scholarly journals Oxford partial knee replacement by microplasty instrumentation: Indian evidence

2020 ◽  
Vol 6 (6) ◽  
pp. 1251
Author(s):  
Mukesh Sancheti
Keyword(s):  
Patient Satisfaction ◽  
Surgical Technique ◽  
Knee Replacement ◽  
Knee Prosthesis ◽  
Oxford Knee Score ◽  
Mobile Bearing ◽  
Average Hospital ◽  
Satisfaction Index ◽  
Select Group ◽  
Partial Knee Replacement

<p class="abstract"><strong>Background:</strong> There is increasing evidence in support of unicondylar knee replacement (UKR) as a superior surgical modality in a select group of patients of osteoarthritis knee. Oxford knee is one type of UKR with fully congruent, mobile bearing designed to minimize wear. This prospective study describes 5-year results of partial medial compartment knee replacement in 92 Indian cases by microplasty instrumentation.</p><p class="abstract"><strong>Methods:</strong> All 92 cases were operated by a single surgeon. Mean follow up was 5 years. In all cases oxford mobile bearing medial unicondylar knee prosthesis was implanted using minimally invasive surgical technique and the cases followed up.<strong></strong></p><p class="abstract"><strong>Results:</strong> Mean oxford score at the end of 5 year was 43. Patient satisfaction index at the end of 5 year was 98%. Mean maximum flexion was 125 degrees. Incidence of revision was 1.9. No deep or superficial infections were encountered. Average hospital stay was 3 days.</p><p class="abstract"><strong>Conclusions:</strong> There are variations in Indian patients as per size of implants, stay and similarities regarding less blood loss, improved oxford knee score, good range of motion, less morbidity, higher postoperative patient satisfaction and early getting back to work. Oxford partial knee replacement by microplasty instrumentation done in carefully selected patients with proper surgical technique gives excellent functional outcome and superior patient satisfaction.</p>

Fixed-bearing medial partial knee replacement: patient selection and surgical technique

2021 ◽  
Vol 35 (1) ◽  
pp. 39-48
Author(s):  
Nick J. London ◽  
James B. Newman ◽  
Dave J. Duffy ◽  
Jon Smith
Keyword(s):  
Surgical Technique ◽  
Knee Replacement ◽  
Patient Selection ◽  
Fixed Bearing ◽  
Partial Knee Replacement

scholarly journals Total versus partial knee replacement in patients with medial compartment knee osteoarthritis: the TOPKAT RCT

2020 ◽  
Vol 24 (20) ◽  
pp. 1-98
Author(s):  
David J Beard ◽  
Loretta J Davies ◽  
Jonathan A Cook ◽  
Graeme MacLennan ◽  
Andrew Price ◽  
...  
Keyword(s):  
Health Care ◽  
Total Knee Replacement ◽  
Knee Osteoarthritis ◽  
Knee Replacement ◽  
Oxford Knee Score ◽  
Medial Compartment ◽  
Knee Score ◽  
Patient Reported ◽  
Total Knee ◽  
Partial Knee Replacement

Background Late-stage medial compartment knee osteoarthritis can be treated using total knee replacement or partial (unicompartmental) knee replacement. There is high variation in treatment choice and insufficient evidence to guide selection. Objective To assess the clinical effectiveness and cost-effectiveness of partial knee replacement compared with total knee replacement in patients with medial compartment knee osteoarthritis. The findings are intended to guide surgical decision-making for patients, surgeons and health-care providers. Design This was a randomised, multicentre, pragmatic comparative effectiveness trial that included an expertise component. The target sample size was 500 patients. A web-based randomisation system was used to allocate treatments. Setting Twenty-seven NHS hospitals (68 surgeons). Participants Patients with medial compartment knee osteoarthritis. Interventions The trial compared the overall management strategy of partial knee replacement treatment with total knee replacement treatment. No specified brand or subtype of implant was investigated. Main outcome measures The Oxford Knee Score at 5 years was the primary end point. Secondary outcomes included activity scores, global health measures, transition items, patient satisfaction (Lund Score) and complications (including reoperation, revision and composite ‘failure’ – defined by minimal Oxford Knee Score improvement and/or reoperation). Cost-effectiveness was also assessed. Results A total of 528 patients were randomised (partial knee replacement, n = 264; total knee replacement, n = 264). The follow-up primary outcome response rate at 5 years was 88% and both operations had good outcomes. There was no significant difference between groups in mean Oxford Knee Score at 5 years (difference 1.04, 95% confidence interval –0.42 to 2.50). An area under the curve analysis of the Oxford Knee Score at 5 years showed benefit in favour of partial knee replacement over total knee replacement, but the difference was within the minimal clinically important difference [mean 36.6 (standard deviation 8.3) (n = 233), mean 35.1 (standard deviation 9.1) (n = 231), respectively]. Secondary outcome measures showed consistent patterns of benefit in the direction of partial knee replacement compared with total knee replacement although most differences were small and non-significant. Patient-reported improvement (transition) and reflection (would you have the operation again?) showed statistically significant superiority for partial knee replacement only, but both of these variables could be influenced by the lack of blinding. The frequency of reoperation (including revision) by treatment received was similar for both groups: 22 out of 245 for partial knee replacement and 28 out of 269 for total knee replacement patients. Revision rates at 5 years were 10 out of 245 for partial knee replacement and 8 out of 269 for total knee replacement. There were 28 ‘failures’ of partial knee replacement and 38 ‘failures’ of total knee replacement (as defined by composite outcome). Beyond 1 year, partial knee replacement was cost-effective compared with total knee replacement, being associated with greater health benefits (measured using quality-adjusted life-years) and lower health-care costs, reflecting lower costs of the index surgery and subsequent health-care use. Limitations It was not possible to blind patients in this study and there was some non-compliance with the allocated treatment interventions. Surgeons providing partial knee replacement were relatively experienced with the procedure. Conclusions Both total knee replacement and partial knee replacement are effective, offer similar clinical outcomes and have similar reoperation and complication rates. Some patient-reported measures of treatment approval were significantly higher for partial knee replacement than for total knee replacement. Partial knee replacement was more cost-effective (more effective and cost saving) than total knee replacement at 5 years. Future work Further (10-year) follow-up is in progress to assess the longer-term stability of these findings. Trial registration Current Controlled Trials ISRCTN03013488 and ClinicalTrials.gov NCT01352247. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 20. See the NIHR Journals Library website for further project information.

scholarly journals A Selective arthroplasty algorithm contributes to clinical outcome and patient satisfaction in patients with osteoarthritis of the knee

2020 ◽  
Vol 8 (5_suppl4) ◽  
pp. 2325967120S0032
Author(s):  
Johannes Holz ◽  
Stefan Schneider ◽  
Nils Hansen-Algenstaedt ◽  
Rene Kaiser ◽  
Ansgar Ilg
Keyword(s):  
Patient Satisfaction ◽  
Total Knee Replacement ◽  
Knee Replacement ◽  
Patient Reported Outcomes ◽  
Oxford Knee Score ◽  
Consecutive Series ◽  
Single Center ◽  
Patient Reported ◽  
Total Knee ◽  
The Mean

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.

scholarly journals Low polyethylene creep and wear following mobile-bearing unicompartmental knee replacement

2020 ◽  
Author(s):  
Priyanka Ghosh ◽  
Hasan R. Mohammad ◽  
Benjamin Martin ◽  
Stefano Campi ◽  
David W. Murray ◽  
...  
Keyword(s):  
Wear Rate ◽  
Knee Replacement ◽  
Oxford Knee Score ◽  
Mobile Bearing ◽  
Unicompartmental Knee Replacement ◽  
Level Of Evidence ◽  
Randomised Study ◽  
Component Size ◽  
Unicompartmental Knee ◽  
Tegner Score

Abstract Purpose The Oxford unicompartmental knee replacement (UKR) has a fully congruent mobile bearing to minimise wear. However, with younger higher demand patients, wear remains a concern. The aim of this study was to quantify the wear rate of Phase 3 Oxford UKR bearings over the course of 5 years and to identify the factors that influence it. Methods 40 medial Oxford UKRs recruited for a randomised study of cemented and cementless fixation were studied with Radiostereometric analysis (RSA) at 1 week, 3 months, 6 months, 1 year, 2 years, and 5 years post-operatively and bearing thickness was calculated. Penetration, defined as the change in thickness compared to the 1-week measurement, was determined. Creep (early penetration) and wear (late penetration at a constant rate) were calculated. The influence of demographic factors, Oxford Knee Score (OKS), Tegner score, fixation and bearing overhang (determined by RSA) on wear was analysed. Results After 6 months the penetration rate was constant, indicating that wear alone was occurring. The wear rate was 0.07 mm/year (SD 0.03). The creep was 0.06 mm with about 95% occurring during the first 3 months. There was no significant relationship between fixation (cemented/cementless), age, component size, OKS and Tegner score with wear rate. Increasing BMI was associated with decreasing wear (p = 0.042). 37/40 bearings overhung the tibia to some extent and 23/40 overhung the tibia medially. An increase in the area of overhang (p = 0.036), amount of medial overhang (p = 0.028) and distance between the bearing and tibial wall (p = 0.019) were associated with increased wear. Bearings that did not overhang (0.06 mm/year) had less wear (p = 0.025) than those that did (0.08 mm/year). There was no relationship (p = 0.6) between the femoral contact area and wear. Conclusion During the first three to six months after implantation, the bearing becomes 0.06 mm thinner due to creep. The combined wear rate of the upper and lower surfaces of the bearing is constant (0.07 mm/year). The wear is lower if the bearing does not overhang the tibia so surgeons should aim for the bearing to be close to the tibial wall. The orientation of the femoral component does not influence wear. Level of evidence Retrospective Study, Level III.

scholarly journals After Partial Knee Replacement, Patients Can Kneel, But They Need to Be Taught to Do So: A Single-Blind Randomized Controlled Trial

2008 ◽  
Vol 88 (9) ◽  
pp. 1012-1021 ◽  
Author(s):  
Cathy Jenkins ◽  
Karen L Barker ◽  
Hemant Pandit ◽  
Christopher AF Dodd ◽  
David W Murray
Keyword(s):  
Randomized Controlled Trial ◽  
Physical Therapy ◽  
Knee Replacement ◽  
Controlled Trial ◽  
Intervention Group ◽  
Oxford Knee Score ◽  
Randomized Controlled ◽  
Patient Reported ◽  
Partial Knee Replacement ◽  
Single Blind

Background and Purpose Kneeling is an important functional activity frequently not performed after knee replacement, thus affecting a patient's ability to carry out basic daily tasks. Despite no clinical reason preventing kneeling, many patients fail to resume this activity. The purpose of this study was to determine whether a single physical therapy intervention would improve patient-reported kneeling ability following partial knee replacement (PKR). Subjects Sixty adults with medial compartment osteoarthritis, suitable for a PKR, participated. Methods This was a single-blind, prospective randomized controlled trial. Six weeks after PKR, participants randomly received either kneeling advice and education or routine care where no specific kneeling advice was given. Reassessment was at 1 year postoperatively. The primary outcome measure was patient-reported kneeling ability, as assessed by question 7 of the Oxford Knee Score. Other factors associated with kneeling ability were recorded. These factors were scar position, numbness, range of flexion, involvement of other joints, and pain. Statistical analysis included nonparametric tests and binary logistic regression. Results A significant improvement in patient-reported kneeling ability was found at 1 year postoperatively in those participants who received the kneeling intervention. Group allocation was the only factor determining an improvement in patient-reported kneeling ability at 1 year postoperatively. Discussion and Conclusion The single factor that predicted patient-reported kneeling ability at 1 year postoperatively was the physical therapy kneeling intervention given at 6 weeks after PKR. The results of this study suggest that advice and instruction in kneeling should form part of a postoperative rehabilitation program after PKR. The results can be applied only to patients following PKR.

scholarly journals On the generalizability of same-day partial knee replacement surgery—A non-selective interventional study evaluating efficacy, patient satisfaction, and safety in a public hospital setting

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0260816
Author(s):  
Magnus Tveit
Keyword(s):  
Patient Satisfaction ◽  
Adverse Events ◽  
Knee Replacement ◽  
Public Hospital ◽  
Class Iii ◽  
Knee Replacement Surgery ◽  
Replacement Surgery ◽  
Outpatient Visits ◽  
Same Day Discharge ◽  
Partial Knee Replacement

Purpose Programs referred to as Fast-Track/Rapid Recovery/Enhanced Recovery After Surgery have proven both effective and safe in joint replacement surgery, to the degree where same-day discharge (SDD) has been attempted in carefully selected cases at specialized outpatient units. Therefore, the primary aim of this study was to evaluate a same-day surgery protocol regarding safety using the minor partial knee replacement (PKR) procedure by non-selectively recruiting patients at a public hospital for one consecutive year. Methods 33 unselected PKR cases were included in this open clinical trial. The inclusion/exclusion criteria were solely based on logistics, as all the procedures were medial PKRs, designated the first morning slots, and performed by one single-surgeon. Strict postoperative criteria based on vital parameters, urinary function, bleeding, and mobilization had to be met before discharge was considered. SDD rate, patient satisfaction, number of outpatient visits, adverse events and readmissions within 90 days were evaluated. A predetermined subgroup analysis was also conducted where patients <80 yrs. and with an American Society of Anesthesiologists (ASA) classification <III was compared with those aged ≥80 yrs. and/or ASA class ≥III. Results 29 of 33 (88%) successfully achieved SDD. In a univariate comparison, 100% of the patients <80 yrs. and ASA class <III achieved SDD, whereas a corresponding 43% applied for those aged ≥80 yrs. and/or ASA class ≥III (p = 0.001). A 93% overall satisfaction rate was reached. Only 8% extra outpatient visits were required, all occurring within the first 2 weeks (well in line with routine practice.) One plausible transient ischemic attack and one readmission caused by a penetrating trauma not affecting the knee were identified, both of which happened 10 weeks after surgery. No adverse events or readmissions occurred within the first 48 hours of surgery. Conclusion When following strict criteria for discharge, same-day partial knee replacement surgery may be both feasible and safe, even without preselection of patients.

scholarly journals Analysis of Friction in Total Knee Prosthesis during a Standard Gait Cycle

Lubricants ◽  
2021 ◽  
Vol 9 (4) ◽  
pp. 36
Author(s):  
Matúš Ranuša ◽  
Markus A. Wimmer ◽  
Spencer Fullam ◽  
Martin Vrbka ◽  
Ivan Křupka
Keyword(s):  
Total Knee Replacement ◽  
Knee Replacement ◽  
Computational Models ◽  
Gait Cycle ◽  
Knee Prosthesis ◽  
Shear Stresses ◽  
Cobalt Chromium ◽  
Joint Friction ◽  
The Coefficient Of Friction ◽  
Total Knee

Total knee arthroplasty is on the rise worldwide. Despite its success, revision surgeries are also increasing. According to the American Joint Replacement Registry 2020, 3.3% of revision surgeries are due to wear, and 24.2% are due to mechanical loosening. The combination of shear stresses and wear particles occurring at the bone/implant interface can lead to local osteolysis. Although the shear stresses are partially driven by joint friction, relatively little is known about the evolution of the coefficient of friction (CoF) during a gait cycle in total knee replacement. Here we describe the CoF during a gait cycle and investigate its association with kinematics (slide–roll-ratio), applied load, and relative velocity. The artificial knee was simulated by cobalt–chromium condyle on a flat ultra-high-molecular-weight polyethylene (UHMWPE) tibial plateau, lubricated by either water or proteinaceous solution. We found that the CoF is not a constant but fluctuates between the values close to 0 and 0.15. Cross-correlation suggested that this is primarily an effect of the slide–roll ratio and the contact pressure. There was no difference in the CoF between water and proteinaceous solution. Knowledge about the CoF behavior during a gait cycle will help to increase the accuracy of future computational models of total knee replacement.

scholarly journals Assessing responsiveness of the EQ-5D-3L, the Oxford Hip Score, and the Oxford Knee Score in the NHS patient-reported outcome measures

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Sujin Kang
Keyword(s):  
Outcome Measures ◽  
Knee Replacement ◽  
Oxford Knee Score ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Knee Score ◽  
Paired Data ◽  
Replacement Surgery ◽  
Patient Reported ◽  
Oxford Hip Score

Abstract Background The degree to which a validated instrument is able to detect clinically significant change over time is an important issue for the better management of hip or knee replacement surgery. This study examines the internal responsiveness of the EQ-5D-3L, the Oxford Hip Score (OHS), and the Oxford Knee Score (OKS) by various methods. Data from NHS patient-reported outcome measures (PROMs) linked to the Hospital Episodes Statistics (HES) dataset (2009–2015) was analysed for patients who underwent primary hip surgery (N = 181,424) and primary knee surgery (N = 191,379). Methods Paired data-specific univariate responsiveness was investigated using the standardized response mean (SRM), the standardized effect size (SES), and the responsiveness index (RI). Multivariate responsiveness was furthermore examined using the defined capacity of benefit score (i.e. paired data-specific MCID), adjusting baseline covariates such as age, gender, and comorbidities in the Box-Cox regression models. The observed and predicted percentages of patient improvement were examined both as a whole and by the patients' self-assessed transition level. Results The results showed that both the OHS and the OKS demonstrated great univariate and multivariate responsiveness. The percentages of the observed (predicted) total improvement were high: 51 (54)% in the OHS and 73 (58)% in OKS. The OHS and the OKS showed distinctive differences in improvement by the 3-level transition, i.e. a little better vs. about the same vs. a little worse. The univariate responsiveness of the EQ-5D-3L showed moderate effects in total by Cohen’s thresholds. The percentages of improvement in the EQ-5D-3L were moderate: 44 (48)% in the hip and 42 (44)% for the knee replacement population. Conclusions Distinctive percentage differences in patients’ perception of improvement were observed when the paired data-specific capacity of benefit score was applied to examine responsiveness. This is useful in clinical practice as rationale for access to surgery at the individual-patient level. This study shows the importance of analytic methods and instruments for investigation of the health status in hip and/or knee replacement surgery. The study finding also supports the idea of using a generic measure along with the disease-specific instruments in terms of cross-validation.

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