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Knee Surgery, Sports Traumatology, Arthroscopy

Published in:

01-05-2019 | KNEE

Minimally invasive Oxford unicompartmental knee arthroplasty ensures excellent functional outcome and high survivorship in the long term

Authors: Tilman Walker, Pit Hetto, Thomas Bruckner, Tobias Gotterbarm, Christian Merle, Benjamin Panzram, Moritz M. Innmann, Babak Moradi

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 5/2019

Abstract

Purpose

Whether unicompartimental or total knee arthroplasty is superior for treatment of anteromedial knee osteoarthritis, is still uncertain. Therefore, the purpose of this study was to evaluate clinical and radiological outcome as well as long-term survivorship of medial Oxford unicompartmental knee arthroplasty (OUKA) at an independent center with a minimum follow-up of 10 years.

Methods

This single-center retrospective cohort study reports the 10–15 years follow-up results of 113 consecutive patients (126 knees) after medial OUKA. Survivorship analysis was performed with several different endpoints and clinical outcome was measured using the Oxford Knee Score (OKS), American Knee Society Score (AKSS-O), range of motion (ROM), Tegner activity score and UCLA score. Radiological analysis was performed with focus on progression of arthritis in the lateral compartment.

Results

A total of 16 patients (16 knees) underwent revision surgery resulting in a survival rate of 92.4% at 10 years and 88.6% at 15 years with the endpoint device-related revisions. The main reason for revision surgery was progression of arthritis in five patients (31.3%) followed by persistency of pain in three patients (18.7%). Clinical outcome was good to excellent with an OKS of 39.9 at 11 years, an AKSS-O of 89.3 and a mean range of motion of 122°. The radiological analysis revealed a significant progression of degenerative changes in the lateral compartment, however without any impact on the functional outcome.

Conclusion

Oxford UKA of the medial compartment ensures good long-term survivorship with an excellent functional outcome. Therefore, the results of this study support the continued use of OUKA in patients with anteromedial osteoarthritis.

Level of evidence

Retrospective cohort study, Level III.

Alnachoukati OK, Barrington JW, Berend KR, Kolczun MC, Emerson RH, Lombardi AV et al (2018) Eight hundred twenty-five medial mobile-bearing unicompartmental knee arthroplasties: the first 10-year US multi-center survival analysis. J Arthroplasty 33:677–683CrossRefPubMed

Arirachakaran A, Choowit P, Putananon C, Muangsiri S, Kongtharvonskul J (2015) Is unicompartmental knee arthroplasty (UKA) superior to total knee arthroplasty (TKA)? A systematic review and meta-analysis of randomized controlled trial. Eur J Orthop Surg Traumatol 25:799–806CrossRefPubMed

Beard DJ, Pandit H, Gill HS, Hollinghurst D, Dodd CA, Murray DW (2007) The influence of the presence and severity of pre-existing patellofemoral degenerative changes on the outcome of the Oxford medial unicompartmental knee replacement. J Bone Joint Surg Br 89:1597–1601CrossRefPubMed

Burn E, Sanchez-Santos MT, Pandit HG, Hamilton TW, Liddle AD, Murray DW et al (2018) 10-year patient-reported outcomes following total and minimally invasive unicompartmental knee arthroplasty: a propensity score-matched cohort analysis. Knee Surg Sports Traumatol Arthrosc 26:1455–1464CrossRefPubMed

Campi S, Pandit H, Hooper G, Snell D, Jenkins C, Dodd CAF et al (2018) 10-year survival and seven-year functional results of cementless Oxford unicompartmental knee replacement: a prospective consecutive series of our first 1000 cases. Knee. https://doi.org/10.1016/j.knee.2018.07.012 CrossRefPubMed

Faour-Martin O, Valverde-Garcia JA, Martin-Ferrero MA, Vega-Castrillo A, de la Red Gallego MA, de Suarez Puga CC et al (2013) Oxford phase 3 unicondylar knee arthroplasty through a minimally invasive approach: long-term results. Int Orthop 37:833–838CrossRefPubMedPubMedCentral

Fisher N, Agarwal M, Reuben SF, Johnson DS, Turner PG (2006) Sporting and physical activity following Oxford medial unicompartmental knee arthroplasty. Knee 13:296–300CrossRefPubMed

Koskinen E, Paavolainen P, Eskelinen A, Pulkkinen P, Remes V (2007) Unicondylar knee replacement for primary osteoarthritis: a prospective follow-up study of 1819 patients from the Finnish Arthroplasty Register. Acta Orthop 78:128–135CrossRefPubMed

Liddle AD, Judge A, Pandit H, Murray DW (2014) Adverse outcomes after total and unicompartmental knee replacement in 101,330 matched patients: a study of data from the National Joint Registry for England and Wales. Lancet 384:1437–1445CrossRefPubMed

10.

Lisowski LA, Meijer LI, Bekerom MP, Pilot P, Lisowski AE (2016) 10- to 15-year results of the Oxford Phase III mobile unicompartmental knee arthroplasty: a prospective study from a non-designer group. Bone Joint J 98-B:41–47CrossRefPubMedPubMedCentral

11.

Mohammad HR, Strickland L, Hamilton TW, Murray DW (2018) Long-term outcomes of over 8000 medial Oxford Phase 3 unicompartmental knees—a systematic review. Acta Orthop 89:101–107CrossRefPubMed

12.

Murray DW, Liddle AD, Dodd CA, Pandit H (2015) Unicompartmental knee arthroplasty: is the glass half full or half empty? Bone Joint J 97-B:3–8CrossRefPubMedPubMedCentral

13.

Naal FD, Fischer M, Preuss A, Goldhahn J, von Knoch F, Preiss S et al (2007) Return to sports and recreational activity after unicompartmental knee arthroplasty. Am J Sports Med 35:1688–1695CrossRefPubMed

14.

Pandit H, Hamilton TW, Jenkins C, Mellon SJ, Dodd CA, Murray DW (2015) The clinical outcome of minimally invasive Phase 3 Oxford unicompartmental knee arthroplasty: a 15-year follow-up of 1000 UKAs. Bone Joint J 97-B:1493–1500CrossRefPubMed

15.

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 Joint Surg Br 93:198–204CrossRefPubMed

16.

Price AJ, Rees JL, Beard DJ, Gill RH, Dodd CA, Murray DM (2004) Sagittal plane kinematics of a mobile-bearing unicompartmental knee arthroplasty at 10 years: a comparative in vivo fluoroscopic analysis. J Arthroplasty 19:590–597CrossRefPubMed

17.

Price AJ, Webb J, Topf H, Dodd CA, Goodfellow JW, Murray DW et al (2001) Rapid recovery after oxford unicompartmental arthroplasty through a short incision. J Arthroplasty 16:970–976CrossRefPubMed

18.

Schroer WC, Barnes CL, Diesfeld P, LeMarr A, Ingrassia R, Morton DJ et al (2013) The oxford unicompartmental knee fails at a high rate in a high-volume knee practice. Clin Orthop Relat Res 471:3533–3539CrossRefPubMedPubMedCentral

19.

Scott CE, Howie CR, MacDonald D, Biant LC (2010) Predicting dissatisfaction following total knee replacement: a prospective study of 1217 patients. J Bone Joint Surg Br 92:1253–1258CrossRefPubMed

20.

Vorlat P, Putzeys G, Cottenie D, Van Isacker T, Pouliart N, Handelberg F et al (2006) The Oxford unicompartmental knee prosthesis: an independent 10-year survival analysis. Knee Surg Sports Traumatol Arthrosc 14:40–45CrossRefPubMed

21.

Walker T, Gotterbarm T, Bruckner T, Merle C, Streit MR (2014) Total versus unicompartmental knee replacement for isolated lateral osteoarthritis: a matched-pairs study. Int Orthop 38:2259–2264CrossRefPubMed

22.

Walker T, Streit J, Gotterbarm T, Bruckner T, Merle C, Streit MR (2015) Sports, physical activity and patient-reported outcomes after medial unicompartmental knee arthroplasty in young patients. J Arthroplasty 30:1911–1916CrossRefPubMed

23.

Willis-Owen CA, Brust K, Alsop H, Miraldo M, Cobb JP (2009) Unicondylar knee arthroplasty in the UK National Health Service: an analysis of candidacy, outcome and cost efficacy. Knee 16:473–478CrossRefPubMed

Title: Minimally invasive Oxford unicompartmental knee arthroplasty ensures excellent functional outcome and high survivorship in the long term
Authors: Tilman Walker
Pit Hetto
Thomas Bruckner
Tobias Gotterbarm
Christian Merle
Benjamin Panzram
Moritz M. Innmann
Babak Moradi
Publication date: 01-05-2019
Publisher: Springer Berlin Heidelberg
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 5/2019
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-018-5299-2

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Minimally invasive Oxford unicompartmental knee arthroplasty ensures excellent functional outcome and high survivorship in the long term

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

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