Short- and mid-term effectiveness of unicompartmental knee arthroplasty for post-traumatic arthritis of knee_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

XUE Huaming , MA Tong , WEN Tao , YANG Tao , XUE Long , LEI Xuefeng , JI Jiazhong , ZHANG Wenzheng ,  TU Yihui

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

Corresponding author：

TU Yihui, Email: tuyihui2010@126.com

Keywords：

Post-traumatic arthritis; unicompartmental knee arthroplasty; knee; short- and mid-term effectiveness

DOI：

10.7507/1002-1892.202303051

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Objective To investigate the short- and mid-term effectiveness of unicompartmental knee arthroplasty (UKA) for post-traumatic arthritis (PTA) of knee. Methods The clinical data of 30 patients with PTA of unilateral knee between March 2014 and September 2021 was retrospectively analyzed. There were 14 males and 16 females with an average of 64.5 years (range, 33-81 years). The average body mass index was 26.7 kg/m² (range, 19.8-35.6 kg/m²). The types of injuries that caused PTA included intra-articular fracture in 16 cases, extra-articular fracture in 8 cases, and soft tissue injury in 6 cases. The initial injuries were treated by conservative therapy in 12 cases and by surgical therapy in 18 cases. Ten cases were medial compartment osteoarthritis and 20 cases were lateral compartment osteoarthritis. According to Kellgren-Lawrence staging, there were 19 cases of grade Ⅲ and 11 cases of grade Ⅳ. The operative time, the length of hospital stay, complications, and subjective satisfaction were recorded. The Oxford Knee Function Score (OKS), Hospital for Special Surgery (HSS) score, and knee range of motion (ROM) were used to evaluate knee function. Weight-bearing X-ray films were taken to measure the femoro-tibial angle (FTA) and to assess alignment correction of the lower limb. Results The operative time ranged from 50 to 95 minutes (mean, 63.7 minutes), the length of hospital stay ranged from 3 to 8 days (mean, 6.9 days). Superficial infection occurred in 2 patients, while the remaining incisions healed by first intention. There was no deep vein thrombosis or neurovascular injury. All patients were followed up 17-109 months (median, 70 months). At last follow-up, OKS score, HSS score, and ROM in 30 cases significantly improved when compared with those before operation (P<0.05). Lower limb alignment was significantly corrected and there was significant difference in FTA of the varus and valgus knees between pre- and post-operation (P<0.05). The patient satisfaction rate was 86.7% (26/30). Two cases developed contralateral osteoarthritis progression during follow-up. No bearing dislocation, prosthesis loosening or sinking occurred and none required further revision. Conclusion For patients with PTA of knee, UKA can obtain definite short- and mid-term effectiveness with high patient satisfaction.

Citation： XUE Huaming, MA Tong, WEN Tao, YANG Tao, XUE Long, LEI Xuefeng, JI Jiazhong, ZHANG Wenzheng, TU Yihui. Short- and mid-term effectiveness of unicompartmental knee arthroplasty for post-traumatic arthritis of knee. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(6): 647-652. doi: 10.7507/1002-1892.202303051 Copy

1.	Thomas AC, Hubbard-Turner T, Wikstrom EA, et al. Epidemiology of posttraumatic osteoarthritis. J Athl Train, 2017, 52(6): 491-496.
2.	Çankaya D, Aktı S, Ünal ŞB, et al. Unicompartmental knee arthroplasty results in a better gait pattern than total knee arthroplasty: Gait analysis with a smartphone application. Jt Dis Relat Surg, 2021, 32(1): 22-27.
3.	Madan F, Alsooreti A, Guatteri GC. Combined unicompartmental knee arthroplasty and anterior cruciate ligament reconstruction in a young patient with post-traumatic arthritis. BMJ Case Rep, 2023, 16(4): e252550. doi: 10.1136/bcr-2022-252550.
4.	Mulhall KJ, Ghomrawi HM, Engh GA, et al. Radiographic prediction of intraoperative bone loss in knee arthroplasty revision. Clin Orthop Relat Res, 2006, 446: 51-58.
5.	Khella CM, Asgarian R, Horvath JM, et al. An evidence-based systematic review of human knee post-traumatic osteoarthritis (PTOA): Timeline of clinical presentation and disease markers, comparison of knee joint PTOA models and early disease implications. Int J Mol Sci, 2021, 22(4): 1996. doi: 10.3390/ijms22041996.
6.	Lützner C, Postler A, Beyer F, et al. Total knee arthroplasty in post-traumatic osteoarthritis is more challenging, but results in similar patient satisfaction—An analysis of 1646 cases. Knee, 2022, 39: 116-123.
7.	Marsh JL, Buckwalter J, Gelberman R, et al. Articular fractures: does an anatomic reduction really change the result? J Bone Joint Surg (Am), 2002, 84(7): 1259-1271.
8.	Kramer WC, Hendricks KJ, Wang J. Pathogenetic mechanisms of posttraumatic osteoarthritis: opportunities for early intervention. Int J Clin Exp Med, 2011, 4(4): 285-298.
9.	McCormack DJ, Puttock D, Godsiff SP. Medial compartment osteoarthritis of the knee: a review of surgical options. EFORT Open Rev, 2021, 6(2): 113-117.
10.	Kim KT, Lee S, Lee JS, et al. Long-term clinical results of unicompartmental knee arthroplasty in patients younger than 60 years of age: minimum 10-year follow-up. Knee Surg Relat Res, 2018, 30(1): 28-33.
11.	Kyriakidis T, Asopa V, Baums M, et al. Unicompartmental knee arthroplasty in patients under the age of 60 years provides excellent clinical outcomes and 10-year implant survival: a systematic review: A study performed by the Early Osteoarthritis group of ESSKA-European Knee Associates section. Knee Surg Sports Traumatol Arthrosc, 2023, 31(3): 922-932.
12.	Calkins TE, Hannon CP, Fillingham YA, et al. Fixed-bearing medial unicompartmental knee arthroplasty in patients younger than 55 years of age at 4-19 years of follow-up: A concise follow-up of a previous report. J Arthroplasty, 2021, 36(3): 917-921.
13.	Lee CS, Su EP, Cross MB, et al. Unicompartmental knee arthroplasty is associated with a lower rate of periprosthetic joint infection compared to total knee arthroplasty. Arthroplast Today, 2021, 10: 117-122.
14.	Lustig S, Parratte S, Magnussen RA, et al. Lateral unicompartmental knee arthroplasty relieves pain and improves function in posttraumatic osteoarthritis. Clin Orthop Relat Res, 2012, 470(1): 69-76.
15.	Sah AP, Scott RD. Lateral unicompartmental knee arthroplasty through a medial approach. Study with an average five-year follow-up. J Bone Joint Surg (Am), 2007, 89(9): 1948-1954.
16.	Romagnoli S, Vitale JA, Marullo M. Outcomes of lateral unicompartmental knee arthroplasty in post-traumatic osteoarthritis, a retrospective comparative study. Int Orthop, 2020, 44(11): 2321-2328.
17.	Liu Y, Zhao XD, Zou C. Lingering risk: A meta-analysis of outcomes following primary total knee arthroplasty for patients with post-traumatic arthritis. Int J Surg, 2020, 77: 163-172.
18.	Varacallo M, Luo TD, Johanson NA. Total knee arthroplasty techniques. Treasure Island: StatPearls Publishing, 2023: 1-29.
19.	薛华明, 马童, 文涛, 等. 膝单髁置换术治疗外侧间室膝骨关节炎的中期随访研究. 中华骨与关节外科杂志, 2023, 16(3): 206-212.

1. Thomas AC, Hubbard-Turner T, Wikstrom EA, et al. Epidemiology of posttraumatic osteoarthritis. J Athl Train, 2017, 52(6): 491-496.
2. Çankaya D, Aktı S, Ünal ŞB, et al. Unicompartmental knee arthroplasty results in a better gait pattern than total knee arthroplasty: Gait analysis with a smartphone application. Jt Dis Relat Surg, 2021, 32(1): 22-27.
3. Madan F, Alsooreti A, Guatteri GC. Combined unicompartmental knee arthroplasty and anterior cruciate ligament reconstruction in a young patient with post-traumatic arthritis. BMJ Case Rep, 2023, 16(4): e252550. doi: 10.1136/bcr-2022-252550.
4. Mulhall KJ, Ghomrawi HM, Engh GA, et al. Radiographic prediction of intraoperative bone loss in knee arthroplasty revision. Clin Orthop Relat Res, 2006, 446: 51-58.
5. Khella CM, Asgarian R, Horvath JM, et al. An evidence-based systematic review of human knee post-traumatic osteoarthritis (PTOA): Timeline of clinical presentation and disease markers, comparison of knee joint PTOA models and early disease implications. Int J Mol Sci, 2021, 22(4): 1996. doi: 10.3390/ijms22041996.
6. Lützner C, Postler A, Beyer F, et al. Total knee arthroplasty in post-traumatic osteoarthritis is more challenging, but results in similar patient satisfaction—An analysis of 1646 cases. Knee, 2022, 39: 116-123.
7. Marsh JL, Buckwalter J, Gelberman R, et al. Articular fractures: does an anatomic reduction really change the result? J Bone Joint Surg (Am), 2002, 84(7): 1259-1271.
8. Kramer WC, Hendricks KJ, Wang J. Pathogenetic mechanisms of posttraumatic osteoarthritis: opportunities for early intervention. Int J Clin Exp Med, 2011, 4(4): 285-298.
9. McCormack DJ, Puttock D, Godsiff SP. Medial compartment osteoarthritis of the knee: a review of surgical options. EFORT Open Rev, 2021, 6(2): 113-117.
10. Kim KT, Lee S, Lee JS, et al. Long-term clinical results of unicompartmental knee arthroplasty in patients younger than 60 years of age: minimum 10-year follow-up. Knee Surg Relat Res, 2018, 30(1): 28-33.
11. Kyriakidis T, Asopa V, Baums M, et al. Unicompartmental knee arthroplasty in patients under the age of 60 years provides excellent clinical outcomes and 10-year implant survival: a systematic review: A study performed by the Early Osteoarthritis group of ESSKA-European Knee Associates section. Knee Surg Sports Traumatol Arthrosc, 2023, 31(3): 922-932.
12. Calkins TE, Hannon CP, Fillingham YA, et al. Fixed-bearing medial unicompartmental knee arthroplasty in patients younger than 55 years of age at 4-19 years of follow-up: A concise follow-up of a previous report. J Arthroplasty, 2021, 36(3): 917-921.
13. Lee CS, Su EP, Cross MB, et al. Unicompartmental knee arthroplasty is associated with a lower rate of periprosthetic joint infection compared to total knee arthroplasty. Arthroplast Today, 2021, 10: 117-122.
14. Lustig S, Parratte S, Magnussen RA, et al. Lateral unicompartmental knee arthroplasty relieves pain and improves function in posttraumatic osteoarthritis. Clin Orthop Relat Res, 2012, 470(1): 69-76.
15. Sah AP, Scott RD. Lateral unicompartmental knee arthroplasty through a medial approach. Study with an average five-year follow-up. J Bone Joint Surg (Am), 2007, 89(9): 1948-1954.
16. Romagnoli S, Vitale JA, Marullo M. Outcomes of lateral unicompartmental knee arthroplasty in post-traumatic osteoarthritis, a retrospective comparative study. Int Orthop, 2020, 44(11): 2321-2328.
17. Liu Y, Zhao XD, Zou C. Lingering risk: A meta-analysis of outcomes following primary total knee arthroplasty for patients with post-traumatic arthritis. Int J Surg, 2020, 77: 163-172.
18. Varacallo M, Luo TD, Johanson NA. Total knee arthroplasty techniques. Treasure Island: StatPearls Publishing, 2023: 1-29.
19. 薛华明, 马童, 文涛, 等. 膝单髁置换术治疗外侧间室膝骨关节炎的中期随访研究. 中华骨与关节外科杂志, 2023, 16(3): 206-212.

Chinese Journal of Reparative and Reconstructive Surgery

Short- and mid-term effectiveness of unicompartmental knee arthroplasty for post-traumatic arthritis of knee

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