Unicondylar Tibiofemoral Arthroplasty – Opinions of the Members of the German Knee Society (DKG) and the German Professional Association of Orthopaedic and Trauma Specialists (BVOU)

Abstract

Background The number of implanted unicondylar tibiofemoral knee arthroplasties (UKA) is despite the potential advantages in comparison to total knee arthroplasties (TKA) in Germany relatively low. Goal of this survey, initiated by the Small Implants Group of the German Knee Society, was to gather opinions and put them into context of the current literature.

Methods Based on the Delphi method and the AWMF rules and standards, 19 statements were developed, which were presented to the members of the DKG and BVOU in an anonymous online survey using “SurveyMonkey”. Overall, 410 colleagues participated.

Results The biggest detected controversies were the determination of indications with respect to the body mass index and the existence of a patellofemoral arthrosis. A general consent was determined that a contralateral tibiofemoral arthrosis grade III – IV and meniscal deficiency in the contralateral compartment are an absolute contraindication. There was a consent that age is not a limitation for the implantation of an UKA. If a personal minimum volume of 15 implantations/year should be implemented was seen controversial.

Conclusion The personal opinion, eventually built by personal experiences, appears to be in conflict with the knowledge of scientific literature in many instances. Intensive training and education appears necessary.

Key words

unicondylar arthroplasty - gonarthrosis - knee - survey

Publikationsverlauf

Artikel online veröffentlicht:
11. November 2019

• References/Literatur

• 1 2. Internationales Symposium „Endoprothetik im Fokus“: Unikondylärer Kniegelenkersatz (2018). Frankfurt am Main, 26. – 27.01.2018.
• 2 Grimberg A, Jansson V, Liebs T. et al. Jahresbericht 2016 – Endoprothesenregister Deutschland (EPRD). 2016: 26 – 32.
• 3 Board TNE. 14th Annual Report. National Joint Registry for England, Wales, Northern Ireland and the Isle of Man. 2017: 102 – 112.
• 4 Robertsson O, W-Dahl A, Lidgren L. et al. Swedish Knee Arthroplasty Register – Annual Report 2017. 2017: 26 – 32.
• 5 Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR). Hip KSA. 2017 Annual Report. Adelaide: 178 – 185.
• 6 Chatellard R, Sauleau V, Colmar M. et al. Medial unicompartmental knee arthroplasty: does tibial component position influence clinical outcomes and arthroplasty survival?. Orthop Traumatol Surg Res 2013; 99: S219-225 doi:10.1016/j.otsr.2013.03.004
• 7 Thiele K, Perka C, Matziolis G. et al. Current failure mechanisms after knee arthroplasty have changed: polyethylene wear is less common in revision surgery. J Bone Joint Surg Am 2015; 97: 715-720 doi:10.2106/JBJS.M.01534
• 8 Berger RA, Della Valle CJ. Unicompartmental knee arthroplasty: indications, techniques, and results. Instr Course Lect 2010; 59: 47-56
• 9 Schindler OS, Scott WN, Scuderi GR. The practice of unicompartmental knee arthroplasty in the United Kingdom. J Orthop Surg (Hong Kong) 2010; 18: 312-319 doi:10.1177/230949901001800311
• 10 Liddle AD, Pandit H, Judge A. et al. Effect of surgical caseload on revision rate following total and unicompartmental knee replacement. J Bone Joint Surg Am 2016; 98: 1-8 doi:10.2106/JBJS.N.00487
• 11 Hasson F, Keeney S, McKenna H. Research guidelines for the Delphi survey technique. J Adv Nurs 2000; 32: 1008-1015
• 12 Kozinn SC, Scott R. Unicondylar knee arthroplasty. J Bone Joint Surg Am 1989; 71: 145-150
• 13 van der List JP, Chawla H, Zuiderbaan HA. et al. The role of preoperative patient characteristics on outcomes of unicompartmental knee arthroplasty: a meta-analysis critique. J Arthroplasty 2016; 31: 2617-2627 doi:10.1016/j.arth.2016.04.001
• 14 Kandil A, Werner BC, Gwathmey WF. et al. Obesity, morbid obesity and their related medical comorbidities are associated with increased complications and revision rates after unicompartmental knee arthroplasty. J Arthroplasty 2015; 30: 456-460 doi:10.1016/j.arth.2014.10.016
• 15 Sun K, Li H. Body mass index as a predictor of outcome in total knee replace: a systemic review and meta-analysis. Knee 2017; 24: 917-924 doi:10.1016/j.knee.2017.05.022
• 16 Xu S, Chen JY, Lo NN. et al. The influence of obesity on functional outcome and quality of life after total knee arthroplasty. Bone Joint J 2018; 100-B: 579-583 doi:10.1302/0301-620X.100B5.BJJ-2017-1263.R1
• 17 Beard DJ, Pandit H, Gill HS. et al. The influence of the presence and severity of pre-existing patellofemoral degenerative changes on the outcome of the Oxford medial unicompartmental knee replacement. J Bone Joint Surg Br 2007; 89: 1597-1601 doi:10.1302/0301-620X.89B12.19259
• 18 Hamilton TW, Pandit HG, Maurer DG. et al. Anterior knee pain and evidence of osteoarthritis of the patellofemoral joint should not be considered contraindications to mobile-bearing unicompartmental knee arthroplasty: a 15-year follow-up. Bone Joint J 2017; 99-B: 632-639 doi:10.1302/0301-620X.99B5.BJJ-2016-0695.R2
• 19 Konan S, Haddad FS. Does location of patellofemoral chondral lesion influence outcome after Oxford medial compartmental knee arthroplasty?. Bone Joint J 2016; 98-B: 11-15 doi:10.1302/0301-620X.98B10.BJJ-2016-0403.R1
• 20 Lim JW, Chen JY, Chong HC. et al. Pre-existing patellofemoral disease does not affect 10-year survivorship in fixed bearing unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2018;
• 21 Bonutti PM, Dethmers DA. Contemporary unicompartmental knee arthroplasty: fixed vs. mobile bearing. J Arthroplasty 2008; 23: 24-27 doi:10.1016/j.arth.2008.06.025
• 22 Smith TO, Hing CB, Davies L. et al. Fixed versus mobile bearing unicompartmental knee replacement: a meta-analysis. Orthop Traumatol Surg Res 2009; 95: 599-605 doi:10.1016/j.otsr.2009.10.006
• 23 Ko YB, Gujarathi MR, Oh KJ. Outcome of unicompartmental knee arthroplasty: a systematic review of comparative studies between fixed and mobile bearings focusing on complications. Knee Surg Relat Res 2015; 27: 141-148 doi:10.5792/ksrr.2015.27.3.141
• 24 van der List JP, Zuiderbaan HA, Pearle AD. Why do lateral unicompartmental knee arthroplasties fail today?. Am J Orthop (Belle Mead NJ) 2016; 45: 432-462
• 25 Mancuso F, Dodd CA, Murray DW. et al. Medial unicompartmental knee arthroplasty in the ACL-deficient knee. J Orthop Traumatol 2016; 17: 267-275 doi:10.1007/s10195-016-0402-2
• 26 Engh GA, Ammeen D. Is an intact anterior cruciate ligament needed in order to have a well-functioning unicondylar knee replacement?. Clin Orthop Relat Res 2004; (428) 170-173
• 27 Hayashi D, Roemer FW, Jarraya M. et al. Imaging in osteoarthritis. Radiol Clin North Am 2017; 55: 1085-1102 doi:10.1016/j.rcl.2017.04.012
• 28 Lee YS, Lee BK, Lee SH. et al. Effect of foot rotation on the mechanical axis and correlation between knee and whole leg radiographs. Knee Surg Sports Traumatol Arthrosc 2013; 21: 2542-2547 doi:10.1007/s00167-013-2419-x
• 29 Robertsson O, Knutson K, Lewold S. et al. The routine of surgical management reduces failure after unicompartmental knee arthroplasty. J Bone Joint Surg Br 2001; 83: 45-49