BACKGROUND Unicompartmental knee arthroplasty(UKA)has great advantages in the treatment of unicompartmental knee osteoarthritis,but its revision rate is higher than that of total knee arthroplasty.AIM To summarize and...BACKGROUND Unicompartmental knee arthroplasty(UKA)has great advantages in the treatment of unicompartmental knee osteoarthritis,but its revision rate is higher than that of total knee arthroplasty.AIM To summarize and analyse the causes of revision after UKA.METHODS This is a retrospective case series study in which the reasons for the first revision after UKA are summarized.We analysed the clinical symptoms,medical histories,laboratory test results,imaging examination results and treatment processes of the patients who underwent revision and summarized the reasons for primary revision after UKA.RESULTS A total of 13 patients,including 3 males and 10 females,underwent revision surgery after UKA.The average age of the included patients was 67.62 years.The prosthesis was used for 3 d to 72 months.The main reasons for revision after UKA were improper suturing of the surgical opening(1 patient),osteophytes(2 patients),intra-articular loose bodies(2 patients),tibial prosthesis loosening(2 patients),rheumatoid arthritis(1 patient),gasket dislocation(3 patients),anterior cruciate ligament injury(1 patient),and medial collateral ligament injury with residual bone cement(1 patient).CONCLUSION The causes of primary revision after UKA were gasket dislocation,osteophytes,intra-articular loose bodies and tibial prosthesis loosening.Avoidance of these factors may greatly reduce the rate of revision after UKA,improve patient satisfaction and reduce medical burden.展开更多
Objective: To evaluate the early clinical effect of unicompartmental knee arthroplasty (UKA) for medial unicompartment osteoarthritis of knee in the old people, providing the evidence for the treatment of clinic. Meth...Objective: To evaluate the early clinical effect of unicompartmental knee arthroplasty (UKA) for medial unicompartment osteoarthritis of knee in the old people, providing the evidence for the treatment of clinic. Methods: From January of 2016 to January of 2017, 20 cases of knee osteoarthritis in medial unicompartment were treated by unicompartmental knee arthroplasty. The knee joint range of motion (ROM), visual analogue scale (VAS) and knee functional Hospital for Special Surgery (HSS) scores were preoperatively recorded. The loss of blood and time of operation were intraoperative recorded. The satisfaction of patient, knee joint range of motion (ROM) and knee functional special surgical hospital score (HSS score) were postoperatively recorded at one year. Results: All patients have been followed up at an average of twelve months. The operation time was 94 - 135 min, mean 105.6 min. The blood loss was 150 - 500 ml, mean 315 ml. The postoperative HSS and ROM were both reduced. The last follow-up, there were no meniscus subluxation, loose prosthesis, and lateral ventricular osteoarthritis or other complications. Conclusion: Unicompartmental knee arthroplasty has the advantages of small operation trauma, early postoperative effect and quick recovery.展开更多
AIM To compare clinical outcomes of patients with and without preoperative genu recurvatum(GR) following mobile bearing unicompartmental knee arthroplasty(UKA). METHODS We prospectively followed 176 patients for at le...AIM To compare clinical outcomes of patients with and without preoperative genu recurvatum(GR) following mobile bearing unicompartmental knee arthroplasty(UKA). METHODS We prospectively followed 176 patients for at least 24 mo who had been treated by unilateral, minimally invasive, Oxford UKA. Patients with medial osteoarthritis(OA) knee and preoperative GR(Group Ⅰ) accounted for 18%(n = 32) and patients without preoperative GR(Group Ⅱ) accounted for the remaining 82%(n = 144). Knee score, pain scores, and functional scores were assessed for each patient and compared between the two groups. The incidence of postoperative GRand the postoperative hyperextension angles also were recorded and analyzed. RESULTS The pain score, knee score and functional score were not significantly different between the two groups. Similarly, the incidence of postoperative GR and the measured hyperextension angles were not significantly different between the two groups. The incidence of postoperative GR was 1/32(3.12%) in Group Ⅰ and 1/144(0.69%) in Group Ⅱ(P = 0.34). The mean postoperative hyperextension angles were 2.40°± 2.19°(range: 1°-7°) for Group Ⅰ and 1.57°± 3.51°(range: 1°-6°) for Group Ⅱ(P = 0.65).CONCLUSION Medial OA of the knee and concomitant GR is not a contraindication for the mobile bearing UKA.展开更多
Unicompartmental knee arthroplasty(UKA) has evolved into a suitable option for diseased knees that cannot be managed with arthroscopic treatment and at the same time are not good candidates for total knee replacement....Unicompartmental knee arthroplasty(UKA) has evolved into a suitable option for diseased knees that cannot be managed with arthroscopic treatment and at the same time are not good candidates for total knee replacement. Since meticulous execution of the surgical technique is essential to optimizing UKA outcome, some procedural key-points are mandatory. Templates(phantoms) are then used to size the required prosthetic component(using these radiographs. Arthritic varus(or valgus) knees with an asymptomatic patellofemoral joint are typically ideal for UKA. Metal-backed tibial components should be favourite instead of allpolyethylene tibial components to avoid polyethylene creep that may occur in fixed bearings. Moreover, a proper thickness of the polyethylene layer is mandatory, in order to avoid early failure.展开更多
Isolated lateral compartment osteoarthritis of the knee is a rare condition affecting approximately 1%of the population,which is ten times less common than osteoarthritis affecting only the medial compartment.Unicompa...Isolated lateral compartment osteoarthritis of the knee is a rare condition affecting approximately 1%of the population,which is ten times less common than osteoarthritis affecting only the medial compartment.Unicompartmental knee arthroplasty(UKA)has many potential advantages over total knee arthroplasty.The benefits of UKA include a smaller incision,preservation of more native tissue(including cruciate ligaments and bone),decreased blood loss,and better overall proprioception.When UKA was first introduced in the 1970s,the outcomes of medial UKA(MUKA)were poor,but the few cases of lateral UKA(LUKA)showed promise.Since that time,there has been a relative paucity of literature focused specifically on LUKA given it is a rare procedure.Refinements in patient selection criteria,implant design,and surgical technique have been made leading to increased popularity.A review of the recent literature reveals that LUKA is associated with excellent long-term clinical outcomes and implant survivorship when performed in properly selected patients.Implant design options include fixed vs mobile bearing as well as metal backed vs all polyethylene tibial component,with improved outcomes noted with fixed bearing designs.Three reasons cited for revision(i.e.,fracture of the femoral component,fracture of the tibial component,and valgus malalignment)had been reported in past literature but not recently.Presently,while rare,the most common cause of failure and need for revision are osteoarthritis progression and aseptic loosening.Despite the need for an occasional revision procedure,the survivorship of LUKA is comparable to MUKA,although it should be noted that outcomes of MUKA have been notably varied.Continued pursuit of improved techniques and implant designs will continue to show LUKA to be an excellent procedure for appropriately indicated patients.展开更多
Unicompartmental Knee Arthroplasty (UKA) is an established procedure for the treatment of unicompartmental arthritis. Success depends on a clear understanding of the principles and kinematics of the knee. Restoration ...Unicompartmental Knee Arthroplasty (UKA) is an established procedure for the treatment of unicompartmental arthritis. Success depends on a clear understanding of the principles and kinematics of the knee. Restoration of the physiological axis and soft tissue balancing is the key to a successful outcome. We outline the basic principles of UKA and the role of computer assisted surgery in achieving these goals.展开更多
Determining the effect of deprivation on quality of life after total and unicompartmental knee arthroplasty Quality of life (QoL) following joint replacement is now a national priority, with every patient being assess...Determining the effect of deprivation on quality of life after total and unicompartmental knee arthroplasty Quality of life (QoL) following joint replacement is now a national priority, with every patient being assessed using the Oxford Knee Score. The current literature is conflicted as to whether deprivation has any effect on outcome after knee surgery. The type of surgery is another variable that may determine outcome. We set out to investigate which of these factors was a more powerful predictor of outcome. A prospective trial began where, 68 patients were telephoned, (30 TKA’s and 38 UKA’s). Each were asked a series of questions comprising the Oxford Knee Score (post operation), Imperial Knee Score (post operation), EuroQol-5D (pre and post operation) and individual deprivation questions. This was compared with the deprivation status using Townsend scores. A comparison of total and unicompartmental outcomes were also analysed including cost-effectiveness. No correlation was found between outcome and Townsend scores (p < 0.05). Age was seen to be a significant indicator of pre surgical QoL. However, a large and significant difference was found between UKA and TKA when using the EQ-5D (p < 0.05) and the Imperial Knee Score (p < 0.09). This was not reflected in the Oxford Knee Score. UKA’s were also found to be more cost-effective than TKA’s. Deprivation has no major effect on the outcome of knee surgery in London. A clear difference in efficacy exists between TKA’s and UKA’s. Sensitivity of scores needs to be addressed.展开更多
BACKGROUND Open reduction and internal fixation(ORIF)is the traditional surgical treatment for patellar fractures,and unicompartmental knee arthroplasty(UKA),especially Oxford UKA,has been increasingly used in patient...BACKGROUND Open reduction and internal fixation(ORIF)is the traditional surgical treatment for patellar fractures,and unicompartmental knee arthroplasty(UKA),especially Oxford UKA,has been increasingly used in patients with medial knee osteoarthritis(OA).However,the process of choosing treatment for patients with both patellar fractures and anteromedial knee OA remains unclear.We present the case of a patient with a patellar fracture and anteromedial OA.CASE SUMMARY We present the case of a 72-year-old woman with a history of bilateral medial compartment OA of the knees and a right Oxford UKA.She also experienced a recent left patellar fracture.ORIF and Oxford UKA were performed in a single stage.The patient showed excellent postoperative clinical results.CONCLUSION ORIF and Oxford UKA can be performed simultaneously for patients with patellar fracture and anteromedial OA on the same knee.展开更多
It is suggested that unicompartmental knee replacement (UKR) offers the potential to restore normal knee kinematics better than total knee replacement (TKR) because of retaining the cruciate ligaments, and better pres...It is suggested that unicompartmental knee replacement (UKR) offers the potential to restore normal knee kinematics better than total knee replacement (TKR) because of retaining the cruciate ligaments, and better preservation of the overall geometry. It was hypothesized that patient-specific UKR would restore normal knee kinematics even better because of a customised articular shape. A comparative kinematics study was conducted on three cadaver limbs using two different test setups, a loaded ankle rig and an unloaded ankle rig. Kinematics was compared between a patient-specific UKR and a conventional fixed-bearing UKR. Both the UKRs showed similar kinematic patterns to the normal knee using both the test apparatus. The patient-specific UKR showed good results and with the other benefits it shows potential to dramatically improve clinical outcomes of knee replacement surgery.展开更多
The article by Zhao et al presents a retrospective case series on the reasons for initial revision after unicompartmental knee arthroplasty(UKA).Clarifying the reasons that may cause UKA revision can further reduce th...The article by Zhao et al presents a retrospective case series on the reasons for initial revision after unicompartmental knee arthroplasty(UKA).Clarifying the reasons that may cause UKA revision can further reduce the rate of revision UKA,focusing on gasket dislocation,osteophytes,intra-articular loose bodies,and tibial prosthesis loosening.This article provides valuable insights,not only by detailing the revision status of 13 patients who underwent revision after initial UKA but also by providing a comprehensive analysis of the incidence of revision after initial UKA.By reviewing and analyzing the causes,they established references for the early detection of risk factors for revision in clinical practice and for formulating surgical strategies and rehabilitation programmes.This commentary emphasizes the need for a meticulous understanding and an analysis of the revision rate following initial UKA and related management strategies.The implant rates,regional variation,and benefits of uncemented Oxford UKA have been explored,particularly in terms of bone preservation,appropriate surgical techniques,and weight management to control complications and improve patient prognosis.展开更多
The study by Zhao et al identifies the factors leading to the failure of unicompartmental knee arthroplasty(UKA)in their patients.These factors include substandard suturing of the wound,the presence of osteophytes and...The study by Zhao et al identifies the factors leading to the failure of unicompartmental knee arthroplasty(UKA)in their patients.These factors include substandard suturing of the wound,the presence of osteophytes and intra-articular loose bodies causing impingement,premature loosening of the tibial component,choosing unsuitable patients for the procedure,dislocation of the movable insert,and damage to the anterior cruciate ligament and medial collateral ligament.The findings suggest that employing the correct surgical techniques and indications is essential for successful outcomes in the UKA.展开更多
Zhao's study,offers a comprehensive analysis of unicompartmental knee arthroplasty(UKA)revision indications.The study provides a detailed,case-by-case analysis of the factors leading to knee revision surgery in 13...Zhao's study,offers a comprehensive analysis of unicompartmental knee arthroplasty(UKA)revision indications.The study provides a detailed,case-by-case analysis of the factors leading to knee revision surgery in 13 patients.Not only elucidates the complexities of UKA revisions but also underscores the importance of continuous improvement in surgical techniques and the adoption of innovative technologies.展开更多
Background:Patellofemoral joint(PFJ)degeneration has traditionally been regarded as a contraindication to unicompartmental knee arthroplasty(UKA).More recently,some researchers have proposed that PFJ degeneration can ...Background:Patellofemoral joint(PFJ)degeneration has traditionally been regarded as a contraindication to unicompartmental knee arthroplasty(UKA).More recently,some researchers have proposed that PFJ degeneration can be ignored in medial UKA,and others have proposed that this change should be reviewed in PFJ degenerative facets and severity.This study aimed to systematically evaluate the effect of PFJ degeneration on patient-reported outcome measures(PROMs)and revision rates after medial UKA.Methods:Electronic databases(PubMed,Embase,Web of Science,etc.)were searched for studies assessing the influence of PFJ degeneration on medial UKA.A random-effects meta-analysis was conducted for the Oxford knee score(OKS),Knee society score(KSS),and revision rates and stratified by PFJ degenerative facets(medial/lateral/trochlear/unspecified),severe PFJ degeneration(bone exposed),and bearing type(mobile/fixed).Heterogeneity was assessed by the Cochran Q test statistic and chi-squared tests with the I-squared statistic.Results:A total of 34 articles with 7007 knees(2267 with PFJ degeneration)were included(5762 mobile-bearing and 1145 fixed-bearing and 100 unspecified).Slight to moderate degenerative changes in the medial and trochlear facets did not decrease the OKS and KSS,and only lateral facets significantly decreased the OKS(mean difference[MD]=-2.18,P<0.01)and KSS(MD=-2.61,P<0.01).The severity degree of PFJ degeneration had no additional adverse effect on the OKS,KSS,or revision rates.For mobile-bearing UKA,only lateral PFJ degeneration significantly decreased the OKS(MD=-2.21,P<0.01)and KSS(MD=-2.44,P<0.01).For fixed-bearing UKA,no correlation was found between PROMs/revision rates and PFJ degeneration.Conclusion:For medial mobile-bearing UKA,slight to moderate degenerative changes in the PFJ,except lateral facet,did not compromise PROMs or revision rates.For medial fixed-bearing UKA,although it might not be conclusive enough,PROMs or revision rates were not adversely affected by PFJ degeneration(regardless of the facet).展开更多
Background: Controversies about the rational positioning of the tibial component in unicompartmental knee arthroplasty (UKA) still exist. Previous finite element (FE) studies were rare, and the results varied. Th...Background: Controversies about the rational positioning of the tibial component in unicompartmental knee arthroplasty (UKA) still exist. Previous finite element (FE) studies were rare, and the results varied. This FE study aimed to analyze the influence of the tibial component coronal alignment on knee biomechanics in mobile-bearing UKA and find a ration range of inclination angles. Methods: A three-dimensional FE model of the intact knee was constructed from image data of one normal subject. A 1000 N compressive load was applied to the intact knee model for validating. Then a set of eleven UKA FE models was developed with the coronal inclination angles of the tibial tray ranging from 10° valgus to 10° varus. Tibial bone stresses and strains, contact pressures and load distribution in all UKA models were calculated and analyzed under the unified loading and boundary conditions. Results: Load distribution, contact pressures, and contact areas in intact knee model were validated. In UKA models, von Mises stress and compressive strain at proximal medial cortical bone increased significantly as the tibial tray was in valgus inclination 〉4°, which may increase the risk of residual pain. Compressive strains at tibial keel slot were above the high threshold with varus inclination 〉4°, which may result in greater risk of component migration. Tibial bone resection comer acted as a strain-raiser regardless of the inclination angles. Compressive strains at the resected surface slightly changed with the varying inclinations and were not supposed to induce bone resorption and component loosening. Contact pressures and load percentage in lateral compartment increased with the more varus inclination, which may lead to osteoarthritis progression. Conclusions: Static knee biomechanics after UKA can be greatly affected by tibial component coronal alignment. A rauge from 4° valgus to 4° varus inclination oftibial component can be recommended in mobile-bearing UKA.展开更多
目的观察活动平台与固定平台单髁置换术对膝骨性关节炎手术治疗的短期疗效。方法选取内侧单间室膝骨关节炎患者155例,均行人工单髁置换术,其中97例选择美国邦美Oxford第三代活动平台(mobilebearing,MB)单髁假体,58例选择德国LINK固定平...目的观察活动平台与固定平台单髁置换术对膝骨性关节炎手术治疗的短期疗效。方法选取内侧单间室膝骨关节炎患者155例,均行人工单髁置换术,其中97例选择美国邦美Oxford第三代活动平台(mobilebearing,MB)单髁假体,58例选择德国LINK固定平台(fixed-bearing,FB)单髁假体。比较两组手术时间及术中出血量;术前及术后1周、1个月视觉模拟评分(VAS);术前及术后1个月、3个月、6个月膝关节活动度(range of motion,ROM)及美国特种外科医院(hospital for special surgery,HSS)评分,并进行统计学分析。结果MB组与FB组手术时间及术中出血量比较差异均无统计学意义(P均>0.05)。术前、术后1周及术后1个月VAS评分差异均无统计学意义(P均>0.05),术前及术后1个月、3个月、6个月两组间ROM、HSS评分及术后6个月内并发症发病率差异均无统计学意义(P均>0.05)。结论MB和FB单髁置换术在膝骨性关节炎中短期疗效差异无统计学意义,MB单髁假体术后易出现假体脱位。展开更多
基金Supported by National Natural Science Foundation of China,No.82004386and Guangdong Basic and Applied Basic Research Foundation,No.2022A1515011700.
文摘BACKGROUND Unicompartmental knee arthroplasty(UKA)has great advantages in the treatment of unicompartmental knee osteoarthritis,but its revision rate is higher than that of total knee arthroplasty.AIM To summarize and analyse the causes of revision after UKA.METHODS This is a retrospective case series study in which the reasons for the first revision after UKA are summarized.We analysed the clinical symptoms,medical histories,laboratory test results,imaging examination results and treatment processes of the patients who underwent revision and summarized the reasons for primary revision after UKA.RESULTS A total of 13 patients,including 3 males and 10 females,underwent revision surgery after UKA.The average age of the included patients was 67.62 years.The prosthesis was used for 3 d to 72 months.The main reasons for revision after UKA were improper suturing of the surgical opening(1 patient),osteophytes(2 patients),intra-articular loose bodies(2 patients),tibial prosthesis loosening(2 patients),rheumatoid arthritis(1 patient),gasket dislocation(3 patients),anterior cruciate ligament injury(1 patient),and medial collateral ligament injury with residual bone cement(1 patient).CONCLUSION The causes of primary revision after UKA were gasket dislocation,osteophytes,intra-articular loose bodies and tibial prosthesis loosening.Avoidance of these factors may greatly reduce the rate of revision after UKA,improve patient satisfaction and reduce medical burden.
文摘Objective: To evaluate the early clinical effect of unicompartmental knee arthroplasty (UKA) for medial unicompartment osteoarthritis of knee in the old people, providing the evidence for the treatment of clinic. Methods: From January of 2016 to January of 2017, 20 cases of knee osteoarthritis in medial unicompartment were treated by unicompartmental knee arthroplasty. The knee joint range of motion (ROM), visual analogue scale (VAS) and knee functional Hospital for Special Surgery (HSS) scores were preoperatively recorded. The loss of blood and time of operation were intraoperative recorded. The satisfaction of patient, knee joint range of motion (ROM) and knee functional special surgical hospital score (HSS score) were postoperatively recorded at one year. Results: All patients have been followed up at an average of twelve months. The operation time was 94 - 135 min, mean 105.6 min. The blood loss was 150 - 500 ml, mean 315 ml. The postoperative HSS and ROM were both reduced. The last follow-up, there were no meniscus subluxation, loose prosthesis, and lateral ventricular osteoarthritis or other complications. Conclusion: Unicompartmental knee arthroplasty has the advantages of small operation trauma, early postoperative effect and quick recovery.
文摘AIM To compare clinical outcomes of patients with and without preoperative genu recurvatum(GR) following mobile bearing unicompartmental knee arthroplasty(UKA). METHODS We prospectively followed 176 patients for at least 24 mo who had been treated by unilateral, minimally invasive, Oxford UKA. Patients with medial osteoarthritis(OA) knee and preoperative GR(Group Ⅰ) accounted for 18%(n = 32) and patients without preoperative GR(Group Ⅱ) accounted for the remaining 82%(n = 144). Knee score, pain scores, and functional scores were assessed for each patient and compared between the two groups. The incidence of postoperative GRand the postoperative hyperextension angles also were recorded and analyzed. RESULTS The pain score, knee score and functional score were not significantly different between the two groups. Similarly, the incidence of postoperative GR and the measured hyperextension angles were not significantly different between the two groups. The incidence of postoperative GR was 1/32(3.12%) in Group Ⅰ and 1/144(0.69%) in Group Ⅱ(P = 0.34). The mean postoperative hyperextension angles were 2.40°± 2.19°(range: 1°-7°) for Group Ⅰ and 1.57°± 3.51°(range: 1°-6°) for Group Ⅱ(P = 0.65).CONCLUSION Medial OA of the knee and concomitant GR is not a contraindication for the mobile bearing UKA.
文摘Unicompartmental knee arthroplasty(UKA) has evolved into a suitable option for diseased knees that cannot be managed with arthroscopic treatment and at the same time are not good candidates for total knee replacement. Since meticulous execution of the surgical technique is essential to optimizing UKA outcome, some procedural key-points are mandatory. Templates(phantoms) are then used to size the required prosthetic component(using these radiographs. Arthritic varus(or valgus) knees with an asymptomatic patellofemoral joint are typically ideal for UKA. Metal-backed tibial components should be favourite instead of allpolyethylene tibial components to avoid polyethylene creep that may occur in fixed bearings. Moreover, a proper thickness of the polyethylene layer is mandatory, in order to avoid early failure.
文摘Isolated lateral compartment osteoarthritis of the knee is a rare condition affecting approximately 1%of the population,which is ten times less common than osteoarthritis affecting only the medial compartment.Unicompartmental knee arthroplasty(UKA)has many potential advantages over total knee arthroplasty.The benefits of UKA include a smaller incision,preservation of more native tissue(including cruciate ligaments and bone),decreased blood loss,and better overall proprioception.When UKA was first introduced in the 1970s,the outcomes of medial UKA(MUKA)were poor,but the few cases of lateral UKA(LUKA)showed promise.Since that time,there has been a relative paucity of literature focused specifically on LUKA given it is a rare procedure.Refinements in patient selection criteria,implant design,and surgical technique have been made leading to increased popularity.A review of the recent literature reveals that LUKA is associated with excellent long-term clinical outcomes and implant survivorship when performed in properly selected patients.Implant design options include fixed vs mobile bearing as well as metal backed vs all polyethylene tibial component,with improved outcomes noted with fixed bearing designs.Three reasons cited for revision(i.e.,fracture of the femoral component,fracture of the tibial component,and valgus malalignment)had been reported in past literature but not recently.Presently,while rare,the most common cause of failure and need for revision are osteoarthritis progression and aseptic loosening.Despite the need for an occasional revision procedure,the survivorship of LUKA is comparable to MUKA,although it should be noted that outcomes of MUKA have been notably varied.Continued pursuit of improved techniques and implant designs will continue to show LUKA to be an excellent procedure for appropriately indicated patients.
文摘Unicompartmental Knee Arthroplasty (UKA) is an established procedure for the treatment of unicompartmental arthritis. Success depends on a clear understanding of the principles and kinematics of the knee. Restoration of the physiological axis and soft tissue balancing is the key to a successful outcome. We outline the basic principles of UKA and the role of computer assisted surgery in achieving these goals.
文摘Determining the effect of deprivation on quality of life after total and unicompartmental knee arthroplasty Quality of life (QoL) following joint replacement is now a national priority, with every patient being assessed using the Oxford Knee Score. The current literature is conflicted as to whether deprivation has any effect on outcome after knee surgery. The type of surgery is another variable that may determine outcome. We set out to investigate which of these factors was a more powerful predictor of outcome. A prospective trial began where, 68 patients were telephoned, (30 TKA’s and 38 UKA’s). Each were asked a series of questions comprising the Oxford Knee Score (post operation), Imperial Knee Score (post operation), EuroQol-5D (pre and post operation) and individual deprivation questions. This was compared with the deprivation status using Townsend scores. A comparison of total and unicompartmental outcomes were also analysed including cost-effectiveness. No correlation was found between outcome and Townsend scores (p < 0.05). Age was seen to be a significant indicator of pre surgical QoL. However, a large and significant difference was found between UKA and TKA when using the EQ-5D (p < 0.05) and the Imperial Knee Score (p < 0.09). This was not reflected in the Oxford Knee Score. UKA’s were also found to be more cost-effective than TKA’s. Deprivation has no major effect on the outcome of knee surgery in London. A clear difference in efficacy exists between TKA’s and UKA’s. Sensitivity of scores needs to be addressed.
文摘BACKGROUND Open reduction and internal fixation(ORIF)is the traditional surgical treatment for patellar fractures,and unicompartmental knee arthroplasty(UKA),especially Oxford UKA,has been increasingly used in patients with medial knee osteoarthritis(OA).However,the process of choosing treatment for patients with both patellar fractures and anteromedial knee OA remains unclear.We present the case of a patient with a patellar fracture and anteromedial OA.CASE SUMMARY We present the case of a 72-year-old woman with a history of bilateral medial compartment OA of the knees and a right Oxford UKA.She also experienced a recent left patellar fracture.ORIF and Oxford UKA were performed in a single stage.The patient showed excellent postoperative clinical results.CONCLUSION ORIF and Oxford UKA can be performed simultaneously for patients with patellar fracture and anteromedial OA on the same knee.
文摘It is suggested that unicompartmental knee replacement (UKR) offers the potential to restore normal knee kinematics better than total knee replacement (TKR) because of retaining the cruciate ligaments, and better preservation of the overall geometry. It was hypothesized that patient-specific UKR would restore normal knee kinematics even better because of a customised articular shape. A comparative kinematics study was conducted on three cadaver limbs using two different test setups, a loaded ankle rig and an unloaded ankle rig. Kinematics was compared between a patient-specific UKR and a conventional fixed-bearing UKR. Both the UKRs showed similar kinematic patterns to the normal knee using both the test apparatus. The patient-specific UKR showed good results and with the other benefits it shows potential to dramatically improve clinical outcomes of knee replacement surgery.
文摘The article by Zhao et al presents a retrospective case series on the reasons for initial revision after unicompartmental knee arthroplasty(UKA).Clarifying the reasons that may cause UKA revision can further reduce the rate of revision UKA,focusing on gasket dislocation,osteophytes,intra-articular loose bodies,and tibial prosthesis loosening.This article provides valuable insights,not only by detailing the revision status of 13 patients who underwent revision after initial UKA but also by providing a comprehensive analysis of the incidence of revision after initial UKA.By reviewing and analyzing the causes,they established references for the early detection of risk factors for revision in clinical practice and for formulating surgical strategies and rehabilitation programmes.This commentary emphasizes the need for a meticulous understanding and an analysis of the revision rate following initial UKA and related management strategies.The implant rates,regional variation,and benefits of uncemented Oxford UKA have been explored,particularly in terms of bone preservation,appropriate surgical techniques,and weight management to control complications and improve patient prognosis.
文摘The study by Zhao et al identifies the factors leading to the failure of unicompartmental knee arthroplasty(UKA)in their patients.These factors include substandard suturing of the wound,the presence of osteophytes and intra-articular loose bodies causing impingement,premature loosening of the tibial component,choosing unsuitable patients for the procedure,dislocation of the movable insert,and damage to the anterior cruciate ligament and medial collateral ligament.The findings suggest that employing the correct surgical techniques and indications is essential for successful outcomes in the UKA.
文摘Zhao's study,offers a comprehensive analysis of unicompartmental knee arthroplasty(UKA)revision indications.The study provides a detailed,case-by-case analysis of the factors leading to knee revision surgery in 13 patients.Not only elucidates the complexities of UKA revisions but also underscores the importance of continuous improvement in surgical techniques and the adoption of innovative technologies.
基金National Natural Science Foundation of China(81802210 and 81672219)Key Project of Sichuan Science&Technology Department(2018SZ0223 and 2018SZ0250)National Clinical Research Center for Geriatrics,West China Hospital,Sichuan University(Z20191008 and Z2018B20)
文摘Background:Patellofemoral joint(PFJ)degeneration has traditionally been regarded as a contraindication to unicompartmental knee arthroplasty(UKA).More recently,some researchers have proposed that PFJ degeneration can be ignored in medial UKA,and others have proposed that this change should be reviewed in PFJ degenerative facets and severity.This study aimed to systematically evaluate the effect of PFJ degeneration on patient-reported outcome measures(PROMs)and revision rates after medial UKA.Methods:Electronic databases(PubMed,Embase,Web of Science,etc.)were searched for studies assessing the influence of PFJ degeneration on medial UKA.A random-effects meta-analysis was conducted for the Oxford knee score(OKS),Knee society score(KSS),and revision rates and stratified by PFJ degenerative facets(medial/lateral/trochlear/unspecified),severe PFJ degeneration(bone exposed),and bearing type(mobile/fixed).Heterogeneity was assessed by the Cochran Q test statistic and chi-squared tests with the I-squared statistic.Results:A total of 34 articles with 7007 knees(2267 with PFJ degeneration)were included(5762 mobile-bearing and 1145 fixed-bearing and 100 unspecified).Slight to moderate degenerative changes in the medial and trochlear facets did not decrease the OKS and KSS,and only lateral facets significantly decreased the OKS(mean difference[MD]=-2.18,P<0.01)and KSS(MD=-2.61,P<0.01).The severity degree of PFJ degeneration had no additional adverse effect on the OKS,KSS,or revision rates.For mobile-bearing UKA,only lateral PFJ degeneration significantly decreased the OKS(MD=-2.21,P<0.01)and KSS(MD=-2.44,P<0.01).For fixed-bearing UKA,no correlation was found between PROMs/revision rates and PFJ degeneration.Conclusion:For medial mobile-bearing UKA,slight to moderate degenerative changes in the PFJ,except lateral facet,did not compromise PROMs or revision rates.For medial fixed-bearing UKA,although it might not be conclusive enough,PROMs or revision rates were not adversely affected by PFJ degeneration(regardless of the facet).
基金This work was funded by a grant from National Natural Science Foundation of China (No. 81273972).
文摘Background: Controversies about the rational positioning of the tibial component in unicompartmental knee arthroplasty (UKA) still exist. Previous finite element (FE) studies were rare, and the results varied. This FE study aimed to analyze the influence of the tibial component coronal alignment on knee biomechanics in mobile-bearing UKA and find a ration range of inclination angles. Methods: A three-dimensional FE model of the intact knee was constructed from image data of one normal subject. A 1000 N compressive load was applied to the intact knee model for validating. Then a set of eleven UKA FE models was developed with the coronal inclination angles of the tibial tray ranging from 10° valgus to 10° varus. Tibial bone stresses and strains, contact pressures and load distribution in all UKA models were calculated and analyzed under the unified loading and boundary conditions. Results: Load distribution, contact pressures, and contact areas in intact knee model were validated. In UKA models, von Mises stress and compressive strain at proximal medial cortical bone increased significantly as the tibial tray was in valgus inclination 〉4°, which may increase the risk of residual pain. Compressive strains at tibial keel slot were above the high threshold with varus inclination 〉4°, which may result in greater risk of component migration. Tibial bone resection comer acted as a strain-raiser regardless of the inclination angles. Compressive strains at the resected surface slightly changed with the varying inclinations and were not supposed to induce bone resorption and component loosening. Contact pressures and load percentage in lateral compartment increased with the more varus inclination, which may lead to osteoarthritis progression. Conclusions: Static knee biomechanics after UKA can be greatly affected by tibial component coronal alignment. A rauge from 4° valgus to 4° varus inclination oftibial component can be recommended in mobile-bearing UKA.
文摘目的观察活动平台与固定平台单髁置换术对膝骨性关节炎手术治疗的短期疗效。方法选取内侧单间室膝骨关节炎患者155例,均行人工单髁置换术,其中97例选择美国邦美Oxford第三代活动平台(mobilebearing,MB)单髁假体,58例选择德国LINK固定平台(fixed-bearing,FB)单髁假体。比较两组手术时间及术中出血量;术前及术后1周、1个月视觉模拟评分(VAS);术前及术后1个月、3个月、6个月膝关节活动度(range of motion,ROM)及美国特种外科医院(hospital for special surgery,HSS)评分,并进行统计学分析。结果MB组与FB组手术时间及术中出血量比较差异均无统计学意义(P均>0.05)。术前、术后1周及术后1个月VAS评分差异均无统计学意义(P均>0.05),术前及术后1个月、3个月、6个月两组间ROM、HSS评分及术后6个月内并发症发病率差异均无统计学意义(P均>0.05)。结论MB和FB单髁置换术在膝骨性关节炎中短期疗效差异无统计学意义,MB单髁假体术后易出现假体脱位。