The Oxford Unicompartmental Knee Replacement (OUKA) is the most popular unicompartmental knee replacement (UKR) in the New Zealand Joint Registry with the majority utilising cementless fixation. We report the 10-year radiological outcomes. This is a prospective observational study. All patients undergoing a cementless OUKA between May 2005 and April 2011 were enrolled. There were no exclusions due to age, gender, body mass index or reduced bone density. All knees underwent fluoroscopic screening achieving true anteroposterior (AP) and lateral images for radiographic assessment. AP assessment for the presence of radiolucent lines and coronal alignment of the tibial and femoral components used Inteliviewer radiographic software. The lateral view was assessed for lucencies as well as sagittal alignment.Introduction
Methods
The purpose of this study is to assess the long term results of combined ACL reconstruction and unicompartmental knee replacements (UKR). These patients have been selected for this combined operation due to their combination of instability symptoms from an absent ACL and unicompartmental arthritis. Retrospective review of 44 combined UKR and ACL reconstruction by a single surgeon. Surgeries included both medial and lateral UKR combined with either revision ACL reconstruction or primary ACL reconstruction. Patient reported outcomes were obtained preoperatively, at one year, 5 years and 10 years. Revision rate was followed up over 13 years for a mean of 7.4 years post-surgery. The average Oxford score at one year was 43 with an average increase from pre-operation to 1 year post operation of 15. For the 7 patients with 10 year follow up average oxford score was 42 at 1 year, 43 at 5 years and 45 at 10 years. There were 5 reoperations. 2 for revision to total knee arthroplasty and 1 for an exchange of bearing due to wear. The other 2 were the addition of another UKR. For those requiring reoperation the average time was 8 years. Younger more active patients presenting with ACL deficiency causing instability and unicompartmental arthritis are a difficult group to manage. Combining UKR and ACL reconstruction has scant evidence in regard to long term follow up but is a viable option for this select group. This paper has one of the largest cohorts with a reasonable follow up averaging 7.4 years and a revision rate of 11 percent. Combined unilateral knee replacements and ACL reconstruction can be a successful operation for patients with ACL rupture causing instability and unicompartmental arthritis.
Cementless fixation is an alternative to cemented unicompartmental knee replacement (UKR), with several advantages over cementation. This study reports on the 15-year survival and 10-year clinical outcomes of the cementless Oxford unicompartmental knee replacement (OUKR). This prospective study describes the clinical outcomes and survival of first 693 consecutive cementless medial OUKRs implanted in New Zealand. The sixteen-year survival was 89.2%, with forty-six knees being revised. The commonest reason for revision was progression of arthritis, which occurred in twenty-three knees, followed by primary dislocation of the bearing, which occurred in nine knees. There were two bearing dislocations secondary to trauma and a ruptured ACL, and two tibial plateau fractures. There were four revisions for polyethylene wear. There were four revisions for aseptic tibial loosening, and one revision for impingement secondary to overhang of the tibial component. There was only one revision for deep infection and one revision where the indication was not stated. The mean OKS improved from 23.3 (7.4 SD) to 40.59 (SD 6.8) at a mean follow-up of sixteen years. In conclusion, the cementless OUKR is a safe and reproducible procedure with excellent sixteen-year survival and clinical outcomes.
We prospectively investigated the radiological outcomes of the uncemented Oxford medial compartment arthroplasty in 231 consecutive patients performed in a single centre with a minimum two year follow up. The functional outcome using the Oxford knee score and the High Activity Arthroplasty Score were significantly improved on the pre-operative scores (p<0.001). There were 196 patients with a radiological examination that was acceptable for analysis of the bone-implant interface. Of the six tibial zones examined on the anteroposterior radiograph there were only three with a partial radiolucent line (3 out of 1176 zones). All were present in the medial aspect of the tibial base plate (Zone 1) and all were <1 mm in size. All of these patients were asymptomatic. There were no radiolucent lines seen around the femoral component or on the lateral tibial view. There was one revision for mal-seating of the tibial component.Method.
Results.
Bone mineral density (BMD) and bone mineral content (BMC) have not been previously assessed in unicompartmental knee replacement (UKR). We studied the early bone changes beneath the uncemented Oxford medial UKR. Our hypothesis was that this implant should decrease the shear stresses across the bone-implant interface and result in improved BMD and BMC beneath the tibial component. Using the Lunar iDXA and knee specific software we developed 7 regions of interest (ROI) in the proximal tibia and assessed 38 patients with an uncemented Oxford UKR at 2 years. We measured the replaced knee and contralateral unreplaced knee using the same ROI and compared the BMD and BMC. The initial precision study in 20 patients demonstrated high precision in all areas. There were 12 males and 16 females with an average age of 65.8 years (46–84 years). ROI 1 and 2 were beneath the tibial tray and had significantly less BMC (p=0.023 and 0.001) and BMD (p=0.012 and 0.002). ROI 3 was the lateral tibial plateau and this area also had significantly less BMC (p=0.007) and BMD (p=0.0001). ROI 4 and 5 immediately below the tibial keel had no significant change. These changes were independent of gender and age. These results were surprising in that the universal loss of BMC and BMD suggested that bone loading of the proximal tibia was not improved even after a UKR. The better BMD and BMC adjacent to the keel confirms other studies that show improved bone in-growth around keels and pegs in the uncemented tibial component. A prospective longitudinal study has been developed to compare BMD and BMC changes over time to see whether these changes are dynamic.
