Titanium Niobium Nitride Mobile-Bearing Unicompartmental Knee Arthroplasty Results in Good to Excellent Clinical and Radiographic Outcomes in Metal Allergy Patients With Medial Knee Osteoarthritis

Beyer

Knee Surg Sports Traumatol Arthrosc

et al. 2022

Purpose Allergy against implant materials is discussed controversially and still not fully understood. Despite these controversies, a relevant number of patients receive hypoallergenic knee implants. The aim of this study was to compare a new coating system with the standard implant in total knee arthroplasty (TKA). Additionally, the influence of proinflammatory cytokines on patient-reported outcome measures (PROMs) was investigated. Methods 120 patients without known metal allergy and without previous metal implants were included. The patients were randomized to receive a coated or standard TKA of the same knee system. 105 patients completed the 5 year follow-up. Patient-reported outcome measures (PROMs) including knee function (Oxford Knee Score, OKS), quality of life (SF36) and UCLA activity scale were assessed. Additionally, several cytokines with a possible role in implant allergy were measured in patient`s serum (IL-1beta, IL-5, IL-6, IL-8, IL-10, IP-10, IFN γ, TNF α). Group comparison was performed using Mann–Whitney U test for continuous values and chi-square test for categorical values. Results There were no differences in PROMs between both groups at any follow-up. The majority of patients demonstrated no elevation of the measured blood cytokines. The blood cytokine pattern after 5 years demonstrated no differences between study groups. There was a significant association between elevated IL-8 values and worse results in the overall OKS (p = 0.041), the OKS function component (p = 0.004), the UCLA activity scale (p = 0.007) and the physical component of SF36 (p = 0.001). Conclusion There were no problems with the new coating during mid-term follow-up and no differences in PROMs between coated and standard TKA. Patients with an increased inflammatory response demonstrated worse functional results, regardless of the implant. Level of evidence I. Clinical trial registration The study protocol was registered in the US National Institutes of Health’s database (http://www.clinicaltrials.gov) registry under NCT00862511.

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Increased inflammatory response is associated with less favorable functional results 5 years after total knee arthroplasty

Beyer

Knee Surg Sports Traumatol Arthrosc

et al. 2022

Computational Intelligence and Neuroscience

“…In 2004, Naudie et al reported that the 5-year and 10-year survival rates after unicondylar knee replacement were 94% and 90%, respectively [ 40 ]. Romanowski et al performed 13 cases of single condylar replacement with small incision, and the survival rate of 8-year follow-up was 93% [ 41 ]. Argenson et al basically agree with these views through research and they believe that computer-aided systems will also increase the accuracy of surgery in the future [ 42 ].…”

Section: Discussionmentioning

confidence: 99%

Safety and Efficacy of Single Condylar Knee Prosthesis When Treating Knee Single Compartment Osteoarthritis: A Prospective, Case-Randomized Controlled Study

Wang¹,

Wang

Wang³

2022

Objective. The aim of this study is to explore the safety and efficacy of single condylar knee prosthesis when treating knee single compartment osteoarthritis by measuring the decrease of hemoglobin, total postoperative blood loss, maximum reduction of HCT, and knee joint activity. Methods. A total of 80 patients with knee joint single compartment osteoarthritis treated in our hospital from January 2020 to December 2021 were studied. They were randomly assigned to a study group (n = 40) and a control group (n = 40). The study group was treated with total knee prosthesis, while the control group was treated with simple knee prosthesis. The decrease rate of hemoglobin, the amount of bleeding, and the maximum decrease of hematocrit were compared after treatment. The range of motion of knee joint was evaluated by the Fugl-Meyer motor function scale (FM-B) and Berg balance scale (BBS). Results. The decrease of hemoglobin in the study group at 24 hours, 36 hours, and 48 hours after treatment was remarkably lower ( P < 0.05). The total blood loss and the maximum reduction of hematocrit(HCT) in the study group were lower ( P < 0.05). The range of motion (ROM) of the knee joint in the study group at 6 and 12 months after treatment was remarkably higher than that before treatment and remarkably higher compared to the control group ( P < 0.05). The FM-B scale and BBS scale of the studied cohort at 6 and 12 months after treatment were remarkably higher than those before treatment and were remarkably higher compared to the control’s ( P < 0.05). Conclusion. The unicondylar knee prosthesis is safer and more effective in the treatment of noncompartmental osteoarthritis of the knee, facilitating less trauma and perioperative blood loss and enhancing the patient’s motion and balance.

Knee Surg Sports Traumatol Arthrosc

“…In modern knee arthroplasty, metal hypersensitivity appears to be a controversial issue [4]. Moreover, there is an ongoing debate about its clinical relevance owing to the possibility of premature implant failure [12].…”

Section: Introductionmentioning

confidence: 99%

“…Cutaneous hypersensitivity to metals ranges from 10 to 48% in general osteoarthritis (OA) population, and this high incidence is likely to be shared with patients eligible for knee arthroplasty [4, 18].…”

Section: Introductionmentioning

confidence: 99%

Similar rates of return to sports and BMI reduction regardless of age, gender and preoperative BMI as seen in matched cohort of hypoallergenic and standard Cobalt Chromium medial unicompartmental knee arthroplasty

D’Ambrosi

Anghilieri

Corona

et al. 2021

Self Cite

Purpose To compare the rate of return to sports and body mass index (BMI) reduction in patients who underwent surgery for unicompartmental knee arthroplasty (UKA) with either Cobalt-Chromium (CoCr) alloy UKA or with hypoallergenic UKA, stratiied by age, gender and BMI. Methods Two consecutive cohorts of patients with a total of 172 UKA and a minimum 2-year follow-up period were prospectively included in this comparative study. The irst cohort consisted of 136 consecutive series of standard Cobalt-Chromium (CoCr Group). The second cohort consisted of 36 consecutive mobile-bearing hypoallergenic Titanium Niobium Nitride UKA, (TiNbN Group). The clinical evaluation was based on the University of California, Los Angeles (UCLA) activity scores and the High-Activity Arthroplasty Score (HAAS) evaluated on the day before surgery (T 0 ) and after a minimum follow-up of 12 months (T 1 ) and 24 months (T 2 ). Radiographic evaluation performed at T 2 included the femoral component position in varus/valgus, the tibial component in varus/valgus and the anteroposterior slope. ResultsNo statistical diferences were found between the groups at each follow-up, as shown by the UCLA and HAAS score (n.s.). Both groups showed a statistically signiicant improvement (p < 0.05) at each follow-up. . Both groups showed a statistically signiicant BMI reduction between T 0 and T 2 (p < 0.05). Radiographic analysis revealed no statistical diferences between the two groups in terms of the three measures after the inal follow-up (n.s.). All the subgroups showed a signiicant (p < 0.05) rate of return to sport if compared with the preoperative value (T 2 versus T 0 ), except for male in TiNbN group. Conclusions Both TiNbN and CoCr medial mobile-bearing UKA enabled patients to return to sports after the inal follow-up, regardless of age, BMI, gender and metal sensitivity. These indings inform shared decision making and can help to manage patient expectations after surgery, in particular, in active patients with an overt metal allergy, a speciic hypoallergenic implant should be considered the gold standard implant in partial knee replacement surgery. Level of evidence Cohort Study, Level III. Registration: researchregistry6250-www.resea rchre gistr y.com.