Research progress in Oxford unicompartmental knee arthroplasty for partial thickness cartilage loss in medial compartment of knee joint_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

HUANG Wenbin , LIU Dianqi ,  LU Weijie

Department of Joint Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Guangdong, 510120, P. R. China;

Corresponding author：

LU Weijie, Email: 13902280296@139.com

Keywords：

Knee joint; osteoarthritis; Oxford unicompartmental knee arthroplasty; partial thickness cartilage loss

DOI：

10.7507/1002-1892.202403091

Video：

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Objective To summarize the research progress of Oxford unicompartmental knee arthroplasty (UKA) in treating partial thickness cartilage loss (PTCL) in the medial compartment of the knee joint, aiming to further clarify the indications and optimize the effectiveness of Oxford UKA. Methods A comprehensive review of recent domestic and international literature on Oxford UKA for PTCL in the medial compartment of the knee joint was conducted to summarize its application and research advancements. Results Based on current researches, the main indication for Oxford UKA is full thinckness cartilage loss in the medial compartment of the knee joint. Although it has shown certain effectiveness in treating PTCL in the medial compartment of the knee joint, there are also reports of opposite conclusions. Therefore, there is still controversy over whether Oxford UKA can be chosen for PTCL, and the large-sample and multi-center studies are needed to further clarify the controversy. Studies indicate that accurate preoperative assessment of cartilage damage severity is crucial for selecting appropriate candidates for Oxford UKA to optimize postoperative effectiveness. Conclusion Oxford UKA may represent an effective treatment for patients with PTCL in the medial compartment of the knee joint. However, strict patient selection and precise preoperative evaluation are essential to ensure surgical success and long-term effectiveness.

Citation： HUANG Wenbin, LIU Dianqi, LU Weijie. Research progress in Oxford unicompartmental knee arthroplasty for partial thickness cartilage loss in medial compartment of knee joint. Chinese Journal of Reparative and Reconstructive Surgery, 2024, 38(9): 1138-1142. doi: 10.7507/1002-1892.202403091 Copy

1.	Murray DW, Parkinson RW. Usage of unicompartmental knee arthroplasty. Bone Joint J, 2018, 100-B(4): 432-435.
2.	李宇轩, 袁伶俐, 许志远, 等. 单髁置换治疗膝关节内侧间室骨关节炎: 关节功能及炎性细胞因子变化. 中国组织工程研究, 2024, 28(36): 5828-5832.
3.	Kahan ME, Chen Z, Angerett NR, et al. Unicompartmental knee arthroplasty has lower infection, conversion, and complication rates compared to high tibial osteotomy. J Knee Surg, 2022, 35(14): 1518-1523.
4.	Uzun E, Misir A, Kizkapan TB, et al. Mid-term functional, clinical, and radiological outcomes with factors affecting revision of mobile-bearing medial unicompartmental knee arthroplasty. Knee, 2020, 27(2): 527-534.
5.	Kozinn SC, Scott R. Unicondylar knee arthroplasty. J Bone Joint Surg (Am), 1989, 71(1): 145-150.
6.	薛华明, 马童, 文涛, 等. 再议膝关节单髁置换术的适应证. 中华医学杂志, 2024, 104(5): 319-324.
7.	李鹏飞, Murray D, 曾意荣, 等. 内侧活动平台牛津单髁膝关节置换术的适应证和禁忌证. 中医正骨, 2018, 30(10): 64-65, 73.
8.	Niinimäki TT, Murray DW, Partanen J, et al. Unicompartmental knee arthroplasties implanted for osteoarthritis with partial loss of joint space have high re-operation rates. Knee, 2011, 18(6): 432-435.
9.	Li Z, Chen ZY, Wei JQ, et al. Excellent outcomes with Oxford uni-compartmental knee arthroplasty in anteromedial osteoarthritis patients (≤60 years) at mid-term follow-up. BMC Musculoskelet Disord, 2021, 22(1): 859. doi: 10.1186/s12891-021-04747-y.
10.	Goodfellow J, O’Connor J, Pandit H, et al. Unicompartmental arthroplasty with the oxford knee. 2nd ed. Oxford: Goodfellow Publishers, 2015.
11.	徐耿彬, 茹江英. 关节间隙宽度测量对内侧膝关节单髁置换效果及预后的影响. 中国组织工程研究, 2024, 28(36): 5877-5883.
12.	唐杞衡, 周一新, 王兆伦, 等. 肥胖对膝骨关节炎内侧单髁置换术疗效的影响. 中国矫形外科杂志, 2022, 30(14): 1267-1271.
13.	Nejima S, Kumagai K, Kobayashi H, et al. Coronal shaft bowing of the femur affects varus inclination of the surgical transepicondylar axis in varus knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc, 2021, 29(3): 814-819.
14.	Panni AS, Vasso M, Cerciello S, et al. Unicompartmental knee replacement provides early clinical and functional improvement stabilizing over time. Knee Surg Sports Traumatol Arthrosc, 2012, 20(3): 579-585.
15.	Hamilton TW, Pandit HG, Jenkins C, et al. Evidence-based indications for mobile-bearing unicompartmental knee arthroplasty in a consecutive cohort of thousand knees. J Arthroplasty, 2017, 32(6): 1779-1785.
16.	Stern SH, Becker MW, Insall JN. Unicondylar knee arthroplasty. An evaluation of selection criteria. Clin Orthop Relat Res, 1993(286): 143-148.
17.	Ritter MA, Faris PM, Thong AE, et al. Intra-operative findings in varus osteoarthritis of the knee. An analysis of pre-operative alignment in potential candidates for unicompartmental arthroplasty. J Bone Joint Surg (Br), 2004, 86(1): 43-47.
18.	Kan HS, Chan PK, Chiu KY, et al. Non-surgical treatment of knee osteoarthritis. Hong Kong Med J, 2019, 25(2): 127-133.
19.	Michael JW, Schlüter-Brust KU, Eysel P. The epidemiology, etiology, diagnosis, and treatment of osteoarthritis of the knee. Dtsch Arztebl Int, 2010, 107(9): 152-162.
20.	郭磊, 齐岩松, 牛啸博. 转化生长因子β亚家族调控骨关节炎中的作用. 中国组织工程研究, 2024, 28(35): 5695-5701.
21.	张通, 蔡金池, 袁志发, 等. 基于透明质酸的复合水凝胶修复骨关节炎软骨损伤: 应用与机制. 中国组织工程研究, 2022, 26(4): 617-625.
22.	Willers C, Wood DJ, Zheng MH. A current review on the biology and treatment of articular cartilage defects (part Ⅰ& part Ⅱ). J Musculoskelet Res, 2003, 7: 157-181.
23.	李晶, 叶清岚, 蔡磊, 等. 膝关节韧带、关节软骨及半月板损伤的多层螺旋CT与MRI诊断分析. 实用放射学杂志, 2023, 39(8): 1314-1317.
24.	靳莉丹, 申瑞田. 三维CT联合MRI分析膝关节ACL损伤重建术后移植物、周围结构与膝关节稳定性关系. 影像科学与光化学, 2022, 40(2): 418-423.
25.	金文宇. 磁共振成像在不同分期的膝半月板及关节软骨损伤中的诊断价值. 当代医学, 2022, 28(2): 36-39.
26.	杨洪敏, 董华, 翟廷贵, 等. 高频超声与MRI用于膝关节软骨退变诊断中的临床意义. 医疗装备, 2022, 35(14): 15-17.
27.	夏卿, 刘华龙, 叶胜豪. MRI在膝关节半月板及关节软骨损伤中的应用价值研究. 浙江创伤外科, 2023, 28(5): 979-982.
28.	Krakowski P, Karpiński R, Jojczuk M, et al. Knee MRI underestimates the grade of cartilage lesions. Appl Sci, 2021, 11(4): 1552. doi: 10.3390/app11041552.
29.	Strickland C, Ibrahim M, McCarty E. Imaging of cartilage damage. Journal of Cartilage & Joint Preservation, 2024, 4(1): 100149. doi: https://doi.org/10.1016/j.jcjp.2023.100149.
30.	Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis, 1957, 16(4): 494-502.
31.	Hamilton TW, Pandit HG, Inabathula A, et al. Unsatisfactory outcomes following unicompartmental knee arthroplasty in patients with partial thickness cartilage loss: a medium-term follow-up. Bone Joint J, 2017, 99-B(4): 475-482.
32.	Nischal N, Iyengar KP, Herlekar D, et al. Imaging of cartilage and chondral defects: an overview. Life (Basel), 2023, 13(2): 363. doi: 10.3390/life13020363.
33.	涂意辉, 马童, 薛华明, 等. 牛津单髁置换术应用于单间室部分软骨损伤的疗效研究. 生物骨科材料与临床研究, 2023, 20(1): 25-30.
34.	Berend KR, Lombardi AV, Jacobs CA. The combination of preoperative bone marrow lesions and partial-thickness cartilage loss did not result in inferior outcomes after medial unicompartmental knee arthroplasty. J Arthroplasty, 2017, 32(10): 3000-3003.
35.	Maier MW, Kuhs F, Streit MR, et al. Unicompartmental knee arthroplasty in patients with full versus partial thickness cartilage loss (PTCL): equal in clinical outcome but with higher reoperation rate for patients with PTCL. Arch Orthop Trauma Surg, 2015, 135(8): 1169-1175.
36.	Pandit H, Gulati A, Jenkins C, et al. Unicompartmental knee replacement for patients with partial thickness cartilage loss in the affected compartment. Knee, 2011, 18(3): 168-171.
37.	Knifsund J, Hatakka J, Keemu H, et al. Unicompartmental knee arthroplasties are performed on the patients with radiologically too mild osteoarthritis. Scand J Surg, 2017, 106(4): 338-341.
38.	Sang W, Qiu H, Xu Y, et al. Malposition is main cause of failure of Oxford mobile-bearing medial unicompartmental knee arthroplasty. Bone Jt Open, 2023, 4(12): 914-922.
39.	刘沛, 夏子麒, 王洋, 等. 年轻人膝关节骨关节炎的保膝治疗进展. 中国矫形外科杂志, 2020, 28(3): 248-251.
40.	Liddle AD, Judge A, Pandit H, et al. Adverse outcomes after total and unicompartmental knee replacement in 101, 330 matched patients: a study of data from the National Joint Registry for England and Wales. Lancet, 2014, 384(9952): 1437-1445.
41.	Smith TO, Drew BT, Toms AP, et al. Accuracy of magnetic resonance imaging, magnetic resonance arthrography and computed tomography for the detection of chondral lesions of the knee. Knee Surg Sports Traumatol Arthrosc, 2012, 20(12): 2367-2379.

1. Murray DW, Parkinson RW. Usage of unicompartmental knee arthroplasty. Bone Joint J, 2018, 100-B(4): 432-435.
2. 李宇轩, 袁伶俐, 许志远, 等. 单髁置换治疗膝关节内侧间室骨关节炎: 关节功能及炎性细胞因子变化. 中国组织工程研究, 2024, 28(36): 5828-5832.
3. Kahan ME, Chen Z, Angerett NR, et al. Unicompartmental knee arthroplasty has lower infection, conversion, and complication rates compared to high tibial osteotomy. J Knee Surg, 2022, 35(14): 1518-1523.
4. Uzun E, Misir A, Kizkapan TB, et al. Mid-term functional, clinical, and radiological outcomes with factors affecting revision of mobile-bearing medial unicompartmental knee arthroplasty. Knee, 2020, 27(2): 527-534.
5. Kozinn SC, Scott R. Unicondylar knee arthroplasty. J Bone Joint Surg (Am), 1989, 71(1): 145-150.
6. 薛华明, 马童, 文涛, 等. 再议膝关节单髁置换术的适应证. 中华医学杂志, 2024, 104(5): 319-324.
7. 李鹏飞, Murray D, 曾意荣, 等. 内侧活动平台牛津单髁膝关节置换术的适应证和禁忌证. 中医正骨, 2018, 30(10): 64-65, 73.
8. Niinimäki TT, Murray DW, Partanen J, et al. Unicompartmental knee arthroplasties implanted for osteoarthritis with partial loss of joint space have high re-operation rates. Knee, 2011, 18(6): 432-435.
9. Li Z, Chen ZY, Wei JQ, et al. Excellent outcomes with Oxford uni-compartmental knee arthroplasty in anteromedial osteoarthritis patients (≤60 years) at mid-term follow-up. BMC Musculoskelet Disord, 2021, 22(1): 859. doi: 10.1186/s12891-021-04747-y.
10. Goodfellow J, O’Connor J, Pandit H, et al. Unicompartmental arthroplasty with the oxford knee. 2nd ed. Oxford: Goodfellow Publishers, 2015.
11. 徐耿彬, 茹江英. 关节间隙宽度测量对内侧膝关节单髁置换效果及预后的影响. 中国组织工程研究, 2024, 28(36): 5877-5883.
12. 唐杞衡, 周一新, 王兆伦, 等. 肥胖对膝骨关节炎内侧单髁置换术疗效的影响. 中国矫形外科杂志, 2022, 30(14): 1267-1271.
13. Nejima S, Kumagai K, Kobayashi H, et al. Coronal shaft bowing of the femur affects varus inclination of the surgical transepicondylar axis in varus knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc, 2021, 29(3): 814-819.
14. Panni AS, Vasso M, Cerciello S, et al. Unicompartmental knee replacement provides early clinical and functional improvement stabilizing over time. Knee Surg Sports Traumatol Arthrosc, 2012, 20(3): 579-585.
15. Hamilton TW, Pandit HG, Jenkins C, et al. Evidence-based indications for mobile-bearing unicompartmental knee arthroplasty in a consecutive cohort of thousand knees. J Arthroplasty, 2017, 32(6): 1779-1785.
16. Stern SH, Becker MW, Insall JN. Unicondylar knee arthroplasty. An evaluation of selection criteria. Clin Orthop Relat Res, 1993(286): 143-148.
17. Ritter MA, Faris PM, Thong AE, et al. Intra-operative findings in varus osteoarthritis of the knee. An analysis of pre-operative alignment in potential candidates for unicompartmental arthroplasty. J Bone Joint Surg (Br), 2004, 86(1): 43-47.
18. Kan HS, Chan PK, Chiu KY, et al. Non-surgical treatment of knee osteoarthritis. Hong Kong Med J, 2019, 25(2): 127-133.
19. Michael JW, Schlüter-Brust KU, Eysel P. The epidemiology, etiology, diagnosis, and treatment of osteoarthritis of the knee. Dtsch Arztebl Int, 2010, 107(9): 152-162.
20. 郭磊, 齐岩松, 牛啸博. 转化生长因子β亚家族调控骨关节炎中的作用. 中国组织工程研究, 2024, 28(35): 5695-5701.
21. 张通, 蔡金池, 袁志发, 等. 基于透明质酸的复合水凝胶修复骨关节炎软骨损伤: 应用与机制. 中国组织工程研究, 2022, 26(4): 617-625.
22. Willers C, Wood DJ, Zheng MH. A current review on the biology and treatment of articular cartilage defects (part Ⅰ& part Ⅱ). J Musculoskelet Res, 2003, 7: 157-181.
23. 李晶, 叶清岚, 蔡磊, 等. 膝关节韧带、关节软骨及半月板损伤的多层螺旋CT与MRI诊断分析. 实用放射学杂志, 2023, 39(8): 1314-1317.
24. 靳莉丹, 申瑞田. 三维CT联合MRI分析膝关节ACL损伤重建术后移植物、周围结构与膝关节稳定性关系. 影像科学与光化学, 2022, 40(2): 418-423.
25. 金文宇. 磁共振成像在不同分期的膝半月板及关节软骨损伤中的诊断价值. 当代医学, 2022, 28(2): 36-39.
26. 杨洪敏, 董华, 翟廷贵, 等. 高频超声与MRI用于膝关节软骨退变诊断中的临床意义. 医疗装备, 2022, 35(14): 15-17.
27. 夏卿, 刘华龙, 叶胜豪. MRI在膝关节半月板及关节软骨损伤中的应用价值研究. 浙江创伤外科, 2023, 28(5): 979-982.
28. Krakowski P, Karpiński R, Jojczuk M, et al. Knee MRI underestimates the grade of cartilage lesions. Appl Sci, 2021, 11(4): 1552. doi: 10.3390/app11041552.
29. Strickland C, Ibrahim M, McCarty E. Imaging of cartilage damage. Journal of Cartilage & Joint Preservation, 2024, 4(1): 100149. doi: https://doi.org/10.1016/j.jcjp.2023.100149.
30. Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis, 1957, 16(4): 494-502.
31. Hamilton TW, Pandit HG, Inabathula A, et al. Unsatisfactory outcomes following unicompartmental knee arthroplasty in patients with partial thickness cartilage loss: a medium-term follow-up. Bone Joint J, 2017, 99-B(4): 475-482.
32. Nischal N, Iyengar KP, Herlekar D, et al. Imaging of cartilage and chondral defects: an overview. Life (Basel), 2023, 13(2): 363. doi: 10.3390/life13020363.
33. 涂意辉, 马童, 薛华明, 等. 牛津单髁置换术应用于单间室部分软骨损伤的疗效研究. 生物骨科材料与临床研究, 2023, 20(1): 25-30.
34. Berend KR, Lombardi AV, Jacobs CA. The combination of preoperative bone marrow lesions and partial-thickness cartilage loss did not result in inferior outcomes after medial unicompartmental knee arthroplasty. J Arthroplasty, 2017, 32(10): 3000-3003.
35. Maier MW, Kuhs F, Streit MR, et al. Unicompartmental knee arthroplasty in patients with full versus partial thickness cartilage loss (PTCL): equal in clinical outcome but with higher reoperation rate for patients with PTCL. Arch Orthop Trauma Surg, 2015, 135(8): 1169-1175.
36. Pandit H, Gulati A, Jenkins C, et al. Unicompartmental knee replacement for patients with partial thickness cartilage loss in the affected compartment. Knee, 2011, 18(3): 168-171.
37. Knifsund J, Hatakka J, Keemu H, et al. Unicompartmental knee arthroplasties are performed on the patients with radiologically too mild osteoarthritis. Scand J Surg, 2017, 106(4): 338-341.
38. Sang W, Qiu H, Xu Y, et al. Malposition is main cause of failure of Oxford mobile-bearing medial unicompartmental knee arthroplasty. Bone Jt Open, 2023, 4(12): 914-922.
39. 刘沛, 夏子麒, 王洋, 等. 年轻人膝关节骨关节炎的保膝治疗进展. 中国矫形外科杂志, 2020, 28(3): 248-251.
40. Liddle AD, Judge A, Pandit H, et al. Adverse outcomes after total and unicompartmental knee replacement in 101, 330 matched patients: a study of data from the National Joint Registry for England and Wales. Lancet, 2014, 384(9952): 1437-1445.
41. Smith TO, Drew BT, Toms AP, et al. Accuracy of magnetic resonance imaging, magnetic resonance arthrography and computed tomography for the detection of chondral lesions of the knee. Knee Surg Sports Traumatol Arthrosc, 2012, 20(12): 2367-2379.

Chinese Journal of Reparative and Reconstructive Surgery

Research progress in Oxford unicompartmental knee arthroplasty for partial thickness cartilage loss in medial compartment of knee joint

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