Sagittal flexion angle of the femoral component in unicompartmental knee arthroplasty: is it same for both medial and lateral UKAs?

Biçer, Elcil Kaya; Servien, Elvire; Lustig, Sébastien; Demey, Guillaume; Selmi, Tarik Aït Si; Neyret, Philippe

doi:10.1007/s00167-010-1063-y

Cited by 20 publications

(11 citation statements)

References 25 publications

(36 reference statements)

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“…Several studies reported excellent 10-year survivorship of UKA [4e7] with better physiological function, quicker recovery, and less perioperative complications as compared to total knee arthroplasty (TKA) [8e10]. UKA remains however a demanding surgical procedure, and optimal implant positioning is essential to obtain satisfactory outcomes [11,12]. The fit of the tibial component has been shown to have an important impact on the success of UKA procedures [13]: implant overhang can lead to soft tissue impingement and pain (particularly with the medial collateral ligament [MCL]) [14,15].…”

Section: Introductionmentioning

confidence: 99%

Better Implant Positioning and Clinical Outcomes With a Morphometric Unicompartmental Knee Arthroplasty. Results of a Retrospective, Matched-Controlled Study

Escudier

Jacquet

Flécher

et al. 2019

The Journal of Arthroplasty

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Keywords:unicompartmental knee arthroplasty morphometric tibial tray implant positioning medial overhang tibial bone coverage a b s t r a c t Background: During medial unicompartmental knee arthroplasty (UKA), tibial tray implantation requires compromise between bone coverage and rotational position. It was hypothesized that morphometric tibial tray (MTT) would improve implant positioning and subsequently clinical outcomes as compared to symmetric tibial tray (STT). Methods: A total of 106 patients who underwent medial UKA in our department between January 2017 and March 2018 were included matched on gender and age (53 in each group). Inclusion criteria were symptomatic medial femorotibial osteoarthritis, functional anterior cruciate ligament, primary arthritis, or osteonecrosis. Rotation of the tibial implant, tibial bone coverage, medial and posterior overhang were assessed with a postoperative computed tomography scan. The Knee Society Score (KSS), the Knee injury and Osteoarthritis Outcome Score Short Form (KOOS SF), and the quality of life score EuroQoL 5-Dimensions 3-Levels (EQ5D3L) were assessed at a minimum of 1-year follow-up. Results: Implants of the STT group exhibited more external rotation (6.3 ± 4.02 vs 4.6 ± 3.59 ; P ¼ .04), and medial and posterior overhang >3 mm (35% vs 0% and 22% vs 0%; P < .0001) but no difference for tibial bone coverage (97.3% ± 11.35% vs 94.7% ± 10.89%; P ¼ .23). Global KSS (188.6 ± 6.6 vs 175.2 ± 31.7; P < .01), KOOS SF (16.9 ± 6.1 vs 22.5 ± 11.8; P < .003), and EQ5D3L (1 ± 0.1 vs 0.9 ± 0.2; P < .001) were higher in MTT group. According to the multivariate analysis, MTT had a positive independent effect on the KSS, KOOS SF, and EQ5D3L. Conclusion: The use of an MTT in medial UKA allowed better implant positioning when decreasing the rate of overhang; superior short-term clinical outcomes were found as compared to STT.

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Section: Introductionmentioning

confidence: 99%

Better Implant Positioning and Clinical Outcomes With a Morphometric Unicompartmental Knee Arthroplasty. Results of a Retrospective, Matched-Controlled Study

Escudier

Jacquet

Flécher

et al. 2019

The Journal of Arthroplasty

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“…The principal finding of this study was that a better ROM was achieved with an intentionally increased flexion angle of the femoral component in mobile bearing UKA. To achieve satisfactory clinical outcomes with UKA, it is crucial to determine the proper position of components 17 – 19) . Radiologically, the femoral component’s varus/valgus angle or mediolateral distance in the coronal plane is important because of impingement or edge loading on the polyethylene bearing especially in fixed bearing UKA 14 , 15) .…”

Section: Discussionmentioning

confidence: 99%

Intentionally Increased Flexion Angle of the Femoral Component in Mobile Bearing Unicompartmental Knee Arthroplasty

Cho

Kim

Song

et al. 2018

Knee Surg Relat Res

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PurposeThe purpose of this study was to determine the results of mobile bearing unicompartmental knee arthroplasty (UKA) with an intentionally increased flexion angle of the femoral component in patients requiring high flexion.Materials and MethodsWe investigated 45 knees treated by UKA. Clinically, we measured the range of motion (ROM) and the American Knee Society (AKS) score preoperatively and at final follow-up and investigated complications. Radiologically, we measured the flexion angle of the femoral component, the posterior slope angle of the tibial component, the femorotibial angle and mechanical axis of the limb postoperatively.ResultsThe ROM was increased from 123° preoperatively to 139° at the final follow-up. The AKS knee and function scores increased from 59 and 68, respectively, preoperatively to 94 and 96, respectively, at the final follow-up. The flexion angle of the femoral component was 9.1°, and the posterior slope angle of the tibial component was 8.6°. There was one case of bearing dislocation in the largest femoral flexion angle case.ConclusionsThe results might reflect the positive effect of an increased flexion angle of the femoral component up to 10° on ROM in mobile bearing UKA, which would contribute to better quality of life after UKA especially in populations requiring deep knee flexion.

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“…Measurements were recorded to a precision of 0.1 mm and 1°. Measurements were performed using a similar method to previous authors [12, 18, 40], where PTS is the acute angle between the tibial plateau in the sagittal view, and the line perpendicular to the tibial mechanical axis (Figs. 1and 2); PCO is the perpendicular distance of the posterior‐most aspect of the femoral condyle from a projection of the posterior femoral line (Figs.…”

Section: Methodsmentioning

confidence: 99%

Posterior condylar offset and posterior tibial slope targets to optimize knee flexion after unicompartmental knee arthroplasty

Khow

Liow

Lee

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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Purpose To evaluate the relationship between posterior tibial slope (PTS), posterior condylar ofset (PCO), femoral sagittal angle (FSA) on clinical outcomes, and propose optimal sagittal plane alignments for unicompartmental knee arthroplasty (UKA). Methods Prospectively collected data of 265 medial UKA was analysed. PTS, PCO, FSA were measured on preoperative and postoperative lateral radiographs. Clinical assessment was done at 6-month, 2-year and 10-year using Oxford Knee Score, Knee Society Knee and Function scores, Short Form-36, range of motion (ROM), fulilment of satisfaction and expectations. Implant survivorship was noted at mean 15-year. Kendall rank correlation test evaluated correlations of sagittal parameters against clinical outcomes. Multivariable linear regression evaluated predictors of postoperative ROM. Efect plots and interaction plots were used to identify angles with the best outcomes. (p < 0.05) was the threshold for statistical signiicance. Results There were signiicant correlations between PTS, PCO and FSA. Younger age, lower BMI, implant type, greater preoperative lexion, steeper PTS and preservation of PCO were signiicant predictors of greater postoperative lexion. There were signiicant interaction efects between PTS and PCO. Efect plots demonstrate a PTS between 2° to 8° and restoration of PCO within 1.5 mm of native values are optimal for better postoperative lexion. Interaction plot reveals that it is preferable to reduce PCO by 1.0 mm when PTS is 2° and restore PCO at 0 mm when PTS is 8°. Conclusion UKA surgeons and future studies should be mindful of the relationship between PTS, PCO and FSA, and avoid considering them in isolation. When deciding on the method of balancing component gaps in UKA, surgeons should rely on the PTS. Decrease the posterior condylar cut when PTS is steep, and increase the posterior condylar cut when PTS is shallow. The acceptable range for PTS is between 2° to 8° and PCO should be restored to 1.5 mm of native values. Level of evidence II.

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Sagittal flexion angle of the femoral component in unicompartmental knee arthroplasty: is it same for both medial and lateral UKAs?

Cited by 20 publications

References 25 publications

Better Implant Positioning and Clinical Outcomes With a Morphometric Unicompartmental Knee Arthroplasty. Results of a Retrospective, Matched-Controlled Study

Better Implant Positioning and Clinical Outcomes With a Morphometric Unicompartmental Knee Arthroplasty. Results of a Retrospective, Matched-Controlled Study

Intentionally Increased Flexion Angle of the Femoral Component in Mobile Bearing Unicompartmental Knee Arthroplasty

Posterior condylar offset and posterior tibial slope targets to optimize knee flexion after unicompartmental knee arthroplasty

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