Unicompartmental knee arthroplasty (UKA) is a successful procedure for medial compartment osteoarthritis (OA). Recent studies using the same implant report a revision rate of 2.9%. Other centers have reported revision rates as high as 10.3%. The purpose of this study was to retrospectively review the clinical results of Oxford Phase 3 UKA's performed in the setting of isolated medial compartment OA and to compare our results to the previous mid-term studies. Our secondary goal was to determine reasons for revision and evaluate selected independent predictors of failure. A retrospective review of 465 Oxford Phase 3 medial UKA's performed on 386 patients (222 female; 164 male) with isolated medial compartment OA. The average age at surgery was 69.5 years (40–88). Outcome measures included: Knee Society Scores(KSS), Oxford Knee Scores(OKS), SF-12, WOMAC, revision rates, and patient satisfaction. We evaluated independently predictors of failure including: gender, body mass index(BMI), number of previous surgeries, implant sizes, cement technique (simultaneous vs staged), cement type. Revision rates based upon the polyethylene thickness (defined as thin 3–4 mm; medium 5–6 mm; thick 7–9 mm). The need for stems and augments and the degree of constraint required at revision to a total knee arthroplasty (TKA) were evaluated.Introduction
Methods
Source of the study: University of Auckland, Auckland, New Zealand. Unicompartmental knee arthroplasty (UKA) is effective for patients with isolated compartment osteoarthritis, however the procedure has higher revision rates. Long-term survivorship and accurate characterisation of revision reasons are limited by a lack of long-term data and standardised revision definitions. We aimed to identify survivorship, risk factors and revision reasons in a large UKA cohort with up to 20 years follow-up. Patient, implant and revision details were recorded through clinical and radiological review for 2,137 consecutive patients undergoing primary medial UKA across Auckland, Canterbury, Counties Manukau and Waitematā DHB between 2000 and 2017. Revision reasons were determined from review of clinical, laboratory, and radiological records for each patient using a standardised protocol. To ensure complete follow-up data was cross-referenced with the New Zealand Joint Registry to identify patients undergoing subsequent revision outside the hospitals. Implant survival, revision risk and revision reasons were analysed using Cox proportional-hazards and competing risk analyses. Implant survivorship at 15 years was comparable for cemented fixed-bearing (cemFB; 91%) and uncemented mobile-bearing (uncemMB; 91%), but lower for cemented mobile-bearing (cemMB; 80%) implants. There was higher incidence of aseptic loosening with cemented implants (3–4% vs. 0.4% uncemented, p<0.01), osteoarthritis (OA) progression with cemMB implants (9% vs. 3% cemFB/uncemMB; p<0.05) and bearing dislocations with uncemMB implants (3% vs. 2% cemMB, p=0.02). Compared with the oldest patients (≥75 years), there was a nearly two-fold increase in risk for those aged 55–64 (hazard ratio 1.9; confidence interval 1.1-3.3, p=0.03). No association was found with gender, BMI or ASA. Cemented
Permanent patellar subluxation is treated with surgeries such as proximal realignment and distal realignment, however, it is difficult to cure this condition by using any methods. We performed mobile-bearing total knee arthroplasty (TKA) in a case of severe knee osteoarthritis complicated with permanent patellar subluxation since childhood, and obtained good results without performing any additional procedures. The patient was an 82-year-old woman with severe pain in the left knee. During the initial examination, the range of motion of the left knee joint was -10°of extension to 140°of flexion, and the Japanese Orthopaedic Association (JOA) score for knee osteoarthritis was 40 points (maximum score: 100). Preoperative radiographs showed a varus deformity in the left lower extremity with a femorotibial angle (FTA) of 188°, the axial view showed luxation of the patella. We performed TKA using a
The Zenith. TM. total ankle replacement (Corin, Cirencester) is a
Goals of the study. (1) to investigate the relationships between the bony contours of the knee and the Popliteus Tendon (PT) in the healthy knee and after implantation of a TKA and (2) to analyze the influence of implant sizing. Hypothesis. With an apparently well-sized TKA, the position of the PT during knee flexion is modified compared with the preoperative situation. Method. In 4 fresh frozen cadavers we injected the PT with Barium-Sulfate and a CT-scan was performed from 0° to 140°. We implanted copies of TKAs’ obtained from the manufacturer, made with a non radio-opaque polymer (Acrylonitrile butadiene styrene) with additive manufacturing technology. Each cadaver received either a normosized (cortical fit), oversized (3mm overhang), undersized (3mm under-coverage) or mobile bearing (normosized) prosthesis. The limb was CT-scanned again. 3D-reconstructions were created using Mimics software (Fig 1). The pre-post operative position of the PT was analyzed with Matlab software. We quantified the postoperative posterior deviation of the tendon (PDT). Results. In the normal knee the PT overlaps the posterolateral corner of the tibial plateau, between 0° and 100° of flexion with a maximum overlapping distance of 5.5mm (Fig2). After implantation of a normosized TKA, the PT was displaced posteriorly from full extension to 100° of flexion (Fig 3). Mean PDT was 6.2mm (range 0 to 13; SD=1.2) in extension and 4.8mm (range −1 to 9.8; SD=1.1) at 20° of knee flexion. After implantation of an oversized TKA, PDT was significantly greater than with a normosized TKA, at each angle of flexion: mean PDT was 16.7mm (range 4.4 to 23; SD=0.6) knee in extension (p<0.0001) and 10mm (range 4.4 to 15.7; SD=1.1) at 20° (p<0.0001). The deviation of the PT decreased during knee flexion but remained significant up to full flexion. When an undersized plateau was implanted, the PDT was significantly decreased compared with a normosized implant and the deviation was non significant compared with the preoperative knee. Mean DPT in extension was −0.8mm (range; −3.1 to 1.8; SD=0.3) (p<0.001). This absence of deviation of the PT with an undersized implant was confirmed during the full range of flexion. With a
Background. The purpose of this study was to assess the overall clinical and radiographic outcomes of unicompartmental knee arthroplasty (UKA) in the 2–10 year postoperative period. The secondary goal was to compare outcomes between fixed- (FB) and
Background: We have noted a concerning number of early failures (as defined by revision) for Preservation medial mobile-bearing uni-compartmental knee replacements (UKR’s) implanted in our hospital. This study retrospectively reviewed the postoperative radiographs to see if these were as a result of surgical technical failure. Methods: Between 2003 and 2004, 43 medial mobile-bearing Preservation UKR’s were implanted into 39 patients. The average age of the patients at the time of the index procedure was 61.4 years (range, 46–85), (20 males). The immediate post-operative radiographs were reviewed by 2 independent orthopaedic consultants and a registrar, who were blinded to the patient outcomes, using the radiographic criteria used for the Oxford UKR. We however, particularly tried to identify any medio-lateral offset between femoral and tibial components due to the constrained nature of the prosthesis. A compound error score for all other technical errors was also calculated for each patient. Results: Six (13.9%) of 43 knees were revised (5 for persistent pain, 1 for tibial component subsidence). Technical errors were few and no correlation was found between post-operative radiographic appearances and the subsequent need for revision. The mean compound error score (maximum value 18) was 4.5 (range, 2–9) in the revision cases and in the non revised cases 3.2 (range, 0–8). Conclusions: We believe this study gives credence to the opinion that the DePuy Preservation
Introduction: The use of total ankle arthroplasty for the management of end stage arthritis of the ankle is gaining in popularity. We performed a review of the literature on Total Ankle Arthroplasty to assess the methodology of studies and to detect possible variation in the reported surgical outcomes. Material and Methods: All relevant articles in peer-reviewed journals were retrieved except those not mentioning outcomes, case reports, review of literature and letters to editors. Studies reporting on implants presently used, with at least 20 subjects followed for a mean of at least two years were included. Two authors independently scored the quality of the studies using the Coleman Methodology Score (CMS). We collected data for type of study, patient numbers, length of follow-up, complications, outcome and prosthesis survival with revision or fusion as an endpoint. Where appropriate, pooling of data was performed. Results: Twenty-one level IV studies, published from 2003 to 2008, reporting on 2167 ankle replacements followed for a mean of 5.6 years, were included. The CMS was 65 (SD 15), with substantial agreement between the two examiners. Inflammatory arthropathy was present in 31% of ankles. The intra-operative fracture rate was 10.5%. Superficial wound healing complication rate was 6.4%, and deep infections occurred in 1.2% of ankles. Patients’ satisfaction rate was 94%. The failure rate of the primary ankle prosthesis was 11.6% (Agility: 12.2% at 4 years, STAR: 11.7% at 4.6 years and Buechel-Pappas (BP): 12.8% at 7.3 years). Pooling the data the six-year survivorship for the Agility was 0.70 (CI 95%, 0.50–0.90), whereas the 10-year survivorship for the STAR was 0.79 (CI 95%, 0.56–1.00) and for the BP 0.87 (CI 95%, 0.69–1.00). Conclusions: Studies reporting on total ankle arthroplasty are of overall moderate quality. Survivorship analysis revealed superior results for
Introduction: Chronic joint pain is the primary reason for individuals electing to undergo TKR and therefore pain relief is an extremely important outcome after surgery. Although the literature suggests that TKR produces excellent pain relief, the prevalence of chronic pain after TKR is often masked in the reporting of mean pain scores. The aim of this study was to explore the prevalence, impact and onset of pain at 1-year after TKR. Methods: 243 patients (251 knees) were recruited into a multi-centre randomised controlled trial comparing the outcomes of the Kinemax Plus fixed-bearing and
The purpose of this study is to compare the long-term clinical results of two total knee replacement designs (the SAL-II
Introduction / Purpose. Many factors can influence postoperative knee flexion angle after total knee arthroplasty (TKA), and range of flexion is one of the most important clinical outcomes. Although many studies have reported that postoperative knee flexion is influenced by preoperative clinical conditions, the factors which affect postoperative knee flexion angle have not been fully elucidated. As appropriate soft-tissue balancing as well as accurate bony cuts and implantation has traditionally been the focus of TKA success, in this study, we tried to investigate the influence of intraoperative soft-tissue balance on postoperative knee flexion angle after cruciate-retaining (CR) TKA using a navigation system and offset-type tensor. Methods. We retrospectively analyzed 55 patients (43 women, 12 men) with osteoarthritis who underwent TKA using the same
Elevated proximal tibial bone strain may cause unexplained pain, an important cause of unicompartmental knee arthroplasty (UKA) revision. This study investigates the effect of tibial component alignment in metal-backed (MB) and all-polyethylene (AP) fixed-bearing medial UKAs on bone strain, using an experimentally validated finite element model (FEM). A previously experimentally validated FEM of a composite tibia implanted with a cemented fixed-bearing UKA (MB and AP) was used. Standard alignment (medial proximal tibial angle 90°, 6° posterior slope), coronal malalignment (3°, 5°, 10° varus; 3°, 5° valgus), and sagittal malalignment (0°, 3°, 6°, 9°, 12°) were analyzed. The primary outcome measure was the volume of compressively overstrained cancellous bone (VOCB) < -3000 µε. The secondary outcome measure was maximum von Mises stress in cortical bone (MSCB) over a medial region of interest.Objectives
Methods
The medially spherical GMK Sphere (Medacta International AG, Castel San Pietro, Switzerland) total knee arthroplasty (TKA) was previously shown to accommodate lateral rollback while pivoting around a stable medial compartment, aiming to replicate native knee kinematics in which some coronal laxity, especially laterally, is also present. We assess coronal plane kinematics of the GMK Sphere and explore the occurrence and pattern of articular separation during static and dynamic activities. Using pulsed fluoroscopy and image matching, the coronal kinematics and articular surface separation of 16 well-functioning TKAs were studied during weight-bearing and non-weight-bearing, static, and dynamic activities. The closest distances between the modelled articular surfaces were examined with respect to knee position, and proportions of joint poses exhibiting separation were computed.Objectives
Methods
Our study aimed to examine if a mobile-bearing total knee replacement
(TKR) offered an advantage over fixed-bearing designs with respect
to rates of secondary resurfacing of the patella in knees in which
it was initially left unresurfaced. We examined the 11-year report of the New Zealand Joint Registry
and identified all primary TKR designs that had been implanted in
>
500 knees without primary resurfacing of the patella. We examined
how many of these were mobile-bearing, fixed-bearing cruciate-retaining
and fixed-bearing posterior-stabilised designs. We assessed the rates
of secondary resurfacing of the patella for each group and constructed
Kaplan-Meier survival curves.Objectives
Methods