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The Bone & Joint Journal
Vol. 106-B, Issue 9 | Pages 916 - 923
1 Sep 2024
Fricka KB Wilson EJ Strait AV Ho H Hopper, Jr RH Hamilton WG Sershon RA

Aims

The optimal bearing surface design for medial unicompartmental knee arthroplasty (UKA) remains controversial. The aim of this study was to compare outcomes of fixed-bearing (FB) and mobile-bearing (MB) UKAs from a single high-volume institution.

Methods

Prospectively collected data were reviewed for all primary cemented medial UKAs performed by seven surgeons from January 2006 to December 2022. A total of 2,999 UKAs were identified, including 2,315 FB and 684 MB cases. The primary outcome measure was implant survival. Secondary outcomes included 90-day and cumulative complications, reoperations, component revisions, conversion arthroplasties, range of motion, and patient-reported outcome measures. Overall mean age at surgery was 65.7 years (32.9 to 94.3), 53.1% (1,593/2,999) of UKAs were implanted in female patients, and demographics between groups were similar (p > 0.05). The mean follow-up for all UKAs was 3.7 years (0.0 to 15.6).


The Bone & Joint Journal
Vol. 106-B, Issue 3 | Pages 249 - 255
1 Mar 2024
Inclan PM Brophy RH Saccone NL Ma Y Pham V Yanik EL

Aims

The purpose of this study is to determine an individual’s age-specific prevalence of total knee arthroplasty (TKA) after cruciate ligament surgery, and to identify clinical and genetic risk factors associated with undergoing TKA.

Methods

This study was a retrospective case-control study using the UK Biobank to identify individuals reporting a history of cruciate ligament surgery. Data from verbal history and procedural codes recorded through the NHS were used to identify instances of TKA. Patient clinical and genetic data were used to identify risk factors for progression from cruciate ligament surgery to TKA. Individuals without a history of cruciate ligament reconstruction were used for comparison.


The Bone & Joint Journal
Vol. 105-B, Issue 3 | Pages 269 - 276
1 Mar 2023
Tay ML Monk AP Frampton CM Hooper GJ Young SW

Aims

Unicompartmental knee arthroplasty (UKA) has higher revision rates than total knee arthroplasty (TKA). As revision of UKA may be less technically demanding than revision TKA, UKA patients with poor functional outcomes may be more likely to be offered revision than TKA patients with similar outcomes. The aim of this study was to compare clinical thresholds for revisions between TKA and UKA using revision incidence and patient-reported outcomes, in a large, matched cohort at early, mid-, and late-term follow-up.

Methods

Analyses were performed on propensity score-matched patient cohorts of TKAs and UKAs (2:1) registered in the New Zealand Joint Registry between 1 January 1999 and 31 December 2019 with an Oxford Knee Score (OKS) response at six months (n, TKA: 16,774; UKA: 8,387), five years (TKA: 6,718; UKA: 3,359), or ten years (TKA: 3,486; UKA: 1,743). Associations between OKS and revision within two years following the score were examined. Thresholds were compared using receiver operating characteristic analysis. Reasons for aseptic revision were compared using cumulative incidence with competing risk.


The Bone & Joint Journal
Vol. 104-B, Issue 5 | Pages 541 - 548
1 May 2022
Zhang J Ng N Scott CEH Blyth MJG Haddad FS Macpherson GJ Patton JT Clement ND

Aims

This systematic review aims to compare the precision of component positioning, patient-reported outcome measures (PROMs), complications, survivorship, cost-effectiveness, and learning curves of MAKO robotic arm-assisted unicompartmental knee arthroplasty (RAUKA) with manual medial unicompartmental knee arthroplasty (mUKA).

Methods

Searches of PubMed, MEDLINE, and Google Scholar were performed in November 2021 according to the Preferred Reporting Items for Systematic Review and Meta-­Analysis statement. Search terms included “robotic”, “unicompartmental”, “knee”, and “arthroplasty”. Published clinical research articles reporting the learning curves and cost-effectiveness of MAKO RAUKA, and those comparing the component precision, functional outcomes, survivorship, or complications with mUKA, were included for analysis.


The Bone & Joint Journal
Vol. 103-B, Issue 4 | Pages 610 - 618
1 Apr 2021
Batailler C Bordes M Lording T Nigues A Servien E Calliess T Lustig S

Aims

Ideal component sizing may be difficult to achieve in unicompartmental knee arthroplasty (UKA). Anatomical variants, incremental implant size, and a reduced surgical exposure may lead to over- or under-sizing of the components. The purpose of this study was to compare the accuracy of UKA sizing with robotic-assisted techniques versus a conventional surgical technique.

Methods

Three groups of 93 medial UKAs were assessed. The first group was performed by a conventional technique, the second group with an image-free robotic-assisted system (Image-Free group), and the last group with an image-based robotic arm-assisted system, using a preoperative CT scan (Image-Based group). There were no demographic differences between groups. We compared six parameters on postoperative radiographs to assess UKA sizing. Incorrect sizing was defined by an over- or under-sizing greater than 3 mm.


The Bone & Joint Journal
Vol. 102-B, Issue 6 Supple A | Pages 91 - 95
1 Jun 2020
Johnson, Jr. WB Engh, Jr. CA Parks NL Hamilton WG Ho PH Fricka KB

Aims

It has been hypothesized that a unicompartmental knee arthroplasty (UKA) is more likely to be revised than a total knee arthroplasty (TKA) because conversion surgery to a primary TKA is a less complicated procedure. The purpose of this study was to determine if there is a lower threshold for revising a UKA compared with TKA based on Oxford Knee Scores (OKSs) and range of movement (ROM) at the time of revision.

Methods

We retrospectively reviewed 619 aseptic revision cases performed between December 1998 and October 2018. This included 138 UKAs that underwent conversion to TKA and 481 initial TKA revisions. Age, body mass index (BMI), time in situ, OKS, and ROM were available for all patients.


The Bone & Joint Journal
Vol. 101-B, Issue 12 | Pages 1469 - 1471
1 Dec 2019
Haddad FS Horriat S


The Bone & Joint Journal
Vol. 101-B, Issue 8 | Pages 922 - 928
1 Aug 2019
Garner A van Arkel RJ Cobb J

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.


The Bone & Joint Journal
Vol. 100-B, Issue 8 | Pages 1033 - 1042
1 Aug 2018
Kayani B Konan S Pietrzak JRT Huq SS Tahmassebi J Haddad FS

Aims

The primary aim of this study was to determine the surgical team’s learning curve for introducing robotic-arm assisted unicompartmental knee arthroplasty (UKA) into routine surgical practice. The secondary objective was to compare accuracy of implant positioning in conventional jig-based UKA versus robotic-arm assisted UKA.

Patients and Methods

This prospective single-surgeon cohort study included 60 consecutive conventional jig-based UKAs compared with 60 consecutive robotic-arm assisted UKAs for medial compartment knee osteoarthritis. Patients undergoing conventional UKA and robotic-arm assisted UKA were well-matched for baseline characteristics including a mean age of 65.5 years (sd 6.8) vs 64.1 years (sd 8.7), (p = 0.31); a mean body mass index of 27.2 kg.m2 (sd 2.7) vs 28.1 kg.m2 (sd 4.5), (p = 0.25); and gender (27 males: 33 females vs 26 males: 34 females, p = 0.85). Surrogate measures of the learning curve were prospectively collected. These included operative times, the Spielberger State-Trait Anxiety Inventory (STAI) questionnaire to assess preoperative stress levels amongst the surgical team, accuracy of implant positioning, limb alignment, and postoperative complications.


The Bone & Joint Journal
Vol. 100-B, Issue 7 | Pages 938 - 944
1 Jul 2018
Karayiannis PN Hill JC Stevenson C Finnegan S Armstrong L Beverland D

Aims

The aims of this study were to determine the indications and frequency of ordering a CT pulmonary angiography (CTPA) following primary arthroplasty of the hip and knee, and to determine the number of positive scans in these patients, the location of emboli and the outcome for patients undergoing CTPA.

Patients and Methods

We analyzed the use of CTPA, as an inpatient and up to 90 days as an outpatient, in a cohort of patients and reviewed the medical records and imaging for each patient undergoing CTPA.


The Bone & Joint Journal
Vol. 100-B, Issue 4 | Pages 450 - 454
1 Apr 2018
Chalmers BP Mehrotra KG Sierra RJ Pagnano MW Taunton MJ Abdel MP

Aims. Primary (or spontaneous) and secondary osteonecrosis of the knee can lead to severe joint degeneration, for which either total or unicompartmental arthroplasty may be considered. However, there are limited studies analyzing outcomes of unicompartmental knee arthroplasties (UKAs) for osteonecrosis involving an isolated compartment of the knee. The aims of this study were to analyze outcomes of UKAs for osteonecrosis with specific focus on 1) survivorship free of any revision or reoperation, 2) risk factors for failure, 3) clinical outcomes, and 4) complications. Patients and Methods. A total of 45 patients underwent 46 UKAs for knee osteonecrosis between 2002 and 2014 at our institution (The Mayo Clinic, Rochester, Minnesota). Twenty patients (44%) were female; the mean age of the patients was 66 years, and mean body mass index (BMI) was 31 kg/m. 2. Of the 46 UKAs, 44 (96%) were medial UKAs, and 35 (76%) were fixed-bearing design. Mean mechanical axis postoperatively was 1.5° varus (0° to 5° varus); 41 UKAs (89%) were performed for primary osteonecrosis. Mean follow-up was five years (2 to 12). Results. Survivorship free of any revision in the cohort was 89% (95% CI 77 to 99) and 76% (95% CI 53 to 99) at five and ten years, respectively. In patients undergoing UKA for primary osteonecrosis survivorship free of any revision was 93% (95% CI 83 to 100)at both five and ten years. Secondary osteonecrosis was a significant risk factor for poorer survivorship free of any revision or reoperation (hazard ratio 7.7, p = 0.03). Three medial UKAs (6.5%) were converted to total knee arthroplasties (TKAs): two for lateral compartment degeneration and one for development of lateral osteonecrosis. No implants were revised for loosening, fracture, or wear. Knee Society scores improved from a mean of 60 (44 to 72) preoperatively to a mean of 94 postoperatively (82 to 100) (p < 0.001). There were no surgical complications. Conclusion. When done for primary osteonecrosis of the knee, UKA resulted in reliable clinical improvement, minimal complications, and durable estimated implant survivorship free of revision at ten years. UKA done for secondary osteonecrosis was substantially less durable at mid-term follow-up. Progression of knee degeneration, rather than implant failure or loosening, was most common indication for conversion to TKA. Cite this article: Bone Joint J 2018;100-B:450–4


The Bone & Joint Journal
Vol. 100-B, Issue 1_Supple_A | Pages 62 - 67
1 Jan 2018
Bedard NA DeMik DE Dowdle SB Callaghan JJ

Aims

The purpose of this study was to evaluate trends in opioid use after unicompartmental knee arthroplasty (UKA), to identify predictors of prolonged use and to compare the rates of opioid use after UKA, total knee arthroplasty (TKA) and total hip arthroplasty (THA).

Materials and Methods

We identified 4205 patients who had undergone UKA between 2007 and 2015 from the Humana Inc. administrative claims database. Post-operative opioid use for one year post-operatively was assessed using the rates of monthly repeat prescription. These were then compared between patients with and without a specific variable of interest and with those of patients who had undergone TKA and THA.


The Bone & Joint Journal
Vol. 99-B, Issue 10 | Pages 1329 - 1334
1 Oct 2017
Lim JBT Chong HC Pang HN Tay KJD Chia SL Lo NN Yeo SJ

Aims

Little is known about the relative outcomes of revision of unicompartmental knee arthroplasty (UKA) and high tibial osteotomy (HTO) to total knee arthroplasty (TKA). The aim of this study is to compare the outcomes of revision surgery for the two procedures in terms of complications, re-revision and patient-reported outcome measures (PROMs) at a minimum of two years follow-up.

Patients and Methods

This study was a retrospective review of data from an institutional arthroplasty registry for cases performed between 2001 and 2014. A total of 292 patients were identified, of which 217 had a revision of HTO to TKA, and 75 had revision of UKA to TKA. While mean follow-up was longer for the HTO group compared with the UKA group, patient demographics (age, body mass index and Charlson co-morbidity index) and PROMs (Short Form-36, Oxford Knee Score, Knee Society Score, both objective and functional) were similar in the two groups prior to revision surgery. Outcomes included the rate of complications and re-operation, PROMS and patient-reported satisfaction at six months and two years post-operatively. We also compared the duration of surgery and the need for revision implants in the two groups.


The Bone & Joint Journal
Vol. 99-B, Issue 6 | Pages 788 - 792
1 Jun 2017
Bradley B Middleton S Davis N Williams M Stocker M Hockings M Isaac DL

Aims

Unicompartmental knee arthroplasty (UKA) has been successfully performed in the United States healthcare system on outpatients. Despite differences in healthcare structure and financial environment, we hypothesised that it would be feasible to replicate this success and perform UKA with safe day of surgery discharge within the NHS, in the United Kingdom. This has not been reported in any other United Kingdom centres.

Patients and Methods

We report our experience of implementing a pathway to allow safe day of surgery discharge following UKA. Data were prospectively collected on 72 patients who underwent UKA as a day case between December 2011 and September 2015.


The Bone & Joint Journal
Vol. 99-B, Issue 1_Supple_A | Pages 65 - 69
1 Jan 2017
Thienpont E

Objectives

Unicompartmental knee arthroplasty (UKA) is a potential treatment for isolated bone on bone osteoarthritis when limited to a single compartment. The risk for revision of UKA is three times higher than for total knee arthroplasty (TKA). The aim of this review was to discuss the different revision options after UKA failure.

Materials and Methods

A search was performed for English language articles published between 2006 and 2016. After reviewing titles and abstracts, 105 papers were selected for further analysis. Of these, 39 papers were deemed to contain clinically relevant data to be included in this review.


The Bone & Joint Journal
Vol. 98-B, Issue 10_Supple_B | Pages 3 - 10
1 Oct 2016
Hamilton TW Pandit HG Lombardi AV Adams JB Oosthuizen CR Clavé A Dodd CAF Berend KR Murray DW

Aims

An evidence-based radiographic Decision Aid for meniscal-bearing unicompartmental knee arthroplasty (UKA) has been developed and this study investigates its performance at an independent centre.

Patients and Methods

Pre-operative radiographs, including stress views, from a consecutive cohort of 550 knees undergoing arthroplasty (UKA or total knee arthroplasty; TKA) by a single-surgeon were assessed. Suitability for UKA was determined using the Decision Aid, with the assessor blinded to treatment received, and compared with actual treatment received, which was determined by an experienced UKA surgeon based on history, examination, radiographic assessment including stress radiographs, and intra-operative assessment in line with the recommended indications as described in the literature.


The Bone & Joint Journal
Vol. 98-B, Issue 10_Supple_B | Pages 22 - 27
1 Oct 2016
Bottomley N Jones LD Rout R Alvand A Rombach I Evans T Jackson WFM Beard DJ Price AJ

Aims

The aim of this to study was to compare the previously unreported long-term survival outcome of the Oxford medial unicompartmental knee arthroplasty (UKA) performed by trainee surgeons and consultants.

Patients and Methods

We therefore identified a previously unreported cohort of 1084 knees in 947 patients who had a UKA inserted for anteromedial knee arthritis by consultants and surgeons in training, at a tertiary arthroplasty centre and performed survival analysis on the group with revision as the endpoint.


The Bone & Joint Journal
Vol. 98-B, Issue 10_Supple_B | Pages 34 - 40
1 Oct 2016
Emerson RH Alnachoukati O Barrington J Ennin K

Aims

Approved by the Food and Drug Administration in 2004, the Phase III Oxford Medial Partial Knee is used to treat anteromedial osteoarthritis (AMOA) in patients with an intact anterior cruciate ligament. This unicompartmental knee arthroplasty (UKA) is relatively new in the United States, and therefore long-term American results are lacking.

Patients and Methods

This is a single surgeon, retrospective study based on prospectively collected data, analysing a consecutive series of primary UKAs using the Phase III mobile-bearing Oxford Knee and Phase III instrumentation.

Between July 2004 and December 2006, the senior author (RHE) carried out a medial UKA in 173 patients (213 knees) for anteromedial osteoarthritis or avascular necrosis (AVN).

A total of 95 patients were men and 78 were women. Their mean age at surgery was 67 years (38 to 89) and mean body mass index 29.87 kg/m2 (17 to 62).

The mean follow-up was ten years (4 to 11).


The Bone & Joint Journal
Vol. 98-B, Issue 10_Supple_B | Pages 16 - 21
1 Oct 2016
Jones GG Kotti M Wiik AV Collins R Brevadt MJ Strachan RK Cobb JP

Aims

To compare the gait of unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA) patients with healthy controls, using a machine-learning approach.

Patients and Methods

145 participants (121 healthy controls, 12 patients with cruciate-retaining TKA, and 12 with mobile-bearing medial UKA) were recruited. The TKA and UKA patients were a minimum of 12 months post-operative, and matched for pattern and severity of arthrosis, age, and body mass index.

Participants walked on an instrumented treadmill until their maximum walking speed was reached. Temporospatial gait parameters, and vertical ground reaction force data, were captured at each speed. Oxford knee scores (OKS) were also collected. An ensemble of trees algorithm was used to analyse the data: 27 gait variables were used to train classification trees for each speed, with a binary output prediction of whether these variables were derived from a UKA or TKA patient. Healthy control gait data was then tested by the decision trees at each speed and a final classification (UKA or TKA) reached for each subject in a majority voting manner over all gait cycles and speeds. Top walking speed was also recorded.


The Bone & Joint Journal
Vol. 98-B, Issue 3 | Pages 341 - 348
1 Mar 2016
Ogonda L Hill J Doran E Dennison J Stevenson M Beverland D

Aims

The aim of this study was to present data on 11 459 patients who underwent total hip (THA), total knee (TKA) or unicompartmental knee arthroplasty (UKA) between November 2002 and April 2014 with aspirin as the primary agent for pharmacological thromboprophylaxis.

Patients and Methods

We analysed the incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE) then compared the 90-day all-cause mortality with the corresponding data in the National Joint Registry for England and Wales (NJR).