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J Knee Surg 2021; 34(08): 793-800
DOI: 10.1055/s-0039-3400536
Original Article

Minimally Invasive Inlay Prosthesis Unicompartmental Knee Arthroplasty for the Treatment of Unicompartmental Osteoarthritis: A Prospective Observational Cohort Study with Minimum 2-Year Outcomes and up to 14-Year Survival

Corey Scholes 
1   EBM Analytics, Crows Nest, Sydney, New South Wales, Australia
,
Milad Ebrahimi
1   EBM Analytics, Crows Nest, Sydney, New South Wales, Australia
,
Clarice Field
2   Joint Orthopaedic Centre, Sydney, New South Wales, Australia
,
Sami Farah
2   Joint Orthopaedic Centre, Sydney, New South Wales, Australia
3   AM Orthopaedics, Sydney, New South Wales, Australia
,
Dennis Kerr
2   Joint Orthopaedic Centre, Sydney, New South Wales, Australia
,
Lawrence Kohan
2   Joint Orthopaedic Centre, Sydney, New South Wales, Australia
› Author Affiliations Funding L.K. reports grants from Smith & Nephew during the conduct of the study, personal fees from Medacta outside the submitted work, and funding from Smith & Nephew to support clinical registry activities by J.M. and C.F. for patient recruitment, follow-up, and data management.
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Abstract

There are limited medium-term outcome data available for the Repicci II device in unicompartmental knee arthroplasty (UKA). The purpose of this study was to report the medium-term (minimum 2 years) patient-reported outcomes and long-term (up to 14 years) procedure survival in a consecutive series of patients undergoing an inlay prosthesis UKA (Repicci II) at an independent orthopaedic clinic. Patients presenting with medially localized unicompartmental knee osteoarthritis and meeting the criteria appropriate for UKA were recruited to a clinical patient registry at the time of presentation. A cemented unicompartmental prosthesis (Repicci II) was implanted using minimally invasive techniques with rapid postoperative mobilization. Patients were asked to complete patient-reported outcomes preoperatively and annually postoperatively. A procedure list was cross-matched with the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), and an analysis of procedure survival was performed with comparison to the national data for UKA. Data from a cohort of 661 primary medial compartment UKA procedures performed in 551 patients over a 15-year period were extracted from the clinical patient registry. Significant improvements were maintained in general health, disease symptoms, pain, and function at an average follow-up of 9 years compared with preoperative data. Threshold analysis revealed that >65% of patients exceeded Patient Acceptable Symptom State at the latest follow-up, with >80% within or exceeding age-matched norms for general health. Cumulative revision rate was significantly lower than that reported for UKA in the AOANJRR at up to 13 years follow-up. This series represents a lower cumulative revision rate than previously reported, with >65% of patients reporting satisfactory functional outcomes at an average of 9 years from surgery. Surgical options for treating unicompartmental knee osteoarthritis could include UKA as a viable alternative; however, clear definitions of procedure success and its overall cost–benefit ratio in the context of ongoing management of knee osteoarthritis remain to be elucidated.

Keywords

unicompartmental knee arthroplasty - patient-reported outcomes - long-term follow-up

Disclosure

Sami Farah has a membership of the Orthopaedic Subcommittee of the Therapeutic Goods Administration, Australia.




Publication History

Received: 05 May 2019

Accepted: 14 October 2019

Article published online:
30 December 2019

© 2019. Thieme. All rights reserved.

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

 

  • References

  • 1 Murray DW, Liddle AD, Judge A, Pandit H. Bias and unicompartmental knee arthroplasty. Bone Joint J 2017; 99-B (01) 12-15
    CrossrefPubMedGoogle Scholar
  • 2 O'Donnell T, Neil MJ. The Repicci II® unicondylar knee arthroplasty: 9-year survivorship and function. Clin Orthop Relat Res 2010; 468 (11) 3094-3102
    CrossrefPubMedGoogle Scholar
  • 3 Kerr DR, Kohan L. Local infiltration analgesia: a technique for the control of acute postoperative pain following knee and hip surgery: a case study of 325 patients. Acta Orthop 2008; 79 (02) 174-183
    CrossrefPubMedGoogle Scholar
  • 4 DeHaven KE. Repicci II unicompartmental knee arthroplasty. Arthroscopy 2003; 19 (Suppl. 01) 117-119
    CrossrefPubMedGoogle Scholar
  • 5 Wiik AV, Manning V, Strachan RK, Amis AA, Cobb JP. Unicompartmental knee arthroplasty enables near normal gait at higher speeds, unlike total knee arthroplasty. J Arthroplasty 2013; 28 (9, Suppl): 176-178
    CrossrefPubMedGoogle Scholar
  • 6 Fuchs S, Rolauffs B, Plaumann T, Tibesku CO, Rosenbaum D. Clinical and functional results after the rehabilitation period in minimally-invasive unicondylar knee arthroplasty patients. Knee Surg Sports Traumatol Arthrosc 2005; 13 (03) 179-186
    CrossrefPubMedGoogle Scholar
  • 7 Fuchs S, Strosche H, Tinius W, Gierse H, Gebhardt U. Preliminary remarks on a prospective multicenter study of the Repicci minimally invasive unicondylar knee replacement. Knee Surg Sports Traumatol Arthrosc 2005; 13 (08) 670-676
    CrossrefPubMedGoogle Scholar
  • 8 Romanowski MR, Repicci JA. Minimally invasive unicondylar arthroplasty: eight-year follow-up. J Knee Surg 2002; 15 (01) 17-22
    PubMedGoogle Scholar
  • 9 Australian Orthopaedic Association National Joint Replacement Registry. Hip, Knee & Shoulder Arthroplasty Annual Report. Adelaide: AOA; 2016
    Google Scholar
  • 10 Repicci JA, Eberle RW. Minimally invasive surgical technique for unicondylar knee arthroplasty. J South Orthop Assoc 1999; 8 (01) 20-27 , discussion 27
    PubMedGoogle Scholar
  • 11 de Steiger RN, Hang JR, Miller LN, Graves SE, Davidson DC. Five-year results of the ASR XL Acetabular System and the ASR Hip Resurfacing System: an analysis from the Australian Orthopaedic Association National Joint Replacement Registry. J Bone Joint Surg Am 2011; 93 (24) 2287-2293
    CrossrefPubMedGoogle Scholar
  • 12 Vandenbroucke JP, von Elm E, Altman DG. et al; STROBE Initiative. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. PLoS Med 2007; 4 (10) e297
    CrossrefPubMedGoogle Scholar
  • 13 Guyatt GH, Osoba D, Wu AW, Wyrwich KW, Norman GR. Clinical Significance Consensus Meeting Group. Methods to explain the clinical significance of health status measures. Mayo Clin Proc 2002; 77 (04) 371-383
    CrossrefPubMedGoogle Scholar
  • 14 Ware Jr JE, Bayliss MS, Rogers WH, Kosinski M, Tarlov AR. Differences in 4-year health outcomes for elderly and poor, chronically ill patients treated in HMO and fee-for-service systems. Results from the Medical Outcomes Study. JAMA 1996; 276 (13) 1039-1047
    CrossrefPubMedGoogle Scholar
  • 15 Quintana JM, Escobar A, Bilbao A, Arostegui I, Lafuente I, Vidaurreta I. Responsiveness and clinically important differences for the WOMAC and SF-36 after hip joint replacement. Osteoarthritis Cartilage 2005; 13 (12) 1076-1083
    CrossrefPubMedGoogle Scholar
  • 16 Selim AJ, Rogers W, Fleishman JA. et al. Updated U.S. population standard for the Veterans RAND 12-item Health Survey (VR-12). Qual Life Res 2009; 18 (01) 43-52
    CrossrefPubMedGoogle Scholar
  • 17 Keurentjes JC, Van Tol FR, Fiocco M. et al. Patient acceptable symptom states after total hip or knee replacement at mid-term follow-up: thresholds of the Oxford hip and knee scores. Bone Joint Res 2014; 3 (01) 7-13
    CrossrefPubMedGoogle Scholar
  • 18 Tubach F, Ravaud P, Baron G. et al. Evaluation of clinically relevant states in patient reported outcomes in knee and hip osteoarthritis: the patient acceptable symptom state. Ann Rheum Dis 2005; 64 (01) 34-37
    CrossrefPubMedGoogle Scholar
  • 19 Briggs KK, Steadman JR, Hay CJ, Hines SL. Lysholm score and Tegner activity level in individuals with normal knees. Am J Sports Med 2009; 37 (05) 898-901
    CrossrefPubMedGoogle Scholar
  • 20 Biswal S, Brighton RW. Results of unicompartmental knee arthroplasty with cemented, fixed-bearing prosthesis using minimally invasive surgery. J Arthroplasty 2010; 25 (05) 721-727
    CrossrefPubMedGoogle Scholar
  • 21 Pandit HG, Campi S, Hamilton TW. et al. Five-year experience of cementless Oxford unicompartmental knee replacement. Knee Surg Sports Traumatol Arthrosc 2017; 25 (03) 694-702
    CrossrefPubMedGoogle Scholar
  • 22 Burn E, Sanchez-Santos MT, Pandit HG. et al. Ten-year patient-reported outcomes following total and minimally invasive unicompartmental knee arthroplasty: a propensity score-matched cohort analysis. Knee Surg Sports Traumatol Arthrosc 2018; 26 (05) 1455-1464
    CrossrefPubMedGoogle Scholar
  • 23 Zuiderbaan HA, van der List JP, Khamaisy S. et al. Unicompartmental knee arthroplasty versus total knee arthroplasty: which type of artificial joint do patients forget?. Knee Surg Sports Traumatol Arthrosc 2017; 25 (03) 681-686
    CrossrefPubMedGoogle Scholar
  • 24 Howieson A, Farrington W. Unicompartmental knee replacement in the elderly: a systematic review. Acta Orthop Belg 2015; 81 (04) 565-571
    PubMedGoogle Scholar
  • 25 Zuiderbaan HA, van der List JP, Chawla H, Khamaisy S, Thein R, Pearle AD. Predictors of subjective outcome after medial unicompartmental knee arthroplasty. J Arthroplasty 2016; 31 (07) 1453-1458
    CrossrefPubMedGoogle Scholar
  • 26 van der List JP, Chawla H, Zuiderbaan HA, Pearle AD. The role of preoperative patient characteristics on outcomes of unicompartmental knee arthroplasty: a meta-analysis critique. J Arthroplasty 2016; 31 (11) 2617-2627
    CrossrefPubMedGoogle Scholar
  • 27 Thompson SAJ, Liabaud B, Nellans KW, Geller JA. Factors associated with poor outcomes following unicompartmental knee arthroplasty: redefining the “classic” indications for surgery. J Arthroplasty 2013; 28 (09) 1561-1564
    CrossrefPubMedGoogle Scholar
  • 28 Hamilton TW, Rizkalla JM, Kontochristos L. et al. The interaction of caseload and usage in determining outcomes of unicompartmental knee arthroplasty: a meta-analysis. J Arthroplasty 2017; 32 (10) 3228-3237.e2
    CrossrefPubMedGoogle Scholar
  • 29 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
    CrossrefPubMedGoogle Scholar
  • 30 Filbay SR, Judge A, Delmestri A, Arden NK. COASt Study Group. Evaluating patients' expectations from a novel patient-centered perspective predicts knee arthroplasty outcome. J Arthroplasty 2018; 33 (07) 2146-2152.e4
    CrossrefPubMedGoogle Scholar
  • 31 Liebs TR, Splietker F, Hassenpflug J. Is a revision a revision? An analysis of National Arthroplasty Registries' definitions of revision. Clin Orthop Relat Res 2015; 473 (11) 3421-3430
    CrossrefPubMedGoogle Scholar
  • 32 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
    CrossrefPubMedGoogle Scholar
  • 33 Burn E, Liddle AD, Hamilton TW. et al. Choosing between unicompartmental and total knee replacement: what can economic evaluations tell us? A systematic review. Pharmacoeconom Open 2017; 1 (04) 241-253
    CrossrefPubMedGoogle Scholar
  • 34 Waldstein W, Kolbitsch P, Koller U, Boettner F, Windhager R. Sport and physical activity following unicompartmental knee arthroplasty: a systematic review. Knee Surg Sports Traumatol Arthrosc 2017; 25 (03) 717-728
    CrossrefPubMedGoogle Scholar
  • 35 Ali AM, Pandit H, Liddle AD. et al. Does activity affect the outcome of the Oxford unicompartmental knee replacement?. Knee 2016; 23 (02) 327-330
    CrossrefPubMedGoogle Scholar
  • 36 Rodrigues da Silva JM, de Rezende MU, Spada TC. et al. Educational program promoting regular physical exercise improves functional capacity and daily living physical activity in subjects with knee osteoarthritis. BMC Musculoskelet Disord 2017; 18 (01) 546
    CrossrefPubMedGoogle Scholar
  • 37 Moyer R, Ikert K, Long K, Marsh J. The value of preoperative exercise and education for patients undergoing total hip and knee arthroplasty: a systematic review and meta-analysis. JBJS Rev 2017; 5 (12) e2
    CrossrefPubMedGoogle Scholar
  • 38 Wang L, Lee M, Zhang Z, Moodie J, Cheng D, Martin J. Does preoperative rehabilitation for patients planning to undergo joint replacement surgery improve outcomes? A systematic review and meta-analysis of randomised controlled trials. BMJ Open 2016; 6 (02) e009857
    CrossrefPubMedGoogle Scholar