Appropriate Timing for Evaluation of the Short-Term Effectiveness of Unicompartmental Knee Arthroplasty

Abstract

Satisfactory results have been achieved with unicompartmental knee arthroplasty (UKA) for the treatment of isolated unicompartmental knee disease. However, UKA is associated with a significantly higher rate of revision. There is a tendency toward early revision of UKA for persistent pain because surgeons are not aware that outcomes can spontaneously improve with time. The aim of this study was to identify the time period that patients achieved the highest clinical outcomes following UKA. In total, we examined 72 knees that underwent Oxford UKA. We evaluated the range of motion and clinical results including Knee Society Knee Score, Knee Society Function Score (KSFS), and patient-reported scores using the Knee injury and Osteoarthritis Outcome Score (KOOS) at 1, 2, and 3 years postoperatively. The extension angle showed significant recovery from 1 to 2 years postoperatively, but no significant recovery was observed between 2 and 3 years. The flexion angle at 2 years is larger than at 1 year. The KSFS at 3 years is significantly lower than that at 1 year. The KOOS subscale of activities of daily living showed no significant differences among three periods after operation. The subscales of pain, symptom, sports, and quality of life showed significant recovery from 1 to 2 years postoperatively, but no significant recovery was observed from 2 to 3 years. To evaluate the effectiveness of Oxford UKA, surgeons should obtain clinical outcomes 2 years after the operation.

Keywords

unicompartmental knee arthroplasty - Oxford knee system - patient-reported outcome - unnecessary earlier revision - deterioration with age

Publication History

Received: 03 May 2019

Accepted: 10 November 2019

Article published online:
30 December 2019

• References

• 1 Goodfellow JW, Tibrewal SB, Sherman KP, O'Connor JJ. Unicompartmental Oxford Meniscal knee arthroplasty. J Arthroplasty 1987; 2 (01) 1-9
• 2 Kendrick BJ, Simpson DJ, Kaptein BL. et al. Polyethylene wear of mobile-bearing unicompartmental knee replacement at 20 years. J Bone Joint Surg Br 2011; 93 (04) 470-475
• 3 Pandit H, Hamilton TW, Jenkins C, Mellon SJ, Dodd CA, Murray DW. The clinical outcome of minimally invasive phase 3 Oxford knee arthroplasty: a 15-year follow-up of 1000 UKAs. Bone Joint J 2015; 97: 1493-1500
• 4 Yoshida K, Tada M, Yoshida H, Takei S, Fukuoka S, Nakamura H. Oxford phase 3 unicompartmental knee arthroplasty in Japan--clinical results in greater than one thousand cases over ten years. J Arthroplasty 2013; 28 (9, Suppl): 168-171
• 5 Liddle AD, Pandit H, Judge A, Murray DW. Optimal usage of unicompartmental knee arthroplasty: a study of 41,986 cases from the National Joint Registry for England and Wales. Bone Joint J 2015; 97-B (11) 1506-1511
• 6 Baker PN, Petheram T, Avery PJ, Gregg PJ, Deehan DJ. Revision for unexplained pain following unicompartmental and total knee replacement. J Bone Joint Surg Am 2012; 94 (17) e126
• 7 The New Zealand Joint Registry: Seventeen Year Report. New Zealand Orthopaedic Association. 2016 https://nzoa.org.nz/system/files/NZJR%2017%20year%20Report.pdf [date last accessed 18 January 2018)
• 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
• 9 Matsuzaki T, Matsumoto T, Muratsu H. et al. The contribution of intraoperative medial compartment stability to post-operative knee flexion angle in unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2017; 25 (01) 272-276
• 10 Guo WS, Zhang QD, Liu ZH. et al. Minimally invasive unicompartmental knee arthroplasty for spontaneous osteonecrosis of the knee. Orthop Surg 2015; 7 (02) 119-124
• 11 Bremner-Smith AT, Ewings P, Weale AE. Knee scores in a ‘normal’ elderly population. Knee 2004; 11 (04) 279-282
• 12 Goodfellow JW, O'Connor JJ, Murray DW. A critique of revision rate as an outcome measure: re-interpretation of knee joint registry data. J Bone Joint Surg Br 2010; 92 (12) 1628-1631
• 13 Kawaguchi K, Inui H, Taketomi S. et al. Meniscal bearing dislocation while rolling over in sleep following Oxford medial unicompartmental knee arthroplasty. Knee 2019; 26 (01) 267-272
• 14 Inui H, Taketomi S, Yamagami R, Tahara K, Tanaka S. Snapping Pes syndrome after unicompartmental knee arthroplasty. Knee Surg Relat Res 2016; 28 (02) 172-175
• 15 Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 1989; (248) 13-14
• 16 Roos EM, Lohmander LS. The Knee injury and Osteoarthritis Outcome Score (KOOS): from joint injury to osteoarthritis. Health Qual Life Outcomes 2003; 1: 64
• 17 Nakamura N, Takeuchi R, Sawaguchi T, Ishikawa H, Saito T, Goldhahn S. Cross-cultural adaptation and validation of the Japanese Knee Injury and Osteoarthritis Outcome Score (KOOS). J Orthop Sci 2011; 16 (05) 516-523
• 18 Goodfellow JW, O'Connor J, Pandit H, Dodd C, Murray D. Unicompartmental arthroplasty with the Oxford knee. Second edition. Goodfellow Publishers, Oxford: Oxford University Press; 2015: 29-89
• 19 Inui H, Taketomi S, Yamagami R, Sanada T, Shirakawa N, Tanaka S. Impingement of the mobile bearing on the lateral wall of the tibial tray in unicompartmental knee arthroplasty. J Arthroplasty 2016; 31 (07) 1459-1464
• 20 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
• 21 Inui H, Taketomi S, Tahara K, Yamagami R, Sanada T, Tanaka S. A modified technique to reduce tibial keel cutting errors during an Oxford unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2017; 25 (03) 710-716
• 22 Kamenaga T, Hiranaka T, Kikuchi K, Hida Y, Fujishiro T, Okamoto K. Influence of tibial component rotation on short-term clinical outcomes in Oxford mobile-bearing unicompartmental knee arthroplasty. Knee 2018; 25 (06) 1222-1230
• 23 Campi S, Pandit H, Hooper G. et al. Ten-year survival and seven-year functional results of cementless Oxford unicompartmental knee replacement: a prospective consecutive series of our first 1000 cases. Knee 2018; 25 (06) 1231-1237
• 24 Davies AP. Rating systems for total knee replacement. Knee 2002; 9 (04) 261-266
• 25 Nerhus TK, Heir S, Svege I. et al. Time-dependent improvement in functional outcome following Oxford medial unicompartmental knee arthroplasty. A prospective longitudinal multicenter study involving 96 patients. Acta Orthop 2012; 83 (01) 46-52
• 26 Ingale PA, Hadden WA. A review of mobile bearing unicompartmental knee in patients aged 80 years or older and comparison with younger groups. J Arthroplasty 2013; 28 (02) 262-267.e2
• 27 Matharu G, Robb C, Baloch K, Pynsent P. The Oxford medial unicompartmental knee replacement: survival and the affect of age and gender. Knee 2012; 19 (06) 913-917
• 28 Jacobs CA, Christensen CP, Karthikeyan T. Patient and intraoperative factors influencing satisfaction two to five years after primary total knee arthroplasty. J Arthroplasty 2014; 29 (08) 1576-1579
• 29 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
• 30 Bergeson AG, Berend KR, Lombardi Jr AV, Hurst JM, Morris MJ, Sneller MA. Medial mobile bearing unicompartmental knee arthroplasty: early survivorship and analysis of failures in 1000 consecutive cases. J Arthroplasty 2013; 28 (9, Suppl): 172-175
• 31 Kawaguchi K, Michishita K, Manabe T, Akasaka Y, Kaminaga N. Arthroscopic scar resection for the treatment of anteromedial knee pain after oxford unicompartmental knee arthroplasty: a case report. J Orthop Case Rep 2016; 6 (04) 96-99
• 32 Lim JW, Cousins GR, Clift BA, Ridley D, Johnston LR. Oxford unicompartmental knee arthroplasty versus age and gender matched total knee arthroplasty - functional outcome and survivorship analysis. J Arthroplasty 2014; 29 (09) 1779-1783
• 33 Lygre SH, Espehaug B, Havelin LI, Furnes O, Vollset SE. Pain and function in patients after primary unicompartmental and total knee arthroplasty. J Bone Joint Surg Am 2010; 92 (18) 2890-2897
• 34 Argenson JN, Parratte S, Ashour A, Saintmard B, Aubaniac JM. The outcome of rotating-platform total knee arthroplasty with cement at a minimum of ten years of follow-up. J Bone Joint Surg Am 2012; 94 (07) 638-644