scholarly journals Medial unicondylar knee arthroplasty should be reserved for patients with complete joint space collapse

2021 ◽  
Author(s):  
Alexander Wurm ◽  
Anna Zechling ◽  
Hermann Leitner ◽  
Dietmar Dammerer ◽  
Bernhard Pfeifer ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Knee Arthroplasty ◽  
Survival Data ◽  
Joint Space Width ◽  
Joint Space ◽  
Unicondylar Knee Arthroplasty ◽  
Womac Pain ◽  
Implant Survival ◽  
Womac Function ◽  
Medial Unicondylar Knee Arthroplasty

Abstract Purpose To determine whether preoperative radiologic joint space width (JSW) is related to the outcome of medial unicondylar knee arthroplasty (UKA) (primary hypothesis). Methods A retrospective comparative analysis was performed. One group was comprised of UKA patients with preoperative JSW 0–1 mm. Another group was made up of patients with preoperative JSW ≥ 2 mm (range 0–4 mm). The JSW was measured from preoperative weight-bearing Schuss-view radiographs. The clinical outcome was determined with the Western Ontario and MacMaster Universities (WOMAC) Osteoarthritis Index score preoperatively and 1 year after medial UKA. Implant survival data were obtained from the arthroplasty register of Tyrol. Results There were 80 patients with a preoperative JSW 0–1 mm (age 66, BMI 27.8) and 70 patients with a preoperative JSW ≥ 2 mm (age 64, IQR 15, BMI 28.1). WOMAC total was 10 ± 10 in patients with 0–1 mm JSW and 25 ± 47 in patients with ≥ 2 mm JSW at 1 year postoperative (p = 0.052). WOMAC pain at 1 year postoperative was 7 ± 16 in patients with 0–1 mm JSW and 18 ± 46 in patients with ≥ 2 mm JSW (p = 0.047). WOMAC function at 1 year postoperative was 10 ± 9 in patients with 0–1 mm JSW and 17 ± 51 in patients with ≥ 2 mm JSW (p = 0.048). In patients with 0–1 mm JSW 5 year prosthesis survival was 92.3% and in patients with ≥ 2 mm JSW, it was 81.1% (p = 0.016). Conclusions In patients with preoperative complete joint space collapse (0–1 mm JSW), clinical outcome was superior to that of patients with incomplete joint space collapse. This was true for both 1 year postoperative WOMAC pain and WOMAC function and for 5 year implant survival rates. On the basis of our findings, it is recommended that ‘complete joint space collapse’ especially be used to achieve best clinical outcome in medial UKA surgery. Level of evidence IV.

An Evaluation of Ultrasound-Guided Adductor Canal Blockade for Postoperative Analgesia After Medial Unicondylar Knee Arthroplasty

2016 ◽  
Vol 122 (4) ◽  
pp. 1192-1201 ◽  
Author(s):  
Daryl S. Henshaw ◽  
Jonathan Douglas Jaffe ◽  
Jon Wellington Reynolds ◽  
Sean Dobson ◽  
Gregory B. Russell ◽  
...  
Keyword(s):  
Knee Arthroplasty ◽  
Postoperative Analgesia ◽  
Unicondylar Knee Arthroplasty ◽  
Ultrasound Guided ◽  
Adductor Canal ◽  
Medial Unicondylar Knee Arthroplasty

Lower limb alignment control: Is it more challenging in lateral compared to medial unicondylar knee arthroplasty?

The Knee ◽  
2015 ◽  
Vol 22 (4) ◽  
pp. 347-350 ◽  
Author(s):  
Saker Khamaisy ◽  
Brian P. Gladnick ◽  
Denis Nam ◽  
Keith R. Reinhardt ◽  
Thomas J. Heyse ◽  
...  
Keyword(s):  
Knee Arthroplasty ◽  
Lower Limb ◽  
Unicondylar Knee Arthroplasty ◽  
Limb Alignment ◽  
Lower Limb Alignment ◽  
Medial Unicondylar Knee Arthroplasty

scholarly journals What is the “safe zone” for transition of coronal alignment from systematic to a more personalised one in total knee arthroplasty? A systematic review

2022 ◽  
Author(s):  
Benjamin L. Schelker ◽  
Andrej M. Nowakowski ◽  
Michael T. Hirschmann
Keyword(s):  
Systematic Review ◽  
Total Knee Arthroplasty ◽  
Clinical Outcome ◽  
Knee Arthroplasty ◽  
Safe Zone ◽  
Patient Specific ◽  
Mechanical Alignment ◽  
Implant Survival ◽  
Total Knee ◽  
Alignment Strategy

Abstract Purpose In total knee arthroplasty (TKA), implants are increasingly aligned based on emerging patient-specific alignment strategies, such as unrestricted kinematic alignment (KA), according to their constitutional limb alignment (phenotype alignment), which results in a large proportion of patients having a hip-knee angle (HKA) outside the safe range of ± 3° to 180° traditionally considered in the mechanical alignment strategy. The aim of this systematic review is to investigate whether alignment outside the safe zone of ± 3° is associated with a higher revision rate and worse clinical outcome than alignment within this range. Methods A systematic literature search was conducted in PubMed, Embase, Cochrane and World of Science, with search terms including synonyms and plurals for “total knee arthroplasty”, “alignment”, “outlier”, “malalignment”, “implant survival” and “outcome”. Five studies were identified with a total number of 927 patients and 952 implants. The Oxford Knee Score (OKS) and the WOMAC were used to evaluate the clinical outcome. The follow-up period was between 6 months and 10 years. Results According to HKA 533 knees were aligned within ± 3°, 47 (8.8%) were varus outliers and 121 (22.7%) were valgus outliers. No significant differences in clinical outcomes were found between implants positioned within ± 3° and varus and valgus outliers. Likewise, no significant differences were found regarding revision rates and implant survival. Conclusion The universal use of the “safe zone” of ± 3° derived from the mechanical alignment strategy is hardly applicable to modern personalised alignment strategies in the light of current literature. However, given the conflicting evidence in the literature on the risks of higher revision rates and poorer clinical outcomes especially with greater tibial component deviation, the lack of data on the outcomes of more extreme alignments, and regarding the use of implants for KA TKA that are actually designed for mechanical alignment, there is an urgent need for research to define eventual evidence-based thresholds for new patient-specific alignment strategies, not only for HKA but also for FMA and TMA, also taking into account the preoperative phenotype and implant design. It is of utmost clinical relevance for the application of modern alignment strategies to know which native phenotypes may be reproduced with a TKA. Level of evidence IV.

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