Role of debulking mucoid ACL in unicompartmental knee arthroplasty: a prospective multicentric study

( Amyn M. Rajani ),( Urvil A. Shah ),( Anmol R. S. Mittal ),( Sheetal Gupta ),( Rajesh Garg ),( Meenakshi Punamiya ) 대한슬관절학회 2022 대한슬관절학회지 Vol.34 No.-

Background: Mucoid degeneration of the anterior cruciate ligament (ACL) has been shown to cause restricted terminal range of motion and rest pain. If present in a patient undergoing unicompartmental knee arthroplasty, it can deteriorate the final outcome. This study aims to compare functional and clinical outcomes of debulking the mucoid ACL in patients undergoing mobile-bearing unicompartmental knee arthroplasty (UKA). Methods: Patients with mucoid ACL undergoing mobile-bearing UKA at five different centres by five different arthroplasty surgeons were included. They were segregated into two groups matched for all demographic and preoperative values: group A did not undergo debulking; group B underwent open debulking by a 15-number blade prior to UKA. Patient-related outcome measures, rest pain, clinical outcomes, and subjective patient satisfaction were recorded and compared at 2 years follow-up. Results: A total of 442 patients (226 patients underwent debulking, 216 patients did not undergo debulking) were included. Both groups showed overall improvement after surgery, however, patients who underwent debulking performed better at 2 years follow-up in terms of Knee Society functional score, International Knee Documentation Committee scores, range of motion, rest pain and overall patient satisfaction (p < 0.05) as compared with their counterparts. Conclusions: Debulking of mucoid ACL in patients undergoing unicompartmental knee arthroplasty significantly reduces the rest pain and improves the final range of motion of the knee joint, subsequently improving the overall functional and clinical outcome of the patient and resulting in greater patient satisfaction.

Robotic-assisted vs conventional surgery in medial unicompartmental knee arthroplasty: a clinical and radiological study

( Roberto Negrín ),( Jaime Duboy ),( Magaly Iñiguez ),( Nicolás O. Reyes ),( Maximiliano Barahona ),( Gonzalo Ferrer ),( Carlos Infante ),( Nicolás Jabes ) 대한슬관절학회 2021 대한슬관절학회지 Vol.33 No.-

Background: The use of unicompartmental knee arthroplasty (UKA) has increased and new technologies have been developed to improve patient survival and satisfaction, soft tissue balance, alignment, and component size. Robot-assisted systems offer an increase in surgical precision and accuracy. The purpose of this study is to evaluate the precision of component position using five radiological parameters in conventional and robotic-assisted medial UKA using the NAVIO system. Methods: A cohort study was designed for patients who underwent medial UKA between April 2017 and March 2019 in a single center. Patients were allocated in the conventional (UKA-C) or robotic-assisted (UKA-R) group. The variables analyzed were age, gender, affected knee side, length of hospital stay, surgical time, and radiological measurements such as anatomical medial distal femoral angle (aMDFA), anatomical medial proximal tibial angle (aMPTA), tibial slope, the sagittal femoral angle, and the component size. A target was defined for each measurement, and a successful UKA was defined if at least four radiological measures were on target after surgery. Also, patients’ reported outcomes were evaluated using the Oxford Knee Score (OKS) and a numeric rating scale (NRS) for pain. Results: Thirty-four patients were included, 18 of them underwent UKA-R. The success rate for UKA in the UKA-R group was 87%; meanwhile, in the UKA-C group this was 28%, this difference was significant and powered (Fisher’s exact test, p = 0.001; 1 - β = 0.95). Also, a 5-point difference in favor of the UKA-R group in the median OKS (p = 0.01), and a significantly lower median NRS for pain (p < 0.000) were found after surgery. Conclusions: UKA-R achieved more precision in the radiological parameters’ measure in this study. Also, UKA-R has a trend towards a better OKS and a lower NRS for pain at short-term follow-up.

Fast-track surgery and telerehabilitation protocol in unicompartmental knee arthroplasty leads to superior outcomes when compared with the standard protocol: a propensity-matched pilot study

( Luca De Berardinis ),( Marco Senarighi ),( Carlo Ciccullo ),( Fabiana Forte ),( Marco Spezia ),( Antonio Pompilio Gigante ) 대한슬관절학회 2022 대한슬관절학회지 Vol.34 No.-

Background: Several strategies have been devised to reduce the length of stay after orthopedic surgery. Telerehabilitation has proved effective in functional outcomes after orthopedic procedures and is appreciated by patients. There is limited information on fast-track surgery and telerehabilitation protocols for unicompartmental knee arthroplasty (UKA). The purpose of this pilot study was to report and compare functional outcomes and satisfaction levels during first 12 months of recovery in patients who underwent UKA according to a fast-track and telerehabilitation protocol (G1) or standard surgery and rehabilitation program (G2). Methods: Data were retrospectively collected and reviewed for all elective UKAs from January 2018 to November 2019. A total of seven patients undergoing UKA according to the fast-track and telerehabilitation protocol were propensity score matched (1:3 ratio) to 21 patients undergoing standard surgery and rehabilitation. Patients were matched for age, sex, body mass index (BMI), and laterality. The Western Ontario and McMaster University (WOMAC) osteoarthritis index and range of motion (ROM) were collected pre- and postoperatively in both groups for 12 months. In addition, patient’ satisfaction was collected at 40 days. Results: The G1 group demonstrated significantly better outcomes in WOMAC index scores at 2, 15, and 40 days (p < 0.001, p < 0.001, p < 0.020, respectively) and a significantly greater knee ROM after surgery and at 2, 15, 40, and 12 months (p < 0.001, p < 0.001, p = 0.014, p < 0.001, p = 0.003, respectively). No patients in either group had postoperative complications. One patient was not completely satisfied in the G2, while no one in G1 reported not being completely satisfied (p = 1.000). Conclusions: This fast-track and telerehabilitation protocol after UKA can potentially be applied to patients as it is safe and effective. At 12-months follow-up, both groups reported favorable outcomes after UKA. However, the G1 score was better regarding WOMAC and ROM when compared with the propensity score-matched G2 program. A larger study is warranted to explore the role of fast-track and telerehabilitation in clinical and functional outcomes of UKA.

Evidence-based surgical technique for medial unicompartmental knee arthroplasty

( Tae Kyun Kim ),( Anurag Mittal ),( Prashant Meshram ),( Woo Hyun Kim ),( Sang Min Choi ) 대한슬관절학회 2021 대한슬관절학회지 Vol.33 No.-

Unicompartmental knee arthroplasty (UKA) is a successful treatment modality in selected patients having advanced, single-compartment osteoarthritis of the knee. The bone and ligament preservation leading to shorter recovery periods, better functional outcomes, lower perioperative complication rates, and easier revision, if needed, are proposed as some of the advantages of UKA over total knee arthroplasty (TKA). Despite several advantages, UKA is reported to have higher failure rates as compared to TKA. The prosthesis failure of UKA is directly correlated to intraoperative technique-related factors like malpositioning of components and the inability to replicate the target-limb alignment as per preoperative planning. An evidence-based surgical technique for UKA may help surgeons to avoid the intraoperative technique-related errors. The purpose of this paper is to describe a stepwise surgical technique for the fixed-bearing medial UKA.

Preserving coronal knee alignment of the knee (CPAK) in unicompartmental knee arthroplasty correlates with superior patient‑reported outcomes

( Sung Eun Kim ),( Kuk‑ro Yun ),( Jae Min Lee ),( Myung Chul Lee ),( Hyuk‑soo Han ) 대한슬관절학회 2024 대한슬관절학회지 Vol.36 No.-

Background The optimal alignment target for unicompartmental knee arthroplasty (UKA) remains controversial, and literature suggests that its impact on patient-reported outcome measures (PROMs) varies. The purpose of this study was to identify the relationship between changes in the coronal plane alignment of the knee (CPAK) and PROMs in patients who underwent UKA. Methods A retrospective analysis of 164 patients who underwent UKA was conducted. The types of CPAK types categorized into unchanged, minor (shift to an adjacent CPAK type, e.g., type I to II or type I to IV), and major changes (transitioning to a nearby diagonal CPAK type or two types across, such as type I to V or type I to III). PROMs were assessed preoperatively and 1 year postoperatively using the Hospital for Special Surgery (HSS) scores, Knee Society (KS) scores, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Forgotten Joint Scores (FJS). Comparison was performed between patients who experienced and who did not experience any changes in the CPAK. Results Patients with preserved native CPAK alignment demonstrated significantly superior 1 year postoperative outcomes, with higher HSS, KS knee, and WOMAC pain scores (p = 0.042, p = 0.009, and p = 0.048, respectively). Meanwhile, the degree of change in CPAK did not significantly influence the PROMs, and patients who experienced minor and major changes in the CPAK showed comparable outcomes. Conclusion Preserving the native CPAK in UKA procedures is important for achieving favorable clinical outcomes at 1 year postoperative. The extent of change in the CPAK type exerted a limited impact on PROMs, thus emphasizing the importance of change in alignment itself.

Unicompartmental vs. segmental bicompartmental vs. total knee replacement: comparison of clinical outcomes

( Oday Al-dadah ),( Georgina Hawes ),( Philip J. Chapman-sheath ),( John William Tice ),( David S. Barrett ) 대한슬관절학회 2020 대한슬관절학회지 Vol.32 No.-

Purpose: Combined medial tibiofemoral and symptomatic patellofemoral osteoarthritis is not amenable to unicompartmental knee replacement (UKR). Total knee replacement (TKR) is an invasive option in younger adults with high functional demands. The aim of this study was to compare the clinical outcome of patients who have undergone UKR, bicompartmental knee replacement (BKR) and TKR up to 2 years post-operatively. Materials and methods: This prospective study comprised 133 subjects including 30 patients in the medial UKR group, 53 patients in the BKR group (combined medial UKR with patellofemoral joint replacement) and 50 patients in the TKR group. All subjects were evaluated using the Oxford Knee Score (OKS) and the Western Ontario and MacMaster Universities Osteoarthritis Index (WOMAC). Patients in each group were assessed using both scoring systems pre-operatively and 6 months, 1 year and 2 years post-operatively. Results: Significant improvement of OKS was found at 6 months compared to baseline for UKR (22.7 to 38.1, p = 0.046), BKR (22.6 to 36.8, p < 0.001) and TKR (16.6 to 34.5, p < 0.001). Significant improvement was also found for the WOMAC sub-scores for all three groups during this time period. After 6 months, there was no further statistically significant improvement in either outcome score in any of the groups up to the 2-year follow-up results. There was no significant difference in either outcome score post-operatively between the three groups. Conclusion: The magnitude of clinical improvement following knee replacement is greatest at 6 months; thereafter, only modest improvements continue to occur. This study also found no significant differences of outcomes at 2 years after surgery among UKR, BKR and TKR. BKR is a good alternative option for combined symptomatic medial and patellofemoral arthritis of the knee.

Mid-Term Results of Oxford Medial Unicompartmental Knee Arthroplasty

Won-Sik Choy,Kap Jung Kim,Sang Ki Lee,Dae Suk Yang,Neung Ki Lee 대한정형외과학회 2011 Clinics in Orthopedic Surgery Vol.3 No.3

Background: This study examined the clinical and radiologic mid-term results of patients treated by Oxford minimally invasiveunicompartmental knee arthroplasty. Methods: One hundred and eighty-eight knees of unicompartmental knee arthroplasties with Oxford Uni® in 166 patients (16males and 150 females), which were performed between 2002 and 2005, were reviewed. The mean age was 65.3 years (range, 44to 82 years) and the mean follow-up period was 79.8 months (range, 56 to 103 months). The preoperative diagnosis was osteoarthritisin 166 patients, osteonecrosis of the medial femoral condyle in 20 and chondrocalcinosis in 2. Results: The mean Hospital for Special Surgery (HSS) knee score was 67.5 (range, 52 to 75) preoperatively and 89.9 (range, 85to 100) at the fi nal follow-up. The mean preoperative fl exion contracture was 6.5o (range, 0 to 15o) and 0.8o (range, 0 to 5o) at thefi nal follow-up. The mean full fl exion increased from 135o (range, 90 to 150o) preoperatively to 150o (range, 140 to 165o) at the fi nalfollow-up. Active full fl exion was possible within 2 postoperative months. The squatting and cross-leg postures were possible in133 patients (80.1%) and 152 patients (91.6%) at the fi nal follow-up. The mean tibiofemoral angle was improved from varus 1.5oto valgus 4.8o. Complications were encountered in 18 cases (9.5%). A bearing dislocation occurred in 10 cases (5.3%), tibial componentloosening in 4 cases (2.1%), femoral loosening in 3 cases (1.6%) and lateral translation in 1 case (0.5%). The mean time fora bearing dislocation was 22.6 months (range, 3 to 70 months) postoperatively. Seven cases returned to the predislocation level ofactivity with the insertion of a thicker bearing and 3 cases converted to total knee arthroplasty. Conclusions: Minimally invasive unicompartmental knee arthroplasty with Oxford Uni® provided rapid recovery, good pain reliefand excellent function suitable for the Korean lifestyle. In contrast, the high complication rates of Oxford Uni® encountered in themid-term results suggested less reliability than total knee arthroplasty.

Implant Overhang after Unicompartmental Knee Arthroplasty: Oxford Prosthesis versus Miller-Galante II Prosthesis

( Geon Hyeong Kim ),( Bum Yong Park ),( Tae Yong Bae ),( Kwang Yun Song ),( Yong In ) 대한슬관절학회 2014 대한슬관절학회지 Vol.26 No.2

Purpose: The purpose of the present study is to compare the prevalence of implant overhang between the Oxford and the Miller-Galante II (M-G II) unicompartmental knee arthroplasty (UKA) prostheses and determine whether overhang is associated with postoperative clinical results. Materials and Methods: We retrospectively reviewed one hundred and seven UKAs which consisted of 37 Oxford UKAs and 70 M-G II. Overhang was considered present if ≥3 mm overhang was observed in any zone. The range of motion, the Knee Society scores and the Western Ontario and McMaster scores were compared after a mean follow-up duration of 48 months. Results: Thirty three of 107 knees (30.8%) had overhang in at least one zone of the femoral or tibial component. In the tibial side, there were no significant differences between the groups in component overhang in each zone. In the femoral side, the Oxford UKA group showed a significantly higher prevalence of the posterior overhang of the femoral component (19/37, 51.4%) than did the M-G II UKA group (3/70, 4.3%; p< 0.001). However, no significant differences in clinical results were observed between the two groups. There were also no significant differences in clinical results between the overhang and the non-overhang groups. Conclusions: Posterior overhang of the femoral component was highly prevalent in Oxford UKA patients. However, posterior overhang of the femoral component had no significant relationship with postoperative clinical results in both Oxford and M-G II UKAs at a mean of 48 months follow-up.

Medial Unicompartmental Knee Arthroplasty in Patients with Spontaneous Osteonecrosis of the Knee

Won Sik Choy,Kap Jung Kim,Sang Ki Lee,Dae Suk Yang,Choon-Myeon Kim,Ju Sang Park 대한정형외과학회 2011 Clinics in Orthopedic Surgery Vol.3 No.4

Background: We analyzed the clinical and radiologic results of patients with spontaneous osteonecrosis of the knee treated byminimally invasive medial unicompartmental arthroplasty using Oxford Uni. Methods: We reviewed 22 knees in 21 patients which were treated for spontaneous osteonecrosis between 2002 and 2006. Patientsincluded one male and 20 females. The mean age was 70.8 years (range, 53 to 82 years). The mean follow-up period was70.3 months (range, 48 to 93 months). The clinical results were evaluated using the Hospital for Special Surgery (HSS) knee scoreand the range of motion of the knee preoperatively and at the fi nal follow-up. Preoperative plain radiographs and magnetic resonanceimages were analyzed to determine the size and stage of osteonecrotic lesions. Results: The mean HSS knee score was 64.3 (range, 54 to 75) preoperatively and 92.0 (range, 71 to 100) at the fi nal follow-up. The mean preoperative fl exion contracture was 8.9o (range, 0 to 15o) and 0.2o (range, 0 to 5o) at the fi nal follow-up. The mean furtherfl exion increased from 138.6o (range, 100 to 145o) preoperatively to 145.6o (range, 140 to 150o) at the fi nal follow-up. Activefull fl exion was possible within 2 months of the operation. The squatting position was possible in 16 patients (84.2%) out of 19,except one case of bronchiectasis and one case of spine fracture. The cross-leg posture was possible in 19 patients (90.5%) out of21. The mean tibiofemoral angle was improved from varus 0.98o to valgus 3.22o. Meniscal bearing dislocation occurred in 2 casesand femoral component loosening occurred in 1 case. Conclusions: Unicompartmental knee arthroplasty using Oxford Uni could be an alternative treatment option in spontaneous osteonecrosisof the knee.

Outcome of Unicompartmental Knee Arthroplasty: A Systematic Review of Comparative Studies between Fixed and Mobile Bearings Focusing on Complications

( Young Bong Ko ),( Manan Ramesh Gujarathi ),( Dnb (d’orth) ),( Kwang Jun Oh ) 대한슬관절학회 2015 대한슬관절학회지 Vol.27 No.3

The purpose of this systematic review is to collate results of studies comparing fixed and mobile bearing unicompartmental knee arthroplasty (UKA), focusing on complications and timing for reoperations. Out of 723 results derived from PubMed, EMBASE and Cochrane database search engines on bearings in arthroplasty, 10 studies comparing clinical results of fixed bearings to mobile bearings in UKA were found eligible for analysis. The reoperation rate was calculated using a novel method such as reoperations per hundred component years, and the causes of specific reoperations were investigated. The overall reoperation rate per hundred component years was similar between the mobile bearings (1.392) and fixed bearings (1.377); however, mobile bearings were more susceptible to reoperations in cases with aseptic loosening (0.393>0.255), progression of arthritis (0.428>0.357) and implant dislocation (0.286>0). The overall incidence of complications is similar for fixed and mobile bearing designs in UKA. The discussion on complications presented above may assist surgeons in their choice of bearing design.