Influence of Bone Marrow Edema on Medial Unicompartmental Knee Arthroplasty among Patients with Patellofemoral Osteoarthritis

Abstract

This study aims to compare clinical outcomes in unicompartmental knee arthroplasty (UKA) patients with or without magnetic resonance imaging (MRI) evidence of bone marrow edema (BME) in the patella and to evaluate the effect of functional outcomes after UKA in patients with patellofemoral osteoarthritis (PF OA). Outcomes of 146 knees in 141 patients who underwent medial UKA were included. According to their preoperative condition of patellofemoral joints, patients were divided into three groups: Group A, non-PF OA (Kellgren–Lawrence [K–L] scale = 0); group B, PF OA without BME (K–L ≥ 1, bone marrow edema pattern [BMEP] = 0); group C, PF OA with BME (K–L ≥ 1, BMEP ≥ 1). Clinical outcomes including visual analog scale (VAS) scores of knee pain, Hospital for Special Surgery (HSS) scores, and range of motions (ROMs) were evaluated and analyzed at the postoperative follow-up of 3 months and 2 years. From our results, BME was highly correlated to poor outcome in patients with UKA. At follow-up of 3 months, BME influenced the clinical outcome of UKA at an early postoperative stage in terms of VAS scores, HSS scores, and ROMs. At the final follow-up of 2 years, the clinical outcome was improved in terms of HSS score, although the anterior knee pain and active ROMs were still worse than that of patients without BME. In conclusion, there was no significant difference in clinical outcomes in patients without BME regardless of PF OA. However, the condition of BME should be taken serious consideration because of its indication of an adverse effect on the outcome after UKA.

High concentration magnesium inhibits extracellular matrix calcification and protects articular cartilage via Erk/autophagy pathway

“…Senility can cause a spontaneous OA in mice, while the DMM surgery can accelerate the pathological process and reproduces a comparable severity and similar location of the lesion 12 weeks postoperative. In DMM-induced OA mouse model, the cartilage degradation starts from the medial compartment of the knee joint due to instability and excessive stress concentration, this pathological mechanism is also similar to how the progression of human knee OA happens (Yue et al, 2017). Chondrocytes are the dominion cells residing in the articular cartilage and are responsible for the synthesis of collagen and aggrecan, as well as the metabolism, and turnover of the ECM (Guo, Chung, Kondo, Bringhurst, & Kronenberg, 2002).…”

Influence of patellofemoral joint degeneration on clinical outcomes after medial unicompartmental knee arthroplasty

“…After the removal of duplicated studies and screening of titles and abstracts, 45 studies qualified for full-text extraction. Of these, 34 studies were included in this study based on our inclusion-exclusion criteria [6,8,9,16–46] . The PRISMA flow diagram summarizing the search results is presented in [Figure 1].…”