J Knee Surg 2019; 32(02): 180-185
DOI: 10.1055/s-0038-1636837
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Patient-Specific Instrument Can Improve Functional and Radiographic Results during Learning Curve for Oxford Unicompartmental Knee Arthroplasty

Pablo Sanz-Ruiz
1   Department of Traumatology and Orthopaedic Surgery, General University Hospital Gregorio Marañón, Madrid, Spain
2   Department of Surgery, Universidad Complutense de Madrid Medicine Faculty, Madrid, Spain
,
Jose Antonio Matas-Diez
1   Department of Traumatology and Orthopaedic Surgery, General University Hospital Gregorio Marañón, Madrid, Spain
,
Esther Carbo-Laso
1   Department of Traumatology and Orthopaedic Surgery, General University Hospital Gregorio Marañón, Madrid, Spain
,
Ruben Perez-Mañanes
1   Department of Traumatology and Orthopaedic Surgery, General University Hospital Gregorio Marañón, Madrid, Spain
,
Javier Vaquero-Martín
1   Department of Traumatology and Orthopaedic Surgery, General University Hospital Gregorio Marañón, Madrid, Spain
2   Department of Surgery, Universidad Complutense de Madrid Medicine Faculty, Madrid, Spain
› Author Affiliations
Further Information

Publication History

13 June 2017

28 January 2018

Publication Date:
07 March 2018 (online)

Abstract

The true value of use of patient-specific instrumentation (PSI) systems by inexperienced surgeons during their learning curve to improve the clinical and radiographic outcome of unicompartmental knee arthroplasty (UKA) has not been previously studied. Fifty patients with a mean age of 64.3 years undergoing surgery for Oxford UKA were prospectively divided into two groups. Twenty-five patients were operated on by a surgeon with no prior experience in UKA using a PSI system and the other 25 patients by an experienced surgeon using a conventional procedure. Patients were scored using joint range of motion (ROM), the Knee Society Score (KSS), the Knee Injury and Osteoarthritis Outcome Score (KOOS), and the 12-item Short-Form (SF-12) before and 3 months and 2 years after surgery. Impact of use of PSI was measured by comparing clinical and radiographic outcome, complications, and implant survival. No evidence of poorer clinical outcome was seen in any subscale of KSS, KOOS, and SF-12 for inexperienced surgeons using PSI (p = 0.45, p = 0.32, and p = 0.61, respectively). No difference was found between the two procedures in precision of radiographic alignment of components (p = 0.53). No complication occurred in any group. PSI may improve precision of component alignment during the learning curve of surgeons, thus achieving functional results similar to those of more experienced surgeons using a conventional procedure.

 
  • References

  • 1 Carr AJ, Robertsson O, Graves S. , et al. Knee replacement. Lancet 2012; 379 (9823): 1331-1340
  • 2 Price AJ, Rees JL, Beard DJ, Gill RH, Dodd CA, Murray DM. Sagittal plane kinematics of a mobile-bearing unicompartmental knee arthroplasty at 10 years: a comparative in vivo fluoroscopic analysis. J Arthroplasty 2004; 19 (05) 590-597
  • 3 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
  • 4 Lunebourg A, Parratte S, Ollivier M, Abdel MP, Argenson JN. Are Revisions of Unicompartmental Knee Arthroplasties More Like a Primary or Revision TKA?. J Arthroplasty 2015; 30 (11) 1985-1989
  • 5 Zambianchi F, Digennaro V, Giorgini A. , et al. Surgeon's experience influences UKA survivorship: a comparative study between all-poly and metal back designs. Knee Surg Sports Traumatol Arthrosc 2015; 23 (07) 2074-2080
  • 6 Emerson Jr RH, Higgins LL. Unicompartmental knee arthroplasty with the oxford prosthesis in patients with medial compartment arthritis. J Bone Joint Surg Am 2008; 90 (01) 118-122
  • 7 Kim KT, Lee S, Kim TW, Lee JS, Boo KH. The influence of postoperative tibiofemoral alignment on the clinical results of unicompartmental knee arthroplasty. Knee Surg Relat Res 2012; 24 (02) 85-90
  • 8 Zhang Q, Zhang Q, Guo W. , et al. The learning curve for minimally invasive Oxford phase 3 unicompartmental knee arthroplasty: cumulative summation test for learning curve (LC-CUSUM). J Orthop Surg 2014; 9: 81
  • 9 Ollivier M, Parratte S, Lunebourg A, Viehweger E, Argenson JN. The John Insall Award: no functional benefit after unicompartmental knee arthroplasty performed with patient-specific instrumentation: a randomized trial. Clin Orthop Relat Res 2016; 474 (01) 60-68
  • 10 Kennedy WR, White RP. Unicompartmental arthroplasty of the knee. Postoperative alignment and its influence on overall results. Clin Orthop Relat Res 1987; (221) 278-285
  • 11 Ares O, Castellet E, Maculé F. , et al. Translation and validation of ‘The Knee Society Clinical Rating System’ into Spanish. Knee Surg Sports Traumatol Arthrosc 2013; 21 (11) 2618-2624
  • 12 Vaquero J, Longo UG, Forriol F, Martinelli N, Vethencourt R, Denaro V. Reliability, validity and responsiveness of the Spanish version of the Knee Injury and Osteoarthritis Outcome Score (KOOS) in patients with chondral lesion of the knee. Knee Surg Sports Traumatol Arthrosc 2014; 22 (01) 104-108
  • 13 Schmidt S, Vilagut G, Garin O. , et al. [Reference guidelines for the 12-Item Short-Form Health Survey version 2 based on the Catalan general population]. Med Clin (Barc) 2012; 139 (14) 613-625
  • 14 Svärd UC, Price AJ. Oxford medial unicompartmental knee arthroplasty. A survival analysis of an independent series. J Bone Joint Surg Br 2001; 83 (02) 191-194
  • 15 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
  • 16 Hernigou P, Deschamps G. Alignment influences wear in the knee after medial unicompartmental arthroplasty. Clin Orthop Relat Res 2004; (423) 161-165
  • 17 Kort NP, van Raay JJ, van Horn JJ. The Oxford phase III unicompartmental knee replacement in patients less than 60 years of age. Knee Surg Sports Traumatol Arthrosc 2007; 15 (04) 356-360
  • 18 Kuipers BM, Kollen BJ, Bots PC. , et al. Factors associated with reduced early survival in the Oxford phase III medial unicompartment knee replacement. Knee 2010; 17 (01) 48-52
  • 19 Robertsson O, Knutson K, Lewold S, Lidgren L. The routine of surgical management reduces failure after unicompartmental knee arthroplasty. J Bone Joint Surg Br 2001; 83 (01) 45-49
  • 20 Fitz W. Unicompartmental knee arthroplasty with use of novel patient-specific resurfacing implants and personalized jigs. J Bone Joint Surg Am 2009; 91 (Suppl. 01) 69-76
  • 21 Frye BM, Najim AA, Adams JB, Berend KR, Lombardi Jr AV. MRI is more accurate than CT for patient-specific total knee arthroplasty. Knee 2015; 22 (06) 609-612
  • 22 Jaffry Z, Masjedi M, Clarke S. , et al. Unicompartmental knee arthroplasties: robot vs. patient specific instrumentation. Knee 2014; 21 (02) 428-434
  • 23 Bell SW, Stoddard J, Bennett C, London NJ. Accuracy and early outcomes in medial unicompartmental knee arthroplasty performed using patient specific instrumentation. Knee 2014; 21 (Suppl. 01) S33-S36
  • 24 Kerens B, Schotanus MG, Boonen B, Kort NP. No radiographic difference between patient-specific guiding and conventional Oxford UKA surgery. Knee Surg Sports Traumatol Arthrosc 2015; 23 (05) 1324-1329
  • 25 Karia M, Masjedi M, Andrews B, Jaffry Z, Cobb J. Robotic assistance enables inexperienced surgeons to perform unicompartmental knee arthroplasties on dry bone models with accuracy superior to conventional methods. Adv Orthop 2013; 2013: 481039
  • 26 Hamilton WG, Ammeen D, Engh Jr CA, Engh GA. Learning curve with minimally invasive unicompartmental knee arthroplasty. J Arthroplasty 2010; 25 (05) 735-740