LATERAL UNICOMPARTMENTAL KNEE ARTHROPLASTY THROUGH A LATERAL PARAPATELLAR APPROACH FOR LATERAL COMPARTMENTAL OSTEOARTHRITIS_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

XUEHuaming , MATong , WENTao , CAIMingwei ,  TUYihui

Department of Orthopaedics, Yangpu Hospital Affiliated to Tongji University, Shanghai, 200090, P. R. China;

Corresponding author：

TUYihui, Email: tuyihui2010@126.com

Keywords：

Lateral unicompartmental knee arthroplasty; Lateral parapatellar approach; Lateral compartment; Osteoarthritis

DOI：

10.7507/1002-1892.20150005

Video：

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Objective To explore the feasibility and short-term effectiveness of lateral unicompartmental knee arthroplasty (LUKA) through a lateral parapatellar approach for lateral compartmental osteoarthritis (LCOA). Methods Between November 2010 and August 2012, 15 consecutive patients (15 knees) with LCOA were treated with LUKA. There were 7 men and 8 women with a mean age of 67.3 years (range, 51-82 years). The mean duration of disease was 5.4 years (range, 3-15 years). The left knee was involved in 6 cases and the right knee in 9 cases. According to Ahlback rating, there were 2 cases (2 knees) of grade I, 8 cases (8 knees) of grade Ⅱ, and 5 cases (5 knees) of grade Ⅲ. The incision length, operation time, blood loss, drainage, and complication were recorded. The pre- and post-operative knee function was evaluated by Hospital for Special Surgery (HSS) score system. The pre- and post-operative range of motion (ROM) and alignment of the lower limbs (hip-knee-ankle angle) were measured and compared. Results ACL rupture or medial compartmental osteoarthritis occurred in 2 patients (2 knees) who changed to total knee arthroplasty (TKA); 1 case (1 knee) failed to follow up. The other 12 cases (12 knees) were followed up 32.5 months on average (range, 26- 45 months). The mean length of incision was 6.9 cm (range, 6-8 cm); the mean operation time was 115.8 minutes (range,90-155 minutes); the mean blood loss volume during operation was 152.2 mL (range, 105-250 mL); and mean drainage was 145.6 mL (range, 50-300 mL). At last follow-up, the average HSS score was significantly improved from 73.4±4.6 preoperatively to 94.6±2.1 postoperatively (t=14.240, P=0.000). The results were excellent in 9 cases, good in 2 cases, and fair in 1 case, with an excellent and good rate of 91.7%. The hip-knee-ankle angle was significantly decreased from valgus angle of (10.08±1.38)° preoperatively to valgus angle of (5.17±0.94)° postoperatively (t=14.626, P=0.000). Postoperative ROM was significantly improved to (123.75±4.09)° from (108.67±5.10)° preoperatively (t=8.998, P=0.000). Two patients developed superficial skin infection, which was managed with anti-inflammatory therapy and dressing. No patient had complication of deep vein thrombosis, prosthesis dislocation and loosing, or development of medial osteoarthritis. Conclusion LUKA through a lateral approach has the advantages of rapid recovery of joint function, less complication, and small trauma in the treatment of LCOA. Correct patient selection and further mid- and long-term studies, however, are essential.

Citation： XUEHuaming, MATong, WENTao, CAIMingwei, TUYihui. LATERAL UNICOMPARTMENTAL KNEE ARTHROPLASTY THROUGH A LATERAL PARAPATELLAR APPROACH FOR LATERAL COMPARTMENTAL OSTEOARTHRITIS. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(1): 19-23. doi: 10.7507/1002-1892.20150005 Copy

1.	Smith JR, Robinson JR, Porteous AJ, et al. Fixed bearing lateral unicompartmental knee arthroplasty-short to midterm survivorship and knee scores for 101 prostheses. Knee, 2014, 21(4):843-847.
2.	肖国庆, 钟喜红, 程劲, 等. 关节镜治疗轻中度膝关节骨关节炎疗效分析. 中国修复重建外科杂志, 2011, 25(6):775-766.
3.	Duthon VB, Miozzari H. Unicompartmental knee replacement. Rev Med Suisse, 2013, 9(411):2380-2384.
4.	薛华明, 蔡珉巍, 涂意辉. 膝关节外侧间室单髁置换术临床应用进展. 中华关节外科(电子版), 2012, 6(3):77-79.
5.	Lustig S, Elguindy A, Servien E, et al. 5- to 16- year follow-up of 54 consecutive lateral unicondylar knee arthroplasties with a fixed-all polyethylene bearing. J Arthroplasty, 2011, 26(8):1318-1325.
6.	Thein R, Khamaisy S, Zuiderbaan HA, et al. Lateral robotic unicompartmental knee arthroplasty. Sports Med Arthrosc, 2014, 22(4):223-228.
7.	Heyse TJ, Tibesku CO. Lateral unicompartmental knee arthroplasty:a review. Arch Orthop Trauma Surg, 2010, 130(12):1539-1548.
8.	Weston-Simons JS, Pandit H, Kendrick BJ, et al. The mid-term outcomes of the Oxford Domed Lateral unicompartmental knee replacement. Bone Joint J, 2014, 96-B(1):59-64.
9.	Ollivier M, Abdel MP, Parratte S, et al. Lateral unicondylar knee arthroplasty (UKA):contemporary indications, surgical technique, and results. Int Orthop, 2014, 38(2):449-455.
10.	Sah AP, Scott RD. Lateral unicompartmental knee arthroplasty through a medial approach. Study with an average five-year followup. J Bone Joint Surg (Am), 2007, 89(9):1948-1954.
11.	Jackson M, Sarangi PP, Newman JH. Revision total knee arthroplasty. Comparison of outcome following primary proximal tibial osteotomy or unicompartmental arthroplasty. J Arthroplasty, 1994, 9(5):539-542.
12.	Berend KR, Kolczun MC 2nd, George JW Jr, et al. Lateral unicompartmental knee arthroplasty through a lateral parapatellar approach has high early survivorship. Clin Orthop Relat Res, 2012, 470(1):77-83.
13.	Pennington DW, Swienckowski JJ, Lutes WB, et al. Lateral unicompartmental knee arthroplasty:survivorship and technical considerations at an average follow-up of 12.4 years. J Arthroplasty, 2006, 21(1):13-17.
14.	Baker PN, Jameson SS, Deehan DJ, et al. Mid-term equivalent survival of medial and lateral unicondylar knee replacement:an analysis of data from a National Joint Registry. J Bone Joint Surg (Br), 2012, 94(12):1641-1648.
15.	Liebs TR, Herzberg W. Better quality of life after medial versus lateral unicondylar knee arthroplasty. Clin Orthop Relat Res, 2013, 471(8):2629-2640.
16.	Scott CE, Nutton RW, Biant LC. Lateral compartment osteoarthritis of the knee:Biomechanics and surgical management of end-stage disease. Bone Joint J, 2013, 95-B(4):436-444.
17.	Gulati A, Chau R, Beard DJ, et al. Localization of the full-thickness cartilage lesions in medial and lateral unicompartmental knee osteoarthritis. J Orthop Res, 2009, 27(10):1339-1346.
18.	Lustig S, Lording T, Frank F, et al. Progression of medial osteoarthritis and long term results of lateral unicompartmental arthroplasty:10 to 18 year follow-up of 54 consecutive implants. Knee, 2014, 21(Suppl 1):S26-32.

1. Smith JR, Robinson JR, Porteous AJ, et al. Fixed bearing lateral unicompartmental knee arthroplasty-short to midterm survivorship and knee scores for 101 prostheses. Knee, 2014, 21(4):843-847.
2. 肖国庆, 钟喜红, 程劲, 等. 关节镜治疗轻中度膝关节骨关节炎疗效分析. 中国修复重建外科杂志, 2011, 25(6):775-766.
3. Duthon VB, Miozzari H. Unicompartmental knee replacement. Rev Med Suisse, 2013, 9(411):2380-2384.
4. 薛华明, 蔡珉巍, 涂意辉. 膝关节外侧间室单髁置换术临床应用进展. 中华关节外科(电子版), 2012, 6(3):77-79.
5. Lustig S, Elguindy A, Servien E, et al. 5- to 16- year follow-up of 54 consecutive lateral unicondylar knee arthroplasties with a fixed-all polyethylene bearing. J Arthroplasty, 2011, 26(8):1318-1325.
6. Thein R, Khamaisy S, Zuiderbaan HA, et al. Lateral robotic unicompartmental knee arthroplasty. Sports Med Arthrosc, 2014, 22(4):223-228.
7. Heyse TJ, Tibesku CO. Lateral unicompartmental knee arthroplasty:a review. Arch Orthop Trauma Surg, 2010, 130(12):1539-1548.
8. Weston-Simons JS, Pandit H, Kendrick BJ, et al. The mid-term outcomes of the Oxford Domed Lateral unicompartmental knee replacement. Bone Joint J, 2014, 96-B(1):59-64.
9. Ollivier M, Abdel MP, Parratte S, et al. Lateral unicondylar knee arthroplasty (UKA):contemporary indications, surgical technique, and results. Int Orthop, 2014, 38(2):449-455.
10. Sah AP, Scott RD. Lateral unicompartmental knee arthroplasty through a medial approach. Study with an average five-year followup. J Bone Joint Surg (Am), 2007, 89(9):1948-1954.
11. Jackson M, Sarangi PP, Newman JH. Revision total knee arthroplasty. Comparison of outcome following primary proximal tibial osteotomy or unicompartmental arthroplasty. J Arthroplasty, 1994, 9(5):539-542.
12. Berend KR, Kolczun MC 2nd, George JW Jr, et al. Lateral unicompartmental knee arthroplasty through a lateral parapatellar approach has high early survivorship. Clin Orthop Relat Res, 2012, 470(1):77-83.
13. Pennington DW, Swienckowski JJ, Lutes WB, et al. Lateral unicompartmental knee arthroplasty:survivorship and technical considerations at an average follow-up of 12.4 years. J Arthroplasty, 2006, 21(1):13-17.
14. Baker PN, Jameson SS, Deehan DJ, et al. Mid-term equivalent survival of medial and lateral unicondylar knee replacement:an analysis of data from a National Joint Registry. J Bone Joint Surg (Br), 2012, 94(12):1641-1648.
15. Liebs TR, Herzberg W. Better quality of life after medial versus lateral unicondylar knee arthroplasty. Clin Orthop Relat Res, 2013, 471(8):2629-2640.
16. Scott CE, Nutton RW, Biant LC. Lateral compartment osteoarthritis of the knee:Biomechanics and surgical management of end-stage disease. Bone Joint J, 2013, 95-B(4):436-444.
17. Gulati A, Chau R, Beard DJ, et al. Localization of the full-thickness cartilage lesions in medial and lateral unicompartmental knee osteoarthritis. J Orthop Res, 2009, 27(10):1339-1346.
18. Lustig S, Lording T, Frank F, et al. Progression of medial osteoarthritis and long term results of lateral unicompartmental arthroplasty:10 to 18 year follow-up of 54 consecutive implants. Knee, 2014, 21(Suppl 1):S26-32.

Chinese Journal of Reparative and Reconstructive Surgery

LATERAL UNICOMPARTMENTAL KNEE ARTHROPLASTY THROUGH A LATERAL PARAPATELLAR APPROACH FOR LATERAL COMPARTMENTAL OSTEOARTHRITIS

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