Advertisement

Early functional outcome after lateral UKA is sensitive to postoperative lower limb alignment

  • J. P. van der List
  • H. Chawla
  • J. C. Villa
  • H. A. Zuiderbaan
  • A. D. Pearle
Knee

Abstract

Purpose

The predictive role of patient-specific characteristics and radiographic parameters on medial unicompartmental knee arthroplasty (UKA) outcomes is well known, but knowledge of these predictors is lacking in lateral UKA. Therefore, purpose of this study was to assess the predictive role of these parameters on short-term functional outcomes of lateral UKA.

Methods

In this retrospective cohort study, Western Ontario and McMaster Universities Arthritis Index scores were collected at 2-year follow-up (median 2.2 years, range 2.0–4.0 years) in 39 patients who underwent lateral UKA. Patient-specific characteristics included age, BMI and gender, while radiographic parameters included osteoarthritis severity of all three compartments and both preoperative and postoperative hip-knee-ankle alignment.

Results

BMI, gender, age and preoperative valgus alignment were not correlated with functional outcomes, while postoperative valgus alignment was correlated with functional outcomes (0.561; p = 0.001). Postoperative valgus of 3°–7° was correlated with better outcomes than more neutral (−2° to 3° valgus) alignment (96.7 vs. 85.6; p = 0.011). Postoperative alignment was a predictor when corrected for patient-specific characteristics (regression coefficient 4.1; p < 0.001) and radiological parameters (regression coefficient 3.8; p = 0.002).

Conclusions

Postoperative valgus alignment of 3°–7° was correlated with the best short-term functional outcomes in lateral UKA surgery, while patient-specific parameters and preoperative alignment were not correlated with functional outcomes. Based on these findings, a surgeon should aim for valgus alignment of 3°–7° when performing lateral UKA surgery for optimal functional outcomes.

Level of evidence

Prognostic study, Level II.

Keywords

Unicompartmental knee arthroplasty Lateral UKA Alignment Patient-reported functional outcomes Predictors 

Notes

Compliance with ethical standard

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Annual Report 2014 Australian Hip and Knee Arthroplasty Register (2014). https://aoanjrr.dmac.adelaide.edu.au/documents/10180/172286/AnnualReport2014
  2. 2.
    Ashraf T, Newman JH, Evans RL, Ackroyd CE (2002) Lateral unicompartmental knee replacement survivorship and clinical experience over 21 years. J Bone Joint Surg Br 84(8):1126–1130CrossRefPubMedGoogle Scholar
  3. 3.
    Baker PN, Jameson SS, Deehan DJ, Gregg PJ, Porter M, Tucker K (2012) Mid-term equivalent survival of medial and lateral unicondylar knee replacement: an analysis of data from a National Joint Registry. J Bone Joint Surg Br 94(12):1641–1648CrossRefPubMedGoogle Scholar
  4. 4.
    Bellamy N, Campbell J, Hill J, Band P (2002) A comparative study of telephone versus onsite completion of the WOMAC 3.0 osteoarthritis index. J Rheumatol 29(4):783–786PubMedGoogle Scholar
  5. 5.
    Bellamy N, Campbell J, Stevens J, Pilch L, Stewart C, Mahmood Z (1997) Validation study of a computerized version of the Western Ontario and McMaster Universities VA3.0 Osteoarthritis Index. J Rheumatol 24(12):2413–2415PubMedGoogle Scholar
  6. 6.
    Bonutti PM, Goddard MS, Zywiel MG, Khanuja HS, Johnson AJ, Mont MA (2011) Outcomes of unicompartmental knee arthroplasty stratified by body mass index. J Arthroplasty 26(8):1149–1153CrossRefPubMedGoogle Scholar
  7. 7.
    Chatellard R, Sauleau V, Colmar M, Robert H, Raynaud G, Brilhault J, Societe d’Orthopedie de Traumatologie de lO (2013) Medial unicompartmental knee arthroplasty: Does tibial component position influence clinical outcomes and arthroplasty survival? Orthop Traumatol Surg Res 99(4 Suppl):S219–S225CrossRefPubMedGoogle Scholar
  8. 8.
    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(11):2433–2441CrossRefPubMedGoogle Scholar
  9. 9.
    Citak M, Cross MB, Gehrke T, Dersch K, Kendoff D (2015) Modes of failure and revision of failed lateral unicompartmental knee arthroplasties. Knee 22(4):338–340CrossRefPubMedGoogle Scholar
  10. 10.
    Evans JD (1996) Straightforward statistics for the behavioral sciences. Brooks/Cole Publishing, Pacific GroveGoogle Scholar
  11. 11.
    Harrington IJ (1983) Static and dynamic loading patterns in knee joints with deformities. J Bone Joint Surg Am 65(2):247–259CrossRefPubMedGoogle Scholar
  12. 12.
    Hernigou P, Deschamps G (2004) Alignment influences wear in the knee after medial unicompartmental arthroplasty. Clin Orthop Relat Res 423:161–165CrossRefGoogle Scholar
  13. 13.
    Hill PF, Vedi V, Williams A, Iwaki H, Pinskerova V, Freeman MA (2000) Tibiofemoral movement 2: the loaded and unloaded living knee studied by MRI. J Bone Joint Surg Br 82(8):1196–1198CrossRefPubMedGoogle Scholar
  14. 14.
    Insall J, Aglietti P (1980) A five to seven-year follow-up of unicondylar arthroplasty. J Bone Joint Surg Am 62(8):1329–1337CrossRefPubMedGoogle Scholar
  15. 15.
    Iwaki H, Pinskerova V, Freeman MA (2000) Tibiofemoral movement 1: the shapes and relative movements of the femur and tibia in the unloaded cadaver knee. J Bone Joint Surg Br 82(8):1189–1195CrossRefPubMedGoogle Scholar
  16. 16.
    Kandil A, Werner BC, Gwathmey WF, Browne JA (2015) Obesity, morbid obesity and their related medical comorbidities are associated with increased complications and revision rates after unicompartmental knee arthroplasty. J Arthroplasty 30(3):456–460CrossRefPubMedGoogle Scholar
  17. 17.
    Kellgren JH, Lawrence JS (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16(4):494–502CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Khamaisy S, Gladnick BP, Nam D, Reinhardt KR, Heyse TJ, Pearle AD (2015) Lower limb alignment control: Is it more challenging in lateral compared to medial unicondylar knee arthroplasty? Knee 22(4):347–350CrossRefPubMedGoogle Scholar
  19. 19.
    Kozinn SC, Marx C, Scott RD (1989) Unicompartmental knee arthroplasty. A 4.5–6-year follow-up study with a metal-backed tibial component. J Arthroplasty 4(Suppl):S1–S10CrossRefPubMedGoogle Scholar
  20. 20.
    Kozinn SC, Scott R (1989) Unicondylar knee arthroplasty. J Bone Joint Surg Am 71(1):145–150CrossRefPubMedGoogle Scholar
  21. 21.
    Kuipers BM, Kollen BJ, Bots PC, Burger BJ, van Raay JJ, Tulp NJ, Verheyen CC (2010) Factors associated with reduced early survival in the Oxford phase III medial unicompartment knee replacement. Knee 17(1):48–52CrossRefPubMedGoogle Scholar
  22. 22.
    Lustig S, Lording T, Frank F, Debette C, Servien E, Neyret P (2014) Progression of medial osteoarthritis and long term results of lateral unicompartmental arthroplasty: 10 to 18 year follow-up of 54 consecutive implants. Knee 21(S1):S26–S32CrossRefPubMedGoogle Scholar
  23. 23.
    Moreland JR, Bassett LW, Hanker GJ (1987) Radiographic analysis of the axial alignment of the lower extremity. J Bone Joint Surg Am 69(5):745–749CrossRefPubMedGoogle Scholar
  24. 24.
    Murray DW, Pandit H, Weston-Simons JS, Jenkins C, Gill HS, Lombardi AV, Dodd CA, Berend KR (2013) Does body mass index affect the outcome of unicompartmental knee replacement? Knee 20(6):461–465CrossRefPubMedGoogle Scholar
  25. 25.
    Nakagawa S, Kadoya Y, Todo S, Kobayashi A, Sakamoto H, Freeman MA, Yamano Y (2000) Tibiofemoral movement 3: full flexion in the living knee studied by MRI. J Bone Joint Surg Br 82(8):1199–1200CrossRefPubMedGoogle Scholar
  26. 26.
    Ohdera T, Tokunaga J, Kobayashi A (2001) Unicompartmental knee arthroplasty for lateral gonarthrosis: midterm results. J Arthroplasty 16(2):196–200CrossRefPubMedGoogle Scholar
  27. 27.
    Pearle AD, O’Loughlin PF, Kendoff DO (2010) Robot-assisted unicompartmental knee arthroplasty. J Arthroplasty 25(2):230–237CrossRefPubMedGoogle Scholar
  28. 28.
    Pennington DW, Swienckowski JJ, Lutes WB, Drake GN (2006) Lateral unicompartmental knee arthroplasty: survivorship and technical considerations at an average follow-up of 12.4 years. J Arthroplasty 21(1):13–17CrossRefPubMedGoogle Scholar
  29. 29.
    World Health Organization (1995) Physical status: The use and interpretation of anthropometry. Report of a WHO Expert Committee. World Health Organization Technical Report, Series 854, pp 1–452Google Scholar
  30. 30.
    Roche M, O’Loughlin PF, Kendoff D, Musahl V, Pearle AD (2009) Robotic arm-assisted unicompartmental knee arthroplasty: preoperative planning and surgical technique. Am J Orthop (Belle Mead NJ) 38(2 Suppl):10–15Google Scholar
  31. 31.
    Sah AP, Scott RD (2007) Lateral unicompartmental knee arthroplasty through a medial approach. Study with an average five-year follow-up. J Bone Joint Surg Am 89(9):1948–1954PubMedGoogle Scholar
  32. 32.
    Scott RD (2005) Lateral unicompartmental replacement: a road less traveled. Orthopedics 28(9):983–984PubMedGoogle Scholar
  33. 33.
    Scott RD, Cobb AG, McQueary FG, Thornhill TS (1991) Unicompartmental knee arthroplasty: eight- to 12-year follow-up evaluation with survivorship analysis. Clin Orthop Relat Res 271:96–100Google Scholar
  34. 34.
    Sebilo A, Casin C, Lebel B, Rouvillain JL, Chapuis S, Bonnevialle P, members of the Societe d’Orthopedie et de Traumatologie de lO (2013) Clinical and technical factors influencing outcomes of unicompartmental knee arthroplasty: retrospective multicentre study of 944 knees. Orthop Traumatol Surg Res 99(4 Suppl):S227–S234CrossRefPubMedGoogle Scholar
  35. 35.
    Servien E, Saffarini M, Lustig S, Chomel S, Neyret P (2008) Lateral versus medial tibial plateau: morphometric analysis and adaptability with current tibial component design. Knee Surg Sports Traumatol Arthrosc 16(12):1141–1145CrossRefPubMedGoogle Scholar
  36. 36.
    Sharma L, Song J, Felson DT, Cahue S, Shamiyeh E, Dunlop DD (2001) The role of knee alignment in disease progression and functional decline in knee osteoarthritis. JAMA 286(2):188–195CrossRefPubMedGoogle Scholar
  37. 37.
    Skytta ET, Haapamaki V, Koivikko M, Huhtala H, Remes V (2011) Reliability of the hip-to-ankle radiograph in determining the knee and implant alignment after total knee arthroplasty. Acta Orthop Belg 77(3):329–335PubMedGoogle Scholar
  38. 38.
    Smith JR, Robinson JR, Porteous AJ, Murray JR, Hassaballa MA, Artz N, Newman JH (2014) Fixed bearing lateral unicompartmental knee arthroplasty-Short to midterm survivorship and knee scores for 101 prostheses. Knee 21(4):843–847CrossRefPubMedGoogle Scholar
  39. 39.
    Specogna AV, Birmingham TB, DaSilva JJ, Milner JS, Kerr J, Hunt MA, Jones IC, Jenkyn TR, Fowler PJ, Giffin JR (2004) Reliability of lower limb frontal plane alignment measurements using plain radiographs and digitized images. J Knee Surg 17(4):203–210PubMedGoogle Scholar
  40. 40.
    Thompson SA, Liabaud B, Nellans KW, Geller JA (2013) Factors associated with poor outcomes following unicompartmental knee arthroplasty: redefining the “classic” indications for surgery. J Arthroplasty 28(9):1561–1564CrossRefPubMedGoogle Scholar
  41. 41.
    Vasso M, Del Regno C, D’Amelio A, Viggiano D, Corona K, Panni AS (2015) Minor varus alignment provides better results than neutral alignment in medial UKA. Knee 22(2):117–121CrossRefPubMedGoogle Scholar
  42. 42.
    Von Keudell A, Sodha S, Collins J, Minas T, Fitz W, Gomoll AH (2014) Patient satisfaction after primary total and unicompartmental knee arthroplasty: an age-dependent analysis. Knee 21(1):180–184CrossRefGoogle Scholar
  43. 43.
    Weidow J, Pak J, Karrholm J (2002) Different patterns of cartilage wear in medial and lateral gonarthrosis. Acta Orthop Scand 73(3):326–329CrossRefPubMedGoogle Scholar

Copyright information

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

Authors and Affiliations

  • J. P. van der List
    • 1
  • H. Chawla
    • 1
  • J. C. Villa
    • 1
  • H. A. Zuiderbaan
    • 2
  • A. D. Pearle
    • 1
  1. 1.Computer Assisted Surgery Center, Department of Orthopaedic Surgery, Hospital for Special SurgeryWeill Medical College of Cornell UniversityNew YorkUSA
  2. 2.Department of Orthopaedic SurgerySpaarne HospitalHoofddorpThe Netherlands

Personalised recommendations