Treatment Of Unicompartmental Osteoarthritis Research Articles

A commentary on "Is opening-wedge high tibial osteotomy superior to closing-wedge high tibial osteotomy in treatment of unicompartmental osteoarthritis? A meta-analysis of randomized controlled trials" [Int J Surg 60 (2018) 153-163

A commentary on "Is opening-wedge high tibial osteotomy superior to closing-wedge high tibial osteotomy in treatment of unicompartmental osteoarthritis? A meta-analysis of randomized controlled trials" [Int J Surg 60 (2018) 153-163

Clinical efficacy of total knee arthroplasty versus unicondylar arthroplasty in the treatment of unicompartmental osteoarthritis.

Clinical efficacy of total knee arthroplasty versus unicondylar arthroplasty in the treatment of unicompartmental osteoarthritis.

A study of functional outcome of medial open wedge verses lateral closed wedge high tibial osteotomy

The treatment of unicompartmental osteoarthritis with high tibial osteotomy using medial open wedge verses lateral closed wedge osteotomy. It is a choice of surgery in young age osteoarthritis. In this study we analyse the functional outcome of medial open wedge osteotomy the tom fix plate and lateral closed wedge osteotomy using staple in patients having unicompartmental osteoarthritis with genu varum.Material and Methods: This is a prospective study of patients who attended the orthopaedic outpatient clinic in tertiary care hospital between July 2021 to December 2022. The patients were evaluated by clinical examination and weight bearing radiographs. The patients who were found to have unicompartmental osteoarthritis with knee pain not relieved by conservative management and who satisfy the inclusion criteria were selected. During this period 30 patients were selected and were included in study.Results: In both groups a significant improvement of both scores were achieved. Both methods obtained safe and reproducible results for the correction considering the different operation techniques. There were no differences in outcome between the two methods. Satisfactory results were also achieved for early arthrosis of the femoropatellar and the lateral compartment.Conclusion: Open and closed wedge HTOs obtain significant improvement in patients with medial osteoarthritis of the knee. Using the right technique is very important for good results. For stabilization of the medial ligament we recommend the open wedge osteotomy. The patient should be informed about the routine removal of the metal plate.

Proximal Fibular Osteotomy in Treatment of Unicompartmental Osteoarthritis

Proximal Fibular Osteotomy in Treatment of Unicompartmental Osteoarthritis

Unicompartmental knee arthroplasty in the over 70 population

Unicompartmental prosthesis (UKA) is a viable option for the treatment of unicompartmental osteoarthritis, most often confined to the medial compartment. Appear to have been well codified indications, contraindications, and surgical techniques related to unicompartmental arthroplasty. The data in the literature show that the selection criteria can be divided into general origin factors (age, weight, activity level) and local factors, more closely related to the joint to be treated [1,2]. The patient's age over 65 years and the functional requirements of a sedentary activity comparable to justify its use in elderly patients with clinical signs and imaging involvement of only one of the joint compartments [3]. We agree, however, with those who recommend its use in older subjects, since it is well tolerated, with low morbidity, reduced blood loss, better preservation of the joint and saving of bone tissue. Other advantages include lower costs, shorter hospitalization, faster rehabilitation and conferment of a greater than pre-op functional efficiency that fully meets the needs of elderly patients. The authors report their experience in 12 patients treated surgically implanting a unicompartmental prosthesis.

Cost-Effectiveness of Unicompartmental Knee Arthroplasty, High Tibial Osteotomy, and KineSpring® Knee Implant System for Unicompartmental Osteoarthritis of the Knee

Osteoarthritis (OA) of the knee is a condition that causes pain and disability. Numerous non-surgical and surgical interventions are available for individuals with OA that result in good pain relief and return of function. The purpose of this economic analysis was to determine the cost-effectiveness of high tibial osteotomy (HTO), unicompartmental knee arthroplasty (UKA) and the KineSpring® Knee Implant System in the treatment of unicompartmental OA of the knee 10 years post-surgery, considering the costs of revisions, conversions, removals, and complications. Estimates of costs and rates of revision, conversion, removal, and complications related to UKA and HTO were obtained from the literature. Internal reports on the KineSpring System were used for calculations on the KineSpring System. The cost-effectiveness of UKA, HTO and the KineSpring System in terms of QALY gained compared to patients without treatment yielded gains of approximately $5150/QALY, $6754/QALY, and $7010/QALY, respectively. Using the accepted standard willingness-to-pay threshold of $50,000 US/QALY gained, the UKA, HTO, and the KineSpring System are economically favorable. Our analysis demonstrates that the KineSpring System, despite a greater initial cost in surgery, has significantly smaller conversion and complication costs compared to UKA and HTO. The 10 years overall expected cost for the KineSpring System ($12,559) is significantly less compared with that of UKA ($17,570) and HTO ($22,825). Future economic analyses regarding this topic should also consider the cost-effectiveness of these procedures on younger, more active individuals who are still working and should take into account productivity loss.

UNICOMPARTMENTAL KNEE ARTHROPLASTY: CURRENT PERSPECTIVES AND TRENDS IN BRAZIL

Objective: The aim of this study was to evaluate the approaches and procedures used by Brazilian orthopedic surgeons for treating osteoarthrosis by means of unicompartmental knee arthroplasty and high tibial osteotomy of the knee. Methods: A questionnaire with 14 closed questions was developed and applied to Brazilian knee surgeons during the three days of the 43rd Brazilian Congress of Orthopedics and Traumatology. Results: A total of 113 surgeons filled out the questionnaire completely and became part of the sample analyzed. In this study, the majority of the surgeons performed fewer than five unicompartmental knee arthroplasty procedures/year (61.1%) and between 5 and 15 high tibial osteotomy procedures/year (37.2%). Use of computerized navigation systems during surgery remains uncommon in our environment, since only 0.9% of the specialists were using it. 65.5% of the surgeons reported that they had chosen to use total knee arthroplasty rather than partial arthroplasty due to lack of familiarity with the surgical technique. When asked about the possibility that the number of unicompartmental prostheses used in Brazil would grow as surgeons in this country become increasingly familiar with the technique, 80.5% of the respondents believed in this hypothesis. In this sample, we found that the greater the surgeon's experience was, the greater the numbers of unicompartmental prostheses and tibial osteotomies performed annually were (r = 0.550 and r = 0.465, respectively; p < 0.05). Conclusions: There is a clear evolutional trend towards treatment of unicompartmental osteoarthritis using partial knee arthroplasty in Brazil. However, further prospective controlled studies are needed in order to evaluate the clinical and scientific benefits of these trends.

Artroplastia unicompartimental do joelho: perspectivas e tendências atuais no Brasil

OBJETIVO: O objetivo deste estudo e avaliar as condutas e procedimentos realizados pelos cirurgioes de joelho do Brasil no tratamento da osteoartrose com artroplastia unicompartimental e osteotomia tibial alta do joelho. METODOS: Um questionario de 14 questoes fechadas foi elaborado e aplicado a cirurgioes brasileiros de joelho durante os tres dias do 43o Congresso Brasileiro de Ortopedia e Traumatologia. RESULTADOS: Um total de 113 cirurgioes de joelho preencheram completamente o questionario e fizeram parte da amostra analisada. Neste estudo, a maioria dos cirurgioes realizava menos de cinco artroplastias unicompartimentais do joelho/ano (61,1%) e entre cinco e 15 osteotomias tibiais altas/ano (37,2%). A utilizacao de navegacao computadorizada no intraoperatorio e ainda infrequente em nosso meio, sendo realizada por apenas 0,9% dos especialistas. A opcao pelo uso da artroplastia total do joelho em detrimento da parcial devido a falta de familiaridade com a tecnica cirurgica foi relatada por 65,5% dos cirurgioes. Quando arguidos sobre a possibilidade de crescimento no numero de proteses unicompartimentais no Brasil com o aumento da familiaridade com a tecnica pelos cirurgioes do Pais, 80,5% dos entrevistados responderam que acreditam nesta hipotese. Nesta amostra, constatamos que quanto maior a experiencia do cirurgiao maior o numero de proteses unicompartimentais e osteotomias tibiais realizadas anualmente (r = 0,550 e r = 0,465, respectivamente, e p < 0,05). CONCLUSOES: Existem claras tendencias em evolucao no tratamento da osteoartrose unicompartimental com artroplastia parcial do joelho no Brasil. No entanto, mais estudos prospectivos controlados sao necessarios para avaliar o beneficio clinico e cientifico destas tendencias.

Comparison of unicompartmental knee arthroplasty and total knee arthroplasty in the treatment of unicompartmental osteoarthritis: a meta-analysis

Background It is not clear whether unicompartmental knee arthroplasty (UKA) or total knee arthroplasty (TKA) leads to better outcomes in the treatment of unicompartmental knee osteoarthritis. The purpose of our meta-analysis was to compare the clinical outcomes of UKA and TKA in the treatment of unicompartmental knee osteoarthritis. Methods We searched all major medical databases for randomized controlled trials or well-designed quasi-randomized trials that compared UKA with TKA in the treatment of unicompartmental knee osteoarthritis and conducted a meta-analysis with RevMan software (The Cochrane Collaboration, Oxford, England) to compare the clinical outcomes after assessment of study quality and heterogeneity. Results The results of the meta-analysis indicated that UKA required more revisions in the group with follow-up of less than 5 years after operation (risk ratio [RR]=3.47; 95% confidence interval [CI]: 1.23-9.77; P=0.02), but the difference was not significant after 5 years (RR=0.87; 95% CI: 0.29-2.60; P=0.81). Patients who underwent UKA had better range of motion (weighted mean difference [WMD]=6.43°; 95% CI: 3.46-9.40; P<0.001) and fewer complications (RR=0.20; 95% CI: 0.08-0.52; P=0.0009) than those who had TKA. Knee Society Scores were similar between the groups (WMD=0.16; 95% CI: -2.12-2.45; P=0.89), but functional scores were higher for the UKA than TKA group (WMD=1.96; 95% CI: 0.15-3.78; P=0.03). Conclusions UKA provided better postoperative function and fewer complications than TKA. UKA called for more revisions in the group with follow-up of 5 years or less (follow up 0–5 years), but the difference was not significant after 5 years (follow-up 5–15 years).

Total knee arthroplasty after failed high tibial osteotomy

The objective of this review was to propose surgical techniques for different technical problems in total knee arthroplasty after high tibial osteotomy and to discuss the literature on the subject. Whereas early results of high tibial osteotomy in the treatment of unicompartmental osteoarthritis of the knee were promising, long-term follow-up indicates recurrence of symptoms and finally the need for total knee replacement in most cases. One of the major problems caused by high tibial osteotomy is an extraarticular deformity difficult to correct with ligament balancing. Based on the parameters “valgus angle”, “ROM” and “patella position”, the knees were evaluated and classified, then surgical techniques for the different grades of this classification were described. Most studies show that arthroplasty in a knee after osteotomy is more prone to complications such as persisting pain, malalignement and infections. After reviewing the literature, the overall results of total knee arthroplasties after failed high tibial osteotomy were found to be inferior to that after primary total knee arthroplasty. We concluded that total knee arthroplasty after failed high tibial osteotomy is technically more demanding than primary arthroplasty and that the use of the appropriate technique, determined by meticulous preoperative planning, is crucial for the outcome of the procedure.

Unicondylar knee replacement for primary osteoarthritis: A prospective follow-up study of 1,819 patients from the Finnish Arthroplasty Register

Background The choice and use of unicondylar knee arthroplasty (UKA) has gone through a nation wide resurgence at the start of the 21st century in Finland. We evaluated the population-based survival of UKA in patients with primary osteoarthritis (OA) in Finland, and the factors affecting their survival.Method The Finnish Arthroplasty Register was established in 1980. During the years 1985–2003, 1,928 primary UKAs were recorded in the register; 1,819 of these were performed for primary OA. Of these 1,819 UKAs, we selected for further analysis implants that had been used in more than 100 operations during the study period. The survival rates of UKAs were analyzed using Kaplan-Meier analysis and the Cox regression model.Results Analysis of the whole study period showed that UKAs had a 73% (95% CI: 70–76) survival rate at 10 years, with revision for any reason as the end point. Those patients who received the Oxford menisceal bearing unicondylar (n = 1145) had a survival rate of 81% (95% CI: 72–89) at 10 years. The group that received the Miller-Galante II unicondylar (n = 330) had a 79% survival rate (95% CI: 71–87) at 10 years, whereas the Duracon (n = 196) had a survival rate of 78% (95% CI: 72–84) and the PCA (n = 146) had a survival rate of 53% (95% CI: 45–60) at 10 years. The number of UKA operations in Finland has increased markedly in recent years. At the time of operation, the mean age of the patients was 65 (38–91) years. Younger patients (≤ 65 years of age) were found to have a 1.5-fold (95% CI: 1.1–2.0; p = 0.04) increased risk of revision compared to older patients (< 65 years).Interpretation UKA is a viable option for the treatment of unicompartmental osteoarthritis of the knee. However, patients should be made aware of the lower survival of the UKAs compared with total knee arthroplasties.

Metallic hemiarthroplasty of the knee

Purpose of review: This review discusses the advantages and disadvantages of metallic hemiarthroplasty. Recent findings: Metallic hemiarthroplasty may continue to have a very selective limited role in the treatment of unicompartmental osteoarthritis. Fewer than 1% of patients with osteoarthritis should be appropriate candidates. The indications might include a young osteoarthritic patient with unicompartmental arthritis in whom an osteotomy is contraindicated but who is considered too young, heavy, and/or active for total knee arthroplasty. Summary: The advantages of metallic hemiarthroplasty include the conservative nature of the operation and permission for the patients to engage in activity to tolerance. Disadvantages are the possibility of incomplete pain relief and that the procedure is technically demanding and sensitive.

Surgical Treatment of Unicompartmental Degenerative Arthritis of the Knee

The number of patients with unicompartmental osteoarthritis is increasing with the average age of our population. Good surgical techniques are available to improve pain and increase motion in the knee with degenerative disease. It is important to make early accurate diagnoses in arthritic patients so that the least surgically ablative procedure can be performed that will maximally benefit each patient. Total knee replacement is an extremely effective operation for relieving pain, but its major drawback is the large amount of bone stock that must be sacrificed during the procedure. Unicondylar knee replacement has proven itself to be an excellent alternative to total knee replacement in more limited arthritic disease. High tibial osteotomy still plays a major role as treatment for unicompartmental arthritis in younger and more active patients. McKeever interpositional hemiarthroplasty is an alternative in young patients when osteotomy is contraindicated. Arthroscopy is playing an increasing role in both diagnosis and treatment of unicompartmental osteoarthritis. The decision to perform unicompartmental arthroplasty, osteotomy, or total knee replacement is made on an individual basis. The extent of cartilage degeneration in the knee as well as the age, weight, and activity demands of the patient help to guide that decision.