Combination of a High Residual Varus and Joint-Line Lowering Strongly Increases the Risk of Early Implant Failure in Medial Unicompartmental Knee Arthroplasty

Foissey, Constant; Batailler, Cécile; Vahabi, Arman; Fontalis, Andreas; Servien, Elvire; Lustig, Sébastien

doi:10.1016/j.arth.2023.05.055

Cited by 12 publications

(2 citation statements)

References 42 publications

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“…Slaven et al reported that when 61 revision cases for loosening after medial fixed-bearing UKAs were compared with 61 matched clinical success UKAs, the loosening group showed the mean HKA angle was 6.1° ± 3.1° of varus while the matched success group showed the mean HKA angle was 4.0° ± 2.7° of varus ( P < 0.001) [ 35 ]. Also, Foissey et al described patients with joint line lowering and postoperative varus malalignment were at high risk of tibial implant failure in 366 UKAs with a mean follow-up period of 61.3 months [ 36 ]. Given these, in medial fixed-bearing UKA with the use of the spacer block technique referring to the surface of the proximal tibial cut, it may be necessary to increase or decrease the amount of tibial osteotomy depending on the preoperative aHKA and consider the thickness of the insert used to maintain proper postoperative alignment.…”

Section: Discussionmentioning

confidence: 99%

Predicting postoperative coronal alignment after fixed-bearing unicompartmental knee arthroplasty using a new morphological assessment method: the arithmetic hip-knee-ankle angle

Nakano,

Tsubosaka,

Kamenaga

et al. 2023

International Orthopaedics (SICOT)

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Purpose Only a few reports have been published so far on factors that predict postoperative coronal alignment after unicompartmental knee arthroplasty (UKA). The purpose of this study is to clarify the relationship between the arithmetic hip-knee-ankle angle (aHKA) and postoperative coronal alignment after medial fixed-bearing UKA. Methods One hundred and one consecutive patients (125 knees) who underwent medial fixed-bearing UKA were assessed. Pre- and postoperative coronal HKA angles, lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), and the thickness of the tibial and femoral bone cut were measured. aHKA was calculated as 180° − LDFA + MPTA. Correlations between postoperative HKA angle and aHKA, LDFA, and MPTA were investigated by single regression analysis. After the patients were divided into three groups according to the postoperative HKA angle, i.e., HKA angle > 180°, 175° < HKA angle ≤ 180°, and HKA angle ≤ 175°, aHKA, LDFA, MPTA, preoperative HKA angle, and the thickness of the distal femoral as well as tibial bone cut were compared among the three groups. Results aHKA and MPTA were positively correlated with postoperative HKA angle, while no correlation was found between postoperative HKA angle and LDFA. Among the three groups classified by postoperative HKA angle, significant differences were found in aHKA, MPTA, and preoperative HKA angle, while no significant difference was found in LDFA and the amount of distal femoral and tibial osteotomies. Conclusions aHKA was correlated with postoperative HKA angle after medial fixed-bearing UKA, which was probably due to the influence of MPTA.

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Section: Discussionmentioning

confidence: 99%

Predicting postoperative coronal alignment after fixed-bearing unicompartmental knee arthroplasty using a new morphological assessment method: the arithmetic hip-knee-ankle angle

Nakano,

Tsubosaka,

Kamenaga

et al. 2023

International Orthopaedics (SICOT)

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“…Advancements in surgical technology have yielded robotic arm-assisted arthroplasty, first introduced into TKA and UKA at the turn of the 20 th century as a potential solution to improve accuracy and patient satisfaction, and tackle the higher revision rates linked to implant malposition. 5 , 6 Early results suggest that robotic arm-assisted TKA and UKA are associated with superior radiological outcomes and reduction in outliers compared to conventional arthroplasty. 7 , 8 It has also been suggested that robotic arm-assistance could be associated with improved functional outcomes, reduced postoperative inflammatory response, soft-tissue injury, and pain.…”

Section: Introductionmentioning

confidence: 99%

Length of stay and discharge dispositions following robotic arm-assisted total knee arthroplasty and unicompartmental knee arthroplasty versus conventional technique and predictors of delayed discharge

Fontalis,

Raj,

Haddad

et al. 2023

Bone Jt Open

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AimsIn-hospital length of stay (LOS) and discharge dispositions following arthroplasty could act as surrogate measures for improvement in patient pathways, and have major cost saving implications for healthcare providers. With the ever-growing adoption of robotic technology in arthroplasty, it is imperative to evaluate its impact on LOS. The objectives of this study were to compare LOS and discharge dispositions following robotic arm-assisted total knee arthroplasty (RO TKA) and unicompartmental arthroplasty (RO UKA) versus conventional technique (CO TKA and UKA).MethodsThis large-scale, single-institution study included patients of any age undergoing primary TKA (n = 1,375) or UKA (n = 337) for any cause between May 2019 and January 2023. Data extracted included patient demographics, LOS, need for post anaesthesia care unit (PACU) admission, anaesthesia type, readmission within 30 days, and discharge dispositions. Univariate and multivariate logistic regression models were also employed to identify factors and patient characteristics related to delayed discharge.ResultsThe median LOS in the RO TKA group was 76 hours (interquartile range (IQR) 54 to 104) versus 82.5 (IQR 58 to 127) in the CO TKA group (p < 0.001) and 54 hours (IQR 34 to 77) in the RO UKA versus 58 (IQR 35 to 81) in the CO UKA (p = 0.031). Discharge dispositions were comparable between the two groups. A higher percentage of patients undergoing CO TKA required PACU admission (8% vs 5.2%; p = 0.040).ConclusionOur study showed that robotic arm assistance was associated with a shorter LOS in patients undergoing primary UKA and TKA, and no difference in the discharge destinations. Our results suggest that robotic arm assistance could be advantageous in partly addressing the upsurge of knee arthroplasty procedures and the concomitant healthcare burden; however, this needs to be corroborated by long-term cost-effectiveness analyses and data from randomized controlled studies.Cite this article: Bone Jt Open 2023;4(10):791–800.

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Gender does not influence outcomes and complications in medial unicompartmental knee arthroplasty

Royon,

Foissey,

Fontalis

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeThe impact of gender on the outcomes of unicompartmental knee arthroplasty (UKA) remains a topic of active discussion with limited exploration thus far. The study aims to elucidate the gender effect on clinical outcomes, complications, pre‐ and postoperative radiological outcomes following the implantation of a medial UKA at mid‐term follow‐up in a large section of patients.MethodsThis was a single‐centre, retrospective cohort study encompassing patients undergoing medial UKA between 2011 and 2019. The International Knee Society (IKS) Knee and Function score, patient satisfaction, complications, revisions, pre‐ and postoperative radiological outcomes (coronal plane alignment, femoral and tibial component positioning, posterior tibial slope) were evaluated. Survival rate at the time of the last follow‐up was also recorded.ResultsOf the 366 knees that met the inclusion criteria, 10 were lost to follow‐up, accounting for a 2.7% loss. Mean follow‐up was 5.2 ± 2 years [2.1–11.3]. Out of the total population, 205 patients were females (57.6%, 205/356) and 151 were males (42.4%, 151/356). Men exhibited superior pre‐ and postoperative IKS function scores (p = 0.017). However, no significant differences were observed between women and men regarding improvements of IKS Knee and Function scores, radiographic outcomes and implant survivorship.ConclusionAt a mean follow‐up of 5 years, this study revealed no significant impact of gender on clinical outcomes and complications in patients undergoing medial UKA. Furthermore, no significant differences were evident in radiographic outcomes, implant positioning and knee phenotype.Level of EvidenceLevel III.

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Combination of a High Residual Varus and Joint-Line Lowering Strongly Increases the Risk of Early Implant Failure in Medial Unicompartmental Knee Arthroplasty

Cited by 12 publications

References 42 publications

Predicting postoperative coronal alignment after fixed-bearing unicompartmental knee arthroplasty using a new morphological assessment method: the arithmetic hip-knee-ankle angle

Predicting postoperative coronal alignment after fixed-bearing unicompartmental knee arthroplasty using a new morphological assessment method: the arithmetic hip-knee-ankle angle

Length of stay and discharge dispositions following robotic arm-assisted total knee arthroplasty and unicompartmental knee arthroplasty versus conventional technique and predictors of delayed discharge

Gender does not influence outcomes and complications in medial unicompartmental knee arthroplasty

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