Unicompartmental knee arthroplasty, an enigma, and the ten enigmas of medial UKA

Mittal, Anurag; Meshram, Prashant; Kim, Woo Hyun; Kim, Tae Kyun

doi:10.1186/s10195-020-00551-x

Cited by 47 publications

(40 citation statements)

References 181 publications

(278 reference statements)

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“…Of note, a systematic review of 10 studies has reported good clinical outcomes with cementless UKA [71]. Nonetheless, we routinely use cemented prosthesis for all our knee arthroplasties, and this is supported by long-term studies [32,[72][73][74] and over a decade of successful results in our patients.…”

Section: Evidencementioning

confidence: 83%

Evidence-based surgical technique for medial unicompartmental knee arthroplasty

Kim¹,

Mittal²,

Meshram³

et al. 2021

Knee Surg & Relat Res

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Unicompartmental knee arthroplasty (UKA) is a successful treatment modality in selected patients having advanced, single-compartment osteoarthritis of the knee. The bone and ligament preservation leading to shorter recovery periods, better functional outcomes, lower perioperative complication rates, and easier revision, if needed, are proposed as some of the advantages of UKA over total knee arthroplasty (TKA). Despite several advantages, UKA is reported to have higher failure rates as compared to TKA. The prosthesis failure of UKA is directly correlated to intraoperative technique-related factors like malpositioning of components and the inability to replicate the target-limb alignment as per preoperative planning. An evidence-based surgical technique for UKA may help surgeons to avoid the intraoperative technique-related errors. The purpose of this paper is to describe a stepwise surgical technique for the fixed-bearing medial UKA.

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Section: Evidencementioning

confidence: 83%

Evidence-based surgical technique for medial unicompartmental knee arthroplasty

Kim¹,

Mittal²,

Meshram³

et al. 2021

Knee Surg & Relat Res

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“…Candidates for UKA have recently expanded to include younger and more active patients [21]. UKA is often compared with HTO [22][23][24], and the indications for surgery may also overlap. Although patients with severe varus alignment (HKA ≥ 185°) may be candidates for HTO, this study demonstrates that PROMs following Oxford UKA for knees with more than 5° of varus alignment were relatively good and not significantly different from those in the mild varus group.…”

Section: Discussionmentioning

confidence: 99%

Perioperative varus alignment does not affect short-term patient-reported outcome measures following mobile-bearing unicompartmental knee arthroplasty

et al. 2022

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Background Although favorable long-term survival of Oxford unicompartmental knee arthroplasty (UKA) has been reported regardless of postoperative varus alignment, the effect of degree of varus alignment on patient-reported outcome measures (PROMs) remains unclear. Furthermore, the Forgotten Joint Score-12 (FJS-12), which has a low ceiling effect, may be useful for such assessment. The objective of this study was to evaluate short-term clinical outcomes after Oxford UKA in knees with a greater degree of preoperative varus alignment focusing on use of the FJS-12. Methods This retrospective study involved 66 knees that had undergone primary Oxford UKA. Based on the hip-knee-ankle angle, the knees were divided into two alignment groups: severe varus group (≥ 185° varus alignment) and a mild varus group (< 185° varus alignment). PROMs, including the FJS-12, Knee Injury and Osteoarthritis Outcome Score, and Knee Society Score, were obtained pre- and postoperatively for assessment of clinical outcomes. In addition, the ceiling effect of the FJS-12 was evaluated. Results All PROMs showed significant improvement after surgery. However, there were no statistically significant differences between the severe varus group and the mild varus group. Moreover, no ceiling effect was found for the FJS-12 in this study. Conclusion Short-term results were good for Oxford UKA in knees with a greater degree of varus alignment and were not significantly different from those in knees with mild varus alignment.

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“…The first treatment line is conservative, mainly symptomatic, to delay joint replacement as long as possible [ 6 ]. Younger patients with mild OA tend to be dissatisfied after total knee arthroplasty (TKA) [ 7 , 8 ], and unicompartmental knee arthroplasty (UKA), in case of medial OA in a varus knee of an active patients, is still discussed but controversial in literature [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

A novel biplanar medial opening-wedge high tibial osteotomy: the Z-shaped technique. A case series at 7.2 years follow-up

Presutti¹,

Goderecci

Palumbo

et al. 2021

J Orthop Traumatol

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Background High tibial osteotomy (HTO) provides reliable and good long-term results, if performed with correct indications, but different techniques and types of fixation have been described. The purpose of this study is to present a novel modified biplanar medial opening-wedge (MOW) HTO technique where the osteotomies are performed in a Z-shaped fashion, and to present the medium-term clinical and radiographic results. Materials and methods We present a case series of 75 patients (80 knees) with mean age of 45.8 years, affected by isolated medial knee osteoarthritis and symptomatic varus knee malalignment, who underwent novel biplanar Z-shaped MOWHTO. Clinical and radiological outcomes were collected, retrospectively before surgery and at median follow-up of 7.2 years (95% CI 5.6–9.2 months) after surgery. Clinical results and satisfaction were assessed by visual analog scale (VAS), Western Ontario and McMaster University Osteoarthritis Index (WOMAC), and Likert scale. Radiological assessment involved the evaluation of the medial proximal tibial angle (MPTA), tibial slope (TS), Caton–Deschamps index, and knee osteoarthritis grade according to Ahlbäck classification. Pre- and postoperative results were compared using the two-tailed t-test or Wilcoxon’s test of independent samples for paired data or nonparametric analog. P < 0.05 was considered significant. Results At medium-term follow-up, Z-shaped MOWHTO showed a survival rate of 95 ± 1.7% with failure occurring in four knees due to symptom recurrence and osteoarthritis progression. No perioperative complications were observed (intraarticular fracture, delayed union or nonunion, and neurological injury). Mean bone healing time was 12 weeks. Clinical scores showed significant improvement at last follow-up and a good grade of satisfaction. MPTA increased significantly, while Caton–Deschamps index decreased significantly. No significant TS increase was found. Conclusions Modified biplanar Z-shaped MOWHTO is a safe and reliable technique that offers satisfactory clinical and radiological medium-term outcomes with low knee arthroplasty conversion rate. The unique three-dimensional geometrical conformation potentially provides a favorable environment for bone healing, increased anteroposterior and rotational stability, and safer opening-wedge loading force application with low lateral hinge fracture risk. Level of evidence Level IV, retrospective observational case series study. Trial registration The study protocol was approved by the Internal Review Board of our Institution (authorization number 54/2019, 20 November 2019).

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Unicompartmental knee arthroplasty, an enigma, and the ten enigmas of medial UKA

Cited by 47 publications

References 181 publications

Evidence-based surgical technique for medial unicompartmental knee arthroplasty

Evidence-based surgical technique for medial unicompartmental knee arthroplasty

Perioperative varus alignment does not affect short-term patient-reported outcome measures following mobile-bearing unicompartmental knee arthroplasty

A novel biplanar medial opening-wedge high tibial osteotomy: the Z-shaped technique. A case series at 7.2 years follow-up

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