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Low implant migration of the SIGMA® medial unicompartmental knee arthroplasty

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of this study was to evaluate implant migration of the fixed-bearing Sigma® medial unicompartmental knee arthroplasty (UKA). UKA is a regularly used treatment for patients with medial osteoarthritis (OA) of the knee. UKA has a higher revision rate than total knee arthroplasty. Implant migration can be used as a predictor of implant loosening.

Methods

A prospective radiostereometric cohort study was performed. Forty-five patients with medial OA of the knee were included and received a cemented Sigma® UKA. The patients were followed for 24 months with radiostereometric analysis (RSA) and clinical outcome scores (Oxford knee score). Clinical precision was based on double determinations taken at 4 and 12 months. Tibial implants were classified as stable (difference in MTPM < 0.2 mm between 1 2 and 24 months) or as continuously migrating (difference in MTPM > 0.2 mm between 12 and 24 months).

Results

No significant differences in migration were found for the femoral component. For the tibial component, a difference of 0.05 mm was shown for translation on the x-axis between 4 months and 12 (p < 0.01) and between 4 months and 24 months (p < 0.01). A difference of − 0.23 to − 0.50° was shown for rotation around the x-axis (p < 0.01) and a difference of − 0.11° was shown for rotation around the z-axis between 4 and 12 months (p = 0.02). These differences in migration over time were small and fall within the clinical precision of the measurements. Tibial components were divided into a stable group (N = 26) and a continuously migrating group (N = 11), which showed a significant difference in maximal total point motion (MTPM) (p < 0.01). The Oxford knee score improved significantly from poor before surgery (23.2) to good at follow-up (37.5–40.9).

Conclusions

The Sigma® UKA showed low implant migration and good clinical outcomes, suggesting that the Sigma UKA can be used in clinical practice. However, continuous migration was found in 30% of our patients which could indicate a risk of later revision surgery in this group.

Level of evidence

II.

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References

  1. Baker PN, Petheram T, Jameson SS, Avery PJ, Reed MR, Gregg PJ et al (2012) Comparison of patient-reported outcome measures following total and unicondylar knee replacement. J Bone Jt Surg Br 94:919–927

    Article  CAS  Google Scholar 

  2. Beard DJ, Harris K, Dawson J, Doll H, Murray DW, Carr AJ et al (2015) Meaningful changes for the Oxford hip and knee scores after joint replacement surgery. J Clin Epidemiol 68:73–79

    Article  PubMed  PubMed Central  Google Scholar 

  3. Bryant D, Havey TC, Roberts R, Guyatt G (2006) How many patients? How many limbs? Analysis of patients or limbs in the orthopaedic literature: a systematic review. J Bone Jt Surg Am 88:41–45

    Google Scholar 

  4. Cheng T, Chen D, Zhu C, Pan X, Mao X, Guo Y et al (2013) Fixed- versus mobile-bearing unicondylar knee arthroplasty: are failure modes different? Knee Surg Sports Traumatol Arthrosc 21:2433–2441

    Article  PubMed  Google Scholar 

  5. Danish Knee Arthroplasty Register-Annual Report (2016). https://www.sundhed.dk/content/cms/99/4699_dkr-rapport-2016.pdf

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

    Article  CAS  Google Scholar 

  7. DePuy International Ltd. (2009) Sigma high performance partial knee: unicondylar technical monograph. In: Ltd DI (ed) 9075–67-000 version 1 ed

  8. Ejaz A, Laursen AC, Jakobsen T, Rasmussen S, Nielsen PT, Laursen MB (2015) Absence of a tourniquet does not affect fixation of cemented TKA: a randomized RSA study of 70 patients. J Arthroplasty 30:2128–2132

    Article  PubMed  Google Scholar 

  9. Ensini A, Barbadoro P, Leardini A, Catani F, Giannini S (2013) Early migration of the cemented tibial component of unicompartmental knee arthroplasty: a radiostereometry study. Knee Surg Sports Traumatol Arthrosc 21:2474–2479

    Article  PubMed  Google Scholar 

  10. Judge A, Arden NK, Kiran A, Price A, Javaid MK, Beard D et al (2012) Interpretation of patient-reported outcomes for hip and knee replacement surgery: identification of thresholds associated with satisfaction with surgery. J Bone Jt Surg Br 94:412–418

    Article  CAS  Google Scholar 

  11. Kalairajah Y, Azurza K, Hulme C, Molloy S, Drabu KJ (2005) Health outcome measures in the evaluation of total hip arthroplasties—a comparison between the Harris hip score and the Oxford hip score. J Arthroplasty 20:1037–1041

    Article  PubMed  Google Scholar 

  12. Kendrick BJ, Kaptein BL, Valstar ER, Gill HS, Jackson WF, Dodd CA et al (2015) Cemented versus cementless Oxford unicompartmental knee arthroplasty using radiostereometric analysis: a randomised controlled trial. Bone J t J 97-B:185–191

    Article  CAS  Google Scholar 

  13. Larsen K, Hansen TB, Thomsen PB, Christiansen T, Soballe K (2009) Cost-effectiveness of accelerated perioperative care and rehabilitation after total hip and knee arthroplasty. J Bone Jt Surg Am 91:761–772

    Article  Google Scholar 

  14. Larsen K, Sorensen OG, Hansen TB, Thomsen PB, Soballe K (2008) Accelerated perioperative care and rehabilitation intervention for hip and knee replacement is effective: a randomized clinical trial involving 87 patients with 3 months of follow-up. Acta Orthop 79:149–159

    Article  PubMed  Google Scholar 

  15. Malchau H (2000) Introducing new technology: a stepwise algorithm. Spine (Phila Pa 1976) 25:285

    Article  CAS  Google Scholar 

  16. Molt M, Ljung P, Toksvig-Larsen S (2012) Does a new knee design perform as well as the design it replaces? Bone Jt Res 1:315–323

    Article  CAS  Google Scholar 

  17. Molt M, Ryd L, Toksvig-Larsen S (2016) A randomized RSA study concentrating especially on continuous migration. Acta Orthop 87:262–267

    Article  PubMed  PubMed Central  Google Scholar 

  18. Murray DW, Fitzpatrick R, Rogers K, Pandit H, Beard DJ, Carr AJ et al (2007) The use of the Oxford hip and knee scores. J Bone Jt Surg Br 89:1010–1014

    Article  CAS  Google Scholar 

  19. National Joint Registry for England, Wales, Northern Ireland and the Isle of Man (2016) 13th Annual Report. http://www.njrreports.org.uk/Portals/0/PDFdownloads/NJR%2013th%20Annual%20Report%202016.pdf

  20. National Joint Replacement Registry, Australian Orthopaedic Association (2016) Hip, Knee and Shoulder Arthroplasty, Annual Report. https://aoanjrr.sahmri.com/documents/10180/275066/Hip%2C%20Knee%20%26%20Shoulder%20Arthroplasty

  21. Nelissen RG, Pijls BG, Karrholm J, Malchau H, Nieuwenhuijse MJ, Valstar ER (2011) RSA and registries: the quest for phased introduction of new implants. J Bone Jt Surg Am 93(Suppl 3):62–65

    Article  Google Scholar 

  22. Pandit H, Jenkins C, Gill HS, Barker K, Dodd CA, Murray DW (2011) Minimally invasive Oxford phase 3 unicompartmental knee replacement: results of 1000 cases. J Bone Jt Surg Br 93:198–204

    Article  CAS  Google Scholar 

  23. Pearse AJ, Hooper GJ, Rothwell A, Frampton C (2010) Survival and functional outcome after revision of a unicompartmental to a total knee replacement: the New Zealand National Joint Registry. J Bone Jt Surg Br 92:508–512

    Article  CAS  Google Scholar 

  24. Peersman G, Stuyts B, Vandenlangenbergh T, Cartier P, Fennema P (2015) Fixed- versus mobile-bearing UKA: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 23:3296–3305

    Article  PubMed  Google Scholar 

  25. Pijls BG, Nelissen RG (2016) The era of phased introduction of new implants. Bone Jt Res 5:215–217

    Article  CAS  Google Scholar 

  26. Pijls BG, Valstar ER, Kaptein BL, Nelissen RG (2012) Differences in long-term fixation between mobile-bearing and fixed-bearing knee prostheses at ten to 12 years’ follow-up: a single-blinded randomised controlled radiostereometric trial. J Bone Jt Surg Br 94:1366–1371

    Article  CAS  Google Scholar 

  27. Pijls BG, Valstar ER, Nouta KA, Plevier JW, Fiocco M, Middeldorp S et al (2012) Early migration of tibial components is associated with late revision: a systematic review and meta-analysis of 21,000 knee arthroplasties. Acta Orthop 83:614–624

    Article  PubMed  PubMed Central  Google Scholar 

  28. Ranstam J (2012) Repeated measurements, bilateral observations and pseudoreplicates, why does it matter? Osteoarthritis Cartilage 20:473–475

    Article  PubMed  CAS  Google Scholar 

  29. Rothwell AG, Hooper GJ, Hobbs A, Frampton CM (2010) An analysis of the Oxford hip and knee scores and their relationship to early joint revision in the New Zealand Joint Registry. J Bone Jt Surg Br 92:413–418

    Article  CAS  Google Scholar 

  30. Ryd L, Albrektsson BE, Carlsson L, Dansgard F, Herberts P, Lindstrand A et al (1995) Roentgen stereophotogrammetric analysis as a predictor of mechanical loosening of knee prostheses. J Bone Jt Surg Br 77:377–383

    Article  CAS  Google Scholar 

  31. Stilling M, Madsen F, Odgaard A, Romer L, Andersen NT, Rahbek O et al (2011) Superior fixation of pegged trabecular metal over screw-fixed pegged porous titanium fiber mesh: a randomized clinical RSA study on cementless tibial components. Acta Orthop 82:177–186

    Article  PubMed  PubMed Central  Google Scholar 

  32. The New Zealand Joint Registry (2016) Seventeen year report, January 1999 to December 2015. https://nzoa.org.nz/system/files/NZJR%2017%20year%20Report.pdf

  33. Tjornild M, Soballe K, Hansen PM, Holm C, Stilling M (2015) Mobile- vs. fixed-bearing total knee replacement. Acta Orthop 86:208–214

    Article  PubMed  PubMed Central  Google Scholar 

  34. Valstar ER, Gill R, Ryd L, Flivik G, Borlin N, Karrholm J (2005) Guidelines for standardization of radiostereometry (RSA) of implants. Acta Orthop 76:563–572

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Orthopedic Department, University Clinic for Hand, Hip and Knee Surgery, Hospital Unit West, Lægårdvej 12, 7500, Holstebro, Denmark

    Daan Koppens, Maiken Stilling, Jesper Dalsgaard & Torben Bæk Hansen

  2. Orthopedic Department, Regional Hospital of Northern Jutland, Barfredsvej 83, 9900, Frederikshavn, Denmark

    Stig Munk

  3. Orthopedic Department, Aarhus University Hospital, Nørrebrogade 44, 8000, Aarhus C, Denmark

    Søren Rytter & Ole Gade Sørensen

Authors
  1. Daan Koppens
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  2. Maiken Stilling
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  4. Jesper Dalsgaard
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  6. Ole Gade Sørensen
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Contributions

DK participated in the design of the study, performed the statistical analysis and drafted the manuscript. MS participated in the design of the study, contributed to the statistical analysis and interpretation and critical revision of the manuscript. SM participated in the conception and design of the study and data acquisition. JD participated in data acquisition. SR participated in data interpretation and critical revision of the manuscript. OGS participated in critical revision of the manuscript. TBH participated in the conception and design of the study, data interpretation and critical revision of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Daan Koppens.

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Conflict of interest

DK received a grant of the Health Research Fund of Central Denmark Region. The other authors had no conflicts of interest.

Funding

The authors received no financial support for the research, authorship, and/or this article.

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Koppens, D., Stilling, M., Munk, S. et al. Low implant migration of the SIGMA® medial unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 26, 1776–1785 (2018). https://doi.org/10.1007/s00167-017-4782-5

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  • DOI: https://doi.org/10.1007/s00167-017-4782-5

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