Skip to main content
SpringerLink
Log in

Restoration of preoperative tibial alignment improves functional results after medial unicompartmental knee arthroplasty

  • KNEE
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The alignment obtained after unicompartmental knee arthroplasty (UKA) influences the risk of failure. Kinematic alignment after UKA based on Cartier angle restauration is likely to improve clinical outcomes compared with mechanical alignment. The purpose of this study is to analyze the influence of implant alignment and native knee restoration after UKA using the conventional techniques on clinical outcomes.

Methods

This retrospective study included 144 medial UKA patients from 2015 to 2020. Radiographic measurements were performed pre- and postoperatively. Outliers were defined as follows: Δ Cartier > 3° (difference between the preoperative and postoperative Cartier angle); Δ MPTA (Medial Proximal Tibial angle) and postoperative TCA (Tibial Coronal component Angle) > 3° (difference between the positioning of the tibial implant and the preoperative proximal tibial deformity). The Knee injury and Osteoarthritis Outcome Score (KOOS), the International Knee Society (IKS) Function and Knee score, the Forgotten Joint Score (FJS), and the Subjective Knee Value (SKV) were evaluated.

A Student t test or a non-parametric Wilcoxon test was used for non-normal data to compare pre- and postoperative values for functional scores and angular measurements. The correlation of postoperative angles with functional outcomes was assessed by the Spearman’s rank correlation coefficient.

Results

During the inclusion period, 214 patients underwent medial UKA, 71 patients were excluded, and 19 were lost to follow-up leaving 124 patients with 144 knees (20 bilateral UKA) included for analysis with a mean follow-up of 54.7 months ± 22.1 (24–95). The Δ Cartier was significantly correlated with IKS function (R2 = 0.06, p < 0.001) and FJS (R2 = 0.05, p < 0.01) scores. The Δ preoperative MPTA–TCA was significantly correlated (p < 0.001) with KOOS (R2 = 0.38), IKS Knee (R2 = 0.17), IKS function (R2 = 0.34), SKV (R2 = 0.08), and FJS (R2 = 0.37) scores. In subgroup analysis, non-outliers (< 3°) for Δ preoperative MPTA–TCA had better KOOS score (Δ = 23.5, p < 0.001) and IKS Function (Δ = 17.7, p < 0.001) compared to outliers (> 3°) patients.

Conclusion

Functional results after medial UKA can be influenced by implant alignment in the coronal plane with slight clinical improvement when positioning the tibial implant close to the preoperative tibial deformity, rather than by restoring the Cartier angle. This series suggests the interest of a more personalized alignment strategy, but these results will have to be confirmed by other controlled studies.

Level of evidence

IV, retrospective case series.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Asada S, Inoue S, Tsukamoto I, Mori S, Akagi M (2019) Obliquity of tibial component after unicompartmental knee arthroplasty. Knee 26(2):410–415

    Article  PubMed  Google Scholar 

  2. Batailler C, Bordes M, Lording T, Nigues A, Servien E, Calliess T, Lustig S (2021) Improved sizing with image-based robotic-assisted system compared to image-free and conventional techniques in medial unicompartmental knee arthroplasty: a case control study. Bone Joint J 103(4):610–618

    Article  PubMed  Google Scholar 

  3. Baur J, Zwicky L, Hirschmann MT, Ilchmann T, Clauss M (2015) Metal backed fixed-bearing unicondylar knee arthroplasties using minimal invasive surgery: a promising outcome analysis of 132 cases. BMC Musculoskelet Disord 16(1):177

    Article  PubMed  PubMed Central  Google Scholar 

  4. Bayoumi T, Burger JA, Ruderman LV, Van Der List JP, Zuiderbaan HA, Kerkhoffs GMMJ, Pearle AD (2023) Restoration or relative overcorrection of pre-arthritic coronal alignment leads to improved results following medial unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-023-07441-9

    Article  PubMed  Google Scholar 

  5. Behrend H, Giesinger K, Giesinger JM, Kuster MS (2012) The “Forgotten Joint” as the Ultimate Goal in Joint Arthroplasty. J Arthroplasty 27(3):430-436.e1

    Article  PubMed  Google Scholar 

  6. Berliner JL, Brodke DJ, Chan V, SooHoo NF, Bozic KJ (2017) Can Preoperative patient-reported outcome measures be used to predict meaningful improvement in function after TKA? Clin Orthop Relat Res 475(1):149–157

    Article  PubMed  Google Scholar 

  7. Brunner J, Jörgens M, Weigert M, Kümpel H, Degen N, Fuermetz J (2023) Significant changes in lower limb alignment due to flexion and rotation—a systematic 3D simulation of radiographic measurements. Knee Surg Sports Traumatol Arthrosc 31(4):1483–1490

    Article  PubMed  PubMed Central  Google Scholar 

  8. Cartier P, Sanouiller J-L, Grelsamer RP (1996) Unicompartmental knee arthroplasty surgery. J Arthroplasty 11(7):782–788

    Article  CAS  PubMed  Google Scholar 

  9. Debette C, Parratte S, Maucort-Boulch D, Blanc G, Pauly V, Lustig S, Servien E, Neyret P, Argenson JN (2014) French adaptation of the new knee society scoring system for total knee arthroplasty. Orthop Traumatol Surg Res 100(5):531–534

    Article  CAS  PubMed  Google Scholar 

  10. Deschamps G, Chol C (2011) Fixed-bearing unicompartmental knee arthroplasty, Patients selection and operative technique. Orthop Traumatol Surg Res 97(6):648–661

    Article  CAS  PubMed  Google Scholar 

  11. Devlin NJ, Brooks R (2017) EQ-5D and the EuroQol group: past, present and future. Appl Health Econ Health Policy 15(2):127–137

    Article  PubMed  PubMed Central  Google Scholar 

  12. Foissey C, Batailler C, Vahabi A, Fontalis A, Servien E, Lustig S (2022) Better accuracy and implant survival in medial imageless robotic-assisted unicompartmental knee arthroplasty compared to conventional unicompartmental knee arthroplasty: two- to eleven-year follow-up of three hundred fifty-six consecutive knees. Int Orthop 47(2):533–541

    Article  PubMed  Google Scholar 

  13. Gill JR, Vermuyten L, Wastnedge E, Nicolai P (2021) The effect of component alignment on clinical outcomes in fixed bearing unicompartmental knee arthroplasty. Knee 29:126–133

    Article  PubMed  Google Scholar 

  14. Heck DA, Marmor L, Gibson A, Rougraff BT (1993) Unicompartmental knee arthroplasty. A multicenter investigation with long-term follow-up evaluation. Clin Orthop Relat Res 286:154–159

    Article  Google Scholar 

  15. Hirschmann MT, Moser LB, Amsler F, Behrend H, Leclerq V, Hess S (2019) Functional knee phenotypes: a novel classification for phenotyping the coronal lower limb alignment based on the native alignment in young non-osteoarthritic patients. Knee Surg Sports Traumatol Arthrosc 27(5):1394–1402

    Article  PubMed  Google Scholar 

  16. Howell SM, Howell SJ, Kuznik KT, Cohen J, Hull ML (2013) Does A Kinematically aligned total knee arthroplasty restore function without failure regardless of alignment category? Clin Orthop Relat Res 471(3):1000–1007

    Article  PubMed  Google Scholar 

  17. Koshino T, Takeyama M, Jiang LS, Yoshida T, Saito T (2002) Underestimation of varus angulation in knees with flexion deformity. Knee 9(4):275–279

    Article  PubMed  Google Scholar 

  18. Lizaur-Utrilla A, Gonzalez-Parreño S, Martinez-Mendez D, Miralles-Muñoz FA, Lopez-Prats FA (2020) Minimal clinically important differences and substantial clinical benefits for knee society scores. Knee Surg Sports Traumatol Arthrosc 28(5):1473–1478

    Article  PubMed  Google Scholar 

  19. Mabrouk A, Nwachukwu B, Pareek A, Karlsson J, Mouton C, Ollivier M, Martin RK (2023) MCID and PASS in knee surgeries theoretical aspects and clinical relevance references. Knee Surg Sports Traumatol Arthrosc 31(6):2060–2067

    Article  PubMed  Google Scholar 

  20. Maderbacher G, Baier C, Benditz A, Wagner F, Greimel F, Grifka J, Keshmiri A (2017) Presence of rotational errors in long leg radiographs after total knee arthroplasty and impact on measured lower limb and component alignment. Int Orthop 41(8):1553–1560

    Article  PubMed  Google Scholar 

  21. Marot V, Justo A, Alshanquiti A, Reina N, Accadbled F, Berard E, Cavaignac E (2021) Simple Knee Value: a simple evaluation correlated to existing knee PROMs. Knee Surg Sports Traumatol Arthrosc 29(6):1952–1959

    Article  PubMed  Google Scholar 

  22. Munford MJ, Stoddart JC, Liddle AD, Cobb JP, Jeffers JRT (2022) Total and partial knee arthroplasty implants that maintain native load transfer in the tibia. Bone Jt Res 11(2):91–101

    Article  Google Scholar 

  23. Paley D (2002) Principles of Deformity Correction. Springer, Berlin Heidelberg, Berlin, Heidelberg

    Book  Google Scholar 

  24. Preston B, Harris S, Villet L, Mattathil C, Cobb J, Rivière C (2021) The medial condylar wall is a reliable landmark to kinematically align the femoral component in medial UKA: an in-silico study. Knee Surg Sports Traumatol Arthrosc 30(9):3220–3227

    Article  PubMed  PubMed Central  Google Scholar 

  25. Ridgeway SR, McAuley JP, Ammeen DJ, Engh GA (2002) The effect of alignment of the knee on the outcome of unicompartmental knee replacement. J Bone Joint Surg Br 84(7):1091

    Google Scholar 

  26. Rivière C, Harman C, Leong A, Cobb J, Maillot C (2019) Kinematic alignment technique for medial OXFORD UKA: An in-silico study. Orthop Traumatol Surg Res 105(1):63–70

    Article  PubMed  Google Scholar 

  27. Rivière C, Iranpour F, Auvinet E, Howell S, Vendittoli P-A, Cobb J, Parratte S (2017) Alignment options for total knee arthroplasty: a systematic review. Orthop Traumatol Surg Res 103(7):1047–1056

    Article  PubMed  Google Scholar 

  28. Rivière C, Logishetty K, Villet L, Maillot C (2021) Calipered kinematic alignment technique for implanting a medial oxford®: a technical note. Orthop Traumatol Surg Res 107(3):102859

    Article  PubMed  Google Scholar 

  29. Rivière C, Sivaloganathan S, Villet L, Cartier P, Lustig S, Vendittoli P-A, Cobb J (2022) Kinematic alignment of medial UKA is safe: a systematic review. Knee Surg Sports Traumatol Arthrosc 30(3):1082–1094

    Article  PubMed  Google Scholar 

  30. Rivière C, Villet L, Bouchard Roby G (2022) Anatomical versus mechanical joint reconstruction: time to pick your surgical philosophy! Knee Surg Sports Traumatol Arthrosc 30(9):2890–2894

    Article  PubMed  Google Scholar 

  31. Schippers P, Drees P, Gercek E, Wunderlich F, Müller D, Ruckes C, Meyer A, Klein S, Fischer S (2023) The controversial definition of normal toe alignment. JCM 12(10):3509

    Article  PubMed  PubMed Central  Google Scholar 

  32. Stoddart JC, Garner A, Tuncer M, Cobb JP, Van Arkel RJ (2022) The risk of tibial eminence avulsion fracture with bi-unicondylar knee arthroplasty: a finite element analysis. Bone Jt Res 11(8):575–584

    Article  Google Scholar 

  33. Tabor OB, Tabor OB (1998) Unicompartmental arthroplasty. J Arthroplasty 13(4):373–379

    Article  PubMed  Google Scholar 

  34. Toliopoulos P, LeBlanc M-A, Hutt J, Lavigne M, Desmeules F, Vendittoli P-A (2016) Anatomic versus mechanically aligned total knee arthroplasty for unicompartmental knee arthroplasty revision. Open Orthop J 10(1):357–363

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

No external funding was required.

Author information

Authors and Affiliations

  1. University Institute of Locomotor and Sports (iULS), Pasteur II Hospital, 30, Voie Romaine, 06000, Nice, France

    Lolita Micicoi, Axel Machado, Régis Bernard de Dompsure, Nicolas Bronsard, Jean-François Gonzalez & Grégoire Micicoi

  2. Unité de Recherche Clinique Côte d’Azur (UR2CA), Université Côte d’Azur, Nice, France

    Lolita Micicoi, Axel Machado, Régis Bernard de Dompsure, Nicolas Bronsard, Jean-François Gonzalez & Grégoire Micicoi

  3. University of Utah Health, Salt Lake City, Utah, USA

    Justin Ernat

  4. Départment of Orthopedics and Traumatology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany

    Philipp Schippers

Authors
  1. Lolita Micicoi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Axel Machado
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Justin Ernat
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Philipp Schippers
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Régis Bernard de Dompsure
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Nicolas Bronsard
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jean-François Gonzalez
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Grégoire Micicoi
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

LM and GM wrote the manuscript, AM and PS performed the inter-observer angle measurements, and JE, JFG, NB, and RBdD corrected the different versions. GM designed the protocol and performed statistical analysis. All authors approved the final manuscript.

Corresponding author

Correspondence to Grégoire Micicoi.

Ethics declarations

Conflict of interest

Dr. Ernat is a paid consultant for Johnson & Johnson Depuy Mitek Sports Medicine. He has received research grants and educational supports from Arthrex, Inc. He has received educational support from Gemini Mountain Medical and Smith & Nephew. He has received travel expenses from Medical Device Business Services. He is a committee member for the Arthroscopy Association of North American and the American Orthopedic Society for Sports Medicine. He is an editorial board member for Arthroscopy Journal. Pr Gonzalez is a paid consultant for Amplitude. The other authors have no conflicts of interest.

Ethical approval

All procedures were performed in accordance with the ethical standards of the institutional and/or national research committee, the 1964 Declaration of Helsinki and its subsequent amendments, or comparable ethical standards. This study was approved by the advisory ethics committee (Ethics Committee of the Côte d'Azur University) under the number IRB 2023–032.

Informed consent

Not required.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Micicoi, L., Machado, A., Ernat, J. et al. Restoration of preoperative tibial alignment improves functional results after medial unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 31, 5171–5179 (2023). https://doi.org/10.1007/s00167-023-07588-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-023-07588-5

Keywords

Search

Navigation