Influence of minimally invasive surgery on implant positioning and the functional outcome for medial unicompartmental knee arthroplasty

Müller, Peter E.; Pellengahr, Christoph von Schulze; Witt, Matthias; Kircher, Jörn; Refior, H. J.; Jansson, Volkmar

doi:10.1016/j.arth.2003.09.013

Cited by 116 publications

(71 citation statements)

References 25 publications

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“…Although there are some concerns that MIS techniques are not as accurate as open UKA in creating the optimal AP tibial placement or postoperative alignment [13,33], other [10,31,36]. In our series, the average HKA alignment postoperatively was less than 2°varus, which we believe ideal, with consistent positioning of the tibial tray on the AP view at less than 3°valgus to the anatomic axis of the tibia.…”

Section: O'donnell and Neil Clinical Orthopaedics And Related Researchmentioning

confidence: 71%

The Repicci II® Unicondylar Knee Arthroplasty: 9-year Survivorship and Function

O’Donnell

Neil

2010

Clinical Orthopaedics &Amp; Related Research

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Background Unicompartmental knee arthroplasty (UKA) is a recognized procedure for treatment of medial compartment osteoarthritis. UKA using minimally invasive surgery (MIS) has the theoretical advantage of less bone resection and quicker rehabilitation. Whether the function of patients with UKA compares with that of patients with conventional TKA is unclear. Questions/purposes We determined (1) the length of stay and complications associated with a short-stay MIS protocol; (2) whether MIS techniques allow for accurate positioning of the implant and alignment of the limb; (3) the change in functional scores; (4) the revision rate, reasons for revision, and survival of this implant. Patients and Methods We prospectively followed 100 patients who had 114 UKAs. All completed an International Knee Society (IKS) score preoperatively, at 1 year, and at last followup. We determined survivorship. Minimum followup was 5.2 years (mean, 7.4 years; range, 5.2-9 years). Results Mean length of stay was 1.2 days, with 41% discharged the same day. The perioperative complication rate was 6%. The mean IKS score improved from 77 to 93 and was 86 at last followup. The mean hip-knee-ankle axis changed from 6°varus to 1.7°varus. Twenty-two patients underwent a revision procedure at a mean 6.2 years after the index procedure. Survivorship of the prosthesis was 78% at 9 years. Conclusions The short-stay protocol was not associated with a high perioperative complication rate. This technique is associated with improvement in function and restoration of limb alignment, allowing accurate positioning of the implant. Compared with other reports of survival of UKA, this implant had a lower survivorship and increased revision rate.

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Section: O'donnell and Neil Clinical Orthopaedics And Related Researchmentioning

confidence: 71%

The Repicci II® Unicondylar Knee Arthroplasty: 9-year Survivorship and Function

O’Donnell

Neil

2010

Clinical Orthopaedics &Amp; Related Research

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“…The medial wall of the intercondylar notch was within 58 internal or external rotation relative to the AP axis in 73.3% of knees (33/45), and therefore we believe would be useful as an alternative to the AP axis for making the tibial sagittal cut. There has been no theoretical background for a reference of correct tibial rotation, although several methods have been proposed and used according to surgeons' preferences and experiences [11,22,27,32]. Some suggest the sagittal cut on the tibia should be directed toward the center of the hip [11]; however, we are unaware of any published studies regarding the theoretical background of this technique, and the position of the center of the hip is difficult to locate intraoperatively.…”

Section: Discussionmentioning

confidence: 99%

“…Some suggest the sagittal cut on the tibia should be directed toward the center of the hip [11]; however, we are unaware of any published studies regarding the theoretical background of this technique, and the position of the center of the hip is difficult to locate intraoperatively. Some surgeons have recommended rangeof-movement methods [22,27,32]. Manual flexion and extension, however, might cause varus, valgus, external, or internal rotation between the femur and the tibia with range-of-movement methods.…”

Section: Discussionmentioning

confidence: 99%

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Is the Medial Wall of the Intercondylar Notch Useful for Tibial Rotational Reference in Unicompartmental Knee Arthroplasty?

Kawahara¹,

Matsuda²,

Okazaki³

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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Background It is difficult to implant components in the correct rotational position in the narrow operating field in a unicompartmental knee arthroplasty. Although no rotational reference has been confirmed for unicompartmental knee arthroplasty, the AP axis of the tibia may serve as a reference for unicompartmental knee arthroplasty and TKA. However, it is difficult to identify the AP axis during unicompartmental knee arthroplasty, especially with the tibia first-cut technique. Questions/purposes We explored whether the medial wall of the intercondylar notch could be useful for the tibial rotational reference as an alternative to the AP axis in unicompartmental knee arthroplasty. Methods We scanned the knees of 24 healthy Asian patients (45 knees) at a flexion angle of 908 using open MRI, then measured the angle between the AP axis and the medial wall of the notch. We determined whether the origins of the ACL and PCL were located lateral to the line on the medial wall of the notch and whether the mediolateral dimension of the bone cut surface of the medial tibial plateau was wide enough relative to the AP dimension to use the commercially available unicompartmental knee arthroplasty tibial components when the tibia was cut parallel to the medial wall of the notch.Results At 908 flexion the medial wall of the notch was externally rotated 0.18 ± 4.48 relative to the AP axis. In all knees, the ACL and PCL were located lateral to the line on the medial wall of the notch. The mediolateral dimension of the bone cut surface was wide enough to use the commercially available tibial components. Conclusions At 908 flexion the medial wall of the intercondylar notch is almost parallel to the AP axis of the tibia at and we believe a reasonable candidate for a rotational reference of tibial placement in unicompartmental knee arthroplasty. This landmark would need to be confirmed in other populations and in patients with osteoarthritis.

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“…However, distal femoral cut sagittal alignment may contribute to the sagittal alignment of the prosthetic joint by determining the relationship between the femoral component and the long axis of the femur, and could be related to the degree of postoperative flexion contracture. While research has examined this relationship in the context of unicompartmental knee arthroplasty (UKA) [15][16][17], there is a paucity of information for TKA.…”

Section: Introductionmentioning

confidence: 99%

Sagittal placement of the femoral component in total knee arthroplasty predicts knee flexion contracture at one-year follow-up

Lustig

Scholes

Stegeman

et al. 2012

International Orthopaedics (SICOT)

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Purpose Flexion contracture has been shown to impair function and reduce satisfaction following total knee arthroplasty (TKA). The aim of this study was to identify modifiable intraoperative variables that predict post-TKA knee extension. Methods Data was collected prospectively on 95 patients undergoing total knee arthroplasty, including pre-operative assessment, intra-operative computer assisted surgery (CAS) measurements and functional outcome including range of motion at one year. Patients were divided into two groups: those with mild flexion contracture (> 5°) at the one-year follow-up and those achieving full extension. Results The sagittal orientation of the distal femoral cut differed significantly between groups at the one-year follow-up (p00.014). Sagittal alignment of greater than 3.5°from the mechanical axis was shown to increase the relative risk of a mild flexion contracture at one-year followup by 2.9 times, independent of other variables. Conclusion Increasing the sagittal alignment of the distal femoral cut more than 3.5°from the mechanical axis is an independent risk factor for clinically detectable flexion contracture one year from index procedure.

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Influence of minimally invasive surgery on implant positioning and the functional outcome for medial unicompartmental knee arthroplasty

Cited by 116 publications

References 25 publications

The Repicci II® Unicondylar Knee Arthroplasty: 9-year Survivorship and Function

The Repicci II® Unicondylar Knee Arthroplasty: 9-year Survivorship and Function

Is the Medial Wall of the Intercondylar Notch Useful for Tibial Rotational Reference in Unicompartmental Knee Arthroplasty?

Sagittal placement of the femoral component in total knee arthroplasty predicts knee flexion contracture at one-year follow-up

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