Abstract
Background
The purpose in the present study was to compare clinical and radiological outcomes of patients who had undergone a mobile-bearing unicompartmental knee arthroplasty (UKA) with either titanium niobium nitride (TiNbN) alloy implants or with fixed-bearing oxidized zirconium alloy implants.
Methods
The records of two consecutive cohorts for a total of 86 hypoallergenic implants were prospectively analyzed. The first cohort consisted of 49 consecutive implantations of the hypoallergenic UKA Journey Uni Oxinium (Ox Group), while the second consisted of 37 consecutive series of UKA Oxford (TiNbN Group). All patients were evaluated by two independent surgeons who were not involved in the index surgery. The clinical evaluation consisted of evaluating each patient’s Oxford Knee Score and Knee Society Score day before surgery (T0), and with two consecutive follow-ups at T1 (minimum follow-up 9 months) and T2 (minimum follow-up 24 months).
Results
The two groups were homogeneous in all preoperative values, except Body Mass Index (BMI) and duration of final follow-up [both statistically higher (p < 0.05) in the TiNbN group]. Both groups showed a clinically significant improvement for all scores at final follow-up (p < 0.05). The only differences between the two groups involved a higher pre-operative Oxford Score in TiNbN group (p = 0.031), and different tibial and femoral angles at the final follow-up.
Conclusions
Both TiNbN and Oxinium UKA procedures enabled patients from good to excellent clinical and radiographic outcomes after the final follow-up, regardless of the age, gender, BMI bearing type, and implant size.
Level of evidence: Level II
Comparative study.
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Raw data have been submitted as supplementary material to the Journal.
References
Roberts TT, Haines CM, Uhl RL (2017) Allergic or hypersensitivity reactions to orthopaedic implants. J Am Acad Orthop Surg 25:693–702. https://doi.org/10.5435/JAAOS-D-16-00007
Willert HG, Buchhorn GH, Fayyazi A, Flury R, Windler M, Köster G, Lohmann CH (2005) Metal-on-metal bearings and hypersensitivity in patients with artificial hip joints. A clinical and histomorphological study. J Bone Joint Surg Am. 87:28–36. Doi: https://doi.org/10.2106/JBJS.A.02039pp.
Hallab N, Merritt K, Jacobs JJ (2001) Metal sensitivity in patients with orthopaedic implants. J Bone Joint Surg Am 83:428–436. https://doi.org/10.2106/00004623-200103000-00017 (PMID: 11263649)
Desai MM, Shah KA, Mohapatra A, Patel DC (2019) Prevalence of metal hypersensitivity in total knee replacement. J Orthop 16:468–472. https://doi.org/10.1016/j.jor.2019.05.005
Innes MB, Atwater AR (2020) Orthopedic Implant Hypersensitivity Reactions: Concepts and Controversies. Dermatol Clin 38:361–369. https://doi.org/10.1016/j.det.2020.02.005
D’Ambrosi R, Anghilieri FM, Corona K, Mariani I, Valli F, Ursino N, Hirschmann MT (2021) 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. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-021-06467-1
Patel AM, Spector M (1997) Tribological evaluation of oxidized zirconium using an articular cartilage counterface: a novel material for potential use in hemiarthroplasty. Biomaterials 18:441–447. https://doi.org/10.1016/s0142-9612(96)00152-4
D’Ambrosi R, Nuara A, Mariani I, Di Feo F, Ursino N, Hirschmann M (2021) 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. J Arthroplasty 36:140-147.e2. https://doi.org/10.1016/j.arth.2020.07.028
Cuschieri S (2019) The STROBE guidelines. Saudi J Anaesth 13(Suppl 1):S31–S34. https://doi.org/10.4103/sja.SJA_543_18
Fransway AF, Zug KA, Belsito DV, Deleo VA, Fowler JF Jr, Maibach HI, Marks JG, Mathias CG, Pratt MD, Rietschel RL, Sasseville D, Storrs FJ, Taylor JS, Warshaw EM, Dekoven J, Zirwas M (2013) North American Contact Dermatitis Group patch test results for 2007–2008. Dermatitis 24:10–21. https://doi.org/10.1097/DER.0b013e318277ca50
Zhang Q, Zhang Q, Guo W, Liu Z, Cheng L, Yue D, Zhang N (2014) The learning curve for minimally invasive Oxford phase 3 unicompartmental knee arthroplasty: cumulative summation test for learning curve (LC-CUSUM). J Orthop Surg Res 9:81. https://doi.org/10.1186/s13018-014-0081-8
Hamilton TW, Pandit HG, Lombardi AV, Adams JB, Oosthuizen CR, Clavé A, Dodd CA, Berend KR, Murray DW (2016) Radiological Decision Aid to determine suitability for medial unicompartmental knee arthroplasty: development and preliminary validation. Bone Joint J. 98-B:3–10. doi: https://doi.org/10.1302/0301-620X.98B10.BJJ-2016-0432.R1.
Mujika KM, Méndez JAJ, de Miguel AF (2018) Advantages and disadvantages in image processing with free software in radiology. J Med Syst 42:36. https://doi.org/10.1007/s10916-017-0888-z
Quah C, Holmes D, Khan T, Cockshott S, Lewis J, Stephen A (2018) The variability in Oxford hip and knee scores in the preoperative period: is there an ideal time to score? Ann R Coll Surg Engl 100:16–20. https://doi.org/10.1308/rcsann.2017.0090
Maltenfort M (2017) CORR Insights®: What is the responsiveness and respondent burden of the new knee society score? Clin Orthop Relat Res 475:2228–2229. https://doi.org/10.1007/s11999-017-5352-3
Costa CR, Johnson AJ, Mont MA (2011) Bonutti PM (2011) Unicompartmental and total knee arthroplasty in the same patient. J Knee Surg 24:273–278. https://doi.org/10.1055/s-0031-1280970
Johal S, Nakano N, Baxter M, Hujazi I, Pandit H, Khanduja V (2018) Unicompartmental knee arthroplasty: the past, current controversies, and future perspectives. J Knee Surg 31:992–998. https://doi.org/10.1055/s-0038-1625961
Jennings JM, Kleeman-Forsthuber LT, Bolognesi MP (2019) Medial unicompartmental arthroplasty of the knee. J Am Acad Orthop Surg 27:166–176. https://doi.org/10.5435/JAAOS-D-17-00690
Innocenti M, Vieri B, Melani T, Paoli T, Carulli C (2017) Metal hypersensitivity after knee arthroplasty: fact or fiction? Acta Biomed 88:78–83. https://doi.org/10.23750/abm.v88i2-S.6517
Middleton S, Toms A (2016) Allergy in total knee arthroplasty: a review of the facts. Bone Joint J. 8-B:437–441. doi: https://doi.org/10.1302/0301-620X.98B4.36767.
Atilla HA, Çevik HB, Akdoğan M, Aslan H (2020) Self-reported metal hypersensitivity in patients undergoing unicondylar knee arthroplasty. J Clin Orthop Trauma 14:17–21. https://doi.org/10.1016/j.jcot.2020.10.002
Zondervan RL, Vaux JJ, Blackmer MJ, Brazier BG, Taunt CJ Jr (2019) Improved outcomes in patients with positive metal sensitivity following revision total knee arthroplasty. J Orthop Surg Res 14:182. https://doi.org/10.1186/s13018-019-1228-4
Thomas P, Hisgen P, Kiefer H, Schmerwitz U, Ottersbach A, Albrecht D, Summer B, Schinkel C (2018) Blood cytokine pattern and clinical outcome in knee arthroplasty patients: comparative analysis 5 years after standard versus “hypoallergenic” surface coated prosthesis implantation. Acta Orthop 89:646–651
Saccomanno MF, Sircana G, Masci G, Cazzato G, Florio M, Capasso L, Passiatore M, Autore G, Maccauro G, Pola E (2019) Allergy in total knee replacement surgery: Is it a real problem? World J Orthop 10:63–70. https://doi.org/10.5312/wjo.v10.i2.63
Zhang W, Wang J, Li H, Wang W, George DM, Huang T (2020) Fixed- versus mobile-bearing unicompartmental knee arthroplasty: a meta-analysis. Sci Rep 10:19075. https://doi.org/10.1038/s41598-020-76124-z
Cheng T, Chen D, Zhu C, Pan X, Mao X, Guo Y, Zhang X (2013) Fixed- versus mobile-bearing unicondylar knee arthroplasty: are failure modes different? Knee Surg Sports Traumatol Arthrosc 21:2433–2441. https://doi.org/10.1007/s00167-012-2208-y
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Appendix 1
Appendix 1
Distribution of femoral, tibial and insert sizes in the two groups.
Ox group n (%) | TiNbN n (%) | |
---|---|---|
N | 49 | 37 |
Femoral size | ||
1 | 2 (4.1) | 0 (0.0) |
2 | 9 (18.4) | 0 (0.0) |
3 | 18 (36.7) | 0 (0.0) |
4 | 16 (32.7) | 0 (0.0) |
5 | 4 (8.2) | 0 (0.0) |
S | 0 (0.0) | 27 (73.0) |
M | 0 (0.0) | 9 (24.3) |
L | 0 (0.0) | 1 (2.7) |
Tibial size | ||
2 | 7 (14.3) | 0 (0.0) |
3 | 16 (32.7) | 0 (0.0) |
4 | 11 (22.4) | 0 (0.0) |
5 | 14 (28.6) | 0 (0.0) |
6 | 1 (2.0) | 0 (0.0) |
A | 0 (0.0) | 15 (40.5) |
B | 0 (0.0) | 12 (32.4) |
C | 0 (0.0) | 7 (18.9) |
D | 0 (0.0) | 3 (8.1) |
Bearing | ||
3 | 0 (0.0) | 23 (62.2) |
4 | 0 (0.0) | 8 (21.6) |
5 | 0 (0.0) | 4 (10.8) |
6 | 0 (0.0) | 2 (5.4) |
8 | 34 (69.4) | 0 (0.0) |
9 | 11 (22.4) | 0 (0.0) |
10 | 3 (6.1) | 0 (0.0) |
11 | 1 (2.0) | 0 (0.0) |
Clinical and radiographic results for patients with small femoral size, in Ox and TiNbN group, respectively, at T0, T1 and T2.
Groups | Between group comparison p value | Within group time comparison | ||||
---|---|---|---|---|---|---|
Ox group Mean ± SD | TiNbN Mean ± SD | Ox group Adj p value | TiNbN Adj p value | |||
N | 29 | 27 | 29 | 27 | ||
Clinical outcomes | ||||||
OKS | ||||||
T0 | 21.41 ± 2.54 | 23.26 ± 2.73 | 0.034* | T0–T1 | < 0.001* | < 0.001* |
T1 | 41.31 ± 4.08 | 42.15 ± 1.32 | 0.341 | T0–T2 | < 0.001* | < 0.001* |
T2 | 44.00 ± 5.38 | 45.00 ± 1.73 | 0.758 | T1–T2 | < 0.001* | < 0.001* |
KSS | ||||||
T0 | 51.17 ± 3.54 | 51.48 ± 5.39 | 0.804 | T0–T1 | < 0.001* | < 0.001* |
T1 | 87.41 ± 5.69 | 87.70 ± 2.13 | 0.606 | T0–T2 | < 0.001* | < 0.001* |
T2 | 91.52 ± 8.06 | 91.78 ± 2.93 | 0.113 | T1–T2 | < 0.001* | < 0.001* |
Angles at T2 | ||||||
Tibial angle | 0.00° ± 3.75 | 3.11° ± 2.29 | 0.001* | |||
Femoral angle | 5.10° ± 2.76 | 6.81° ± 4.90 | 0.180 | |||
Tibial Slope | 6.48° ± 1.68 | 5.26° ± 3.50 | 0.246 |
SD Standard deviation; * = statistical significant value (p < 0.05).
OKS Oxford Knee Score, KSS Knee Society Score.
Clinical and radiographic results for patients with big femoral size, in Ox and TiNbN group, respectively, at T0, T1 and T2.
Groups | Between group comparison p value | Within group time comparison | |||||
---|---|---|---|---|---|---|---|
Ox group Mean ± SD | TiNbN Mean ± SD | Ox group Adj p value | TiNbN Adj p value | ||||
N | 20 | 10 | 20 | 10 | |||
Clinical outcomes | |||||||
OKS | |||||||
T0 | 22.00 ± 2.38 | 22.50 ± 2.72 | 0.549 | T0–T1 | < 0.001* | 0.017* | |
T1 | 41.20 ± 3.04 | 41.90 ± 2.64 | 0.790 | T0–T2 | < 0.001* | 0.006* | |
T2 | 44.85 ± 2.81 | 45.20 ± 2.35 | 0.929 | T1–T2 | 0.001* | 0.196 | |
KSS | |||||||
T0 | 51.10 ± 4.13 | 51.50 ± 4.20 | 0.858 | T0–T1 | < 0.001* | 0.018* | |
T1 | 86.75 ± 4.69 | 87.50 ± 2.37 | 0.499 | T0–T2 | < 0.001* | 0.018* | |
T2 | 92.20 ± 4.54 | 92.30 ± 4.55 | 0.493 | T1–T2 | < 0.001* | 0.017* | |
Angles at T2 | |||||||
Tibial angle | 0.05° ± 3.61 | 2.90° ± 1.66 | 0.010* | ||||
Femoral angle | 4.05° ± 3.19 | 7.40° ± 3.44 | 0.013* | ||||
Tibial Slope | 4.70° ± 3.57 | 4.80° ± 2.30 | 0.876 |
SD Standard deviation; * = statistical significant value (p < 0.05).
OKS Oxford Knee Score, KSS Knee Society Score.
Clinical and radiographic results for patients with small tibial size, in Ox and TiNbN group, respectively, at T0, T1 and T2.
Groups | Between group comparison p value | Within group time comparison | |||||
---|---|---|---|---|---|---|---|
Ox group Mean ± SD | TiNbN Mean ± SD | Ox group Adj p value | TiNbn Adj p value | ||||
N | 23 | 15 | 23 | 15 | |||
Clinical outcomes | |||||||
OKS | |||||||
T0 | 21.52 ± 2.52 | 23.07 ± 2.15 | 0.050 | T0–T1 | < 0.001* | 0.002* | |
T1 | 41.52 ± 4.32 | 42.80 ± 1.61 | 0.178 | T0–T2 | < 0.001* | 0.002* | |
T2 | 43.96 ± 5.98 | 44.67 ± 1.84 | 0.704 | T1–T2 | 0.005* | 0.041* | |
KSS | |||||||
T0 | 51.26 ± 3.62 | 51.53 ± 5.45 | 0.834 | T0–T1 | < 0.001* | 0.002* | |
T1 | 87.74 ± 6.32 | 87.73 ± 1.91 | 0.180 | T0–T2 | < 0.001* | 0.002* | |
T2 | 91.39 ± 9.02 | 91.73 ± 3.01 | 0.134 | T1–T2 | 0.002* | 0.004* | |
Angles at T2 | |||||||
Tibial angle | −0.26° ± 3.85 | 3.73° ± 2.43 | 0.001* | ||||
Femoral angle | 4.65° ± 2.69 | 5.40° ± 5.53 | 0.905 | ||||
Tibial Slope | 5.87° ± 2.01 | 6.47° ± 2.85 | 0.565 |
SD Standard deviation; * = statistical significant value (p < 0.05).
OKS Oxford Knee Score; KSS Knee Society Score.
Clinical and radiographic results for patients with large tibial size, in Ox and TiNbN group, respectively, at T0, T1 and T2.
Groups | Between group comparison p value | Within group time comparison | |||||
---|---|---|---|---|---|---|---|
Ox group Mean ± SD | TiNbN Mean ± SD | Ox group Adj p value | TiNbN Adj p value | ||||
N | 26 | 22 | 26 | 22 | |||
Clinical outcomes | |||||||
OKS | |||||||
T0 | 21.77 ± 2.47 | 23.05 ± 3.08 | 0.255 | T0–T1 | < 0.001* | < 0.001* | |
T1 | 41.04 ± 3.03 | 41.59 ± 1.68 | 0.785 | T0–T2 | < 0.001* | < 0.001* | |
T2 | 44.69 ± 2.65 | 45.32 ± 1.91 | 0.614 | T1–T2 | < 0.001* | 0.001* | |
KSS | |||||||
T0 | 51.04 ± 3.92 | 51.45 ± 4.88 | 0.933 | T0–T1 | < 0.001* | < 0.001* | |
T1 | 86.62 ± 4.18 | 87.59 ± 2.36 | 0.152 | T0–T2 | < 0.001* | < 0.001* | |
T2 | 92.15 ± 4.09 | 92.05 ± 3.67 | 0.328 | T1–T2 | < 0.001* | < 0.001* | |
Angles at T2 | |||||||
Tibial angle | 0.27° ± 3.53 | 2.59° ± 1.79 | 0.007* | ||||
Femoral angle | 4.69° ± 3.22 | 8.05° ± 3.40 | 0.002* | ||||
Tibial Slope | 5.65° ± 3.29 | 4.23° ± 3.16 | 0.182 |
SD Standard deviation; * = statistical significant value (p < 0.05).
OKS Oxford Knee Score, KSS Knee Society Score.
Clinical and radiographic results for patients with small bearing, in Ox and TiNbN group, respectively, at T0, T1 and T2.
Groups | Between group comparison p value | Within group time comparison | |||||
---|---|---|---|---|---|---|---|
Ox group Mean ± SD | TiNbN Mean ± SD | Ox group Adj p value | TiNbN Adj p value | ||||
N | 34 | 23 | 34 | 23 | |||
Clinical outcomes | |||||||
OKS | |||||||
T0 | 21.35 ± 2.58 | 22.57 ± 2.69 | 0.101 | T0–T1 | < 0.001* | < 0.001* | |
T1 | 41.15 ± 4.34 | 42.26 ± 2.03 | 0.367 | T0–T2 | < 0.001* | < 0.001* | |
T2 | 43.91 ± 5.31 | 45.00 ± 1.81 | 0.811 | T1–T2 | < 0.001* | 0.004* | |
KSS | |||||||
T0 | 50.91 ± 3.62 | 52.13 ± 5.18 | 0.481 | T0–T1 | < 0.001* | < 0.001* | |
T1 | 87.09 ± 6.24 | 88.04 ± 1.97 | 0.805 | T0–T2 | < 0.001* | < 0.001* | |
T2 | 91.62 ± 8.06 | 92.35 ± 3.64 | 0.265 | T1–T2 | < 0.001* | < 0.001* | |
Angles at T2 | |||||||
Tibial angle | 0.38° ± 3.52 | 3.30° ± 2.36 | 0.001* | ||||
Femoral angle | 4.53° ± 2.81 | 6.87° ± 4.81 | 0.052 | ||||
Tibial Slope | 5.71° ± 3.02 | 5.57° ± 2.94 | 0.737 |
SD Standard deviation; * = statistical significant value (p < 0.05).
OKS Oxford Knee Score, KSS Knee Society Score.
Clinical and radiographic results for patients with large bearing, in Ox and TiNbN group, respectively, at T0, T1 and T2.
Groups | Between group comparison p value | Within group time comparison | |||||
---|---|---|---|---|---|---|---|
Ox group Mean ± SD | TiNbN Mean ± SD | Ox group Adj p value | TiNbN Adj p value | ||||
N | 15 | 14 | 15 | 14 | |||
Clinical outcomes | |||||||
OKS | |||||||
T0 | 22.33 ± 2.13 | 23.86 ± 2.63 | 0.233 | T0–T1 | 0.002* | 0.003* | |
T1 | 41.53 ± 1.13 | 41.79 ± 1.12 | 0.628 | T0–T2 | 0.002* | 0.003* | |
T2 | 45.33 ± 1.11 | 45.14 ± 2.07 | 0.876 | T1–T2 | 0.002* | 0.007* | |
KSS | |||||||
T0 | 51.67 ± 4.10 | 50.43 ± 4.80 | 0.227 | T0–T1 | 0.002* | 0.003* | |
T1 | 87.27 ± 1.79 | 87.00 ± 2.39 | 0.787 | T0–T2 | 0.002* | 0.003* | |
T2 | 92.20 ± 2.18 | 91.21 ± 2.89 | 0.198 | T1–T2 | 0.002* | 0.005* | |
Angles at T2 | |||||||
Tibial angle | −0.80° ± 3.95 | 2.64° ± 1.65 | 0.020* | ||||
Femoral angle | 5.00° ± 3.34 | 7.14° ± 4.15 | 0.155 | ||||
Tibial Slope | 5.87° ± 2.03 | 4.43° ± 3.59 | 0.310 |
SD Standard deviation; * = statistical significant value (p < 0.05).
OKS Oxford Knee Score, KSS Knee Society Score.
Statistical significant correlations between clinical score and angles.
Ox group N = 49 Rho (p value) | TiNbN N = 37 Rho (p value) | |||
---|---|---|---|---|
Physical activity indexes | ||||
OKS | ||||
T0 | T1 | T0 | T1 | |
T1 | 0.17 (0.252) | 1.00 | 0.07 (0.663) | 1.00 |
T2 | 0.11 (0.449) | 0.77 (< 0.001*) | −0.36 (0.028*) | −0.28 (0.091) |
KSS | ||||
T0 | T1 | T0 | T1 | |
T1 | 0.05 (0.711) | 1.00 | 0.22 (0.182) | 1.00 |
T2 | 0.02 (0.902) | 0.59 (< 0.001*) | 0.41 (0.013*) | 0.45 (0.005*) |
Angles at T2 | ||||
Tibial Slope | Tibial angle | Tibial Slope | Tibial angle | |
Tibial angle | 0.18 (0.205) | 1.00 | −0.07 (0.678) | 1.00 |
Femoral angle | 0.18 (0.210) | 0.36 (0.011*) | −0.29 (0.081) | 0.07 (0.698) |
Significant correlations between clinical outcomes, angles and other continuous variables.
Ox group N = 49 | TiNbN N = 37 | ||||
---|---|---|---|---|---|
Variables | Rho (p value) | Variables | Rho (p value) | ||
OKS T0 | KSS T0 | 0.39 (0.006*) | OKS T2 | KSS T1 | −0.33 (0.044) |
OKS T2 | KSS T0 | 0.31 (0.031*) | KSS T0 | Weight | 0.44 (0.007*) |
OKS T1 | KSS T1 | 0.57 (< 0.001*) | KSS T2 | Weight | 0.36 (0.029*) |
OKS T2 | KSS T1 | 0.57 (< 0.001*) | Femoral angle | Final follow−up | −0.36 (0.029*) |
OKS T1 | KSS T2 | 0.48 (< 0.001*) | |||
OKS T2 | KSS T2 | 0.45 (< 0.001*) | |||
KSS T2 | Age | −0.34 (0.016*) | |||
Femoral angle | Final follow-up | 0.39 (0.006*) |
* = statistical significant value (p < 0.05).
OKS Oxford Knee Score, KSS Knee Society Score.
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D’Ambrosi, R., Ursino, N., Mariani, I. et al. Similar clinical and radiographic outcomes after two different hypoallergenic medial unicompartmental knee in patients with metal allergy. Eur J Orthop Surg Traumatol 33, 1315–1328 (2023). https://doi.org/10.1007/s00590-022-03295-y
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DOI: https://doi.org/10.1007/s00590-022-03295-y