Deep Srivastava, Hemant Pandit et Naman Wahal. « Femoral Component Sizing in Oxford Unicompartmental Knee Replacement : Existing Guidelines Do Not Work for Indian Patients ». Journal of Knee Surgery 32, n^o 03 (28 février 2018) : 205–10. http://dx.doi.org/10.1055/s-0038-1635113.

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AbstractOxford unicompartmental knee replacement (OUKR) has shown excellent long-term clinical outcomes as well as implant survival when used for correct indications with optimal surgical technique. Anteromedial osteoarthritis is highly prevalent in Indian patients, and OUKR is the ideal treatment option in such cases. Uncertainty prevails about the best method to determine femoral component size in OUKR. Preoperative templating has been shown to be inaccurate, while height- and gender-based guidelines based on European population might not apply to the Indian patients. Microplasty instrumentation introduced in 2012 introduced the sizing spoon, which has the dual function of femoral component sizing and determining the level of tibia cut. We aimed to check the accuracy of sizing spoon and also to determine whether the present guidelines are appropriate for use in the Indian patients. A total of 130 consecutive Oxford mobile bearing medial cemented UKR performed using the Microplasty instrumentation were included. The ideal femoral component size for each knee was recorded by looking for overhang and underhang in post-operative lateral knee radiograph. The accuracy of previous guidelines was determined by applying them to our study population. Previously published guidelines (which were based on Western population) proved to be accurate in only 37% of cases. Hence, based on the demographics of our study population, we formulated modified height- and gender-based guidelines, which would better suit the Indian population. Accuracy of modified guidelines was estimated to be 74%. The overall accuracy of sizing spoon (75%), when used as an intraoperative guide, was similar to that of modified guidelines. Existing guidelines for femoral component sizing do not work in Indian patients. Modified guidelines and use of intraoperative spoon should be used to choose the optimal implant size while performing OUKR in Indian patients.

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Campi, Stefano, Giuseppe Francesco Papalia, Carlo Esposito, Erika Albo, Francesca Cannata, Biagio Zampogna, Rocco Papalia et Vincenzo Denaro. « Unicompartmental Knee Replacement in Obese Patients : A Systematic Review and Meta-Analysis ». Journal of Clinical Medicine 10, n^o 16 (15 août 2021) : 3594. http://dx.doi.org/10.3390/jcm10163594.

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Thanks to modern surgical techniques and implants, traditional exclusion criteria for unicompartmental knee arthroplasty (UKA) are no longer considered contraindications. The aim of this study is to clarify the impact of obesity on functional outcomes and revision rates of UKA. We performed a comprehensive systematic review using PubMed–Medline, Google Scholar and Cochrane Central. Then, we extracted data related to body mass index (BMI), age and follow-up, functional outcome scores and rate of revisions (all-cause, aseptic and septic). Patients were stratified according to BMI into two groups: non-obese (BMI < 30) and obese (BMI ≥ 30). We identified 22 eligible studies, of which 13 were included in the meta-analysis. Patients with a BMI > 30 had a significantly higher likelihood for revision (p = 0.02), while the risk of septic revision was similar (p = 0.79). The clinical outcome measures showed a significant difference in favor of patients with a BMI < 30 (p < 0.0001). The improvements in Oxford Knee Score and Knee Society Score were significant in both obese and non-obese patients, although the latter showed inferior results. The results of this systematic review and meta-analysis show that BMI is not a contraindication to UKA. However, obese patients have a higher risk for aseptic failure and lower improvement in clinical scores compared to non-obese patients.

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Holz, Johannes, Stefan Schneider, Ansgar Ilg et Rene Kaiser. « Bicompartmental Knee Arthroplasty (BKA) in comparison to unicompartmental (UKA), Patellofemoral (PFA) ans total knee arthroplasty (TKA) – Early Clinical Results ». Orthopaedic Journal of Sports Medicine 7, n^o 6_suppl4 (1 juin 2019) : 2325967119S0023. http://dx.doi.org/10.1177/2325967119s00234.

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Aims and Objectives: The purpose was to evaluate the clinical outcomes of patients with knee osteoarthritis treated with bicompartmental arthroplasty (BKA) in comparison to unicompartmental (UKA), patellofemoral (PFA) and total knee arthroplasty (TKA) in a single center. Materials and Methods: This is a prospective study analyzing a consecutive series of 396 patients from two surgeons in a single center. In 191 men and 205 women either partial or total knee replacement were performed. Their mean age at surgery was 63±6,85 years and mean BMI 29,55±5,00 kg/m2. In 238 patients UKA, in 125 TKA, in 21 PFA and in 11 patients BKA was performed. Implants were cemented and made of cobalt chrome in partial knee and zirconium oxide in total knee replacement. Demographics and patient reported outcomes (VAS, KOOS, Oxford Knee Score (OKS)) were collected preoperatively and 3,6 and 12 months postoperatively. A total of 202 patients have thus far completed the 12 months follow-up time point. Results: All mean KOOS and OKS scores improved significantly 1 year after surgery (p<0.05). Mean preoperative aggregated KOOS improved from 49,0±14,1 to 74,3±17,8 in UKA, from 44,1±12,9 to 67,5±9,4 in PFA, from 46,1±15,1 to 71,0±14,8 in TKA and from 45,7±13,8 to 72,6±9,7 in BKA (p<0.05). Mean preoperative aggregated OKS improved from 25,1±7,6) to 38,5±9,7 in UKA, from 23,0±7,6 to 36,8±3,8 in PFA, from 23,4±8,2 to 37,3±8,1 in TKA and from 22,9±9,6 to 37,0±1,5 in BKA (p<0.05). The mean pain level (VAS)decreased from pre-treatment to 12 months after surgery in UKA from 5,5 to 1,6, in PFA from 6,1 to 2,5, in TKA from 6,0 to 1,9 and in BKA from 6,6 to 2,6. One patient (0.4%) underwent revision (at 3 month for inlay dislocation). Conclusion: This study shows excellent early clinical results of patients treated with unicompartmental, bicompartmental and total knee arthroplasty. Adherence to strict indications lead to a significant improvement of patient reported outcomes and a low revision rate one year postoperatively. The reported results for BKA are comparable to those of patients treated with unicompartmental arthroplasty. We conclude that bicompartmental arthroplasty is a safe and reliable surgery for patients with bicompartmental osteoarthritis.

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Zhang, Dahua, et Xiang Zhang. « Safety and Efficacy of Unicondylar Knee Prosthesis Treatment for Unicompartmental Osteoarthritis of the Knee Joint ». Computational and Mathematical Methods in Medicine 2022 (15 juillet 2022) : 1–9. http://dx.doi.org/10.1155/2022/2938380.

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Background. Knee osteoarthritis (KOA) is a chronic disease that seriously endangers the health of the elderly. Choosing appropriate surgery for knee osteoarthritis patients is especially important. Objective. To investigate the safety and efficacy of unicondylar knee prosthesis treatment for unicompartmental osteoarthritis of the knee. Materials and Methods. One hundred patients with unicondylar osteoarthritis of the knee treated in our hospital from June 2019 to June 2021 were selected as retrospective study subjects and were divided into 50 cases each in the comparison group and the observation group according to the different surgical methods. Among them, the comparison group was treated with unicondylar knee arthroplasty (UKA), and the observation group was treated with unicondylar knee prosthesis replacement, and the differences in AKS score, knee flexion angle, tibial angle orthosis, joint mobility, and postoperative recovery were compared between the two groups. Results. The AKS score and knee flexion angle score of the observation group were higher than those of the comparison group after surgery. However, the tibial angle orthopedic score of the observation group was significantly lower than that of the comparison group after surgery for comparison, and the VAS score of the observation group was lower than that of the comparison group. However, the Lysholm score of the observation group was higher than that of the control group after surgery ( P < 0.05 ). The complication rate of patients in the observation group was significantly lower than that of the comparison group, and the HSS score, VAS score, and knee mobility (ROM) of the two groups were statistically significant ( P < 0.05 ) when compared at 7 d after surgery and 6 months after surgery. Conclusion. The clinical efficacy of unicondylar knee prosthesis replacement for osteoarthritis of the knee is better than that of unicondylar knee arthroplasty (UKA) treatment.

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Wenzhong, Chen, Zou Shiping et Siwen Teng. « Influence of preoperative weight on the early and middle outcome of fixed platform medial unicompartmental knee arthroplasty ». Orthopaedic Journal of Sports Medicine 8, n^o 9_suppl7 (1 septembre 2020) : 2325967120S0054. http://dx.doi.org/10.1177/2325967120s00540.

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Introduction: Obesity is an important independent risk factor for the development of knee osteoarthritis .According to the data of the world Health Organization, there were more than 1.9 billion overweight adults in the world in 2014, among which at least 600 million were clinically obese .Therefore, among the patients undergoing knee replacement, the number of obese patients is increasing .The use of single condyle replacement for medial compartment arthritis of the knee began in the 1970s.With the continuous development of new implants, the continuous improvement of surgical techniques and the strict control of indications by surgeons, the 15-year survival rate of single condyle replacement is over 90%, and the 20-year survival rate is 84%, achieving good results.In the indications of knee monocepicondylar replacement, the maximum weight standard has been increased from 82kg in 1989 [8] to 90kg in 2002 [9].However, there is still controversy over the body weight cut-off point in the indications, especially the observation on the postoperative effect of single condyle replacement in obese patients, which has been rarely reported in China. Hypotheses: To evaluate the near and middle term efficacy of unicompartmental knee arthroplasty(UKA) in patients with medial knee osteoarthritis with different body mass index, and to determine the effect of body weight on the efficacy and complications of UKA. Methods: A total of 128 patients who underwent UKA in department I of arthropathy, zhengzhou orthopaedic hospital from December 2016 to December 2018 due to medial knee osteoarthritis were included as study subjects, and the clinical data of the study subjects were retrospectively analyzed. There were 29 males and 99 females, with an average age of 65.13± 7.37 years (range: 51˜87 years).According to the preoperative body mass index (BMI), the subjects were divided into three groups, namely the underweight or normal weight group (BMI < 24kg /㎡), the overweight group (24kg /㎡≤BMI < 28kg /㎡) and the obese group (BMI≥ 28kg /㎡).Visual analogue scale (VAS), knee range of motion(ROM), American hospital for special surgery (HSS) score of knee joint, complications and other relevant indicators were recorded before and at the last follow-up for each group. According to the data types of preoperative and postoperative efficacy evaluation indexes of the same group, paired sample T test, c² test or Wilcoxon sign rank sum test were used for difference analysis. One-way anova, c² test or K-W rank sum test were used to evaluate the difference between groups. Results: All subjects were followed up for 13-37 months (22.34± 7.22).Compared with before surgery, VAS scores of patients in the last follow-up were significantly lower in the underweight or normal weight group, the overweight group and the obese group (6.91±6.34 vs. 0.44±0.67, 6.90 ±0.77 vs. 0.63±0.68, 6.78±0.71 vs. 0.59±0.61) (t= 46.488-42.654,P values <0.01), knee ROM significantly increased (97.67±10.87 vs. 114.77±8.01, 98.96±10.67 vs. 116.03±6.96, 95.31±11.50 vs. 110.93±11.46) (t= -20.83 - -11.039,All P values were <0.01), and knee HSS score was significantly improved (51.63±0.61 vs 88.00±4.06, 50.68±6.46 vs 87.87±5.73, 48.25±6.70 vs 87.03±5.17) (t= -48.920- -34.010, all P values <0.01).There were no statistically significant differences in VAS score, knee ROM and knee HSS score between the overweight group and the obese group compared with the underweight or normal group. None of the patients had serious complications such as periprosthesis infection, simple prosthesis loosening and periprosthesis fracture. The incidence of venous thrombosis in lower extremities was 14.06% (18/128), with no significant difference between groups. There were 7 cases of poor incision healing (overweight group is 3 and obese group is 4), and the risk of poor incision healing was higher in the obese group than in the underweight or normal weight group, with statistical significance (P=0.03). Conclusion: UKA can achieve satisfactory clinical effect in patients with different body mass index, but patients in obesity group are prone to complications such as poor incision healing.

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Abdulkarim, Ali, Turlough O'Donnell et Michael Neil. « The influence of patellofemoral degenerative changes on the outcome of unicompartmental knee replacement (UKA) ». International Journal of Surgery 11, n^o 8 (octobre 2013) : 661. http://dx.doi.org/10.1016/j.ijsu.2013.06.401.

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Cammisa, Eugenio, Iacopo Sassoli, Matteo La Verde, Stefano Fratini, Vito Gaetano Rinaldi, Giada Lullini, Vittorio Vaccari, Stefano Zaffagnini et Giulio Maria Marcheggiani Muccioli. « Bilateral Knee Arthroplasty in Patients Affected by Windswept Deformity : A Systematic Review ». Journal of Clinical Medicine 11, n^o 21 (6 novembre 2022) : 6580. http://dx.doi.org/10.3390/jcm11216580.

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Background: “Windswept” deformity (WSD) consists of a non-frequent condition in which the patient presents a valgus deformity in one knee and a varus deformity in the other. We performed a review of the available literature to aggregate the accessible data on the outcomes of bilateral knee arthroplasty in patients with WSD and to discuss the surgical challenges that this condition might pose. Methods: A systematic review of the literature following the PRISMA guidelines was conducted. The relevant studies between 1979 and 2021 were identified. Four studies with a total of 68 patients were included for analysis. The mean follow-up for varus knees was 3.3 years, 3.1 years for valgus knees. The quality and rigor of the included studies was assessed using the Methodological index for non-randomized studies (MINORS). Results: All the studies reported improvement in knee function following knee replacement surgery, and a reduction in axial deviation of both knees, with similar results in valgus and varus knees in terms of patient satisfaction. The most relevant data were that unicompartmental knee arthroplasty (UKA) allowed for limited axial correction with slightly inferior functional results. Kinematic alignment (KA) allowed for similar results in both knees. Conclusion: The present review shows how satisfactory results can be achieved in both knees in patients with WSD and osteoarthrosis (OA). However, the operating surgeon should be aware of the importance of the implant choice in terms of functional outcomes. In the absence of extra-articular deformities, calipered KA total knee arthroplasty (TKA) can be performed on both knees with good axial correction and functional outcome. Level of evidence: II —Systematic review of cohort studies.

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Carli, Alberto V., Milan Kapadia, Yu-fen Chiu, Michael Henry et Andy O. Miller. « 399. Treatment and Outcome of Prosthetic Joint Infection in Unicompartmental Knee Arthroplasty ». Open Forum Infectious Diseases 6, Supplement_2 (octobre 2019) : S204. http://dx.doi.org/10.1093/ofid/ofz360.472.

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Abstract Background Unicompartmental knee arthroplasty (UKA) is an increasingly popular alternative to total knee replacement due to easier recovery and greater satisfaction. However, limited evidence guides the management of periprosthetic joint infection (PJI) in UKA specifically. We retrospectively reviewed the largest cohort of UKA PJI to date, providing our experience in a high volume tertiary institution. Methods An institutional PJI database was queried from 2008 to 2016 to identify all PJI cases with an index procedure of UKA. Treatment, diagnostic criteria, Charlson Comorbidity Index (CCI) and microbiology data were collected. Success was defined as no further surgical treatment for infection at 2 years. A chi-square test or Fisher’s exact test was used for comparisons between treatment success and failure groups. Survival probability was calculated using the Kaplan–Meier method. Results A total of 24 UKA PJIs were identified with 22 meeting MSIS criteria. Median age at infection was 65.9 years (range, 50.8–87.4), median BMI was 26.7 kg/m2 (range, 21.2–49.5), 75% male (18/24).The average follow-up time was 2.83 years. 9 patients presented with early (4 weeks of symptoms). 63% (15/24) of PJI cases were staphylococcal and 8.3% (2/24) were culture negative. Patients were either treated with 1 stage exchange (n = 3, 100% success), two-stage exchange (n = 5, 80% success) or implant retention (n = 16, 75% success). Overall survivorship was 79% at 2 years (95% confidence interval [CI], 63%–95%). Overall there was no significant association between success and CCI (P = 0.46), infection type (P = 0.29), surgical therapy (P = 0.62), and microorganism (P = 0.05). Conclusion In this series, UKA PJIs tended to present more often as early post-operative or hematogenous infections. We observed no significant benefit with revision surgery and therefore conclude that implant retention should be considered as first-line surgical treatment. Outcomes of UKA PJI appear comparable to those in TKA PJIs. Disclosures All authors: No reported disclosures.

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Burger, Joost A., Matthew S. Dooley, Laura J. Kleeblad, Hendrik A. Zuiderbaan et Andrew D. Pearle. « What is the impact of patellofemoral joint degeneration and malalignment on patient-reported outcomes after lateral unicompartmental knee arthroplasty ? » Bone & ; Joint Journal 102-B, n^o 6 (juin 2020) : 727–35. http://dx.doi.org/10.1302/0301-620x.102b6.bjj-2019-1429.r1.

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Aims It remains controversial whether patellofemoral joint pathology is a contraindication to lateral unicompartmental knee arthroplasty (UKA). This study aimed to evaluate the effect of preoperative radiological degenerative changes and alignment on patient-reported outcome scores (PROMs) after lateral UKA. Secondarily, the influence of lateral UKA on the alignment of the patellofemoral joint was studied. Methods A consecutive series of patients who underwent robotic arm-assisted fixed-bearing lateral UKA with at least two-year follow-up were retrospectively reviewed. Radiological evaluation was conducted to obtain a Kellgren Lawrence (KL) grade, an Altman score, and alignment measurements for each knee. Postoperative PROMs were assessed using the Kujala (Anterior Knee Pain Scale) score, Knee Injury and Osteoarthritis Outcome Score Joint Replacement (KOOS JR), and satisfaction levels. Results A total of 140 knees (130 patients) were identified for analysis. At mean 4.1 years (2.0 to 8.5) follow-up, good to excellent Kujala scores were reported. The presence of mild to moderate preoperative patellofemoral joint osteoarthritis had no impact on these scores (KL grade 0 vs 1 to 3, p = 0.203; grade 0 to 1 vs 2 to 3, p = 0.674). Comparable scores were reported by patients with osteoarthritis (Altman score of ≥ 2) evident on either the medial or lateral patellofemoral joint facet (medial, p = 0.600 and lateral, p = 0.950). Patients with abnormal patellar congruence and tilt angles (≥ 17° and ≥ 14°, respectively) reported good to excellent Kujala scores. Furthermore, lateral UKA resulted in improvements to patellofemoral alignment. Conclusion This is the first study demonstrating that mild to moderate preoperative radiological degenerative changes and malalignment of the patellofemoral joint are not associated with poor patient-reported outcomes at mid-term follow-up after lateral fixed-bearing UKA. Our data suggest that this may be explained by realignment of the patella and thereby redistribution of loads across the patellofemoral joint. Cite this article: Bone Joint J 2020;102-B(6):727–735.

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IMRAN, AHMED. « SAGITTAL PLANE KNEE LAXITY AFTER LIGAMENT RETAINING UNCONSTRAINED ARTHROPLASTY : A MATHEMATICAL ANALYSIS ». Journal of Mechanics in Medicine and Biology 12, n^o 02 (avril 2012) : 1240002. http://dx.doi.org/10.1142/s0219519412400027.

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Passive knee laxity is an important clinical measure to assess function after joint replacement. Clinical observations suggest that the use of minimally invasive surgical techniques in knee arthroplasty may affect the surgeon's ability to orient and position the prosthetic components accurately. Further, recent studies suggest that malplaced prosthetic components in ligament retaining unconstrained unicompartmental knee arthroplasty (UKA) can affect the ligament forces and, hence, the knee laxity. In the present study, a sagittal plane mathematical model of the knee with intact ligaments and unconstrained prosthetic components is used to analyze antero-posterior (A–P) knee laxity during passive flexion at different force levels. Also, the effects of errors in component placement are evaluated. The model calculations show a reasonable agreement with the experimental observations reported in literature. The results show that the A–P laxity during 0°–120° flexion first increases from 0° to about 30°, remains nearly constant for another 10° and then decreases somewhat linearly for higher flexion angles. Some errors in the placement of femoral component of the order of 1 mm can affect the knee laxity by nearly 3 mm in some flexion positions. The analysis has clinical relevance and suggests that the UKA requires close attention to component placement.

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Pisanu, Gabriele, Federica Rosso, Corrado Bertolo, Federico Dettoni, Davide Blonna, Davide Bonasia et Roberto Rossi. « Patellofemoral Arthroplasty : Current Concepts and Review of the Literature ». Joints 05, n^o 04 (4 octobre 2017) : 237–45. http://dx.doi.org/10.1055/s-0037-1606618.

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AbstractPatellofemoral osteoarthritis (PFOA) can be associated with anterior knee pain, stiffness, and functional impairment. Some authors report that PFOA affects approximately 9% of patients older than 40 years with a greater prevalence in females. Etiology of PFOA is multifactorial and is related to the presence of abnormal stresses at the PF joint due to knee- and patient-related factors. The need for a joint preserving treatment by isolated replacement of the injured compartment of the knee led to the development of PF arthroplasty (PFA). When a correct PF replacement is performed, PFA preserves physiologic tibiofemoral joint, thus allowing patients for a rapid recovery with a high satisfaction. The outcomes for PFA are quite variable with a trend toward good to excellent results, mainly owing to the improvement in surgical techniques, patient selection, and implant design. The development of the second generation of PFA improved the outcomes, which is attributed to the different trochlear designs. Recently, encouraging results have been provided by the association of PFA and unicompartmental knee arthroplasty (UKA). In many studies, the main cause of PFA failure is progression of tibiofemoral OA. The aim of this brief review of literature is to summarize the clinical features, indications and contraindications, surgical techniques, complications, and outcomes of PFA.

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Yun, Andrew G., Marilena Qutami et Kory B. Dylan Pasko. « Modified Two-Stage Exchange for Periprosthetic Joint Infection in UKA ». Case Reports in Orthopedics 2020 (17 août 2020) : 1–6. http://dx.doi.org/10.1155/2020/8860433.

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Periprosthetic joint infection (PJI) is a rare complication following unicompartmental knee arthroplasty (UKA), and current management guidelines are still evolving. This report presents a novel surgical technique of resection arthroplasty with an articulated hemispacer as part of a 2-stage exchange protocol. A 66-year-old man developed a culture-negative PJI four months after a medial UKA. Rather than conventional full resection arthroplasty, the patient underwent partial resection with preservation of the lateral and patellofemoral compartments to maintain vascularized bone stock. An articulating hemispacer fashioned from the old implants after sterilization was reimplanted medially to preserve function during the course of antibiotic treatment. After successful eradication of infection, the patient underwent an uncomplicated conversion total knee replacement facilitated by prior preservation of bone stock. No stems or augments were needed. Therefore, a partial resection arthroplasty with an articulating hemispacer used in a 2-stage exchange protocol may be a reasonable option to eradicate infection and maintain function. In future cases of infected UKA, this technique warrants further consideration and investigation.

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Zhang, Chaofan, Yongbin Li, Yunzhi Lin, Xuehui Zhang, Zida Huang, Guochang Bai, Yao Wan, Wenming Zhang, Xinyu Fang et Wenbo Li. « Joint Replacement Surgeries Can Be Safely Performed in HIV Patients ». Journal of Clinical Medicine 12, n^o 1 (30 décembre 2022) : 293. http://dx.doi.org/10.3390/jcm12010293.

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Whether joint replacement surgery can be performed safely on HIV patients is still a matter of debate. This study aimed to report the surgical efficacy and complications of joint replacement surgery in HIV patients. A total of 21 HIV patients and 27 non-HIV patients who underwent arthroplasties in our hospital were retrospectively reviewed. The 21 HIV patients received 29 joint replacement surgeries including 27 cases of total hip arthroplasty (THA) and 2 cases of total knee arthroplasty (TKA). The non-HIV patients received 16 THA, 10 TKA, and 3 unicompartmental arthroplasty (UKA). The length of hospital stay of HIV patients was significantly lower than that of non-HIV patients. At the last follow-up, there were no significant complications both in the HIV group and the non-HIV groups. No medical staff had any occupational exposure. We concluded that joint replacement surgery in HIV patients is safe and effective. Optimization of patients is key to treatment success. Strictly following the standardized protection protocol can prevent the risk of occupational exposure.

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Crizer, Meredith P., Amer Haffar, Andrew Battenberg, Mikayla McGrath, Ryan Sutton et Jess H. Lonner. « Robotic Assistance in Unicompartmental Knee Arthroplasty Results in Superior Early Functional Recovery and Is More Likely to Meet Patient Expectations ». Advances in Orthopedics 2021 (14 juillet 2021) : 1–8. http://dx.doi.org/10.1155/2021/4770960.

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Robotic technology has reduced the errors of implant alignment in unicompartmental knee arthroplasty (UKA), but its impact on functional recovery after UKA is poorly defined. The purpose of this study was to compare early functional recovery, pain levels, and satisfaction in UKA performed with either robotic assistance or conventional methods. A retrospective analysis was performed on 89 matched consecutive patients who underwent outpatient UKA by a single physician using either conventional instruments (n = 39) or robotic methods (n = 50), with otherwise identical perioperative protocols. Outcomes studied included Lower Extremity Functional Score (LEFS), new Knee Society Score (KSS), Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS-JR.), VR/SF-12, Visual Analog Scale (VAS) pain scores, and perioperative opioid consumption. Patients in the robotic cohort had superior early functional outcomes, with greater LEFS (conventional = 23; robotic = 31) at 1 week post-op p = 0.015 and KOOS-JR (conventional = 74; robotic = 81) at up to 6 months post-op p = 0.037 ; these two values remained statistically significant after mixed-model regression analysis p = 0.010 ; p = 0.023 , respectively. At 1 year post-op, expectations were more likely to be met in those who received robotic assistance p = 0.06 . No differences were reported with respect to postoperative opioid usage p = 0.320 , reoperations p = 1.00 , and complications p = 0.628 . Robotic-assisted UKA resulted in more rapid recovery and less early postoperative pain and were more likely to meet expectations than conventional UKA, although functional differences equilibrated by 1 year postoperatively. Further follow-up is necessary to determine if implant durability is impacted by robotics.

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Weber, Patrick, Matthias Woiczinski, Arnd Steinbrück, Florian Schmidutz, Thomas Niethammer, Christian Schröder, Volkmar Jansson et Peter E. Müller. « Increase in the Tibial Slope in Unicondylar Knee Replacement : Analysis of the Effect on the Kinematics and Ligaments in a Weight-Bearing Finite Element Model ». BioMed Research International 2018 (5 juillet 2018) : 1–9. http://dx.doi.org/10.1155/2018/8743604.

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Introduction. Unicompartmental arthroplasty (UKA) of the knee in patients with isolated medial osteoarthritis yields adequate results; however, the survival rate is inferior to that of total knee arthroplasty (TKA). A key factor in the longevity of the implant is the positioning; however, the optimal tibial slope in UKA has not been determined. The aim of this study was to establish a finite element (FE) model and investigate the effect of the tibial slope on the strain of the ligaments, kinematics, inlay movement, and load in the nonreplaced patellofemoral compartment in a medial mobile bearing UKA. Materials and Methods. An FE model of a leg was established with a virtual UKA implantation with three different tibial slopes (0°, 5°, and 10°). Subsequently, the knee was flexed from 14–73°. In addition, the ground reaction force and the muscles were simulated. Results. With a higher tibial slope, there was more external rotation of the tibia. An increased tibial slope provided a lateral shift of the patella in the trochlear groove and a more anterior position of the inlay. The ligament strains were also changed, specifically, the anterior portion of the medial collateral ligament and the posterior cruciate ligament (PCL). Discussion. This study established the first model of a quasidynamic mobile bearing UKA in a leg under weight-bearing conditions. With an increasing tibial slope, there was a higher external rotation of the tibia that created different femorotibial and retropatellar kinematics and different strains in the ligaments. This knowledge adds important information for the optimal tibial slope that has to be determined individually depending on the patient’s preoperative kinematics, desired postoperative kinematics, ligament status, and location of the retropatellar chondral damage.

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Burger, Joost A., Laura J. Kleeblad, Niels Laas et Andrew D. Pearle. « Mid-term survivorship and patient-reported outcomes of robotic-arm assisted partial knee arthroplasty ». Bone & ; Joint Journal 102-B, n^o 1 (janvier 2020) : 108–16. http://dx.doi.org/10.1302/0301-620x.102b1.bjj-2019-0510.r1.

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Aims Limited evidence is available on mid-term outcomes of robotic-arm assisted (RA) partial knee arthroplasty (PKA). Therefore, the purpose of this study was to evaluate mid-term survivorship, modes of failure, and patient-reported outcomes of RA PKA. Methods A retrospective review of patients who underwent RA PKA between June 2007 and August 2016 was performed. Patients received a fixed-bearing medial or lateral unicompartmental knee arthroplasty (UKA), patellofemoral arthroplasty (PFA), or bicompartmental knee arthroplasty (BiKA; PFA plus medial UKA). All patients completed a questionnaire regarding revision surgery, reoperations, and level of satisfaction. Knee Injury and Osteoarthritis Outcome Scores (KOOS) were assessed using the KOOS for Joint Replacement Junior survey. Results Mean follow-up was 4.7 years (2.0 to 10.8). Five-year survivorship of medial UKA (n = 802), lateral UKA (n = 171), and PFA/BiKA (n = 35/10) was 97.8%, 97.7%, and 93.3%, respectively. Component loosening and progression of osteoarthritis (OA) were the most common reasons for revision. Mean KOOS scores after medial UKA, lateral UKA, and PFA/BiKA were 84.3 (SD 15.9), 85.6 (SD 14.3), and 78.2 (SD 14.2), respectively. The vast majority of the patients reported high satisfaction levels after RA PKA. Subgroup analyses suggested tibial component design, body mass index (BMI), and age affects RA PKA outcomes. Five-year survivorship was 98.4% (95% confidence interval (CI) 97.2 to 99.5) for onlay medial UKA (n = 742) and 99.1% (95% CI 97.9 to 100) for onlay medial UKA in patients with a BMI < 30 kg/m2 (n = 479). Conclusion This large single-surgeon study showed high mid-term survivorship, satisfaction levels, and functional outcomes in RA UKA using metal-backed tibial onlay components. In addition, favourable results were reported in RA PFA and BiKA. Cite this article: Bone Joint J 2020;102-B(1):108–116

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Feltri, Pietro, Camilla Mondini Trissino da Lodi, Alberto Grassi, Stefano Zaffagnini, Christian Candrian et Giuseppe Filardo. « One-stage bilateral unicompartmental knee arthroplasty is a suitable option vs. the two-stage approach : a meta-analysis ». EFORT Open Reviews 6, n^o 11 (novembre 2021) : 1063–72. http://dx.doi.org/10.1302/2058-5241.6.210047.

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To compare one-stage vs. two-stage bilateral unicondylar knee arthroplasty (UKA) in terms of complications, mortality, reinterventions, transfusion rate, days to discharge, and outcomes for the treatment of bilateral mono-compartmental knee osteoarthritis. A systematic review was performed in the PubMed, Web of Science, and Cochrane databases up to February 2021. Randomized controlled trials, case-control studies, and case series describing the use of bilateral UKA were retrieved. A meta-analysis was performed on complications, mortality, reinterventions, transfusion rate, and days to discharge comparing one-stage vs. two-stage replacement, and outcomes were also reported. Assessment of risk of bias and quality of evidence was performed with the Newcastle-Ottawa Scale. Fifteen articles were included on 1451 patients who underwent bilateral UKA (44.9% men, 55.1% women, mean age 66 years). The systematic review documented, for bilateral one-stage UKA: 2.6% major and 5.4% minor complication rates, 0.5% mortality, 1.9% reintervention, 4.1% transfusion rates, and 4.5 mean days to discharge. No studies reported functional differences. The meta-analysis did not find differences for major complications, minor complications, mortality, reintervention, transfusion rates, or days to discharge versus two-stage bilateral procedures. The operative time was 112.3 vs. 125.4 minutes for one-stage and two-stage surgeries, respectively. The overall quality of the retrieved studies was high. Bilateral single-stage UKA is a safe procedure, with a few complications, and overall positive clinical results. No differences were found in terms of complications, mortality, reinterventions, transfusion rate, and days to discharge in comparison with the two-stage approach. Cite this article: EFORT Open Rev 2021;6:1063-1072. DOI: 10.1302/2058-5241.6.210047

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Holz, Johannes, Stefan Schneider, Nils Hansen-Algenstaedt, Rene Kaiser et Ansgar Ilg. « A Selective arthroplasty algorithm contributes to clinical outcome and patient satisfaction in patients with osteoarthritis of the knee ». Orthopaedic Journal of Sports Medicine 8, n^o 5_suppl4 (1 mai 2020) : 2325967120S0032. http://dx.doi.org/10.1177/2325967120s00323.

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Aims and Objectives: The purpose was to evaluate the clinical outcomes and patient satisfaction of patients with knee osteoarthritis treated within a selective arthroplasty algorithm, using focal metal implants (FMI), unicompartmental (UKA), patellofemoral (PFA), bicompartimental (BKA) and total knee arthroplasty (TKA) in a single center. Materials and Methods: This is a prospective study analyzing a consecutive series of 613 patients treated by two surgeons in a single center. In 283 men and 330 women either partial or total knee replacement were performed. Their mean age at surgery was 63±6,85 years and mean BMI 29,55±5,00 kg/m2. 357 UKA, 178 TKA, 30 PFA, 23 BKA and 25 FMI were performed. Implants were cemented or cementless (UKA) and made of cobalt chrome in partial knee and zirconium oxide in total knee replacement. Demographics and patient reported outcomes (VAS, KOOS, Oxford Knee Score (OKS) and Knee Society Score (KSS Expectations and satisfaction)) were collected preoperatively and 3,6 and 12 months postoperatively. A total of 442 of 457 eligible patients (Compliance = 96,7%) have thus far completed the 12 months follow-up time point. Results: All mean KOOS, OKS, KSS and VAS scores improved significantly 1 year after surgery (p<0.05). Mean preoperative aggregated KOOS improved from 49.8±13,3 to 74,8±16.9 in UKA, from 43,9±13,3 to 65,2±12,4 in PFA, from 46.6±13,1 to 73,8±14,4 in TKA, from 45,2±11,2 to 73,0±9,8 in BKA and 40.9 ± 23.0 to 63.2 in FMI (p<0.05). Mean preoperative aggregated OKS improved from 25,3±7,6 to 38,7±8,4 in UKA, from 22,9±7,6 to 33,3±8,6 in PFA, from 23.3±7.3 to 37,5±7.7 in TKA, from 22,0±7,5 to 39,0±4.0 in BKA and from 22.9 ± 10.0 to 33.4 ± 11.3 in FMI (p<0.05). The mean pain level VAS decreased from pre-treatment to 12 months after surgery in UKA from 5.6 to 1.6, in PFA from 6.2 to 2.8, in TKA from 6.2 to 1.7, in BKA from 6.8 to 1.6 and VAS 5.5 to 2.4. The Mean KSS Expectation/Satisfaction improved at 1 y FU in UKA in expectation 13.7 ± 1.6 and mean KSS satisfaction: 31.1 ± 8.4, in FMI in expectation: 13.5 ± 1.6 and mean KSS satisfaction 26.0 ± 11.4 , in TKA: expectation 13.5 ± 1.8 and mean KSS satisfaction 30.0 ± 7.1, in PFA: expectation 13.7 ± 1.7 and mean KSS satisfaction 26.4 ± 9.2 and BKA: expectation 13.6 ± 1.9 and mean KSS satisfaction 31.2 ± 4.2. Two patients (0.4%) underwent revision (at 3 month for inlay dislocation (UKA) and at 12 Month for desease progression (FMI)). Conclusion: This study shows excellent clinical results and patient satisfaction of patients treated within a selective arthroplasty algorithm. Adherence to strict indications for partial as well as for total knee replacement will lead to a comparable significant improvement of patient reported outcomes, patient satisfaction and a low revision rate one year postoperatively.

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Moretti, Lorenzo, Michele Coviello, Federica Rosso, Giuseppe Calafiore, Edoardo Monaco, Massimo Berruto et Giuseppe Solarino. « Current Trends in Knee Arthroplasty : Are Italian Surgeons Doing What Is Expected ? » Medicina 58, n^o 9 (26 août 2022) : 1164. http://dx.doi.org/10.3390/medicina58091164.

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Objectives: The purpose of this study is to evaluate Italian surgeons’ behavior during knee arthroplasty. Materials and Methods: All orthopedic surgeons who specialized in knee replacement surgeries and were members of the Italian Society of Knee, Arthroscopy, Sport, Cartilage and Orthopedic Technologies (SIGASCOT) between January 2019 and August 2019 were asked to complete a survey on the management of knee arthroplasty. Data were collected, analyzed, and presented as frequencies and percentages. Results: One-hundred and seventy-seven surgeons completed the survey and were included in the study. Ninety-five (53.7%) surgeons were under 40 years of age. Eighty-five surgeons (48%) worked in public hospitals and 112 (63.3%) were considered “high volume surgeons”, with more than 100 knee implants per year. Postero-stabilized total knee arthroplasty was the most commonly used, implanted with a fully cemented technique by 162 (91.5%) surgeons. Unicompartmental knee arthroplasty (UKA) was a rarer procedure compared to TKA, with 77% of surgeons performing less than 30% of UKAs. Most common TKA pre-operative radiological planning included complete antero-posterior (AP) weight-bearing lower limb radiographs, lateral view and patellofemoral view (used by 91%, 98.9% and 70.6% of surgeons, respectively). Pre-operative UKA radiological images included Rosenberg or Schuss views, patellofemoral view and magnetic resonance imaging (66.1%, 71.8% and 46.3% of surgeons, respectively). One hundred and thirty-two surgeons (74.6%) included an AP weight-bearing lower limb X-ray one year after surgery in the post-operative radiological follow-up. Furthermore, 119 surgeons (67.2%) did not perform a post-operative patellofemoral view because it was not considered useful for radiological follow-up. There was no uniformity in the timing and features of post-operative follow-up, with 13 different combinations. Conclusions: Italian surgeons perform TKA more commonly than UKA. Pre-operative TKA planning is quite uniform rather than UKA planning. Despite literature evidence, there is no agreement on follow-up. It may be useful to create a uniform checklist, including correct timing and exams needed. This analysis is also part of a society surgical educational project for training doctor.

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Kamenaga, Tomoyuki, Takafumi Hiranaka, Yuichi Hida, Takaaki Fujishiro et Koji Okamoto. « Morphometric analysis of medial and lateral tibia plateau and adaptability with Oxford partial knee replacement in a Japanese population ». Journal of Orthopaedic Surgery 28, n^o 2 (1 janvier 2020) : 230949902091930. http://dx.doi.org/10.1177/2309499020919309.

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Aims: In unicompartmental knee arthroplasty (UKA), tibial components must be correctly sized and positioned so that tibial cut surfaces are well covered without marked under- or overhang with impingement of the surrounding soft tissue. We used morphometric data of both medial and lateral tibial plateaus separately to plan UKA and evaluated the compatibility of the measurement data to the dimensions of six currently available tibial prostheses in a Japanese population. Materials and Methods: Using computed tomography, we preoperatively examined 60 patients (30 medial and 30 lateral osteoarthritis (OA)) scheduled for primary UKA at our hospital between 2013 and 2017. Each tibial cutting surface was measured in the transverse plane at 2 mm below the respective joint line. We used anteroposterior and mediolateral length to calculate the mediolateral length/anteroposterior ratio of both medial and lateral compartments. We then compared measurements across six current UKA systems: Oxford fixed tibia and fixed lateral tibia, Triathlon, TRIBRID, JOURNEY UNI, and HLS Uni Evolution. Results: We found no significant differences in morphometric data between the medial and the lateral OA. The cutting surface of lateral plateau, however, had smaller anteroposterior dimensions, greater mediolateral length, and higher mediolateral length/anteroposterior ratio than those of medial plateau. Therefore, in this Japanese population-based study, Oxford lateral tibia had good compatibility with the measurement data of lateral compartments. Conclusions: Lateral compartments had lower anteroposterior length, greater mediolateral length, and higher mediolateral length/anteroposterior ratio than those of medial compartments. We, therefore, strongly recommend using Oxford fixed lateral tibia for lateral OA over other current tibial prostheses because of superior coverage.

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Zaidi, F., S. M. Bolam, T. C. Yeung, T. F. Besier, M. Hanlon, J. T. Munro et A. P. Monk. « REMOTE EVALUATION OF POSTOPERATIVE OUTCOMES USING WEARABLE SENSORS COMPARING ROBOTIC-ASSISTED AND CONVENTIONAL KNEE ARTHROPLASTY ». Orthopaedic Proceedings 105-B, SUPP_2 (février 2023) : 68. http://dx.doi.org/10.1302/1358-992x.2023.2.068.

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Patient-reported outcome measures (PROMs) have failed to highlight differences in function or outcome when comparing knee replacement designs and implantation techniques. Ankle-worn inertial measurement units (IMUs) can be used to remotely measure and monitor the bi-lateral impact load of patients, augmenting traditional PROMs with objective data. The aim of this study was to compare IMU-based impact loads with PROMs in patients who had undergone conventional total knee arthroplasty (TKA), unicompartmental knee arthroplasty (UKA), and robotic-assisted TKA (RA-TKA).77 patients undergoing primary knee arthroplasty (29 RA-TKA, 37 TKA, and 11 UKA) for osteoarthritis were prospectively enrolled. Remote patient monitoring was performed pre-operatively, then weekly from post-operative weeks two to six using ankle-worn IMUs and PROMs. IMU-based outcomes included: cumulative impact load, bone stimulus, and impact load asymmetry. PROMs scores included: Oxford Knee Score (OKS), EuroQol Five-dimension with EuroQol visual analogue scale, and the Forgotten Joint Score.On average, patients showed improved impact load asymmetry by 67% (p=0.001), bone stimulus by 41% (p<0.001), and cumulative impact load by 121% (p=0.035) between post-operative week two and six. Differences in IMU-based outcomes were observed in the initial six weeks post-operatively between surgical procedures. The mean change scores for OKS were 7.5 (RA-TKA), 11.4 (TKA), and 11.2 (UKA) over the early post-operative period (p=0.144). Improvements in OKS were consistent with IMU outcomes in the RA-TKA group, however, conventional TKA and UKA groups did not reflect the same trend in improvement as OKS, demonstrating a functional decline.Our data illustrate that PROMs do not necessarily align with patient function, with some patients reporting good PROMs, yet show a decline in cumulative impact load or load asymmetry. These data also provide evidence for a difference in the functional outcome of TKA and UKA patients that might be overlooked by using PROMs alone.

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Schneider, Brandon L., Daphne I. Ling, Laura J. Kleebad, Sabrina Strickland et Andrew Pearle. « Comparing Return to Sports After Patellofemoral and Knee Arthroplasty in an Age- and Sex-Matched Cohort ». Orthopaedic Journal of Sports Medicine 8, n^o 10 (1 octobre 2020) : 232596712095742. http://dx.doi.org/10.1177/2325967120957425.

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Background: Return to sports is an important outcome in ensuring patient satisfaction after knee-replacement surgery. However, few studies have directly compared unicompartmental knee arthroplasty (UKA), total knee arthroplasty (TKA), and patellofemoral arthroplasty (PFA). Hypothesis: TKA will result in lower rates of return to sports than either UKA and PFA due to increased complexity and invasiveness. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent UKA, TKA, or PFA with 1 to 2 years of follow-up were sent a questionnaire regarding return to sports, satisfaction with return to sports, pain, the University of California, Los Angeles activity scale, and the High Activity Arthroplasty Score (HAAS). The patients who underwent either TKA or UKA were matched 2:1 with regard to age and sex to patients who underwent PFA. Differences were compared using analysis of variance, t tests, and chi-square tests. Results: A total of 202 patients were eligible. After matching, the final cohort consisted of 23 PFA patients, 46 UKA patients, and 46 TKA patients. The majority of patients were female (87%), and the mean ± SD age was 56 ± 9.1 years. The UKA group had higher HAAS values than the TKA group pre- and postoperatively (9.9 vs 7.1 [ P = .001] and 12.4 vs 9.5 [ P < .001], respectively). Patients with UKA had higher rates of return to sports after surgery than those with TKA or PFA (UKA, 80.5%; TKA, 71.7%; PFA, 69.5%; P = 0.08). In addition, the UKA group had the highest satisfaction with this outcome. Improvement between pre- and postoperative scores was similar in all 3 groups. Conclusion: Patients who underwent UKA reported better activity scores and return-to-sports rates than patients who had TKA and PFA. No differences were found in improvement after surgery, suggesting that preoperative differences were reflected postoperatively. These findings inform shared decision making and can help to manage patient expectations after surgery.

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Mouli, Vibav H., Christopher X. Carrera, Natalie Schudrowitz, Jean Flanagan Jay, Vivek Shah et Wolfgang Fitz. « Post-Operative Remote Monitoring for Same-Day Discharge Elective Orthopedic Surgery : A Pilot Study ». Sensors 21, n^o 17 (26 août 2021) : 5754. http://dx.doi.org/10.3390/s21175754.

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The purposes of this pilot study are to utilize digital remote monitoring to (a) evaluate the usability and satisfaction of a wireless blood pressure (BP) and heart rate (HR) monitor and (b) determine whether these data can enable safe mobilization at home after same-day discharge (SDD) joint replacement. A population of 23 SDD patients undergoing unicompartmental knee arthroplasty (UKA), total knee arthroplasty (TKA), or total hip arthroplasty (THA) were given a cellular BP/HR monitor, with real-time data capture. Patients took three readings after surgery, observing for specific blood pressure decreases, HR increases, or hypotensive symptoms. If any criteria applied, patients followed a hydration protocol and delayed ambulation. Home coaching was also provided to each patient. Patient experience was surveyed, and responses were assessed using descriptive statistics. Of 18 patients discharged (78%), 17 returned surveys, of which 100% reported successful device operation. The mean “ease of use” rating was 8.9/10; satisfaction with home coaching was 9.7/10; and belief that the protocol improved patient safety was 8.4/10. A total of 27.8% (n = 5) had hypotensive readings and appropriately delayed ambulation. Our pilot findings support the feasibility of and confirm the satisfaction with remote monitoring after SDD arthroplasty. All patients with symptoms of hypotension were successfully remotely managed using a standardized hydration protocol prior to safe mobilization.

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Scholes, Corey, Milad Ebrahimi, Nalan Ektas et John Ireland. « Efficacy of a Second-Generation Rotating Bearing Tibial Platform in Total Knee Arthroplasty : A Prospective Observational Cohort Study with Registry Analysis ». Journal of Knee Surgery 33, n^o 05 (5 mars 2019) : 513–24. http://dx.doi.org/10.1055/s-0039-1678679.

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AbstractThere is a lack of clinical outcomes reported for the rotating bearing knee (RBK) total knee arthroplasty (TKA), which is a second-generation rotating platform knee, with purported benefits over earlier versions. The purpose of the study was to report the complications, short-term (minimum 1 year) patient-reported outcomes and long-term (up to 15 years) procedure survival in a consecutive series of patients receiving a rotating platform TKA (RBK) from an independent clinic. A retrospective analysis of a single-surgeon, private/public practice, with prospectively collected data in a subset of patients were performed. A total of 1,130 procedures (primary, revision from unicompartmental knee arthroplasty (UKA) to TKA) were crossmatched with manufacturer records. Clinical outcomes (complications, reoperations) were summarized and linked to patient-reported outcome measures (Eq. 5D, KSS-function, Oxford knee score [OKS]). OKS results were classified using minimally clinical important difference (MCID) and patient acceptable symptom state (PASS). PROMs were summarized and regression models used to determine relationships between patient factors and outcomes in this cohort. Cumulative percent revision was reported by the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) and compared between the senior author and national data using Kaplan–Meier survival analysis. We report a complication rate of 19.7% with the majority (> 60%) being thromboembolic events and complaints of stiffness. Significant improvements were observed in general health, knee pain, and function with > 89% exceeding the MCID for the OKS and > 65% exceeding the PASS for the OKS at an average follow-up of 3.2 years. We report a cumulative revision rate of 4.3% at 5 years and 4.8% at 14 years, with significantly lower revision rates in females and patients aged 55 to 64 years compared with AOANJRR data for fixed bearing designs. The RBK rotating platform TKA provides good functional outcomes, with relatively low revision and complications rates at up to 14 years follow-up. This design in conjunction with a gap balancing technique may be advantageous in certain patient subgroups.

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Gaudiani, Michael A., Linsen T. Samuel, John N. Diana, Jennifer L. DeBattista, Thomas M. Coon, Ryan E. Moore et Atul F. Kamath. « 5-Year Survivorship and Outcomes of Robotic-Arm-Assisted Medial Unicompartmental Knee Arthroplasty ». Applied Bionics and Biomechanics 2022 (6 mai 2022) : 1–5. http://dx.doi.org/10.1155/2022/8995358.

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Purpose. While unicompartmental knee arthroplasty (UKA) has demonstrated benefits over total knee arthroplasty (TKA) in selected populations, component placement continues to be challenging with conventional surgical instruments, resulting in higher early failure rates. Robotic-arm-assisted UKA (RA-UKA) has shown to be successful in component positioning through preop planning and intraop adjustability. The purpose of this study is to assess the 5-year clinical outcomes of medial RA-UKA. Methods. This study was a retrospective review of a single-center prospectively maintained cohort of 133 patients (146 knees) indicated for medial UKA from 2009 to 2013. Perioperative data and 2- and 5-year Knee injury Osteoarthritis Outcome Score (KOOS), Western Ontario and McMaster Universities Osteoarthritis Score (WOMAC), and Forgotten Joint Score (FJS) outcome measures were collected. Five-year follow-up was recorded in 119 patients (131 knees). Results. Mean follow-up was 5.1 ± 0.2 years. Mean age and BMI were 68.0 ± 8.1 years and 29.3 ± 4.7 kg/m2, respectively. At 2-year follow-up, mean KOOS, WOMAC, and FJS were 71.5 ± 15.3 , 14.3 ± 7.9 , and 79.1 ± 25.8 , respectively. At 5-year follow-up, mean KOOS, WOMAC, and FJS were 71.6 ± 15.2 , 14.2 ± 7.9 , and 80.9 ± 25.1 , respectively. Mean change in KOOS and WOMAC was 34.6 ± 21.4 and 11.0 ± 13.6 , respectively ( p < 0.001 and p < 0.001 ). For patient satisfaction at last follow-up, 89% of patients were very satisfied/satisfied and 5% were dissatisfied. For patient activity expectations at last follow-up, 85% met activity expectations, 52% were more active than before, 25% have the same level of activity, 23% were less active than before, and 89% were walking without support. All patients returned to driving after surgery at a mean 15.2 ± 9.4 days. Survivorship was 95% (95% CI 0.91-0.98) at 5 years. One knee (1%) had a patellofemoral revision, two knees (1.3%) were revised to different partial knee replacements, and five knees (3.4%) were converted to TKA. Conclusion. Overall, medial RA-UKA demonstrated improved patient-recorded outcomes, high patient satisfaction, met expectations, and excellent functional recovery. Midterm survivorship was excellent. Longitudinal follow-up is needed to evaluate long-term outcomes of robotic-arm-assisted UKA procedures.

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