Progress of lateral unicompartmental knee arthroplasty for lateral compartment osteoarthritis of the knee / 国际外科学杂志

With the development of the knee-preservation concept and surgical techniques, lateral unicompartmental knee arthroplasty (UKA) has become an effective method for the lateral compartment osteoarthritis of the knee.The incidence of knee osteoarthritis is low in the lateral compartment, which is different from the medial compartment in anatomical and kinematic characteristics. These two factors increase the challenge of lateral UKA, so the clinical efficacy of lateral UKA has been controversial. With the improvement and renewal of treatment concepts, surgical techniques and prosthesis design, the clinical effect of lateral UKA and the survival rate of the prosthesis have been continuously optimized. This article aims to summarize the characteristics of lateral compartment knee osteoarthritis, clinical efficacy, prosthesis selection, reasons for revision, future application and prospects, combined with relevant literature in recent years, to review the current progress of lateral UKA.

META analysis of mobile bearing and fixed bearing unicondyle replacement for medial knee osteoarthritis / 中国骨伤

OBJECTIVE@#To evaluate of the clinical effects of mobile-bearing(MB) and fixed-bearing(FB) unicompartmental knee arthroplasty(UKA) in the treatment of knee osteoarthritis by Meta-analysis.@*METHODS@#The literature on FB UKA and MB UKA in the treatment of knee osteoarthritis in PubMed, CNKI, Wanfang, Cochrane and EMBASE database were searched by computer from January 2000 to April 2020. According to the inclusion and exclusion criteria, two authors were selected independently and the selected literature was evaluated for quality.After literature data were extracted, Review Manager 5.3 software was used to analyze knee function score, postoperative activity, revision rate, polyethylene wear rate, pad dislocation, aseptic loosening, postoperative pain, knee arthritis progression, mechanical shaft alignment of lower limbs, and imaging clarity line respectively.@*RESULTS@#A total of 13 literatures were included in this meta-analysis, including 2 randomized controlled studies and 11 cohort studies. A total of 1 871 patients were included, including 913 in FB UKA group and 958 in MB UKA group. Meta analysis results showed that:postoperative knee joint function score[MD=-0.84, 95%CI(-1.46, -0.21), P=0.008] and postoperative knee joint range of motion [MD=-1.51, 95%CI(-2.84, -0.18), P=0.03] in FB UKA group were better than those in MB UKA group. Compared with FB UKA group, MB UKA group had a higher lower limb mechanical axis alignment rate[OR=2.08, 95%CI(1.27, 3.39), P=0.003], and the wear rate of polyethylene [OR=0.11, 95%CI(0.01, 0.91), P=0.04] was lower. There were no differences between two groups in the renovation rate [OR=1.16, 95%CI(0.75, 1.80), P=0.50), liner dislocation rate[OR=3.78, 95%CI(0.93, 15.29), P=0.06], aseptic loosening [OR=2.11, 95%CI(0.81, 5.51), P=0.13], postoperative pain[OR=1.13, 95%CI(0.37, 3.43), P=0.83], osteoarthritis progression[OR=1.28, 95%CI(0.67, 2.47), P=0.46)and imaging radiolucent line[OR=1.62, 95%CI(0.09, 30.22), P=0.75].@*CONCLUSION@#FB UKA has a higher postoperative functional score and range of motion.MB UKA has more advantages in the correction of lower limb mechanical axis, and the wear rate of polyethylene is also lower. There was no significant difference between the two groups in revision rate, dislocation of the liner, aseptic loosening, postoperative pain, progression of osteoarthritis, and postoperative translucency.

A mid-term clinical follow-up of unicompartmental knee arthroplasty with fixed bearing / 中国组织工程研究

BACKGROUND: Most of the domestic and foreign literatures reported the mid-term and long-term effects of the unicompartmental knee arthroplasty of the mobile bearing, but few reported the mid-term and long-term clinical effects of the unicompartmental knee arthroplasty of the fixed bearing. Simultaneously, most of the studies did not analyze the knee function recovery and the lower limb force line change at different time points after the fixed bearing unicompartmental knee arthroplasty, and also ignored the follow-up of the patients’ self-feeling after the unicompartmental knee arthroplasty. OBJECTIVE: To explore the mid-term clinical effect of fixed bearing unicompartmental knee arthroplasty in the treatment of medial compartment osteoarthritis of knee joint and to observe the change of force line of lower limbs. METHODS: From January 2014 to January 2015, a retrospective analysis was made of the data of 66 patients diagnosed as osteoarthritis of the medial compartment of the knee in the Department of Arthritis, Foshan Hospital of Traditional Chinese Medicine. According to the inclusion and exclusion criteria, 66 patients were included, including 18 males and 48 females, aged (62.36±16.33) years. The American Knee Society knee score and the hospital for special surgery knee score were used to assess the knee function before and 1, 3 and 5 years after the operation. Visual analogue scale score was utilized to evaluate the severity of knee. Forgotten joint score was used to assess the subjective feeling of prosthesis after unicompartmental knee arthroplasty. Hip-knee-ankle angle and tibiofemoral angle were measured using X-ray films before treatment and at follow-up to evaluate the force line of weight-bearing lower limbs. RESULTS AND CONCLUSION: (1) The postoperative follow-up time was 5-6 years, averagely 5.5 years. The incision healed in the first stage. There was no early complication such as joint infection or lower extremity deep vein thrombosis, and there was no prosthesis loosening, dislocation or other diseases of the contralateral compartment and patellofemoral joint. (2) The American Knee Society knee score clinical score, American Knee Society knee score function score, hospital for special surgery knee score, knee motion range and visual analogue scale score were lower at 1, 3 and 5 years after operation than those before treatment (P 0.05). (3) Forgotten joint score was higher at 3 and 5 years after treatment than that at 1 year after treatment (P 0.05). (4) Hip-knee-ankle angle and tibiofemoral angle were significantly improved after treatment in all patients compared with those before treatment (P 0.05). (5) The results show that the mid-term clinical effect of unicompartmental knee arthroplasty with fixed bearing is satisfactory, and the degree of self-prosthesis is high. After treatment, the force line of lower limbs was improved, and there was no significant change in the 5-year follow-up.

Mid-Term Results of Fixed Bearing Unicompartmental Knee Arthroplasty: Minimum 5-Year Follow-Up / 대한정형외과학회잡지

PURPOSE: To evaluate the clinical and radiological outcomes, and the complications of unicompartmental knee arthroplasty (UKA) using a fixed bearing prosthesis after 5-year follow-up. MATERIALS AND METHODS: Twenty-six knees (25 patients) that underwent fixed bearing UKA between May 2003 and August 2011 were included. The subjects were 3 males (3 knees) and 22 females (23 knees), and the average age was 63.5 years. The preoperative diagnosis was osteoarthritis (23 knees) and osteonecrosis (3 knees). The mean follow-up duration was 67 months (from 60 to 149 months). The clinical evaluation included pre- and postoperative American knee society knee and function score, and range of motion. The radiology evaluation included standing antero-posterior, lateral view, and fluoroscopic film to analyze the postoperative alignment and osteolysis. RESULTS: The mean American Knee Society knee score and function score were improved from 42.0 and 57.5 to 87.9 and 85.0, respectively (p < 0.001). The mean preoperative and postoperative range of motion was 132.9° and 132.5°, respectively. The mean femorotibial angle were varus 0.5° preoperatively and valgus 2.2° postoperatively. A radiolucent line was observed in 2 knees; one knee had a stable implant, while in the other knee, patellofemoral arthritis was identified during UKA. Diffuse pain of the knee joint with tenderness of the medial joint line was identified at the follow-up, so conversion to total knee arthroplasty was recommended. No other complications, such as osteolysis, infections, postoperative stiffness, and dislocation, were encountered. CONCLUSION: The midterm results of fixed bearing UKA were clinically and radiologically satisfactory.

MOBILE- VS. FIXED-BEARING TOTAL KNEE ARTHROPLASTY / Мэс засал

Introduction: The theory that usingmobile bearing (MB) design for total kneereplacementsurgeries can reduce the riskof tibial component loosening compared tofixed-bearing (FB) designs is still unclear.Arthroplastic surgeries developed rapidlywithin recent 10 years, but there is no similarstudy performed yet. This randomized studyinvestigated the impact of prosthesis design toloosening of components at 2 years for totalknee replacement surgeries.Materials and Methods: 479 patientswho underwent total knee arthroplastyin FirstCentral Hospital of Mongolia were allocated toeither FB or MB tibialarticulation.We comparedour results to similar studies which performedabroad due to there is no such a studyperformed before in Mongolia.Results: There is no significant differenceby age, sex, weight, height, body mass index,operation side (right or left) in both groups.Pre- and postoperative range of motionwasalmostsame for MB and FB groups.Butloosening complication was higher for the FBgroup (1.16%) than MB group (0%).Conclusion: Using MB design for total kneearthroplasty has less loosening complicationthan using FB design in Mongolians. Bonemineral density (dual energy absorptiometry)and radiostereometric analysis are necessaryfor widening studies in field of total kneereplacement surgeries in the future.

Comparison of Mobile-Bearing and Fixed-Bearing Designs in High Flexion Total Knee Arthroplasty: Using a Navigation System

PURPOSE: We compared and analyzed the short term results of high flexion total knee arthroplasty (TKA) with mobile-bearing and fixed bearing designs. MATERIALS AND METHODS: We studied 32 patients that had undergone TKA with LPS-Flex Mobile and 34 patients with LPS-Flex Fixed using an electromagnetic navigation system between January 2010 and June 2010, and were followed up for at least 1 year. RESULTS: Knee Society Functional Score (KSFS) and Knee Society Knee Score (KSKS) of the mobile-bearing group were 94.5 and 93.8 points, respectively, and were 48.2 and 45.3 points preoperatively, whereas those of the fixed-bearing group were 95.1 and 94.2 points, respectively, and were 49.5 and 46.9 points preoperatively. Postoperative mechanical axis deviation and implant position of the femoral and tibial component both on the coronal and sigittal planes showed no significant differences between the two groups. Range of motion (ROM) and maximal flexion angle (MFA) of the knee joint also showed no significant differences between the two groups. The possibility of crossed-legged sitting and kneeling position also showed no significant differences between the two groups. CONCLUSIONS: Clinical and radiologic parameters, ROM and MFA of knee joints showed no significant differences in both the groups, but long term follow-up results may be necessary, including survival rate.

Bilateral Total Knee Arthroplasty using the Fixed Bearing Platform and the Rotating Platform in the Same Patient

PURPOSE: We wanted to evaluate the clinical and radiological results after total knee arthoplasty using the Press Fit Condylar (PFC) Sigma fixed bearing platform knee and the rotating platform knee in the same patient. MATERIALS AND METHODS: We enrolled 44 patients who had undergone bilateral total knee arthroplasties due to osteoarthritis of both knees from November 2001 to December 2004, using the fixed bearing platform and the rotating platform, respectively. The mean age of the study group was 71.5 years (range: 65~85 years). The mean follow up period was 74.3 months (range: 62~86 months). The clinical results were evaluated according to the knee score, the functional score, the presence of flexion contracture, the range of motion and the complications, and the visual analog scale system was used for the patients' satisfaction. The radiological results using the American Knee Society criteria and the tibiofemoral angle were also evaluated. RESULTS: The average knee score improved from 36.5 to 87.3 in the fixed bearing group and from 38.8 to 87.9 in the rotating platform group, respectively. The average functional score improved from 28.4 to 83.5 in the fixed bearing group and from 32.6 to 85.8 in the rotating platform group, respectively. The average range of knee motion improved from 85.5degrees to 115.5degrees in the fixed bearing group and from 86.6degrees to 116.8degrees in the rotating platform group. The average tibiofemoral angle improved from varus 8.2degrees to valgus 5.5degrees in the fixed bearing group and from varus 7.1degrees to valgus 5.3degrees in the rotating platform group. We did not observe any clinically significant osteolysis or wear. However, there were 3 cases of instability out of the 13 cases in rotating platform group, and this was accompanied by varus deformities of over 15 degree and 6 cases of friction sound during walking. CONCLUSION: We could find no clinical and radiological differences between the fixed bearing platform and the rotating platform in this study. However, we should regard the fixed bearing prosthesis as a good option for the patients with severe varus deformities, with considering performing bulky soft tissue release for obtaining a balanced gap, for preventing spin-out and to correct deformity.

Comparison of the Mobile-bearing and Fixed-bearing Designs for High Flexion Total Knee Arthroplasty

PURPOSE: We compared and analyzed the follow-up results of high flexion total knee arthroplasty (TKA) with using the mobile-bearing and fixed-bearing designs. MATERIALS AND METHODS: We studied 130 patients who had undergone high-flexion TKA from December 2003 to December 2007 and who were followed up for at least 2 years. Of all the 130 patients, 65 patients had undergone TKA using a mobile-bearing design, and the other 65 patients had undergone TKA using the fixed-bearing design. RESULTS: The post-operative Knee Society Knee Score (KSKS) and Knee Society Functional Score (KSFS) of the mobile-bearing group were 95.6 and 96.1 points, which were 53.2 and 49.7 points, respectively, preoperatively, and the post-operative KSKS and KSFS of the fixed-bearing group were 94.5 and 95.1 points, which were 54.1 and 50.9 points, respectively, preoperatively. The range of motion (ROM) and maximal flexion angle (MFA) of the knee joints of the mobile-bearing group were 129.1degrees and 131.4degrees, which were 122.3degrees and 125.8degrees, respectively, preoperatively, and those of the fixed-bearing group were 128.3degrees and 129.3degrees, which were 122.2degrees and 123.9degrees, respectively, preoperatively. There were no significant differences between the two groups. Crossed-legged sitting and attaining a kneeling position also showed no significant differences between the two groups, but the mobile-bearing group could easily take a crossed-legged sitting position. CONCLUSION: The clinical parameters and the ROM and MFA of the knee joint showed no significant differences between both groups, but the mobile-bearing group felt more comfortable in the crossed-legged sitting position.

Short-Term Outcomes of Miller Galante(R) Fixed-Bearing Unicondylar Knee Arthroplasty: A Comparative Study in Outcomes according to Postoperative Correction Angle / 대한정형외과학회잡지

PURPOSE: To evaluate short-term clinical and radiographical results of fixed bearing unicondylar knee arthroplasty (UKA) comparing results between over-corrected group and under-corrected group. MATERIALS AND METHODS: Clinical and radiographical outcomes of 47 Miller-Galante(R) UKAs with a minimum of 4-year follow-up were evaluated. We also compared both clinical and radiographical results between over and under corrected groups, which were divided by 2degrees varus of mechanical axis postoperatively. RESULTS: HSS and WOMAC scores improved from 75.4 and 57.7 preoperatively to respectively, 95.2 and 12.1 at the last follow up. Radiographically, the mechanical axis changed from 7.2degrees varus preoperatively to 2.8degrees varus at the last follow-up. A partial radiolucent line on the medial side of the tibia was observed in 23% of the 47 cases. Degenerative changes in the lateral compartment and the patellofemoral joint were observed, respectively, in 23% and 26%. There were no significant differences between the two groups in clinical and radiographical results (p>0.05). In the undercorrected group, three cases converted to total knee arthroplasty because of medial tibial collapse. CONCLUSION: Miller-Galante(R) UKA showed good outcomes in short-term follow-up with the exception of three failures. There were no significant differences between more than 2degrees varus corrected and under 2degrees varus corrected groups in clinical and radiographical results. However, all 3 conversions to total knee arthroplasties occurred in the undercorrected group.

Comparision between Mobile Bearing and Fixed Bearing T.K.A. in the Same Patient / 대한정형외과학회잡지

PURPOSE: To evaluate the radiological and clinical results including the patient's satisfaction after total knee arthroplasty (TKA) using two differently designed system for both knees in the same patient. MATERIALS AND METHODS: From January 2002 to January 2003, thirty-two bilateral TKAs were prospectively performed using two differently designed systems. One side TKA was performed using a mobile bearing (PFC RP, Dupey) system, and the other side was performed using a fixed bearing system (PFC, Dupey). All 32 patients were followed up for an average of 51.4 months. The mean age of the study group was 67 years (range 54-75). The clinical results were evaluated from the Knee Score, WOMAC score for the patient's satisfaction and range of motion. Radiological analysis including the tibiofemoral angle was also carried out. An independent T-test was used for statistical analysis. RESULTS: The preoperative average knee score improved to 87.3 from 42.5 in the mobile bearing group and to 86 from 39 in the fixed bearing group respectively. The preoperative average WOMAC score decreased to 11.2 from 84.9 in the mobile bearing group and to 16 from 85.5 in the fixed bearing group. The average preoperative range of knee motion improved to 114.5degrees from 104.5degrees in the mobile bearing group and to 113.8degrees from 104.7degrees in the fixed bearing group. The average preoperative tibiofemoral angle improved to 5.3degrees valgus form 4.5degrees varus in the mobile bearing group and to 6degrees valgus from 3.8degrees varus in the fixed bearing group. The only result statistically significant was the WOMAC score (p<0.05). CONCLUSION: The two differently designed TKA system produce similar outcomes except for the subjective satisfaction in the mid-term clinical and radiological evaluation.

Dislocation of Tibial Insert after Fixed Bearing TKA using Minimal Invasive Surgery: A Case Report

Posterior instability after mobile bearing total knee replacement may be caused by gap imbalance, component malpo- sition, and delayed rupture of posterior cruciate ligament, but could not be easily considered other cause except component breakage in fixed bearing posterior cruciate substituted total knee replacement. The dislocation of tibial polyethylene insert was reported after mobile bearing total knee replacement but rare after fixed bearing total knee replacement. We report a case of dislocation of tibial polyethylene insert that have been found at a patient who had continuing posterior instability after fixed bearing posterior cruciate ligament substituted total knee replacement with a review of article.

A Comparison of Mobile-bearing and Fixed-bearing Total Knee Arthroplasties in Osteoarthritic Patients

PURPOSE: To compare the early clinical and radiographic results including patient's satisfaction after total knee arth- roplasty(TKA) using a mobile bearing knee prosthesis with fixed-bearing device. MATERIALS AND METHODS: From February 2002 to March 2004, author performed 30 posterior cruciate-retaining mobile bearing TKA and 39 posterior cruciate-retaining fixed bearing TKA. Clinical results were evaluated with knee score, patient's satisfaction by WOMAC score and range of motion. Radiographic analysis including tibio-femoral angle was also done. RESULTS: 1) The average knee score improved from 41.9 to 88.6 in mobile bearing group and from 44.3 to 87.6 in fixed bearing group respectively. The improvement of functional score were similar that 49.7 in mobile bearing group, 50.2 in fixed bearing group. 2) The average WOMAC score improved from 85.2 to 12.5 in mobile bearing group and from 85.3 to 13.9 in fixed bearing group. 3) The average range of motion of knee improved from 106.2 to 120.5 in mobile bearing group and from 105.2 to 118.8 in fixed bearing group. 4) The average tibio-femoral angle improved from 5.0 varus to 5.7 valgus in mobile bearing group and from 5.6 varus to 5.7 valgus in fixed bearing group. 5) Two of mobile and one of fixed bearing group complained persistent knee pain and two of mobile and one of fixed bearing group complained giving way sensation. CONCLUSION: This study shows that no significant difference in ROM, function, subjective evaluation and radiologic analysis for patients between two groups after minimum two-year follow-up.

Comparison of the clinical results of fixed-bearing and mobile-bearing total knee arthroplasty / 中国矫形外科杂志

0.05) at preoperatively and postoperatively the total knee score,preoperatively and postoperatively pain score,preoperatively and postoperatively patient function score,and preoperatively and postoperatively Patellar score.The postoperative maximum flexion of the fixed-bearing group and the mobile-bearing group was 108??9.3? and 99.5??10.1? respectively.There was significant difference between the 2 groups for the postoperative maximum flexion (P0.05) at the femoral valgus angle,the tibial angle,the tibial slope angle,and preoperatively and postoperatively the patellar height (Install-Salvati ratio).[Conclusion]The short-term results of the fixed-bearing posterior stabilized prosthesis and the mobile-bearing prosthesis TKA were successful.There was no significance difference between the two groups for the total knee score,function score,pain score,patellar score and radiographic results.The postoperative maximum flexion in fixed-bearing group was higher than that in mobile-bearing group.

Condylar Lift Off in Fixed and Mobile Bearing Total Knee Arthroplasty

PURPOSE: To compare the performance of a total knee arthroplasty with either a PFC Sigma fixed bearing or a rotating platform in the same patient. MATERIALS AND METHODS: 48 cases (24 patients) that received a PFC Sigma fixed bearing and a rotating platform in both knees, one in each knee. The knee score, functional score, activity level, radiologic analyses through fluoroscope , varus/valgus stress, and subjective satisfaction evaluation were performed at the last follow up in the same patient. RESULTS: There were no significant differences in the knee score, functional score, activity level, radiological findings through fluoroscope, and subjective satisfaction. In the varus/valgus stress views, 3 cases of lateral femoral condylar lift-off were observed in the fixed bearing type and 6 cases of lateral femoral condylar lift-off were observed in the rotating platform type. CONCLUSION: In cases of total knee arthroplasty with PFC Sigma fixed bearing and with rotating platform performed in the same patient, there were no significant differences in the clinical, radiological and subjective satisfaction. However, it is considered that the fixed bearing is more stable in terms of medial and lateral femoral condylar lift-off with varus and valgus stress than rotating platform. Therefore long term follow-up would be necessary.

Moderate to Severe Varus Deformity in Total Knee Arthroplasty: PFC Sigma Fixed Bearing Versus Rotating Platform / 대한정형외과학회잡지

PURPOSE: To compare the performance of a fixed bearing with a PFC Sigma with that of a rotating platform in a total knee arthroplasty performed on patients with a moderate to severe varus deformity. MATERIALS AND METHODS: Among the patients who had received a total knee arthroplasty with either a PFC sigma fixed bearing or a rotating platform between October 1998 to June 2002, 77 cases (53 patients) with a > 15degrees varus deformity were examined. The surgery time and the clinical ratings and the radiographic images for each patient were investigated. RESULTS: There were no significant differences in the knee score, functional score, activity level, or radiological findings. There were seven cases where friction sounds were produced from the insertions in the rotating platform whilst walking and there were three cases of lateral instability. CONCLUSION: The PFC sigma fixed bearing was more effective for stabilizing the knees with a moderate to severe varus deformity because the rotating platform had a friction sound from the insertions while walking and lateral instability.