Abstract
PurposeThe aim of the study was to investigate the long-term outcomes of the Focal Femoral Condyle Resurfacing Prosthesis for treatment of localized cartilage lesion in patients > 65 years.MethodsThis was a prospective case series study. Non-reopererated patients initially treated with resurfacing condylar miniprothesis (HemiCAP/UniCAP) were evaluated clinically and radiographically at 7–10 years follow-up (mean 9 years). The clinical examination included the Knee Society Score (KSS) and Visual Analogue Scale (VAS) pain score and EQ5D. The radiographic examination included the Kellgren-Lawrence (KL) grade for investigate of OA progression. A comparison analysis of the preoperative and follow-up subjective outcome data and a Kaplan-Meier implant survival analysis were performed.ResultsTwenty-three patients were included in the study (9 HemiCAP and 14 UniCAP). There were seven revisions (one HemiCap and six UniCap respectively) (30%) and three patients had died. Follow-up examinations were performed on 10 patients. When comparing follow-up with the preoperative state, there were significant increases in the KSS objective (50.0 ± 8.3) vs. 90.0 ± 6.3)) and KSS function (45.0 ± 11.7) vs. 85.0 ± 4.7)) scores, a decrease in the pain VAS score (7.0 ± 0.9) vs. (4.0 ± 1.9)). Radiographic evaluation demonstrated increase in osteoarthritis development with a KL medial score (2.0 ± 0.6) and KL lateral score (1.4 ± 0.6) vs. (2.0 ± 0.9)).The EQ5D-score was 86 ± 8.4 and patients Health-score was 85 ± 18).ConclusionsResurfacing implant treatment for early OA in patients above 65 years can require revision to knee arthroplasty in 30% of patients. But in patients that are not revised long-term improvements in subjective clinical outcome was demonstrated. This suggests that even elderly patients with isolated cartilage lesions or early OA might benefit from the limited invasive resurfacing implant treatment.Level of evidenceIV
Highlights
Middle aged to elderly patients with knee pain and disability caused by localized cartilage lesions or early osteoarthritis (OA) can be challenging to treat, when radiographic and clinical status does indicate treatment with a unicompartmental knee arthroplasty (UKA) or total knee arthroplasty (TKA)
The EQ5D at followup was median at 86 ± 8.4 and health-score median at 84.5 ± 17.8)
The present study results of clinical relevant outcomes in patients above 65 years may indicate that, with proper patient selection, a mini prosthesis can serve as a long-term treatment modality for middle-aged patients [3, 4, 11, 15–18], and for older patients with significant knee symptoms and impaired function, that do not have severe enough cartilage pathology for UKA/TKA treatment
Summary
Middle aged to elderly patients with knee pain and disability caused by localized cartilage lesions or early osteoarthritis (OA) can be challenging to treat, when radiographic and clinical status does indicate treatment with a unicompartmental knee arthroplasty (UKA) or total knee arthroplasty (TKA). These patients may pursue nonoperative treatment modalities, such as physiotherapy, weight loss, analgesics and activity modifications [19]. In 2003, an anatomic metallic implant for femoral resurfacing called the Focal Femoral Condyle Resurfacing Prosthesis (HemiCAP) was introduced for full-thickness smaller condylar lesions (both femoral and trochlear) It was first approved for use in Denmark in 2006, with a 2015 publication describing its specific indications [17]. No studies have investigated more long-term outcomes in more elderly patients with moderate sized cartilage lesions treated with the mini-prothesis concept
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