Disease progression, aseptic loosening and bearing dislocations are the main revision indications after lateral unicompartmental knee arthroplasty: a systematic review

Tay, Mei Lin; Matthews, Brya G.; Monk, Paul; Young, Simon W.

doi:10.1016/j.jisako.2022.06.001

Cited by 10 publications

(11 citation statements)

References 57 publications

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“…The findings of this study are consistent with the aforementioned systematic analyses, in which metal-backed FB-UKR showed lowest revision rates for lateral UKR [9,36].…”

Section: Discussionsupporting

confidence: 91%

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

Hariri

Zahn

Mick

et al. 2023

Knee Surg Sports Traumatol Arthrosc

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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.

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“…The findings of this study are consistent with the aforementioned systematic analyses, in which metal-backed FB-UKR showed lowest revision rates for lateral UKR [9,36].…”

Section: Discussionsupporting

confidence: 91%

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

Hariri

Zahn

Mick

et al. 2023

Knee Surg Sports Traumatol Arthrosc

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“…Mobile-bearing prostheses were initially introduced in an attempt to lower polyethylene wear; however, bearing dislocation remains a frequent indication for revision when they are used on the lateral side. 40 The lateral knee condylar is less constrained contributing to the underlying risk of bear dislocation for mobile-bearing implants, whereas fixed-bearing constructs reduce the complexity and improve the bearing instability. The introduction of 'domed' mobile-bearing tibial implants does not eliminate the change of bearing dislocation, albeit with a significantly reduced rate.…”

Section: Discussionmentioning

confidence: 99%

“…36,41 We observed no significant differences between bearing types in the analysis of long-term survival and one possible explanation for this might be that bearing dislocations were the common reason for early revision. 40 Another possible explanation for this is that a limited number of studies were included for analysis, representing an important issue for future research.…”

Section: Discussionmentioning

confidence: 99%

“…Our results, consistent with those of prior reviews, 38,39 indicated that mobile‐bearing lateral UKAs had significantly higher survival rates than their fix‐bearing counterparts with regards to early to mid‐term follow‐up (96–97% versus 92%–94%). Mobile‐bearing prostheses were initially introduced in an attempt to lower polyethylene wear; however, bearing dislocation remains a frequent indication for revision when they are used on the lateral side 40 . The lateral knee condylar is less constrained contributing to the underlying risk of bear dislocation for mobile‐bearing implants, whereas fixed‐bearing constructs reduce the complexity and improve the bearing instability.…”

Section: Discussionmentioning

confidence: 99%

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Survival of lateral unicompartmental knee arthroplasty at short‐, mid‐, and long‐term follow‐up: a systematic review and meta‐analysis

Wang

Mao

et al. 2023

ANZ Journal of Surgery

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Background: The infrequency of lateral unicompartmental knee arthroplasty (UKA) has led to a lack of understanding of its survival. This study aimed to systematically evaluate the survivorship results of lateral UKA at different follow-ups based on available literature. Methods: Five databases were searched for eligible studies. Pooled survivorships with 95% confidence intervals (CIs) at 3, 5, 10, 15, and 20 years after lateral UKA were estimated using a random-effect model. Subgroup and sensitivity analyses were performed. Results: A total of 26 studies involving 5470 lateral UKAs were included. Survivorships of lateral UKA at 3-, 5-, 10-, 15-, and 20-year follow-ups were 96% (95% CI: 95-98%, I 2 : 77.5%), 94% (95% CI: 93-96%, I 2 : 70.8%), 88% (95% CI: 84-91%, I 2 : 70.8%), 85% (95% CI: 79-91%, I 2 : 70.8%), and 78% (95% CI: 71-85%, I 2 : 54.2%), respectively. Subgroup analyses found that bearing type, the number of surgeons, and year of publication might be associated with implant survival outcomes. Conclusion: Lateral UKA is an effective procedure with excellent survivorships at short-, mid-, and long-term follow-ups. Results suggest a single-surgeon lateral UKA using fixedbearing. Additional well-designed studies are needed to elucidate the current findings.

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“…Postoperative knee alignment is also the most important factor that the surgeon can control and modify. A number of studies have demonstrated the correlation between postoperative knee alignment and clinical outcomes and UKA survival 8,9 . Therefore, the knee alignment axis after UKA has been used to measure UKA outcome and a risk factor for early failure.…”

Section: Introductionmentioning

confidence: 99%

Valgus Stress Radiograph Can Predict Alignment Change of Medial Mobile‐Bearing Unicompartmental Knee Arthroplasty

Jiao

et al. 2023

Orthopaedic Surgery

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Objective Finding reliable tools to predict alignment change after medial mobile‐bearing unicompartmental knee arthroplasty (UKA) can help surgeons avoid under‐ or over‐correction. This prospective study aimed to investigate whether the parameters related to medial collateral ligament tension on valgus stress radiograph can predict the alignment change of medial mobile‐bearing UKA and establish a prediction model. Methods This study prospectively included the patients undergoing medial mobile‐bearing UKA for knee osteoarthritis from November 2018 and April 2021. Patients took valgus stress radiograph and MRI preoperatively and took full‐length weight‐bearing anterior–posterior radiograph of the lower extremity preoperatively and postoperatively. The medial joint space width (MJSW) on valgus stress radiograph, area of femoral and tibial osteophyte on MRI, medial extrusion distance (MED) of the meniscus on MRI, and the change in hip‐knee‐ankle angle (∆HKAA) were measured. Factors influencing ∆HKAA were analyzed by correlation analysis. Univariable and multivariable linear regression analysis was performed to establish a prediction model of ∆HKAA. Results One hundred and seven knees were included. On average, the preoperative HKAA was 170.84° ± 3.73°, and UKA corrected the alignment to 175.16° ± 3.21° postoperatively (p < 0.001), with ∆HKAA of 4.33° ± 1.93°. Correlation analysis showed that ∆HKAA correlated with MJSW (r = 0.628, p < 0.001), MED (r = 0.262, p < 0.001), and tibial osteophyte area (r = 0.235, p < 0.001). The prediction model for ∆HKAA was obtained by multivariable linear regression: ∆HKAA = −2.003 + 0.947 × MJSW(mm) + 1.838 × total osteophyte area(cm2). Conclusion Valgus stress radiographic MJSW and osteophyte area are correlated to the alignment change of medial mobile‐bearing UKA. The prediction model for HKAA change is: ∆HKAA = −2.003 + 0.947 × MJSW(mm) + 1.838 × total osteophyte area(cm2).

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Disease progression, aseptic loosening and bearing dislocations are the main revision indications after lateral unicompartmental knee arthroplasty: a systematic review

Cited by 10 publications

References 57 publications

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

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

Survival of lateral unicompartmental knee arthroplasty at short‐, mid‐, and long‐term follow‐up: a systematic review and meta‐analysis

Valgus Stress Radiograph Can Predict Alignment Change of Medial Mobile‐Bearing Unicompartmental Knee Arthroplasty

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