Introduction.
UKA with mobile bearing is a one of the treatment of medial osteoarthritis. However, some reports refer to the risk of dislocation of the mobile bearing. Past reports pointed out that medial gap might be enlarged in deep flexion position (over 120 degrees), and says that it will lead to instability of the mobile bearing. The purpose of this study is to research the risk factors of enlargement of medial gap in deep flexion position. We performed 81 UKAs with mobile bearing system from November 2013 to December 2015, and could evaluate 41 knees. This study of 41 knees included 9 males and 32 females, with average operation age of 75.4years(63–89years). The diagnosis was osteoarthritis in 39 knees and osteonecrosis in 2 knees. The UKA(Oxford partial knee microplasty, Biomet, Warsaw, IN) was used in all cases. We performed distal femur and proximal tibia osteotomy using CT-Free navigation system(Stryker Navigation System II/precision Knee Navigation ver4.0). And we inserted femoral and tibial trial component, then we placed an UKA tensioner on the medial component of the knee. Using tensioner under 30 lbs, we measured joint medial gap at 0,20,45,90,130(deep flexion) degrees. When we compared medial gap at 90 degrees position with at 130 degrees, we defined it as ‘instability group’ if there was gap enlargement more than 1mm, and defined it as ‘stability group’ if there wasn't. We compared this two groups with regard to age, BMI, femoro-tibial angle (FTA), the diameter of anterior cruciate ligament (ACL), tibial angle and tibial posterior slope angle of the implant. We evaluated preoperative and postoperative FTA by weightbearing long leg antero-posterior alignment view X-rays. We measured ACL diameter at its condyle level in coronal view of MRI. Also we evaluated tibial component implantation angle by postoperative CT using 3D template system. These measurement were analyzed statistically using The stability group contained 26 knees, and the instability group contained 15 knees. Compared with the stability group, the instability group indicated higher FTA (p=0.001). Between 20 and 90 degrees flexion position, there was no change of medial gap. Dislocation of the mobile bearing is one of the complications of UKA and it will need re-operation. It is said to be caused by impingement of the bearing and osteophyte of femur. However, some reports said that dislocation was happened when the knee was flexed deeply or twisted, and there was no impingement. We think it may means that dislocation could be caused by medial gap enlargement. This study indicates that higher FTA could be risk factor of dislocation of mobile bearing. It is important to evaluate preoperatively FTA by X-ray.
The purpose of this study is to evaluate accuracy of tibia cutting and tibia implantation in UKA which used navigation system for tibia cutting and tibia component implantation, and to evaluate clinical results. We performed 72 UKAs using navigation system from November, 2012. This study of 72 knees included 56 females and 16 males with an average operation age of 74.2 years and an average body mass index (BMI) of 24.8 kg/m2. The diagnosis was osteoarthritis (OA) in 67 knees and osteonecrosis (ON) in 5 knees. The UKA (Oxford partial knee microplasty, Biomet, Warsaw, IN) was used all cases. We evaluated patients clinically using the Japanese orthopaedic association (JOA) score, range of motion (ROM), operation time, the amount of bleeding and complications. Patients were evaluated clinically at preoperation and final follow up in JOA score and ROM. As an radiologic examination, we evaluated preoperative and postoperative lower limb alignment in FTA (femoro-tibial angle) by weightbearing long leg antero-posterior alignment view X-rays. Also we evaluated a tibial component implantation angle by postoperative CT, and tibia cutting angle by intraoperative navigation system. We defined the tibial angle which a tibia functional axis and the tibia component made in coronal plane, also tibial posterior slope angle which a tibia axis and tibia component made in sagittal plane by CT. We measured tibial angle and tibial posterior slope angle by 3D template system. We performed UKA in all cases mini-midvastus approach. At first we performed osteotomy of the proximal medial tibia using CT-Free navigation. At this procedure we performed osteotomy to do re-cut if check did cutting surface in navigation, and there was cutting error (>3°), and then to do check again in navigation. Next we did not use navigation and went the osteotomy of the distal femur with an IM rod and drill guide of microplasty system. And then we performed a trial and decided bearing gap and moved to cementing. At first we went cementing of the tibia component. At this procedure we went to drive implant again if check did implant surface in navigation, and there was implantation error(>3°), and to do check. We checked did tibia cutting, tibia implantation carefully in navigation. In addition, We sterilize a clips and use it came to be in this way possible for the check of the first osteotomy side exactly. ROM was an average of 122.7° of preoperation became an average of 128.2° at final follow up, and JOA score was an average of 50.5 points of preoperation improved an average of 86.6 points at final follow up after UKA. An average of the operation time was 94 minutes, an average of the amount of bleeding was 137.7ml, and complications were one proximal type deep venous thrombosis (DVT) and one pin splinter joining pain by navigation, .Asetic loosening(tibial component) was one case, and this conversed the TKA. In the radiologic evaluation, FTA was an average of 182.1° of preoperation corrected an average of 175.9°after UKA. In other words, an average of 6.2° were corrected by UKA. The tibia component implantation angle was an average of 90.18° in a measurement by the CT after UKA, intoraoperative tibia component implantation angle was an average of 90.32° in a measurement by the navigation system. These two differences did not accept the significant difference at an average of 1.33°.(P=0.5581). Similarly, the posterior slope angle were as follow; average of 5.65°by CT and average of 5.75°by navigation. These two differences did not accept the significant difference at an average of 1.33°. (P=0.6475) Discussion: We performed UKA using navigation and evaluated the implantation accuracy for tibia osteotomy, tibia implantation. They were good alignment with an average of 90.18°, and outliers more than 3° were two cases(2.8%). It will be necessary to examine long-term progress including clinical results complications in future. We are performed UKA now in femur side using PSI(patient specific instruments) and tbia side using Navigation.
Aims.
Aims. Robotic arm-assisted surgery offers accurate and reproducible guidance in component positioning and assessment of soft-tissue tensioning during knee arthroplasty, but the feasibility and early outcomes when using this technology for revision surgery remain unknown. The objective of this study was to compare the outcomes of robotic arm-assisted revision of
Robotic-assisted unicompartmental knee arthroplasty (R-UKA) has been proposed as an approach to improve the results of the conventional manual UKA (C-UKA). The aim of this meta-analysis was to analyze the studies comparing R-UKA and C-UKA in terms of clinical outcomes, radiological results, operating time, complications, and revisions. The literature search was conducted on three databases (PubMed, Cochrane, and Web of Science) on 20 February 2024 according to the guidelines for Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Inclusion criteria were comparative studies, written in the English language, with no time limitations, on the comparison of R-UKA and C-UKA. The quality of each article was assessed using the Downs and Black Checklist for Measuring Quality.Aims
Methods
Treatment of end-stage anteromedial osteoarthritis (AMOA) of the knee is commonly approached using one of two surgical strategies: medial unicompartmental knee arthroplasty (UKA) or total knee arthroplasty (TKA). In this study we aim to investigate if there is any difference in outcome for patients undergoing UKA or TKA, when treated by high-volume surgeons, in high-volume centres, using two different clinical guidelines. The two strategies are ‘UKA whenever possible’ vs TKA for all patients with AMOA. A total of 501 consecutive AMOA patients (301 UKA) operated on between 2013 to 2016 in two high-volume centres were included. Centre One employed clinical guidelines for the treatment of AMOA allowing either UKA or TKA, but encouraged UKA wherever possible. Centre Two used clinical guidelines that treated all patients with a TKA, regardless of wear pattern. TKA patients were included if they had isolated AMOA on preoperative radiographs. Data were collected from both centres’ local databases. The primary outcome measure was change in Oxford Knee Score (OKS), and the proportion of patients achieving the patient-acceptable symptom state (PASS) at one-year follow-up. The data were 1:1 propensity score matched before regression models were used to investigate potential differences.Aims
Methods
The patient-acceptable symptom state (PASS) is a level of wellbeing, which is measured by the patient. The aim of this study was to determine if the proportion of patients who achieved an acceptable level of function (PASS) after medial unicompartmental knee arthroplasty (UKA) was different based on the status of the anterior cruciate ligament (ACL) at the time of surgery. A total of 114 patients who underwent UKA for isolated medial osteoarthritis (OA) of the knee were included in the study. Their mean age was 65 years (SD 10). No patient underwent a bilateral procedure. Those who had undergone ACL reconstruction during the previous five years were excluded. The Knee injury Osteoarthritis Outcome Score Activities of Daily Living (KOOS ADL) function score was used as the primary outcome measure with a PASS of 87.5, as described for total knee arthroplasty (TKA). Patients completed all other KOOS subscales, Lysholm score, the Western Ontario and McMaster Universities Osteoarthritis Index, and the Veterans Rand 12-item health survey score. Failure was defined as conversion to TKA.Aims
Methods
The aim of this study was to compare the clinical outcomes of robotic arm-assisted bi-unicompartmental knee arthroplasty (bi-UKA) with conventional mechanically aligned total knee arthroplasty (TKA) during the first six weeks and at one year postoperatively. A per protocol analysis of 76 patients, 43 of whom underwent TKA and 34 of whom underwent bi-UKA, was performed from a prospective, single-centre, randomized controlled trial. Diaries kept by the patients recorded pain, function, and the use of analgesics daily throughout the first week and weekly between the second and sixth weeks. Patient-reported outcome measures (PROMs) were compared preoperatively, and at three months and one year postoperatively. Data were also compared longitudinally and a subgroup analysis was conducted, stratified by preoperative PROM status.Aims
Methods
Aims. Day-case arthroplasty is gaining popularity in Europe. We report outcomes from the first 12 months following implementation of a day-case pathway for
Aims. A functional anterior cruciate ligament (ACL) or posterior cruciate ligament (PCL) has been assumed to be required for patients undergoing
Aims.
Aims.
Aims. The aim of this study was to compare ten-year longitudinal healthcare costs and revision rates for patients undergoing
Aims. The aim of this study was to describe the pattern of revision indications for
Aims. The COVID-19 pandemic has caused unprecedented disruption to elective orthopaedic services. The primary objective of this study was to examine changes in functional scores in patients awaiting total hip arthroplasty (THA), total knee arthroplasty (TKA), and
Aims. Mobile-bearing
Aims.
Aims. Ideal component sizing may be difficult to achieve in
Aims. Commonly performed
Aims. It has been hypothesized that a
Objectives.
Aims. Higher osteoblastic bone activity is expected in aseptic loosening and painful
Aims. The aim of this prospective multicentre study was to describe trends in length of stay and early complications and readmissions following
Aims.
Aims. To report mid- to long-term results of Oxford mobile bearing domed lateral
Aims. The primary aim of the study was to perform an analysis to identify the cost per quality-adjusted life-year (QALY) of robot-assisted unicompartmental knee arthroplasty (rUKA) relative to manual total knee arthroplasty (TKA) and
Objectives.
Aims.
Cementless knee arthroplasty has seen a recent resurgence in popularity due to conceptual advantages, including improved osseointegration providing biological fixation, increased surgical efficiency, and reduced systemic complications associated with cement impaction and wear from cement debris. Increasingly younger and higher demand patients are requiring knee arthroplasty, and as such, there is optimism cementless fixation may improve implant survivorship and functional outcomes. Compared to cemented implants, the National Joint Registry (NJR) currently reports higher revision rates in cementless total knee arthroplasty (TKA), but lower in
Aims. It remains controversial whether patellofemoral joint pathology is a contraindication to lateral
Abstract. Introduction. In patients with bilateral unicompartmental knee osteoarthritis, simultaneous bilateral surgery is cost effective, with both patient-specific and wider socioeconomic benefits. There are concerns however regarding higher complication rates with bilateral knee surgery. This study compares simultaneous bilateral
Aims. Due to the opioid epidemic in the USA, our service progressively decreased the number of opioid tablets prescribed at discharge after primary hip (THA) and knee (TKA) arthroplasty. The goal of this study was to analyze the effect on total morphine milligram equivalents (MMEs) prescribed and post-discharge opioid repeat prescriptions. Methods. We retrospectively reviewed 19,428 patients undergoing a primary THA or TKA between 1 February 2016 and 31 December 2019. Two reductions in the number of opioid tablets prescribed at discharge were implemented over this time; as such, we analyzed three periods (P1, P2, and P3) with different routine discharge MME (750, 520, and 320 MMEs, respectively). We investigated 90-day refill rates, refill MMEs, and whether discharge MMEs were associated with represcribing in a multivariate model. Results. A discharge prescription of < 400 MMEs was not a risk factor for opioid represcribing in the entire population (p = 0.772) or in opioid-naïve patients alone (p = 0.272). Procedure type was the most significant risk factor for narcotic represcribing, with unilateral TKA (hazard ratio (HR) = 5.62), bilateral TKA (HR = 6.32), and bilateral
Introduction. A key outcome measured by national joint registries are revision events. This informs best practice and identifies poor-performing surgical devices. Although registry data often record reasons for revision arthroplasty, interpretation is limited by lack of standardised definitions of revision reasons and objective assessment of radiologic and laboratory parameters. Our study aim was to compare reasons for
Aims. The objectives of this study were to compare postoperative pain, analgesia requirements, inpatient functional rehabilitation, time to hospital discharge, and complications in patients undergoing conventional jig-based
Abstract. Purpose.
Patient-reported outcome measures (PROMs) have failed to highlight differences in function or outcome when comparing knee replacement designs and implantation techniques. Ankle-worn inertial measurement units (IMUs) can be used to remotely measure and monitor the bi-lateral impact load of patients, augmenting traditional PROMs with objective data. The aim of this study was to compare IMU-based impact loads with PROMs in patients who had undergone conventional total knee arthroplasty (TKA),
Source of the study: University of Auckland, Auckland, New Zealand.
Source of the study: University of Auckland, Auckland, New Zealand.
Abstract. Aims. The association between body mass index (BMI) and venous thromboembolism (VTE) is well studied, but remains unclear in the literature. We aimed to determine whether morbid obesity (BMI≥40) was associated with increased risk of VTE following total knee arthroplasty (TKA) or
Source of the study: University of Auckland, Auckland, New Zealand and University of Otago, Christchurch, New Zealand. Outcomes following knee arthroplasty are typically defined as implant survivorship at defined timepoints, or revision incidence over time. These estimates are difficult to conceptualise, and lack context for younger patients with more remaining years of life. We therefore aimed to determine a ‘lifetime’ risk of revision as a more useful metric for total (TKA) and
Source of the study: University of Auckland, Auckland, New Zealand and University of Otago, Christchurch, New Zealand. Patient reported outcome measures (PROMs) are predictors of knee arthroplasty revision.
Objectives. Patient-specific (PS) implantation surgical technology has been introduced in recent years and a gradual increase in the associated number of surgical cases has been observed. PS technology uses a patient’s own geometry in designing a medical device to provide minimal bone resection with improvement in the prosthetic bone coverage. However, whether PS
Aims. The purpose of this multicentre observational study was to investigate the association between intraoperative component positioning and soft-tissue balancing on short-term clinical outcomes in patients undergoing robotic-arm assisted
Objectives.
The application of robotics in the operating theatre for knee arthroplasty remains controversial. As with all new technology, the introduction of new systems might be associated with a learning curve. However, guidelines on how to assess the introduction of robotics in the operating theatre are lacking. This systematic review aims to evaluate the current evidence on the learning curve of robot-assisted knee arthroplasty. An extensive literature search of PubMed, Medline, Embase, Web of Science, and Cochrane Library was conducted. Randomized controlled trials, comparative studies, and cohort studies were included. Outcomes assessed included: time required for surgery, stress levels of the surgical team, complications in regard to surgical experience level or time needed for surgery, size prediction of preoperative templating, and alignment according to the number of knee arthroplasties performed. A total of 11 studies met the inclusion criteria. Most were of medium to low quality. The operating time of robot-assisted total knee arthroplasty (TKA) and
Objectives. Elevated proximal tibial bone strain may cause unexplained pain, an important cause of
Aim. There has been a significant reduction in
Introduction and Objective. In recent studies, robotic-assisted surgical techniques for
Aims.
Aims. Return to sport following undergoing total (TKA) and
Aims. Limited evidence is available on mid-term outcomes of robotic-arm assisted (RA) partial knee arthroplasty (PKA). Therefore, the purpose of this study was to evaluate mid-term survivorship, modes of failure, and patient-reported outcomes of RA PKA. Methods. A retrospective review of patients who underwent RA PKA between June 2007 and August 2016 was performed. Patients received a fixed-bearing medial or lateral
Unicompartmental knee osteoarthritis can be treated with either Total Knee Arthroplasty (TKA) or
Aims. The aim of this study was to assess the influence of obesity on the clinical outcomes and survivorship ten years postoperatively in patients who underwent a fixed-bearing
Objectives.
Aims. In the last decade, interest in partial knee arthroplasties and bicruciate retaining total knee arthroplasties has increased. In addition, patient-related outcomes and functional results such as range of movement and ambulation may be more promising with less invasive procedures such as bicompartmental arthroplasty (BCA). The purpose of this study is to evaluate clinical and radiological outcomes after a third-generation patellofemoral arthroplasty (PFA) combined with a medial or lateral
Introduction. The efficacy of Virtual Reality (VR) as a teaching augment for arthroplasty has not been well examined for unfamiliar multistep procedures such as
Objectives.
Aims. The purpose of this study was to evaluate trends in opioid use
after
Objectives. This study reports on a secondary exploratory analysis of the early clinical outcomes of a randomised clinical trial comparing robotic arm-assisted
Aims.
Background. Lateral
Introduction. Both mobile bearing and fixed bearing
Background.
In recent years, reduction in the length of stay in patients undergoing UKA has gained considerable interest. This has led to development of ‘fast-track' and even day-case protocols aimed at decreasing length of stay (LOS), enhancing post-operative recovery and decreasing post-operative morbidity. One potential barrier to faster discharge and patient recovery is the need for post-operative haemoglobin checks and allogenic blood transfusion; which has been shown to increase LOS. Allogenic blood transfusion itself is not without risk, including immunological reactions, transfusion associated lung injury, infection and transmission of disease, thus reducing blood loss and the need for transfusion is imperative. Currently there is a knowledge gap regarding post-operative transfusion need and blood loss following UKA. We aimed to investigate blood loss and transfusion rates following UKA. Our primary aim was to evaluate the extent of post-operative transfusion need following UKA and identify which patients are at higher risk of needing transfusion. Following institutional approval, a retrospective analysis of all patients undergoing
Aims. The interest in
Purpose. Long-term clinical and radiographic results and survival rates were compared between closed-wedge high tibial osteotomy (HTOs) and fixed-bearing
Objectives. Up to 40% of
Background. The purpose of this study was to assess the overall clinical and radiographic outcomes of
Aims. Our unit was identified as a negative outlier in the national patient-reported outcome measures (PROMs) programme, which has significant funding implications. As a centre that carries out a high volume of
The role of
INTRODUCTION. Controversy exists regarding the ability of
Introduction. It has been hypothesized that a
Young, active patients with end-stage medial osteoarthritis (OA) secondary to anterior cruciate ligament (ACL) deficiency present a treatment challenge for surgeons. Current surgical treatment options include high tibial osteotomy (HTO) with or without ACL reconstruction,
There exists a variety of options for a medial compartment knee with osteoarthritis, specifically a unicompartmental knee, high tibial osteotomy, and total knee arthroplasty. This surgeon prefers a rotating platform posterior stabilised total knee to the unicompartmental knee.
Introduction.
The influence of amount of tibial posterior slope changes on joint gap and postoperative range of motion was investigated in 35 patients undergoing
Purpose.
Introduction. Robotic technology has been applied to
Introduction & aims. Patient specific instrumentation (PSI) is a useful tool to execute pre-operatively planned surgical cuts and reduce the number of trays in surgery. Debate currently exists around improved accuracy, efficacy and patient outcomes when using PSI cutting guides compared to conventional instruments.
One of the arguments in favor of
In
INTRODUCTION.
A majority of patients present with varus alignment and predominantly medial compartment disease. The secret of success in osteoarthritis (OA) treatment is patient selection and patient specific treatment. Different wear patterns have been described and that knowledge should be utilised in modern knee surgery. In case of isolated anteromedial OA,
Introduction. The prescription of opioids has increased in the last two decades. Recently, several states have developed online Prescription Drug Monitoring Programs aimed at preventing overprescribing of controlled substances.
Introduction.
Aims. It is not clear whether anterior knee pain and osteoarthritis
(OA) of the patellofemoral joint (PFJ) are contraindications to
medial
Aims. The role of high tibial osteotomy (HTO) is being questioned by
the use of
Purpose. To update current surgical management of knee osteoarthritis. Methods. A literature review was done using standard keyword search. Articles were scrutinized by the investigators to ensure relevancy to the purpose of this review. Summary of the review. Arthroscopy, osteotomy and arthroplasty are three major techniques for knee osteoarthritis. Arthroscopy is more and more common as it is diagnostically and therapeutically useful, especially for patients with painful osteoarthritis with mechanical symptoms. Recently, arthroscopic techniques to treat subchondral bone marrow lesions associated with knee osteoarthritis have been developed. Osteotomy is a technique that preserves the natural biomechanics of the joint and reestablishes joint alignment. Its accuracy has been improved with the advancement of computer-assisted surgery. Arthroplasty includes
Background. The indication of
Introduction. Robotic technology has been applied to
INTRODUCTION. Successful clinical outcomes following