Aims. Joint registries classify all further arthroplasty procedures to a knee with an existing partial arthroplasty as revision surgery, regardless of the actual procedure performed. Relatively minor procedures, including bearing exchanges, are classified in the same way as major operations requiring augments and stems. A new classification system is proposed to acknowledge and describe the detail of these procedures, which has implications for risk, recovery, and health economics. Methods. Classification categories were proposed by a surgical consensus group, then ranked by patients, according to perceived invasiveness and implications for recovery. In round one, 26 revision cases were classified by the consensus group. Results were tested for inter-rater reliability. In round two, four additional cases were added for clarity. Round three repeated the survey one month later, subject to inter- and intrarater reliability testing. In round four, five additional expert partial knee arthroplasty surgeons were asked to classify the 30 cases according to the proposed revision partial knee classification (RPKC) system. Results. Four classes were proposed: PR1, where no bone-implant interfaces are affected; PR2, where surgery does not include conversion to total knee arthroplasty, for example, a second partial arthroplasty to a native compartment; PR3, when a standard primary total knee prosthesis is used; and PR4 when revision components are necessary. Round one resulted in 92% inter-rater agreement (Kendall’s W 0.97; p < 0.005), rising to 93% in round two (Kendall’s W 0.98; p < 0.001). Round three demonstrated 97% agreement (Kendall’s W 0.98; p < 0.001), with high intra-rater reliability (interclass correlation coefficient (ICC) 0.99; 95% confidence interval 0.98 to 0.99). Round four resulted in 80% agreement (Kendall’s W 0.92; p < 0.001). Conclusion. The RPKC system accounts for all procedures which may be appropriate following partial knee arthroplasty. It has been shown to be reliable, repeatable and pragmatic. The implications for patient care and health economics are discussed. Cite this article: Bone Jt Open 2021;2(8):638–645

Aims. There has been a recent resurgence in interest in combined partial knee arthroplasty (PKA) as an alternative to total knee arthroplasty (TKA). The varied terminology used to describe these procedures leads to confusion and ambiguity in communication between surgeons, allied health professionals, and patients. A standardized classification system is required for patient safety, accurate clinical record-keeping, clear communication, correct coding for appropriate remuneration, and joint registry data collection. Materials and Methods. An advanced PubMed search was conducted, using medical subject headings (MeSH) to identify terms and abbreviations used to describe knee arthroplasty procedures. The search related to TKA, unicompartmental (UKA), patellofemoral (PFA), and combined PKA procedures. Surveys were conducted of orthopaedic surgeons, trainees, and biomechanical engineers, who were asked which of the descriptive terms and abbreviations identified from the literature search they found most intuitive and appropriate to describe each procedure. The results were used to determine a popular consensus. Results. Survey participants preferred “bi-unicondylar arthroplasty” (Bi-UKA) to describe ipsilateral medial and lateral unicompartmental arthroplasty; “medial bi-compartmental arthroplasty” (BCA-M) to describe ipsilateral medial unicompartmental arthroplasty with patellofemoral arthroplasty; “lateral bi-compartmental arthroplasty” (BCA-L) to describe ipsilateral lateral unicompartmental arthroplasty with patellofemoral arthroplasty; and tri-compartmental arthroplasty (TCA) to describe ipsilateral patellofemoral and medial and lateral unicompartmental arthroplasties. “Combined partial knee arthroplasty” (CPKA) was the favoured umbrella term. Conclusion. We recommend bi-unicondylar arthroplasty (Bi-UKA), medial bicompartmental arthroplasty (BCA-M), lateral bicompartmental arthroplasty (BCA-L), and tricompartmental arthroplasty (TCA) as the preferred terms to classify CPKA procedures. Cite this article: Bone Joint J 2019;101-B:922–928

Intro/Purpose. Lateral partial knee replacement is indicated as an alternative to total knee replacement for isolated end stage lateral compartment degenerative joint disease. The purpose of this study is to report the surgical technique and clinical results of a large series of lateral partial knee replacements from two institutions. Methods. A retrospective review identified 205 lateral unicompartmental arthroplasty procedures performed in two practices over a six-year period (Aug 2011 – June 2017). Patients indicated for surgery met specific preoperative clinical and radiographic criteria confirming lateral compartment arthritic disease with a correctable deformity, intact full-thickness medial cartilage, competent anterior cruciate ligament, and minimal disease in the patellofemoral compartment. A single cemented fixed bearing tibial component design was used in all cases specifically designed for lateral compartment anatomy. Results. The average age was 65 years old and 76% were female. Average follow-up in the lateral partials was 1.7 years (range 0.5 years to 6 years). Knee Society Scores improved from 45 (pre-op) to 88 points (post-op). Range of motion improved from 6–115o (pre-op) to 0–122 o (post-op). No knees were revised to a TKA. One knee had an additional medial partial knee placed at 1.1 years post lateral partial knee replacement for medial disease progression. Two knees required an irrigation and debridement for traumatic wound dehiscence. Conclusion. This is the largest series of lateral partial knee replacements reported. Clinical improvements, range of motion, and survivorship were excellent at short-term follow-up. Long-term follow-up is needed for additional understanding of a novel implant designed specifically for the lateral compartment and the survivorship of the unreplaced compartments. We believe the lateral partial knee replacement to be a viable option for isolated lateral compartment disease in approximately 4% of patients

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 arthroplasty (UKA), patellofemoral arthroplasty (PFA), or bicompartmental knee arthroplasty (BiKA; PFA plus medial UKA). All patients completed a questionnaire regarding revision surgery, reoperations, and level of satisfaction. Knee Injury and Osteoarthritis Outcome Scores (KOOS) were assessed using the KOOS for Joint Replacement Junior survey. Results. Mean follow-up was 4.7 years (2.0 to 10.8). Five-year survivorship of medial UKA (n = 802), lateral UKA (n = 171), and PFA/BiKA (n = 35/10) was 97.8%, 97.7%, and 93.3%, respectively. Component loosening and progression of osteoarthritis (OA) were the most common reasons for revision. Mean KOOS scores after medial UKA, lateral UKA, and PFA/BiKA were 84.3 (SD 15.9), 85.6 (SD 14.3), and 78.2 (SD 14.2), respectively. The vast majority of the patients reported high satisfaction levels after RA PKA. Subgroup analyses suggested tibial component design, body mass index (BMI), and age affects RA PKA outcomes. Five-year survivorship was 98.4% (95% confidence interval (CI) 97.2 to 99.5) for onlay medial UKA (n = 742) and 99.1% (95% CI 97.9 to 100) for onlay medial UKA in patients with a BMI < 30 kg/m. 2. (n = 479). Conclusion. This large single-surgeon study showed high mid-term survivorship, satisfaction levels, and functional outcomes in RA UKA using metal-backed tibial onlay components. In addition, favourable results were reported in RA PFA and BiKA. Cite this article: Bone Joint J 2020;102-B(1):108–116

Aims. To explore the clinical relevance of joint space width (JSW) narrowing on standardized-flexion (SF) radiographs in the assessment of cartilage degeneration in specific subregions seen on MRI sequences in knee osteoarthritis (OA) with neutral, valgus, and varus alignments, and potential planning of partial knee arthroplasty. Methods. We retrospectively reviewed 639 subjects, aged 45 to 79 years, in the Osteoarthritis Initiative (OAI) study, who had symptomatic knees with Kellgren and Lawrence grade 2 to 4. Knees were categorized as neutral, valgus, and varus knees by measuring hip-knee-angles on hip-knee-ankle radiographs. Femorotibial JSW was measured on posteroanterior SF radiographs using a special software. The femorotibial compartment was divided into 16 subregions, and MR-tomographic measurements of cartilage volume, thickness, and subchondral bone area were documented. Linear regression with adjustment for age, sex, body mass index, and Kellgren and Lawrence grade was used. Results. We studied 345 neutral, 87 valgus, and 207 varus knees. Radiological JSW narrowing was significantly (p < 0.01) associated with cartilage volume and thickness in medial femorotibial compartment in neutral (r = 0.78, odds ratio (OR) 2.33) and varus knees (r = 0.86, OR 1.92), and in lateral tibial subregions in valgus knees (r = 0.87, OR 3.71). A significant negative correlation was found between JSW narrowing and area of subchondral bone in external lateral tibial subregion in valgus knees (r = −0.65, p < 0.01) and in external medial tibial subregion in varus knees (r = −0.77, p < 0.01). No statistically significant correlation was found in anterior and posterior subregions. Conclusion. SF radiographs can be potentially used for initial detection of cartilage degeneration as assessed by MRI in medial and lateral but not in anterior or posterior subregions. Cite this article: Bone Joint Res 2021;10(3):173–187

This is a study of the quality of outcome of the first 100 patients who received the Twin Peg Oxford Partial knee replacement; which has been designed with a 15 degree extra surface for contact in deep flexion, and two pins for more secure fixation. We measured the outcome in patients with anteromedial osteoarthritis at 2 years after implantation using patient perception outcome measures: the OKS (Oxford Knee Score) and a patient satisfaction questionnaire. We also measured range of motion, the AKS (American Knee Society Score-Objective), the AFS (American Knee Society Score-Functional), and carried out a radiological assessment. The results showed a mean OKS of 41, a mean AKS of 93, a mean AFS of 84, a mean range of motion of 130 degrees and a 97% satisfaction rate. Results were significantly better in male patients. There were no deaths, infections, dislocations, fractures or revisions. There were no radiolucent lines of 2 mms or more at the femoral bone-cement interfaces. The introduction of this new version of the Oxford knee shows excellent clinical and radiological results which are at least as good as those seen with the Phase 3 Oxford Partial knee replacement. Small adjustments were made to the minimally invasive approach: a reduced invasive incision for ease of implantation. For those surgeons who are concerned over the risks of femoral loosening with the Phase 3 implant, or desire an improved surface area of contact at high angles of flexion, this Twin Peg Oxford Partial knee replacement offers an excellent alternative

Introduction. The purpose of this study was to use patient generated digital surveillance PROM's to track outcomes of TKA, Medial PKA, Lateral PKA. Methods. From Aug 2018 until June 2019 we performed 873 knee arthroplasties. Of these, 41 were fixed bearing lateral partial knee replacements (5%), 309 medial partial knee replacements (35%), and 523 total knee replacements (60%). The average age was 65 years old and 59% were female. KOOS-Jr scores were recorded preoperatively, and 6, 12 months postoperatively using digital surveillance technology with a greater than 90% response rate. Results. Baseline, 6 month, and 12 month KOOS-JR scores for TKR (54, 76, 79) were not different than baseline, 6 month, and 12 month KOOS-JR scores for medial PKA (56, 78, 82) [p values of 0.23, 0.32, 0.20 respectively]. Baseline and 6 month KOOS-JR scores for TKR were not different than baseline and 6 month KOOS-JR scores for lateral PKA (55, 77) [p values of 0.35 and 0.50 respectively). Where as, the 12 month KOOS-JR scores for TKR (79) were significantly less than 12 month KOOS-JR scores for lateral PKA (84)[p value of 0.04]. Baseline, 6 month, and 12 month KOOS-JR scores for medial PKR were not different than lateral PKR (55, 77, 84) [p values of 0.49, 0.39, 0.20]. Conclusions. Prospective digital surveillance of PROM following knee arthroplasty has proven to be a cost-effective strategy. Short term improvements in PROM's following TKA and medial PKA were not different. Lateral PKA demonstrated statistically significant higher 1 year PROM but unlikely clinically significant. Longer-term follow-up is needed for determination of implant and unreplaced compartment survivorship. For figures, tables, or references, please contact authors directly

Aims. To map the Oxford Knee Score (OKS) and High Activity Arthroplasty Score (HAAS) items to a common scale, and to investigate the psychometric properties of this new scale for the measurement of knee health. Methods. Patient-reported outcome measure (PROM) data measuring knee health were obtained from the NHS PROMs dataset and Total or Partial Knee Arthroplasty Trial (TOPKAT). Assumptions for common scale modelling were tested. A graded response model (fitted to OKS item responses in the NHS PROMs dataset) was used as an anchor to calibrate paired HAAS items from the TOPKAT dataset. Information curves for the combined OKS-HAAS model were plotted. Bland-Altman analysis was used to compare common scale scores derived from OKS and HAAS items. A conversion table was developed to map between HAAS, OKS, and the common scale. Results. We included 3,329 response sets from 528 patients undergoing knee arthroplasty. These generally met the assumptions of unidimensionality, monotonicity, local independence, and measurement invariance. The HAAS items provided more information than OKS items at high levels of knee health. Combining both instruments resulted in higher test-level information than either instrument alone. The mean error between common scale scores derived from the OKS and HAAS was 0.29 logits. Conclusion. The common scale allowed more precise measurement of knee health than use of either the OKS or HAAS individually. These techniques for mapping PROM instruments may be useful for the standardization of outcome reporting, and pooling results across studies that use either PROM in individual-patient meta-analysis. Cite this article: Bone Joint Res 2023;12(10):624–635

Introduction. Partial knee arthroplasty (PKA) has demonstrated the potential to improve patient satisfaction over total knee arthroplasty. It is however perceived as a more challenging procedure that requires precise adaptation to the complex mechanics of the knee. A recently developed PKA system aims to address these challenges by anatomical, compartment specific shapes and fine-tuned mechanical instrumentation. We investigated how closely this PKA system replicates the balance and kinematics of the intact knee. Materials and Methods. Eight post-mortem human knee specimens (age: 55±11 years, BMI: 23±5, 4 male, 4 female) underwent full leg CT scanning and comprehensive robotic (KUKA KR140 comp) assessments of tibiofemoral and patellofemoral kinematics. Specimens were tested in the intact state and after fixed bearing medial PKA. Implantations were performed by two experienced surgeons. Assessments included laxity testing (anterior-posterior: ±100 N, medial-lateral: ±100 N, internal-external: ±3 Nm, varus- valgus: ±12 Nm) under 2 compressive loads (44 N, 500 N) at 7 flexion angles and simulations of level walking, lunge and stair descent based on in-vivo loading profiles. Kinematics were tracked robotically and optically (OptiTrack) and represented by the femoral flexion facet center (FFC) motions. Similarity between intact and operated curves was expressed by the root mean square of deviations (RMSD) along the curves. Group data were summarized by average and standard deviation and compared using the paired Student's T-test (α = 0.05). Results. During the varus-valgus balancing assessment the medial and lateral opening of the PKAs closely resembled the intact openings across the full arch of flexion, with RMSD values of 1.0±0.5 mm and 0.4±0.2 mm respectively. The medial opening was nearly constant across flexion, its average was not statistically different between intact (3.8±1.0 mm) and PKA (4.0±1.1 mm) (p=0.49). Antero-posterior envelope of motion assessments revealed a close match between the intact and PKA group for both compression levels. Net rollback was not statistically different, either under low compression (intact: 10.9±1.5 mm, PKA: 10.7±1.2, p=0.64) or under high compression (intact: 13.2±2.3 mm, PKA: 13.0±1.6 mm, p=0.77). Similarly, average laxity was not statistically different, either under low (intact: 7.7±3.2 mm, PKA: 8.6±2.5 mm, p=0.09) or under high (intact: 7.2±2.6 mm, PKA: 7.8±2.2 mm, p=0.08) compression. Activities of daily living exhibited a close match in the anterior-posterior motion profile of the medial condyle (RMSD: lunge: 2.2±1.0 mm, level walking: 2.4±0.9 mm, stair descent: 2.2±0.6 mm) and lateral condyle (RMSD: lunge: 2.4±1.4 mm, level walking: 2.2±1.4 mm, stair descent: 2.7±2.0 mm). Patellar medial-lateral tilt (RMSD: 3.4±3.8°) and medial-lateral shift (RMDS: 1.5±0.6 mm) during knee flexion matched closely between groups. Conclusion. Throughout the comprehensive functional assessments the investigated PKA system behaved nearly identical to the intact knee. The small residuals are unlikely to have a clinical effect; further studies are necessary as cadaveric studies are not necessarily indicative of clinical results. We conclude that PKA with anatomical, compartment specific shapes and fine-tuned mechanical instrumentation can be adapted precisely to the complex mechanics of the knee and replicates intact knee balance and kinematics very closely

Purpose. Late stage medial unicompartmental osteoarthritic disease of the knee can be treated by either Total Knee Replacement (TKR) or Unicompartmental Replacement (UKR). As a precursor to the TOPKAT study this work tested the postulate that individual surgeons show high variation in the choice of treatment for individual patients. Method. Four surgeons representing four different levels of expertise or familiarity with partial knee replacement (UKR design centre knee surgeon, specialist knee surgeon, arthroplasty surgeon and a year six trainee) made a forced choice decision of whether they would perform a TKR or UKR based on the same pre-operative radiographic and clinical data in 140 individual patients. Consistency of decision was also evaluated for each surgeon 3 months later and the effect of additional clinical data was also evaluated. The sample consisted of the 100 patients who had subsequently undergone UKR and 40 who had undergone TKR. Results. The specialist knee surgeon from the design centre would have performed UKR in 80% of the patients. The other surgeons would have performed a UKR in between 32-43% of the patients representing a variation in decision making of up to 59%. The choice of treatment for each surgeon remained unchanged in between 80-87% of cases after viewing additional clinical data. There was high intra surgeon repeatability in decision making when assessed 3 months later. Conclusion. Despite being given identical information, surgeons show high variability in decision making for patients with medial OA of the knee. A knee surgeon with a special interest in partial knee replacement is twice as likely to choose UKR for a patient with medial compartment OA than a non specialist surgeon. The choice is predominantly based on radiological findings but decision making for each individual surgeon is reassuringly consistent. The implications are that if TKR and UKR have unequal efficacy, some patients may be undergoing a suboptimal procedure

Aims. The primary aim was to assess change in health-related quality of life (HRQoL) of patients as they waited from six to 12 months for a total hip (THA) or total or partial knee arthroplasty (KA). Secondary aims were to assess change in joint-specific function, mental health, quality of sleep, number living in a state worse than death (WTD), wellbeing, and patient satisfaction with their healthcare. Methods. This prospective study included 142 patients awaiting a THA (mean age 66.7 years (SD 11.4); 71 female) and 214 patients awaiting KA (mean age 69.7 years (SD 8.7); 117 female). Patients completed questionnaires (EuroQol five-dimension health questionnaire (EQ-5D), Oxford Hip and Knee Scores (OHS/OKS), Pittsburgh Sleep Quality Index (PSQI), Hospital Anxiety and Depression Score (HADS), University of California, Los Angeles Activity Scale, wellbeing assessment, and satisfaction with their healthcare) at six and 12 months while awaiting surgery. Results. There was a clinical and statistically significant deterioration in the EQ-5D while awaiting THA (mean change 0.071 (95% confidence interval (CI) 0.018 to 0.124); p = 0.009) and KA (mean change 0.069 (95% CI 0.032 to 0.106); p < 0.001). For patients awaiting a THA, there were deteriorations in OHS (p = 0.003), PSQI (p = 0.008), both HADS depression (p = 0.001) and anxiety (p = 0.002), and an increased prevalence in those in a state WTD (p = 0.010). For those awaiting KA, there were significant deteriorations in OKS (p < 0.001), UCLA (p = 0.001), and HADS depression (p < 0.001) and anxiety (p < 0.001). There were significant decreases in wellbeing (satisfaction with life, feeling life to be worthwhile, and happiness) and increases in anxiety for those awaiting THA or KA (p < 0.001). Those awaiting THA (odds ratio (OR) 0.52 (95% CI 0.31 to 0.89); p = 0.016) and KA (OR 0.46 (95% CI 0.31 to 0.71); p < 0.001) had a significant decrease in satisfaction with their healthcare. Conclusion. As patients waited from six to 12 months for THA or KA, they experienced a clinically significant deterioration in HRQoL. There were also deteriorations in joint-specific function, mental health, wellbeing, and patient satisfaction with healthcare. Cite this article: Bone Joint J 2024;106-B(2):166–173

Introduction: The results of the mobile bearing Oxford partial knee replacement (PKR) in the lateral compartment have been disappointing with a five year survival of 82%. Bearing dislocation is a particular concern, and to address this issue a new domed implant was introduced with a modified surgical technique. The aim of this study was to compare the risk of dislocation between a domed and flat lateral PKR. Methods: Separate kinematic models were generated for the domed and flat bearings. The femoral component, tibial tray and bearing were aligned in a neutral position; the flat bearing was positioned centrally on the tibial tray and 2 mm from the side wall; the domed bearing was placed concentrically on the domed tibial tray. Dislocation in the Posterior (A-P), Lateral (M-L) and Medial against the tray wall (L-M-wall) were investigated. For each dislocation the tibial tray was restrained in all degrees of freedom (DOF) and the femoral component was restrained in five DOF; A-P and M-L displacements; A-P, M-L and Superior-Inferior (S-I) rotations. The bearing was restrained from rotating about the S-I axis for each dislocation. For the L-M-wall dislocation the underside of the bearing was held in contact with the tibial tray wall such that the lowest S-I displacement of the femoral component was achieved. The least amount of distraction required for bearing dislocation to occur was calculated for the seven bearing sizes available. The effect of medial-lateral positioning of the femur on dislocation was investigated. Results: The minimum femur distraction to cause A-P flat and domed bearing dislocation ranged from 4.68mm to 3.91mm and 6.29mm to 5.59mm respectively as the bearing thickness increased from 3.5mm to 9.5mm. The minimum femur distraction to cause L-M-wall flat and domed bearing dislocation ranged from 3.42mm to 4.16mm and 4.55mm to 5.44mm respectively as the bearing thickness increased from 3.5 mm to 9.5 mm. The femur distraction required for L-M-wall bearing dislocation increased from 4.55mm to 6.3mm with a 2 mm medial movement of the femoral component. A 4 mm lateral movement of the femoral component decreased the distraction from 4.55mm to 2.35mm. Discussion: A domed bearing can lead to an increased femoral distraction of between 25% and 37%, significantly reducing the likelihood of dislocation. This may be significant during everyday activities and demonstrates that the new domed design should reduce the incidence of bearing dislocation by increasing the amount of entrapment; our current series of 200 patients has no dislocations. Increasing the thickness of the bearing has a small effect on the distraction required to allow bearing dislocation. The medial-lateral placement of the femoral component has a pronounced effect on the femoral distraction required for bearing dislocation over the tray wall; medial placement of the femoral component is advisable

Introduction: Partial Knee Replacement (PKR) is an appealing alternative to Total Knee Replacement (TKR) when the patient has isolated compartment osteoarthritis (OA). In nearly all cases there is a radiolucency observed between the tibial tray wall and the boney interface. The reasons why radiolucencies appear are unknown, but the bone will adapt to its altered mechanical environment by bone remodelling in accordance with ‘Wollf’s Law’. The aim of this study was to investigate the mechanical environment of the tibia bone adjacent to the tray wall, following cemented and cementless PKR, in order to determine whether this region of bone resorbs. Methods: A validated finite element (FE) model of a cadaver tibia implanted with an Oxford PKR was used in this study. Kinematic data from fluoroscopy measurements during a step-up activity were used to determine the relative tibio-femoral positioning for the Oxford PKR model. Load data were adapted from the in-vivo measured loads using an instrumented implant during a step-up activity. The standard operating protocol was simulated for the Oxford PKR FE models, with the tibial tray implanted in a neutral position. The tibia was sectioned around the tray. Zone 7 was defined as parallel to the vertical tray wall, corresponding to the region on screened x-rays where radiolucencies are observed. It was assumed that the bone in the implanted tibia will attempt to normalise its stress-strain patterns locally to its equilibrium state, the intact tibia, for the same loading conditions. Forty patients (20 cemented, 20 cementless) who had undergone PKR were randomly selected from a database, and their screened x-rays assessed for radiolucency in region 7. Results: The SED in region 7 was 80% lower in the cemented and cementless tibia, compared to the intact tibia (Figure 2). The maximum tensile stress was 63% lower in the cemented and cementless tibia, compared to the intact tibia. The corresponding maximum compressive stress was 52% lower. Radiolucency was observed in all forty radiographs in region 7. Discussion: After implantation with a cemented or cementless PKR the bone strains and SED in region 7 are reduced. This reduction may provide the signal for adaptive bone remodelling and bone will be resorbed from this region, decreasing the volume and increasing the SED. Bone resorption will continue until the equilibrium state is reached. If a ‘lazy’ zone between 35% and 50% of the remodelling signal is considered, bone resorption will still occur due to the large decrease in SED for this region. For region 7 to return its SED to the equilibrium state, its volume will need to be reduced by 80%. This is likely to be the reason why a radiolucency is observed clinically in this region in almost every case, whether a cemented or cementless implant is used

Aims

Unicompartmental and total knee arthroplasty (UKA and TKA) are successful treatments for osteoarthritis, but the solid metal implants disrupt the natural distribution of stress and strain which can lead to bone loss over time. This generates problems if the implant needs to be revised. This study investigates whether titanium lattice UKA and TKA implants can maintain natural load transfer in the proximal tibia.

Abstract

INTRODUCTION

There is strong current interest to provide reliable treatments for one- and two-compartment arthritis in the cruciate-ligament intact knee. An alternative to total knee arthroplasty is to resurface only the diseased compartments with discrete compartmental components. Placing multiple small implants into the knee presents a greater surgical challenge than total knee arthroplasty, and it is not certain natural knee mechanics can be maintained. The goal of this study was to compare functional kinematics in cruciate-intact knees with either medial unicondylar (mUKA), mUKA plus patellofemoral (mUKA+PF), or bi-unicondylar (biUNI) arthroplasty using discrete compartmental implants with preparation and placement assisted by haptic robotic technology.

Background

More and more patients with end-stage knee OA are treated with total knee replacements (TKR). A modern TKR (Persona PS system, Zimmer Inc.) was designed with the hope to improve fit by providing additional sizing options on the femur and tibia. To date, there is very little information regarding the knee strength and knee mechanics during gait after the TKR. Furthermore, as a great percentage of knee OA patients have OA limited in one knee compartment and in the patellofemoral joint, a bi-compartmental knee replacement (BKR) (iDUO system, ConforMIS Inc.) was designed to treat OA at these affected areas. The BKR re-creates the individual's knee shape while correcting for any deformity. In addition, the BKR procedure results in less bone loss and retains the cruciate ligaments. To date, the influence of the BKR on knee strength and knee mechanics remains unknown. The purpose of the study was to evaluate knee strength and mechanics during level walking after the TKR and BKR surgeries.

The aim of this study is to assess the accuracy of patients' shoe size as a predictor of femoral component size of Oxford unicompartmental knee replacement (UKR).

A retrospective study was conducted to identify the correlation between patients' shoe size (British system) and the femoral component size. After excluding patients who died (n=2) and patients in whom the implanted femoral component size was inaccurate (n=13), the remaining cases (93 UKR in 88 patients) formed the study sample. Postoperative radiographs were reviewed to determine femoral component fit. We found positive correlation between shoe size and femoral component size. In females; a shoe size from 2.5 to 6 predicted a small femoral component and shoe size from 6.5 to 8.0 predicted a medium femoral component. In males, a shoe size from 6 to 9.5 predicted a medium femoral component and a shoe size from 10 to 13 predicted a large femoral component. This relation predicted the femoral component size accurately in 80% of cases. In the rest of cases, the prediction was only one size smaller or larger than the ideal size. A subgroup analysis, after excluding patients who changed their shoe size during adulthood after foot surgery or pathology (n=20), showed an accuracy rate of 81%.

Shoe size is a simple method that predicts femoral component size more accurately than other methods currently used such as templating, tibial component size and height based on gender.

Background: The Oxford unicompartmental knee replacement (UKR) use in the lateral compartment has been associated with a reduced flexion range, increased medial compartment pain and a higher dislocation rate than seen with its medial counterpart due to the inadequacy of a flat tibial tray replacing the domed anatomy of the lateral tibia. A new design incorporating a domed tibial component and a biconcave meniscal bearing has been developed to overcome these problems. This current study was designed to establish whether this modi-fied ‘domed’ implant has maintained the established normal kinematic profile of the Oxford UKR.

Methods: The study population consisted of 60 participants from three equal groups; Group 1- Normal volunteer knees (n = 20), Group 2 – Flat Oxford Lateral UKR’s (n = 20) and Group 3 – Domed Oxford Lateral UKR’s (n = 20). The sagittal plane kinematics of each involved knee was assessed continuously using videofluoroscopic analysis. A standardised protocol of step-up and deep lunge was used to assess loadbearing range of motion during which the patella tendon angle (PTA) was measured as a function of the knee flexion angle (KFA).

Results: PTA/KFA values compared at 10 degree KFA increments from maximal extension to maximal flexion for all 3 groups did not demonstrate any statistically significant difference in PTA values between any group as measured by a 3-way ANOVA. The Domed implant achieved higher maximal active flexion during the lunge exercise than those with a Flat implant. Only 33% of the Flat UKR’s achieved KFA of 130 degrees or more under load whilst performing a lunge, compared with 75% of domed UKR’s and 90% of normal knees. No Flat UKR achieved a KFA of 140 degrees or more, yet 50% of all domed UKR’s did, as also did 60% of all normal knees.

Conclusions: There is no significant difference in the sagittal plane kinematics of the domed and flat Oxford UKR’s. Both implant designs have a favourable kinematic profile closely resembling the normal knee. The domed knees though do have a greater range of motion under load as compared to the flats, approaching levels seen with the normal knee.

Not all degenerative knees need a total knee replacement. Over the last few decades we have shifted our surgical treatment of end-stage osteoarthritis (OA) of the knee to a “compartmental approach” resulting in approximately half of end-stage OA knees receiving a partial knee replacement. Of these an emerging procedure is isolated lateral compartment replacement with the indications being isolated bone-on-bone osteoarthritis or avascular necrosis of the lateral compartment of the knee. Associated significant patellofemoral disease and inflammatory arthritis are contraindications. The purpose of this study is to present the indications, surgical technique, and early outcome of lateral partial knees from our institution. From Aug 2011 until June 2017 we have performed 3,548 knee arthroplasties. Of these 147 were fixed bearing lateral partial knee replacements via a lateral parapatellar approach (4%), 1,481 medial partial knee replacements (42%), and 1,920 total knee replacements (54%). The average age was 66 years old and 76% were female. Average follow-up in the lateral partials was 1.3 years (range 0.5 years to 6 years). Knee Society Scores improved from 41 (pre-op) to 86 points (post-op). Range of motion improved from 6 – 113 degrees (pre-op) to 0 – 123 degrees (post-op). No knees were revised to a TKA. One knee required I&D for traumatic wound dehiscence. This is the largest single center series of lateral partial knee replacements. We have observed this cohort to have more female patients and gain additional range of motion compared to our historic cohorts of TKA's. Longer-term follow-up is needed for determination of implant and unreplaced compartment survivorship. We believe the lateral partial knee replacement to be a viable option for isolated lateral compartment disease in approximately 4% of patients