A Safe Overhang Limit for Unicompartmental Knee Arthroplasties Based on Medial Collateral Ligament Strains

Gudena, Ravindra; Pilambaraei, Mohammad Atarod; Werle, Jason; Shrive, Nigel G.; Frank, Cyril B.

doi:10.1016/j.arth.2012.05.019

Cited by 40 publications

(32 citation statements)

References 15 publications

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“…Die unterschiedlichen Geometrien des medialen vs. lateralen Tibiaplateaus wurden bereits beim tibialen Knochenschnitt diskutiert. Bei medialer UKA ist der mediale Überstand wegen der Gefahr einer schmerzhaften Irritation des medialen Kollateralbandes problematisch [10,14]. Bei medialer und lateraler UKA bestimmen wir die anteroposterior optimale Tibiakomponentengröße und passen den sagittalen Schnitt in Richtung Eminentia intercondylaris soweit möglich an.…”

Section: Präparation Der Tibiakomponenteunclassified

Moderne unikondyläre Kniearthroplastik

Knoch

Munzinger

2014

Orthopäde

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Zusammenfassung Hintergrund Die unikondyläre Kniearthroplastik (UKA) ist bei fortgeschrittener medialer oder lateraler Gonarthrose eine etablierte Therapieoption. Ziel der Arbeit Die Eckpfeiler einer erfolgreichen UKA – sorgfältige Patientenselektion, präoperative Planung und präzise Operationstechnik – werden in dieser Übersichtsarbeit behandelt. Stellenwert Im Unterschied zur Knietotalarthroplastik erlaubt die UKA den Erhalt des kontralateralen und patellofemoralen Kompartiments sowie der Kreuzbänder und ist oft mit einer rascheren postoperativen Erholung, verbesserten Kniekinematik und Kniefunktion verbunden. Allerdings ist die UKA technisch sehr anspruchsvoll. Hohe Revisionsraten wurden v. a. bei breiter Anwendung gemäß nationaler Prothesenregister berichtet. Schlussfolgerung Der Erfolg der UKA hängt von einer sorgfältigen Patientenauswahl, detaillierten präoperativen Planung und Operationstechnik ab. Eine Erweiterung der klassischen Indikationskriterien für UKA halten wir für gerechtfertigt. Drei Typen der mechanischen Varus-Valgus-Deformität vor medialer oder lateraler UKA können unterschieden werden: Typ 1 (isolierte intraartikuläre Deformität), Typ 2 (übermäßige Deformität durch extraartikuläre Varusdeformität bei medialer UKA oder Valgusdeformität bei lateraler UKA), Typ 3 (reduzierte Deformität durch extraartikuläre Valgusdeformität bei medialer UKA oder Varusdeformität bei lateraler UKA). Diese Deformitäten sollten bei der Operationstechnik berücksichtigt werden.

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Section: Präparation Der Tibiakomponenteunclassified

Moderne unikondyläre Kniearthroplastik

Knoch

Munzinger

2014

Orthopäde

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“…UKA remains however a demanding surgical procedure, and optimal implant positioning is essential to obtain satisfactory outcomes [11,12]. The fit of the tibial component has been shown to have an important impact on the success of UKA procedures [13]: implant overhang can lead to soft tissue impingement and pain (particularly with the medial collateral ligament [MCL]) [14,15]. Conversely, tibial tray subsidence and early loosening are increased when cortical support is insufficient and tibial surface undercovered [16,17].…”

Section: Introductionmentioning

confidence: 99%

Better Implant Positioning and Clinical Outcomes With a Morphometric Unicompartmental Knee Arthroplasty. Results of a Retrospective, Matched-Controlled Study

Escudier

Jacquet

Flécher

et al. 2019

The Journal of Arthroplasty

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Keywords:unicompartmental knee arthroplasty morphometric tibial tray implant positioning medial overhang tibial bone coverage a b s t r a c t Background: During medial unicompartmental knee arthroplasty (UKA), tibial tray implantation requires compromise between bone coverage and rotational position. It was hypothesized that morphometric tibial tray (MTT) would improve implant positioning and subsequently clinical outcomes as compared to symmetric tibial tray (STT). Methods: A total of 106 patients who underwent medial UKA in our department between January 2017 and March 2018 were included matched on gender and age (53 in each group). Inclusion criteria were symptomatic medial femorotibial osteoarthritis, functional anterior cruciate ligament, primary arthritis, or osteonecrosis. Rotation of the tibial implant, tibial bone coverage, medial and posterior overhang were assessed with a postoperative computed tomography scan. The Knee Society Score (KSS), the Knee injury and Osteoarthritis Outcome Score Short Form (KOOS SF), and the quality of life score EuroQoL 5-Dimensions 3-Levels (EQ5D3L) were assessed at a minimum of 1-year follow-up. Results: Implants of the STT group exhibited more external rotation (6.3 ± 4.02 vs 4.6 ± 3.59 ; P ¼ .04), and medial and posterior overhang >3 mm (35% vs 0% and 22% vs 0%; P < .0001) but no difference for tibial bone coverage (97.3% ± 11.35% vs 94.7% ± 10.89%; P ¼ .23). Global KSS (188.6 ± 6.6 vs 175.2 ± 31.7; P < .01), KOOS SF (16.9 ± 6.1 vs 22.5 ± 11.8; P < .003), and EQ5D3L (1 ± 0.1 vs 0.9 ± 0.2; P < .001) were higher in MTT group. According to the multivariate analysis, MTT had a positive independent effect on the KSS, KOOS SF, and EQ5D3L. Conclusion: The use of an MTT in medial UKA allowed better implant positioning when decreasing the rate of overhang; superior short-term clinical outcomes were found as compared to STT.

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“…Chau et al6) reported that surgeons must avoid medial tibial overhang of 3 mm or more, as this severely compromised the outcome and might cause irritation of soft tissue and pain. In an in vitro study by Gudena et al17), they demonstrated that medial collateral ligament load almost doubled from overhang of 2 to 4 mm. When compared with the results of a study by Chau et al6) which demonstrated a 9% prevalence of medial overhang of the tibial component, the prevalence of medial overhang of the tibial component in our study population was not that high (2.7% in the Oxford UKA group and 5.7% in the M-G II UKA group).…”

Section: Discussionmentioning

confidence: 97%

Implant Overhang after Unicompartmental Knee Arthroplasty: Oxford Prosthesis versus Miller-Galante II Prosthesis

Kim

Park

Bae

et al. 2014

Knee Surg Relat Res

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PurposeThe purpose of the present study is to compare the prevalence of implant overhang between the Oxford and the Miller-Galante II (M-G II) unicompartmental knee arthroplasty (UKA) prostheses and determine whether overhang is associated with postoperative clinical results.Materials and MethodsWe retrospectively reviewed one hundred and seven UKAs which consisted of 37 Oxford UKAs and 70 M-G II. Overhang was considered present if ≥3 mm overhang was observed in any zone. The range of motion, the Knee Society scores and the Western Ontario and McMaster scores were compared after a mean follow-up duration of 48 months.ResultsThirty three of 107 knees (30.8%) had overhang in at least one zone of the femoral or tibial component. In the tibial side, there were no significant differences between the groups in component overhang in each zone. In the femoral side, the Oxford UKA group showed a significantly higher prevalence of the posterior overhang of the femoral component (19/37, 51.4%) than did the M-G II UKA group (3/70, 4.3%; p<0.001). However, no significant differences in clinical results were observed between the two groups. There were also no significant differences in clinical results between the overhang and the non-overhang groups.ConclusionsPosterior overhang of the femoral component was highly prevalent in Oxford UKA patients. However, posterior overhang of the femoral component had no significant relationship with postoperative clinical results in both Oxford and M-G II UKAs at a mean of 48 months follow-up.

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A Safe Overhang Limit for Unicompartmental Knee Arthroplasties Based on Medial Collateral Ligament Strains

Cited by 40 publications

References 15 publications

Moderne unikondyläre Kniearthroplastik

Moderne unikondyläre Kniearthroplastik

Better Implant Positioning and Clinical Outcomes With a Morphometric Unicompartmental Knee Arthroplasty. Results of a Retrospective, Matched-Controlled Study

Implant Overhang after Unicompartmental Knee Arthroplasty: Oxford Prosthesis versus Miller-Galante II Prosthesis

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