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.

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 Does new instrument for Oxford unicompartmental knee arthroplasty improve short-term clinical outcome and component alignment? A meta-analysis

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Xiao Wei Sun ◽  
Fei Fan Lu ◽  
Kun Zou ◽  
Mao Hong ◽  
Qi Dong Zhang ◽  
...  
Keyword(s):  
Femoral Component ◽  
Knee Arthroplasty ◽  
Unicompartmental Knee Arthroplasty ◽  
Revision Rate ◽  
Meta Analysis ◽  
Phase Iii ◽  
Cochrane Library ◽  
Radiological Assessment ◽  
Short Term ◽  
Unicompartmental Knee

Abstract Background The Microplasty (MP) instrumentation designed for the Phase III Oxford mobile-bearing unicompartmental knee arthroplasty (UKA) system is considered a better option to achieve more accurate component positioning and alignment. In the present study, we focused on short-term clinical and radiological outcomes to determine whether the MP instrumentation can reduce the short-term revision rate and occurrence of outliers of metallic components. Methods The literature in PubMed, Embase, the Cochrane Library, and Web of Science was searched up to May 2020. Studies were scrutinized by two independent authors, and the revision rate, complication spectrum, and radiological assessment with outlier rates were specifically analyzed. RevMan 5.3 was used for the statistical analysis. Results Seven studies were included in the meta-analysis. Four studies reported both clinical and radiological outcomes, two reported only radiological outcomes, and one reported only clinical outcomes. The pooled analysis showed that the revision rate in the MP instrumentation group was 0.866 per 100 component years, while that in the control group was 1.124 (odds ratio, 0.77; p < 0.05). The subgroup analysis of the bearing dislocation rate showed a significantly greater reduction in the Korean population than in the populations of other countries (p < 0.05). The radiological assessment showed that the alignment of the femoral component was significantly improved (p < 0.05), while that of the tibial component was not (p > 0.05). Conclusion The newly developed MP instrumentation for Oxford UKA significantly reduced the revision rate of this treatment. The positioning of the femoral component was also proven to be better by radiological assessments.

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.

scholarly journals Does robotic-assisted unicompartmental knee arthroplasty have lower complication and revision rates than the conventional procedure? A systematic review and meta-analysis

BMJ Open ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. e044778
Author(s):  
Yifeng Sun ◽  
Wei Liu ◽  
Jian Hou ◽  
Xiuhua Hu ◽  
Wenqiang Zhang
Keyword(s):  
Systematic Review ◽  
Knee Arthroplasty ◽  
Unicompartmental Knee Arthroplasty ◽  
Meta Analysis ◽  
Surgical Techniques ◽  
Complication Rates ◽  
Case Control Studies ◽  
Eligibility Criteria ◽  
Robotic Assisted ◽  
Unicompartmental Knee

ObjectiveWe conducted this systematic review and meta-analysis of studies on patients who underwent unicompartmental knee arthroplasty (UKA) to compare the complication rates, revision rates and non-implant-specific complications between robotic-assisted and conventional UKA.DesignSystematic review and meta-analysis.Data sourcesThe PubMed, Embase, Web of Science and Cochrane databases were searched up to 30 June 2020.Eligibility criteriaCase–control studies comparing robotic-assisted and conventional UKA.Data extraction and synthesisData from all eligible articles were independently extracted by two authors. We analysed the differences in outcomes between robotic-assisted and conventional UKA by calculating the corresponding 95% CIs and pooled relative risks (RRs). Heterogeneity was assessed using the χ2 and I2 tests. All analyses were performed using the ‘metafor’ package of R V.3.6.2 software.ResultsA total of 16 studies involving 50 024 patients were included in the final meta-analysis. We found that robotic-assisted UKA had fewer complications (RR: 0.52, 95% CI: 0.28 to 0.96, p=0.036) and lower revision rates (RR: 0.42, 95% CI: 0.20 to 0.86, p=0.017) than conventional UKA. We observed no significant differences in non-implant-specific complications between the two surgical techniques (RR: 0.80, 95% CI: 0.61 to 1.04, p=0.96). No publication bias was found in this meta-analysis.ConclusionsThis study provides evidence that robotic-assisted UKA has fewer complications and lower revision rates than conventional UKA; however, owing to important limitations, the results lack reliability, and more studies are required.PROSPERO registration numberCRD42021246927.

Outcomes of Combined Unicompartmental Knee Replacement and Anterior Cruciate Ligament Reconstruction: A Systematic Review

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Timour Fekry El-Husseini ◽  
Mustafa Ali Ahmed ◽  
Yahia Ahmed Sadek
Keyword(s):  
Systematic Review ◽  
Acl Reconstruction ◽  
Knee Arthroplasty ◽  
Unicompartmental Knee Arthroplasty ◽  
Functional Outcomes ◽  
Revision Rate ◽  
Unicompartmental Knee ◽  
The Mean ◽  
Acl Deficient ◽  
Deficient Knee

Abstract Background The incidence of osteoarthritis of the medial compartment after ACL injury has been quoted to range from 33% to 70%. Medial osteoarthritis in ACL deficient knee is a challenge. Patients are mainly young and active. First reports highlighted a higher incidence of complications, in terms of tibial loosening and higher revision rate, when UKA were performed in ACL-deficient knees. They defined ACL deficiency is a contraindication to UKA. Objectives A systematic review and meta-analysis of literature to assess functional outcomes of combined unicompartmental knee arthroplasty with ACL reconstruction and revision rate. Data Sources The following electronic databases were searched up to 2019: PubMed, Google Scholar search engine, JBJS {Journal of bone and joint Surgery}, Cochrane database of systematic reviews, EMBASE and Science Direct. Results A total of 10 studies met the inclusion criteria encompassing 218 patients who were treated with simultaneous ACL reconstruction and unicompartmental knee arthroplasty. The mean age was 49.5 years (range from 36 to 71) with a mean follow-up of 49.3 months (range from 9 to 258). There was an improvement in mean Oxford Score from 29 to 42.5. The mean knee society score improved from 88.3 to 159. Complications reported included tibial inlay dislocation (n = 3), conversion to a total knee arthroplasty (n = 2), infection requiring two-stage revision (n = 2), stiffness requiring manipulation under anaesthesia (n = 1). Average revision rate was 1.8%. Conclusion Literature has strong evidence to support that combined UKA and ACL reconstruction show good functional outcomes and less revision rate. It is a valid treatment option for MOA more in young age group in whom MOA secondary to ACL tear and intact other knee compartments. there is no clinical trial or study suggest that UKA and ACL reconstruction is superior to UKA with tibial slope change or using fixed bearing prosthesis for MOA in ACL deficient knee with instability.

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