Simultaneous Unicompartmental Knee Arthroplasty and Lateral Patellar Facetectomy for Bicompartmental Degenerative Disease

2013 ◽  
Vol 3 (1) ◽  
pp. 61-66 ◽  
Author(s):  
Robert A Magnussen ◽  
Evrard Gancel ◽  
Elvire Servien ◽  
Matthias Jacobi ◽  
Guillaume Demey ◽  
...  
Keyword(s):  
Treatment Option ◽  
Knee Arthroplasty ◽  
Unicompartmental Knee Arthroplasty ◽  
Patient Population ◽  
Patellofemoral Joint ◽  
Degenerative Disease ◽  
Functional Score ◽  
Unicompartmental Knee ◽  
The Mean

ABSTRACT Introduction Unicompartmental knee arthroplasty (UKA) is a treatment option in patients with unicompartmental degenerative disease. Compared to total knee arthroplasty (TKA), the advantages of UKA include accelerated recovery and cruciate ligament retention. These advantages, along with emerging evidence that mild patellofemoral joint osteoarthritis does not compromise results of UKA have encouraged expansion of the indications for UKA. Symptomatic lateral patellofemoral joint degenerative disease is a common cause of UKA revision. Partial lateral patellar facetectomy can provide relief from symptoms of lateral patellofemoral degenerative disease. We hypothesize that simultaneous UKA and lateral patellar facetectomy provides durable pain relief and functional improvement in a patient population with degenerative disease of one tibiofemoral compartment and the lateral patellofemoral joint. Materials and methods: Between 2004 and 2008, 11 lateral UKA's were performed in association with partial lateral patellar facetectomy in 11 female patients (mean age: 66.7 years) with degenerative changes in one tibiofemoral compartment and the lateral patellofemoral joint. Patients were followed clinically and radiographically for a mean of 5 years. Results No patient underwent revision surgery in the followup period. The mean international Knee Society (IKS) knee score improved from 64.9 ± 11.2 points preoperatively to 87.5 ± 12.6 points at final follow-up (p = 0.01). The mean IKS functional score improved from 65.9 ± 23.5 points preoperatively to 83.2 ± 23.3 points at final follow-up (p = 0.012). The mean Kujala score was 84.3 ± 13.5 points postoperatively. Progression of patellofemoral OA was observed in one patient. Conclusion Simultaneous UKA and partial lateral patellar facetectomy is a viable treatment option for symptomatic degenerative disease involving one tibiofemoral compartment and the lateral patellofemoral joint. This treatment approach may be a useful alternative to TKA or bicompartmental arthroplasty in a carefully selected patient population. Level of evidence Case series—Level IV. Magnussen RA, Gancel E, Servien E, Jacobi M, Demey G, Neyret P, Lustig S. Simultaneous Unicompartmental Knee Arthroplasty and Lateral Patellar Facetectomy for Bicompartmental Degenerative Disease. The Duke Orthop J 2013;3(1):61-66.

scholarly journals Unicompartmental knee arthroplasty for spontaneous osteonecrosis

2017 ◽  
Vol 25 (1) ◽  
pp. 230949901769032 ◽  
Author(s):  
Tong Ma ◽  
Yihui Tu ◽  
Huaming Xue ◽  
Tao Wen ◽  
Jiong Mei
Keyword(s):  
Knee Arthroplasty ◽  
Unicompartmental Knee Arthroplasty ◽  
Lateral Compartment ◽  
Phase Iii ◽  
Complication Rates ◽  
Effective Treatment Option ◽  
Unicompartmental Knee ◽  
Spontaneous Osteonecrosis ◽  
The Mean

Background: Unicompartmental knee arthroplasty (UKA) is an effective treatment option for medial compartment osteoarthritis (OA) of the knee. Whether spontaneous osteonecrosis of the knee (SPONK) can be successfully treated with UKA remains controversial. This study evaluated the clinical and radiological results of patients with SPONK who were treated by UKA using Oxford phase III prostheses. Methods: We compared a prospective series of 23 UKA cases operated for SPONK with 235 UKA cases operated for OA. All patients underwent Magnetic Resonance Imaging (MRI) to confirm the diagnosis and exclude any major lesion in the lateral compartment. The stage, condylar ratio, and volume of the necrotic lesion were evaluated. The pre and postoperative Oxford knee scores (OKSs) were compared. Results: The mean follow-up was 60 months. No statistical differences in complication rates between the groups were found. The mean OKS improved from 39.48 ± 5.69 to 18.83 ± 3.82 ( p < 0.05). There were no significant differences in the pre and postoperative OKS between the different groups. Conclusion: SPONK can be successfully treated with UKA, with a favorable short- to mid-term follow-up.

scholarly journals FRI0418 SELECTIVE PATELLAR RESURFACING IN TOTAL KNEE ARTHROPLASTY FOR THE OSTEOARTHRITIC KNEE: A PROSPECTIVE STUDY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 807.3-807
Author(s):  
I. Moriyama
Keyword(s):  
Total Knee Arthroplasty ◽  
Clinical Outcome ◽  
Knee Arthroplasty ◽  
Patellofemoral Joint ◽  
Osteoarthritis Of The Knee ◽  
Patellar Resurfacing ◽  
Criterion A ◽  
Total Knee ◽  
The Mean

Background:No widely accepted view or criteria currently exist concerning whether or not patellar replacement (resurfacing) should accompany total knee arthroplasty for osteoarthritis of the knee.1)2)3)Objectives:We recently devised our own criteria for application of patellar replacement and performed selective patellar replacement in accordance with this set of criteria. The clinical outcome was analyzed.Methods:The study involved 1150 knees on which total knee arthroplasty was performed between 2005 and 2019 because of osteoarthritis of the knee. The mean age at operation was 73, and the mean postoperative follow-up period was 91 months. Our criteria for application of patellar replacement are given below. Criterion A pertains to evaluation of preoperative clinical symptoms related to the patellofemoral joint: (a) interview regarding presence/absence of pain around the patella, (b) cracking or pain heard or felt when standing up from a low chair, (c) pain when going upstairs/downstairs. Because it is difficult for individual patients to identify the origin of pain (patellofemoral joint or femorotibial joint), the examiner advised each patient about the location of the patellofemoral joint when checking for these symptoms. Criterion B pertains to intense narrowing or disappearance of the patellofemoral joint space on preoperative X-ray of the knee. Criterion C pertains to the intraoperatively assessed extent of patellar cartilage degeneration corresponding to class 4 of the Outerbridge classification. Patellar replacement was applied to cases satisfying at least one of these sets of criteria (A-a,-b,-c, B and C). Postoperatively, pain of the patellofemoral joint was evaluated again at the time of the last observation, using Criterion A-a,-b,-c.Results:Patellar replacement was applied to 110 knees in accordance with the criteria mentioned above. There were 82 knees satisfying at least one of the Criterion sets A-a,-b,-c, 39 knees satisfying Criterion B and 70 knees satisfying Criterion C. (Some knees satisfied 2 or 3 of Criteria A, B and C).When the pain originating from patellofemoral joint (Criterion A) was clinically assessed at the time of last observation, pain was not seen in any knee of the replacement group and the non-replacement group.Conclusion:Whether or not patellar replacement is needed should be determined on the basis of the symptoms or findings related to the patellofemoral joint, and we see no necessity of patellar replacement in cases free of such symptoms/findings. When surgery was performed in accordance with the criteria on patellar replacement as devised by us, the clinical outcome of the operated patellofemoral joint was favorable, although the follow-up period was not long. Although further follow-up is needed, the results obtained indicate that selective patellar replacement yields favorable outcome if applied to cases judged indicated with appropriate criteria.References:[1]The Effect of Surgeon Preference for Selective Patellar Resurfacing on Revision Risk in Total Knee Replacement: An Instrumental Variable Analysis of 136,116 Procedures from the Australian Orthopaedic Association National Joint Replacement Registry.Vertullo CJ, Graves SE, Cuthbert AR, Lewis PL J Bone Joint Surg Am. 2019 Jul 17;101(14):1261-1270[2]Resurfaced versus Non-Resurfaced Patella in Total Knee Arthroplasty.Allen W1, Eichinger J, Friedman R. Indian J Orthop. 2018 Jul-Aug;52(4):393-398.[3]Is Selectively Not Resurfacing the Patella an Acceptable Practice in Primary Total Knee Arthroplasty?Maradit-Kremers H, Haque OJ, Kremers WK, Berry DJ, Lewallen DG, Trousdale RT, Sierra RJ. J Arthroplasty. 2017 Apr;32(4):1143-1147.Disclosure of Interests:None declared

scholarly journals Good mid- to long-term results of the cemented oxford phase 3 unicompartmental knee arthroplasty in a non-designer centre

2021 ◽  
Author(s):  
D. M. Moore ◽  
G. A. Sheridan ◽  
A. Welch-Phillips ◽  
J. M. O’Byrne ◽  
P. Kenny
Keyword(s):  
Knee Arthroplasty ◽  
Unicompartmental Knee Arthroplasty ◽  
Womac Score ◽  
Long Term Results ◽  
Secondary Outcome ◽  
Osteoarthritis Of The Knee ◽  
Phase 3 ◽  
Unicompartmental Knee ◽  
Aseptic Revision

Abstract Purpose Unicompartmental knee arthroplasty (UKA) provides patients with an alternative treatment to TKA in isolated medial compartment osteoarthritis providing better functional outcomes and faster recovery in the short term. Our aim was to quantify revision rates, predictors of revision, mortality rate and functionality of the Oxford Phase 3 UKA in a non-designer institution. Methods This was a retrospective review of prospectively collected regional registry data. All Oxford Phase 3 UKAs performed for medial tibio-femoral osteoarthritis of the knee joint were included from a single academic institution between the period of January 1st 2006 and December 30th 2009. Kaplan-Meier survivorship curves adjusting for loss to follow-up and deceased patients were generated. Primary outcome variables included all-cause and aseptic revision. Secondary outcome variables included functional outcome scores. Patients were reviewed at 6 months, 2 years, 5 years, 10 years and 15 years. Results A total of 64 cemented Oxford phase 3 UKAs were performed between January 2006 and November 2009. Fifteen-year follow-up data were available for 51 patients, of these 12 required revision. Survival rates, adjusting for patients that were either lost to follow-up or deceased, were 87.5% at 5 years, 81.4% at 10 years and 76.4% at 15 years. The overall aseptic revision rate at the time of review was 18.75% (n = 12). The only significant predictor of postoperative WOMAC score at 15 years was the preoperative WOMAC score (p = 0.03). Conclusion The Oxford Phase 3 UKA for medial tibio-femoral arthritis has promising outcomes at 15-year follow-up with a survival rate of 76.4% in a non-designer centre. Level of Evidence III.

Patient-acceptable symptom state for reporting outcomes following unicompartmental knee arthroplasty

2021 ◽  
Vol 103-B (8) ◽  
pp. 1367-1372
Author(s):  
Kevin D. Plancher ◽  
Jasmine E. Brite ◽  
Karen K. Briggs ◽  
Stephanie C. Petterson
Keyword(s):  
Knee Arthroplasty ◽  
Unicompartmental Knee Arthroplasty ◽  
Cruciate Ligament ◽  
Intact Group ◽  
Unicompartmental Knee ◽  
Significant Difference ◽  
Patient Acceptable Symptom State ◽  
Acl Deficient ◽  
Deficient Group

Aims The patient-acceptable symptom state (PASS) is a level of wellbeing, which is measured by the patient. The aim of this study was to determine if the proportion of patients who achieved an acceptable level of function (PASS) after medial unicompartmental knee arthroplasty (UKA) was different based on the status of the anterior cruciate ligament (ACL) at the time of surgery. Methods A total of 114 patients who underwent UKA for isolated medial osteoarthritis (OA) of the knee were included in the study. Their mean age was 65 years (SD 10). No patient underwent a bilateral procedure. Those who had undergone ACL reconstruction during the previous five years were excluded. The Knee injury Osteoarthritis Outcome Score Activities of Daily Living (KOOS ADL) function score was used as the primary outcome measure with a PASS of 87.5, as described for total knee arthroplasty (TKA). Patients completed all other KOOS subscales, Lysholm score, the Western Ontario and McMaster Universities Osteoarthritis Index, and the Veterans Rand 12-item health survey score. Failure was defined as conversion to TKA. Results Survivorship at ten years was 97% in both the ACL-deficient and ACL-intact groups. The mean survival was 16.1 years (95% confidence interval (CI) 15.3 to 16.8) for the ACL-deficient group and 15.6 years (95% CI 14.8 to 16.361) for the ACL-intact group (p = 0.878). At a mean of nine years (SD 3.5) in the ACL-deficient group, 32 patients (87%) reached the PASS for the KOOS ADL. In the ACL-intact group, at a mean of 8.6 years (SD 3) follow-up, 63 patients (85%) reached PASS for the KOOS ADL. There was no significant difference in the percentage of patients who reached PASS for all KOOS subscales and Lysholm between the two groups. Conclusion PASS was achieved in 85% of all UKAs for KOOS ADL, similar to reports for TKA. Fixed-bearing, medial, non-robotically-assisted UKA resulted in 97% survival at ten years in both the ACL-deficient and ACL-intact groups. There was no significant difference in all outcomes between the two groups. Understanding PASS will allow better communication between surgeons and patients to improve the surgical management of patients with single compartment OA of the knee. This study provides mid- to long-term data supporting the use of PASS to document outcomes following UKA. PASS was met in more than 85% of patients with no differences between ACL-deficient and ACL-intact knees at a mean follow-up of nine years. Cite this article: Bone Joint J 2021;103-B(8):1367–1372.

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.

scholarly journals Robotic Assistance in Unicompartmental Knee Arthroplasty Results in Superior Early Functional Recovery and Is More Likely to Meet Patient Expectations

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Meredith P. Crizer ◽  
Amer Haffar ◽  
Andrew Battenberg ◽  
Mikayla McGrath ◽  
Ryan Sutton ◽  
...  
Keyword(s):  
Functional Recovery ◽  
Knee Arthroplasty ◽  
Unicompartmental Knee Arthroplasty ◽  
Mixed Model ◽  
Functional Score ◽  
Robotic Assistance ◽  
Pain Scores ◽  
Unicompartmental Knee ◽  
Implant Alignment ◽  
Early Functional Recovery

Robotic technology has reduced the errors of implant alignment in unicompartmental knee arthroplasty (UKA), but its impact on functional recovery after UKA is poorly defined. The purpose of this study was to compare early functional recovery, pain levels, and satisfaction in UKA performed with either robotic assistance or conventional methods. A retrospective analysis was performed on 89 matched consecutive patients who underwent outpatient UKA by a single physician using either conventional instruments (n = 39) or robotic methods (n = 50), with otherwise identical perioperative protocols. Outcomes studied included Lower Extremity Functional Score (LEFS), new Knee Society Score (KSS), Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS-JR.), VR/SF-12, Visual Analog Scale (VAS) pain scores, and perioperative opioid consumption. Patients in the robotic cohort had superior early functional outcomes, with greater LEFS (conventional = 23; robotic = 31) at 1 week post-op p = 0.015 and KOOS-JR (conventional = 74; robotic = 81) at up to 6 months post-op p = 0.037 ; these two values remained statistically significant after mixed-model regression analysis p = 0.010 ; p = 0.023 , respectively. At 1 year post-op, expectations were more likely to be met in those who received robotic assistance p = 0.06 . No differences were reported with respect to postoperative opioid usage p = 0.320 , reoperations p = 1.00 , and complications p = 0.628 . Robotic-assisted UKA resulted in more rapid recovery and less early postoperative pain and were more likely to meet expectations than conventional UKA, although functional differences equilibrated by 1 year postoperatively. Further follow-up is necessary to determine if implant durability is impacted by robotics.

scholarly journals Efficacy and mid/long-term survivorship of mobile-bearing unicompartmental knee arthroplasty for medial compartment knee osteoarthritis combined patellofemoral joint arthritis: a prospective cohort study protocol

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e038448
Author(s):  
Jingbo Cheng ◽  
Mingli Feng ◽  
Guanglei Cao ◽  
Shibao Lu
Keyword(s):  
Cohort Study ◽  
Knee Osteoarthritis ◽  
Prospective Cohort Study ◽  
Knee Arthroplasty ◽  
Unicompartmental Knee Arthroplasty ◽  
Prospective Cohort ◽  
Patellofemoral Joint ◽  
Medial Compartment ◽  
Unicompartmental Knee

IntroductionUnicompartmental knee arthroplasty (UKA) is one of the most effective surgical procedures for treating isolated medial compartment knee osteoarthritis. However, previous studies have regarded patellofemoral osteoarthritis as a contraindication for UKA. In contrast, most current research shows that damage to the articular cartilage of the patellofemoral joint, even to the extent of full-thickness cartilage loss, has no influence on the outcome of UKA.Methods and analysisStudy settings: This study is a prospective cohort study that will compare the Forgotten Joint Score and Lonner patellofemoral joint score of patients who have undergone UKA; the patients will be divided into two groups (with and without patellofemoral joint osteoarthritis (PFJOA)). Primary objective: Long-term follow-up will be used to evaluate the effect of the operation on the above-mentioned scores in both the groups. Secondary objective: We will divide the patients from the with PFJOA group into three subgroups according to the localisation of patellofemoral cartilage lesions (medial zone, lateral zone and central zone). We aim to compare knee joint scores among these groups and clarify the impact of different wear sites on clinical efficacy. We will use CT to explore the potential mechanism through which UKA affects patellofemoral joint-related parameters (lateral patellar tilt, lateral patellar shift and tibia tuberosity-trochlear groove distance). We will also record mid-term/long-term post-surgery complications.Ethics and disseminationThis study’s protocol is in accordance with the Declaration of Helsinki. This study was approved by the Ethics Committee of Xuanwu Hospital. The results of this study will be disseminated in international peer-reviewed journals.Trial registration numberChiCTR2000030310.

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