Top

Knee Surgery, Sports Traumatology, Arthroscopy

Published in:

Open Access 24-04-2023 | Osteoarthrosis | KNEE

Fixed-bearing is superior to mobile-bearing in lateral unicompartmental knee replacement: a retrospective matched-pairs analysis

Authors: Mustafa Hariri, Niklas Zahn, Paul Mick, Ayham Jaber, Tobias Reiner, Tobias Renkawitz, Moritz Innmann, Tilman Walker

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 9/2023

Abstract

Purpose

Due to low incidence of isolated lateral osteoarthritis (OA), there are limited data on whether a fixed-bearing (FB) or a mobile-bearing (MB) design is superior for lateral unicompartmental knee replacement (UKR). The aim of this matched-pairs analysis was to compare both designs in terms of implant survival and clinical outcome.

Methods

Patients who received MB-UKR (Group A) and FB-UKR (Group B) at a single centre were matched according to gender, age at time of surgery and body mass index (BMI). Survivorship analysis was performed with the endpoint set as “revision for any reason”. Clinical outcome was assessed using the Oxford knee score (OKS), visual analogue scale for pain (VAS), patients’ satisfaction, University of California Los Angeles activity scale (UCLA) and the Tegner activity score (TAS).

Results

A total of 60 matched pairs were included with a mean follow-up (FU) of 3.4 ± 1.3 (range 1.2–5.0) years in Group A and 2.7 ± 1.2 (range 1.0–5.0) years in Group B. Survivorship between both groups differed significantly (Group A: 78.7%; Group B: 98.3%, p = 0.003) with bearing dislocation being the most common reason for revision in Group A (46.2%). The relative and absolute risk reduction were 92.2% and 20%, respectively, with 5 being the number needed to treat. There were no differences in OKS (Group A: 41.6 ± 6.5; Group B: 40.4 ± 7.7), VAS (Group A: 2.9 ± 3.2; Group B: 1.6 ± 2.2), UCLA (Group A: 5.7 ± 1.3; Group B: 5.9 ± 1.8) and TAS (Group A: 3.0 ± 1.0; Group B: 3.1 ± 1.2) between both groups on follow-up.

Conclusion

Despite modern prosthesis design and surgical technique, implant survival of lateral MB-UKR is lower than that of FB-UKR on the short- to mid-term due to bearing dislocation as the most common cause of failure. Since clinical results are equivalent in both groups, FB-UKR should be preferred in treatment of isolated lateral OA.

Level of evidence

Retrospective case–control study, Level III.

Afghanyar Y, Klug A, Rehbein P, Dargel J, Drees P, Kutzner KP (2021) One-stage bilateral versus unilateral short-stem total hip arthroplasty: a matched-pair analysis of 216 hips. J Orthop 27:130–136PubMedPubMedCentralCrossRef

Argenson JN, Parratte S, Bertani A, Flecher X, Aubaniac JM (2008) Long-term results with a lateral unicondylar replacement. Clin Orthop Relat Res 466:2686–2693PubMedPubMedCentralCrossRef

Asadollahi S, Wilson HA, Thomson FR, Vaz K, Middleton R, Jenkins C et al (2022) Early results of fixed-bearing unicompartmental knee replacement designed for the lateral compartment. J Orthop Surg Res 17:146PubMedPubMedCentralCrossRef

Batailler C, White N, Ranaldi FM, Neyret P, Servien E, Lustig S (2019) Improved implant position and lower revision rate with robotic-assisted unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 27:1232–1240PubMedCrossRef

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

Burger JA, Kleeblad LJ, Sierevelt IN, Horstmann WG, Nolte PA (2019) Bearing design influences short- to mid-term survivorship, but not functional outcomes following lateral unicompartmental knee arthroplasty: a systematic review. Knee Surg Sports Traumatol Arthrosc 27:2276–2288PubMedCrossRef

Burger JA, Kleeblad LJ, Sierevelt IN, Horstmann WG, van Geenen RCI, van Steenbergen LN et al (2020) A comprehensive evaluation of lateral unicompartmental knee arthroplasty short to mid-term survivorship, and the effect of patient and implant characteristics: an analysis of data from the Dutch arthroplasty register. J Arthroplast 35:1813–1818CrossRef

Burnett RS, Nair R, Hall CA, Jacks DA, Pugh L, McAllister MM (2014) Results of the Oxford Phase 3 mobile bearing medial unicompartmental knee arthroplasty from an independent center: 467 knees at a mean 6-year follow-up: analysis of predictors of failure. J Arthroplast 29:193–200CrossRef

Fratini S, Meena A, Alesi D, Cammisa E, Zaffagnini S, MarcheggianiMuccioli GM (2022) Does implant design influence failure rate of lateral unicompartmental knee arthroplasty? A meta-analysis. J Arthroplast 37(985–992):e983

10.

Gaudiani MA, Samuel LT, Diana JN, DeBattista JL, Coon TM, Moore RE et al (2023) Robotic-arm assisted lateral unicompartmental knee arthroplasty: 5-Year outcomes & survivorship. J Orthop Surg (Hong Kong) 31:10225536221138986PubMedCrossRef

11.

Gulati A, Weston-Simons S, Evans D, Jenkins C, Gray H, Dodd CA et al (2014) Radiographic evaluation of factors affecting bearing dislocation in the domed lateral Oxford unicompartmental knee replacement. Knee 21:1254–1257PubMedCrossRef

12.

Gunther TV, Murray DW, Miller R, Wallace DA, Carr AJ, O’Connor JJ et al (1996) Lateral unicompartmental arthroplasty with the Oxford meniscal knee. Knee 3:33–39CrossRef

13.

Hariri M, Hagemann M, Mick P, Deisenhofer J, Panzram B, Innmann M et al (2023) Physical activity of young patients following minimally invasive lateral unicompartmental knee replacement. J Clin Med 12:635PubMedPubMedCentralCrossRef

14.

Hariri M, Hauer G, Smolle M, Sadoghi P, Leithner A, Panzram B et al (2022) Mobile bearing versus fixed bearing medial unicompartmental knee replacement: an independent two center matched-pairs analysis. Arch Orthop Trauma Surg. https://doi.org/10.1007/s00402-022-04629-5CrossRefPubMedPubMedCentral

15.

Heckmann ND, Antonios JK, Chen XT, Kang HP, Chung BC, Piple AS et al (2022) Midterm survivorship of robotic-assisted lateral unicompartmental knee arthroplasty. J Arthroplast 37:831–836CrossRef

16.

Kahlenberg CA, Richardson SS, Gruskay JA, Cross MB (2021) Trends in utilization of total and unicompartmental knee arthroplasty in the United States. J Knee Surg 34:1138–1141PubMedCrossRef

17.

Kennedy JA, Mohammad HR, Yang I, Mellon SJ, Dodd CAF, Pandit HG et al (2020) Oxford domed lateral unicompartmental knee arthroplasty. Bone Jt J 102-B:1033–1040CrossRef

18.

Kerens B, Boonen B, Schotanus MG, Lacroix H, Emans PJ, Kort NP (2013) Revision from unicompartmental to total knee replacement: the clinical outcome depends on reason for revision. Bone Jt J 95-B:1204–1208CrossRef

19.

Kozinn SC, Scott R (1989) Unicondylar knee arthroplasty. J Bone Jt Surg Am 71:145–150CrossRef

20.

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 384:1437–1445PubMedCrossRef

21.

Liddle AD, Pandit H, Judge A, Murray DW (2015) Patient-reported outcomes after total and unicompartmental knee arthroplasty: a study of 14,076 matched patients from the National Joint Registry for England and Wales. Bone Jt J 97-B:793–801CrossRef

22.

Lustig S, Lording T, Frank F, Debette C, Servien E, Neyret P (2014) Progression of medial osteoarthritis and long term results of lateral unicompartmental arthroplasty: 10 to 18 year follow-up of 54 consecutive implants. Knee 21(Suppl 1):S26-32PubMedCrossRef

23.

Maritan G, Franceschi G, Nardacchione R, Furlan E, Mariani I, Ursino N et al (2023) Similar survivorship at the 5-year follow-up comparing robotic-assisted and conventional lateral unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 31:1063–1071PubMedCrossRef

24.

Mohammad HR, Kennedy JA, Mellon SJ, Judge A, Dodd CA, Murray DW (2020) Ten-year clinical and radiographic results of 1000 cementless Oxford unicompartmental knee replacements. Knee Surg Sports Traumatol Arthrosc 28:1479–1487PubMedCrossRef

25.

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 89:101–107PubMedCrossRef

26.

Nakagawa S, Kadoya Y, Todo S, Kobayashi A, Sakamoto H, Freeman MA et al (2000) Tibiofemoral movement 3: full flexion in the living knee studied by MRI. J Bone Jt Surg Br 82:1199–1200CrossRef

27.

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 Jt J 97-B:1493–1500CrossRef

28.

Pandit H, Jenkins C, Beard DJ, Price AJ, Gill HS, Dodd CA et al (2010) Mobile bearing dislocation in lateral unicompartmental knee replacement. Knee 17:392–397PubMedCrossRef

29.

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 93:198–204CrossRef

30.

Pandit H, Jenkins C, Gill HS, Smith G, Price AJ, Dodd CA et al (2011) Unnecessary contraindications for mobile-bearing unicompartmental knee replacement. J Bone Jt Surg Br 93:622–628CrossRef

31.

Pennington DW, Swienckowski JJ, Lutes WB, Drake GN (2006) Lateral unicompartmental knee arthroplasty: survivorship and technical considerations at an average follow-up of 12.4 years. J Arthroplast 21:13–17CrossRef

32.

Robinson BJ, Rees JL, Price AJ, Beard DJ, Murray DW, McLardy Smith P et al (2002) Dislocation of the bearing of the Oxford lateral unicompartmental arthroplasty. A radiological assessment. J Bone Jt Surg Br 84:653–657CrossRef

33.

Sah AP, Scott RD (2007) Lateral unicompartmental knee arthroplasty through a medial approach. Study with an average five-year follow-up. J Bone Jt Surg Am 89:1948–1954CrossRef

34.

Schelfaut S, Beckers L, Verdonk P, Bellemans J, Victor J (2013) The risk of bearing dislocation in lateral unicompartmental knee arthroplasty using a mobile biconcave design. Knee Surg Sports Traumatol Arthrosc 21:2487–2494PubMedCrossRef

35.

Smith JR, Robinson JR, Porteous AJ, Murray JR, Hassaballa MA, Artz N et al (2014) Fixed bearing lateral unicompartmental knee arthroplasty–short to midterm survivorship and knee scores for 101 prostheses. Knee 21:843–847PubMedCrossRef

36.

Tay ML, Matthews BG, Monk AP, Young SW (2022) Disease progression, aseptic loosening and bearing dislocations are the main revision indications after lateral unicompartmental knee arthroplasty: a systematic review. J ISAKOS 7:132–141CrossRef

37.

Tokuhara Y, Kadoya Y, Nakagawa S, Kobayashi A, Takaoka K (2004) The flexion gap in normal knees. An MRI study. J Bone Jt Surg Br 86:1133–1136CrossRef

38.

Walker T, Gotterbarm T, Bruckner T, Merle C, Streit MR (2015) Return to sports, recreational activity and patient-reported outcomes after lateral unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 23:3281–3287PubMedCrossRef

39.

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 38:2259–2264PubMedCrossRef

40.

Walker T, Hariri M, Eckert J, Panzram B, Reiner T, Merle C et al (2020) Minimally invasive lateral unicompartmental knee replacement: early results from an independent center using the Oxford fixed lateral prosthesis. Knee 27:235–241PubMedCrossRef

41.

Walker T, Zahn N, Bruckner T, Streit MR, Mohr G, Aldinger PR et al (2018) Mid-term results of lateral unicondylar mobile bearing knee arthroplasty: a multicentre study of 363 cases. Bone Jt J 100-B:42–49CrossRef

42.

Weston-Simons JS, Pandit H, Kendrick BJ, Jenkins C, Barker K, Dodd CA et al (2014) The mid-term outcomes of the Oxford Domed Lateral unicompartmental knee replacement. Bone Jt J 96-B:59–64CrossRef

43.

Yang I, Hamilton TW, Mellon SJ, Murray DW (2021) Systematic review and meta-analysis of bearing dislocation in lateral meniscal bearing unicompartmental knee replacement: Domed versus flat tibial surface. Knee 28:214–228PubMedCrossRef

44.

Zahiri CA, Schmalzried TP, Szuszczewicz ES, Amstutz HC (1998) Assessing activity in joint replacement patients. J Arthroplast 13:890–895CrossRef

45.

Zimmerer A, Navas L, Kinkel S, Weiss S, Hauschild M, Miehlke W et al (2021) Sports activity and patient-related outcomes after fixed-bearing lateral unicompartmental knee arthroplasty. Knee 28:64–71PubMedCrossRef

Title: Fixed-bearing is superior to mobile-bearing in lateral unicompartmental knee replacement: a retrospective matched-pairs analysis
Authors: Mustafa Hariri
Niklas Zahn
Paul Mick
Ayham Jaber
Tobias Reiner
Tobias Renkawitz
Moritz Innmann
Tilman Walker
Publication date: 24-04-2023
Publisher: Springer Berlin Heidelberg
Keywords: Osteoarthrosis
Osteoarthrosis
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 9/2023
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-023-07417-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Fixed-bearing is superior to mobile-bearing in lateral unicompartmental knee replacement: a retrospective matched-pairs analysis

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

Please log in to get access to this content

Other articles of this Issue 9/2023

Patellofemoral arthroplasty with onlay prosthesis leads to higher rates of osteoarthritis progression than inlay design implants: a systematic review

The coronal plane alignment of the knee classification does not correlate with the functional knee phenotype classification

An MCL internal brace can withstand cyclic fatigue loading and produce a valgus load to failure similar to that of intact knees

Medial pivot design does not yield superior results compared to posterior-stabilised total knee arthroplasty: a systematic review and meta-analysis of randomised control trials

Functional scores and prosthetic implant placement are different for navigated medial UKA left in varus alignment

Health-economic evaluation of meniscus tear treatments: a systematic review