Abstract
ABSTRACT BACKGROUND: Medial unicompartmental knee arthroplasty (UKA) is advocated for treating symptomatic anteromedial osteoarthritis (AMOA). Correctable mediolateral tibiofemoral (TF) subluxation can be safely ignored according to the UKA enthusiasts. However, no clinical studies compare the results in AMOA patients with and without subluxation. This study reports the early prospective clinical outcomes of medial UKA in AMOA, with and without correctable mediolateral TF subluxation and the comparison to the retrospective larger patient cohort. METHODS: The results of an initial retrospective study (R) consisting of 436 consecutive UKA cases (patients treated from May 2012 to October 2017) were compared to a prospective study (P) consisting of 272 consecutive UKA cases in 248 patients with AMOA (evaluated from November 2017 to May 2020). All patients in both cohorts underwent cementless Oxford UKA and were classified into two groups: group 1 (AMOA without mediolateral subluxation) and group 2 (AMOA with mediolateral subluxation) on anteroposterior (AP) radiological knee stress views. Survival analysis methods (Kaplan-Meier and logrank test) were utilised to compare implant survival between the two groups (1 and 2) and the cohorts (R and P). The multivariable Cox proportional hazards model was used to determine risk factors for time to revision. RESULTS: The two cohorts, R and P, had patient groups (group 1 vs group 2) matched for age, sex, wear pattern, preoperative Oxford Knee Score and follow-up period. The overall implant survival for the P cohort that had at least 20 months of follow-up was 98%. The overall implant survival for group 1 (99%) was significantly better compared to group 2 (93%). These results are amplified in the R cohort with an average follow-up of 54 months, and with the group 1 survival at 97% and group 2 at 86%. Subsequent months of follow-up show more failures in group 2 compared to group 1. Patient-reported outcome measures (PROMs) and range of movement were similar for both groups. CONCLUSION: Patients with AMOA and correctable mediolateral TF subluxation have a significantly higher risk of implant failure compared to those without subluxation. This study establishes this association, which has an important implication on patient selection, but does not confirm causality. Level of evidence: Level 4. Keywords: unicompartmental knee arthroplasty, partial, osteoarthritis, X-ray, implant
Highlights
Medial unicompartmental knee arthroplasty (UKA) is advocated for treating symptomatic anteromedial osteoarthritis (AMOA)
Patient-reported outcome measures (PROMs) and range of movement were similar for both groups
To confirm the diagnosis of AMOA, use of varus and valgus stress radiographs in addition to weight-bearing anteroposterior (AP) and lateral radiographs is recommended.[2]
Summary
Medial unicompartmental knee arthroplasty (UKA) is advocated for treating symptomatic anteromedial osteoarthritis (AMOA). To confirm the diagnosis of AMOA, use of varus and valgus stress radiographs in addition to weight-bearing anteroposterior (AP) and lateral radiographs is recommended.[2]. These radiographs are performed with the patient lying supine and the knee under study flexed at 20°, with either manual or aided stress applied to the knee. A valgus stress radiograph helps confirm normal thickness of articular cartilage in the lateral TF compartment and demonstrates that the intraarticular varus deformity is correctable (i.e., the medial collateral ligament is not shortened). This study reports the early prospective clinical outcomes of medial UKA in AMOA, with and without correctable mediolateral TF subluxation and the comparison to the retrospective larger patient cohort
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