Abstract
BackgroundThe goal of this study was to assess short-term outcomes in single compartment osteoarthritis patients associated with the coronal tibiofemoral subluxation (CTFS) of the knee joint after Oxford unicompartmental knee arthroplasty (OUKA), and to establish the potential impact of the degree of CTFS on operative outcomes.MethodsData pertaining to 183 patients with medial compartment osteoarthritis that underwent OUKA treatment between February 2016 and June 2019 were retrospectively analyzed. The presence and degree of severity of CTFS were assessed using preoperative weight-bearing anteroposterior X-ray images of the knee. Patients were stratified into three subgroups based upon the observed degree of subluxation: a normal group, a mild subluxation group (CTFS < 0.5 cm), and a severe subluxation group (CTFS ≥ 0.5 cm). Anterior and posterior X-ray examination of the knee was conducted at the time of most recent follow-up for each patient to assess the degree of CTFS correction following OUKA. Clinical function was assessed using Oxford knee score (OKS) and Hospital for Special Surgery score (HSS) values, while pain was rated using visual-analog scale (VAS) scores. The mechanical femoral tibial angle (mFTA), range of motion (ROM), and complication rates in these three groups were additionally compared.ResultsThe average follow-up duration for patients in this study was 24.1 months (range: 17–32 months). There were no significant differences in patient age, sex, body mass index (BMI), follow-up duration, mFTA, ROM, OKS, HSS, or VAS scores among these three groups (P > 0.05). After surgery, OKS and HSS scores declined significantly, but no differences in these scores were observed among groups (P > 0.05). Of these patients, 135 (73.8%) were satisfied with the operation, of whom 80 (43.7%) were very satisfied. There were no significant differences in ROM or VAS scores among groups (P > 0.05). The degree of CTFS for patients in the mild and severe subluxation groups was significantly improved following OUKA relative to preoperative values such that the degree of postoperative CTFS did not differ significantly among these groups (P > 0.05). Postoperative mFTA was also significantly improved in these three patient subgroups (P < 0.05). No patients experienced operative complications over the follow-up period.ConclusionsOUKA can successfully improve clinical symptoms in patients with single compartmental osteoarthritis. Moreover, OUKA can effectively correct CTFS of the knee in these patients, and the degree of preoperative CTFS has no impact on surgical efficacy.Level of evidenceIII.
Highlights
Oxford unicompartmental knee arthroplasty (OUKA) is an effective approach to treating single-compartmental knee osteoarthritis, and the implementation of this procedure has increased by 30% in recent years
While the mechanistic basis for this phenotype is poorly understood, it may be linked to severe wear to the cartilage and to ligament relaxation surrounding the knee joint [11, 12] Whether coronal subluxation is a contraindication for OUKA remains a matter of active debate, with some studies having suggested that tibiofemoral subluxation be considered an exclusion criterion for OUKA, whereas others suggest that an OUKA approach may still be applicable for these patients provided the subluxation is “correctable” based upon the results of preoperative pressure imaging [13, 14]
There were no differences among groups with respect to patient age, gender, body mass index (BMI), mechanical femoral tibial angle (mFTA), preoperative range of motion (ROM), preoperative Oxford knee score (OKS) scores, preoperative Hospital for Special Surgery score (HSS) scores, or preoperative visual-analog scale (VAS) scores (P > 0.05)
Summary
Oxford unicompartmental knee arthroplasty (OUKA) is an effective approach to treating single-compartmental knee osteoarthritis, and the implementation of this procedure has increased by 30% in recent years. X-ray films of the weight-bearing lateral position and 90° flexion lateral position have revealed that the wear site is limited to the front and middle of the medial tibial platform, whereas the articular cartilage behind the medial tibial platform remains intact [6,7,8] These analyses, fail to account for the potential effects of the coronal subluxation of the knee on OUKA surgical outcomes. The goal of this study was to assess short-term outcomes in single compartment osteoarthritis patients associated with the coronal tibiofemoral subluxation (CTFS) of the knee joint after Oxford unicompartmental knee arthroplasty (OUKA), and to establish the potential impact of the degree of CTFS on operative outcomes
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