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Long-term deterioration after one-stage unicompartmental knee arthroplasty and anterior cruciate ligament reconstruction

  • I. Iriberri
  • S. Suau
  • L. Payán
  • J. F. Aragón
Original Article
  • 6 Downloads

Abstract

Purpose

Treatment for unicompartmental knee osteoarthritis (OA) is controversial in young patients with concomitant anterior cruciate ligament (ACL) deficiency. The aim of the current study is to report long-term results after the combination of unicompartmental knee arthroplasty (UKA) and ACL reconstruction.

Methods

Retrospective study of one-stage medial UKA and ACL reconstruction was performed on eight patients at a mean age of 52 years (42–60). Clinical and radiological results were assessed and analyzed after a mean follow-up of 14.6 years.

Results

Patients were satisfied and mean personal satisfaction rate was 8.8 (4–10). At the last follow-up, mean WOMAC score was 26 (1–52) and mean global KSS was 154 (102–200). One revision surgery to total knee arthroplasty was performed 9 years after the combined procedure due to aseptic loosening. One more case of clinical deterioration was observed 13 years after index surgery.

Conclusions

Combined UKA and ACL reconstruction can be a therapeutic option for young and active patients with concomitant knee instability and unicompartmental OA. The procedure is highly demanding and reliable only in hands of experienced surgeons. Overall, satisfactory outcome can be achieved at a minimum follow-up of 10 years. However, clinical deterioration can be observed in the long term.

Keywords

UKA ACL reconstruction One stage Long term 

Notes

Acknowledgements

Support for statistical analysis was provided by Luis I. Martínez. Language edition was performed by Toby D. Howick.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Compliance with ethical standards

Conflict of interest

Outside the submitted work, Dr. J. F. Aragón reports personal fees and non-financial support from the Smith & Nephew company. The rest of authors declare that they have no conflict of interest.

Statement of human rights

This study was carried out at the Fundació Hospital de l’Esperit Sant (Santa Coloma de Gramenet, Spain) and was approved by the institutional review board and ethical committee of the United Catalonian Hospitals Foundation (Barcelona, Spain), with the code CEIC 15/102. All procedures performed in these studies were in accordance with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

All patients were informed about the study and gave informed consent to the work. No dead patient was included in the study.

References

  1. 1.
    Goodfellow JW, Kershaw CJ, Benson MK, O’Connor JJ (1988) The Oxford Knee for unicompartmental osteoarthritis. The first 103 cases. J Bone Joint Surg 70(5):692–701CrossRefGoogle Scholar
  2. 2.
    Deschamps G, Lapeyre B (1987) Rupture of the anterior cruciate ligament: a frequently unrecognized cause of failure of unicompartmental knee prostheses. Apropos of a series of 79 Lotus prostheses with a follow-up of more than 5 years. Rev Chir Orthop Reparatrice Appar Mot 73:544–551 (in French) PubMedGoogle Scholar
  3. 3.
    Christensen NO (1991) Unicompartmental prosthesis for gonarthrosis. A nine-year series of 575 knees from a Swedish hospital. Clin Orthop 273:165–169Google Scholar
  4. 4.
    Cartier P, Sanouiller JL, Grelsamer RP (1996) Unicompartmental knee arthroplasty surgery. 10-year minimum follow-up period. J Arthroplasty 11(7):782–788CrossRefPubMedGoogle Scholar
  5. 5.
    Pandit H, Beard DJ, Jenkins C et al (2006) Combined anterior cruciate reconstruction and Oxford unicompartmental knee arthroplasty. J Bone Joint Surg Br 88(7):887–892.  https://doi.org/10.1302/0301-620X.88B7.17847 CrossRefPubMedGoogle Scholar
  6. 6.
    Weston-Simons JS, Pandit H, Jenkins C et al (2012) Outcome of combined unicompartmental knee replacement and combined or sequential anterior cruciate ligament reconstruction: a study of 52 cases with mean follow-up of five years. J Bone Joint Surg Br 94(9):1216–1220.  https://doi.org/10.1302/0301-620X.94B9.28881 CrossRefPubMedGoogle Scholar
  7. 7.
    Tinius M, Hepp P, Becker R (2012) Combined unicompartmental knee arthroplasty and anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 20(1):81–87.  https://doi.org/10.1007/s00167-011-1528-7 CrossRefPubMedGoogle Scholar
  8. 8.
    Dervin GF, Conway AF, Thurston P (2007) Combined anterior cruciate ligament reconstruction and unicompartmental knee arthroplasty: surgical technique. Orthopedics 30(5 Suppl):39–41PubMedGoogle Scholar
  9. 9.
    Citak M, Bosscher MR, Citak M, Musahl V, Pearle AD, Suero EM (2011) Anterior cruciate ligament reconstruction after unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 19(10):1683–1688.  https://doi.org/10.1007/s00167-011-1449-5 CrossRefPubMedGoogle Scholar
  10. 10.
    Ahlbäck S, Rydberg J (1980) X-ray classification and examination technics in gonarthrosis. Lakartidningen 77(22):2091–2096 (in Swedish) PubMedGoogle Scholar
  11. 11.
    Piperno M, Hellio Le Graverand MP, Conrozier T, Bochu M, Mathieu P, Vignon E (1998) Quantitative evaluation of joint space width in femorotibial osteoarthritis: comparison of three radiographic views. Osteoarthr Cartil 6(4):252–259CrossRefPubMedGoogle Scholar
  12. 12.
    Dejour H, Bonnin M (1994) Tibial translation after anterior cruciate ligament rupture. Two radiological tests compared. J Bone Joint Surg Br 76(5):745–749CrossRefPubMedGoogle Scholar
  13. 13.
    Luo CF (2004) Reference axes for reconstruction of the knee. Knee 11(4):251–257CrossRefPubMedGoogle Scholar
  14. 14.
    Tibrewal SB, Grant KA, Goodfellow JW (1984) The radiolucent line beneath the tibial components of the Oxford meniscal knee. J Bone Joint Surg Br 66(4):523–528CrossRefPubMedGoogle Scholar
  15. 15.
    Hernigou P, Deschamps G (2004) Posterior slope of the tibial implant and the outcome of unicompartmental knee arthroplasty. J Bone Joint Surg Am 86-A(3):506–511CrossRefPubMedGoogle Scholar
  16. 16.
    Lee SY, Chay S, Lim HC, Bae JH (2017) Tibial component rotation during the unicompartmental knee arthroplasty: is the anterior superior iliac spine an appropriate landmark? Knee Surg Sports Traumatol Arthrosc 25(12):3723–3732.  https://doi.org/10.1007/s00167-016-4192-0 CrossRefPubMedGoogle Scholar
  17. 17.
    Lee YS, Yun JY, Lee BK (2014) Tibial component coverage based on bone mineral density of the cut tibial surface during unicompartmental knee arthroplasty: clinical relevance of the prevention of tibial component subsidence. Arch Orthop Trauma Surg 134(1):85–89.  https://doi.org/10.1007/s00402-013-1895-2 CrossRefPubMedGoogle Scholar
  18. 18.
    Saldanha KA, Keys GW, Svard UC, White SH, Rao C (2007) Revision of Oxford medial unicompartmental knee arthroplasty to total knee arthroplasty—results of a multicentre study. Knee 14(4):275–279.  https://doi.org/10.1016/j.knee.2007.03.005 CrossRefPubMedGoogle Scholar
  19. 19.
    Levine WN, Ozuna RM, Scott RD, Thornhill TS (1996) Conversion of failed modern unicompartmental arthroplasty to total knee arthroplasty. J Arthroplasty 11(7):797–801.  https://doi.org/10.1016/S0883-5403(96)80179-3 CrossRefPubMedGoogle Scholar
  20. 20.
    Järvenpää J, Kettunen J, Miettinen H, Kröger H (2010) The clinical outcome of revision knee replacement after unicompartmental knee arthroplasty versus primary total knee arthroplasty: 8–17 years follow-up study of 49 patients. Int Orthop 34(5):649–653.  https://doi.org/10.1007/s00264-009-0811-4 CrossRefPubMedGoogle Scholar
  21. 21.
    Newman J, Pydisetty RV, Ackroyd C (2009) Unicompartmental or total knee replacement: the 15-year results of a prospective randomised controlled trial. J Bone Joint Surg Br 91(1):52–57.  https://doi.org/10.1302/0301-620X.91B1.20899 CrossRefPubMedGoogle Scholar
  22. 22.
    Banks SA, Fregly BJ, Boniforti F, Reinschmidt C, Romagnoli S (2005) Comparing in vivo kinematics of unicondylar and bi-unicondylar knee replacements. Knee Surg Sports Traumatol Arthrosc 13(7):551–556.  https://doi.org/10.1007/s00167-004-0565-x CrossRefPubMedGoogle Scholar

Copyright information

© Istituto Ortopedico Rizzoli 2018

Authors and Affiliations

  • I. Iriberri
    • 1
  • S. Suau
    • 2
  • L. Payán
    • 2
  • J. F. Aragón
    • 2
  1. 1.Department of Orthopaedic SurgeryBidasoako OspitaleaHondarribiaSpain
  2. 2.Department of Orthopaedic SurgeryFundació Hospital de l’Esperit SantSanta Coloma de GramenetSpain

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