Unicompartmental knee replacement for medial compartmental knee osteoarthritis: a four to six-year follow-up

doi:10.3969/j.issn.2095-4344.2016.31.002

Abstract

Abstract:

BACKGROUND: Unicompartment knee replacement is more popular for small trauma, rapid recovery, low complication and almost normal knee mechanics, and has been more and more used in clinic to repair single compartment knee disease. At present, there is no report about the influence of the angle of the single condyle prosthesis on the survival rate.

OBJECTIVE: To evaluate the effectiveness of unicompartmental knee replacement for medial compartmental osteoarthritis of the knee in 4-6 years of follow-up.

METHODS: Thirty patients with medial compartmental osteoarthritis of the knee were treated by unicompartmental knee replacement with Oxford system. Complication occurrence was observed. Curative effects were evaluated with Hospital for Special Surgery score before and 3 months, 6 months and 1 year after surgery. On anteroposterior view, the varus/valgus alignments of the tibial components were measured relative to the long axis of the tibia. On lateral view, flexion/extension of the femoral component was measured relative to the posterior femoral cortex.

RESULTS AND CONCLUSION: (1) Primary healing of incision was obtained in all patients, and no infection or lower limb deep venous thrombosis occurred. (2) All of the patients were followed up for 48-72 months. There was no prosthetic loosening, dislocation or revision for contralateral compartment and patellofemoral joint symptoms. (3) Hospital for Special Surgery score was significantly increased to (90.47±4.05) (P=0.00). (4) Tibial placement angle of single condyle prosthesis: The axis of the prosthesis was perpendicular to the axis of the tibia in 21 cases. Varus placement: 2° in 1 case, 4° in 3 cases, 5° in 2 cases, 6° in 2 cases, and 10° in 1 case. No valgus occurred in the tibial side. (5) Femoral prosthesis placement angle: The axis of the femoral prosthesis was parallel to the posterior edge of the femoral cortex in 22 cases, on the flexed position: 4° in 2 cases, 5° in 1 case, 6° in 1 case and 7° in 1 case; in the extension position: 3° in 1 case, 4° in 1 case and 5° in 1 case. (6) Results suggested that the unilateral condylar replacement for the repair of medial compartment osteoarthritis of the knee has a good initial effect. The middle-term and long-term efficacy needs longer follow-up study.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Knee Joint, Osteoarthritis, Follow-Up Studies, Tissue Engineering

CLC Number:

R318

Lu Ning, Yang Yang. Unicompartmental knee replacement for medial compartmental knee osteoarthritis: a four to six-year follow-up[J]. Chinese Journal of Tissue Engineering Research, 2016, 20(31): 4575-4581.

Figures/Tables 3

References

[1] Goodfellow JW, O’Connor J. Clinical results of the Oxford knee surface arthroplasty of the tibiofemoral joint with a meniscal bearing prosthesis. Clin Orthop Relat Res. 1986;205:21-42.
[2] White SH, Ludkowski PF, Goodfellow JW. Anterome- dial osteoarthritis of the knee. J Bone Joint Surg Br. 1991;73(4):582-586.
[3] Kozinn SC, Marx C, Scott RD. Unicompartmenta lknee arthroplasty a 4.5-6-year follow-up study with a metal-backed tibial component. J Arthroplasty. 1989;4: S1-10.
[4] Pandit H,Jenkins C,Gill HS,etal.Unnecessary contraindications for mobile-bearing unicompartmental knee replacement. J Bone Joint Surg Br. 2011; 93(5): 622-628.
[5] Lindstrand A, Stenstrom A. Polyethylene wear of the PCA unicompartmental knee prospective 5 (4–8)year study of 120 arthrosis knees. Acta Orthop Scand. 1992; 63(3):260-262.
[6] Price AJ, Short A, Kellett C, et al. Ten-year in vivo wear measurement of a fully congruent mobile bearing unicompartmental knee arthroplasty. J Bone Joint Surg Br. 2005;87(11):1493-1497.
[7] 鲁宁,杨阳,Alejandro Gonzalez Della Valle,等.多重血栓预防方案在髋关节置换中的应用[J].实用医学杂志, 2013, 29(14):104-106.
[8] McKeever DC. Tibial plateau prosthesis. Clin Orthop. 1960;18:86-95.
[9] MacIntosh DL, Hunter GA. The use of the hemiarthroplasty prosthesis for advanced osteoarthritis and rheumatoid arthritis of the knee. J Bone Joint Surg Br. 1972;54:244-255.
[10] MacIntosh DL. Arthroplasty of the knee in rheumatoid arthritis using the hemiarthroplasty prosthesis. In: Stuttgart GC, editor. Synovectomy and Arthroplasty in rheumatoid arthritis; second international symposium. Stuttgart, Germany 7 Theime, 1967:79.
[11] Friedman MJ. UniSpacer. Arthroscopy. 2003;19(10): 120-121.
[12] Skolnick M, Peterson LF, Combs JJ. Polycentric knee arthroplasty. A two-year follow-up study. J Bone Joint Surg.1975;57A:1033.
[13] Skolnick M, Coventry M, Ilstrup D. Geometric total knee arthroplasty. A two-year follow-up study. J Bone Joint Surg Am.1976;58A:749-753
[14] Insall J, Aglietti P. A five- to seven-year follow-up of unicondylar arthroplasty. J Bone Joint Surg. 1980;62A: 1329-1337.
[15] Kozinn SC, Scott R. Unicondylar knee arthroplasty. J Bone Joint Surg Am. 1989;71:145-150.
[16] Berger RA, Meneghini RM, Jacobs JJ, et al. Results of unicompartmental knee arthroplasty at a minimum of 10 years follow-up. J Bone Joint Surg Am. 2005;87: 999.
[17] Foran JR, Brown NM, Della Valle CJ, et al, .Long-term survivorship and failure modes of unicompartmental knee arthroplasty. Clin Orthop Relat Res. 2013;471(1): 102-108.
[18] Ritter MA, Faris PM, Thong AE, et al. Intra-operative findings in varusosteoarthritis of the knee: An analysisof preoperative alignment in potentialcandidates for unicompartmental arthroplasty.J Bone Joint Surg Br. 2004;86:43-47.
[19] White SH, Ludkowski PF, Goodfellow JW. Anteromedial osteoarthritis of the knee. J Bone Joint Surg Br. 1991;73(4):582-586.
[20] Goodfellow J, O’Connor J, Dodd C, et al. Unicompartmental arthroplasty with the Oxford knee. Oxford (United Kingdom): Oxford University Press, 2006: 1-67.
[21] Berend KR, Lombardi AV Jr, Adams JB. Obesity, young age, patellofemoral disease,and anterior knee pain: identifying the unicondylar arthroplasty patient inthe United States. Orthopedics. 2007;30:19-23.
[22] Pandit H, Jenkins C, Gill HS, et al. Unnecessary contraindications for mobile bearing unicompartmental knee replacement. J Bone Joint Surg Br. 2011;93(5): 622-628.
[23] Wainwright C, Theis JC, Garneti N, et al. Age at hip or knee joint replacement surgery predicts likelihood of revision surgery. J Bone Joint Surg Br. 2011;93(10): 1411-1415.
[24] Kandil A, Werner BC, Gwathmey WF,et al. Obesity, morbid obesity and their related medical comorbidities are associated with increased complications and revision rates after unicompartmental knee arthroplasty. J Arthroplasty. 2015;30(3):456-460.
[25] Murray DW, Goodfellow JW, O’Connor JJ. The Oxford medial unicompartmental arthroplasty: a ten-year survival study. J Bone Joint Surg Br. 1998;80(6): 983-989.
[26] Svard UC, Price AJ. Oxford medial unicompartmental knee arthroplasty: a survival analysis of an independent series. J Bone Joint Surg Br. 2001;83(2): 191-194.
[27] Price AJ, Svard U. A second decade lifetable survival analysis of the Oxford unicompartmental knee arthroplasty. Clin Orthop Relat Res. 2011;469(1): 174-179.
[28] Gulati A,Chau R, Simpson DJ,et al.Influence of component alignment on outcome for unicompartmental replacement. Knee. 2009;16: 196-199.
[29] Morris MJ, Molli RG, Berend KR, et al. Mortality and perioperative complications after unicompartmental knee arthroplasty. Knee. 2012;20:218-220.
[30] 张曦,高俊,吕正祥.Oxford单髁置换治疗膝内侧间室骨性关节炎[J]. 临床骨科杂志,2015, 18(1):45-47
[31] 马广文,尹宗生,黄斐,等.单髁置换术治疗膝关节内侧间室骨关节炎初期疗效[J].中国修复重建外科杂志,2014, 28(10):1208-1211.