unicompartmental knee arthroplasty
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2022 ◽  
pp. 1-6
Author(s):  
Connor Fitz-Gerald ◽  
David Kieser

<b>Background</b> The objective of this article is to describe for the first time a case of 90<sup>°</sup> spin out of a mobile bearing unicompartmental knee arthroplasty (UKA) polyethylene insert. In this report, we present a 57-year-old gentleman with a medial compartment UKA for osteoarthritis in 2017 who developed dislodgement and 90<sup>°</sup> rotation subsequent to traumatic injury when he was involved in a bus crash and impacted the anterolateral knee sustaining a valgus type injury 1 week postoperatively. Following the injury, he reported medial knee pain and a sensation of something moving within the joint. He was initially managed conservatively and progressed to full weight bearing; however, he experienced intermittent symptoms of catching and blocking of the joint, as well as medial knee swelling, that inhibited his ability to perform activities involving walking, kneeling, or pivoting. Imaging taken in 2018 show a 90° rotation of the polyethylene insert. These images showed the longitudinal metallic marker on the insert facing in an anteroposterior direction as opposed to the normal medial-lateral orientation. Failing conservative management, he presented to our clinic in 2019 and proceeded for revision of his UKA. Intraoperatively, his insert was reviewed and seen to easily spin on axis. The liner was therefore removed and upsized from a size 5 medium to a size 7 medium insert which provided excellent stability and stopped any further spinning. He has done tremendously well since the operation and reports full range of motion and no concerns. In patients with a history of pain, swelling, or locking following a UKA, it would be prudent to consider insert spinning, as well as the more common dislocation, through confirming the orientation of the metallic insert marker. Revision surgery to correct the spinning defect has proven effective with good resolution of symptoms and return to full range of motion.


Author(s):  
Niall Cochrane ◽  
Elshaday Belay ◽  
Mark Wu ◽  
Jeffrey O'Donnell ◽  
Billy Kim ◽  
...  

AbstractUnicompartmental knee arthroplasty (UKA) volume has increased with advances in implant design, perioperative protocols, and patient selection. This study analyzed national trends of UKA from 2013 to 2018 and the relationship between patient demographics and postoperative outcomes. Data on UKA (CPT 27446) from 2013 to 2018 was collected from the National Surgical Quality Improvement Program (NSQIP). Variables collected included patient demographics, American Society of Anesthesiology classification, functional status, NSQIP morbidity probability, operative time, length of stay, 30-day reoperation, and readmission rates. There was an increase in outpatient UKAs performed (920 in 2013; 11,080 in 2018) (p < 0.0001). Analysis of variance from 2013 to 2018 revealed significant decrease in patient body mass index (BMI) (32.5 in 2013; 31.5 in 2018) (p < 0.01) and NSQIP morbidity probability (0.014 in 2013; 0.011 in 2018) (p < 0.0001). Operative time increased (79.1 minutes in 2013; 84.4 minutes in 2018) (p < 0.01), but length of stay decreased (0.9 days in 2013; 0.5 days in 2018) (p < 0.0001). The number of all-cause and related readmissions decreased significantly (p < 0.045; p < 0.01). Age, male gender, BMI >40 and chronic obstructive pulmonary disease (COPD) were significant predictors for 30-day readmission. BMI >40 was a significant predictor for discharge destination. UKA has seen a rise in incidence from 2013 to 2018 with an increasing number of outpatient UKAs. Operative times and 30-day readmissions have both decreased in this time. BMI > 40 is predictive for discharge destination after UKA, while age, male gender, BMI >40, and COPD are independent risk factors for 30-day readmission.


2022 ◽  
Vol 104-B (1) ◽  
pp. 34-44
Author(s):  
Lucas Beckers ◽  
Félix Dandois ◽  
Dirk Ooms ◽  
Pieter Berger ◽  
Koen Van Laere ◽  
...  

Aims Higher osteoblastic bone activity is expected in aseptic loosening and painful unicompartmental knee arthroplasty (UKA). However, insights into normal bone activity patterns after medial UKAs are lacking. The aim of this study was to identify the evolution in bone activity pattern in well-functioning medial mobile-bearing UKAs. Methods In total, 34 patients (13 female, 21 male; mean age 62 years (41 to 79); BMI 29.7 kg/m2 (23.6 to 42.1)) with 38 medial Oxford partial UKAs (20 left, 18 right; 19 cementless, 14 cemented, and five hybrid) were prospectively followed with sequential 99mTc-hydroxymethane diphosphonate single photon emission CT (SPECT)/CT preoperatively, and at one and two years postoperatively. Changes in mean osteoblastic activity were investigated using a tracer localization scheme with volumes of interest (VOIs), reported by normalized mean tracer values. A SPECT/CT registration platform additionally explored cortical tracer evolution in zones of interest identified by previous experimental research. Results Significant reduction of tracer activity from the preoperative situation was found in femoral and anteromedial tibial VOIs adjacent to the UKA components. Temporarily increased osteoblastic bone activity was observed in VOIs comprising the UKA keel structure at one year postoperatively compared to the preoperative activity. Persistent higher tracer uptake was found in the posterior tibial cortex at final follow-up. Multivariate analysis showed no statistical difference in osteoblastic bone activity underneath cemented or cementless components. Conclusion Well-functioning medial mobile-bearing UKAs showed distinct changes in patterns of normalized bone tracer activity in the different VOIs adjacent to the prosthetic components, regardless of their type of fixation. Compared to the preoperative situation, persistent high bone activity was found underneath the keel and the posterior tibial cortex at final follow-up, with significant reduced activity only being identified in femoral and anteromedial tibial VOIs. Cite this article: Bone Joint J 2022;104-B(1):34–44.


2022 ◽  
pp. 102-108
Author(s):  
Charles C.J. Rivière ◽  
Philippe Cartier ◽  
Pascal André Vendittoli ◽  
Justin Cobb

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