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J Knee Surg 2023; 36(14): 1447-1453
DOI: 10.1055/a-1946-6892
Original Article

Reduced 5-Year Risk for Revision of the Oxford UKA Using New Instrumentation versus Conventional Instrumentation: A Registry Study of 12,867 UKAs

Stephan J. van Langeveld 
1   Department of Orthopaedic Surgery, FORCE (Foundation for Orthopaedic Research Care and Education), Amphia Hospital, Breda, The Netherlands
,
Stein J. Janssen
2   Department of Orthopaedic Surgery, Academic Medical Center, Amsterdam Movement Sciences, Amsterdam University Medical Centers, Amsterdam, The Netherlands
,
Koen L. M. Koenraadt
1   Department of Orthopaedic Surgery, FORCE (Foundation for Orthopaedic Research Care and Education), Amphia Hospital, Breda, The Netherlands
,
Leon H. G. J. Elmans
1   Department of Orthopaedic Surgery, FORCE (Foundation for Orthopaedic Research Care and Education), Amphia Hospital, Breda, The Netherlands
,
Liza N. van Steenbergen
3   Dutch Arthroplasty Register (LROI),'s-Hertogenbosch, The Netherlands
,
Rutger C. I. van Geenen
1   Department of Orthopaedic Surgery, FORCE (Foundation for Orthopaedic Research Care and Education), Amphia Hospital, Breda, The Netherlands
› Institutsangaben Funding One of the authors has done consulting work for a commercial party related to the subject of this study, and one of the authors has received institutional funding from the same commercial party. This party had no involvement in the study design, data collection, analysis and interpretation, or writing of the results.
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Abstract

Microplasty instrumentation was introduced for a more consistent surgical implantation technique, especially component alignment and tibial resection level, of the Oxford medial unicompartmental knee arthroplasty (UKA) and thereby aims to improve UKA survival. This study aimed to assess the 5-year risk for revision and reasons for revision of the Oxford medial UKA using the new instrumentation (Microplasty) with its predecessor, that is, conventional instrumentation (Phase 3). Data of all medial UKAs from the Dutch Arthroplasty Register (Landelijke Registratie Orthopedische Implantaten) between 2007 and 2019 were collected. Type of instrumentation was divided into new (Microplasty) and conventional instrumentation. Kaplan–Meier analysis was performed to calculate 5-year cumulative revision percentage with any reason for revision as end point. A multivariable Cox regression with outcome revision of UKA adjusted for age, gender, American Society of Anesthesiologists score, surgical history, and type of fixation was performed. Additionally, reasons for revision at 3-year were assessed and tested through Fisher's exact tests. A total of 12,867 Oxford medial UKAs, 8,170 using new and 4,697 using conventional instrumentation, were included. The 5-year revision percentage was 9.2% (95% confidence interval [CI]: 8.4–10.1%) for UKAs using the conventional and 6.1% (95% CI: 5.4–6.7%) for new instrumentation. The adjusted hazard ratio for revision at 5-year follow-up was 0.74 (95% CI: 0.63–0.87) in favor of UKAs using the new instrumentation. Malalignment was more frequently registered as reason for revision in UKAs using the conventional compared with the new instrumentation (16% versus 7.5%; p = 0.001). Our results show a reduced 5-year risk for revision of the medial Oxford UKAs using the new compared with the conventional instrumentation. This might be the result of a lower revision rate for malalignment in UKAs using the new instrumentation.

Keywords

Microplasty instrumentation - unicompartmental knee arthroplasty - revision - reason for revision

Ethics Approval and Informed Consent

As this study was based on the LROI registry database, no informed consent or Institutional Review Board approval was needed.




Publikationsverlauf

Eingereicht: 09. Februar 2022

Angenommen: 15. September 2022

Accepted Manuscript online:
19. September 2022

Artikel online veröffentlicht:
23. Dezember 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Hansen EN, Ong KL, Lau E, Kurtz SM, Lonner JH. Unicondylar knee arthroplasty in the U.S. patient population: prevalence and epidemiology. Am J Orthop 2018; 47 (12)
    CrossrefPubMedSuche in Google Scholar
  • 2 Agarwal A, Miller S, Hadden W. et al. Comparison of gait kinematics in total and unicondylar knee replacement surgery. Ann R Coll Surg Engl 2019; 101 (06) 391-398
    CrossrefPubMedSuche in Google Scholar
  • 3 Wilson HA, Middleton R, Abram SGF. et al. Patient relevant outcomes of unicompartmental versus total knee replacement: systematic review and meta-analysis. BMJ 2019; 364: l352
    CrossrefPubMedSuche in Google Scholar
  • 4 Migliorini F, Tingart M, Niewiera M, Rath B, Eschweiler J. Unicompartmental versus total knee arthroplasty for knee osteoarthritis. Eur J Orthop Surg Traumatol 2019; 29 (04) 947-955
    CrossrefPubMedSuche in Google Scholar
  • 5 Beard DJ, Davies LJ, Cook JA. et al; TOPKAT Study Group. The clinical and cost-effectiveness of total versus partial knee replacement in patients with medial compartment osteoarthritis (TOPKAT): 5-year outcomes of a randomised controlled trial. Lancet 2019; 394 (10200): 746-756
    CrossrefPubMedSuche in Google Scholar
  • 6 Murray DW, Liddle AD, Dodd CA, Pandit H. Unicompartmental knee arthroplasty: is the glass half full or half empty?. Bone Joint J 2015; 97-B (10, suppl A): 3-8
    CrossrefPubMedSuche in Google Scholar
  • 7 van Oost I, Koenraadt KLM, van Steenbergen LN, Bolder SBT, van Geenen RCI. Higher risk of revision for partial knee replacements in low absolute volume hospitals: data from 18,134 partial knee replacements in the Dutch Arthroplasty Register. Acta Orthop 2020; 91 (04) 426-432
    CrossrefPubMedSuche in Google Scholar
  • 8 Price AJ, Webb J, Topf H, Dodd CA, Goodfellow JW, Murray DW. Oxford Hip and Knee Group. Rapid recovery after oxford unicompartmental arthroplasty through a short incision. J Arthroplasty 2001; 16 (08) 970-976
    CrossrefPubMedSuche in Google Scholar
  • 9 Dalury DF, Dennis DA. Mini-incision total knee arthroplasty can increase risk of component malalignment. Clin Orthop Relat Res 2005; 440 (440) 77-81
    CrossrefPubMedSuche in Google Scholar
  • 10 Gulati A, Chau R, Simpson DJ, Dodd CA, Gill HS, Murray DW. Influence of component alignment on outcome for unicompartmental knee replacement. Knee 2009; 16 (03) 196-199
    CrossrefPubMedSuche in Google Scholar
  • 11 Pandit H, Jenkins C, Gill HS, Barker K, Dodd CA, Murray DW. Minimally invasive Oxford phase 3 unicompartmental knee replacement: results of 1000 cases. J Bone Joint Surg Br 2011; 93 (02) 198-204
    CrossrefPubMedSuche in Google Scholar
  • 12 Morris MJ, Frye BM, Ekpo TE, Berend KR. Unicompartmental knee replacement with new Oxford instruments. Oper Tech Orthop 2012; 22 (04) 189-195
    CrossrefPubMedSuche in Google Scholar
  • 13 Gaba S, Wahal N, Gautam D, Pandit H, Kumar V, Malhotra R. Early results of oxford mobile bearing medial unicompartmental knee replacement (UKR) with the Microplasty instrumentation: an Indian experience. Arch Bone Jt Surg 2018; 6 (04) 301-311
    PubMedSuche in Google Scholar
  • 14 Hurst JM, Berend KR, Adams JB, Lombardi Jr AV. Radiographic comparison of mobile-bearing partial knee single-peg versus twin-peg design. J Arthroplasty 2015; 30 (03) 475-478
    CrossrefPubMedSuche in Google Scholar
  • 15 Koh IJ, Kim JH, Jang SW, Kim MS, Kim C, In Y. Are the Oxford(®) medial unicompartmental knee arthroplasty new instruments reducing the bearing dislocation risk while improving components relationships? A case control study. Orthop Traumatol Surg Res 2016; 102 (02) 183-187
    CrossrefPubMedSuche in Google Scholar
  • 16 Tu Y, Xue H, Ma T. et al. Superior femoral component alignment can be achieved with Oxford Microplasty instrumentation after minimally invasive unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2017; 25 (03) 729-735
    CrossrefPubMedSuche in Google Scholar
  • 17 Walker T, Heinemann P, Bruckner T, Streit MR, Kinkel S, Gotterbarm T. The influence of different sets of surgical instrumentation in Oxford UKA on bearing size and component position. Arch Orthop Trauma Surg 2017; 137 (07) 895-902
    CrossrefPubMedSuche in Google Scholar
  • 18 Ng JP, Fan JCH, Lau LCM, Tse TTS, Wan SYC, Hung YW. Can accuracy of component alignment be improved with Oxford UKA Microplasty® instrumentation?. J Orthop Surg Res 2020; 15 (01) 354
    CrossrefPubMedSuche in Google Scholar
  • 19 Jang KM, Lim HC, Han SB, Jeong C, Kim SG, Bae JH. Does new instrumentation improve radiologic alignment of the Oxford® medial unicompartmental knee arthroplasty?. Knee 2017; 24 (03) 641-650
    CrossrefPubMedSuche in Google Scholar
  • 20 Pocock SJ, Clayton TC, Altman DG. Survival plots of time-to-event outcomes in clinical trials: good practice and pitfalls. Lancet 2002; 359 (9318): 1686-1689
    CrossrefPubMedSuche in Google Scholar
  • 21 Basso M, Arnaldi E, Bruno AAM, Formica M. Outcomes of cementless fixation in medial unicompartmental knee arthroplasty: review of recent literature. Musculoskelet Surg 2021; 105 (02) 131-138
    CrossrefPubMedSuche in Google Scholar
  • 22 Burger JA, Jager T, Dooley MS, Zuiderbaan HA, Kerkhoffs GMMJ, Pearle AD. Comparable incidence of periprosthetic tibial fractures in cementless and cemented unicompartmental knee arthroplasty: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2022; 30 (03) 852-874
    CrossrefPubMedSuche in Google Scholar
  • 23 Mohammad HR, Matharu GS, Judge A, Murray DW. New surgical instrumentation reduces the revision rate of unicompartmental knee replacement: a propensity score matched comparison of 15,906 knees from the National Joint Registry. Knee 2020; 27 (03) 993-1002
    CrossrefPubMedSuche in Google Scholar
  • 24 Mittal A, Meshram P, Kim WH, Kim TK. Unicompartmental knee arthroplasty, an enigma, and the ten enigmas of medial UKA. J Orthop Traumatol 2020; 21 (01) 15
    CrossrefPubMedSuche in Google Scholar
  • 25 van der List JP, Zuiderbaan HA, Pearle AD. Why do medial unicompartmental knee arthroplasties fail today?. J Arthroplasty 2016; 31 (05) 1016-1021
    CrossrefPubMedSuche in Google Scholar
  • 26 Vasso M, Corona K, D'Apolito R, Mazzitelli G, Panni AS. Unicompartmental knee arthroplasty: modes of failure and conversion to total knee arthroplasty. Joints 2017; 5 (01) 44-50
    Thieme ConnectPubMedSuche in Google Scholar
  • 27 Gulati A, Pandit H, Jenkins C, Chau R, Dodd CA, Murray DW. The effect of leg alignment on the outcome of unicompartmental knee replacement. J Bone Joint Surg Br 2009; 91 (04) 469-474
    CrossrefPubMedSuche in Google Scholar
  • 28 White SH, Roberts S, Kuiper JH. The twin peg Oxford knee - medium term survivorship and surgical principles. Knee 2018; 25 (02) 314-322
    CrossrefPubMedSuche in Google Scholar
  • 29 Liddle AD, Pandit H, Judge A, Murray DW. Effect of surgical caseload on revision rate following total and unicompartmental knee replacement. J Bone Joint Surg Am 2016; 98 (01) 1-8
    CrossrefPubMedSuche in Google Scholar
  • 30 Mohammad HR, Matharu GS, Judge A, Murray DW. Comparison of the 10-year outcomes of cemented and cementless unicompartmental knee replacements: data from the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man. Acta Orthop 2020; 91 (01) 76-81
    CrossrefPubMedSuche in Google Scholar