Top

Knee Surgery, Sports Traumatology, Arthroscopy

Published in:

01-04-2023 | Osteoarthrosis | KNEE

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

Authors: Adil Douiri, Nicolas Bouguennec, Alexandre Biset, Philippe Colombet, Pierre Laboudie, Nicolas Graveleau

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

Abstract

Purpose

The purpose of this study was to analyze the clinical outcomes and radiologic position of the knee in two groups of patients after medial unicompartmental knee arthroplasty (UKA): one group with residual varus axis (RVA) alignment and other one with neutral mechanical axis (NMA) of the lower limb.

Methods

All patients who underwent UKA between January 2015 and January 2018 were evaluated retrospectively. Inclusion criteria were: medial UKA for isolated medial femoro-tibial osteoarthritis, a varus deformity of < 15°, and a minimal follow-up of 2 years. All patients had a preoperative and postoperative clinical examination with functional scores (New International Knee Score (NewIKS) and Knee injury and Osteoarthritis Outcome Score (KOOS) and radiographs. Preoperative and postoperative values for continuous outcomes were compared using the Student’s t test for paired data and differences between the groups were compared with the Mann–Whitney U test. p < 0.05 was considered statistically significant.

Results

The RVA group consisted of 48 cases of medial UKA in 48 patients (22 females). Mean postoperative hip–knee–ankle (HKA) angle was 174.3° ± 2.8 and the corresponding mean AKI angle (tibial mechanical angle) was 82.9° ± 2.9. The NMA group consisted of 35 cases of medial UKA in 35 patients (14 females). Mean postoperative HKA angle was 178.9° ± 3 and the corresponding mean AKI angle was 85.5° ± 3.1. A significant difference was found between the two groups for the KOOS score and for global NewIKS, with a better score in the RVA group.

Conclusions

RVA alignment after medial UKA results in a significant improvement in functional knee scores at 2-year post-surgery. Return to sport and recreational activities was better than in patients with postoperative NMA.

Level of evidence

Level 3; retrospective cohort study.

Admin The New Knee Society Knee Scoring System. The Knee Society

Barrett WP, Scott RD (1987) Revision of failed unicondylar unicompartmental knee arthroplasty. J Bone Joint Surg Am 69:1328–1335CrossRefPubMed

Berger RA, Meneghini RM, Sheinkop MB, Della Valle CJ, Jacobs JJ, Rosenberg AG, Galante JO (2004) The progression of patellofemoral arthrosis after medial unicompartmental replacement: results at 11 to 15 years. Clin Orthop Relat Res 428:92–99CrossRef

Brazier J, Migaud H, Gougeon F, Cotten A, Fontaine C, Duquennoy A (1996) Evaluation of methods for radiographic measurement of the tibial slope. A study of 83 healthy knees. Rev Chir Orthop Reparatrice Appar Mot 82:195–200PubMed

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

Carlsson LV, Albrektsson BEJ, Regnér LR (2006) Minimally invasive surgery vs conventional exposure using the Miller-Galante unicompartmental knee arthroplasty: a randomized radiostereometric study. J Arthroplasty 21:151–156CrossRefPubMed

Cartier P, Sanouiller JL, Grelsamer RP (1996) Unicompartmental knee arthroplasty surgery. 10-year minimum follow-up period. J Arthroplasty 11:782–788CrossRefPubMed

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

Dugdale TW, Noyes FR, Styer D (1992) Preoperative planning for high tibial osteotomy. The effect of lateral tibiofemoral separation and tibiofemoral length. Clin Orthop Relat Res 274:248–264CrossRef

10.

Epinette J-A, Brunschweiler B, Mertl P, Mole D, Cazenave A, French Society for Hip and Knee (2012) Unicompartmental knee arthroplasty modes of failure: wear is not the main reason for failure: a multicentre study of 418 failed knees. Orthop Traumatol Surg Res 98:S124-130CrossRefPubMed

11.

Goodfellow JW, Kershaw CJ, Benson MK, O’Connor JJ (1988) The Oxford Knee for unicompartmental osteoarthritis. The first 103 cases. J Bone Joint Surg Br 70:692–701CrossRefPubMed

12.

Gulati A, Pandit H, Jenkins C, Chau R, Dodd CaF, Murray DW (2009) The effect of leg alignment on the outcome of unicompartmental knee replacement. J Bone Joint Surg Br 91:469–474CrossRefPubMed

13.

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

14.

Hirvasniemi J, Thevenot J, Guermazi A, Podlipská J, Roemer FW, Nieminen MT, Saarakkala S (2017) Differences in tibial subchondral bone structure evaluated using plain radiographs between knees with and without cartilage damage or bone marrow lesions—the Oulu Knee Osteoarthritis study. Eur Radiol 27:4874–4882CrossRefPubMedPubMedCentral

15.

Howell RE, Lombardi AV, Crilly R, Opolot S, Berend KR (2015) Unicompartmental knee arthroplasty: does a selection bias exist? J Arthroplasty 30:1740–1742CrossRefPubMed

16.

Innocenti B, Pianigiani S, Ramundo G, Thienpont E (2016) Biomechanical effects of different varus and valgus alignments in medial unicompartmental knee arthroplasty. J Arthroplasty 31:2685–2691CrossRefPubMed

17.

Jeer PJS, Keene GCR, Gill P (2004) Unicompartmental knee arthroplasty: an intermediate report of survivorship after the introduction of a new system with analysis of failures. Knee 11:369–374CrossRefPubMed

18.

Kim S-J, Bae J-H, Lim HC (2012) Factors affecting the postoperative limb alignment and clinical outcome after Oxford unicompartmental knee arthroplasty. J Arthroplasty 27:1210–1215CrossRefPubMed

19.

Klemme WR, Galvin EG, Petersen SA (1994) Unicompartmental knee arthroplasty. Sequential radiographic and scintigraphic imaging with an average five-year follow-up. Clin Orthop Relat Res 301:233–238CrossRef

20.

Koshino T, Morii T, Wada J, Takahashi S (1991) Unicompartmental replacement with the Marmor Modular knee: operative procedure and results. Bull Hosp Jt Dis Orthop Inst 51:119–131PubMed

21.

Lonner JH, Laird MT, Stuchin SA (1996) Effect of rotation and knee flexion on radiographic alignment in total knee arthroplasties. Clin Orthop Relat Res 331:102–106CrossRef

22.

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

23.

Mullaji AB, Marawar SV, Luthra M (2008) Tibial articular cartilage wear in varus osteoarthritic knees: correlation with anterior cruciate ligament integrity and severity of deformity. J Arthroplasty 23:128–135CrossRefPubMed

24.

Müller PE, Pellengahr C, Witt M, Kircher J, Refior HJ, Jansson V (2004) Influence of minimally invasive surgery on implant positioning and the functional outcome for medial unicompartmental knee arthroplasty. J Arthroplasty 19:296–301CrossRefPubMed

25.

Perlick L, Bäthis H, Tingart M, Perlick C, Lüring C, Grifka J (2004) Minimally invasive unicompartmental knee replacement with a nonimage-based navigation system. Int Orthop 28:193–197CrossRefPubMedPubMedCentral

26.

Ramadier JO, Buard JE, Lortat-Jacob A, Benoit J (1982) Radiological assessment of knee deformity in the frontal plane (author’s transl). Rev Chir Orthop Reparatrice Appar Mot 68:75–78PubMed

27.

Rivière C, Sivaloganathan S, Villet L, Cartier P, Lustig S, Vendittoli P-A, Cobb J (2022) Kinematic alignment of medial UKA is safe: a systematic review. Knee Surg Sports Traumatol Arthrosc 30:1082–1094CrossRefPubMed

28.

Roos EM, Lohmander LS (2003) The knee injury and osteoarthritis outcome score (KOOS): from joint injury to osteoarthritis. Health Qual Life Outcomes 1:64CrossRefPubMedPubMedCentral

29.

Scott RD (2006) Three decades of experience with unicompartmental knee arthroplasty: mistakes made and lessons learned. Orthopedics 29:829–831CrossRefPubMed

30.

Squire MW, Callaghan JJ, Goetz DD, Sullivan PM, Johnston RC (1999) Unicompartmental knee replacement. A minimum 15 year followup study. Clin Orthop Relat Res 367:61–72CrossRef

31.

Vaishya R, Vijay V, Birla VP, Agarwal AK (2016) Inter-observer variability and its correlation to experience in measurement of lower limb mechanical axis on long leg radiographs. J Clin Orthop Trauma 7:260–264CrossRefPubMedPubMedCentral

32.

Vasso M, Del Regno C, D’Amelio A, Viggiano D, Corona K, Schiavone Panni A (2015) Minor varus alignment provides better results than neutral alignment in medial UKA. Knee 22:117–121CrossRefPubMed

33.

Weale AE, Murray DW, Baines J, Newman JH (2000) Radiological changes five years after unicompartmental knee replacement. J Bone Joint Surg Br 82:996–1000CrossRefPubMed

34.

Wen P-F, Guo W-S, Gao F-Q, Zhang Q-D, Yue J-A, Cheng L-M, Zhu G-D (2017) Effects of lower limb alignment and tibial component inclination on the biomechanics of lateral compartment in unicompartmental knee arthroplasty. Chin Med J 130:2563–2568CrossRefPubMedPubMedCentral

35.

Squire MW, Callaghan JJ, Goetz DD, Sullivan PM, Johnston RC (1999) Unicompartmental knee replacement. A minimum 15 year followup study. Clin Orthop (367):61–72

Title: Functional scores and prosthetic implant placement are different for navigated medial UKA left in varus alignment
Authors: Adil Douiri
Nicolas Bouguennec
Alexandre Biset
Philippe Colombet
Pierre Laboudie
Nicolas Graveleau
Publication date: 01-04-2023
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/s00167-023-07388-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

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 9/2023

Independent of the preoperative coronal deformity, adjusted mechanical alignment leads in a high percentage to non-anatomical tibial and femoral bone cuts

Bicruciate-retaining total knee arthroplasty procedure reduced tensile force in the middle and posterior components of lateral collateral ligament during deep knee flexion activities with no effect on tensile force of the medial collateral ligament

The trochlear sulcus of the native knee is consistently orientated close to the sagittal plane despite variation in distal condylar anatomy

Rotator cuff repairs with all-suture tape anchors: no difference in outcomes between with or without all-suture tape anchors

Arthroscopic modified Broström procedure achieved similar favorable short term outcomes to open procedure for chronic lateral ankle instability cases with generalized joint laxity

MCL internal brace does not fully recapitulate normal MCL function in valgus stress