Native rotational knee kinematics is restored after lateral UKA but not after medial UKA

Wada, Keizo; Hamada, Daisuke; Takasago, Tomoya; Nitta, Akihiro; Goto, Tomohiro; Tonogai, Ichiro; Tsuruo, Yoshihiro; Sairyo, Koichi

doi:10.1007/s00167-018-4919-1

Cited by 19 publications

(15 citation statements)

References 30 publications

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“…In the native knee, the tibia internally rotates during flexion, which decreases the Q-angle and optimizes the retinacular ligament tension that guides patellofemoral tracking [ 2 , 11 , 12 ]. Hence, a lateral insert without a posterior upslope, which promotes internal tibial rotation, could potentially minimize the risks of lateral patellar displacement and anterior knee pain [ 29 , 30 , 31 ].…”

Section: Discussionmentioning

confidence: 99%

A TKA Insert with A Lateral Flat Articular Surface Maximizes External and Internal Tibial Orientations without Anterior Lift-Off Relative to Low- and Ultracongruent Surfaces

Nedopil

Howell

Hull

2022

JPM

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Background: In total knee arthroplasty (TKA), inserts can have different levels of medial and lateral congruency determined by the acuteness of the upslopes of the anterior and posterior articular surfaces. The present study evaluated an insert with different levels of lateral congruency and a medial ball-in-socket congruency to test the hypothesis that a lateral flat (F) insert maximizes external tibial orientation at extension and internal orientation at 90° flexion and lowers the incidence of anterior lift-off relative to low-congruent (LC) and ultracongruent (UC) lateral inserts. Methods: Two surgeons treated 23 patients with unrestricted caliper-verified kinematic alignment (KA) and posterior cruciate ligament (PCL) retention. They randomly trialed inserts with a medial radial dial that functioned as a built-in goniometer by measuring the tibial orientation relative to a sagittal line on the femoral trial component. Anterior lift-off of the insert from the baseplate indicated PCL tightness. Results: The F insert’s mean of 9° of external tibial orientation was higher than that of the LC (5°, p < 0.0001) and UC inserts (2°, p < 0.0001). The −13° of internal tibial orientation at 90° flexion was higher than that of the LC (−9°, p < 0.0001) and UC inserts (−7°, p < 0.0001). The 0% incidence of anterior lift-off was less than that of the LC (26%) and UC inserts (57%) (p < 0.0001). Conclusions: Surgeons and implant manufacturers should know that adding congruency to the lateral articular surface limits external tibial orientation in extension and internal tibial orientation at 90° flexion and overtightens the PCL. These rotational limitations and flexion space tightness can adversely affect patellofemoral tracking and knee flexion.

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Section: Discussionmentioning

confidence: 99%

A TKA Insert with A Lateral Flat Articular Surface Maximizes External and Internal Tibial Orientations without Anterior Lift-Off Relative to Low- and Ultracongruent Surfaces

Nedopil

Howell

Hull

2022

JPM

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“… 22 This has been attributed to UKA better preserving the native intra-articular knee ligaments, soft tissue envelope, joint line, and Q angle. 9 , 20 , 47 , 48 The rapid RTS after UKA may reflect the reduced invasiveness and surgical trauma of this procedure compared with conventional TKA. Yang et al have shown that UKA is associated with reduced need for analgesia, faster postoperative functional rehabilitation, earlier hospital discharge, and less time to normalization of gait compared with TKA.…”

Section: Discussionmentioning

confidence: 99%

Return to Sport After Unicompartmental Knee Arthroplasty: A Systematic Review and Meta-analysis

Radhakrishnan

Magan

Kayani

et al. 2022

Orthopaedic Journal of Sports Medicine

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Background: Patients undergoing unicompartmental knee arthroplasty (UKA) often want to return to sport (RTS) after surgery. However, the time taken to RTS and proportion of patients who RTS after UKA remain unknown. Purpose: To determine the time to RTS and proportion of patients who RTS after UKA. Study Design: Systematic review; Level of evidence, 4. Methods: A search was performed using PubMed, Medline, Embase, SPORTDiscus and the Cochrane Library databases for clinical trials reporting on RTS after UKA published between database inception and September 2021. In addition, a manual search was performed of relevant sports medicine and orthopaedic journals, and bibliographies were reviewed for eligible trials. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were used to undertake this study. Results: This meta-analysis included 11 studies (749 patients) that reported on RTS after UKA. The proportion of patients returning to sports increased over time: 6 studies (432 patients) demonstrated an overall pooled proportion of 48.1% (95% CI, 36.3%-60.2%) of patients who returned to sport at 3 months after surgery, while 7 studies (443 patients) demonstrated an overall pooled proportion of 76.5% (95% CI, 63.9%-87.1%) of patients who returned to sport at 6 months after surgery. Overall, 92.7% (95% CI, 85.8%-97.4%) of 749 patients were able to RTS at 4 years after surgery. Overall excellent patient-reported functional outcomes scores and low risk of complications with RTS after UKA were reported. Conclusion: The authors found that 48.1% of patients were able to RTS at 3 months after surgery and 76.5% were able to RTS at 6 months after UKA. Pooled proportion analysis showed that >90% of patients undergoing UKA were able to RTS at 48 months after surgery. The majority of patients who were able to RTS after UKA did so at a lower level of intensity than their preoperative level. RTS after UKA was associated with good patient-reported functional outcomes scores and a low risk of complications.

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“…Instead, people with a normal weight, demanding a more active lifestyle and frequently, as in our cohort, continue to practice amateur sports, tennis, skiing, hiking: this may amplify every sensation of pain [ 6 , 35 ]. Furthermore, a recent biokinematic study shows that in lateral UKA the rotational kinematics of the native knee was restored but not after medial UKA [ 34 ]. Finally, the obese patients tended to be younger at surgery time with high satisfaction rates [ 18 ]; in our work, the highest BMI group present slightly lower mean age and lowest preoperative scores but also a greater improvement in scores compared to other groups as shown in Table 2 .…”

Section: Discussionmentioning

confidence: 99%

A BMI above 30 results in satisfying outcomes in patients undergoing fixed-bearing lateral unicompartmental knee arthroplasty

Giordano

Maffulli

Morenghi

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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Purpose The purpose of this study is to analyse the effect of BMI on clinical outcomes of cemented fixed-bearing lateral unicompartmental knee arthroplasty (UKA) on a 2- to 12-year follow-up. Methods Between January 2010 and January 2020, a total of 103 lateral UKAs were implanted. The Oxford Knee Score (OKS) and the Western Ontario and McMaster University Osteoarthritis Index for pain, stiffness, function, and total score were administered to estimate patients’ overall health status pre- and post-operatively. Results were considered good or excellent for WOMAC values > 85 points and OKS > 40 points. Survivorship, described with Kaplan–Meier method, was defined as the lack of revision at the latest follow-up. Complications or further operations were recorded. p values of < 0.05 were considered significant. Results One hundred one lateral UKAs were assessed at a mean follow-up of 77.8 months. No patients underwent revision, but 2 patients (2, 0%) developed aseptic loosening of the implant 2 and 5 years after surgery but for clinical reasons neither undergo revision (5-year survivor 97.2%). Overall satisfaction was generally high, with excellent scores in all WOMAC subscales and OKS for all BMI groups. Considering the pain subscale (WOMAC pain), patients with normal weight and overweight achieve excellent results more frequently [10 (25.64%) vs 10 (23.81%) p = 0.026] than obese patients ( n = 0); on the other hand, considering the quality of life (WOMAC QoL), obese patients most frequently reach excellent values, even statistically significant [ n = 15 (75.00%) p = 0.040]. Conclusion Although obesity has historically been described as a contraindication to UKA, improved outcomes with modern UKA implant designs have challenged this perception. Therefore, the classic contraindication of UKAs in patients with BMI > 30 kg/m 2 may not be justified. According to the present study, lateral UKA patients with BMI > 30 kg/m 2 had satisfactory patient-reported outcome measures compared to non-obese patients on a long term with survival rates comparable to medial UKA. Obese patients should not be excluded from the benefit of lateral UKA surgery.

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Native rotational knee kinematics is restored after lateral UKA but not after medial UKA

Cited by 19 publications

References 30 publications

A TKA Insert with A Lateral Flat Articular Surface Maximizes External and Internal Tibial Orientations without Anterior Lift-Off Relative to Low- and Ultracongruent Surfaces

A TKA Insert with A Lateral Flat Articular Surface Maximizes External and Internal Tibial Orientations without Anterior Lift-Off Relative to Low- and Ultracongruent Surfaces

Return to Sport After Unicompartmental Knee Arthroplasty: A Systematic Review and Meta-analysis

A BMI above 30 results in satisfying outcomes in patients undergoing fixed-bearing lateral unicompartmental knee arthroplasty

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