scholarly journals Chondrocalcinosis does not affect functional outcome and prosthesis survival in patients after total or unicompartmental knee arthroplasty: a systematic review

2021 ◽  
Author(s):  
Céline S. Moret ◽  
Edna Iordache ◽  
Riccardo D’Ambrosi ◽  
Michael T. Hirschmann
Keyword(s):  
Systematic Review ◽  
Functional Outcome ◽  
Knee Arthroplasty ◽  
Unicompartmental Knee Arthroplasty ◽  
Survival Rates ◽  
Level Of Evidence ◽  
Tissue Samples ◽  
Unicompartmental Knee ◽  
Prosthesis Survival ◽  
The Impact

Abstract Purpose There are contentious data about the role calcium pyrophosphate (CPP) crystals and chondrocalcinosis (CC) play in the progression of osteoarthritis (OA), as well as in the outcomes after knee arthroplasty. Hence, the purpose of this systematic review was to analyse the clinical and functional outcome, progression of OA and prosthesis survivorship after unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA) in patients with CC compared to patients without CC. Methods A systematic review of the literature in PubMed, Medline, Embase and Web of Science was performed using the “Preferred Reporting Items for Systematic Reviews and Meta-Analysis” (PRISMA) guidelines. Articles which reported the outcome and survival rates of prosthesis after TKA or UKA in patients with CC were included. Results A total of 3718 patient knees were included in eight selected publications, with a median sample sizes of 234 knees (range 78–1000) and 954 knees (range 408–1500) for publications including UKA and TKA, respectively. At time of surgery, the mean age was 69 years and the prevalence for CC ranged from 12.6 to 36%. Chondrocalcinosis did not significantly influence the functional and clinical outcome, the implant survival as well as the radiologic progression of OA disease after UKA and TKA. Conclusion The presence of CPP crystals in tissue samples, synovial fluid or evidence of calcifications on preoperative radiographs did not significantly influence the postoperative functional and activity scores. It also had no significant influence on prosthesis survival rate, whether it was a UKA or a TKA. This study shows that the impact of a subclinical form of chondrocalcinosis may not be of clinical relevance in the context of arthroplasty. Level of evidence IV.

Simultaneous bilateral unicompartmental knee arthroplasty surgery has benefits in low complication rate and cost-effectiveness: a systematic review

2020 ◽  
Vol 5 (4) ◽  
pp. 218-223
Author(s):  
Nicolas Pujol ◽  
Yoshiki Okazaki ◽  
Takayuki Furumatsu
Keyword(s):  
Systematic Review ◽  
Cost Effectiveness ◽  
Knee Osteoarthritis ◽  
Knee Arthroplasty ◽  
Unicompartmental Knee Arthroplasty ◽  
Cost Savings ◽  
Level Of Evidence ◽  
Patient Profile ◽  
One Stage ◽  
Unicompartmental Knee

ImportanceBilateral knee osteoarthritis is frequent and the best choice of treatment remains questionable, especially when the surgeon has to consider simultaneous or staged bilateral unicompartmental knee arthroplasty (UKA).ObjectiveThe purpose of this systematic review was to conduct a systematic review assessing the clinical outcomes associated with simultaneous bilateral and staged bilateral UKA.Evidence reviewA literature search was conducted in June 2019 in Medline, PubMed and Embase. A full-text review of eligible studies was conducted by two investigators.FindingsA total of 10 retrospective studies were identified. These studies described the results of simultaneous bilateral UKA compared either to staged bilateral UKA or unilateral UKA. Results showed that the prevalence of mortality at a minimum of 30 days postoperatively, deep vein thrombosis, the rate of blood transfusion and reintervention were not higher in patients undergoing a one-stage bilateral UKA. The cost-effectiveness is in favour of doing a one-stage procedure due to the shortness of total hospital stay.Conclusions and relevanceOne-stage simultaneous bilateral UKA can be performed with preventing the postoperative complication, and result in cost savings for patients with symptomatic medial bilateral unicompartmental knee osteoarthritis. Further comparative studies are necessary to determine the best patient profile for such a surgery, and the technical considerations during surgery (consecutive surgery or simultaneous surgery with two operative teams).Level of evidenceIV.

scholarly journals The effect of obesity on revision rate in unicompartmental knee arthroplasty: a systematic review and meta-analysis

2020 ◽  
Author(s):  
Omar Musbahi ◽  
Thomas W. Hamilton ◽  
Adam J. Crellin ◽  
Stephen J. Mellon ◽  
Benjamin Kendrick ◽  
...  
Keyword(s):  
Systematic Review ◽  
Knee Arthroplasty ◽  
Unicompartmental Knee Arthroplasty ◽  
Revision Rate ◽  
Meta Analysis ◽  
Obese Patients ◽  
Level Of Evidence ◽  
Unicompartmental Knee ◽  
Significant Difference ◽  
The Mean

Abstract The number of patients with knee osteoarthritis, the proportion that is obese and the number undergoing unicompartmental knee arthroplasty (UKA) are all increasing. The primary aim of this systematic review was to determine the effects of obesity on outcomes in UKA. A systematic review was performed using PRISMA guidelines and the primary outcome was revision rate per 100 observed component years, with a BMI of ≥ 30 used to define obesity. The MINORS criteria and OCEBM criteria were used to assess risk of bias and level of evidence, respectively. 9 studies were included in the analysis. In total there were 4621 knees that underwent UKA. The mean age in included studies was reported to be 63 years (mean range 59.5–72 years old)) and range of follow up was 2–18 years. Four studies were OCEBM level 2b and the average MINORS score was 13. The mean revision rate in obese patients (BMI > 30) was 0.33% pa (95% CI − 3.16 to 2.5) higher than in non-obese patients, however this was not statistically significant (p = 0.82). This meta-analysis concludes that there is no significant difference in outcomes between obese and non-obese patients undergoing UKA. There is currently no evidence that obesity should be considered a definite contraindication to UKA. Further studies are needed to increase the numbers in meta-analysis to explore activity levels, surgeon’s operative data, implant design and perioperative complications and revision in more depth. Level of evidence Level III.

scholarly journals Complications, Reasons for Reoperation, and 5-Year Prosthesis Survival Compared Between the Cemented and Cementless Oxford Unicompartmental Knee Arthroplasty Fixation Techniques at Thailand’s Largest National Tertiary Referral Center

2021 ◽  
Author(s):  
Jirayu Paugchawee ◽  
Chaturong Pornrattanamaneewong ◽  
Pakpoom Ruangsomboon ◽  
Rapeepat Narkbunnam ◽  
Keerati Chareancholvanich
Keyword(s):  
Knee Osteoarthritis ◽  
Knee Arthroplasty ◽  
Unicompartmental Knee Arthroplasty ◽  
Cox Proportional Hazards Model ◽  
Implant Survival ◽  
Unicompartmental Knee ◽  
Prosthesis Survival ◽  
Significant Difference ◽  
Oxford Unicompartmental Knee Arthroplasty

Abstract Background: Oxford unicompartmental knee arthroplasty (OUKA) yields favorable outcomes in patients with medial compartmental knee osteoarthritis; however, it remains unknown whether cemented or cementless OUKA fixation delivers better outcomes in Asian population. Accordingly, this study aimed to investigate the complications, reasons for reoperation, and 5-year prosthesis survival compared between cemented and cementless OUKA in Thai patients.Methods: A total of 466 cemented and 36 cementless OUKA that were performed during 2011-2015 with a minimum follow-up of five years were included. With reoperation for any reason as the endpoint, Kaplan-Meier analysis was performed to compare 5-year implant survival between groups. Complications, reasons for reoperation, and 90-day morbidity and mortality were compared between groups. Cox proportional hazards model was used to identify independent predictors of implant survival.Results: There was no significant difference in 5-year implant survival between the cemented and cementless groups (96.4% vs. 94.4%, p=0.375). The mean implant survival time was 113.0±0.8 and 70.8±1.9 months in the cemented and cementless groups, respectively (p=0.383). The most common reason for reoperation was bearing dislocation, and only one patient had 90-day morbidity. There was no significant difference between groups for complications or reasons for reoperation. No independent predictors of implant survival were identified in multivariate analysis.Conclusions: OUKA was shown to be a safe and durable reconstructive procedure in Thai patients with medial compartmental knee osteoarthritis. There was no significant difference in implant survival between the cemented and cementless groups during the 5-year follow-up, and no independent predictors of implant survival were identified. Trial registration: Thai Clinical Trials Registry, TCTR20200427004. Registered 27 April 2020 – Retrospectively registered.

Improving Estimates of Annual Survival Rates for Medial Unicompartmental Knee Arthroplasty, a Meta-Analysis

2019 ◽  
Vol 34 (7) ◽  
pp. 1538-1545 ◽  
Author(s):  
Braiden M. Heaps ◽  
Jason L. Blevins ◽  
Yu-Fen Chiu ◽  
Joseph F. Konopka ◽  
Shaun P. Patel ◽  
...  
Keyword(s):  
Knee Arthroplasty ◽  
Unicompartmental Knee Arthroplasty ◽  
Meta Analysis ◽  
Survival Rates ◽  
Annual Survival ◽  
Unicompartmental Knee ◽  
Medial Unicompartmental Knee Arthroplasty

A systematic review of robotic-assisted unicompartmental knee arthroplasty

2019 ◽  
Vol 101-B (7) ◽  
pp. 838-847 ◽  
Author(s):  
P. G. Robinson ◽  
N. D. Clement ◽  
D. Hamilton ◽  
M. J. G. Blyth ◽  
F. S. Haddad ◽  
...  
Keyword(s):  
Systematic Review ◽  
United Kingdom ◽  
Knee Arthroplasty ◽  
Unicompartmental Knee Arthroplasty ◽  
Functional Outcomes ◽  
Implant Design ◽  
Current Evidence ◽  
Robotic Assisted ◽  
Implant Positioning ◽  
Unicompartmental Knee

AimsRobotic-assisted unicompartmental knee arthroplasty (UKA) promises accurate implant placement with the potential of improved survival and functional outcomes. The aim of this study was to present the current evidence for robotic-assisted UKA and describe the outcome in terms of implant positioning, range of movement (ROM), function and survival, and the types of robot and implants that are currently used.Materials and MethodsA search of PubMed and Medline was performed in October 2018 in line with the Preferred Reporting Items for Systematic Review and Meta-Analysis statement. Search terms included “robotic”, “knee”, and “surgery”. The criteria for inclusion was any study describing the use of robotic UKA and reporting implant positioning, ROM, function, and survival for clinical, cadaveric, or dry bone studies.ResultsA total of 528 articles were initially identified from the databases and reference lists. Following full text screening, 38 studies that satisfied the inclusion criteria were included. In all, 20 studies reported on implant positioning, 18 on functional outcomes, 16 on survivorship, and six on ROM. The Mako (Stryker, Mahwah, New Jersey) robot was used in 32 studies (84%), the BlueBelt Navio (Blue Belt Technologies, Plymouth, Minnesota) in three (8%), the Sculptor RGA (Stanmore Implants, Borehamwood United Kingdom) in two (5%), and the Acrobot (The Acrobot Co. Ltd., London, United Kingdom) in one study (3%). The most commonly used implant was the Restoris MCK (Stryker). Nine studies (24%) did not report the implant that was used. The pooled survivorship at six years follow-up was 96%. However, when assessing survival according to implant design, survivorship of an inlay (all-polyethylene) tibial implant was 89%, whereas that of an onlay (metal-backed) implant was 97% at six years (odds ratio 3.66, 95% confidence interval 20.7 to 6.46, p < 0.001).ConclusionThere is little description of the choice of implant when reporting robotic-assisted UKA, which is essential when assessing survivorship, in the literature. Implant positioning with robotic-assisted UKA is more accurate and more reproducible than that performed manually and may offer better functional outcomes, but whether this translates into improved implant survival in the mid- to longer-term remains to be seen. Cite this article: Bone Joint J 2019;101-B:838–847.

Metal-Backed Tibial Components Do Not Reduce Risk of Early Aseptic Loosening in Unicompartmental Knee Arthroplasty: A Systematic Review and Meta-Analysis

2019 ◽  
Vol 33 (02) ◽  
pp. 180-189 ◽  
Author(s):  
Giuseppe Gianluca Costa ◽  
Mirco Lo Presti ◽  
Alberto Grassi ◽  
Giuseppe Agrò ◽  
Sergio Cialdella ◽  
...  
Keyword(s):  
Systematic Review ◽  
Aseptic Loosening ◽  
Knee Arthroplasty ◽  
Unicompartmental Knee Arthroplasty ◽  
Tibial Component ◽  
Revision Rate ◽  
Meta Analysis ◽  
Female Patients ◽  
Unicompartmental Knee

AbstractLong-term results of unicompartmental knee arthroplasty (UKA) have shown a slightly higher revision rate than total knee arthroplasty (TKA), and implant fixation geometry seems to affect prosthetic survivorship. Whether metal-backed tibial component leads to superior performance over the all-polyethylene design is unclear, and a lack of evidence exists in literature. Our purpose was to demonstrate which implant design of UKA (all-polyethylene or metal-backed tibial component) is clinically superior regarding revision rates and clinical functioning, and investigate the role of potential factors that could affect the revision rate. A systematic review was conducted for clinical studies comparing all-polyethylene and metal-backed tibial components used in primary UKAs in terms of revision rates and clinical scores. Meta-regression techniques were used to explore factors modifying the observed effect. All causes of revision were extracted and analyzed, to find statistically significant differences between the two groups. Our research strategy generated a systematic review of nine studies comprising 1,101 UKAs in 1,088 patients with 87 revisions for any reason. Meta-analysis showed a higher, but not statistically significant, risk of aseptic revision in the all-polyethylene group. Studies with a smaller sample size and higher percentage of female patients were correlated to a higher relative risk of revision in favor of all-polyethylene UKAs. Differently, patients' age and duration of follow-up did not influence the risk ratio. The main cause for revision was aseptic loosening in both implants' component, with no statistically differences in the two groups examined. Our results do not show a superiority of the metal-backed tibial component in UKAs in terms of survivorship, although extreme care must be given for patients with high risk of early failure, such as female patients. However, surgical experience, in combination with careful patient selection, remains paramount and may lead to better long-term outcomes in patients requiring UKA. This is a Level III, therapeutic study.

Robotic-Assisted versus Manual Unicompartmental Knee Arthroplasty: Contemporary Systematic Review and Meta-analysis of Early Functional Outcomes

2020 ◽  
Author(s):  
Michael A. Gaudiani ◽  
Linsen T. Samuel ◽  
Atul F. Kamath ◽  
P. Maxwell Courtney ◽  
Gwo-Chin Lee
Keyword(s):  
Systematic Review ◽  
Knee Arthroplasty ◽  
Unicompartmental Knee Arthroplasty ◽  
Fixed Effects ◽  
Meta Analysis ◽  
Forest Plot ◽  
Robotic Assisted ◽  
Unicompartmental Knee ◽  
Surgeon Experience

AbstractRobotic-assisted unicompartmental knee arthroplasty (RA-UKA) aims to improve accuracy of component placement. Studies have shown improvement in radiographic positioning/alignment with RA-UKA but have not addressed clinical outcome measures (COMs). The purpose of this study was to determine if RA-UKA is associated with improved early revision rates and functional outcome scores (FOS) compared with manual UKA. A systematic review of all English language articles from 1999 to 2019 on RA-UKA using Medline, EMBASE, Scopus, and Web of Science databases identified 277 studies. Seven (three randomized controlled trials) met inclusion criteria. Revision rates/FOS were aggregated for RA-UKA and manual UKA; a forest plot was constructed utilizing inverse variance/Mantel–Haenszel fixed-effects meta-analysis. The seven articles included a total of 363 RA-UKA patients and 425 manual UKA patients. Mean age was 66 ± 3.5 and 65 ± 4.0 years, and mean body mass index (BMI) was 26.8 ± 2.1 and 27.1 ± 1.5 kg/m2, respectively. Mean follow-up was 25.5 months (4.5–48) and 29.1 months (4.5–48) for RA-UKA and manual UKA, respectively. At latest follow-up, RA-UKA patients showed a 26% ± 12 improvement in COMs versus 24% ± 12 improvement for manual UKA patients (p = 0.6). The revision rate was 3% for both groups (p = 0.8); however, a meta-analysis of RCTs showed no difference. Robotic and manual UKAs offer comparable improvements in pain, FOS, and revision rates. The effects of follow-up duration, ceiling effects of COMs, and surgeon experience remain unknown. Future studies comparing robotic versus manual UKAs with longer term follow-up may inform further benefits of each, with respect to component durability, alignment, and functional improvement.

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