Clinical outcome of bi-unicompartmental knee arthroplasty for both medial and lateral femorotibial arthritis: a systematic review—is there proof of concept?

Wada, Keizo; Price, Andrew; Gromov, Kirill; Lustig, Sébastien; Troelsen, Anders

doi:10.1007/s00402-020-03492-6

Cited by 17 publications

(15 citation statements)

References 48 publications

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“…They reported a 100% graft survival with a mean follow-up of 24 months. More recently, Gilat et al [81] evaluated 36 patients younger than 18 years, with a mean follow-up of 4.6 years. They found a failure rate of 5.6% and a re-operation rate of 28.8%.…”

Section: Discussionmentioning

confidence: 99%

Fresh Osteochondral Allograft Transplantation in Osteochondritis Dissecans in the Knee Joint

Sarsisa

Fiore

Coco

et al. 2021

Life

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Osteochondritis dissecans (OCD) is a chronic and painful joint condition that can occur from childhood through to adult life. Microtrauma, vascular insufficiency, or abnormal endochondral ossification are the most common causes of OCD. Reconstructive techniques for OCD of the knee are typically necessary when either non-operative or reparative/regenerative operative treatments fail, or when the OCD is irreversible. To analyze the clinical outcomes and failure rates of fresh osteochondral allograft transplantation (FOCA) used as a reconstructive strategy in OCD patients, an in-depth search was carried out on the PubMed, Scopus, and Web of Science databases concerning the existing evidence related to the use of FOCA for OCD patients in the knee joint. A total of 646 studies were found through the search and 2 studies were added after a cross-referenced examination of the articles within the bibliography. Six studies with a total of 303 OCD lesions treated with FOCA, with a mean follow-up of 6.3 years, were included. Although a limited number of low-level evidence studies on this topic are available in previous research, satisfactory clinical results and survival rates of the reconstruction are reported. However, to better define the real advantages of FOCA in the healing process of OCD lesions, comparative studies with different techniques are needed.

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Section: Discussionmentioning

confidence: 99%

Fresh Osteochondral Allograft Transplantation in Osteochondritis Dissecans in the Knee Joint

Sarsisa

Fiore

Coco

et al. 2021

Life

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“…27 Alongside gait analysis, proprioception metrics are reviewed to compare cruciate-retaining bi-unicompartmental knee arthroplasty (bi-UKA) with a cruciate-sacrificing TKA approach. Wada et al 28 have reviewed the sparse literature on simultaneous bi-UKA, and concluded that there was a need for further studies, such as this one, to determine the efficacy of two UKAs as an alternative to TKA with isolated degeneration in the condyles and an intact ACL.…”

Section: Introductionmentioning

confidence: 99%

Are there functional biomechanical differences in robotic arm-assisted bi-unicompartmental knee arthroplasty compared with conventional total knee arthroplasty? A prospective, randomized controlled trial

Banger

Doonan

Jones

et al. 2022

The Bone & Joint Journal

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Aims The aim of this study was to compare any differences in the primary outcome (biphasic flexion knee moment during gait) of robotic arm-assisted bi-unicompartmental knee arthroplasty (bi-UKA) with conventional mechanically aligned total knee arthroplasty (TKA) at one year post-surgery. Methods A total of 76 patients (34 bi-UKA and 42 TKA patients) were analyzed in a prospective, single-centre, randomized controlled trial. Flat ground shod gait analysis was performed preoperatively and one year postoperatively. Knee flexion moment was calculated from motion capture markers and force plates. The same setup determined proprioception outcomes during a joint position sense test and one-leg standing. Surgery allocation, surgeon, and secondary outcomes were analyzed for prediction of the primary outcome from a binary regression model. Results Both interventions were shown to be effective treatment options, with no significant differences shown between interventions for the primary outcome of this study (18/35 (51.4%) biphasic TKA patients vs 20/31 (64.5%) biphasic bi-UKA patients; p = 0.558). All outcomes were compared to an age-matched, healthy cohort that outperformed both groups, indicating residual deficits exists following surgery. Logistic regression analysis of primary outcome with secondary outcomes indicated that the most significant predictor of postoperative biphasic knee moments was preoperative knee moment profile and trochlear degradation (Outerbridge) (R2 = 0.381; p = 0.002, p = 0.046). A separate regression of alignment against primary outcome indicated significant bi-UKA femoral and tibial axial alignment (R2 = 0.352; p = 0.029), and TKA femoral sagittal alignment (R2 = 0.252; p = 0.016). The bi-UKA group showed a significant increased ability in the proprioceptive joint position test, but no difference was found in more dynamic testing of proprioception. Conclusion Robotic arm-assisted bi-UKA demonstrated equivalence to TKA in achieving a biphasic gait pattern after surgery for osteoarthritis of the knee. Both treatments are successful at improving gait, but both leave the patients with a functional limitation that is not present in healthy age-matched controls. Cite this article: Bone Joint J 2022;103-B(4):433–443.

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“…[1][2][3] One-third of people with knee OA have damage limited to just two compartments of the knee, 4 and as such there has been a renewed interest in combined partial knee arthroplasty (CPKA) to treat knee OA in a limited manner. [5][6][7][8][9][10][11][12][13][14] In particular, bi-unicondylar arthroplasty (Bi-UKA) is of interest for patients with a healthy patellofemoral compartment and functional cruciate ligaments, and either ipsilateral medial and lateral tibiofemoral OA, 4,5,11,12 or a well-functioning unicondylar arthroplasty (UKA) with subsequent degeneration in the other tibiofemoral compartment. 13 Recent evidence suggests that Bi-UKA patients have superior outcomes and biomechanics compared to those with a similar disease pattern but treated with total knee arthroplasty (TKA).…”

Section: Introductionmentioning

confidence: 99%

The risk of tibial eminence avulsion fracture with bi-unicondylar knee arthroplasty

Stoddart

Garner

Tuncer³

et al. 2022

Bone & Joint Research

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Aims The aim of this study was to determine the risk of tibial eminence avulsion intraoperatively for bi-unicondylar knee arthroplasty (Bi-UKA), with consideration of the effect of implant positioning, overstuffing, and sex, compared to the risk for isolated medial unicondylar knee arthroplasty (UKA-M) and bicruciate-retaining total knee arthroplasty (BCR-TKA). Methods Two experimentally validated finite element models of tibia were implanted with UKA-M, Bi-UKA, and BCR-TKA. Intraoperative loads were applied through the condyles, anterior cruciate ligament (ACL), medial collateral ligament (MCL), and lateral collateral ligament (LCL), and the risk of fracture (ROF) was evaluated in the spine as the ratio of the 95th percentile maximum principal elastic strains over the tensile yield strain of proximal tibial bone. Results Peak tensile strains occurred on the anterior portion of the medial sagittal cut in all simulations. Lateral translation of the medial implant in Bi-UKA had the largest increase in ROF of any of the implant positions (43%). Overstuffing the joint by 2 mm had a much larger effect, resulting in a six-fold increase in ROF. Bi-UKA had ~10% increased ROF compared to UKA-M for both the male and female models, although the smaller, less dense female model had a 1.4 times greater ROF compared to the male model. Removal of anterior bone akin to BCR-TKA doubled ROF compared to Bi-UKA. Conclusion Tibial eminence avulsion fracture has a similar risk associated with Bi-UKA to UKA-M. The risk is higher for smaller and less dense tibiae. To minimize risk, it is most important to avoid overstuffing the joint, followed by correctly positioning the medial implant, taking care not to narrow the bone island anteriorly. Cite this article: Bone Joint Res 2022;11(8):575–584.

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Clinical outcome of bi-unicompartmental knee arthroplasty for both medial and lateral femorotibial arthritis: a systematic review—is there proof of concept?

Cited by 17 publications

References 48 publications

Fresh Osteochondral Allograft Transplantation in Osteochondritis Dissecans in the Knee Joint

Fresh Osteochondral Allograft Transplantation in Osteochondritis Dissecans in the Knee Joint

Are there functional biomechanical differences in robotic arm-assisted bi-unicompartmental knee arthroplasty compared with conventional total knee arthroplasty? A prospective, randomized controlled trial

The risk of tibial eminence avulsion fracture with bi-unicondylar knee arthroplasty

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