Periprosthetic fractures after medial unicompartmental knee arthroplasty: a narrative review

Thoreau, Loïc; Marfil, D. Morcillo; Thienpont, Emmanuel

doi:10.1007/s00402-021-04063-z

Cited by 14 publications

(7 citation statements)

References 81 publications

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“…Lower extremity deep vein thrombosis is theoretically a serious complication common to both total knee replacement and unicondylar knee replacement, and dislodgment of lower extremity deep vein thrombosis such as embolization of the pulmonary artery is often life-threatening to patients and a common cause of death after arthroplasty [24]. In contrast, unicondylar knee replacements actually have a much lower incidence of lower extremity DVT and pulmonary embolism than total knee replacements due to their less invasive procedure and the advantage of early mobilization [25]. Figure 4: Complications.…”

Section: Computational and Mathematical Methods In Medicinementioning

confidence: 99%

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

Zhang

2022

Computational and Mathematical Methods in Medicine

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Background. Knee osteoarthritis (KOA) is a chronic disease that seriously endangers the health of the elderly. Choosing appropriate surgery for knee osteoarthritis patients is especially important. Objective. To investigate the safety and efficacy of unicondylar knee prosthesis treatment for unicompartmental osteoarthritis of the knee. Materials and Methods. One hundred patients with unicondylar osteoarthritis of the knee treated in our hospital from June 2019 to June 2021 were selected as retrospective study subjects and were divided into 50 cases each in the comparison group and the observation group according to the different surgical methods. Among them, the comparison group was treated with unicondylar knee arthroplasty (UKA), and the observation group was treated with unicondylar knee prosthesis replacement, and the differences in AKS score, knee flexion angle, tibial angle orthosis, joint mobility, and postoperative recovery were compared between the two groups. Results. The AKS score and knee flexion angle score of the observation group were higher than those of the comparison group after surgery. However, the tibial angle orthopedic score of the observation group was significantly lower than that of the comparison group after surgery for comparison, and the VAS score of the observation group was lower than that of the comparison group. However, the Lysholm score of the observation group was higher than that of the control group after surgery ( P < 0.05 ). The complication rate of patients in the observation group was significantly lower than that of the comparison group, and the HSS score, VAS score, and knee mobility (ROM) of the two groups were statistically significant ( P < 0.05 ) when compared at 7 d after surgery and 6 months after surgery. Conclusion. The clinical efficacy of unicondylar knee prosthesis replacement for osteoarthritis of the knee is better than that of unicondylar knee arthroplasty (UKA) treatment.

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Section: Computational and Mathematical Methods In Medicinementioning

confidence: 99%

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

Zhang

2022

Computational and Mathematical Methods in Medicine

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“…This may be attributed to postoperative lower limb alignment, implant position, and osteotomy level. 37 Our study findings indicate that there is no statistically significant difference in the incidence of periprosthetic fractures between the outpatient and inpatient groups. This suggests that outpatient UKA does not increase the risk of periprosthetic fractures.…”

Section: Discussionmentioning

confidence: 49%

The safety and efficacy of unicompartmental knee arthroplasty in outpatient surgical centers: A systematic review and meta-analysis

Fan,

Zhang,

Zhang

et al. 2024

J Orthop Surg (Hong Kong)

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Background Unicompartmental knee arthroplasty (UKA) is an effective treatment method for knee osteoarthritis. With the development and implementation of enhanced recovery after surgery, UKA is now increasingly performed in outpatient surgical centers. However, there is ongoing debate regarding the safety and effectiveness of performing UKA in outpatient settings. Methods The search was performed to retrieve randomized controlled trials and cohort studies on outpatient UKA from PubMed, Cochrane Library, EMbase, CNKI, and WanFangData databases. The search was conducted from the inception of the databases until August 31, 2023. After independent screening, data extraction, and risk of bias evaluation by two researchers, meta-analysis was performed using RevMan 5.4 software. Results A total of eight studies involving 18,411 patients were included. The results showed that the postoperative transfusion rate in the outpatient group was lower than that in the inpatient group [OR = 0.36, 95%CI (0.24, 0.54), p < 0.00001], and the difference was statistically significant. However, there was no significant difference between the two groups in terms of readmission rate, reoperation rate, surgical site infection, and periprosthetic fracture. The differences were not statistically significant. Conclusion Compared to the traditional inpatient route, the blood transfusion rate for single-condyle replacement in the outpatient operation center is lower, and there is no significant difference in readmission rate, reoperation rate, surgical site infection, and periprosthesis fracture. The outpatient approach to UKA is safe, feasible, and highly satisfactory for patients. However, the results have certain limitations, and a rigorous preoperative complication risk assessment can minimize the risk of UKA in outpatient surgery centers. Trial registration PROSPERO number CRD42023405373.

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“…Furthermore, other finite element studies have shown that trabecular bone density and maximal force loading capability decreases as resection depth of tibia increases [28]. Periprosthetic fracture and subsidence occur when the balance between the supporting bones and the force applied on bearing area is disrupted [8]. When tibia resection level is lowered, the implant bearing surface of the tibia decreases, resulting in more compression force per unit area and a decrease in the quantity and quality of trabecular bone that supports it, increasing the risk of fracture and subsidence [4,8,29].…”

Section: Discussionmentioning

confidence: 99%

“…Periprosthetic fracture and subsidence occur when the balance between the supporting bones and the force applied on bearing area is disrupted [8]. When tibia resection level is lowered, the implant bearing surface of the tibia decreases, resulting in more compression force per unit area and a decrease in the quantity and quality of trabecular bone that supports it, increasing the risk of fracture and subsidence [4,8,29]. Therefore, the surgical technique used in this study may help prevent periprosthetic fractures and increase UKA's survivorship.…”

Section: Discussionmentioning

confidence: 99%

“…During UKA, many technical factors affect the patient outcome, such as tibia component position, postoperative limb alignment, and depth of tibia resection [3][4][5][6]. Previous studies indicate that minimising proximal tibia resection improves clinical outcomes and reduces complications such as periprosthetic fractures [7,8]. Specific methods to achieve minimal tibia resection during UKA, however, are scarce.…”

Section: Introductionmentioning

confidence: 99%

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Controlled posterior condylar milling technique for unicompartmental knee arthroplasty minimises tibia resection during gap balancing: Short‐term clinical results

Koh,

Lim,

Park

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeThe purpose of this study was to demonstrate the clinical utility of controlled posterior condylar milling (CPCM) in gap balancing while minimally resecting the tibia during fixed‐bearing unicompartmental knee arthroplasty (UKA).MethodsThis study is a retrospective cohort study. Patients who underwent medial UKA for isolated medial compartment osteoarthritis with a minimum follow‐up of 2 years were included. The patients were divided into two groups: the conventional group (n = 56) and the CPCM group (n = 66). In the CPCM group, the proximal tibia was resected at the level of the distal end of the subchondral bone. If the flexion gap was tighter than extension, the posterior condyle was additionally milled to adjust gap tightness. Standing knee X‐ray and scanogram were used to evaluate alignment and tibia resection amount. Range of motion (ROM) and Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) scores were used to evaluate clinical outcomes.ResultsThe CPCM group showed significantly smaller tibia resection (3.6 ± 1.9 mm) compared to the conventional group (5.2 ± 2.7 mm) (p < 0.001). Postoperative ROM (133.0 ± 8.3°, 135.2 ± 7.2°, n.s.) and WOMAC (19.3 ± 13.6, 23.6 ± 17.7, n.s.) were not significantly different between the two groups. Postoperative periprosthetic fractures occurred in two patients in conventional group, while the CPCM group had no periprosthetic fractures.ConclusionThe CPCM technique may be a simple and useful intraoperative technique that can achieve minimal tibia resection and promising clinical outcomes while easily adjusting gap tightness between flexion and extension during medial fixed‐bearing UKA.Level of EvidenceLevel III.

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Periprosthetic fractures after medial unicompartmental knee arthroplasty: a narrative review

Cited by 14 publications

References 81 publications

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

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

The safety and efficacy of unicompartmental knee arthroplasty in outpatient surgical centers: A systematic review and meta-analysis

Controlled posterior condylar milling technique for unicompartmental knee arthroplasty minimises tibia resection during gap balancing: Short‐term clinical results

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