Minimally invasive Oxford medial unicompartmental knee arthroplasty in young patients

  • Marcus R. Streit
  • Julia Streit
  • Tilman Walker
  • Thomas Bruckner
  • J. Philippe Kretzer
  • Volker Ewerbeck
  • Christian Merle
  • Peter R. Aldinger
  • Tobias Gotterbarm
Knee

Abstract

Purpose

Advanced knee arthritis in young patients is a challenging problem that may necessitate surgical treatment. There are few published studies of mobile-bearing unicompartmental knee arthroplasty (UKA) in young patients, while indications have expanded to its use in this demanding patient group.

Methods

The clinical and radiographic results of the first 118 consecutive Oxford medial UKAs (OUKA) using a minimally invasive technique (phase 3) in 101 patients 60 years of age or younger at the time of surgery were evaluated. Median age at surgery was 57 (25–60) years. Kaplan–Meier survivorship analysis was used to estimate implant survival.

Results

Mean time of follow-up evaluation was five (SD 1.6) years. At final follow-up, three patients (three knees) had died, and two patients (three knees) were lost to follow-up. Five knees were revised: three for unexplained pain, one for early infection and one for bearing fracture. There was one impending revision for progression of osteoarthritis in the lateral compartment. The radiographic review demonstrated that 5 % of the knees had progressive arthritis in the lateral knee compartment, of those 2 % with full joint space loss and pain. The Kaplan–Meier survival analysis, using revision for any reason as the endpoint, estimated the five-year survival rate at 97 % (95 % CI 91–99). Ninety-six per cent of the non-revised patients were satisfied with the outcome, and 4 % were dissatisfied. The mean Oxford knee score was 41 (SD 7), with 6 % of the knees having a poor result. The mean AKSS was 89 (SD 14), mean flexion was 129° (SD 13) and the mean UCLA score was 6.8 (SD 1.5).

Conclusion

Minimally invasive Oxford medial UKA was reliable and effective in this young and active patient cohort providing high patient satisfaction at mid-term follow-up. Progressive arthritis in the lateral knee compartment was a relevant failure mode in this age group. Most revisions were performed for unexplained pain, while we did not find loosening or wear in any patient.

Level of evidence

IV.

Keywords

Oxford UKA Young patients Medial UKA Unicompartmental knee arthroplasty Active patients UKR Mobile-bearing UKA 

Notes

Acknowledgments

MRS. was supported by the non-commercial research fund of Deutsche Arthrose-Hilfe e.V. The study was supported by Biomet Inc.

Conflict of interest

None.

References

  1. 1.
    Akizuki S, Shibakawa A, Takizawa T, Yamazaki I, Horiuchi H (2008) The long-term outcome of high tibial osteotomy: a 10- to 20-year follow-up. J Bone Joint Surg Br 90:592–596CrossRefPubMedGoogle Scholar
  2. 2.
    Argenson JN, Flecher X (2004) Minimally invasive unicompartmental knee arthroplasty. Knee 11:341–347CrossRefPubMedGoogle Scholar
  3. 3.
    Argenson JN, Komistek RD, Aubaniac JM, Dennis DA, Northcut EJ, Anderson DT, Agostini S (2002) In vivo determination of knee kinematics for subjects implanted with a unicompartmental arthroplasty. J Arthroplast 17:1049–1054CrossRefGoogle Scholar
  4. 4.
    Argenson JN, Parratte S (2006) The unicompartmental knee: design and technical considerations in minimizing wear. Clin Orthop Relat Res 452:137–142CrossRefPubMedGoogle Scholar
  5. 5.
    Asif S, Choon DS (2005) Midterm results of cemented press fit condylar sigma total knee arthroplasty system. J Orthop Surg (Hong Kong) 13:280–284CrossRefGoogle Scholar
  6. 6.
    Badawy M, Espehaug B, Indrekvam K, Havelin LI, Furnes O (2014) Higher revision risk for unicompartmental knee arthroplasty in low-volume hospitals. Acta Orthop 85:342–347CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Bennell KL, Bowles KA, Payne C, Cicuttini F, Williamson E, Forbes A, Hanna F, Davies-Tuck M, Harris A, Hinman RS (2011) Lateral wedge insoles for medial knee osteoarthritis: 12 month randomised controlled trial. BMJ 342:d2912CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Berger R, Della Valle C, Jacobs JJ, Sheinkop MB, Rosenberg AG, Galante JO (2006) The progression of patellofemoral arthrosis after medial unicompartmental replacement: results at 11–15 years. Clin Orthop Relat Res 452:285–286CrossRefPubMedGoogle Scholar
  9. 9.
    Bonasia DE, Dettoni F, Sito G, Blonna D, Marmotti A, Bruzzone M, Castoldi F, Rossi R (2014) Medial opening wedge high tibial osteotomy for medial compartment overload/arthritis in the varus knee: prognostic factors. Am J Sports Med 42:690–698CrossRefPubMedGoogle Scholar
  10. 10.
    Bourne RB, Chesworth BM, Davis AM, Mahomed NN, Charron KD (2010) Patient satisfaction after total knee arthroplasty: who is satisfied and who is not? Clin Orthop Relat Res 468:57–63CrossRefPubMedGoogle Scholar
  11. 11.
    Brinkman JM, Lobenhoffer P, Agneskirchner JD, Staubli AE, Wymenga AB, van Heerwaarden RJ (2008) Osteotomies around the knee: patient selection, stability of fixation and bone healing in high tibial osteotomies. J Bone Joint Surg Br 90:1548–1557CrossRefPubMedGoogle Scholar
  12. 12.
    Brown NM, Sheth NP, Davis K, Berend ME, Lombardi AV, Berend KR, Della Valle CJ (2012) Total knee arthroplasty has higher postoperative morbidity than unicompartmental knee arthroplasty: a multicenter analysis. J Arthroplast 27:86–90CrossRefGoogle Scholar
  13. 13.
    Clement ND, Duckworth AD, MacKenzie SP, Nie YX, Tiemessen CH (2012) Medium-term results of Oxford phase-3 medial unicompartmental knee arthroplasty. J Orthop Surg (Hong Kong) 20:157–161CrossRefGoogle Scholar
  14. 14.
    Crawford DC, Miller LE, Block JE (2013) Conservative management of symptomatic knee osteoarthritis: a flawed strategy? Orthop Rev (Pavia) 5:e2CrossRefGoogle Scholar
  15. 15.
    Dawson J, Fitzpatrick R, Murray D, Carr A (1998) Questionnaire on the perceptions of patients about total knee replacement. J Bone Joint Surg Br 80:63–69CrossRefPubMedGoogle Scholar
  16. 16.
    Deshmukh RV, Scott RD (2002) Unicompartmental knee arthroplasty for younger patients: an alternative view. Clin Orthop Relat Res 404:108–112CrossRefGoogle Scholar
  17. 17.
    Felts E, Parratte S, Pauly V, Aubaniac JM, Argenson JN (2010) Function and quality of life following medial unicompartmental knee arthroplasty in patients 60 years of age or younger. Orthop Traumatol Surg Res 96:861–867CrossRefPubMedGoogle Scholar
  18. 18.
    Flecher X, Parratte S, Aubaniac JM, Argenson JN (2006) A 12-28-year followup study of closing wedge high tibial osteotomy. Clin Orthop Relat Res 452:91–96CrossRefPubMedGoogle Scholar
  19. 19.
    Floerkemeier S, Staubli AE, Schroeter S, Goldhahn S, Lobenhoffer P (2013) Outcome after high tibial open-wedge osteotomy: a retrospective evaluation of 533 patients. Knee Surg Sports Traumatol Arthrosc 21:170–180CrossRefPubMedGoogle Scholar
  20. 20.
    Goodfellow J (2006) Unicompartmental arthroplasty with the Oxford knee. Oxford medical publications. Oxford University Press, Oxford, New YorkGoogle Scholar
  21. 21.
    Gstottner M, Pedross F, Liebensteiner M, Bach C (2008) Long-term outcome after high tibial osteotomy. Arch Orthop Trauma Surg 128:111–115CrossRefPubMedGoogle Scholar
  22. 22.
    Hanssen AD, Stuart MJ, Scott RD, Scuderi GR (2001) Surgical options for the middle-aged patient with osteoarthritis of the knee joint. Instr Course Lect 50:499–511PubMedGoogle Scholar
  23. 23.
    Heyse TJ, Khefacha A, Peersman G, Cartier P (2012) Survivorship of UKA in the middle-aged. Knee 19:585–591CrossRefPubMedGoogle Scholar
  24. 24.
    Howells NR, Salmon L, Waller A, Scanelli J, Pinczewski LA (2014) The outcome at ten years of lateral closing-wedge high tibial osteotomy: determinants of survival and functional outcome. Bone Joint J 96:1491–1497CrossRefPubMedGoogle Scholar
  25. 25.
    Hui C, Salmon LJ, Kok A, Williams HA, Hockers N, van der Tempel WM, Chana R, Pinczewski LA (2011) Long-term survival of high tibial osteotomy for medial compartment osteoarthritis of the knee. Am J Sports Med 39:64–70CrossRefPubMedGoogle Scholar
  26. 26.
    Hunt LP, Ben-Shlomo Y, Clark EM, Dieppe P, Judge A, MacGregor AJ, Tobias JH, Vernon K, Blom AW (2014) 45-day mortality after 467,779 knee replacements for osteoarthritis from the National Joint Registry for England and Wales: an observational study. Lancet 384:1429–1436CrossRefPubMedGoogle Scholar
  27. 27.
    Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the knee society clinical rating system. Clin Orthop Relat Res 248:13–14Google Scholar
  28. 28.
    Jones RK, Nester CJ, Richards JD, Kim WY, Johnson DS, Jari S, Laxton P, Tyson SF (2013) A comparison of the biomechanical effects of valgus knee braces and lateral wedged insoles in patients with knee osteoarthritis. Gait Posture 37:368–372CrossRefPubMedGoogle Scholar
  29. 29.
    Keenan AC, Wood AM, Arthur CA, Jenkins PJ, Brenkel IJ, Walmsley PJ (2012) Ten-year survival of cemented total knee replacement in patients aged less than 55 years. J Bone Joint Surg Br 94:928–931CrossRefPubMedGoogle Scholar
  30. 30.
    Kerens B, Boonen B, Schotanus MG, Lacroix H, Emans PJ, Kort NP (2013) Revision from unicompartmental to total knee replacement: the clinical outcome depends on reason for revision. Bone Joint J 95:1204–1208CrossRefPubMedGoogle Scholar
  31. 31.
    Kort NP, van Raay JJ, van Horn JJ (2007) The Oxford phase III unicompartmental knee replacement in patients less than 60 years of age. Knee Surg Sports Traumatol Arthrosc 15:356–360CrossRefPubMedGoogle Scholar
  32. 32.
    Kozinn SC, Scott R (1989) Unicondylar knee arthroplasty. J Bone Joint Surg Am 71:145–150CrossRefPubMedGoogle Scholar
  33. 33.
    Kurtz S, Ong K, Lau E, Mowat F, Halpern M (2007) Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 89:780–785PubMedGoogle Scholar
  34. 34.
    Labek G, Sekyra K, Pawelka W, Janda W, Stockl B (2011) Outcome and reproducibility of data concerning the Oxford unicompartmental knee arthroplasty: a structured literature review including arthroplasty registry data. Acta Orthop 82:131–135CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174CrossRefPubMedGoogle Scholar
  36. 36.
    Laskin RS (1978) Unicompartmental tibiofemoral resurfacing arthroplasty. J Bone Joint Surg Am 60:182–185CrossRefPubMedGoogle Scholar
  37. 37.
    Liddle AD, Judge A, Pandit H, Murray DW (2014) Adverse outcomes after total and unicompartmental knee replacement in 101,330 matched patients: a study of data from the National Joint Registry for England and Wales. Lancet 384:1437–1445CrossRefPubMedGoogle Scholar
  38. 38.
    Losina E, Thornhill TS, Rome BN, Wright J, Katz JN (2012) The dramatic increase in total knee replacement utilization rates in the United States cannot be fully explained by growth in population size and the obesity epidemic. J Bone Joint Surg Am 94:201–207CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Lutzner J, Hubel U, Kirschner S, Gunther KP, Krummenauer F (2011) Long-term results in total knee arthroplasty. A meta-analysis of revision rates and functional outcome. Chirurg 82:618–624CrossRefPubMedGoogle Scholar
  40. 40.
    Murray DW, Fitzpatrick R, Rogers K, Pandit H, Beard DJ, Carr AJ, Dawson J (2007) The use of the Oxford hip and knee scores. J Bone Joint Surg Br 89:1010–1014CrossRefPubMedGoogle Scholar
  41. 41.
    Murray DW, Goodfellow JW, O’Connor JJ (1998) The Oxford medial unicompartmental arthroplasty: a ten-year survival study. J Bone Joint Surg Br 80:983–989CrossRefPubMedGoogle Scholar
  42. 42.
    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 91:52–57CrossRefPubMedGoogle Scholar
  43. 43.
    Newman JH, Ackroyd CE, Shah NA (1998) Unicompartmental or total knee replacement? Five-year results of a prospective, randomised trial of 102 osteoarthritic knees with unicompartmental arthritis. J Bone Joint Surg Br 80:862–865CrossRefPubMedGoogle Scholar
  44. 44.
    Niinimaki TT, Eskelinen A, Mann BS, Junnila M, Ohtonen P, Leppilahti J (2012) Survivorship of high tibial osteotomy in the treatment of osteoarthritis of the knee: finnish registry-based study of 3195 knees. J Bone Joint Surg Br 94:1517–1521CrossRefPubMedGoogle Scholar
  45. 45.
    Pandit H, Jenkins C, Barker K, Dodd CA, Murray DW (2006) The Oxford medial unicompartmental knee replacement using a minimally-invasive approach. J Bone Joint Surg Br 88:54–60CrossRefPubMedGoogle Scholar
  46. 46.
    Pandit H, Jenkins C, Gill HS, Barker K, Dodd CA, Murray DW (2011) Minimally invasive Oxford phase 3 unicompartmental knee replacement: results of 1000 cases. J Bone Joint Surg Br 93:198–204CrossRefPubMedGoogle Scholar
  47. 47.
    Parkes MJ, Maricar N, Lunt M, LaValley MP, Jones RK, Segal NA, Takahashi-Narita K, Felson DT (2013) Lateral wedge insoles as a conservative treatment for pain in patients with medial knee osteoarthritis: a meta-analysis. JAMA 310:722–730CrossRefPubMedPubMedCentralGoogle Scholar
  48. 48.
    Parratte S, Argenson JN, Pearce O, Pauly V, Auquier P, Aubaniac JM (2009) Medial unicompartmental knee replacement in the under-50s. J Bone Joint Surg Br 91:351–356CrossRefPubMedGoogle Scholar
  49. 49.
    Parvizi J, Nunley RM, Berend KR, Lombardi AV Jr, Ruh EL, Clohisy JC, Hamilton WG, Della Valle CJ, Barrack RL (2014) High level of residual symptoms in young patients after total knee arthroplasty. Clin Orthop Relat Res 472:133–137CrossRefPubMedGoogle Scholar
  50. 50.
    Pearse AJ, Hooper GJ, Rothwell A, Frampton C (2010) Survival and functional outcome after revision of a unicompartmental to a total knee replacement: the New Zealand National Joint Registry. J Bone Joint Surg Br 92:508–512CrossRefPubMedGoogle Scholar
  51. 51.
    Pegg E, Pandit H, Gill HS, Keys GW, Svard UG, O’Connor JJ, Murray DW (2011) Examination of ten fractured Oxford unicompartmental knee bearings. J Bone Joint Surg Br 93:1610–1616CrossRefPubMedGoogle Scholar
  52. 52.
    Pennington DW, Swienckowski JJ, Lutes WB, Drake GN (2003) Unicompartmental knee arthroplasty in patients sixty years of age or younger. J Bone Joint Surg Am 85:1968–1973CrossRefPubMedGoogle Scholar
  53. 53.
    Price AJ, Dodd CA, Svard UG, Murray DW (2005) Oxford medial unicompartmental knee arthroplasty in patients younger and older than 60 years of age. J Bone Joint Surg Br 87:1488–1492CrossRefPubMedGoogle Scholar
  54. 54.
    Price AJ, Webb J, Topf H, Dodd CAF, Goodfellow JW, Murray DW (2001) Rapid recovery after oxford unicompartmental arthroplasty through a short incision. J Arthroplast 16:970–976CrossRefGoogle Scholar
  55. 55.
    Psychoyios V, Crawford RW, O’Connor JJ, Murray DW (1998) Wear of congruent meniscal bearings in unicompartmental knee arthroplasty: a retrieval study of 16 specimens. J Bone Joint Surg Br 80:976–982CrossRefPubMedGoogle Scholar
  56. 56.
    Richards JD, Sanchez-Ballester J, Jones RK, Darke N, Livingstone BN (2005) A comparison of knee braces during walking for the treatment of osteoarthritis of the medial compartment of the knee. J Bone Joint Surg Br 87:937–939CrossRefPubMedGoogle Scholar
  57. 57.
    Saragaglia D, Blaysat M, Inman D, Mercier N (2011) Outcome of opening wedge high tibial osteotomy augmented with a Biosorb(R) wedge and fixed with a plate and screws in 124 patients with a mean of ten years follow-up. Int Orthop 35:1151–1156CrossRefPubMedGoogle Scholar
  58. 58.
    Schai PA, Suh JT, Thornhill TS, Scott RD (1998) Unicompartmental knee arthroplasty in middle-aged patients: a 2- to 6-year follow-up evaluation. J Arthroplast 13:365–372CrossRefGoogle Scholar
  59. 59.
    Scott CE, Howie CR, MacDonald D, Biant LC (2010) Predicting dissatisfaction following total knee replacement: a prospective study of 1217 patients. J Bone Joint Surg Br 92:1253–1258CrossRefPubMedGoogle Scholar
  60. 60.
    Simpson DJ, Price AJ, Gulati A, Murray DW, Gill HS (2009) Elevated proximal tibial strains following unicompartmental knee replacement–a possible cause of pain. Med Eng Phys 31:752–757CrossRefPubMedGoogle Scholar
  61. 61.
    Springer BD, Scott RD, Sah AP, Carrington R (2006) McKeever hemiarthroplasty of the knee in patients less than 60 years old. J Bone Joint Surg Am 88:366–371PubMedGoogle Scholar
  62. 62.
    Sutton PM, Holloway ES (2013) The young osteoarthritic knee: dilemmas in management. BMC Med 11:14CrossRefPubMedPubMedCentralGoogle Scholar
  63. 63.
    Tang WC, Henderson IJ (2005) High tibial osteotomy: long term survival analysis and patients’ perspective. Knee 12:410–413CrossRefPubMedGoogle Scholar
  64. 64.
    Ten Brinke B, de Haan LJ, Koenraadt KL, van Geenen RC (2014) Medial femoral condyle fracture as an intraoperative complication of Oxford unicompartmental knee replacement. Knee Surg Sports Traumatol Arthrosc. doi: 10.1007/s00167-014-3459-6 PubMedGoogle Scholar
  65. 65.
    W-Dahl A, Robertsson O, Lidgren L, Miller L, Davidson D, Graves S (2010) Unicompartmental knee arthroplasty in patients aged less than 65. Acta Orthop 81:90–94CrossRefPubMedPubMedCentralGoogle Scholar
  66. 66.
    W-Dahl A, Robertsson O, Lohmander LS (2012) High tibial osteotomy in Sweden, 1998–2007: a population-based study of the use and rate of revision to knee arthroplasty. Acta Orthop 83:244–248CrossRefPubMedPubMedCentralGoogle Scholar
  67. 67.
    Zahiri CA, Schmalzried TP, Szuszczewicz ES, Amstutz HC (1998) Assessing activity in joint replacement patients. J Arthroplast 13:890–895CrossRefGoogle Scholar

Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2015

Authors and Affiliations

  • Marcus R. Streit
    • 1
  • Julia Streit
    • 1
    • 2
  • Tilman Walker
    • 1
  • Thomas Bruckner
    • 3
  • J. Philippe Kretzer
    • 1
  • Volker Ewerbeck
    • 1
  • Christian Merle
    • 1
  • Peter R. Aldinger
    • 4
  • Tobias Gotterbarm
    • 1
  1. 1.Department of Orthopaedic and Trauma SurgeryUniversity of HeidelbergHeidelbergGermany
  2. 2.BG Trauma Center LudwigshafenLudwigshafen am RheinGermany
  3. 3.Institute of Medical Biometry and InformaticsUniversity of HeidelbergHeidelbergGermany
  4. 4.Department of Orthopaedic and Trauma SurgeryOrthopädische Klinik Paulinenhilfe, DiakonieklinikumStuttgartGermany

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