ObjectiveTo investigate the effect of anterior cruciate ligament (ACL) integrity on the short- and mid-term effectiveness of mobile-bearing medial unicompartmental knee arthroplasty (UKA). MethodsThe clinical data of 128 patients with anteromedial osteoarthritis who underwent mobile-bearing medial UKA between June 2019 and June 2021 was retrospectively analyzed. According to the integrity of ACL structure under direct vision during operation, the patients were divided into normal group (30 cases), synovial defect group (53 cases), and longitudinal split group (45 cases). There was no significant difference in gender, age, body mass index, preoperative knee range of motion (ROM), hip-knee-ankle angle (HKA), Knee Society Score (KSS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and other baseline data among the 3 groups (P>0.05). The knee ROM, KSS score (including clinical and functional scores), WOMAC score (including pain, stiffness, and function scores) before operation and at last follow-up, the Lysholm score, International Knee Documentation Committee (IKDC) score, and Forgetting Joint Score (FJS-12) at last follow-up were recorded and compared among the 3 groups. Imaging examination was performed to evaluate the wear of cartilage in the lateral tibiofemoral compartment and patellofemoral compartment of the knee joint. HKA and posterior tibial slope (PTS) were measured at last follow-up. ResultsAll the patients of 3 groups were followed up 22-56 months (mean, 40.4 months). There was no significant difference in follow-up time among the 3 groups (P>0.05). At last follow-up, imaging examination showed no obvious cartilage wear progression of the lateral tibiofemoral compartment and patellofemoral compartment, and no adverse events such as aseptic loosening of the prosthesis, dislocation of the removable pad, or infection occurred during the follow-up. At last follow-up, knee ROM, HKA, KSS scores, and WOMAC scores of the 3 groups significantly improved when compared with preoperative ones (P<0.05). There was no significant difference in the changes of the above indicators before and after operation, and also the Lysholm score, IKDC score, FJS-12 score, and PTS among the 3 groups (P>0.05). ConclusionThe integrity of ACL has no significant effect on the short- and mid-term effectiveness of mobile-bearing medial UKA.
Objective To investigate the short- and mid-term effectiveness of unicompartmental knee arthroplasty (UKA) for post-traumatic arthritis (PTA) of knee. Methods The clinical data of 30 patients with PTA of unilateral knee between March 2014 and September 2021 was retrospectively analyzed. There were 14 males and 16 females with an average of 64.5 years (range, 33-81 years). The average body mass index was 26.7 kg/m2 (range, 19.8-35.6 kg/m2). The types of injuries that caused PTA included intra-articular fracture in 16 cases, extra-articular fracture in 8 cases, and soft tissue injury in 6 cases. The initial injuries were treated by conservative therapy in 12 cases and by surgical therapy in 18 cases. Ten cases were medial compartment osteoarthritis and 20 cases were lateral compartment osteoarthritis. According to Kellgren-Lawrence staging, there were 19 cases of grade Ⅲ and 11 cases of grade Ⅳ. The operative time, the length of hospital stay, complications, and subjective satisfaction were recorded. The Oxford Knee Function Score (OKS), Hospital for Special Surgery (HSS) score, and knee range of motion (ROM) were used to evaluate knee function. Weight-bearing X-ray films were taken to measure the femoro-tibial angle (FTA) and to assess alignment correction of the lower limb. Results The operative time ranged from 50 to 95 minutes (mean, 63.7 minutes), the length of hospital stay ranged from 3 to 8 days (mean, 6.9 days). Superficial infection occurred in 2 patients, while the remaining incisions healed by first intention. There was no deep vein thrombosis or neurovascular injury. All patients were followed up 17-109 months (median, 70 months). At last follow-up, OKS score, HSS score, and ROM in 30 cases significantly improved when compared with those before operation (P<0.05). Lower limb alignment was significantly corrected and there was significant difference in FTA of the varus and valgus knees between pre- and post-operation (P<0.05). The patient satisfaction rate was 86.7% (26/30). Two cases developed contralateral osteoarthritis progression during follow-up. No bearing dislocation, prosthesis loosening or sinking occurred and none required further revision. Conclusion For patients with PTA of knee, UKA can obtain definite short- and mid-term effectiveness with high patient satisfaction.
Objective To conclude the research progress of unicompartmental knee arthroplasty (UKA) in the treatment of elderly patients with knee osteoarthritis (KOA). Methods The literature on UKA at home and abroad in recent years was reviewed to summarize the clinical characteristics of elderly patients with KOA, perioperative management (including evaluating indications preoperatively, intraoperative prosthesis selection, postoperative complication management, etc). Results Through reasonable preoperative evaluation, prosthesis selection, and advanced perioperative management, for elderly patients with KOA who meet the indications, UKA can be considered. Compared with total knee arthroplasty, the incidence of postoperative complications in elderly patients undergoing UKA is lower, joint awareness is reduced, functional improvement and satisfaction are higher. Meanwhile, choosing appropriate prostheses and fixation methods can lead to a good survival rate. ConclusionUKA can provide a safe and effective treatment option for elderly patients with KOA within a certain range of indications.
Objective To summarize the computer assisted navigation and robotics in the classification of knee surgery, and the development, surgical indications and contraindication, effectiveness, and the research progress of computer assisted navigation and robotics in unicompartmental knee arthroplasty (UKA). Methods The related literature on computer assisted navigation and robotics in UKA was extensively reviewed, summarized, and analyzed. Results Recently, satisfactory results have been achieved in UKA for the treatment of single compartmental knee osteoarthritis. With the rapid development of computer navigation and robotic technology gradually combined with clinical practice, the great precision and accuracy of implant have been improved in computer navigation and robotics in UKA surgery. Postoperative function is well recovered, meanwhile, prosthesis survival can be significantly increased. Conclusion Computer assisted navigation and robotics in UKA can greatly improve the accuracy of the implant when compared with traditional UKA. The early effectiveness is satisfactory, but the long-term effectiveness still needs to be further observed.
ObjectivesTo systematically review the efficacy of unicompartmental knee arthroplasty on forgotten joint score (FJS) in patients with knee osteoarthritis.MethodsPubMed, EMbase, The Cochrane Library, Web of Science, CNKI, CBM, WanFang Data and VIP databases were electronically searched to collect randomized controlled trials (RCTs) and cohort studies on unicompartmental knee arthroplasty on FJS in patients with knee osteoarthritis from inception to December 31st, 2019. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 2 RCTs and 11 cohort studies were included. The results of meta-analysis based on RCTs showed that: compared to posterior stabilized total knee arthroplasty (PS-TKA), unicompartmental knee arthroplasty could improve FJS on 12-month (MD=9.23, 95%CI 0.53 to 17.93, P=0.04) after operation. The results of meta-analysis based on cohort studies showed that: compared to PS-TKA, unicompartmental knee arthroplasty could improve FJS on 6-week (MD=8.90, 95%CI 6.87 to 10.94, P<0.000 01), 6-month (MD=18.72, 95%CI 8.71 to 28.74, P=0.000 2), 1-year after operation (MD=13.41, 95%CI 8.87 to 17.95, P<0.000 01), and the last follow-up (MD=0.99, 95%CI 0.47 to 1.54, P=0.000 2).ConclusionsCurrent evidence shows that, comparing with PS-TKA, unicompartmental knee arthroplasty in knee osteoarthritis shows advantage in the improvement of FJS. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify above conclusions.
ObjectiveTo explore the short- and mid-term effectivenesses of combined unicompartmental knee arthroplasty (UKA) and anterior cruciate ligament (ACL) reconstruction for osteoarthritis (OA) and ACL injury. MethodsBetween January 2006 and January 2014, 32 patients with knee OA and ACL injury were treated by combined UKA and ACL reconstruction. There were 12 males and 20 females, aged 41-63 years (mean, 50 years); 17 left knees and 15 right knees were involved. The causes of ACL injury were sports injury (25 cases) and traffic accident injury (7 cases), including 27 cases of old injury and 5 cases of acute injury. Pain of the medial compartment of the knee and unstable knee joint were the main clinical symptoms. Preoperative X-ray films showed (3.1±0.6)° of varus deformity. ResultsAll incisions healed by first intention, without complication. The patients were followed up 16-112 months (mean, 55 months). Mobile bearing dislocation occurred in 2 cases after operation, and was cured after replacing much thicker mobile bearings. X-ray films showed (4.0±0.7)° of valgus at last follow-up. There was no loosening of the prosthesis. Physiological radiolucent line (<1 mm) was observed around the tibial component in 10 patients. The Oxford Knee Score (OKS), Knee Society Score (KSS) clinical score, KSS functional score, and Tegner activity score at last follow-up were improved significantly (P<0.05). The range of motion (ROM) of the operated knee was (123.5±2.8)°, and the posterior slope of the tibial component was (3.9±1.2)° at last follow-up; a significant correlation was found between ROM and posterior slope according to the Pearson's correlation (r=0.392, P=0.031). ConclusionCombined UKA and ACL reconstruction has good short- and mid-term effectivenesses for OA and ACL injury.
Objective To compare the early analgesic effects and the impact on knee joint function recovery after unicompartmental knee arthroplasty (UKA) between single adductor canal block (SACB) and continuous adductor canal block (CACB) combined with local infiltration anesthesia (LIA) using a prospective study. Methods The patients with knee osteoarthritis admitted between April 2022 and December 2023 were enrolled as a subject. Among them, 60 patients met the selection criteria and were enrolled in the study. They were randomly assigned to the SACB group or CACB group in a ratio of 1:1 using a random number table method. There was no significant difference between the two groups (P>0.05) in terms of age, gender, height, body mass, body mass index, affected side, and preoperative resting visual analogue scale (VAS) score and active VAS score, Oxford knee score (OKS), and American Hospital of Special Surgery (HSS) score. All patients received multimodal analgesia management using LIA combined with SACB or CACB. The operation time, pain related indicators (resting and activity VAS scores, number and timing of breakthrough pain, opioid consumption), joint function related indicators (quadriceps muscle strength, knee range of motion, OKS score, and HSS score), as well as postoperative block complications and adverse events were recorded and compared between the two groups. Results There was no significant difference in the operation time between the two groups (P<0.05). All patients in the two groups were followed up with a follow-up time of (9.70±4.93) months in the SACB group and (12.23±5.05) months in the CACB group, and the difference was not significant (P>0.05). The CACB group had a significant lower resting VAS score at 24 hours after operation compared to the SACB group (P<0.05). There was no significant difference in resting and active VAS scores between the two groups at other time points (P>0.05). The CACB group had a significantly lower incidence of breakthrough pain compared to the SACB group [9 cases (30.00%) vs. 17 cases (56.67%); P<0.05). However, there was no significant difference in the timing of breakthrough pain occurrence and opioid consumption between the two groups (P>0.05). Four cases in the SACB group and 7 cases in the CACB group experienced adverse events, with no significant difference in the incidence of adverse events between the two groups (P>0.05). The CACB group had significantly better knee joint mobility than the SACB group at 1 and 2 days after operation (P<0.05). There was no significant difference between the two groups in knee joint mobility on 0 day after operation and quadriceps muscle strength and OKS and HSS scores at different time points (P>0.05). Conclusion In UKA, the analgesic effects and knee joint function recovery are similar when compared between LIA combined with SACB and LIA combined with CACB. However, SACB is simpler to perform and can avoid adverse events such as catheter displacement and dislocation. Therefore, SACB may be a better choice.
ObjectiveTo summarize research progress of change in bone mineral density (BMD) after knee arthroplasty and its diagnostic methods, influencing factors, and drug prevention and treatment.MethodsThe relevant literature at home and abroad was reviewed and summarized from research status of the advantages and disadvantages of BMD assessment methods, the trend of changes in BMD after knee arthroplasty and its influencing factors, and the differences in effectiveness of drugs.ResultsThe central BMD and mean BMD around the prosthesis decrease after knee arthroplasty, which is closely associated with body position, age, weight, daily activities, and the fixation methods, design, and material of prosthesis. Denosumab, bisphosphonates, and teriparatide et al. can decrease BMD loss after knee arthroplasty.ConclusionBMD after knee arthroplasty decreases, which is related to various factors, but the mechanism is unclear. At present, some inhibitors of bone resorption can decrease BMD loss after knee arthroplasty. However, its long-term efficacy remains to be further explored.
Objective To analyze the accuracy of prosthesis size selection in Naton robot-assisted medial unicondyle knee arthroplasty by comparing the actual prosthesis size used during operation and the preoperative planning. Methods The clinical data of 100 patients (110 knees) who underwent Naton robot-assisted medial unicondylar knee arthroplasty between June 2023 and July 2024 was retrospectively analyzed, including 47 knees on left side and 63 knees on right side. There were 37 males (40 knees) and 63 females (70 knees) with a mean age of 65.4 years (range, 59-71 years). Body mass index was 22.2-28.6 kg/m2 (mean, 25.4 kg/m2). The disease duration ranged from 1 to 8 years (mean, 3.4 years). Preoperative planning was performed by Naton robotic surgical system based on lower limb CT data. The final prosthesis size after osteotomy was recorded and compared with the preoperative plan to analyse whether it was consistent with the preoperative plan, as well as the situation of knee flexion and extension gaps (<0.5 mm, >2.0 mm) corresponding to the different models of prostheses. ResultsDuring operation, 5 patients (5 knees) were treated with traditional UKA due to mechanical arm failure, software obstacles, significant bone amputation bias, or loose reference frame, and were excluded from the final analysis. The remaining 95 patients (105 knees) successfully received Naton robot-assisted surgery, and no related complications occurred. The prosthesis size was consistent with the preoperative plan in 101 knees (96.2%) on the femur side, 100 knees (95.2%) on the tibia side, and 97 knees (92.4%) on both femur and tibia sides. The prosthesis size was inconsistent in 3 cases (2.86%) on the femur side alone, 4 cases (3.81%) on the tibial side alone, and 1 case (0.95%) on both femur and tibial sides. Among the prostheses with different models, the flexion and extension gaps were less than 0.5 mm in 3 knees, the flexion gap was less than 0.5 mm and the extension gap was more than 2.0 mm in 3 knees, and the flexion gap was more than 2.0 mm and the extension gap was less than 0.5 mm in 2 knees. Conclusion The accuracy of prosthesis size selection for Naton robot-assisted medial unicondylar knee arthroplasty is relatively high.
【Abstract】 Objective To evaluate the mid-term effectiveness of Oxford Unicompartmental Knee system Phase III for medial unicompartmental knee osteoarthritis (OA). Methods Between December 2008 and August 2010, 26 patients (32 knees) with medial unicompartmental knee OA were treated. Of 26 patients, 11 were followed up more than 2 years, including 7 males and 4 females (14 knees, 6 left and 8 right knees) with an average age of 62.4 years (range, 50-74 years). All patients had load suffering and tenderness of medial unicompartmental knee, and complicated by varus deformity without limitation of flexion and extension; the disease duration ranged 5-23 years (mean, 11.6 years). According to Ahlback staging, 4 knees were at stage II and 10 knees at stage III. Cemented unicompartmental knee arthroplasty (Oxford Unicompartmental Knee system Phase III) was performed by minimally invasive technique. Results All the incisions were primary healing after operation. Five cases suffered from local ache in the pes anserinus during the first 3 months after operation, which was cured after conservative therapy. Of them, 11 patients were followed up 27.5 months on average (range, 24-30 months). During follow-up, no complication of prosthesis loosening, displacement, arthropathy in the opposite department, or the patellofemoral joint occurred. The range of motion was significantly improved from (109.2 ± 8.7)° preoperatively to (123.5 ± 6.7)° at last follow-up (P lt; 0.05); knee society score (KSS) and Western Ontario and McMaster University Osteoarthritis Index (WOMAC) scores were all significantly improved (P lt; 0.05). At last follow-up, the femoro-tibial angle was significantly improved (P lt; 0.05); tibial plateau and the tibial anatomical axis increased, showing no significant difference (P gt; 0.05); and posterior tibial slope was significantly decreased (P lt; 0.05). Conclusion Oxford Unicompartmental Knee system Phase III has satisfactory mid-term effectiveness in treating medial unicompartmental knee OA with the advantages of little trauma and rapid recovery, but long-term effectiveness is expected for further follow-up.