Is knee function better with contemporary modular bicompartmental arthroplasty compared to total knee arthroplasty? Short-term outcomes of a prospective matched study including 68cases

Parratte, Sébastien; Ollivier, Matthieu; Opsomer, Gaëtan; Lunebourg, Alexandre; Argenson, Jean-Noël; Thienpont, Emmanuel

doi:10.1016/j.otsr.2015.03.019

Cited by 40 publications

(17 citation statements)

References 26 publications

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“…Otherwise, modular “off-the-shelf” implants using unicondylar implants combined with a patellofemoral implant are required. However, controversy still exists regarding the functional outcomes when compared to TKA [ 23 , 31 ]. To date, scarce data are available on the treatment of bicompartmental osteoarthritis.…”

Section: Introductionmentioning

confidence: 99%

A high level of satisfaction after bicompartmental individualized knee arthroplasty with patient-specific implants and instruments

Ogura

Merkely

et al. 2018

Knee Surg Sports Traumatol Arthrosc

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Purpose Customized Individually Made (CIM) Bicompartmental Knee Arthroplasty (BKA) implants and three-dimensional printed customized instruments are available to fit to each patient’s unique anatomy, medial or lateral with patellofemoral. This study aimed to evaluate the clinical outcomes after CIM-BKA. Methods Fifty-five patients [59 knees; average age, 51 years; standard deviation (SD), 6.8; range 37–65 years] who underwent CIM-BKA were evaluated over an average of 3.8-year follow-up (SD 1.6; range 1–6 years). Forty-one knees underwent BKA combined medial and patellofemoral replacement (BKA-MP) and 18 knees underwent BKA combined lateral with patellofemoral replacement (BKA-LP). Survival rates, the modified Cincinnati Knee Rating Scale, WOMAC, VAS, SF-36, a satisfaction survey, and radiographic evaluation were used to evaluate outcomes. Results Overall, survival rates were 98% and 92% at 2 and 5 years, respectively. Of 56 knees (95%) that did not fail, all patient-reported functional scores significantly improved post-operatively ( P < 0.01), regardless of the previous surgeries, with a high level of satisfaction (51/56 knees, 91%). Radiographically, all the femoral components fit perfectly and 56 knees (95%) of the tibial components fit with less than 2 mm of undercoverage or overhang. Three knees (5%) required the conversion to TKA and 17 knees (29%) required subsequent surgical procedures, of which multiply operated knees had higher rate than virgin knee [14/40 (35%) vs. 3/16 (19%)]. Conclusion CIM-BKA allowed precise fit of the components and provided a significant improvement post-operatively with a high level of satisfaction over short- to mid-term follow-up. This novel CIM-BKA is resurfacing, and does not require 10-mm faceted cuts, being only 3-mm-thick, which preserves bone stock for the future. It may be a promising option for relatively young active patients with bicompartmental osteoarthritis with a longer term follow-up being necessary. Level of evidence IV.

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Section: Introductionmentioning

confidence: 99%

A high level of satisfaction after bicompartmental individualized knee arthroplasty with patient-specific implants and instruments

Ogura

Merkely

et al. 2018

Knee Surg Sports Traumatol Arthrosc

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“…In total, 6 studies were selected for inclusion in the meta-analysis, as shown in the PRISMA flow diagram ( Fig. 1 ) [13] , [14] , [15] , [16] , [17] , [18] . A kappa value of 0.9 was determined based on the selections of two reviewers (S. K. and H.…”

Section: Resultsmentioning

confidence: 99%

“… Study Design Level Implant N Age Gender (female:male) BMI Follow-Up, y Complications Revisions BKA TKA BKA TKA BKA TKA BKA TKA BKA TKA BKA TKA Parratte et al. 2015 [13] Pseudorandomized IIA Modular 34 34 61 (7) 61 (8) 21:13 21:13 27.5 (4) 27.5 (4.5) 3.8 (1.7) 0 1 0 1 Yeo et al. 2015 [16] RCT I Modular 22 20 63.8 (8.03) 63.1 (7.34) 21:5 16:6 27.28 (3.04) 28.15 (4.52) 6 m, 1, 2, 5 1 0 1 0 Engh et al.…”

Section: Resultsmentioning

confidence: 99%

Bicompartmental knee arthroplasty vs total knee arthroplasty for the treatment of medial compartment and patellofemoral osteoarthritis

2017

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BackgroundInterest in bicompartmental knee arthroplasty (BKA) for the treatment of medial patellofemoral osteoarthritis (MPFOA) has grown in recent years because BKA offers a bone and ligament-preserving alternative to total knee arthroplasty (TKA). BKA only resurfaces the diseased compartments, while preserving proprioception and native knee kinematics. Therefore, the objective of this study is to assess knee function, perioperative morbidity, and implant survivability in patients undergoing BKA vs TKA for MPFOA.MethodsThe databases MEDLINE, PUBMED, and EMBASE were systematically searched. Randomized controlled trials and nonrandomized comparative studies comparing BKA with TKA for the treatment of MPFOA were included for further analysis. The primary outcome of interest was knee function. Secondary outcomes included range of movement, operation length, intraoperative blood loss, hospital length of stay, postoperative complications, and rate of revision length. The quality of evidence was evaluated using the GRADE approach. Meta-analysis was performed by pooling the results of the selected studies when possible.ResultsSix studies were selected for inclusion (4 prospective studies and 2 retrospective cohort studies). In total, 274 patients and 277 knees were included for analysis. There were no significant differences between the 2 groups at any time points in terms of knee function, length of stay, complication rate, or revision rate, when monolithic BKA designs were controlled for. BKA did result in significantly decreased intraoperative blood loss, at the expense of increased operative length compared with TKA.ConclusionsThe use of modular BKA for MPFOA is comparable with TKA in terms of short-term function, complication rate, and revision rate. BKA reduces intraoperative blood losses, but it is also more technically demanding, resulting in increased operation length. The use of modular BKA has acceptable short-term outcomes, but more long-term data are needed before it can be recommended for routine use in the treatment of MPFOA. The selection of modular BKA should be determined on a patient-specific basis. Currently, there is no evidence to suggest the use of monolithic BKA designs because of their high revision and failure rate.

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“…Short-term result of modular BKR is good, [4][5][6][7][8] with most studies showing similar or better function than TKR. 9,10 Other advantages include less blood loss, 11,12 better gait pattern, and knee kinematics [13][14][15][16] as BKR is more bone/ ligament preserving than TKR. However, there is still no conclusion whether it is a worthwhile procedure when compared to UKR and TKR in the long run, in terms of clinical outcome, survivorship, and late complications.…”

Section: Discussionmentioning

confidence: 99%

Early promising result of bicompartmental knee replacement in middle-aged patients

Tang

Cheung

Tsui

et al. 2019

Journal of Orthopaedics, Trauma and Rehabilitation

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Introduction: Partial knee replacement (PKR) is one of the treatment options in middle-aged patients with less extensive knee osteoarthritis, with unicompartmental knee replacement (UKR) most commonly done for medial osteoarthritis. There are numerous advantages like bone/ligament preserving and faster recovery. However, the indications of UKR remain controversial, as most patients have some patellofemoral joint (PFJ) osteoarthritis. We performed modular bicruciate-retaining bicompartmental knee replacement (BKR) in this group of patients and compared the outcome with total knee replacement (TKR). Materials and Methods: From 2016 to 2017, 14 BKR were performed in patients with medial and PFJ osteoarthritis. They were retrospectively compared with 14 TKR performed in patients with similar age and severity. The incision length, operative time, blood loss (in terms of hemoglobin drop), and length of stay were recorded. Pre- and postoperative range of motion and Knee Society knee score at 1-year follow-up were compared. Results: The mean incision length for BKR was shorter than TKR (130.1 vs. 185.1 mm), but the mean operative time was also longer (152.6 vs. 88.1 min). There was also less mean hemoglobin drop (1.8 vs. 2.6 g/dL) and shorter length of stay (7.4 vs. 9.2 days). The mean postoperative function score is better in BKR group (90.4 vs. 77.5), and the mean postoperative knee score (87.2 vs 88.9) and flexion (115.7° vs. 111.4°) were similar for both groups. Discussion: In selected patients, BKR is a good alternative to TKR. It preserves advantages of UKR while also tackle the PFJ which is the most controversial aspect of UKR. The early clinical outcome in our study is promising. However, there is a learning curve. Longer follow-up is necessary to study on the performance and survivorship as compared with UKR and TKR.

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Is knee function better with contemporary modular bicompartmental arthroplasty compared to total knee arthroplasty? Short-term outcomes of a prospective matched study including 68cases

Abstract: III, case-control study.

Cited by 40 publications

References 26 publications

A high level of satisfaction after bicompartmental individualized knee arthroplasty with patient-specific implants and instruments

A high level of satisfaction after bicompartmental individualized knee arthroplasty with patient-specific implants and instruments

Bicompartmental knee arthroplasty vs total knee arthroplasty for the treatment of medial compartment and patellofemoral osteoarthritis

Early promising result of bicompartmental knee replacement in middle-aged patients

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