Download PDF
J Knee Surg 2019; 32(05): 468-474
DOI: 10.1055/s-0038-1651528
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Mid-Term Clinical Outcome and Reconstruction of Posterior Tibial Slope after UKA

Alois Franz
1   Department of Orthopaedic Surgery and Sports Traumatology, St. Marien-Krankenhaus Siegen, Germany
,
Christoph Kolja Boese
2   Department of Trauma and Orthopaedic Surgery, University Hospital of Cologne, Cologne, Germany
,
Andrej Matthies
1   Department of Orthopaedic Surgery and Sports Traumatology, St. Marien-Krankenhaus Siegen, Germany
,
Jörg Leffler
1   Department of Orthopaedic Surgery and Sports Traumatology, St. Marien-Krankenhaus Siegen, Germany
,
Christian Ries
2   Department of Trauma and Orthopaedic Surgery, University Hospital of Cologne, Cologne, Germany
› Author Affiliations Funding None.
Further Information

Publication History

14 December 2017

08 April 2018

Publication Date:
21 May 2018 (online)

    Permissions and Reprints

Abstract

Unicompartmental knee arthroplasty (UKA) has gained growing popularity over the last decades. The posterior tibial slope (PTS) has been shown to play a significant role for knee biomechanics and is thought to be crucial for clinical function of the UKA. We evaluated the clinical outcome at mid-term follow-up after UKA. Furthermore, the reconstruction of the individual PTS was analyzed. A total of 91 consecutive patients undergoing medial UKA for osteoarthritis were included. Patients were contacted by telephone for a survival analysis at a minimum of 30 months after surgery. Patient-oriented questionnaires and Knee Osteoarthritis Outcome Score (KOOS) were obtained. A retrospective chart review and radiological analysis of component alignment were performed for all patients before and at 6 weeks after surgery. Of 91 patients (93 knees) undergoing UKA, 69 patients (70 knees) were available for clinical follow-up after a mean of 56.0 (range 31–81) months post-surgery. The clinical results of the examined patients in the present study showed mean subscale scores of the KOOS and Western Ontario and McMaster Universities Osteoarthritis Index between 71 and 91%. Overall 7 of 91 patients were revised during the course of follow-up period and underwent total knee arthroplasty. A Kaplan–Meier analysis showed a survival rate for UKA of 90.5% after 48 months. Calculated implant survival was 75.9 months (95% confidence interval 72.3–79.6) at the mean. The radiographic analysis of pre- and postoperative PTS showed no differences (p = 0.113).UKA for osteoarthritis of the medial knee compartment shows encouraging clinical results at mid-term follow-up. The individual PTS could be reconstructed within acceptable ranges. This is a retrospective therapeutic study with Level IV.

Keywords

unicompartmental knee arthroplasty - all-polyethylene - metal-backed - tibial component - posterior tibial slope

Ethical Approval

This article does not contain any studies with human participants or animals performed by any of the authors.


 

  • References

  • 1 13th Annual Report of the National Joint Registry for England & Wales, Northern Ireland and the Isle of Man; 2016
    PubMed
  • 2 Chatellard R, Sauleau V, Colmar M, Robert H, Raynaud G, Brilhault J. ; Société d'Orthopédie et de Traumatologie de l'Ouest (SOO). Medial unicompartmental knee arthroplasty: does tibial component position influence clinical outcomes and arthroplasty survival?. Orthop Traumatol Surg Res 2013; 99 (4, Suppl): S219-S225
    CrossrefPubMedGoogle Scholar
  • 3 Nunley RM, Nam D, Johnson SR, Barnes CL. Extreme variability in posterior slope of the proximal tibia: measurements on 2395 CT scans of patients undergoing UKA?. J Arthroplasty 2014; 29 (08) 1677-1680
    CrossrefPubMedGoogle Scholar
  • 4 Griffin T, Rowden N, Morgan D, Atkinson R, Woodruff P, Maddern G. Unicompartmental knee arthroplasty for the treatment of unicompartmental osteoarthritis: a systematic study. ANZ J Surg 2007; 77 (04) 214-221
    CrossrefPubMedGoogle Scholar
  • 5 Newman J, Pydisetty RV, Ackroyd C. Unicompartmental or total knee replacement: the 15-year results of a prospective randomised controlled trial. J Bone Joint Surg Br 2009; 91 (01) 52-57
    CrossrefPubMedGoogle Scholar
  • 6 Deschamps G, Chol C. Fixed-bearing unicompartmental knee arthroplasty. Patients' selection and operative technique. Orthop Traumatol Surg Res 2011; 97 (06) 648-661
    CrossrefPubMedGoogle Scholar
  • 7 Lustig S, Paillot J-L, Servien E, Henry J, Ait Si Selmi T, Neyret P. Cemented all polyethylene tibial insert unicompartimental knee arthroplasty: a long term follow-up study. Orthop Traumatol Surg Res 2009; 95 (01) 12-21
    CrossrefPubMedGoogle Scholar
  • 8 Hopkins AR, New AM, Rodriguez-y-Baena F, Taylor M. Finite element analysis of unicompartmental knee arthroplasty. Med Eng Phys 2010; 32 (01) 14-21
    CrossrefPubMedGoogle Scholar
  • 9 Agneskirchner JD, Hurschler C, Stukenborg-Colsman C, Imhoff AB, Lobenhoffer P. Effect of high tibial flexion osteotomy on cartilage pressure and joint kinematics: a biomechanical study in human cadaveric knees. Winner of the AGA-DonJoy Award 2004. Arch Orthop Trauma Surg 2004; 124 (09) 575-584
    CrossrefPubMedGoogle Scholar
  • 10 Giffin JR, Stabile KJ, Zantop T, Vogrin TM, Woo SL, Harner CD. Importance of tibial slope for stability of the posterior cruciate ligament deficient knee. Am J Sports Med 2007; 35 (09) 1443-1449
    CrossrefPubMedGoogle Scholar
  • 11 Hernigou P, Deschamps G. Posterior slope of the tibial implant and the outcome of unicompartmental knee arthroplasty. J Bone Joint Surg Am 2004; 86-A (03) 506-511
    PubMedGoogle Scholar
  • 12 Lombardi Jr AV, Berend KR, Aziz-Jacobo J, Davis MB. Balancing the flexion gap: relationship between tibial slope and posterior cruciate ligament release and correlation with range of motion. J Bone Joint Surg Am 2008; 90 (Suppl. 04) 121-132
    CrossrefPubMedGoogle Scholar
  • 13 Haddad B, Konan S, Mannan K, Scott G. Evaluation of the posterior tibial slope on MR images in different population groups using the tibial proximal anatomical axis. Acta Orthop Belg 2012; 78 (06) 757-763
    Google Scholar
  • 14 Takayama K, Matsumoto T, Muratsu H. , et al. The influence of posterior tibial slope changes on joint gap and range of motion in unicompartmental knee arthroplasty. Knee 2016; 23 (03) 517-522
    CrossrefPubMedGoogle Scholar
  • 15 Collier MB, Eickmann TH, Sukezaki F, McAuley JP, Engh GA. Patient, implant, and alignment factors associated with revision of medial compartment unicondylar arthroplasty. J Arthroplasty 2006; 21 (06) (Suppl. 02) 108-115
    CrossrefPubMedGoogle Scholar
  • 16 Iacono F, Raspugli GF, Akkawi I. , et al. Unicompartmental knee arthroplasty in patients over 75 years: a definitive solution?. Arch Orthop Trauma Surg 2016; 136 (01) 117-123
    CrossrefPubMedGoogle Scholar
  • 17 Bruni D, Iacono F, Russo A. , et al. Minimally invasive unicompartmental knee replacement: retrospective clinical and radiographic evaluation of 83 patients. Knee Surg Sports Traumatol Arthrosc 2010; 18 (06) 710-717
    CrossrefPubMedGoogle Scholar
  • 18 Utzschneider S, Goettinger M, Weber P. , et al. Development and validation of a new method for the radiologic measurement of the tibial slope. Knee Surg Sports Traumatol Arthrosc 2011; 19 (10) 1643-1648
    CrossrefPubMedGoogle Scholar
  • 19 Barbadoro P, Ensini A, Leardini A. , et al. Tibial component alignment and risk of loosening in unicompartmental knee arthroplasty: a radiographic and radiostereometric study. Knee Surg Sports Traumatol Arthrosc 2014; 22 (12) 3157-3162
    CrossrefPubMedGoogle Scholar
  • 20 Newman JH, Ackroyd CE, Shah NA. Unicompartmental or total knee replacement? Five-year results of a prospective, randomised trial of 102 osteoarthritic knees with unicompartmental arthritis. J Bone Joint Surg Br 1998; 80 (05) 862-865
    CrossrefPubMedGoogle Scholar
  • 21 Robertsson O, Borgquist L, Knutson K, Lewold S, Lidgren L. Use of unicompartmental instead of tricompartmental prostheses for unicompartmental arthrosis in the knee is a cost-effective alternative. 15,437 primary tricompartmental prostheses were compared with 10,624 primary medial or lateral unicompartmental prostheses. Acta Orthop Scand 1999; 70 (02) 170-175
    CrossrefPubMedGoogle Scholar
  • 22 Sarraf KM, Konan S, Pastides PS, Haddad FS, Oussedik S. Bone loss during revision of unicompartmental to total knee arthroplasty: an analysis of implanted polyethylene thickness from the National Joint Registry data. J Arthroplasty 2013; 28 (09) 1571-1574
    CrossrefPubMedGoogle Scholar
  • 23 Epinette JA, Brunschweiler B, Mertl P, Mole D, Cazenave A. ; French Society for Hip and Knee. Unicompartmental knee arthroplasty modes of failure: wear is not the main reason for failure: a multicentre study of 418 failed knees. Orthop Traumatol Surg Res 2012; 98 (6, Suppl): S124-S130
    CrossrefPubMedGoogle Scholar
  • 24 Aleto TJ, Berend ME, Ritter MA, Faris PM, Meneghini RM. Early failure of unicompartmental knee arthroplasty leading to revision. J Arthroplasty 2008; 23 (02) 159-163
    CrossrefPubMedGoogle Scholar
  • 25 Mariani EM, Bourne MH, Jackson RT, Jackson ST, Jones P. Early failure of unicompartmental knee arthroplasty. J Arthroplasty 2007; 22 (06) (Suppl. 02) 81-84
    CrossrefPubMedGoogle Scholar
  • 26 Borus T, Thornhill T. Unicompartmental knee arthroplasty. J Am Acad Orthop Surg 2008; 16 (01) 9-18
    CrossrefPubMedGoogle Scholar
  • 27 Hyldahl HC, Regnér L, Carlsson L, Kärrholm J, Weidenhielm L. Does metal backing improve fixation of tibial component in unicondylar knee arthroplasty? A randomized radiostereometric analysis. J Arthroplasty 2001; 16 (02) 174-179
    CrossrefPubMedGoogle Scholar
  • 28 Hernigou P, Deschamps G. Alignment influences wear in the knee after medial unicompartmental arthroplasty. Clin Orthop Relat Res 2004; (423) 161-165
    PubMedGoogle Scholar
  • 29 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
    CrossrefPubMedGoogle Scholar