Lateral Unicompartmental Knee Arthroplasty in Structure of Modern Knee Replacement: Is It «Woe From Wit» or a Viable Go-To Method?

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Abstract

Background. Results of numerous contemporary studies indicate that medial and lateral unicompartmental knee arthroplasty (UKA) are almost equally effective both in clinical and functional aspects with no statistically significant difference in most cases. Furthermore, both operations tend to reach the effectiveness of total knee arthroplasty (TKA), despite the common opinion that any UKA is a more complex and skill challenging surgery with a less predictable outcome. The purpose — to asses if UKA in the patients with end-stage lateral unicompartmental osteoarthritis is an effective surgical intervention that may allow obtaining good and excellent medium-term functional results, that are comparable to the results of the medial unicompartmental arthroplasty, and to see if there are any benefits in comparison to the total knee arthroplasty (TKA). Materials and Methods. 140 middle-aged and elderly adults with end-stage osteoarthritis underwent knee arthroplasty at Vreden National Medical Research Center of Traumatology and Cheboksary Federal Center of Traumatology, Orthopedics and Arthroplasty. Group I (lateral UKA) (the main ) consisted of 15 patients with knee arthritis and type I Krakow valgus knee deformity, who underwent the lateral UKA with a fixed all-polyethylene tibial component. Group II (medial UKA) included 58 patients with end-stage medial unicompartmental osteoarthritis, who underwent the medial UKA using an endoprosthesis of a similar design. Group III (TKA) was represented by 67 patients with gonarthrosis accompanied by type II Krackow valgus knee deformity, who underwent the total knee arthroplasty with cruciate retaining (CR) prosthesis. The comparison between the groups was carried out regarding the achieved range of motion, functional result (using Oxford Knee Score and Forgotten Joint Score), as well as the rate of different types of complications. Results. During the study, two main objectives were set. The first was to compare the outcomes of the lateral and medial UKA. It was revealed that the lateral UKA allowed the patients to obtain good function of the operated knee, with the best results among the compared groups on the Forgotten Joint Score. The second objective was to compare the results of the lateral UKA and TKA in the patients with type II Krackow knee valgus deformity. Here, our study revealed that the group of UKA (group I) compared to the TKA had better results according to Forgotten Joint Score (71.5±5.3 vs 65.2±7; p = 0.9) and had a slightly lower range of motion according to Oxford Knee Score (34.6±2.3 versus 35.9±2.2; p = 0.7). It is worth noting that in both cases the difference was not statistically significant. Conclusion. Despite the fact that the lateral UKA made it possible to achieve a good functional outcome, the integral score was the same as in the groups with the medial UKA and the total knee arthroplasty. The older patients were more satisfied with the results of the partial arthroplasty than with the results of the total.

About the authors

D. V. Chugaev

Vreden National Medical Research Center of Traumatology and Orthopedics

Author for correspondence.
Email: dr.chugaev@gmail.com
ORCID iD: 0000-0001-5127-5088

Dmitrii V. Chugaev — Cand. Sci. (Med.), Orthopedic Surgeon

St. Petersburg

Russian Federation

N. N. Kornilov

Vreden National Medical Research Center of Traumatology and Orthopedics

Email: fake@neicon.ru
ORCID iD: 0000-0001-6905-7900

Nikolai N. Kornilov — Dr. Sci. (Med.), Professor, Chair of Traumatology and Orthopedics; Leading Researcher, Knee Pathology Department

St. Petersburg

Russian Federation

A. S. Karpukhin

Vreden National Medical Research Center of Traumatology and Orthopedics; Federal Center of Traumatology, Orthopedics and Arthroplasty

Email: fake@neicon.ru
ORCID iD: 0000-0002-4525-2135

Aleksey S. Karpukhin — Head of Department, Federal Center of Traumatology, Orthopedics and Arthroplasty

Cheboksary

Russian Federation

P. G. Kogan

Vreden National Medical Research Center of Traumatology and Orthopedics

Email: fake@neicon.ru
ORCID iD: 0000-0002-7179-4851

Pavel G. Kogan — Cand. Sci. (Med.), Orthopedic Surgeon

St. Petersburg

Russian Federation

S. A. Lasunsky

Vreden National Medical Research Center of Traumatology and Orthopedics

Email: fake@neicon.ru
ORCID iD: 0000-0003-4159-0724

Sergei A. Lasunsky — Cand. Sci. (Med.), Head of the Trauma and Orthopedic Department

St. Petersburg

Russian Federation

References

  1. Корнилов Н.Н., Денисов А.А. Парадигма раннего гонартроза: обзор современных возможностей диагностики и лечения (часть 1). Терапевтический архив. 2017;89(12):238–243. doi: 10.17116/terarkh20178912238-243.
  2. Dunbar M.J., Richardson G., Robertsson O. I can’t get no satisfaction after my total knee replacement: rhymes and reasons. Bone Joint J. 2013;95-B(11 Suppl A):148-152. doi: 10.1302/0301-620x.95B11.32767.
  3. Wylde V., Dieppe P., Hewlett S., Learmonth I.D. Total knee replacement: is it really an effective procedure for all? Knee. 2007;14(6):417-423. doi: 10.1016/j.knee.2007.06.001.
  4. Scott C.E., Howie C.R., MacDonald D., Biant L.C. Predicting dissatisfaction following total knee replacement: a prospective study of 1217 patients. J Bone Joint Surg Br. 2010;92(9):1253-1258. doi: 10.1302/0301-620x.92B9.24394.
  5. Lyons M.C., MacDonald S.J., Somerville L.E., Naudie D.D., McCalden R.W. Unicompartmental versus total knee arthroplasty database analysis: is there a winner? Clin Orthop Relat Res. 2012;470(1):84-90. doi: 10.1007/s11999-011-2144-z.
  6. Даниляк В.В., Молодов М.А., Ключевский В.В., Вергай А.А., Жиженкова Т.В. Осложнения одномыщелкового эндопротезирования коленного сустава. Кремлевская медицина. 2015; (4):21-26.
  7. Эшназаров К., Хонг-Чул Л., Каримов М. Анализ отдаленныx результатов применения и срокoв выживаемости одномыщелковых эндопротезов коленного сустава. Гений ортопедии. 2016;1:60-65. doi: 10.18019/1028-4427-2016-1-60-65.
  8. Thein R., Khamaisy S., Zuiderbaan H.A., Nawabi D.H., Pearle A.D. Lateral robotic unicompartmental knee arthroplasty. Sports Med Arthrosc Rev. 2014;22(4):223-228. doi: 10.1097/JSA.0000000000000053.
  9. Wada K., Hamada D., Takasago T., Nitta A., Goto T., Tonogai I. et al. Native rotational knee kinematics is restored after lateral UKA but not after medial UKA. Knee Surg Sports Traumatol Arthrosc. 2018;26(11):3438-3443. doi: 10.1007/s00167-018-4919-1.
  10. Rossi R., Rosso F., Cottino U., Dettoni F., Bonasia D.E., Bruzzone M. Total knee arthroplasty in the valgus knee. Int Orthop. 2014;38(2):273-283. doi: 10.1007/s00264-013-2227-4.
  11. Ranawat A.S., Ranawat C.S., Elkus M., Rasquinha V.J., Rossi R., Babhulkar S. Total knee arthroplasty for severe valgus deformity. J Bone Joint Surg Am. 2005;87 Suppl 1 (Pt 2):271-284. doi: 10.2106/JBJS.E.00308.
  12. Krackow K.A., Jones M.M., Teeny S.M., Hungerford D.S. Primary total knee arthroplasty in patients with fixed valgus deformity. Clin Orthop Relat Res. 1991;(273):9-18.
  13. Lustig S., Parratte S., Magnussen R.A., Argenson J.N., Neyret P. Lateral unicompartmental knee arthroplasty relieves pain and improves function in posttraumatic osteoarthritis. Clin Orthop Relat Res. 2012;470(1):69-76. doi: 10.1007/s11999-011-1963-2.
  14. Elsoe R., Johansen M.B., Larsen P. Tibial plateau fractures are associated with a long-lasting increased risk of total knee arthroplasty a matched cohort study of 7,950 tibial plateau fractures. Osteoarthritis Cartilage. 2019;27(5):805-809. doi: 10.1016/j.joca.2018.12.020.
  15. Papagelopoulos P.J., Partsinevelos A.A., Themistocleous G.S., Mavrogenis A.F., Korres D.S., Soucacos P.N. Complications after tibia plateau fracture surgery. Injury. 2006;37(6):475-84. doi: 10.1016/j.injury.2005.06.035.
  16. Wasserstein D., Henry P., Paterson J.M., Kreder H.J., Jenkinson R. Risk of total knee arthroplasty after operatively treated tibial plateau fracture: a matchedpopulation-based cohort study. J Bone Joint Surg Am. 2014. 96(2): 144-150. doi: 10.2106/JBJS.L.01691.
  17. Berend K.R., Turnbull N.J., Howell R.E., Lombardi A.V. Jr. The current trends for lateral unicondylar knee arthroplasty. Orthop Clin North Am. 2015;46(2):177-184. doi: 10.1016/j.ocl.2014.10.001.
  18. Стафеев Д.В., Чугаев Д.В., Ласунский С.А., Корнилов Н.Н., Синеокий А.Д. эффективность и безопасность скользящей остеотомии наружного мыщелка бедренной кости при артропластике коленного сустава у пациентов с фиксированной вальгусной деформацией III типа по классификации Krakow. Гений Ортопедии. 2017;23(3):314-322. doi: 10.18019/1028-4427-2017-23-3-314-322.
  19. Fiocchi A., Condello V., Madonna V., Bonomo M., Zorzi C. Medial vs lateral unicompartmental knee arthroplasty: clinical result. Acta Biomed. 2017;88(2S):38-44. doi: 10.23750/abm.v88i2-S.6510.
  20. Johal S., Nakano N., Baxter M., Hujazi I., Pandit H., Khanduja V. Unicompartmental Knee Arthroplasty: The Past, Current Controversies, and Future Perspectives. J Knee Surg. 2018;31(10):992-998. doi: 10.1055/s-0038-1625961.
  21. Синеокий А.Д., Билык С.С., Близнюков В.В., Ефимов Н.Н., Коваленко А.Н., Бадмаев А.О. Кросскультурная адаптация и валидация русскоязычной версии анкеты Oxford Knee Score для пациентов с гонартрозом, ожидающих выполнения первичного эндопротезирования. Современные проблемы науки и образования. 2017;(2). Режим доступа: http://science-education.ru/ru/article/view?id=26312.
  22. Behrend H., Giesinger K., Giesinger J.M., Kuster M.S. The «Forgotten Joint» as the Ultimate Goal in Joint Arthroplasty. Validation of a New Patient-Reported Outcome Measure. J Arthroplasty. 2012;27(3):430-436.e1. doi: 10.1016/j.arth.2011.06.035.
  23. Paley D. Principles of deformity correction. Berlin Heidelberg : Springer-Verlag, 2002. pp. 64-81.
  24. Goodfellow J., O’Connor J., Dodd C. Unicompartmental Arthroplasty with the Oxford Knee. Goodfellow Publishers; 2011. 290 p.
  25. Keblish P.A. The lateral approach for total knee arthroplasty. J Knee Surg. 2003;16(1):62-68.
  26. van der List J., Chawla H., Villa J.C., Pearle A.D. The Role of Patient Characteristics on the Choice of Unicompartmental versus Total Knee Arthroplasty in Patients With Medial Osteoarthritis. J Arthroplasty. 2017;32(3):761-766. doi: 10.1016/j.arth.2016.08.015.
  27. Liebs T.R., Herzberg W. Better quality of life after medial versus lateral unicondylar knee arthroplasty. Clin Orthop Relat Res. 2013;471(8):2629-2640. doi: 10.1007/s11999-013-2966-y.
  28. Parratte S., Pauly V., Aubaniac J.M., Argenson J.N. No long-term difference between fixed and mobile medial unicompartmental arthroplasty. Clin Orthop Relat Res. 2012;470(1):61-68. doi: 10.1007/s11999-011-1961-4.
  29. Manzotti A., Cerveri P., Pullen C., Confalonieri N. A flat all-polyethylene tibial component in medial unicompartmental knee arthroplasty: a long-term study. Knee. 2014;21 Suppl 1:S20-25. doi: 10.1016/S0968-0160(14)50005-1.
  30. Amaro J.T., Arliani G.G., Astur D.C., Debieux P., Kaleka C.C., Cohen M. No difference between fixed- and mobilebearing total knee arthroplasty in activities of daily living and pain: a randomized clinical trial. Knee Surgery, Sport Traumatol Arthrosc. 2017;25(6):1692-1696. doi: 10.1007/s00167-016-4106-1.
  31. Kozinn S.C., Scott R.D. Surgical treatment of unicompartmental degenerative arthritis of the knee. Rheum Dis Clin North Am. 1988;14(3):545-564.
  32. Witjes S., Gouttebarge V., Kuijer P.P., van Geenen R.C., Poolman R.W., Kerkhoffs G.M. Return to Sports and Physical Activity After Total and Unicondylar Knee Arthroplasty: A Systematic Review and Meta-Analysis. Sports Med. 2016;46(2):269-292. doi: 10.1007/s40279-015-0421-9.
  33. Jeschke E., Gehrke T., Günster C., Hassenpflug J., Malzahn J., Niethard F.U. et al. Five-year survival of 20,946 unicondylar knee replacements and patient risk factors for failure: An analysis of German insurance data. J Bone Joint Surg Am. 2016;98(20):1691-1698. doi: 10.2106/JBJS.15.01060.
  34. van der List J.P., Zuiderbaan H.A., Pearle A.D. Why Do Medial Unicompartmental Knee Arthroplasties Fail Today? J Arthroplasty. 2016;31(5):1016-1021. doi: 10.1016/j.arth.2015.11.030.
  35. Ollivier M., Parratte S., Argenson J.N. Results and outcomes of unicompartmental knee arthroplasty. Orthop Clin North Am. 2013;44(3):287-viii. doi: 10.1016/j.ocl.2013.03.004.
  36. Pandit H., Mancuso F., Jenkins C., Jackson W.F.M., Price A.J., Dodd C.A.F. et al. Lateral unicompartmental knee replacement for the treatment of arthritis progression after medial unicompartmental replacement. Knee Surg Sports Traumatol Arthrosc. 2017;25(3):669-674. doi: 10.1007/s00167-016-4075-4.
  37. Murray D.W., Pandit H., Weston-Simons J.S., Jenkins C., Gill H.S., Lombardi A.V. et al. Does body mass index affect the outcome of unicompartmental knee replacement? Knee. 2013;20(6):461-465. doi: 10.1016/j.knee.2012.09.017.
  38. Plate J.F., Augart M.A., Seyler T.M., Bracey D.N., Hoggard A., Akbar M. et al. Obesity has no effect on outcomes following unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2017;25(3):645-651. doi: 10.1007/s00167-015-3597-5.
  39. Vasso M., Corona K., D’Apolito R., Mazzitelli G., Panni A.S. Unicompartmental Knee Arthroplasty: Modes of Failure and Conversion to Total Knee Arthroplasty. Joints. 2017;5(1):44-50. doi: 10.1055/s-0037-1601414.
  40. van der List J.P., Chawla H., Villa J.C., Zuiderbaan H.A., Pearle A.D. Early functional outcome after lateral UKA is sensitive to postoperative lower limb alignment. Knee Surg Sports Traumatol Arthrosc. 2017;25(3):687-693. doi: 10.1007/s00167-015-3877-0.
  41. Ohdera T., Tokunaga J., Kobayashi A. Unicompartmental knee arthroplasty for lateral gonarthrosis: midterm results. J Arthroplasty. 2001;16(2):196-200. doi: 10.1054/arth.2001.2090.
  42. van der List J.P., Chawla H., Villa J.C., Pearle A.D. Different optimal alignment but equivalent functional outcomes in medial and lateral unicompartmental knee arthroplasty. Knee. 2016;23(6):987-995. doi: 10.1016/j.knee.2016.08.008.
  43. Vasso M., Del Regno C., D’Amelio A., Viggiano D., Corona K., Schiavone Panni A. Minor varus alignment provides better results than neutral alignment in medial UKA. Knee. 2015;22(2):117-121. doi: 10.1016/j.knee.2014.12.004.
  44. Cinotti G., Sessa P., Ragusa G., Ripani F.R., Postacchini R., Masciangelo R. et al. Influence of cartilage and menisci on the sagittal slope of the tibial plateaus. Clin Anat. 2013;26(7):883-892. doi: 10.1002/ca.22118.
  45. Lustig S., Scholes C.J., Leo S.P., Coolican M., Parker D.A. Influence of soft tissues on the proximal bony tibial slope measured with two-dimensional MRI. Knee Surg Sports Traumatol Arthrosc. 2013;21(2):372-379. doi: 10.1007/s00167-012-1990-x.
  46. Lee S.C., Hwang S.H., Nam C.H., Ryu S.R., Ahn H.S. The 180° spin of meniscal bearing in unicompartmental knee arthroplasty. J Orthop Surg (Hong Kong). 2017;25(3):2309499017731630. doi: 10.1177/2309499017731630.
  47. Qiu S., Zhang M., Jia T. Total knee arthroplasty for severe valgus knee deformity. Int J Clin Exp Med. 2016;9(5):8725-8730.
  48. Brilhault J., Lautman S., Favard L., Burdin P. Lateral femoral sliding osteotomy in total knee arthroplasty for fixed valgus deformity. Int Surg. 2008;3(1):27-33.
  49. Edmiston T.A., Manista G.C., Courtney P.M., Sporer S.M., Della Valle CJ. Et al. Clinical Outcomes and Survivorship of Lateral Unicompartmental Knee Arthroplasty: Does Surgical Approach Matter? J Arthroplasty. 2018;33(2):362-365. doi: 10.1016/j.arth.2017.09.009.
  50. Sah A.P., Scott R.D. Lateral unicompartmental knee arthroplasty through a medial approach. Surgical technique. J Bone Joint Surg Am. 2008;90 Suppl 2 Pt 2:195-205. doi: 10.2106/JBJS.H.00257.
  51. Fujii T., Matsui y., Noboru M., Inagaki y., Kadoya y., Tanaka y. Meniscal Bearing Dislocation of Unicompartmental Knee Arthroplasty with Faint Symptom. Case Rep Orthop. 2015;2015:217842. doi: 10.1155/2015/217842.
  52. Redish M.H., Fennema P. Good results with minimally invasive unicompartmental knee resurfacing after 10-year follow-up. Eur J Orthop Surg Traumatol. 2018;28(5):959-965. doi: 10.1007/s00590-017-2079-5.
  53. Tabor O.B., Tabor O.B. Unicompartmental arthroplasty: A long-term follow-up study. J Arthroplasty. 1998;13(4): 373-379. doi: 10.1016/s0883-5403(98)90001-8.
  54. van der List J.P., Zuiderbaan H.A., Pearle A.D. Why Do Lateral Unicompartmental Knee Arthroplasties Fail Today? Am J Orthop (Belle Mead NJ). 2016;45(7):432-462.
  55. Johnson M.J., Mahfouz M.R. Cartilage loss patterns within femorotibial contact regions during deep knee bend. J Biomech. 2016;49(9):1794-1801. doi: 10.1016/j.jbiomech.2016.04.011.
  56. Epinette J.A., Brunschweiler B., Mertl P., Mole D., Cazenave A. French Society for Hip and Knee. Unicompartmental knee arthroplasty modes of failure: wear is not the main reason for failure: a multicentre study of 418 failed knees. Orthop Traumatol Surg Res. 2012;98(6 Suppl):S124-130. doi: 10.1016/j.otsr.2012.07.002.
  57. Baker P.N., Petheram T., Avery P.J., Gregg P.J., Deehan D.J. Revision for unexplained pain following unicompartmental and total knee replacement. J Bone Joint Surg Am. 2012;94(17):e126. doi: 10.2106/JBJS.K.00791.
  58. Chawla H., van der List J.P., Christ A.B., Sobrero M.R., Zuiderbaan H.A., Pearle A.D. Annual revision rates of partial versus total knee arthroplasty: A comparative meta-analysis. Knee. 2017;24(2):179-190. doi: 10.1016/j.knee.2016.11.006.
  59. Peersman G., Stuyts B., Vandenlangenbergh T., Cartier P., Fennema P. Fixed- versus mobile-bearing UKA: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2015;23(11):3296-3305. doi: 10.1007/s00167-014-3131-1.
  60. Saragaglia D., Bevand A., Refaie R., Rubens-Duval B., Pailhé R. Results with nine years mean follow up on one hundred and three KAPS® uni knee arthroplasties: eighty six medial and seventeen lateral. Int Orthop. 2018;42(5):1061-1066. doi: 10.1007/s00264-017-3717-6.
  61. Walker T., Gotterbarm T., Bruckner T., Merle C., Streit M.R. Total versus unicompartmental knee replacement for isolated lateral osteoarthritis: a matched-pairs study. Int Orthop. 2014;38(11):22592264. doi: 10.1007/s00264-014-2473-0.
  62. Walker T., Zahn N., Bruckner T., Streit M.R., Mohr G., Aldinger P.R. et al. Mid-term results of lateral unicondylar mobile bearing knee arthroplasty: A multicentre study of 363 cases. Bone Joint J. 2018;100B(1):42-49. doi: 10.1302/0301-620x.100B1.BJJ-2017-0600.R1.
  63. Smith J.R., Robinson J.R., Porteous A.J., Murray J.R., Hassaballa M.A., Artz N. et al. Fixed bearing lateral unicompartmental knee arthroplasty short to midterm survivorship and knee scores for 101 prostheses. Knee. 2014;21(4):843-847. doi: 10.1016/j.knee.2014.04.003.
  64. Argenson J.N., Parratte S., Bertani A., Flecher x., Aubaniac J.M. Long-term results with a lateral unicondylar replacement. Clin Orthop Relat Res. 2008;466(11):26862693. doi: 10.1007/s11999-008-0351-z.
  65. Walker T., Gotterbarm T., Bruckner T., Merle C., Streit M.R. Return to sports, recreational activity and patient-reported outcomes after lateral unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2015;23(11):3281-3287. doi: 10.1007/s00167-014-3111-5.
  66. Matthews D.J., Hossain F.S., Patel S., Haddad F.S. A Cohort Study Predicts Better Functional Outcomes and Equivalent Patient Satisfaction Following UKR Compared with TKR [published correction appears in HSS J. 2013;9(2):212]. HSS J. 2013;9(1):21-24. doi: 10.1007/s11420-012-9326-4.
  67. Weiss N.G., Parvizi J., Trousdale R.T., Bryce R.D., Lewallen D.G. Total knee arthroplasty in patients with a prior fracture of the tibial plateau. J Bone Joint Surg Am. 2003;85(2):218-221. doi: 10.2106/00004623-200302000-00006.

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