Necessary Factors to Achieve Deep Flexion for Asian Populations after Oxford Unicompartmental Knee Arthroplasty

Inui, Hiroshi; Taketomi, Shuji; Yamagami, Ryota; Kawaguchi, Kohei; Nakazato, Keiu; Tanaka, Sakae

doi:10.1055/s-0039-1678539

Cited by 9 publications

(9 citation statements)

References 41 publications

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“…The anterior tibial cortex was tilted about 3° from this axis, 31 so taking this into account, the osteotomy was almost on target in all knees. Although the posterior tibial slope is reportedly an important factor that relates to the clinical outcomes, such as the angle of flexion postoperatively and rate of survival in patients undergoing UKA, 32,33 it did not relate to the KCDs in this study.…”

Section: Discussioncontrasting

confidence: 57%

Varus placement of the tibial component of Oxford unicompartmental knee arthroplasty decreases the risk of postoperative tibial fracture

Suda

Hiranaka

Kamenaga

et al. 2022

The Bone & Joint Journal

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Aims A fracture of the medial tibial plateau is a serious complication of Oxford mobile-bearing unicompartmental knee arthroplasty (OUKA). The risk of these fractures is reportedly lower when using components with a longer keel-cortex distance (KCDs). The aim of this study was to examine how slight varus placement of the tibial component might affect the KCDs, and the rate of tibial plateau fracture, in a clinical setting. Methods This retrospective study included 255 patients who underwent 305 OUKAs with cementless tibial components. There were 52 males and 203 females. Their mean age was 73.1 years (47 to 91), and the mean follow-up was 1.9 years (1.0 to 2.0). In 217 knees in 187 patients in the conventional group, tibial cuts were made orthogonally to the tibial axis. The varus group included 88 knees in 68 patients, and tibial cuts were made slightly varus using a new osteotomy guide. Anterior and posterior KCDs and the origins of fracture lines were assessed using 3D CT scans one week postoperatively. The KCDs and rate of fracture were compared between the two groups. Results Medial tibial fractures occurred after surgery in 15 patients (15 OUKAs) in the conventional group, but only one patient (one OUKA) had a tibial fracture after surgery in the varus group. This difference was significant (6.9% vs 1.1%; p = 0.029). The mean posterior KCD was significantly shorter in the conventional group (5.0 mm (SD 1.7)) than in the varus group (6.1 mm (SD 2.1); p = 0.002). Conclusion In OUKA, the distance between the keel and posterior tibial cortex was longer in our patients with slight varus alignment of the tibial component, which seems to decrease the risk of postoperative tibial fracture. Cite this article: Bone Joint J 2022;104-B(10):1118–1125.

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Section: Discussioncontrasting

confidence: 57%

Varus placement of the tibial component of Oxford unicompartmental knee arthroplasty decreases the risk of postoperative tibial fracture

Suda

Hiranaka

Kamenaga

et al. 2022

The Bone & Joint Journal

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“…A recent study on the Japanese population with an average of approximately 3-year follow-up in single surgeon series of Oxford UKA demonstrated that postoperative knee flexion !140 degrees was associated with tibial component posterior slope. 20 In the current study, regardless of surgeons, it was observed that larger knee flexion following UKA was associated with !80 KOOS subscale of symptoms at both 1 and 2 years postoperatively. For the Asian population that needs deep knee flexion in their daily living activities, especially in their sitting positions, 36,37 it has been estimated that the knee's postoperative ROM-especially knee flexion angleshas a significant positive effect on PRO.…”

Section: Discussionmentioning

confidence: 52%

“…[17][18][19] Additionally, some retrospective clinical studies have shown that the coronal or sagittal alignment of the tibial component was linked to clinical results, such as the implant survival rate [14][15][16] or the postoperative knee flexion angles. 20 However, to date, there is limited data available on the implant alignment's direct influence on the clinical score,…”

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confidence: 99%

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Implant Alignment and Patient Factors Affecting the Short-Term Patient-Reported Clinical Outcomes after Oxford Unicompartmental Knee Arthroplasty

et al. 2020

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This study aims at clarifying implant alignment and other patient factors' influence on clinical outcomes, particularly on patient-reported outcomes (PRO), following Oxford unicompartmental knee arthroplasty (OUKA). A total of 142 patients after OUKA were divided into two groups according to the validated Japanese version of the knee injury and osteoarthritis outcome score (KOOS) for each subscale of pain, symptoms, and activities of daily living (ADL) at postoperative year 1 and 2: group 1 had ≥80 scores and group 2 had <80 scores. Postoperative clinical and radiographical findings were then compared among groups in each subscale. Using postoperative year 1 and 2 data, a multivariable logistic regression analysis was conducted to clarify factors for clinical outcomes' improvement. In the analysis of KOOS subscale of symptoms at postoperative year 1, gender distribution, preoperative body mass index, and postoperative maximum knee flexion angles differed significantly among groups. In the analysis for KOOS subscale of ADL, significant differences were observed in postoperative tibial component varus angles. Multivariable logistic regression analysis revealed that all of these parameters significantly related to ≥80 KOOS scores of each subscale at postoperative year 1. Additionally, at postoperative year 2, larger postoperative knee flexion angles and tibial component varus angles related to ≥80 KOOS subscale of symptoms and ADL were observed. In conclusion, tibial component's larger varus alignment was associated with the better PRO at both 1 and 2 years after OUKA. Importantly, larger postoperative knee flexion angle helped achieve good short-term PRO after OUKA.

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“…Numerous previous studies have considered KOOS scores of 90 or more after knee joint arthroplasty as excellent results. 9,21 As a consequence, the patients enrolled in this study were divided into two groups based on their 1-year postoperative KOOS scores of each subscale. The groups were as follows: group H (each subscale) consisted of patients with !90 scores and group L (each subscale) consisted of patients with <90 scores.…”

Section: Statistical Analysesmentioning

confidence: 99%

Both Intraoperative Medial and Lateral Joint Stabilities at Midflexion Influence Postoperative Patient-Reported Outcome Measures Following Bi-Cruciate Stabilized Total Knee Arthroplasty

et al. 2022

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Bi-cruciate stabilized (BCS) total knee arthroplasty (TKA) was developed to approximate normal knee kinematics and is expected to improve clinical outcomes. However, the effects of soft tissue balance at the medial or lateral compartment on patient-reported outcome measures (PROMs) following BCS TKA are unclear. The purpose of this study was to clarify the relationship between the medial or lateral component gaps and PROMs following BCS TKA. One hundred seventeen knees with varus deformities which underwent BCS TKA were included in this study. They were divided into two groups according to the validated Japanese version of the Knee Injury and Osteoarthritis Outcome Score for each subscale of pain, symptoms, and activities of daily living (ADL) at 1 year postoperatively: group H consisted of patients with ≥90 points and group L consisted of patients with <90 points. Intraoperative medial and lateral joint laxities at 0°, 30°, 60°, 90°, and 120° flexion measured using a tensor device were compared between the two groups in each subscale. In the pain subscale, the medial joint laxities at 30° (p < 0.05) and 60° flexion (p < 0.05) in group H were significantly smaller than those in group L. In the ADL subscale, the medial joint laxity at 60° flexion in group H was significantly smaller than that in group L (p < 0.05). In the symptom subscale, the lateral joint laxity at 60° flexion in group H was significantly smaller than that in group L (p < 0.05). Surgeons should pay attention to the importance of both medial and lateral joint stabilities to achieve better postoperative PROMs following BCS TKA.

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Necessary Factors to Achieve Deep Flexion for Asian Populations after Oxford Unicompartmental Knee Arthroplasty

Cited by 9 publications

References 41 publications

Varus placement of the tibial component of Oxford unicompartmental knee arthroplasty decreases the risk of postoperative tibial fracture

Varus placement of the tibial component of Oxford unicompartmental knee arthroplasty decreases the risk of postoperative tibial fracture

Implant Alignment and Patient Factors Affecting the Short-Term Patient-Reported Clinical Outcomes after Oxford Unicompartmental Knee Arthroplasty

Both Intraoperative Medial and Lateral Joint Stabilities at Midflexion Influence Postoperative Patient-Reported Outcome Measures Following Bi-Cruciate Stabilized Total Knee Arthroplasty

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