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Cementless fixation in medial unicompartmental knee arthroplasty: a systematic review

  • S. CampiEmail author
  • H. G. Pandit
  • C. A. F. Dodd
  • D. W. Murray
Knee

Abstract

Purpose

The aim of this study was to evaluate clinical outcome, failures, implant survival, and complications encountered with cementless fixation in unicompartmental knee arthroplasty (UKA).

Methods

A systematic review of the literature on cementless fixation in UKA was performed according to the PRISMA guidelines. The following database was comprehensively searched: PubMed, Cochrane, Medline, CINAHL, Embase, and Google Scholar. The keywords “unicompartmental”, “unicondylar”, “partial knee arthroplasty”, and “UKA” were combined with each of the keyword “uncemented”, “cementless” and “survival”, “complications”, and “outcome”. The following data were extracted: demographics, clinical outcome, details of failures and revisions, cumulative survival, and complications encountered. The risk of bias of each study was estimated with the MINORS score and a further scoring system based on the presence of the primary outcomes.

Results

From a cohort of 63 studies identified using the above methodology, 10 papers (1199 knees) were included in the final review. The mean follow-up ranged from 2 to 11 years (median 5 years). The 5-year survival ranged from 90 to 99 % and the 10-year survival from 92 to 97 %. There were 48 revisions with an overall revision rate of 0.8 per 100 observed component-years. The most common cause of failure was progression of osteoarthritis in the retained compartment (0.9 %). The cumulative incidence of complications and revisions was comparable to that reported in similar studies on cemented UKAs. The advantages of cementless fixation include faster surgical time, avoidance of cementation errors, and lower incidence of radiolucent lines.

Conclusions

Cementless fixation is a safe and effective alternative to cementation in medial UKA. Clinical outcome, failures, reoperation rate, and survival are similar to those reported for cemented implants with lower incidence of radiolucent lines.

Level of evidence

IV.

Keywords

Unicompartmental knee arthroplasty Cementless Partial knee arthroplasty UKA 

Abbreviations

AMOA

Anteromedial osteoarthritis

CI

Confidence intervals

KSS

Knee Society Score

N.R.

Not reported

OA

Osteoarthritis

OKS

Oxford Knee Score

OUKA

Oxford unicompartmental knee arthroplasty

RCT

Randomised controlled trial

RLs

Radiolucent lines

RSA

Radiostereometric analysis

SD

Standard deviation

TKA

Total knee arthroplasty

UKA

Unicompartmental knee arthroplasty

Notes

Acknowledgments

The authors would like to thank T.W. Hamilton, B.E. Marks, J. Brown, and J. Ferris for their assistance with this study.

Compliance with ethical standards

Conflict of interest

Some of the authors have received or will receive benefits for personal or professional use from a commercial party related directly or indirectly to the subject of this article. In addition, benefits have been or will be directed to a research fund, foundation, educational institution, or other non-profit organisation with which one or more of the authors are associated.

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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2016

Authors and Affiliations

  • S. Campi
    • 1
    • 2
    Email author
  • H. G. Pandit
    • 1
    • 2
  • C. A. F. Dodd
    • 2
  • D. W. Murray
    • 1
    • 2
  1. 1.Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal SciencesUniversity of OxfordOxfordUK
  2. 2.Nuffield Orthopaedic Centre, Oxford University HospitalNHS Foundation TrustOxfordUK

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