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Archives of Orthopaedic and Trauma Surgery
Published in: Archives of Orthopaedic and Trauma Surgery 3/2019

01-03-2019 | Osteoarthrosis | Knee Arthroplasty

Does unicompartmental knee arthroplasty have worse outcomes in spontaneous osteonecrosis of the knee than in medial compartment osteoarthritis? A systematic review and meta-analysis

Authors: Chan Yoon, Moon Jong Chang, Chong Bum Chang, Ji Hye Choi, Seung Ah Lee, Seung-Baik Kang

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 3/2019

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Abstract

Introduction

The role of unicompartmental knee arthroplasty (UKA) in spontaneous osteonecrosis of the knee (SONK) remains controversial, even though SONK involves only one compartment of the knee joint. We aimed to compare the survival rate and clinical outcomes of UKA in SONK and medial compartment osteoarthritis (MOA) via a meta-analysis of previous studies.

Materials and methods

MEDLINE, Embase, and Cochrane Library were searched up to January 2018 with keywords related to SONK and knee arthroplasty. Studies were selected with predetermined inclusion criteria: (1) medial UKA as the primary procedure, (2) reporting implant survival or clinical outcomes of osteonecrosis and osteoarthritis, and (3) follow-up period > 1 year. Quality assessment was performed using the risk of bias assessment tool for non-randomized studies. A random-effects model was used to estimate the pooled relative risk (RR) and standardized mean difference.

Results

The incidence of UKA revision for any reason was significantly higher in SONK than in MOA group (pooled RR = 1.83, p = 0.009). However, the risk of revision due to aseptic loosening was not significantly different between the groups. Moreover, when stratified by the study quality, high-quality studies showed similar risk of overall revision in SONK and MOA (p = 0.71). Subgroup analysis revealed no significant difference in failure between SONK and MOA after cemented mobile and fixed bearing UKA. Results of uncemented UKA were reported only in one study, which showed higher failure of SONK compared to MOA. Clinical outcomes after UKA were similar between SONK and MOA (p = 0.66).

Conclusions

Cemented UKA has similar survival and clinical outcomes in SONK and MOA. Prospective studies designed specifically to compare the UKA outcomes in SONK and MOA are necessary.
Appendix
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Literature
1.
Pape D, Seil R, Fritsch E, Rupp S, Kohn D (2002) Prevalence of spontaneous osteonecrosis of the medial femoral condyle in elderly patients. Knee Surg Sports Traumatol Arthrosc 10:233–240CrossRefPubMed
2.
Mont MA, Marker DR, Zywiel MG, Carrino JA (2011) Osteonecrosis of the knee and related conditions. J Am Acad Orthop Surg 19:482–494CrossRefPubMed
3.
Yamamoto T, Bullough PG (2000) Spontaneous osteonecrosis of the knee: the result of subchondral insufficiency fracture. J Bone Joint Surg Am 82:858–866CrossRefPubMed
4.
Myers TG, Cui Q, Kuskowski M, Mihalko WM, Saleh KJ (2006) Outcomes of total and unicompartmental knee arthroplasty for secondary and spontaneous osteonecrosis of the knee. J Bone Joint Surg Am 88:76–82PubMed
5.
Radke S, Wollmerstedt N, Bischoff A, Eulert J (2005) Knee arthroplasty for spontaneous osteonecrosis of the knee: unicompartimental vs bicompartimental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 13:158–162CrossRefPubMed
6.
Pandit H, Jenkins C, Barker K, Dodd CAF, Murray DW (2006) The Oxford medial unicompartmental knee replacement using a minimally-invasive approach. J Bone Joint Surg Br 88:54–60CrossRefPubMed
7.
Servien E, Verdonk PC, Lustig S, Paillot JL, Kara AD, Neyret P (2008) Medial unicompartimental knee arthroplasty for osteonecrosis or osteoarthritis. Knee Surg Sports Traumatol Arthrosc 16:1038–1042CrossRefPubMed
8.
Bruni D, Zaffagnini S, Iacono F, Bragonzoni L, Lo Presti M, Neri MP, Muccioli GM, Nitri M, Raspugli G, Marcacci M (2016) High rate of implant loosening for uncemented resurfacing-type medial unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 24:3175–3182CrossRefPubMed
9.
Langdown AJ, Pandit H, Price AJ, Dodd CAF, Murray DW, Svärd UCG, Gibbons CL (2005) Oxford medial unicompartmental arthroplasty for focal spontaneous osteonecrosis of the knee. Acta Orthop 76:688–692CrossRefPubMed
10.
Heller S, Fenichel I, Salai M, Luria T, Velkes S (2009) The Oxford unicompartmental knee prosthesis for the treatment of medial compartment knee disease: 2 to 5 year follow-up. Isr Med Assoc J 11:266–268PubMed
11.
Xue H, Tu Y, Ma T, Wen T, Yang T, Cai M (2017) Up to twelve year follow-up of the Oxford phase three unicompartmental knee replacement in China: seven hundred and eight knees from an independent centre. Int Orthop 41:1571–1577CrossRefPubMed
12.
Lustig S, Paillot JL, Servien E, Henry J, Selmi TA, Neyret P (2009) Cemented all polyethylene tibial insert unicompartimental knee arthroplasty: a long term follow-up study. Orthop Traumatol Surg Res 95:12–21CrossRefPubMed
13.
Cartier P, Cheaib S (1987) Unicondylar knee arthroplasty: 2–10 years of follow-up evaluation. J Arthroplasty 2:157–162CrossRefPubMed
14.
Moher D, Liberati A, Tetzlaff J, Altman DG, Group P (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6:e1000097CrossRefPubMedPubMedCentral
15.
Kim SY, Park JE, Lee YJ, Seo HJ, Sheen SS, Hahn S, Jang BH, Son HJ (2013) Testing a tool for assessing the risk of bias for nonrandomized studies showed moderate reliability and promising validity. J Clin Epidemiol 66:408–414CrossRefPubMed
16.
Bruni D, Iacono F, Russo A, Zaffagnini S, Marcheggiani Muccioli GM, Bignozzi S, Bragonzoni L, Marcacci M (2010) Minimally invasive unicompartmental knee replacement: retrospective clinical and radiographic evaluation of 83 patients. Knee Surg Sports Traumatol Arthrosc 18:710–717CrossRefPubMed
17.
Bruni D, Gagliardi M, Akkawi I, Raspugli GF, Bignozzi S, Marko T, Bragonzoni L, Grassi A, Marcacci M (2016) Good survivorship of all-polyethylene tibial component UKA at long-term follow-up. Knee Surg Sports Traumatol Arthrosc 24:182–187CrossRefPubMed
18.
Zhang Q, Guo W, Liu Z, Cheng L, Yue D, Zhang N (2015) Minimally invasive unicompartmental knee arthroplasty in treatment of osteonecrosis versus osteoarthritis: a matched-pair comparison. Acta Orthop Belg 81:333–339PubMed
19.
Zermatten P, Munzinger U (2012) The Oxford II medial unicompartmental knee arthroplasty: an independent 10-year survival study. Acta Orthop Belg 78:203–209PubMed
20.
21.
Ma T, Tu Y, Xue H, Wen T, Mei J (2017) Unicompartmental knee arthroplasty for spontaneous osteonecrosis. J Orthop Surg (Hong Kong) 25:1–5
22.
Collins NJ, Misra D, Felson DT, Crossley KM, Roos EM (2011) Measures of knee function: International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, Knee Injury and Osteoarthritis Outcome Score (KOOS), Knee Injury and Osteoarthritis Outcome Score Physical Function Short Form (KOOS-PS), Knee Outcome Survey Activities of Daily Living Scale (KOS-ADL), Lysholm Knee Scoring Scale, Oxford Knee Score (OKS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Activity Rating Scale (ARS), and Tegner Activity Score (TAS). Arthritis Care Res 63:S208–S228CrossRef
23.
Zuiderbaan HA, van der List JP, Khamaisy S, Nawabi DH, Thein R, Ishmael C, Paul S, Pearle AD (2017) Unicompartmental knee arthroplasty versus total knee arthroplasty: which type of artificial joint do patients forget? Knee Surg Sports Traumatol Arthrosc 25:681–686CrossRefPubMed
24.
Canetti R, Batailler C, Bankhead C, Neyret P, Servien E, Lustig S (2018) Faster return to sport after robotic-assisted lateral unicompartmental knee arthroplasty: a comparative study. Arch Orthop Trauma Surg 138:1765–1771CrossRefPubMed
25.
Bini SA, Cafri G, Khatod M (2017) Midterm-adjusted survival comparing the best performing unicompartmental and total knee arthroplasties in a registry. J Arthroplasty 32:3352–3355CrossRefPubMed
26.
Siman H, Kamath AF, Carrillo N, Harmsen WS, Pagnano MW, Sierra RJ (2017) Unicompartmental knee arthroplasty vs total knee arthroplasty for medial compartment arthritis in patients older than 75 years: comparable reoperation, revision, and complication rates. J Arthroplasty 32:1792–1797CrossRefPubMed
27.
Koskinen E, Eskelinen A, Paavolainen P, Pulkkinen P, Remes V (2008) Comparison of survival and cost-effectiveness between unicondylar arthroplasty and total knee arthroplasty in patients with primary osteoarthritis: a follow-up study of 50,493 knee replacements from the Finnish Arthroplasty Register. Acta Orthop 79:499–507CrossRefPubMed
28.
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
29.
Heyse TJ, Khefacha A, Fuchs-Winkelmann S, Cartier P (2011) UKA after spontaneous osteonecrosis of the knee: a retrospective analysis. Arch Orthop Trauma Surg 131:613–617CrossRefPubMed
30.
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 470:1442–1451CrossRefPubMedPubMedCentral
31.
Parratte S, Argenson JNA, Dumas J, Aubaniac JM (2007) Unicompartmental knee arthroplasty for avascular osteonecrosis. Clin Orthop Rel Res 464:37–42
32.
Scott CE, Wade FA, MacDonald D, Nutton RW (2018) Ten-year survival and patient-reported outcomes of a medial unicompartmental knee arthroplasty incorporating an all-polyethylene tibial component. Arch Orthop Trauma Surg 138:719–729CrossRefPubMedPubMedCentral
33.
Antoniadis A, Dimitriou D, Canciani JP, Helmy N (2018) A novel preoperative scoring system for the indication of unicompartmental knee arthroplasty, as predictor of clinical outcome and satisfaction. Arch Orthop Trauma Surg 1–8
34.
Mears SC, McCarthy EF, Jones LC, Hungerford DS, Mont MA (2009) Characterization and pathological characteristics of spontaneous osteonecrosis of the knee. Iowa Orthop J 29:38–42PubMedPubMedCentral
35.
Ramnath RR, Kattapuram SV (2004) MR appearance of SONK-like subchondral abnormalities in the adult knee: SONK redefined. Skeletal Radiol 33:575–581CrossRefPubMed
36.
Graham J, Ries M, Pruitt L (2003) Effect of bone porosity on the mechanical integrity of the bone-cement interface. J Bone Joint Surg Am 85:1901–1908CrossRefPubMed
37.
Debi R, Elbaz A, Mor A, Kahn G, Peskin B, Beer Y, Agar G, Morag G, Segal G (2017) Knee osteoarthritis, degenerative meniscal lesion and osteonecrosis of the knee: Can a simple gait test direct us to a better clinical diagnosis. Orthop Traumatol Surg Res 103:603–608CrossRefPubMed
38.
Hernigou P, Deschamps G (2002) Patellar impingement following unicompartmental arthroplasty. J Bone Joint Surg Am 84:1132–1137CrossRefPubMed
Metadata
Title
Does unicompartmental knee arthroplasty have worse outcomes in spontaneous osteonecrosis of the knee than in medial compartment osteoarthritis? A systematic review and meta-analysis
Authors
Chan Yoon
Moon Jong Chang
Chong Bum Chang
Ji Hye Choi
Seung Ah Lee
Seung-Baik Kang
Publication date
01-03-2019
Publisher
Springer Berlin Heidelberg
Published in
Archives of Orthopaedic and Trauma Surgery / Issue 3/2019
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI
https://doi.org/10.1007/s00402-019-03125-7

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