Early Recovery Following Total and Unicompartmental Knee Arthroplasty Assessed Using Novel Patient-Reported Measures

Strickland, Louise; Rahman, Azmi; Jenkinson, Crispin; Pandit, Hemant; Murray, David

doi:10.1016/j.arth.2021.05.025

Cited by 5 publications

(4 citation statements)

References 22 publications

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“…In accordance, a recent prospective randomized multicenter trial that compared UKA and CR TKA showed that the UKA group experienced a faster recovery time than the TKA group, as determined by the Oxford Knee Score (OKS) and Knee Injury and Osteoarthritis Score (KOOS) at 2 and 12 months postoperatively. 24 Strickland et al 25 demonstrated that UKA resulted in a 2–3 times faster recovery period than TKA, according to the Oxford Arthroplasty Early Recovery Score (OARS) in the first 6 weeks post-surgery. Recently, a systematic review demonstrated that the average time for patients to return to work following UKA was 5.4 weeks (range 1–32 weeks), and > 80% of patients were able to work the same or longer hours or undertake more physically demanding tasks post-surgery.…”

Section: Discussionmentioning

confidence: 99%

Cruciate-Retaining Total Knee Arthroplasty versus Unicompartmental Knee Arthroplasty in Medial Compartmental Osteoarthritis: A Propensity Score-Matched Analysis of Early Postoperative Recovery

Laoruengthana,

Reosanguanwong,

Rattanaprichavej

et al. 2024

ORR

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Background Cruciate-retaining (CR) total knee arthroplasty (TKA) may provide better physiological knee kinematics, proprioception, and quadricep recovery than posterior-stabilized (PS) TKA. Therefore, we hypothesized that CR TKA with multimodal pain control may provide comparable postoperative pain and recovery as unicompartmental knee arthroplasty (UKA). Methods This study included patients with isolated medial compartment knee osteoarthritis who underwent CR TKA and UKA. TKA and UKA patients were propensity score-matched with age and body mass index (BMI) and compared using visual analog scales (VAS) for pain scores, total amount of morphine use (TMU), knee flexion angle, straight leg raise (SLR), independent ambulation, length of hospital stay (LOS), and costs during hospitalization. Results After propensity score matching, 46 patients were included in the TKA and UKA groups, respectively, with no differences in demographic data. VAS at 6–72 h and TMU at 48 h after surgery were comparable between the groups. The knee flexion angle in the UKA group was significantly higher at 24 h (60.0° vs 46.6°; p<0.001) and 48 h (76.9° vs 69.1°; p = 0.021) than that in the TKA group. The SLR in the UKA group was significantly higher than that in the TKA group at 24–72 h. The UKA group ambulated significantly earlier (1.56 vs 2.13 days; p<0.001), had shorter LOS (3.68 vs 4.28 days; p<0.004) and incurred 12.43% lower costs when compared to the TKA group. Conclusion Patients who underwent CR TKA with multimodal pain management did not experience more postoperative pain or morphine use than those who underwent UKA. However, UKA patients seem to experienced faster recovery and shorter LOS than CR-TKA patients during the early postoperative course. Accordingly, UKA may be considered instead of TKA for patients who are good candidates for UKA and require expedited recovery.

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Section: Discussionmentioning

confidence: 99%

Cruciate-Retaining Total Knee Arthroplasty versus Unicompartmental Knee Arthroplasty in Medial Compartmental Osteoarthritis: A Propensity Score-Matched Analysis of Early Postoperative Recovery

Laoruengthana,

Reosanguanwong,

Rattanaprichavej

et al. 2024

ORR

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“…Pain is relatively common early after all types of knee replacement, and in a few patients, it may persist [12,14,16]. Following UKR, if early pain occurs, it is usually anteromedial about 2 cm below the tibial component.…”

Section: Introductionmentioning

confidence: 99%

Microporous titanium and hydroxyapatite improve fixation of the tibial wall in unicompartmental knee replacement

Rahman,

Omoregie,

Mellon

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeCementless Oxford unicompartmental knee replacement (OUKR) is associated with less pain than cemented OUKR 5 years postoperatively. This may be due to improved fixation at the tibial wall, which transmits tension and reduces stress in the bone below the tibial component. This study compares tibial wall fixation with three different types of fixation: cemented, cementless with hydroxyapatite (HA) and cementless with a microporous titanium coat and HA (HA + MPC).MethodsThree consecutive cohorts were identified (n = 221 cemented in 2005–2007, n = 118 HA in 2014–2015, n = 125 HA + MPC in 2016–2017). Analysis was performed on anterior–posterior radiographs aligned on the tibial component taken 1–2 years postoperatively. Aligned radiographs are needed to see narrow radiolucencies adjacent to the wall. Alignment was assessed with rotation ratio (RR = wall width/internal wall height). Perfect RR is 0.3, and a maximum threshold of 0.5 was used. Quality of fixation to the wall was assessed with fixation ratio (FR = bone wall contact height/total wall height). Notable radiographic features at the tibial wall were also recorded.ResultsA total of 33 knees with cement, 37 knees with cementless with HA and 57 knees cementless with HA + MPC had adequately aligned radiographs. Fixation was significantly better with HA compared with cement (55% vs. 25%, p = 0.0016). The microporous coat further improved fixation (81% vs. 55%, p < 0.0001). FR > 80% was achieved in 3% of the cemented implants, 32% of HA and 68% of HA + MPC. In cementless cohorts, features suggestive of a layer of bone that had delaminated from the wall were seen in 8 (22%) HA and 3 (5%) HA + MPC knees.ConclusionRadiographic tibial wall fixation in OUKR is poor with cement. It improves with an HA coating and improves further with an intermediary MPC. Improved tibial wall fixation may explain the lower levels of pain observed with cementless rather than cemented fixation described in the literature, but further clinical correlation is needed.Level of EvidenceLevel III, retrospective cohort study.

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“…Unicompartmental knee arthroplasty (UKA) is considered an alternative therapy for anteromedial knee osteoarthritis and osteonecrosis if conservative treatment is noneffective [1][2][3]. Consequently, UKA yields a better range of motion and joint function as seen in early follow-ups than TKA [4][5][6][7][8]. Therefore, Mobile-bearing UKA (MB-UKA) represented by the Oxford system has slowly gained global popularity.…”

Section: Introductionmentioning

confidence: 99%

Can mobile-bearing unicompartmental knee arthroplasty achieve natural gap-balancing? An observational study with a novel pressure sensor

et al. 2022

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Background Mobile-bearing unicompartmental knee arthroplasty (MB-UKA) is an effective treatment for anteromedial knee osteoarthritis. Meticulous intraoperative soft tissue balancing remains challenging yet consequential for a successful operation. Currently, surgeons rely mostly on their experience during soft tissue balancing, yielding unreproducible results. The purpose of this study was to quantified measure the soft tissue tension of medial compartment and determine if an optimal "target" tension values with the natural state exists. Methods This was an observational study of 24 consecutive patients. All 30 UKAs were performed by a single surgeon. The piezoresistive sensor was custom designed to fit in the medial compartment gap. Contact pressures were measured at 5 angular positions of the knee intraoperatively: 0°, 20°, 45°, 90°, and 110° of flexion. The change in pressure from extension (20° position) and flexion (110° position) was also calculated (E-FPD). Data on age, sex, body mass index, operative side, and bearing size were collected. Outcome measures were measured at baseline and at the 6-month postoperative follow-up; Oxford Knee Score, visual analog scale score, and range of motion were compared to evaluate clinical outcomes. Results There was a significant improvement in patients in all measured outcomes at 6 months from baseline (P < 0.05). The E-FPD of 14.9 N (8.9, 24.6) was indicative of appropriate soft tissue balancing throughout the functional range of knee motion. Of 30 knees, 22 were 3-mm bearing and 8 were 4- or 5-mm bearing. The pressure data of the 3-mm bearing group was larger than that of the non-3-mm bearing group for each knee flexion degree, but the difference was not statistically significant (P > 0.05). Conclusions Objective data from sensor output may assist surgeons in decreasing loading variability during MB-UKA. The data suggested that MB-UKA could not accurately restore soft tissue tension to the natural state, which was related to the inability of MB-UKA surgical instruments to fine adjust the bone cut and soft tissue release. Study registration Chinese Clinical Trial Registry (http://www.chictr.org.cn): ChiCTR1900024146.

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Early Recovery Following Total and Unicompartmental Knee Arthroplasty Assessed Using Novel Patient-Reported Measures

Cited by 5 publications

References 22 publications

Cruciate-Retaining Total Knee Arthroplasty versus Unicompartmental Knee Arthroplasty in Medial Compartmental Osteoarthritis: A Propensity Score-Matched Analysis of Early Postoperative Recovery

Cruciate-Retaining Total Knee Arthroplasty versus Unicompartmental Knee Arthroplasty in Medial Compartmental Osteoarthritis: A Propensity Score-Matched Analysis of Early Postoperative Recovery

Microporous titanium and hydroxyapatite improve fixation of the tibial wall in unicompartmental knee replacement

Can mobile-bearing unicompartmental knee arthroplasty achieve natural gap-balancing? An observational study with a novel pressure sensor

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