Abstract
PurposeTo determine the preferred knee in patients with both one total and one unicompartmental knee arthroplasty.MethodPatients simply with a unicompartmental (UKA) and total knee arthroplasty (TKA) on contralateral sides were retrospectively screened from three senior knee surgeon’s logs over a 15 year period. Patients safe and free from other diseases to affect gait were approached. A total of 16 patients (mean age 70 ± 8) agreed to ground reaction force testing on an instrumented treadmill at a fair pace and incline. A gender-ratio identical group of 16 healthy control subjects (mean age 67 ± 10) and 16 patients with ipsilateral medial knee OA (mean age 66 ± 7) were analysed to compare.ResultsRadiographically the mode preoperative Kellgren–Lawrence knee grade for each side was 3. Postoperatively, the TKA side had a mean coronal femoral component alignment of 7° and a mean tibial coronal alignment of 89° with a mean posterior slope of 5° in the sagittal plane. The UKA side had a mean coronal femoral component alignment of 7° and a mean tibial coronal alignment of 86° with a mean posterior slope of 4° in the sagittal plane. In 7 patients, the TKA was the first procedure, while 6 for the UKA and 3 done simultaneously. Gait analysis demonstrated in both walking conditions the UKA limb was the preferred side through all phases of loading (p < 0.05) and nearer to normal than the TKA limb when compared to healthy controls and patients with knee OA. The greatest difference was observed between the transition of weight acceptance and midstance (p = 0.008), when 22% more load was taken by the UKA side.ConclusionBy using a dynamic metric of an everyday activity, a distinct gait difference between differing arthroplasty types were established. A more natural loading pattern can be achieved with unicompartmentals as compared to total knees.Level of evidenceRetrospective comparative study, Level III.
Highlights
In the United Kingdom as much as 47% of patients presenting with symptomatic knee osteoarthritis (OA) have single compartment disease [5, 23, 29]
The great majority are offered and accept total knee arthroplasty (TKA) [17] which will result in the removal of a potentially functional anterior cruciate ligament (ACL) together with otherwise competent compartments
One pair of knees was wind swept and the two others had patellofemoral wear on one side
Summary
In the United Kingdom as much as 47% of patients presenting with symptomatic knee osteoarthritis (OA) have single compartment disease [5, 23, 29]. The great majority are offered and accept total knee arthroplasty (TKA) [17] which will result in the removal of a potentially functional anterior cruciate ligament (ACL) together with otherwise competent compartments. Functional studies have shown statistically significant advantages of UKA by having better patient-reported outcome measures and activities of daily living (ADLs) when compared to TKA [11, 12, 27, 28, 30]. The primary aim of this study was, to compare how patients with both a UKA and TKA on either side load their limbs at an everyday walking pace and incline. The null hypothesis was that no difference would be detected between the way patients load the limb with well performing UKA and the TKA on either side
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