UKA Group Research Articles

Non-Sagittal Knee Joint Kinematics and Kinetics during Gait on Level and Sloped Grounds with Unicompartmental and Total Knee Arthroplasty Patients.

After knee arthroplasty (KA) surgery, patients experience abnormal kinematics and kinetics during numerous activities of daily living. Biomechanical investigations have focused primarily on level walking, whereas walking on sloped surfaces, which is stated to affect knee kinematics and kinetics considerably, has been neglected to this day. This study aimed to analyze over-ground walking on level and sloped surfaces with a special focus on transverse and frontal plane knee kinematics and kinetics in patients with KA. A three-dimensional (3D) motion analysis was performed by means of optoelectronic stereophogrammetry 1.8 ± 0.4 years following total knee arthroplasty (TKA) and unicompartmental arthroplasty surgery (UKA). AnyBody™ Modeling System was used to conduct inverse dynamics. The TKA group negotiated the decline walking task with reduced peak knee internal rotation angles compared with a healthy control group (CG). First-peak knee adduction moments were diminished by 27% (TKA group) and 22% (UKA group) compared with the CG during decline walking. No significant differences were detected between the TKA and UKA groups, regardless of the locomotion task. Decline walking exposed apparently more abnormal knee frontal and transverse plane adjustments in KA patients than level walking compared with the CG. Hence, walking on sloped surfaces should be included in further motion analysis studies investigating KA patients in order to detect potential deficits that might be not obvious during level walking.

Outcomes and survivorship of unicondylar knee arthroplasty in patients with severe deformity.

Fifty-three patients with severe deformity (40 patients with FFD ≥15° and 13 patients with varus deformity ≥15°, Group A) were matched with 53 patients with less severe deformities who underwent UKA (Group B/controls) in terms of age, sex, BMI and duration of follow-up. Their flexion range, Knee Society scores (KSS), Oxford knee scores (OKS) and SF-36 QOL scores were analysed pre-operatively and at 2years. Group A patients were largely similar to Group B patients pre-operatively in terms of maximum flexion angle, OKS and SF-36 scores except for knee score and mental health component of SF-36. At 2years, Group A reported largely similar results compared with Group B in all outcome scores (OKS, KSS, SF-36) and flexion angle. Post-operative mechanical alignment was better for the control group though it is not statistically significant. There were no revisions in the patients with severe pre-operative deformity at 5years post-operatively. (Survivorship 100% at 5years). Selected patients with severe deformity can achieve good function and QOL with UKA if satisfactory mechanical alignment is restored. This study supports a broadening of the indications of UKA; however, further follow-up is needed to assess the longer-term durability of the operation. IV.

Robotic Guidance Does Not Improve Component Position or Short-Term Outcome in Medial Unicompartmental Knee Arthroplasty

We performed a retrospective review in a matched group of patients on the use of robotic-assisted UKA implantation versus UKA performed using standard operative techniques to assess differences between procedures. While both techniques resulted in reproducible and excellent outcomes with low complication rates, the results demonstrate little to no clinical or radiographic difference in outcomes between cohorts. Average operative time differed significantly with, and average of 20minutes greater in, the robotic-assisted UKA group (P=0.010). Our minimal clinical and radiographic differences lend to the argument that it is difficult to justify the routine use of expensive robotic techniques for standard medial UKA surgery, especially in a well-trained, high-volume surgeon. Further surgical, clinical and economical study of this technology is necessary.

EVALUATION OF MIDTERM FUNCTIONAL RESULTS AFTER TOTAL AND UNICOMPARTMENTAL KNEE ARTHROPLASTY WITH DIFFERENT SCORING SYSTEMS

Using KSS, WOMAC and IKDC score systems the authors evaluated functional results of 64 total (TKA) and unicompartmental (UKA) knee arthroplasties performed in department of knee pathology of Vreden’s Russian Research Institute Travmatology and Orthopaedics from 2001 till 2006. Before joint replacement there was no significant difference in magnitude of performance deficit between both groups. After 5-10 years (7 in average) all patients had similar pain relief but activities of daily living and level of physical performance, including high flexion, were significantly higher in UKA group than TKA. KSS and WOMAC score systems did not reflect this important difference in physical capacities of UKA and TKA patients comparing to IKDC.

Does arthroplasty type influence knee joint proprioception? A longitudinal prospective study comparing total and unicompartmental arthroplasty

Proprioception was assessed after knee replacement to compare total (TKA) to unicompartmental (UKA) knee arthroplasty. Thirty-four patients were recruited; seventeen patients underwent TKA and seventeen patients underwent UKA. The patient's age was similar in both groups. Two measures of proprioception, joint position sense (JPS) and postural sway (PS) were measured. Function was assessed using the Oxford Knee Score (OKS). Measurements were taken pre-operatively and 6 months post-operatively on both the operated and contralateral leg. Pre-operatively, no differences in JPS or PS were found between groups or between limbs in either group. Post-operatively, both groups had significant improvement of JPS in the operated limb only (20% increase). The improvement in JPS was similar in both groups. PS also improved significantly in both groups although the improvement of PS in the UKA group was twice that for the TKA group. The OKS improved by a similar amount in both groups. Both UKA and TKA result in a significant improvement in proprioception. Dynamic aspects of proprioception improve more after UKA than TKA, which may explain, in part, why UKA patients have superior functional outcome to that of TKA patients.

Mid-age health in women from the Indian subcontinent (MAHWIS): general health and the experience of menopause in women

Objectives First, to examine the experience of menopause and quality of life in a migrated Asian population from the Indian subcontinent living in Birmingham, UK, and, second, to compare their experience with a matched sample of Caucasian women living in the same geographical area and also with a sample of Asian women with similar socioeconomic background living in Delhi, India.Methods In this cross-sectional study of 153 peri- and postmenopausal women aged 45–55 years, 52 Asian women originating from the Indian subcontinent living in Birmingham (UKA, mean age 51.4 years), 51 Caucasian women (UKC, mean age 52.3 years) and 50 Asian women living in Delhi, India (DEL, mean age 49.72 years) were interviewed to collect information about their lifestyle, general health, menopause experience and help-seeking behavior. The Women's Health Questionnaire and the Menopause Representation Questionnaire (both translated and linguistically validated in Hindi) were used to examine the prevalence of physical and emotional symptoms and the extent to which these were attributed to the menopause.Results The two Asian groups (UKA, DEL) reported poorer health and generally more physical and emotional symptoms than the UKC group. However, for menopausal symptoms (hot flushes and night sweats) there was a different pattern; the DEL group reported significantly fewer symptoms compared to the UKA and UKC groups (hot flushes: UKC 60.8%, UKA 75%, DEL 32% (p < 0.001); night sweats: UKC 50%, UKA 56.9%, DEL 24% (p = 0.002)). The prevalence of vaginal dryness was highest in the UKA group and lowest in the DEL group (UKC 21.6%, UKA 38.2%, DEL 7.3% (p = 0.005)). The number of symptoms attributed to menopause was significantly lower in the DEL group (9.3 ± 7.8) compared to the two UK groups (UKC 18.9 ± 7.4, UKA 19.8 ± 10.7), but the UKA women tended to attribute some physical symptoms to the menopause such as breathlessness, weight gain and stiff joints that might have other causes.Conclusions The UK Asian women's experience of the menopause is more similar to the Caucasian women in the UK than that of the women in Delhi. However, Asian women living in the UK and the Indian subcontinent shared the experience of poor health and reports of more physical and emotional symptoms in general. The possible reasons for these differences are discussed.

Leptosphaeria maculans causing stem canker of oilseed rape in China

Leptosphaeria maculans occurs on oilseed rape (Brassica napus) as two types: the aggressive A-group and less damaging B-group (West et al., 1999). The disease occurs worldwide, but little is known of L. maculans from China. Stems with early stem lesion symptoms were collected from three field-sites in central China, Wuhan, Hefei and Guiyang, in April 1999. Pseudothecia appeared on stem surfaces after three months incubation in natural conditions. The ascospores produced in the pseudothecia (Figure 1) fit the description of Leptosphaeria maculans (Knashnobish & Shearer, 1996; Punithalingham & Holliday, 1972) and were similar to ascospores produced from UK debris (Figure 2). Pseudothecia did not develop on stems from Wuhan. Eight single ascospore cultures were made from two stems collected in Hefei, and ten were made from two stems collected in Guiyang. All isolates were classified in the B-group of L. maculans, based on colony growth rate and production of a yellow pigment (Williams & Fitt, 1999). Leaves two and four of oilseed rape plants cv. Lipton, grown in 9 cm pots, with 4 leaves expanded, were wounded with three adjacent pinpricks. Conidial suspensions (2x107 ml-1) of two isolates from Hefei (HefA1 and HefB2), two from Guiyang (Gui2b3 and Gui2a2), a UK B-group isolate (UK11) and a UK A-group isolate (96M5) were sprayed onto two plants, per isolate. Plants were grown at 15°C, initially under polyethylene to maintain high humidity. Small lesions appeared at the wound sites after 12 days on all inoculated leaves and pin-point lesions appeared on unwounded areas. Isolations from wound-site lesions confirmed the presence of the inoculated pathogen. After 14 days, some pin-point lesions expanded (Figure 3) occasionally coalescing and producing pycnidia, with a bright pink cirrus. In central China in April 1999, stem canker was found rarely but only the less aggressive, B-group was found. This, and cultural practices that result in the removal of most potential inoculum, suggests why stem canker is not currently considered to be a problem in central China.