Unicondylar Knee Arthroplasty Research Articles

Assessment of Patient Satisfaction and Outcomes After Outpatient Joint Arthroplasty in Academic Medical Centers

BackgroundThere is limited literature evaluating patient satisfaction and outcomes after outpatient joint arthroplasty procedures in academic medical centers (AMCs). The aims of this study are to determine: (1) patients' desires to repeat their procedures and be discharged on the same day, (2) patient-reported outcome measures (PROMs), (3) time to discharge, (4) readmission rates, and (5) factors that predict PROMs in patients undergoing outpatient joint arthroplasty in AMCs. MethodsA prospective survey was completed by 66 total hip arthroplasty (THA), 35 total knee arthroplasty (TKA), and 180 unicondylar knee arthroplasty (UKA) outpatients who underwent surgery from May 2018 to December 2020 in 2 AMCs. The survey consisted of questions regarding hip or knee PROMs (Hip Disability and Osteoarthritis Outcome Score for Joint Replacement, and Knee Injury and Osteoarthritis Outcome Score for Joint Replacement), satisfaction with outpatient procedures and discharges, and reasons for readmissions. Linear regression analysis was conducted with statistical significance set at P < .05. Results100% of THA, 93.8% of TKA, and 93.0% of UKA outpatients stated that they would re-elect to undergo their respective procedure. Furthermore, 94% of THA, 81% of TKA, and 95% of UKA patients stated they would like same-day discharge again. THA, TKA, and UKA patients reported respective mean PROM scores of 94.7, 89.9, and 86.1. Readmission rates were 1.5%, 0.0%, and 0.5%, for THA, TKA, and UKA, respectively. ConclusionsPatients who underwent outpatient joint arthroplasty procedures at 2 AMCs experienced minimal readmissions and reported a high desire to repeat their outpatient procedures.

No Difference in Range of Motion, Components, or Complications Following Conversion of Robotic-Assisted Total Knee Arthroplasty Compared to Manual TKA After Undergoing Manual or Robotic-Assisted Unicompartmental Knee Arthroplasty

BackgroundConversion surgery from unicondylar knee arthroplasty (UKA) to total knee arthroplasty (TKA) remains a challenge due to scarring, implant/cement removal, and loss of bony landmarks. Robotic-assisted (RA) TKA may assist in challenges seen in manual conversion TKA. The aim of this study is to identify if there are differences in components and functional outcomes dependent on manual/RA primary UKA and conversion TKA. MethodsA retrospective chart review was performed on patients undergoing conversion from UKA to TKA over a 10-year period at a single institution. Data extracted included surgical technique, reason for UKA failure, range of motion at 1 year, need for augments, and utilization of revision components. ResultsForty-nine patients (50 knees) with a UKA converted to a TKA were divided into 4 groups based on primary and conversion surgery: manual-to-manual (n = 11), manual-to-robot (n = 11), robot-to-manual (n = 11), and robot-to-robot (n = 17). There was no difference in need for augments (P = .376), size of poly (P = .23), postoperative flexion (P = .52), or extension (P = .76) at 1 year between the 4 groups. However, patients with primary manual UKA did require significantly more augments during revision (P = .032). ConclusionsOur study did not show any statistically significant differences of primary RA or manual UKA to RA or manual TKA in terms of range of motion at 1 year, complications, or differences in components. RA conversion from UKA to TKA is a new but equivalent technique to manual conversion. Primary surgery may impact the requirement for augments during conversion surgery.

Robotic arm-assisted unicondylar knee arthroplasty resulted in superior radiological accuracy: a propensity score-matched analysis

IntroductionUnicompartmental knee arthroplasty (UKA) is an effective surgical treatment for medial compartment arthritis of the knee, yet surgical outcomes are directly related to surgical execution. Robotic arm-assisted surgery aims to address these difficulties by allowing for detailed preoperative planning, real-time intraoperative assessment and haptic-controlled bone removal. This study aimed to compare the clinical and radiological outcomes between conventional manual mobile bearing and robot arm-assisted fixed bearing medial UKA in our local population.Materials and methodsThis is a retrospective case–control study of 148 UKAs performed at an academic institution with a minimum of 1-year follow-up. 74 robotic arm-assisted UKAs were matched to 74 conventional UKAs via propensity score matching. Radiological outcomes included postoperative mechanical axis and individual component alignment. Clinical parameters included a range of motion, Knee Society knee score and functional assessment taken before, 6 and 12 months after the operation.ResultsRobot arm-assisted UKA produced a more neutral component coronal alignment in both femoral component (robotic -0.2 ± 2.8, manual 2.6 ± 2.3; P = 0.043) and tibial component (robotic -0.3 ± 4.0, manual 1.7 ± 5.3; P < 0.001). While the postoperative mechanical axis was comparable, robot arm-assisted UKA demonstrated a smaller posterior tibial slope (robotic 5.7 ± 2.7, manual 8.2 ± 3.3; P = 0.02). Clinical outcomes did not show any statistically significant differences.ConclusionCompared with conventional UKA, robotic arm-assisted UKA demonstrated improved component alignment and comparable clinical outcomes. Improved radiological accuracy with robotic-arm assistance demonstrated promising early results.

UNICONDYLAR KNEE ARTHROPLASTY — PROS AND CONS (LITERATURE REVIEW)

In the modern world, despite the increased availability of hightech orthopedic care, the number of patients with gonarthrosis does not decrease, and thanks to public awareness, more and more people turn to orthopedists for surgical help. Due to its high efficiency, the leading role in the treatment of terminal gonarthrosis has been firmly occupied by total knee arthroplasty for more than four decades. Unicondylar knee arthroplasty in patients with unilateral arthrosis allows to largely preserve physiological kinematics, to achieve minimal bone and soft tissue traumatization during surgery and, as a result, to obtain a higher functional result. The objective of the work is to analyze the data of the world literature regarding unicondylar knee arthroplasty, its advantages and disadvantages. Material and methods. The authors analyzed the publications devoted to single-condylar knee arthroplasty from the Google search engine, scientific and metric electronic databases PubMed, Medline and other relevant sources of scientific and medical information. Correct patient selection is vital to ensure a successful outcome with OEKS. The main indication for OEKS is deforming arthrosis of the II–III century. with a predominant lesion of the internal part of the knee joint and varus deformation of the lower limb or with a more pronounced pathology of the external part of the knee joint and valgus deformation of the lower limb. Results. The authors analyzed the literature sources on single-condylar endoprosthesis of the knee joint. Indications, contraindications, biomechanical features, type of endoprosthesis fixation, type of endoprosthesis platform, features of lateral gonarthrosis, and complications of single-condylar knee arthroplasty are determined. Conclusions. The analysis of selected literary sources showed that single-condylar arthroplasty of the knee joint is an effective means of preserving the bone. However, careful patient selection and precision of surgical technique remain the key to a successful outcome.

Published Comorbidity Indices Poorly Identify Patients at Risk for Failing to Achieve Same Day Discharge Following Unilateral Unicondylar Knee Arthroplasty

Published Comorbidity Indices Poorly Identify Patients at Risk for Failing to Achieve Same Day Discharge Following Unilateral Unicondylar Knee Arthroplasty

Dizde Medial Kompartman Artrozlu Hastalarda Uygulanan Unikondiler Diz Artroplastisi Cerrahisinin Kısa-Orta Dönemde Retrospektif Sonuçları

Aim: The aim of this study was to compare of preoperative and postoperative clinical and radiological findings of the patients with medial compartmental artrosis who underwent the surgery of the unicondylar knee prosthesis. Decrease or disappearance of patient's pain level, assessment of the quality of life of these patients and Knee Society Score (KSS), KSS function score and VAS score compared in both groups. &#x0D; &#x0D; &#x0D; &#x0D; Materials and methods: Between January 2014 and December 2017 in the Orthopaedic Clinic of Health Sciences University Izmir Bozyaka Training and Research Hospital, patients who underwent Unicondyler Knee Arthroplasty surgery due to medial compartmental arthrosis were included in the study. Retrospectively, demographic data, weight bearing anteroposterior-lateral knee x-ray graphics, orthoroentgenogram, KSS and VAS scores, preoperative and postoperative knee range of motions were recorded. &#x0D; &#x0D; &#x0D; &#x0D; Results: 44 knees of the 38 patients are evaluated, the mean age of the 44 cases was 57.09 years. Of the 44 cases, the mean follow-up period was 40,08 months. According to the Knee Society Score system, the preoperative score was 55.64 and postoperative 83.32; the KSS function score was 83.75 before the operation and 93.98 postoperatively. The mean range of motion was 107.61 degrees preoperatively and 118.52 degrees postoperatively. &#x0D; &#x0D; &#x0D; &#x0D; Conclusion: The short-mid-term results of our cases are similar as literature which compares Knee Society Score and the radiographical evaluation. Unicondylar knee arthroplasty can be performed in selected appropriated cases.

Regional Trends in Unicondylar and Patellofemoral Knee Arthroplasty: An Analysis of the American Joint Replacement Registry

BackgroundAs the popularity of unicondylar knee arthroplasty (UKA) and patellofemoral arthroplasty (PFA) have expanded, more patients who have limited arthritis are undergoing partial knee arthroplasty. No studies have evaluated if any regional differences in the United States (U.S.) exist between partial versus total knee arthroplasty (TKA). The purpose of this study was to utilize the American Joint Replacement Registry to evaluate regional differences in UKA, PFA, and TKA. MethodsThe American Joint Replacement Registry was queried for all TKA, PFA, and UKA procedures between 2012 and 2021. Surgical volume was compared between the Midwest (MW), Northeast (NE), South, and West (W) regions. Trends were compared using multivariate logistic regression analyses and least squared mean logistic regression models. ResultsSince 2012, there has been a steady increase in the amount of UKAs performed across the U.S., except during the COVID-19 pandemic when numbers decreased. Logistic regression analyses demonstrated a higher likelihood of receiving a UKA compared to TKA in the NE compared to other regions, and higher likelihood of receiving a PFA in the NE and W compared to other regions over the study period. Other factors that increased the likelihood of having a UKA nationally were men, the procedure being performed at a teaching hospital, and having surgery in urban areas. Patients were more likely to have a PFA in the NE compared to the S and MW, and higher odds in the South and W compared to the MW, with rates of PFA consistently lower in the MW compared to other regions. ConclusionsPatients were more likely to have a UKA in the NE compared to other regions of the country. Patients had higher odds of having a PFA in the NE and W regions relative to the MW. Men had higher odds of having either UKA or PFA than women across the nation.

Study of bone density according to СT data before and in the remote period after unicondylar knee arthroplasty

Background. Unicondylar knee arthroplasty has become popular among orthopedists in recent years. The main complication of this technology is the instability of the tibial component of the endoprosthesis due to the development of local osteoporosis in the area of arthroplasty. Patients with decreased bone density are at high risk of developing instability of the tibial component of the endoprosthesis. Therefore, determining the levels of bone mineral density in patients with osteopenia before arthroplasty make it possible to calculate the risk of complications in the long term. Objective: to evaluate the bone mineral density according to the computed tomography (CT) of the tibial plateau resection zone for unicondylar arthroplasty in patients at risk. Materials and methods. The state of three cortical layer zones was assessed: anterior, middle, posterior and 4 zones of the plateau cut plane. The optical density of bone tissue was measured on CT images of the tibial plateau of the knee joint using the Hounsfield scale. Changes in bone structures in the area of placing tibial component of the endoprosthesis were studied in 2 groups of patients: group I — ten individuals who had undergone unicondylar knee arthroplasty 3–6 years ago and complained of negative phenomena in the prosthetic knee, group II — ten patients who had undergone unicondylar arthroplasty 1.2–2 years ago. These patients underwent CT densitometry at the follow-up examination. Results. Before arthroplasty, the maximum optical density of bone tissue was statistically the same. The density of the cortical layer was maximal in the anterior part of the bone (~ 720 HU), minimal — in the posterior part (580 HU). For the spongy bone zone, the maximum optical density was observed in the anterior part (~ 470 HU), and in the posterior part, it was lower. In 3–6 years, patients of group I showed a significant decrease in the optical density of the bone, both in its cortical layer and in the cancellous tissue. The greatest losses were detected in the medial zones of the cancellous bone. Patients had areas of cortical layer resorption, and in some individuals, its complete absence. At the same time, the absorption index of the cortical layer in the areas of destruction did not exceed 100 HU. The maximum optical density of the cortical layer in the zones also decreased. In patients of group II, 1.5–2 years after arthroplasty, there were no noticeable changes in the bone structures in the surgery area. Changes occurred in the medial zones of the cancellous bone of the tibial plateau. Patients with osteopenia reported changes in bone optical density already in the first years after arthroplasty, although they do not lead to instability of the tibial component of the endoprosthesis. Conclusions. Patients with decreased bone density (osteopenia) during joint arthroplasty are at risk of developing local osteoporosis in the area of bone resection. The first signs of resorption of the cancellous bone can be observed 1.5–2 years after arthroplasty. Timely treatment measures can slow down the further progression of osteoporosis.

The Length of Incision in Unicondylar Knee Arthroplasty Is More Affected by the Patient's Height Than Their Weight.

Objective Obesity leads to osteoarthritis due to increased loading forces on joint cartilage and inflammatory agents released from adipose tissue. In patients with a high body mass index (BMI), during hip and total knee arthroplasty, surgical technical challenges such as longer incisions and wider exposure are encountered, resulting in increased postoperative complications (wound healing problems and infection, venous thromboembolism (VTE)- pulmonary embolism (PE), dislocation, early implant failure) and ultimately decreased patient satisfaction and implant survival. This study investigates whether BMI, height, weight, and patient age are associated with longer incisions in patients undergoing unicondylar knee prosthesis (UKP) placement. Method Between January 2017 and December 2018, 30 patients (29 females and 1 male) who underwent UKP surgery due to medial gonarthrosis were included in the study. The UKP used in the procedures was the Oxford Knee Phase III by Biomet Ltd., UK. The study comprised 43 knees, 13 being bilateral cases, 8 on the right, and 9 on the left. Data regarding the patient's height, weight, BMI, age, and the operated side were collected and compiled. The relationships between these variables and the surgical incision length were statistically analyzed. Results The average age of the patients was 66.3 years, with an average weight and height of 77.6 kg (ranging from 62 to 98 kg) and 167 cm (ranging from 150 to 184 cm), respectively. The lengths of the surgical incisions ranged from 70 mm to 160 mm, with an average length of 124.5 mm. When comparing the incision lengths between the right and left sides, it was observed that the incisions on the left side were longer. The average incision length on the right side was 122.09 mm, while on the left, it was 126.86 mm. Moreover, in the 13 patients who underwent bilateral surgery, this difference in incision length was even more pronounced. The average incision length on the right side was 117.15 mm, whereas on the left, it was 124.23 mm. Bivariate correlation analyses were performed to examine the relationship between the length of the incision and BMI and age. However, no significant relationship was found between the incision length and BMI or age. On the other hand, there was a correlation between the patient's weight values and the incision length (p < 0.05, correlation 0.335). Furthermore, a higher correlation was observed between the patient's height and the incision length (p < 0.01, correlation 0.595). Conclusion The latest advances in surgical techniques and instrumentation have enabled surgeons to perform the procedure using a reliable mini-incision approach. Mid-term evaluation of UKP with mini-incision shows faster recovery and lower morbidity. The findings show that in UKP, the length of the surgical incision is more strongly related to the patient's height than their weight.

Long-term results of per-operative knee arthroscopy in confirming suitability for unicompartmental arthroplasty

BackgroundPatient selection is key to the success of medial unicondylar knee arthroplasty (UKA). Progression of arthritis is the most common indication for revision surgery. Per-operative arthroscopy is a means of directly assessing the integrity of the lateral compartment. The aim of the study is to assess the long-term survivorship of UKA performed when per-operative arthroscopy is used as a final means of deciding whether to proceed with UKA. MethodsWe used per-operative arthroscopy as a means to confirm suitability for UKA in a consecutive series of 279 Oxford medial UKA. Our series of UKA with per-operative arthroscopy (Group 1) was compared to all Oxford UKA (Group 2) and all UKA in the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) (Group 3). ResultsThe 14-year cumulative percentage revision (CPR) was 18.5% (95% CI 12.7, 26.4) for group 1, 19.7% (95% CI 18.8, 20.6) for group 2, and 19.2% (95% CI 18.5, 19.8) for group 3. There was no statistically significant difference in the (CPR) for the entire period when group 1 was compared to groups 2 or 3. Progression of arthritis was least in Group 1 compared to groups 2 and 3; 3.6 versus 4.4 and 4.1% respectively. Following per-operative arthroscopy 21.6% (77/356) of knees underwent a change of surgical plan from UKA to TKA. ConclusionIn our practice, which includes per-operative arthroscopy, we have identified a reduced risk of revision due to progression of arthritis but no difference in overall long-term implant survivorship.

LONG-TERM RESULTS OF PER-OPERATIVE KNEE ARTHROSCOPY IN CONFIRMING SUITABILITY FOR UNICOMPARTMENTAL KNEE ARTHROPASTY

AbstractIntroductionPatient selection is key to the success of medial unicondylar knee arthroplasty (UKA). Progression of arthritis is the most common indication for revision. Various methods of assessing the lateral compartment have been used including stress radiography, radioisotope bone scanning, MRI, and visualisation at the time of surgery. Arthroscopy is another means of assessing the integrity of the lateral compartment.MethodsWe used per-operative arthroscopy as a means to confirm suitability for UKA in a consecutive series of 279 Oxford medial UKA. This study reports the long-term results of a previously published cohort of knees. Our series of UKA with per-operative arthroscopy (Group 1) was compared to all Oxford UKA (Group 2) and all UKA in the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) (Group 3).ResultsThe 14-year cumulative percentage revision (CPR) was 18.5% (95% CI 12.7, 26.4) for group 1, 19.7% (95% CI 18.8, 20.6) for group 2, and 19.2% (95% CI 18.5, 19.8) for group 3. There was no statistically significant difference in the (CPR) for the entire period when group 1 was compared to groups 2 or 3. Progression of arthritis was the indication for revision in similar proportions for the three groups (Group 1: 32.3%, Group 2: 35.7% and Group 3: 33.5%). Following per-operative arthroscopy 21.6% (77/356) of knees underwent a change of surgical plan from UKA to TKA.ConclusionPer-operative arthroscopy may improve medium-term medial unicompartmental knee survivorship but does not improve long-term survivorship nor reduce revision due to progression of arthritis.

Severe patellofemoral arthritis does not compromise 6-month post-operative range of motion or function following unicondylar knee arthroplasty.

The presence of significant patellofemoral arthritis (PFA) is still considered a contraindication for unicondylar knee arthroplasty (UKA) by many surgeons. The purpose of this study was to determine if the presence of severe PFA at the time of UKA compromised early (< 6months) post-operative knee range of motion or functional outcomes. This retrospective review evaluated unilateral and bilateral UKA (323 patients; 418 knees) between 2015 and 2019. Procedures were grouped by degree of PFA present at the time of surgery, including mild PFA (Group 1; N = 266), moderate to severe PFA (Group 2; N = 101), and severe PFA with lateral compartment bone-on-bone contact (Group 3; N = 51). Knee range of motion and Knee Society Knee (KSS-K) and Function (KSS-F) scores were collected both before and at 6months following surgery. Group differences were evaluated with Kruskal-Wallis and Chi-square tests for continuous and categorical variables, respectively. Univariate and multivariable logistic regressions were performed to determine influential variables associated with post-operative knee flexion being ≤ 120° and presented as odds ratios (OR) and 95% confidence intervals (CI). Pre-operative flexion was lowest in Group 3 (p = 0.010) with 17.6% of knees having flexion ≤ 120°. Post-operative flexion was lowest in Group 3 (119.1° ± 8.4°, p = 0.003) with 19.6% knees having flexion ≤ 120° compared to 9.8% and 8.9% in Groups 1 and 2, respectively. No significant difference in KSS-F following surgery was found; all three groups demonstrated similar clinical improvement. Increased age (OR 1.089, CI 1.036-1.144; p = 0.001) and body mass index (OR 1.082, CI 1.006-1.163; p = 0.034) were found to be associated with post-operative knee flexion ≤ 120°, while high pre-operative flexion (OR 0.949, CI 0.921-0.978; p = 0.001) was found to be inversely associated with poor knee flexion following surgery. Patients with severe PFA demonstrate similar clinical improvement following UKA at 6months as patients with less severe PFA.

Subsidence of All-Polyethylene Tibial Components Used in Unicondylar Knee Arthroplasty: A Cohort Study.

Unicompartmental designs and techniques have been developed to preserve bone stock and minimize soft tissue trauma. Early modern designs andtechniques have been introduced with little support in the peer-reviewed literature. From October 2002 to May 2004, 64 consecutive DePuy Preservation unicondylar knee arthroplasties (UKAs) were performed in 56 patients.Two patients died of unrelated consequences, leaving 62 UKAs for review (55 medial, 7 lateral). All procedures were performed through a quadriceps-sparing approach.All components were cemented, including an all polyethylene tibial component.Clinical and radiographic follow-up data were reviewed and analyzed. At an average follow-up of 2.5 years, six (11%)of the medial tibial components have subsided.Of these, four had moderate-to-severe pain, one did require a revision to a total knee arthroplasty (TKA), and another did stabilize. An additional two patients continued to have knee pain (one requiring conversion to TKA), leaving a total of 55 UKAs (89%) functioning well at early follow-up.Additional complications have included four deep vein thromboses, three cardiac issues following the index procedure, one surgical site infection, one intraoperative medial femoral condyle fracture, and one reoperation forloose cementfragments. This study demonstrates a high rate of subsidence for all-polyethylene tibial components used in UKA, resulting in pain and failure of the arthroplasty.Despite the less invasive approach, we found complications that are usually associated with TKA surgery as well as those unique to UKA.

Total Hip and Knee Arthroplasty Implant Revision Risk to 5 Years From a State-wide Arthroplasty Registry in Michigan.

Information on the revision risk of implants is useful for improving the quality of care for elective hip and knee arthroplasty. The purpose of this study was to report on the revision risk of implants using a state-wide registry in the United States. The Michigan Arthroplasty Registry Collaborative Quality Initiative systematically collects data on elective primary and revision hip and knee arthroplasty cases in Michigan. It contained data on 139,970 hip and 245,499 knee arthroplasty cases from February 15, 2012, to December 31, 2021. Kaplan-Meier estimates of revision risk were computed using time to first revision as the dependent variable, and the results were computed and expressed as the cumulative percent revision (CPR). CPR estimates were computed for all implants having at least 500 cases in the Michigan Arthroplasty Registry Collaborative Quality Initiative dataset. At 5-years postoperatively, elective primary conventional total hip arthroplasty implant stem/cup combinations had CPR values from 0.95% (0.39%-2.30%, 95% confidence intervals [CI]) to 5.77% (4.22%-7.85%, 95% CI), and elective primary total knee arthroplasty CPR ranged from 1.10% (0.64%-1.89%, 95% CI) to 12.52% (8.37%-18.50%, 95% CI). Unicondylar knee arthroplasty CPR at 5-years went from 4.23% (3.54%-5.06%, 95% CI) to 7.13% (6.20%-8.20%, 95% CI). The wide variation in CPR points to the need for surgeons to choose implants wisely to improve quality of care.

Physical activity after revision knee arthroplasty including return to sport and work: a systematic review and meta-analysis including GRADE

BackgroundThe number of primary knee arthroplasties (KAs) performed annually is rising, especially among active, working age patients. Consequently, revision KA is also increasingly performed. Our aim was to systematically review the extent to which patients were physically active following revision KA, and the rate and timing of return to sport and work.MethodsA search was conducted in the databases Medline and Embase until February 24th, 2023. Studies describing patients with revision total knee arthroplasty (rTKA) or revision unicondylar knee arthroplasty (rUKA), with outcomes regarding physical activity or return to sport (RTS) or work (RTW) were included. Quality of studies was assessed using the Newcastle–Ottawa scale, meta-analyses were performed using RevMan 5.4 and Grading of Recommendations, Assessment, Development, and Evaluations (GRADE).ResultsOf the 4,314 articles screened, 22 studies were included describing 2,462 rTKA patients (no rUKA), 42% were male with a mean age of 67 years (range 24 – 95). No studies reported objective physical activity measurements. Twenty-two studies reported patient reported outcome measures (PROMs). The PROMs that were pooled on a scale from zero to ten were the UCLA Activity Score, the Tegner Activity Level Scale, the Lower-Extremity Activity Scale, Devane Activity Score, and physical activity related subscales of the Knee injury and Osteoarthritis Outcome Score. The retrospective studies of moderate quality showed a statistically significant postoperative improvement of 1.7 points (MD = 1.71, 95% CI 1.48 – 1.94 (p < 0.0001); 14 studies, n = 1,211). For the prospective moderate-quality studies, a statistically significant postoperative increase of 0.9 points was found (MD = 0.89, 95% CI 0.48 – 1.30 (p < 0.0001); 6 studies, n = 1,027). Regarding RTS, 12% of patients participated in so-called ‘non-recommended’ activities (i.e., hockey, soccer, football, gymnastics, jogging, singles tennis, and basketball) after rTKA (1 study, n = 206). The pooled RTW was 86% (2 studies, range 18–95%, n = 234).ConclusionsThe majority of patients self-reported an improved postoperative activity level after rTKA. Patients could maintain an active lifestyle in daily life, including sports and work. For reliable physical activity, RTS and RTW estimations, more studies are required. In terms of GRADE, the quality of evidence for the five prospective studies was rated as low.Level of evidenceLevel 3.

A PROSPECTIVE STUDY ON THE FUNCTIONAL OUTCOME OF PROXIMAL FIBULAR OSTEOTOMY IN GRADE 2 AND 3 MEDIAL COMPARTMENT ARTHRITIS OF THE KNEE.

Introduction: Osteoarthritis of the knee is a common musculoskeletal diseases affecting a major population in India. It can impact the individual's functions and activities of daily living. Total knee arthroplasty may raise controversy when treating the younger, athletic patient with arthritis. Arthroscopic debridement, high tibial osteotomy, unicondylar knee arthroplasty, and total knee arthroplasty allow younger patients to maintain an active, healthy lifestyle but can take a longer time to rehabilitate. PFO could be used as an alternative procedure. The Proximal Fibular Osteotomy, which provides immediate short term relief in cases with medial compartment osteoarthritis. Resecting a segment of bula, loosens the lateral side allowing the upper tibia to settle into a more favorable lateral alignment, shifting the mechanical axis towards neutral or valgus. Aims &amp; objectives: Ÿ To assess the functional, clinical and radiological outcome of proximal bular osteotomy in grade 2 and 3 OA of knee and followed up for 1 year. Ÿ The clinical and functional outcome is accessed by Knee Society Score and VAS observed pre-op , post-op ,3 months ,6 months and 12 months. Ÿ The improvement in radiology is accessed using change in the medial joint space improvements in CP angle, change in the ratio of medial joint space to lateral joint space observed pre-op and post-op Methodology: The patients selected had grade 2 and 3 Osteoarthritis of knee according to Kellgren Lawrence classication between the age groups 20yrs-80yrs and are admitted to RajaRajeswari Medical College and Hospital, Bangalore. The Sample Size is 30 and is calculated based on previous studies as well as approximate availability of number of cases in the above mentioned duration satisfying inclusion and exclusion criteria. Clinical, functional and radiological outcome were used, Results were calculated using Knee Society Scoring Scale score. This study Conclusion: suggested that Proximal Fibular Osteotomy is an alternative procedure that can be used to treat medial compartment knee Osteoarthritis, if the patients are selected carefully. Patients followed up for one year showed a signicant improvement in radiological, clinical and functional outcomes and thereby is an effective method of treatment in younger patients with Grade 2 and Grade 3 Osteoarthritis with an average BMI of 26.2

The clinical outcome of total knee arthroplasty is compromised by a previously implanted medial unicondylar knee arthroplasty

ObjectiveTo investigate the clinical outcome of patients that underwent conversion of a medial unicondylar knee arthroplasty (UKA) to a total knee arthroplasty (TKA) and to compare that outcome to patients that underwent primary TKA. It was hypothesized that those groups would significantly differ in terms of knee score outcome and implant survival.MethodsA retrospective-comparative study was conducted utilizing data from the Federal state’s arthroplasty registry. Included were patients from our department that undergone a conversion of a medial UKA to a TKA (UKA-TKA group). The Western Ontario and MacMaster Universities Osteoarthritis Index (WOMAC) from preoperative and 1-year postoperative was used. Moreover, the implant survival was analyzed.ResultsIn the UKA-TKA group, there were 51 cases (age 67 ± 10, 74% women), and in the TKA group, there were 2247 cases (age 69 ± 9, 66% women). The one-year postoperative WOMAC total score was 33 in the UKA-TKA group und 21 in the TKA group (p < 0.001). Similarly, the WOMAC pain, WOMAC stiffness, and WOMAC function scores were significantly worse in the UKA-TKA. After 5 years, the survival rates were 82% and 95% (p = 0.001). The 10-years prosthesis survival was 74% and 91% in the UKA-TKA and TKA groups, respectively (p < 0.001).ConclusionsBased on our findings it is concluded that patients who received a TKA after UKA have inferior results than those that directly receive a TKA. This is true for both patient-reported knee outcome and prosthesis survival. Converting UKA to TKA should not be seen as an easy operation, but should rather be done by surgeons with considerable experience in both primary and revision knee arthroplasty.

The effect of femoral component valgus/varus angle on the mid-term efficacy of unicondylar knee arthroplasty

ABSTRACT Objective: To investigate the effect of femoral component valgus/varus angle (FCVA) on the mid-term outcome after unicondylar knee arthroplasty. Methods: Patients who underwent unicompartmental knee replacement in the Department of Bone and Joint Surgery, were retrospectively analyzed. According to the postoperative femoral prosthesis internal and external rotation angle, patients were divided into six groups the postoperative femoral prosthesis internal and external rotation angle: standard group, mildly abnormal group. The patients were followed up for 12 months, and complications were recorded during the follow-up period. The Range of motion (ROM), visual analog scale (VAS), and Knee society score (KSS) were compared between the six groups. Results: One hundred twenty-four patients with 124 knees were included in this study. There were no statistical differences in age, gender, body mass index, preoperative ROM, or preoperative VAS, KSS-C, and KSS-F scores among the six groups. Comparison of postoperative outcomes and efficacy grades showed that: (1) the differences in ROM grades, as well as VAS, KSS-C, and KSS-F efficacy at 12 months postoperatively were statistically significant in all six groups by rank sum test; and patients in the normal group had better ROM grades and KSS-F grades than those in the mild and severe abnormality groups; (2) During the follow-up, no patient records had other serious complications such as periprosthetic infection, prosthetic loosening, periprosthetic fracture, and spacer dislocation. Conclusion: Controlling the femoral prosthetic internal rotation angle between 6° and 0° in unicompartmental knee replacements can lead to better mid-term outcomes for patients.

Robotic-assisted unicompartimental knee arthroplasty performed with Navio system: a systematic review.

Robotic-assisted arthroplasty is a relatively modern concept, quickly arising in its use. The aim of this systematic review is to assess, according to the existing literature, which are the functional and clinical outcomes and component positioning and implant survivorship of unicompartmental knee arthroplasty surgery performed using an image-free hand-held robotic system. Moreover, we analyzed whether there are significant differences and advantages compared to conventional surgery. A systematic review has been performed on studies published between 2004 and 2021, on the electronic library databases, according to the Preferred Reporting Items of Systematic Reviews and Meta-analysis (PRISMA) statement. The inclusion criteria were all studies described as unicompartmental knee arthroplasty performed with the Navio robotic system. Fifteen studies were included, and 1,262 unicondylar knee arthroplasties were analyzed. These studies showed a satisfactory recovery of joint function, with a good range of motion (extension <5° and flexion which ranged from 105° to 130.3°) in patients of the NAVIO group. The revision rate was <2% while the infection rate <1%; no postoperative transfusion was needed in all UKA implanted. The use of a robotic tool for unicompartmental knee arthroplasty (UKA) could lead to a better implant positioning and joint alignment than conventional surgery. There is still limited evidence to support that the use of this robot in unicompartmental knee arthroplasty is a greater survivorship than other systems or conventional techniques; therefore, a long-term follow-up is needed.

Impact of Proximal Tibial Varus Anatomy on Survivorship After Medial Unicondylar Knee Arthroplasty

BackgroundPrecise indications for medial unicondylar knee arthroplasty (UKA) continue to be defined. It is unclear if patients who have proximal tibia vara should be considered candidates for UKA. The purpose of this study was to evaluate the impact of proximal tibial varus alignment on outcomes after UKA. MethodsA retrospective review identified 2,416 patients (3,029 knees) who underwent mobile-bearing medial UKA with 2-year minimum follow-up or revision. Preoperative radiographs were evaluated, and medial proximal tibial angle (mPTA) was measured. Patients were grouped into two groups as follows: mPTA <80 degrees and mPTA ≥80 degrees. Analyses were performed on the impact of mPTA on clinical outcomes, all-cause revisions, and tibial failures. ResultsAt a mean follow-up of 5 years (range, 0.5 years to 12.8 years), there was not a statistically significant difference in clinical outcomes nor increased risk for all-cause revision or tibial failure in patients who had an mPTA <80°. Mean mPTA in patients who had tibial failures was 82.5° and not significantly different than those who did not have a tibial failure (82.9°) (P = .289). Tibial failure rate in knees with an mPTA <80° was 2.2% and not significantly different than knees with an mPTA ≥80° at 1.4% (P = .211). The all-cause revision rate in knees with an mPTA <80° was 5.8% and was not significantly different than knees with an mPTA ≥80° at 4.9% (P = .492). ConclusionPatients who have tibia vara are not at increased risk for tibial related or all-cause failure in medial UKA. This data may allow surgeons to increase their indications for medial UKA.