Surgical technique of lateral unicompartmental knee arthroplasty and discussion of the maximum correction value in the treatment of knee valgus deformity_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIU Xin , ZHENG Kai , ZHU Feng , WANG Yijun , ZHANG Lianfang , ZHANG Weicheng , GENG Dechun , ZHOU Jun ,  XU Yaozeng

Department of Orthopedics, the First Affiliated Hospital of Soochow University, Suzhou Jiangsu, 215006, P. R. China;

Corresponding author：

XU Yaozeng, Email: xuyaozeng@163.com

Keywords：

Lateral unicompartmental knee arthroplasty; knee valgus; preoperative planning; correctable knee valgus deformity value

DOI：

10.7507/1002-1892.202307005

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Objective To investigate the surgical technique and the short-term effectivenss of lateral unicompartmental knee arthroplasty (LUKA) through lateral approach in the treatment of valgus knee and to calculate the maximum value of the theoretical correction of knee valgus deformity. Methods A retrospective analysis was performed on 16 patients (20 knees) who underwent LUKA and met the selection criteria between April 2021 and July 2022. There were 2 males and 14 females, aged 57-85 years (mean, 71.5 years). The disease duration ranged from 1 to 18 years, with an average of 11.9 years. Knee valgus was staged according to Ranawat classification, there were 6 knees of type Ⅰ, 13 knees of type Ⅱ, and 1 knee of type Ⅲ. All patients were assigned the expected correction value of genu valgus deformity by preoperative planning, including the correction value of lateral approach, intra-articular correction value, and residual knee valgus deformity value. The actual postoperative corrected values of the above indicators were recorded and the theoretical maximum correctable knee valgus deformity values were extrapolated. The operation time, intraoperative blood loss, incision length, hospital stay, hip-knee-ankle angle (HKA), mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibia angle (mMPTA), joint line convergence angle (JLCA), posterior tibial slope (PTS), range of motion (ROM), Hospital for Special Surgery (HSS) score, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score were also recorded for effectiveness evaluation. Results The patients’ incision length averaged 13.83 cm, operation time averaged 85.8 minutes, intraoperative blood loss averaged 74.9 mL, and hospital stay averaged 6.7 days. None of the patients suffered any significant intraoperative neurological or vascular injuries. All patients were followed up 10-27 months, with a mean of 17.9 months. One patient with bilateral knee valgus deformities had intra-articular infection in the left knee at 1 month after operation and the remaining patients had no complication such as prosthesis loosening, dislocation, and infection. The ROM, HSS score, and WOMAC score of knee joint significantly improved at each time point after operation when compared to those before operation, and the indicators further improved with time after operation, the differences were all significant (P<0.05). Imaging measurement showed that HKA, mLDFA, JLCA, and PTS significantly improved at 3 days after operation (P<0.05) except for mMPTA (P>0.05). Postoperative evaluation of the knee valgus deformity correction values showed that the actual intra-articular correction values ranged from 0.54° to 10.97°, with a mean of 3.84°. The postoperative residual knee valgus deformity values ranged from 0.42° to 5.30°, with a mean of 3.59°. The actual correction values of lateral approach ranged from 0.21° to 12.73°, with a mean of 4.26°. Conclusion LUKA through lateral approach for knee valgus deformity can achieve good early effectiveness. Preoperative planning can help surgeons rationally allocate the correction value of knee valgus deformity, provide corresponding treatment strategies, and the maximum theoretical correction value of knee valgus deformity can reach 25°.

Citation： LIU Xin, ZHENG Kai, ZHU Feng, WANG Yijun, ZHANG Lianfang, ZHANG Weicheng, GENG Dechun, ZHOU Jun, XU Yaozeng. Surgical technique of lateral unicompartmental knee arthroplasty and discussion of the maximum correction value in the treatment of knee valgus deformity. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(10): 1238-1245. doi: 10.7507/1002-1892.202307005 Copy

1.	Sharma L, Song J, Felson DT, et al. The role of knee alignment in disease progression and functional decline in knee osteoarthritis. JAMA, 2001, 286(2): 188-195.
2.	Wang D, Willinger L, Athwal KK, et al. Knee joint line obliquity causes tibiofemoral subluxation that alters contact areas and meniscal loading. Am J Sports Med, 2021, 49(9): 2351-2360.
3.	Stoddart JC, Dandridge O, Garner A, et al. The compartmental distribution of knee osteoarthritis-a systematic review and meta-analysis. Osteoarthritis Cartilage, 2021, 29(4): 445-455.
4.	Cvetanovich GL, Christian DR, Garcia GH, et al. Return to sport and patient satisfaction after meniscal allograft transplantation. Arthroscopy, 2020, 36(9): 2456-2463.
5.	Ramkumar PN, Karnuta JM, Haeberle HS, et al. Effect of preoperative imaging and patient factors on clinically meaningful outcomes and quality of life after osteochondral allograft transplantation: A machine learning analysis of cartilage defects of the knee. Am J Sports Med, 2021, 49(8): 2177-2186.
6.	Sherman SL, Thompson SF, Clohisy JCF. Distal femoral varus osteotomy for the management of valgus deformity of the knee. J Am Acad Orthop Surg, 2018, 26(9): 313-324.
7.	Johal S, Nakano N, Baxter M, et al. Unicompartmental knee arthroplasty: the past, current controversies, and future perspectives. J Knee Surg, 2018, 31(10): 992-998.
8.	Greco NJ, Cook GJE, Lombardi Jr AV, et al. Lateral unicompartmental knee arthroplasty utilizing a modified surgical technique and specifically adapted fixed-bearing implant. Surg Technol Int, 2019, 34: 371-378.
9.	Plancher KD, Briggs KK, Chinnakkannu K, et al. Isolated lateral tibiofemoral compartment osteoarthritis: survivorship and patient acceptable symptom state after lateral fixed-bearing unicompartmental knee arthroplasty at mean 10-year follow-up. J Bone Joint Surg (Am), 2022, 104(18): 1621-1628.
10.	Sah AP, Scott RD. Lateral unicompartmental knee arthroplasty through a medial approach. Surgical technique. J Bone Joint Surg (Am), 2008, 90 Suppl 2 Pt 2: 195-205.
11.	Berend KR, Kolczun MC, George JW, et al. Lateral unicompartmental knee arthroplasty through a lateral parapatellar approach has high early survivorship. Clin Orthop Relat Res, 2012, 470(1): 77-83.
12.	Thein R, Khamaisy S, Zuiderbaan HA, et al. Lateral robotic unicompartmental knee arthroplasty. Sports Med Arthrosc Rev, 2014, 22(4): 223-228.
13.	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.
14.	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.
15.	Isaac SM, Barker KL, Danial IN, et al. Does arthroplasty type influence knee joint proprioception? A longitudinal prospective study comparing total and unicompartmental arthroplasty. Knee, 2007, 14(3): 212-217.
16.	Sun PF, Jia YH. Mobile bearing UKA compared to fixed bearing TKA: a randomized prospective study. Knee, 2012, 19(2): 103-106.
17.	Smith E, Lee D, Masonis J, et al. Lateral unicompartmental knee arthroplasty. JBJS Rev, 2020, 8(3): e0044.
18.	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.
19.	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.
20.	Dudek P, Marczak D, Okoń T, et al. Lateral or medial parapatellar surgical approach to the valgus osteoarthritic knee? A retrospective single-center study. J Clin Med, 2022, 11(19): 5953.
21.	Keblish PA. The lateral approach to the valgus knee. Surgical technique and analysis of 53 cases with over two-year follow-up evaluation. Clin Orthop Relat Res, 1991(271): 52-62.
22.	Eberbach H, Mehl J, Feucht MJ, et al. Geometry of the valgus knee: Contradicting the dogma of a femoral-based deformity. Am J Sports Med, 2017, 45(4): 909-914.
23.	Xue H, Ma T, Wen T, et al. Predictors of satisfactory outcomes with fixed-bearing lateral unicompartmental knee arthroplasty: Up to 7-year follow-up. J Arthroplasty, 2021, 36(3): 910-916.
24.	Heckmann ND, Antonios JK, Chen XT, et al. Midterm survivorship of robotic-assisted lateral unicompartmental knee arthroplasty. J Arthroplasty, 2022, 37(5): 831-836.
25.	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.
26.	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. 中华关节外科杂志 (电子版), 2012, 6(3): 77-79.
27.	Elkus M, Ranawat CS, Rasquinha VJ, et al. Total knee arthroplasty for severe valgus deformity. Five to fourteen-year follow-up. J Bone Joint Surg (Am), 2004, 86(12): 2671-2676.
28.	Pagoti R, O’Brien S, Doran E, et al. Unconstrained total knee arthroplasty in significant valgus deformity: a modified surgical technique to balance the knee and avoid instability. Knee Surg Sports Traumatol Arthrosc, 2017, 25(9): 2825-2834.
29.	McLean SG, Mallett KF, Arruda EM. Deconstructing the anterior cruciate ligament: what we know and do not know about function, material properties, and injury mechanics. J Biomech Eng, 2015, 137(2): 020906.
30.	Defrate LE, Papannagari R, Gill TJ, et al. The 6 degrees of freedom kinematics of the knee after anterior cruciate ligament deficiency: an in vivo imaging analysis. Am J Sports Med, 2006, 34(8): 1240-1246.
31.	Hart HF, Stefanik JJ, Wyndow N, et al. The prevalence of radiographic and MRI-defined patellofemoral osteoarthritis and structural pathology: a systematic review and meta-analysis. Br J Sports Med, 2017, 51(16): 1195-1208.
32.	Wen T, Xue H, Ma T, et al. A standardized technique for lateral unicompartmental knee arthroplasty. J Orthop Surg (Hong Kong), 2023, 31(1): 10225536231164028.
33.	Katz JN, Arant KR, Loeser RF. Diagnosis and treatment of hip and knee osteoarthritis: A review. JAMA, 2021, 325(6): 568-578.
34.	Witjes S, Gouttebarge V, Kuijer PP, et al. Return to sports and physical activity after total and unicondylar knee arthroplasty: A systematic review and meta-analysis. Sports Med, 2016, 46(2): 269-292.
35.	Fujita M, Hiranaka T, Mai B, et al. External rotation of the tibial component should be avoided in lateral unicompartmental knee arthroplasty. Knee, 2021, 30: 70-77.

1. Sharma L, Song J, Felson DT, et al. The role of knee alignment in disease progression and functional decline in knee osteoarthritis. JAMA, 2001, 286(2): 188-195.
2. Wang D, Willinger L, Athwal KK, et al. Knee joint line obliquity causes tibiofemoral subluxation that alters contact areas and meniscal loading. Am J Sports Med, 2021, 49(9): 2351-2360.
3. Stoddart JC, Dandridge O, Garner A, et al. The compartmental distribution of knee osteoarthritis-a systematic review and meta-analysis. Osteoarthritis Cartilage, 2021, 29(4): 445-455.
4. Cvetanovich GL, Christian DR, Garcia GH, et al. Return to sport and patient satisfaction after meniscal allograft transplantation. Arthroscopy, 2020, 36(9): 2456-2463.
5. Ramkumar PN, Karnuta JM, Haeberle HS, et al. Effect of preoperative imaging and patient factors on clinically meaningful outcomes and quality of life after osteochondral allograft transplantation: A machine learning analysis of cartilage defects of the knee. Am J Sports Med, 2021, 49(8): 2177-2186.
6. Sherman SL, Thompson SF, Clohisy JCF. Distal femoral varus osteotomy for the management of valgus deformity of the knee. J Am Acad Orthop Surg, 2018, 26(9): 313-324.
7. Johal S, Nakano N, Baxter M, et al. Unicompartmental knee arthroplasty: the past, current controversies, and future perspectives. J Knee Surg, 2018, 31(10): 992-998.
8. Greco NJ, Cook GJE, Lombardi Jr AV, et al. Lateral unicompartmental knee arthroplasty utilizing a modified surgical technique and specifically adapted fixed-bearing implant. Surg Technol Int, 2019, 34: 371-378.
9. Plancher KD, Briggs KK, Chinnakkannu K, et al. Isolated lateral tibiofemoral compartment osteoarthritis: survivorship and patient acceptable symptom state after lateral fixed-bearing unicompartmental knee arthroplasty at mean 10-year follow-up. J Bone Joint Surg (Am), 2022, 104(18): 1621-1628.
10. Sah AP, Scott RD. Lateral unicompartmental knee arthroplasty through a medial approach. Surgical technique. J Bone Joint Surg (Am), 2008, 90 Suppl 2 Pt 2: 195-205.
11. Berend KR, Kolczun MC, George JW, et al. Lateral unicompartmental knee arthroplasty through a lateral parapatellar approach has high early survivorship. Clin Orthop Relat Res, 2012, 470(1): 77-83.
12. Thein R, Khamaisy S, Zuiderbaan HA, et al. Lateral robotic unicompartmental knee arthroplasty. Sports Med Arthrosc Rev, 2014, 22(4): 223-228.
13. 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.
14. 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.
15. Isaac SM, Barker KL, Danial IN, et al. Does arthroplasty type influence knee joint proprioception? A longitudinal prospective study comparing total and unicompartmental arthroplasty. Knee, 2007, 14(3): 212-217.
16. Sun PF, Jia YH. Mobile bearing UKA compared to fixed bearing TKA: a randomized prospective study. Knee, 2012, 19(2): 103-106.
17. Smith E, Lee D, Masonis J, et al. Lateral unicompartmental knee arthroplasty. JBJS Rev, 2020, 8(3): e0044.
18. 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.
19. 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.
20. Dudek P, Marczak D, Okoń T, et al. Lateral or medial parapatellar surgical approach to the valgus osteoarthritic knee? A retrospective single-center study. J Clin Med, 2022, 11(19): 5953.
21. Keblish PA. The lateral approach to the valgus knee. Surgical technique and analysis of 53 cases with over two-year follow-up evaluation. Clin Orthop Relat Res, 1991(271): 52-62.
22. Eberbach H, Mehl J, Feucht MJ, et al. Geometry of the valgus knee: Contradicting the dogma of a femoral-based deformity. Am J Sports Med, 2017, 45(4): 909-914.
23. Xue H, Ma T, Wen T, et al. Predictors of satisfactory outcomes with fixed-bearing lateral unicompartmental knee arthroplasty: Up to 7-year follow-up. J Arthroplasty, 2021, 36(3): 910-916.
24. Heckmann ND, Antonios JK, Chen XT, et al. Midterm survivorship of robotic-assisted lateral unicompartmental knee arthroplasty. J Arthroplasty, 2022, 37(5): 831-836.
25. 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.
26. 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. 中华关节外科杂志 (电子版), 2012, 6(3): 77-79.
27. Elkus M, Ranawat CS, Rasquinha VJ, et al. Total knee arthroplasty for severe valgus deformity. Five to fourteen-year follow-up. J Bone Joint Surg (Am), 2004, 86(12): 2671-2676.
28. Pagoti R, O’Brien S, Doran E, et al. Unconstrained total knee arthroplasty in significant valgus deformity: a modified surgical technique to balance the knee and avoid instability. Knee Surg Sports Traumatol Arthrosc, 2017, 25(9): 2825-2834.
29. McLean SG, Mallett KF, Arruda EM. Deconstructing the anterior cruciate ligament: what we know and do not know about function, material properties, and injury mechanics. J Biomech Eng, 2015, 137(2): 020906.
30. Defrate LE, Papannagari R, Gill TJ, et al. The 6 degrees of freedom kinematics of the knee after anterior cruciate ligament deficiency: an in vivo imaging analysis. Am J Sports Med, 2006, 34(8): 1240-1246.
31. Hart HF, Stefanik JJ, Wyndow N, et al. The prevalence of radiographic and MRI-defined patellofemoral osteoarthritis and structural pathology: a systematic review and meta-analysis. Br J Sports Med, 2017, 51(16): 1195-1208.
32. Wen T, Xue H, Ma T, et al. A standardized technique for lateral unicompartmental knee arthroplasty. J Orthop Surg (Hong Kong), 2023, 31(1): 10225536231164028.
33. Katz JN, Arant KR, Loeser RF. Diagnosis and treatment of hip and knee osteoarthritis: A review. JAMA, 2021, 325(6): 568-578.
34. Witjes S, Gouttebarge V, Kuijer PP, et al. Return to sports and physical activity after total and unicondylar knee arthroplasty: A systematic review and meta-analysis. Sports Med, 2016, 46(2): 269-292.
35. Fujita M, Hiranaka T, Mai B, et al. External rotation of the tibial component should be avoided in lateral unicompartmental knee arthroplasty. Knee, 2021, 30: 70-77.

Chinese Journal of Reparative and Reconstructive Surgery

Surgical technique of lateral unicompartmental knee arthroplasty and discussion of the maximum correction value in the treatment of knee valgus deformity

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