Cementless unicompartmental knee arthroplasty results in higher pain levels compared to the cemented technique: a prospective register study

Abstract

Purpose In recent years, the preferred fixation method for unicompartmental knee arthroplasty (UKA) has changed from cemented to cementless. The aim of this study was to compare patient-reported outcome measures (PROMs) from the cemented versus cementless techniques two- and twelve-months post-operation. Methods From 2015 to 2019, 187 cemented and 261 cementless UKAs were included based on an institutional registry. The Oxford Unicompartmental Knee System™ (Zimmer Biomet, Bridgend, United Kingdom) was used for all patients. Three experienced surgeons performed all procedures. Data were collected pre- and peroperatively, and at two- and twelve-months postoperatively. PROMs included pain (evaluated on a numeric rating scale [NRS] during activity and at rest), and knee function (evaluated with the disease-specific short form of the Knee injury and Osteoarthritis Outcome Score [KOOS-PS]). Patients also rated postoperative joint function (better, unchanged, uncertain or worse) and were asked, “based on your experience to date, would you go through the surgery again?”. Duration of surgery was noted and revisions during the first post-operative year were evaluated. Results The cemented group reported significantly lower activity-related pain at both two- and twelve-month follow-up. This was also the case for pain at rest at twelve-month follow-up, and KOOS-PS at two-month follow-up. Duration of surgery (adjusted for surgeon differences) was eight minutes less on average with the cementless technique. Eleven prosthetic joint infections (PJIs) were found following the cementless fixation technique compared to three using the cemented implant. Conclusion UKA cases with cemented implants had lower pain scores during activity two and twelve months after surgery compared with those who had cementless implants. Differences in favor of the cemented group were also found for pain at rest one year after surgery and for KOOS-PS two months after. Surgery was significantly shorter in duration in the cementless group, but a relatively high number of PJIs were found in that same group. Level of evidence Level II.

The Effects of Periarticular Injection Cocktail in Postoperative Analgesia after Bilateral Unicompartmental Knee Arthroplasty

“…However, pain after knee replacement has always been an important factor of restricting knee replacement effect [ 17 ], lived around joints in knee surgery is a cocktail drugs can effectively alleviate postoperative pain, and is compared with femoral nerve block and vertebral canal or intravenous patient controlled analgesia, has little influence on quadriceps, benefit patients early postoperative activities, avoid wrestling and reduce opioid nausea, lethargy and other adverse reactions [ 18 , 19 ]. When choosing a drug cocktail, different joint surgeons take different drug cocktail formulations for different reasons.…”

Safety and Efficacy of Unicondylar Knee Prosthesis Treatment for Unicompartmental Osteoarthritis of the Knee Joint

“…Exposing only the diseased compartment without cutting the quadriceps muscle also avoids damage to the knee extension function, facilitates postoperative rehabilitation, and reduces adverse effects [19]. It allows accurate prosthesis placement, avoiding collision of ligaments and prosthesis; it allows complete removal of excess bone cement, reducing complications [20]. The unicondylar knee prosthesis replaces only the medial compartment of the knee joint without damaging the lateral compartment and without affecting the normal knee struc-ture.…”

Comparison of the early postoperative outcomes of cementless and cemented medial unicompartmental knee arthroplasty

“…In a prospective cohort study, Gifstad et al 11 found significantly higher activity- and rest-related pain scores in the first year after cementless medial UKA compared to cemented cases. Using a large registry cohort, we were unable to replicate these results.…”