Abstract
Background
Unicompartmental knee arthroplasty (UKA) is a recognized procedure for treatment of medial compartment osteoarthritis. UKA using minimally invasive surgery (MIS) has the theoretical advantage of less bone resection and quicker rehabilitation. Whether the function of patients with UKA compares with that of patients with conventional TKA is unclear.
Questions/purposes
We determined (1) the length of stay and complications associated with a short-stay MIS protocol; (2) whether MIS techniques allow for accurate positioning of the implant and alignment of the limb; (3) the change in functional scores; (4) the revision rate, reasons for revision, and survival of this implant.
Patients and Methods
We prospectively followed 100 patients who had 114 UKAs. All completed an International Knee Society (IKS) score preoperatively, at 1 year, and at last followup. We determined survivorship. Minimum followup was 5.2 years (mean, 7.4 years; range, 5.2–9 years).
Results
Mean length of stay was 1.2 days, with 41% discharged the same day. The perioperative complication rate was 6%. The mean IKS score improved from 77 to 93 and was 86 at last followup. The mean hip-knee-ankle axis changed from 6° varus to 1.7° varus. Twenty-two patients underwent a revision procedure at a mean 6.2 years after the index procedure. Survivorship of the prosthesis was 78% at 9 years.
Conclusions
The short-stay protocol was not associated with a high perioperative complication rate. This technique is associated with improvement in function and restoration of limb alignment, allowing accurate positioning of the implant. Compared with other reports of survival of UKA, this implant had a lower survivorship and increased revision rate.
Level of Evidence
Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
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References
Ahlback S. Osteoarthrosis of the knee: a radiographic investigation. Acta Radiol Diagn (Stockh). 1968;277(suppl):7–72.
Altman DG. Practical Statistics for Medical Research. London, UK: Chapman and Hall; 1991.
Altman R, Asch E, Bloch D, Bole G, Borenstein D, Brandt K, Christy W, Cooke TD, Greenwald R, Hochberg M, et al. Development of criteria for the classification and reporting of osteoarthritis: classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. Arthritis Rheum. 1986;29:1039–1049.
Ansari S, Warwick D, Ackroyd CE, Newman JH. Incidence of fatal pulmonary embolism after 1,390 knee arthroplasties without routine prophylactic anticoagulation, except in high-risk cases. J Arthroplasty. 1997;12:599–602.
Argenson JN, Chevrol-Benkeddache Y, Aubaniac JM. Modern unicompartmental knee arthroplasty with cement: a three to ten-year follow-up study. J Bone Joint Surg Am. 2002;84:2235–2239.
Beard DJ, Pandit H, Gill HS, Hollinghurst D, Dodd CA, Murray DW. The influence of the presence and severity of pre-existing patellofemoral degenerative changes on the outcome of the Oxford medial unicompartmental knee replacement. J Bone Joint Surg Br. 2007;89:1597–1601
Berend KR, Lombardi AV Jr. Liberal indications for minimally invasive Oxford unicondylar arthroplasty provide rapid functional recovery and pain relief. Surg Technol Int. 2007;16:193–197.
Bert JM. 10-year survivorship of metal-backed, unicompartmental arthroplasty. J Arthroplasty. 1998;13:901–905.
Borus T, Thornhill T. Unicompartmental knee arthroplasty. J Am Acad Orthop Surg. 2008;16:9–18.
Carlsson LV, Albrektsson BE, Regnér LR. Minimally invasive surgery vs conventional exposure using the Miller-Galante unicompartmental knee arthroplasty: a randomized radiostereometric study. J Arthroplasty. 2006;21:151-156.
Carr A, Keyes G, Miller R, O’Connor J, Goodfellow J. Medial unicompartmental arthroplasty: a survival study of the Oxford meniscal knee. Clin Orthop Relat Res. 1993;295:205–213.
Cartier P, Sanouiller JL, Grelsamer RP. Unicompartmental knee arthroplasty surgery: 10-year minimum follow-up period. J Arthroplasty. 1996;11:782–788.
Emerson RH Jr, Higgins LL. A comparison of highly instrumented and minimally instrumented unicompartmental knee prostheses. Clin Orthop Relat Res. 2004;428:153–157.
Emerson RH Jr, Higgins LL. Unicompartmental knee arthroplasty with the oxford prosthesis in patients with medial compartment arthritis. J Bone Joint Surg Am. 2008;90:118–122.
Fisher DA, Watts M, Davis KE. Implant position in knee surgery: a comparison of minimally invasive open unicompartmental, and total knee arthroplasty. J Arthroplasty. 2003;18(7 suppl 1):2–8.
Hanson GR, Moynihan AL, Suggs JF, Kwon YM, Johnson T, Li G. Kinematics of medial unicondylar knee arthroplasty: an in vivo investigation. J Knee Surg. 2009;22:237–242.
Insall J, Aglietti P. A 5- to 7-year follow-up of unicondylar arthroplasty. J Bone Joint Surg Am. 1980;62:1329–1337.
Insall J, Dorr LD, Scott RD, Scott RN. Rationale of the knee society clinical rating system. Clin Orthop Relat Res. 1989;248:13–14.
Knutson K, Lewold S, Robertsson O, Lidgren L. The Swedish knee arthroplasty register: a nationwide study of 30,003 knees 1976-1992. Acta Orthop Scand. 1994;65:375–386.
Koskinen E, Eskelinen A, Paavolainen P, Pulkkinen P, Remes V. Comparison of survival and cost-effectiveness between unicondylar arthroplasty and total knee arthroplasty in patients with primary osteoarthritis: a follow-up study of 50,493 knee replacements from the Finnish Arthroplasty Register. Acta Orthop. 2008;79:499–507.
Koskinen E, Paavolainen P, Eskelinen A, Harilainen A, Sandelin J, Ylinen P, Tallroth K, Remes V. Medial unicompartmental knee arthroplasty with Miller-Galante II prosthesis: mid-term clinical and radiographic results. Arch Orthop Trauma Surg. 2009;129:617–624.
Kozinn SC, Scott R. Unicondylar knee arthroplasty. J Bone Joint Surg Am. 1989;71:145–150.
Kumar A, Fiddian NJ. Medial unicompartmental arthroplasty of the knee. Knee. 1999;6:21–23.
Larsen K, Sorensen OG, Hansen TB, Thomsen PB, Soballe K. Accelerated perioperative care and rehabilitation intervention for hip and knee replacement is effective: a randomized clinical trial involving 87 patients with 3 months of follow-up. Acta Orthop. 2008;79:149–159.
Laskin RS. Unicompartmental tibiofemoral resurfacing arthroplasty. J Bone Joint Surg Am. 1978;60:182–185.
Laurencin CT, Zelicof SB, Scott RD, Ewald FC. Unicompartmental versus total knee arthroplasty in the same patient: a comparative study. Clin Orthop Relat Res. 1991;273:151–156.
Lidgren L. Swedish knee arthroplasty register: 2002 annual report. Available at: www.ort.lu.se/knee. Accessed April 1, 2010.
Macaulay W, Yoon RS. Fixed-bearing, medial unicondylar knee arthroplasty rapidly improves function and decreases pain: a prospective, single-surgeon outcomes study. J Knee Surg. 2008;21:279–284.
McAllister CM. The role of unicompartmental knee arthroplasty versus total knee arthroplasty in providing maximal performance and satisfaction. J Knee Surg. 2008;21:286–292.
Mullaji AB, Sharma A, Marawar S. Unicompartmental knee arthroplasty: functional recovery and radiographic results with a minimally invasive technique. J Arthroplasty. 2007;22:7–11.
Müller PE, Pellengahr C, Witt M, Kircher J, Refior HJ, Jansson V. Influence of minimally invasive surgery on implant positioning and the functional outcome for medial unicompartmental knee arthroplasty. J Arthroplasty. 2004;19:296–301.
Murray DW, Britton AR, Bulstrode CJ. Loss to follow-up matters. J Bone Joint Surg Br. 1997;79:254–257.
Newman J, Pydsietty RV, Ackroyd C. Unicompartmental or total knee replacement: the 15-year results of a prospective randomized controlled trial. J Bone Joint Surg Br. 2009;91:52–57.
Newman JH, Ackroyd CE, Shah NA. Unicompartmental or total knee replacement? Five year results of a prospective, randomized trial of 102 osteoarthritic knees with unicompartmental arthritis. J Bone Joint Surg Br. 1998;80:862–865.
Pennington DW, Swienckowski JJ, Lutes WB, Drake GN. Unicompartmental knee arthroplasty in patients sixty years of age or younger. J Bone Joint Surg Am. 2003;85:1968–1973.
Price AJ, Waite JC, Svard U. Long-term clinical results of the medial oxford unicompartmental knee arthroplasty. Clin Orthop Relat Res. 2005;435:171–180.
Romanowski MR, Repicci JA. Minimally invasive unicondylar arthroplasty: eight-year follow-up. J Knee Surg. 2002;15:17–22.
Soohoo NF, Sharifi H, Kominski G, Lieberman JR. Cost-effectiveness analysis of unicompartmental knee arthroplasty as an alternative to total knee arthroplasty for unicompartmental osteoarthritis. J Bone Joint Surg Am. 2006;88:1975–1982.
Willis-Owen CA, Brust K, Alsop H, Miraldo M, Cobb JP. Unicondylar knee arthroplasty in the UK National Health Service: an analysis of candidacy, outcome, and cost efficacy. Knee. 2009;16:473–478.
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Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.
Each author certifies that his or her institution approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.
This work was performed at St Vincent’s Clinic.
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O’Donnell, T., Neil, M.J. The Repicci II® Unicondylar Knee Arthroplasty: 9-year Survivorship and Function. Clin Orthop Relat Res 468, 3094–3102 (2010). https://doi.org/10.1007/s11999-010-1474-6
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DOI: https://doi.org/10.1007/s11999-010-1474-6