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1.
Burton Ma John Rudan Raja Chakravertty Heather Grant 《Canadian journal of surgery》2009,52(5):379-385
Background
Most authorities recognize minimally invasive unicompartmental knee arthroplasty (UKA) as technically demanding with concerns regarding loss of implantation accuracy. We have previously reported on the potential inaccuracy of femoral intramedullary guides in UKA leading to poor component positioning. Our 3-dimensional analysis of alignment error showed that a short, narrow intramedullary rod inserted according to the manufacturer’s specifications did not accurately find the direction of the anatomic axis, with errors occurring in both the coronal and sagittal planes. We sought to evaluate whether a fluoroscopic computer-assisted minimally invasive UKA procedure would improve the accuracy and precision in the placement of the femoral component in the coronal and sagittal planes compared with conventional surgery.Methods
We performed a prospective study involving cohorts of 45 conventional versus 53 navigated UKAs. A single surgeon performed all surgeries over a 4-year period.Results
Pain and knee function significantly improved in both surgical groups at 1 and 2 years after surgery. At a minimum of 1-year follow-up, radiographic evaluation revealed significant improvements in coronal alignment precision of the tibial component (p = 0.026) and sagittal alignment precision of the femoral component for the navigated group (p = 0.037). The use of a fluoroscopic computer-assisted technique did not significantly improve the accuracy of any of the alignment angles.Conclusion
We cannot justify the additional expense and complexity imposed by fluoroscopic navigation despite the observed improvements in alignment precision. Improved positioning precision may translate into a greater number of long-term functional results, but larger, longer-term studies are needed. 相似文献2.
Omar K. Alnachoukati John W. Barrington Keith R. Berend Michael C. Kolczun Roger H. Emerson Adolph V. Lombardi David R. Mauerhan 《The Journal of arthroplasty》2018,33(3):677-683
Background
FDA approval for the Oxford phase III device was approved for use in the United States in 2004. This study seeks to provide the first long-term, large patient sample size, Oxford phase III multi-site survivorship study in the United States, investigating patient reported outcomes of pain and function, while also providing an in-depth analysis of causes for revision, and finally addressing recent advancements that can help aid the unicompartmental knee arthroplasty (UKA) process and further improve partial knee survivorship.Methods
Between July 2004 and December 2006, 5 surgeons from around the United States performed medial UKA through the minimally invasive surgical approach, on 825 knees in 695 patients. This was a consecutive series of primary UKAs using the phase III mobile bearing; cemented Oxford Knee (Zimmer Biomet, Warsaw, IN), implanted utilizing phase III instrumentation. UKA survivorship considered all revisions as the end point. Implant survivorship eliminated revisions at which the original Oxford implant was determined to be well fixated and functional intra-operatively.Results
A total of 93 knees were revised in this study. Mean follow-up was 9.7 years (6-12). Implant survivorship at year 10 was 90% (confidence interval 2.7%). UKA survivorship at year 10 was 85% (confidence interval 3.8%). Average preoperative American Knee Society Score (knee score) was 49 and rose to 90 postoperatively (standard deviations 16 and 18, respectively). Average preoperative American Knee Society Score (function score) was 55 and rose to 77 postoperatively (standard deviations 15 and 28, respectively).Conclusion
This was the first large-scale, 10-year, multi-site follow-up of the Oxford mobile-bearing medial UKA undertaken in the United States, displaying good survivorship and excellent patient outcomes. 相似文献3.
Background and purpose
After total knee arthroplasty with conventional surgical approach, more than half of the quadriceps extension strength is lost in the first postoperative month. Unicompartmental knee arthroplasty (UKA) operated with minimally invasive surgery (MIS) results in less operative trauma. We investigated changes in leg-extension power (LEP) in the first month after MIS Oxford UKA and its relation to pain, knee motion, functional performance, and knee function.Patients and methods
In 35 consecutive Oxford UKA patients, LEP was measured 1 week before and 1 month after surgery together with knee motion, knee swelling, the 30-second chair-stand test, and Oxford knee score. Assessment of knee pain at rest and walking was done using a visual analog scale.Results
30 patients were discharged on the day after surgery, and 5 on the second day after surgery. LEP and functional performance reached the preoperative level after 1 month. Only slight postoperative knee swelling was observed with rapid restoration of knee flexion and function. A high level of pain during the first postoperative night and day fell considerably thereafter. None of the patients needed physiotherapy supervision in the first month after discharge.Interpretation
Fast-track MIS Oxford UKA with discharge on the day after surgery is safe and leads to early recovery of knee motion and strength even when no physiotherapy is used.After total knee arthroplasty (TKA), more than half of the preoperative quadriceps strength is lost in the first month after surgery (Mizner et al. 2005). TKA surgery with minimally invasive surgery (MIS) may lead to less postoperative pain, shorter length of stay in hospital, and greater knee flexion (Chen et al. 2006), and the MIS approach may result in better outcome with regard to maintaining extensor strength than the conventional surgical approach (Kim et al. 2010). In unicompartment knee arthrosis, the Oxford Group recommend unicompartmental knee arthroplasty (UKA) operated with MIS, since recovery is twice as fast as after the conventional approach and damage to the soft tissue of the joint is greatly diminished (Price et al. 2001). Althrough fast-track UKA with length of stay of about 1.5 days has been described (Reilly et al. 2005), there have been few reports on quadriceps strength after UKA (Mancher et al. 2002) and to our knowledge there have been no reports on early leg-extension power (LEP) after UKA.We studied changes in LEP within the first month after fast-track MIS Oxford Phase III medial UKA in relation to pain, knee motion, functional performance, knee function, and the need for physiotherapy after discharge. 相似文献4.
Michael E. Neufeld Anthony Albers Nelson V. Greidanus Donald S. Garbuz Bassam A. Masri 《The Journal of arthroplasty》2018,33(6):1713-1718
Background
The long-term survivorship and functional outcomes of the mobile-bearing (MB) compared to the fixed-bearing (FB) unicompartmental knee arthroplasty (UKA) implant design remain a topic of debate. The aim of the current study was to compare the survivorship and functional outcomes of MB and FB UKA at a minimum 10-year follow-up.Methods
We retrospectively reviewed 106 consecutive medial UKAs (89 patients) from our institution with a minimum 10-year follow-up. The 38 MB and 68 FB knees had follow-up of 14.2 years (12.9-15.5) and 11.5 years (10.2-15.1), respectively. Validated patient-reported outcomes and radiographs were evaluated as were etiology, timing, and complexity of revision. Kaplan-Meier 10-year survival was calculated with revision to total knee arthroplasty as the end point.Results
The 10-year survival was 82.9% (95% confidence interval [CI] 65.8-91.9) for MB and 90.9% (95% CI 79.4-96.2) for FB UKA (P = .102), and 88.0% (95% CI 79.3-93.2) for the entire cohort. Patient outcomes were similar between groups, as were timing and etiologies for revision to total knee arthroplasty. One-third of revisions required either stems or tibial augments, and of these, all were of MB design.Conclusion
Survival and functional outcomes were similar between MB and FB designs. One-third of revisions required either stems or augments, all were of MB design. 相似文献5.
Thomas W. Hamilton James M. Rizkalla Leonidas Kontochristos Barbara E. Marks Stephen J. Mellon Christopher A.F. Dodd Hemant G. Pandit David W. Murray 《The Journal of arthroplasty》2017,32(10):3228-3237.e2
Background
Outcomes after unicompartmental knee arthroplasty (UKA) are variable and influenced by caseload (UKA/y) and usage (percentage of knee arthroplasty that are UKA), which relates to indications. This meta-analysis assesses the relative importance of these factors.Methods
MEDLINE (Ovid), Embase (Ovid), and Web of Science (ISI) were searched for consecutive series of cemented Phase 3 Oxford medial UKA. The primary outcome was revision rate/100 observed component years (% pa) with subgroup analysis based on caseload and usage.Results
Forty-six studies (12,520 knees) with an annual revision-rate ranging from 0% to 4.35% pa, mean 1.21% pa (95% confidence interval [CI], 0.97-1.47), were identified. In series with mean follow-up of 10-years, the revision-rate was 0.63% pa (95% CI, 0.46-0.83), equating to a 94% (95% CI, 92%-95%) 10-year survival. Aseptic loosening, lateral arthritis, bearing dislocation, and unexplained pain were the predominant failure mechanisms with revision for patellofemoral problems and polyethylene wear exceedingly rare. The lowest revision-rates were achieved with caseload >24 UKA/y (0.88% pa; 95% CI, 0.63-1.61) and usage >30% (0.69% pa; 95% CI, 0.50-0.90). Usage was more important than caseload; with high usage (≥20%), the revision-rate was low, whether the caseload was high (>12 UKA/y) or low (≤12 UKA/y; (0.94% pa; 95% CI, 0.69-1.23 and 0.85% pa; 95% CI, 0.65-1.08), respectively); with low usage (<20%), the revision-rate was high, whether the caseload was high or low (1.58% pa; 95% CI, 0.57-3.05 and 1.76% pa; 95% CI, 1.21-2.41, respectively).Conclusion
To achieve optimum results, surgeons, whether high or low caseload, should adhere to the recommended indications such that ≥20%, or ideally >30% of their knee arthroplasties are UKA. If they do this, then they can expect to achieve results similar to those of the long-term series, which all had high usage (>20%) and an average 10-year survival of 94%. 相似文献6.
Yasushi Kotani Mitsuru Shiota Masahiko Umemoto Takako Tobiume Eiji Koike Masao Shimaoka Yohko Takahashi Kazumi Kanemura Ayako Ishizu Hiroshi Hoshiai 《JSLS, Journal of the Society of Laparoendoscopic Surgeons》2009,13(2):203-206
Background and Objectives:
Pseudomyxoma peritonei results from ovarian and appendiceal mucinous tumors. Cyst rupture results in intraabdominal mucin accumulation, leading to abdominal distension. No effective treatment has yet been established. Pseudomyxoma peritonei is generally associated with a poor prognosis. In a recent Mayo Clinic report, the 5-year survival rate for this disease was 53% and the 10-year survival rate was 32%, while the Memorial Sloan-Kettering Cancer Center reported 5- and 10-year survival rates of 75% and 10%.Methods and Results:
In this report, we describe 4 patients with a laparoscopically confirmed recurrence of pseudomyxoma peritonei who subsequently underwent repeated laparoscopic mucin removal.Conclusion:
Because laparoscopic surgery can be performed frequently, it appears that laparoscopic surgery, a minimally invasive procedure, greatly improves the quality of life of patients with pseudomyxoma peritonei. 相似文献7.
Objective
To identify the demographic and operative factors that determine outcome in supracondylar femoral osteotomy for lateral compartment osteoarthritis of the knee.Design
Clinical and radiologic review of a nonrandomized, consecutive one-surgeon series.Setting
A university-affiliated, elective surgical referral centre.Patients
Forty-nine consecutive patients with unicompartmental osteoarthritis of the knee, involving the lateral compartment, and of sufficient severity that the alternative surgical procedure would be total knee replacement.Intervention
Supracondylar varus osteotomy stabilized with a blade plate.Main outcome measures
Knee function measured by the Knee Society Score and time to conversion to total knee replacement.Results
A Knee Society Score greater than 80 was obtained in 81% of patients, but in the function portion of the measurement only 30% had a similar score. After discarding the patients who died, life-table analysis demonstrated the predicted survival before conversion to total knee replacement to be 87% at 7 years. There was no correlation with patient age or sex, femorotibial angulation, amount of correction or time after the intervention. Removal of the fixation device improved the clinical result.Conclusion
The role of supracondylar femoral osteotomy remains poorly defined, but the procedure can delay total knee replacement for considerable time in appropriate patients. 相似文献8.
Background:
Unicompartmental knee arthroplasty (UKA) is specifically indicated in isolated unicompartmental arthritis with competent ligaments. Recent series of UKA for unicompartmental arthritis have shown good function, persistence of pain relief, and nearly 90% survivorship at 15 years, even in knees that would perhaps not be considered good indications for UKA today. The perioperative morbidity of UKA is less than total knee arthroplasty. We present our series of 19 octogenarians with tricompartment osteoarthritis (predominant medial compartment involvement) treated with UKA as definitive surgery.Materials and Methods:
We performed UKA on 29 knees (19 patients) average 83 years (79-94 years) of either sex from Jan 2002 to Dec 2006. All the patients had tricompartment knee osteoarthritis (with predominant medial and some patellofemoral compartment involvement).Results:
The results were evaluated using the Knee Society scores and visual analogue score over an average 48-month follow-up (range, 24 to 81 months). Barring one (medial femoral condyle fracture detected on postoperative radiography), all patients achieved promised levels of satisfaction.Discussion:
UKA for tricompartment knee arthritis in the young active patient entails risk of dissatisfaction and failure. We present UKA in select ‘very elderly’ patients with tricompartment osteoarthritis (with predominant unicompartment involvement). 相似文献9.
Italo BRAGHETTO M Gonzalo CARDEMIL H Carlos MANDIOLA B Gonzalo MASIA L Francesca GATTINI S 《Brazilian archives of digestive surgery》2014,27(4):237-242
Background
Surgical treatment of esophageal cancer is associated to a high morbidity and mortality rate. The open transthoracic or transhiatal esophagectomy are considerably invasive procedures and have been associated to high rates of complications and operative mortality. In this way, minimally invasive esophageal surgery has been suggested as an alternative to the classic procedures because would produce improvement in clinical longterm postoperative outcomes.Aim
To assess survival, mortality and morbidity results of esophagectomy due to esophageal cancer submitted to minimally invasive techniques and compare them to results published in international literature.Method
An observational, prospective study. Between 2003 and 2012, 69 patients were submitted to a minimally invasive esophagectomy due to cancer. It was recorded postoperative morbidity and mortality according to the Clavien-Dindo classification. The survival rate was analyzed with the Kaplan-Meier method. The number of lymph nodes obtained during the lymph node dissection, as an index of the quality of the surgical technique, was analysed.Results
63.7% of patients had minor complications (type I-II Clavien Dindo), while nine (13%) required surgical re-exploration. The most common postoperative complication corresponded to leak of the cervical anastomosis seen in 44 (63.7%) patients but without clinical repercusion, only two of them required reoperation. The mortality rate was 4.34%, and reoperation was necessary in nine (13%) cases. The average survival time was 22.59±25.38 months, with the probability of a 3-year survival rate estimated at 30%. The number of resected lymph nodes was 17.17±9.62.Conclusion
Minimally invasive techniques have lower morbidity and mortality rate, very satisfactory lymphnodes resection and similar long term outcomes in term of quality of life and survival compared to results observed after open surgery. 相似文献10.
Matthias F. Pietschmann Lisa Wohlleb Patrick Weber Florian Schmidutz Andreas Ficklscherer Mehmet F. Gülecyüz Elem Safi Thomas R. Niethammer Volkmar Jansson Peter E. Müller 《International orthopaedics》2013,37(1):31-37
Purpose
Excellent long-term results have been reported for implantation of unicompartmental knee arthroplasty (UKA). In many patients the desire for improvement in function often includes an aspiration to return to sports. The purpose of our study was to evaluate physical activities after medial Oxford-III (Biomet) UKA surgery.Methods
Patients’ physical activity before and after the surgery was assessed using a self reporting questionnaire. We used the Oxford knee scoring system (OKS), the WOMAC-, the Knee society- (KSS) and the UCLA-score to assess postoperative knee function. The mean follow-up was 4.2 years. The female-to-male ratio was 1.3:1. The mean age at surgery was 65.3 years.Results
Of the 131 patients studied 78 participated in some kind of sports before surgery (mean age 64.4 years), while 53 patients did not perform any sports (mean age 66.5 years) (p > 0.05). At follow-up the patients in the active group were significantly younger than the patients in the inactive group (p < 0.05). The majority of patients (80.1 %) returned to their level of sports activity after UKA surgery. Six patients took up sports after surgery while 15 patients stopped their sports. Among the active patients we found a shift from high- towards low-impact sports. The active patients had significantly higher scores for the OKS, KSS, WOMAC and UCLA score. The complication rate was comparable in both groups.Conclusion
Our study demonstrates that a high degree of patient satisfaction in terms of sports activity can be achieved using the Oxford-III UKA for medial osteoarthritis. 相似文献11.
12.
Munk S Odgaard A Madsen F Dalsgaard J Jorn LP Langhoff O Jepsen CF Hansen TB 《Acta orthopaedica》2011,82(5):582-588
Background and purpose
There is disagreement in the literature about the importance of patellofemoral joint degeneration and knee pain for the outcome of unicompartmental knee arthroplasty (UKA). We therefore investigated the importance of selected predictors including patellofemoral joint degeneration and the location of preoperative knee pain for the early outcome of UKA.Patients and methods
The study group comprised 260 consecutive patients from 5 hospitals who underwent Oxford UKA for anteromedial osteoarthritis. Data were collected at baseline and included pain location, radiologically observed degeneration of the patellofemoral joint including subluxation of the patella, intraoperative cartilage status of the patellofemoral joint, disease-specific knee status, and Oxford knee score (OKS). Outcomes were evaluated after 1 year using the OKS, global patient satisfaction, and global patient result.Results
The average OKS score at baseline was 24 (SD 7), and it was 40 (SD 8) at the 1-year follow-up. 94% of the patients claimed improvement after the operation and 90% were satisfied with the UKA. Lateral subluxation of the patella was a predictor of poor outcome, and the preoperative OKS score was also a predictor of outcome. Full-thickness cartilage loss at any location gave a similar outcome to that with a normal or near-normal joint surface, and likewise, preoperative anterior knee pain was not a predictor of outcome.Interpretation
We conclude that the good early outcome after UKA in this study is in line with the best reported results. Patellofemoral degeneration should not be considered a contraindication to Oxford UKA. Patients with lateral subluxation of the patella have an increased risk of a poor result after UKA and should preferably be offered a total knee replacement.There is no consensus about the indications for choosing unicompartmental knee arthroplasty (UKA) instead of total knee arthroplasty. Kozinn and Scott (1989) accepted only minor degenerative changes in the patellofemoral joint, and anterior knee pain—thought to be a sign of significant patellofemoral involvement—has also been an exclusion criterion (Stern et al. 1993). Berger et al. (2004) stated that patients with clinical, radiographic, or intraoperative evidence of patellofemoral arthrosis are not appropriate candidates for unicompartmental knee arthroplasty. However, the Oxford Group recommended that the state of the patellofemoral joint should be ignored when deciding whether or not to use UKA (Goodfellow et al. 1986, 2006). A recent paper by the Oxford group (Beard et al. 2007a) demonstrated that anterior knee pain or damage to the patellofemoral joint (provided that there is not bone loss and grooving of the lateral facet) is not a contraindication for Oxford UKA, while caution should be observed in cases with lateral patellofemoral joint degeneration. In these cases, a TKR should be preferred to avoid clinical failure.Here we describe early outcome after Oxford phase-III UKA. We also investigated the importance of selected predictors—including patellofemoral joint degeneration, subluxation of the patella, and the location of preoperative knee pain—for early outcome. 相似文献13.
Chloe E.H. Scott Matilda F.R. Powell-Bowns Deborah J. MacDonald Philip M. Simpson Frazer A. Wade 《The Journal of arthroplasty》2018,33(7):2203-2209
Background
The aim of this study is to investigate differences in implant requirement, outcomes, and re-revision when total knee arthroplasty (TKA) was performed following unicompartmental knee arthroplasties (UKAs) with metal-backed (MB) compared to all-polyethylene (AP) tibial components.Methods
Retrospective study of 60 UKAs converted to 60 TKAs at mean 7.3 years (0.1 to 17) after implantation in 55 patients (mean age, 64 [49-83]; 44% male): 44 MB and 16 AP. TKA implant requirement was investigated in addition to mode of failure, Oxford Knee Score, and TKA survival at mean 5.4 years (0.5 to 17).Results
Progression of osteoarthritis was the commonest mode of failure in MB UKAs (P = .03) and unexplained pain in AP (P = .011) where revisions were performed earlier (4.8 ± 3.2 vs 8.2 ± 4.5, P = .012). In 56 of 60 (93%) cases, unconstrained TKA implants were used. The use of standard cruciate-retaining TKAs without augments or stems was less likely following MB UKA compared to AP (12 of 38 [32%] vs 10/14 [71%], P = .013). Specifically MB UKA implants were associated with more tibial stem use (P = .04) and more use of cruciate-substituting polyethylene (P = .05). There was no difference in the use of constrained implants. Multivariate analysis showed tibial resection depth to predict stem requirement. Seven were re-revised giving 7-year TKA survival: from MB UKA 70.3 (95% CI, 47.0 to 93.6) and from AP UKA 87.5 (95% CI, 64.6 to 100; P = .191).Conclusion
MB UKA implants increase the chances of a complex revision requiring tibial stems and cruciate substitution but reduce the chances of early revision compared to AP UKA which often fail early with pain. 相似文献14.
Mona Badawy Birgitte Espehaug Kari Indrekvam Leif I Havelin Ove Furnes 《Acta orthopaedica》2014,85(4):342-347
Background and purpose
Some studies have found high complication rates and others have found low complication rates after unicompartmental knee arthroplasty (UKA). We evaluated whether hospital procedure volume influences the risk of revision using data from the Norwegian Arthroplasty Register (NAR).Materials and methods
5,791 UKAs have been registered in the Norwegian Arthroplasty Register. We analyzed the 4,460 cemented medial Oxford III implants that were used from 1999 to 2012; this is the most commonly used UKA implant in Norway. Cox regression (adjusted for age, sex, and diagnosis) was used to estimate risk ratios (RRs) for revision. 4 different volume groups were compared: 1–10, 11–20, 21–40, and > 40 UKA procedures annually per hospital. We also analyzed the reasons for revision.Results and interpretation
We found a lower risk of revision in hospitals performing more than 40 procedures a year than in those with less than 10 UKAs a year, with an unadjusted RR of 0.53 (95% CI: 0.35–0.81) and adjusted RR of 0.59 (95% CI: 0.39–0.90). Low-volume hospitals appeared to have a higher risk of revision due to dislocation, instability, malalignment, and fracture than high-volume hospitals.The Norwegian Arthroplasty Register (NAR) has been registering knee arthroplasties since 1994 and has a registration-completeness of 99% (Espehaug et al. 2006).In a study from the NAR, the 10-year survival probability was 80% for unicompartmental knee arthroplasty (UKA), as compared to 92% for the TKA (Furnes et al. 2007). The Finnish Arthroplasty Register had an even worse result, presenting a 60% survival rate for the UKA at 15-year follow-up (Koskinen et al. 2008). The Swedish Knee Arthroplasty Register and other database studies have also indicated that survival is higher in patients with TKA than in patients with UKA (Lyons et al. 2012, SKAR 2012).High-volume centers and high-volume surgeons have reported excellent results in their studies and follow-up of UKA (Murray et al. 1998, Lisowski et al. 2011, Price and Svard 2011). Advantages of a unicompartmental knee arthroplasty over total knee arthroplasty, such as reduced risk of complications, faster recovery, and a more rapid discharge, have been described by some authors (Lombardi et al. 2009, Brown et al. 2012) but not by others (Lygre et al. 2010). Technical failures leading to malpositioning of the components (Argenson and Parratte 2006, Mercier et al. 2010) are associated with procedure volume. There is a learning curve with this procedure, as demonstrated by Hamilton et al. (2009), but the failure rate persisted despite modifications to improve surgical techniques.The purpose of this study was to establish the numbers of UKA procedures performed annually at the different hospitals, to investigate a possible correlation between low hospital procedure volume and high risk of revision regarding the Oxford III unicompartmental knee arthroplasty using the data from the NAR, and to investigate possible variation in the reasons for revision. Our hypothesis was that technical errors would occur more often in the low-volume hospitals. 相似文献15.
Ramin Mehin Peter O��Brien Henry Broekhuyse Piotr Blachut Pierre Guy 《Canadian journal of surgery》2012,55(2):87-94
Background
Patients with tibial plateau fractures are believed to have an increased risk for posttraumatic arthritis that may require reconstructive surgery. The incidence of this problem is, however, unknown. We sought to determine the average 10-year incidence of posttraumatic arthritis necessitating reconstructive surgery following tibia plateau fractures.Methods
We used data from our orthopedic trauma database to identify patients with operatively treated tibia plateau fractures. Their cases were cross-referenced with the data from our province’s administrative health database and tracked over time for the performance of reconstructive knee surgery. The average follow-up was 10 years.Results
There were 311 tibial plateau fractures treated at our institution between 1987 and 1994. The 10-year Kaplan–Meier survival analysis for the primary outcome of endstage arthritis was 96%. Analysis of the secondary outcome measure, specifically surgeries for what was thought to be “minor arthritis,” revealed a 10-year Kaplan–Meier survival of 87%.Conclusion
Our findings may be used to counsel patients who require surgical treatment of tibia plateau fractures about the long-term risk of requiring reconstructive knee surgery for endstage arthritis in the knee. 相似文献16.
Omar Faour-Martín Jose Antonio Valverde-García Miguel Ángel Martín-Ferrero Aurelio Vega-Castrillo María Angeles de la Red Gallego Cesar C. Suárez de Puga Luis Amigo-Liñares 《International orthopaedics》2013,37(5):833-838
Purpose
Surgical treatment options for medial compartment osteoarthritis of the knee include high tibial osteotomy, total knee arthroplasty or unicompartmental knee arthroplasty (UKA), depending on the patient’s age, level of physical activity and the degree of deformity.Methods
In this study, we evaluated the long-term results of patients who underwent the Oxford cemented meniscal-bearing unicondylar knee prosthesis through a minimally invasive approach including a clinical, functional and radiographic assessment.Results
Favourable clinical and radiological outcomes were registered overall at ten years after surgery. Overall results of UKA according to the American Knee Society (AKS) using Insall’s criteria showed an excellent or good outcome for 492 knees (96.28 %), fair for 11 (2.15 %) and poor for eight (1.57 %) in the post-operative long term.Conclusions
We believe that with appropriate surgical technique, patient selection, prosthetic design and specific training, surgeons should achieve good outcomes with the added advantages of a minimally invasive approach. High volume for this technique is important in our opinion. 相似文献17.
Vikas Kulshrestha Barun Datta Santhosh Kumar Gaurav Mittal 《The Journal of arthroplasty》2017,32(5):1460-1469
Background
With increasing number of patients with early osteoarthritis of knee opting for total knee arthroplasty (TKA), there has been increase in patients dissatisfied with surgical outcomes. It is being presumed that offering unicondylar knee arthroplasty (UKA) to them would improve outcomes.Methods
Primary objective of our study was to look for any difference in patient-reported outcome and function at 2-year follow-up in patients undergoing UKA as compared to TKA. Our study was a randomized study with parallel assignment conducted at a high-volume specialized arthroplasty center. Eighty patients with bilateral isolated medial compartment knee arthritis were randomized into simultaneous 2-team bilateral TKA (n = 40) and UKA (n = 40) group. We finally analyzed 36 patients in each group. Main outcome measure was improvement in Knee Outcome Survey-Activities of Daily Living Scale (KOS-ADLS) and High Activity Arthroplasty Score (HAAS) obtained at 2-year follow-up.Results
Improvement in KOS-ADLS and HAAS at 2 years was similar (P = .2143 and .2010) in both groups. Performance as assessed with Delaware index was also similar. Length of hospital stay was less in UKA group (6.6 days as against 5.4 days). Complications and readmission rates were more in TKA group (nil in UKA group; 08 in TKA group).Conclusion
At 2-year follow-up, UKA provides similar improvement in patient-reported outcomes, function, and performance as compared to TKA when performed in patients with early arthritis. However, UKA patients have shorter hospital stay and fewer complications. 相似文献18.
Graham Seow-Hng Goh Hamid Rahmatullah Bin Abd Razak Darren Keng-Jin Tay Shi-Lu Chia Ngai-Nung Lo Seng-Jin Yeo 《The Journal of arthroplasty》2018,33(2):355-361
Background
Improvements in surgical techniques, implant design, and adherence to indications have resulted in favorable outcomes after unicompartmental knee arthroplasty (UKA), particularly in an older population. However, no studies have compared the performance of contemporary UKA and total knee arthroplasty (TKA) in a young population.Methods
Prospectively collected registry data of 160 UKAs performed in 160 patients younger than 55 years were reviewed. Propensity scores generated using logistic regression were used to adjust for confounding variables of age, gender, body mass index, preoperative range of motion, Knee Society Score, Oxford Knee Score, and Short-Form 36, allowing matching of the TKA cohort to the UKA cohort in a 1:1 ratio using the nearest-neighbor method.Results
The UKA group had significantly greater flexion at 6 months and 2 years (P < .001). There was no significant difference in Knee Society Score, Oxford Knee Score, and Short-Form 36. At 2 years, 89.4% and 88.8% of the TKA and UKA groups were satisfied (P = 1.00) while 86.9% and 86.3% had their expectations fulfilled (P = 1.00). At a mean follow-up of 7 years, there were 2 revisions in each group (2.2%).Conclusion
Although native knee biomechanics are preserved, younger patients do not seem to perceive this oft-cited benefit of UKA, as this did not translate into greater health-related quality of life or patient satisfaction compared to TKA. The theoretical advantages of UKA were not borne out by our findings, other than greater flexion up to 2 years postoperatively. 相似文献19.
Brian P. Gladnick Denis Nam Saker Khamaisy Sophia Paul Andrew D. Pearle 《HSS journal》2015,11(1):43-49
Background
Unicompartmental knee arthroplasty (UKA) is an increasingly popular option for the treatment of single-compartment knee osteoarthritis (OA) in adults. Two options for tibial resurfacing during UKA are (1) all-polyethylene inlays and (2) metal-backed onlays.Questions/Purposes
The aim of this study was to determine whether there are any differences in clinical outcomes with inlay versus onlay tibial components.Patients and Methods
We identified 39 inlays and 45 onlays, with average 2.7- and 2.3-year follow-up, respectively, from a prospective robotic-assisted surgery database. The primary outcome was the Western Ontario and McMaster University Arthritis Index (WOMAC), subcategorized by the pain, stiffness, and function subscores, at 2 years postoperatively. The secondary outcome was the need for secondary or revision surgery.Results
Postoperative WOMAC pain score was 3.1 for inlays and 1.6 for onlays (p = 0.03). For 25 inlays and 30 onlays with both preoperative and postoperative WOMAC data, pain score improved from 8.3 to 4.0 for inlays versus from 9.2 to 1.7 for onlays (p = 0.01). Function score improved from 27.5 to 12.5 for inlays versus from 32.1 to 7.3 for onlays (p = 0.03). Four inlays and one onlay required a secondary or revision procedure (p = 0.18).Conclusions
We advise using metal-backed onlays during UKA to improve postoperative clinical outcomes.Electronic supplementary material
The online version of this article (doi:10.1007/s11420-014-9421-9) contains supplementary material, which is available to authorized users. 相似文献20.
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