Top

Knee Surgery, Sports Traumatology, Arthroscopy

Published in:

01-11-2013 | Knee

Minimum thickness of all-poly tibial component unicompartmental knee arthroplasty in patients younger than 60 years does not increase revision rate for aseptic loosening

Authors: Danilo Bruni, Ibrahim Akkawi, Francesco Iacono, Giovanni Francesco Raspugli, Michele Gagliardi, Marco Nitri, Alberto Grassi, Stefano Zaffagnini, Simone Bignozzi, Maurilio Marcacci

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 11/2013

Abstract

Purpose

Management of unicompartmental knee osteoarthritis in middle-aged patients is a challenging problem. Despite its functional advantages, UKA still raises questions concerning implant survivorship and an increased revision risk for aseptic loosening mainly due to polyethylene wear. The main purpose of the present study was to investigate whether using the minimum thickness of an all-poly tibial UKA in patients under 60 years of age increases the revision rate for aseptic loosening. The secondary purposes were to compare implant survivorship with data reported in literature and to prospectively evaluate the clinical outcome in this selected group of patients.

Methods

Thirty-three consecutive patients under 60 years of age at the time of surgery with isolated medial compartment osteoarthritis underwent a unilateral medial UKA from 2002 to 2005 and were prospectively followed. A Kaplan–Meier analysis was performed to determine the 8-year implant survivorship with revision for any reason as endpoint. KSS, WOMAC, Tegner–Lysholm, Tegner and VAS scores were prospectively evaluated at 3- to 8-year follow-up. Weight-bearing radiographs were collected pre-operatively and at 3- to 8-year follow-up to prospectively evaluate hip-knee-ankle angle (HKA), femoro-tibial angle (FTA), tibial plateau angle and posterior tibial slope.

Results

The 8-year Kaplan–Meier survivorship with revision for any reason as endpoint was 83 %. Five failures were reported, and in 3 patients’ aseptic loosening of the tibial component was the reason for failure. All clinical scores significantly improved at 3-year follow-up, and no further modification was demonstrated up to 8-year follow-up. HKA, FTA and TPA had a significant difference at 3-year follow-up with respect to pre-operative values (p < 0.01) and no further difference at 8-year follow-up was found.

Conclusions

The present study failed to demonstrate an increased revision rate for aseptic loosening of the implant in patients under 60 years of age, who received an all-poly tibial component UKA using the minimum thickness of the implant in all cases.

Level of evidence

Case series, Level IV.

Argenson JN, Chevrol-Benkeddache Y, Aubaniac JM (2002) Modern unicompartmental knee arthroplasty with cement: a three to ten year follow-up study. J Bone Joint Surg Am 84:2235–2239PubMed

Argenson JN, Parratte S, Flecher X, Aubaniac JM (2007) Unicompartmental knee arthroplasty: technique through a mini-incision. Clin Orthop Relat Res 464:32–36PubMed

Bhattacharya R, Scott CE, Morris HE, Wade F, Nutton RW (2011) Survivorship and patient satisfaction of a fixed bearing unicompartmental knee arthroplasty incorporating an all-polyethylene tibial component. Knee 19(4):348–351PubMedCrossRef

Biswal S, Brighton RW (2009) Results of unicompartmental knee arthroplasty with cemented, fixed-bearing prosthesis using minimally invasive surgery. J Arthroplasty 25(5):721–727PubMedCrossRef

Briggs KK, Steadman JR, Hay CJ, Hines SL (2009) Lysholm score and Tegner activity level in individuals with normal knees. Am J Sports Med 37(5):898–901PubMedCrossRef

Bruni D, Iacono F, Raspugli G, Zaffagnini S, Marcacci M (2012) Is unicompartmental arthroplasty an acceptable option for spontaneous osteonecrosis of the knee? Clin Orthop Relat Res 470:1442–1451PubMedCrossRef

Bruni D, Iacono F, Russo A, Zaffagnini S, Muccioli GMM, Bignozzi S, Bragonzoni L, Marcacci M (2009) Minimally invasive unicompartmental knee replacement: retrospective clinical and radiographic evaluation of 83 patients. Knee Surg Sports Traumatol Arthrosc 18(6):710–717PubMedCrossRef

Cartier P, Khefacha A, Sanouiller JL, Frederick K (2007) Unicondylar knee arthroplasty in middle-aged patients: a minimum 5-year follow-up. Orthopedics 30(8 Suppl):62–65PubMed

Choy WS, Kim KJ, Lee SK, Yang DS, Lee NK (2011) Mid-term results of oxford medial unicompartmental knee arthroplasty. Clin Orthop Surg 3(3):178–183PubMedCrossRef

10.

Clement ND, Duckworth AD, MacKenzie SP, Nie YX, Tiemessen CH (2012) Medium-term results of Oxford phase-3 medial unicompartmental knee arthroplasty. J Orthop Surg (Hong Kong) 20(2):157–161

11.

Collier MB, Eickmann TH, Sukezaki F, McAuley JP, Engh GA (2006) Patient, implant, and alignment factors associated with revision of medial compartment unicondylar arthroplasty. J Arthroplasty 21(6 suppl 2):108–115PubMedCrossRef

12.

Collier MB, Engh CA Jr, McAuley JP, Engh GA (2007) Factors associated with the loss of thickness of polyethylene tibial bearings after knee arthroplasty. J Bone Joint Surg Am 89(6):1306–1314PubMedCrossRef

13.

Dawson J, Fitzpatrick R, Murray D, Carr A (1998) Questionnaire on the perceptions of patients about total knee replacement. J Bone Joint Surg Br 80(1):63–69PubMedCrossRef

14.

Egidy CC, Sherman SL, Macdessi SJ, Cross MB, Windsor RE (2012) Long-term survivorship of a unicondylar knee replacement—a case report. Knee 19(6):944–947PubMedCrossRef

15.

Felts E, Parratte S, Pauly V, Aubaniac JM, Argenson JN (2010) Function and quality of life following medial unicompartmental knee arthroplasty in patients 60 years of age or younger. Orthop Traumatol Surg Res 96(8):861–867PubMedCrossRef

16.

Goodfellow J, O’Connor J, Dodd C (2006) Unicompartmental arthroplasty with the Oxford knee. Oxford University Press, Oxford

17.

Hanssen AD, Stuart MJ, Scott RD, Scuderi GR (2001) Surgical options for the middle-aged patient with osteoarthritis of the knee joint. Instr Course Lect 50:499–511PubMed

18.

Hernigou P, Deschamps G (2004) Alignment influences wear in the knee after medial unicompartmental arthroplasty. Clin Orthop Relat Res 423:161–165PubMedCrossRef

19.

Heyse TJ, Khefacha A, Peersman G, Cartier P (2012) Survivorship of UKA in the middle-aged. Knee 19(5):585–591PubMedCrossRef

20.

Hopgood P, Martin CP, Rae PJ (2004) The effect of tibial implant size on post-operative alignment following medial unicompartmental knee replacement. Knee 11:385–388PubMedCrossRef

21.

Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 248:13–14PubMed

22.

Kennedy WR, White RP (1987) Unicompartmental arthroplasty of the knee: postoperative alignment and its influence on overall results. Clin Orthop Relat Res 221:278–285PubMed

23.

Kort NP, van Raay JJ, van Horn JJ (2007) The Oxford phase III unicompartmental knee replacement in patients less than 60 years of age. Knee Surg Sports Traumatol Arthrosc 15(4):356–360PubMedCrossRef

24.

Koskinen E, Paavolainen P, Eskelinen A, Harilainen A, Sandelin J, Ylinen P, Tallroth K, Remes V (2008) Medial unicompartmental knee arthroplasty with Miller-Galante II prosthesis: mid-term clinical and radiographic results. Arch Orthop Trauma Surg 129(5):617–624PubMedCrossRef

25.

Kuipers BM, Kollen BJ, Bots PC, Burger BJ, van Raay JJ, Tulp NJ, Verheyen CC (2010) Factors associated with reduced early survival in the Oxford phase III medial unicompartment knee replacement. Knee 17(1):48–52PubMedCrossRef

26.

Larsson SE, Larsson S, Lundkvist S (1988) Unicompartmental knee arthroplasty. Clin Orthop Relat Res 232:174–181PubMed

27.

Mariani EM, Bourne MH, Jackson RT, Jackson ST, Jones P (2007) Early failure of unicompartmental knee arthroplasty. J Arthroplasty 22(6 Suppl 2):81–84PubMedCrossRef

28.

Marmor L (1988) Unicompartmental knee arthroplasty. Ten- to 13-year follow-up study. Clin Orthop Relat Res 226:14–20PubMed

29.

McConnell S, Kolopack P, Davis AM (2001) The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC): a review of its utility and measurement properties. Arthritis Rheum 45(5):453–461PubMedCrossRef

30.

Pandit H, Jenkins C, Barker K (2006) The Oxford medial unicompartmental knee replacement using a minimally-invasive approach. J Bone Joint Surg Br 88:54–60PubMed

31.

Parratte S, Argenson JN, Pearce O, Pauly V, Auquier P, Aubaniac JM (2009) Medial unicompartmental knee replacement in the under-50s. J Bone Joint Surg Br 91(3):351–356PubMed

32.

Pennington DW, Swienckowski JJ, Lutes WB, Drake GN (2003) Unicompartmental knee arthroplasty in patients sixty years of age or younger. J Bone Joint Surg Am 85-A(10):1968–1973PubMed

33.

Price AJ, Dodd CA, Svard UG, Murray DW (2005) Oxford medial unicompartmental knee arthroplasty in patients younger and older than 60 years of age. J Bone Joint Surg Br 87(11):1488–1492PubMed

34.

Ridgeway SR, McAuley JP, Ammeen DJ, Engh GA (2002) The effect of alignment of the knee on the outcome of unicompartmental knee replacement. J Bone Joint Surg Br 84(3):351–355PubMedCrossRef

35.

Schai PA, Suh JT, Thornhill TS, Scott RD (1998) Unicompartmental knee arthroplasty in middle-aged patients: a 2- to 6-year follow-up evaluation. J Arthroplasty 13(4):365–372PubMedCrossRef

36.

Stukenborg-Colsman C, Wirth CJ, Lazovic D, Wefer A (2001) High tibial osteotomy versus unicompartmental joint replacement in unicompartmental knee joint osteoarthritis: 7–10-year follow-up prospective randomised study. Knee 8(3):187–194PubMedCrossRef

37.

Tabor OB Jr, Tabor OB, Bernard M, Wan JY (2005) Unicompartmental knee arthroplasty: long-term success in middle-age and obese patients. J Surg Orthop Adv 14(2):59–63PubMed

38.

W-Dahl A, Robertsson O, Lidgren L (2010) Surgery for knee osteoarthritis in younger patients. Acta Orthop 81(2):161–164PubMedCrossRef

39.

Wasielewski RC, Galante JO, Leighty RM, Natarajan RN, Rosenberg AG (1994) Wear patterns on retrieved polyethylene tibial inserts and their relationship to technical considerations during total knee arthroplasty. Clin Orthop Relat Res 299:31–43PubMed

40.

Weston-Simons JS, Pandit H, Jenkins C, Jackson WF, Price AJ, Gill HS, Dodd CA, Murray DW (2012) Outcome of combined unicompartmental knee replacement and combined or sequential anterior cruciate ligament reconstruction: a study of 52 cases with mean follow-up of five years. J Bone Joint Surg Br 94(9):1216–1220PubMed

41.

Whiteside LA (2005) Making your next unicompartmental knee arthroplasty last: three keys to success. J Arthroplasty 20(4 Suppl 2):2–3PubMedCrossRef

42.

Xing Z, Katz J, Jiranek W (2012) Unicompartmental knee arthroplasty: factors influencing the outcome. J Knee Surg 25(5):369–374PubMedCrossRef

Title: Minimum thickness of all-poly tibial component unicompartmental knee arthroplasty in patients younger than 60 years does not increase revision rate for aseptic loosening
Authors: Danilo Bruni
Ibrahim Akkawi
Francesco Iacono
Giovanni Francesco Raspugli
Michele Gagliardi
Marco Nitri
Alberto Grassi
Stefano Zaffagnini
Simone Bignozzi
Maurilio Marcacci
Publication date: 01-11-2013
Publisher: Springer Berlin Heidelberg
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 11/2013
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-013-2578-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Minimum thickness of all-poly tibial component unicompartmental knee arthroplasty in patients younger than 60 years does not increase revision rate for aseptic loosening

Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

Please log in to get access to this content

Other articles of this Issue 11/2013

Lateral uni-compartmental knee replacement: current concepts and future directions

Unicompartmental osteoarthritis: an integrated biomechanical and biological approach as alternative to metal resurfacing

Patient satisfaction after total knee arthroplasty is affected by their general physical well-being

Improved accuracy in computer-assisted unicondylar knee arthroplasty: a meta-analysis

Gender differences in tibio-femoral kinematics and quadriceps muscle force during weight-bearing knee flexion in vitro

Translation and validation of ‘The Knee Society Clinical Rating System’ into Spanish