Skip to main content

Fixed-bearing unicompartmental knee arthroplasty tolerates higher variance in tibial implant rotation than mobile-bearing designs

Abstract

Background

UKA necessitates a learning period. From this point of view, it would be logical to prefer the design that tolerates suboptimal tibial rotations better, especially for inexperienced surgeons. The aim of this study was to evaluate and compare the clinical and radiological results of mobile-bearing and fix-bearing UKA designs in case of suboptimal tibial rotations.

Methods

A retrospective case–control evaluation was made of all the patients with medial compartment osteoarthritis, treated between January 2011 and January 2015. 324 patients ideal femoral rotation were enrolled in the study. 153 patients (Group 1) were treated with fix-bearing design with a mean 28.8 ± 11.3 month follow-up and 171 patients (Group 2) were treated with mobile-bearing design with a 31 ± 14.3 month follow-up. Each patient in groups was subdivided into (A): optimal tibial rotation, (B): external rotation of tibial component > 5°, (C): internal rotation of tibial component > 5° subgroups. WOMAC and KSS scores of each patient at preoperative and postoperative final control were compared between groups and subgroups.

Results

No significant differences were determined between the groups in terms of mean follow-up time (p = 0.0612), preoperative WOMAC, and KSS scores (p = 0.754 and p = 0.832, respectively). No significant differences were determined between subgroups 1A and 2A in terms of WOMAC and KSS scores at the final evaluation (p = 0.314 and p = 0.546, respectively). A significant difference was determined between subgroups 1B and 2B in terms of WOMAC and KSS scores (p = 0.021 and p = 0.012, respectively). In addition, the difference between subgroups 1C and 2C was significant (p = 0.047 and p = 0.034, respectively) at the final evaluation.

Conclusion

Both mobile- and fix-bearing designs are beneficial in the treatment of medial compartment osteoarthritis of the knee. However, in case of both tibial internal or external suboptimal tibial rotations, fix-bearing design have better results compared to mobile-bearing design.

Study design

Level III retrospective comparative clinical study.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2

References

  1. 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 15:356–360

    Article  PubMed  Google Scholar 

  2. Scott CEH, Wade FA, MacDonald D, Nutton RW (2018) Ten-year survival and patient-reported outcomes of a medial unicompartmental knee arthroplasty incorporating an all-polyethylene tibial component. Arch Orthop Trauma Surg 138:719–729

    Article  PubMed  PubMed Central  Google Scholar 

  3. Tang H, Zhao L, Yan H, Jin D, Su X (2012) Mid-term effectiveness of Oxford unicompartmental knee system phase III for medial unicompartmental knee osteoarthritis. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 26:17–20

    PubMed  Google Scholar 

  4. Kaya Bicer E, Servien E, Lustig S, Demey G, Ait Si Selmi T, Neyret P (2010) Sagittal flexion angle of the femoral component in unicompartmental knee arthroplasty: is it same for both medial and lateral UKAs? Knee Surg Sports Traumatol Arthrosc 18:928–933

    Article  PubMed  Google Scholar 

  5. Kim JG, Kasat NS, Bae JH, Kim SJ, Oh SM, Lim HC (2012) The radiological parameters correlated with the alignment of the femoral component after Oxford phase 3 unicompartmental knee replacement. J Bone Jt Surg Br 94:1499–1505

    Article  CAS  Google Scholar 

  6. Bert JM (1998) 10-year survivorship of metal-backed, unicompartmental arthroplasty. J Arthroplast 13:901–905

    Article  CAS  Google Scholar 

  7. Cartier P, Sanouiller JL, Grelsamer RP (1996) Unicompartmental knee arthroplasty surgery. 10-year minimum follow-up period. J Arthroplast 11:782e788

    Article  Google Scholar 

  8. Zhang Q, Zhang Q, Guo W, Liu Z, Cheng L, Yue D, Zhang N (2014) The learning curve for minimally invasive Oxford phase 3 unicompartmental knee arthroplasty: cumulative summation test for learning curve (LC-CUSUM). J Orthop Surg Res 6(9):81

    Article  Google Scholar 

  9. Dionigi G, Bacuzzi A, Boni L, Rovera F, Dionigi R (2008) What is the learning curve for intraoperative neuromonitoring in thyroid surgery? Int J Surg 6:7–12

    Article  Google Scholar 

  10. Walton R, Theodorides A, Molloy A, Melling D (2012) Is there a learning curve in foot and ankle surgery? Foot Ankle Surg 18:62–65

    Article  PubMed  Google Scholar 

  11. Peersman G, Stuyts B, Vandenlangenbergh T, Cartier P, Fennema P (2015) Fixed- versus mobile-bearing UKA: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 23:3296–3305

    Article  PubMed  Google Scholar 

  12. Peersman G, Slane J, Vuylsteke P, Fuchs-Winkelmann S, Dworschak P, Heyse T, Scheys L (2017) Kinematics of mobile-bearing unicompartmental knee arthroplasty compared to native: results from an in vitro study. Arch Orthop Trauma Surg 137:1557–1563

    Article  PubMed  Google Scholar 

  13. Akagi M, Matsusue Y, Mata T, Asada Y, Horiguchi M, Iida H, Nakamura T (1999) Effect of rotational alignment on patellar tracking in total knee arthroplasty. Clin Orthop Relat Res 366:155–163

    Article  Google Scholar 

  14. Akagi M, Mori S, Nishimura S, Nishimura A, Asano T, Hamanishi C (2005) Variability of extraarticular tibial rotation references for total knee arthroplasty. Clin Orthop Relat Res 436:172–176

    Article  Google Scholar 

  15. Kang KT, Son J, Baek C, Kwon OR, Koh YG (2018) Femoral component alignment in unicompartmental knee arthroplasty leads to biomechanical change in contact stress and collateral ligament force in knee joint. Arch Orthop Trauma Surg 138:563–572

    Article  PubMed  Google Scholar 

  16. Matziolis G, Mueller T, Layher F, Wagner A (2018) The femoral component alignment resulting from spacer block technique is not worse than after intramedullary guided technique in medial unicompartimental knee arthroplasty. Arch Orthop Trauma Surg 138:865–870

    Article  PubMed  Google Scholar 

  17. Iriberri I, Aragon JF (2014) Alignment of the tibial component of the unicompartmental knee arthroplasty, assessed in the axial view by CT scan: does it in uence the outcome? Knee 21:1269–1274

    Article  PubMed  Google Scholar 

  18. Campbell DG, Johnson LJ, West SC (2006) Multiparameter quantitative computer-assisted tomography assessment of uni-compartmental knee arthroplasties. ANZ J Surg 76:782–787

    Article  PubMed  Google Scholar 

  19. Kawahara S, Okazaki K, Matsuda S, Mitsuyasu H, Nakahara H, Okamoto S, Iwamoto Y (2014) Medial sixth of the patellar tendon at the tibial attachment is useful for the anterior reference in rotational alignment of the tibial component. Knee Surg Sports Traumatol Arthrosc 22:1070–1075

    Article  PubMed  Google Scholar 

  20. Servien E, Fary C, Lustig S, Demey G, Saffarini M, Chomel S, Neyret P (2011) Tibial component rotation assessment using CT scan in medial and lateral unicompartmental knee arthroplasty. Orthop Traumatol Surg Res 97:272–275

    Article  PubMed  CAS  Google Scholar 

  21. Shakespeare D, Ledger M, Kinzel V (2005) The influence of the tibial sagittal cut on component position in the Oxford knee. Knee 12:169–176

    Article  PubMed  Google Scholar 

  22. Goodfellow J (2006) Unicompartmental arthroplasty with the Oxford knee. Oxford University Press, Oxford

    Google Scholar 

  23. Gulati A, Pandit H, Jenkins C, Chao R, Dodd CA, Murray DW (2009) The effect of leg alignment on the outcome ofunicompartmental knee replacement. J Bone Jt Surg Br 91:469

    Article  CAS  Google Scholar 

  24. Bell SW, Young P, Drury C, Smith J, Anthony I, Jones B, Blyth M, McLean A (2014) Component rotational alignment in unexplainedpainful primary total knee arthroplasty Knee 21:272

    Article  PubMed  Google Scholar 

  25. Small SR, Berend ME, Rogge RD, Archer DB, Kingman AL, Ritter MA (2013) Tibial loading after UKA: evaluation oftibial slope, resection depth, medial shift and component rotation. J Arthroplast 28:179

    Article  Google Scholar 

Download references

Funding

There is no funding source for the current study.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Murat Bozkurt.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Ozcan, C., Simsek, M.E., Tahta, M. et al. Fixed-bearing unicompartmental knee arthroplasty tolerates higher variance in tibial implant rotation than mobile-bearing designs. Arch Orthop Trauma Surg 138, 1463–1469 (2018). https://doi.org/10.1007/s00402-018-3005-y

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-018-3005-y

Keywords

  • Unicompartmental
  • Knee
  • Arthroplasty
  • Component
  • Rotation