Download PDF
J Knee Surg 2019; 32(09): 860-865
DOI: 10.1055/s-0038-1669448
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Early Failure in Medial Unicondylar Arthroplasty: Radiographic Analysis on the Importance of Joint Line Restoration

Mirco Lo Presti
1   2nd Orthopaedic and Traumatology Clinic, Rizzoli Orthopaedic Institute, Bologna, Italy
,
Giovanni Francesco Raspugli
2   Department of Biomedical Sciences, Humanitas University, Humanitas Clinical and Research Center, Milan, Italy
,
Davide Reale
1   2nd Orthopaedic and Traumatology Clinic, Rizzoli Orthopaedic Institute, Bologna, Italy
3   NABI Laboratory, IRCCS, Istituto Ortopedico Rizzoli, Bologna, Italy
,
Francesco Iacono
2   Department of Biomedical Sciences, Humanitas University, Humanitas Clinical and Research Center, Milan, Italy
,
Stefano Zaffagnini
1   2nd Orthopaedic and Traumatology Clinic, Rizzoli Orthopaedic Institute, Bologna, Italy
4   DIBINEM, Bologna University, Bologna, Italy
,
Giuseppe Filardo
3   NABI Laboratory, IRCCS, Istituto Ortopedico Rizzoli, Bologna, Italy
,
Maurilio Marcacci
2   Department of Biomedical Sciences, Humanitas University, Humanitas Clinical and Research Center, Milan, Italy
› Author Affiliations
Further Information

Publication History

02 December 2017

23 July 2018

Publication Date:
13 September 2018 (online)

    Permissions and Reprints

Abstract

Survivorship of unicondylar knee arthroplasty (UKA) remains a drawback, especially compared with the outcome of total knee arthroplasty. This could be improved by identifying and correcting failure mechanisms. To this purpose, this study aimed at exploring failure modalities of UKA, with particular focus on the role of joint line (JL) position and alignment as variable to be optimized for a successful outcome. This study explored modes of failure in 266 medial UKAs. Radiological comparison was performed between 24 failures and 24 matched controls, to determine the importance of UKA positioning in terms of femorotibial angle (FTA), tibial plateau angle, and posterior tibial slope (PTS). Radiographic comparative analysis showed statistically significant differences in the failure group compared with the control group in terms of variation in FTA (p = 0.0222), PTS (p = 0.0025), and JL height (p = 0.0022). Variations not only in FTA but also PTS and JL height were correlated with failures observed in this series. Thus, based on the results of this study, it emerges that JL position should be carefully controlled in all planes while implanting a UKA. This is a Level III, case–control study.

Keywords

unicondylar knee arthroplasty - knee - joint line - alignment - failure mechanism
 

  • References

  • 1 Dettoni F, Bonasia DE, Castoldi F, Bruzzone M, Blonna D, Rossi R. High tibial osteotomy versus unicompartmental knee arthroplasty for medial compartment arthrosis of the knee: a review of the literature. Iowa Orthop J 2010; 30: 131-140
    PubMedGoogle Scholar
  • 2 Griffin T, Rowden N, Morgan D, Atkinson R, Woodruff P, Maddern G. Unicompartmental knee arthroplasty for the treatment of unicompartmental osteoarthritis: a systematic study. ANZ J Surg 2007; 77 (04) 214-221
    CrossrefPubMedGoogle Scholar
  • 3 Koskinen E, Eskelinen A, Paavolainen P, Pulkkinen P, Remes V. Comparison of survival and cost-effectiveness between unicondylar arthroplasty and total knee arthroplasty in patients with primary osteoarthritis: a follow-up study of 50,493 knee replacements from the Finnish Arthroplasty Register. Acta Orthop 2008; 79 (04) 499-507
    CrossrefPubMedGoogle Scholar
  • 4 Laurencin CT, Zelicof SB, Scott RD, Ewald FC. Unicompartmental versus total knee arthroplasty in the same patient. A comparative study. Clin Orthop Relat Res 1991; (273) 151-156
    PubMedGoogle Scholar
  • 5 Lyons MC, MacDonald SJ, Somerville LE, Naudie DD, McCalden RW. Unicompartmental versus total knee arthroplasty database analysis: is there a winner?. Clin Orthop Relat Res 2012; 470 (01) 84-90
    CrossrefPubMedGoogle Scholar
  • 6 Dalury DF, Fisher DA, Adams MJ, Gonzales RA. Unicompartmental knee arthroplasty compares favorably to total knee arthroplasty in the same patient. Orthopedics 2009;32(04): orthosupersite.com/view.asp?rID=38057
    PubMedGoogle Scholar
  • 7 Robertsson O, Borgquist L, Knutson K, Lewold S, Lidgren L. Use of unicompartmental instead of tricompartmental prostheses for unicompartmental arthrosis in the knee is a cost-effective alternative. 15,437 primary tricompartmental prostheses were compared with 10,624 primary medial or lateral unicompartmental prostheses. Acta Orthop Scand 1999; 70 (02) 170-175
    CrossrefPubMedGoogle Scholar
  • 8 Heyse TJ, El-Zayat BF, De Corte R. , et al. UKA closely preserves natural knee kinematics in vitro. Knee Surg Sports Traumatol Arthrosc 2014; 22 (08) 1902-1910
    CrossrefPubMedGoogle Scholar
  • 9 Myers TG, Cui Q, Kuskowski M, Mihalko WM, Saleh KJ. Outcomes of total and unicompartmental knee arthroplasty for secondary and spontaneous osteonecrosis of the knee. J Bone Joint Surg Am 2006; 88 (Suppl. 03) 76-82
    PubMedGoogle Scholar
  • 10 Parratte S, Argenson J-NA, Pearce O, Pauly V, Auquier P, Aubaniac JM. Medial unicompartmental knee replacement in the under-50s. J Bone Joint Surg Br 2009; 91 (03) 351-356
    PubMedGoogle Scholar
  • 11 Price AJ, Dodd CA, Svard UG, Murray DW. Oxford medial unicompartmental knee arthroplasty in patients younger and older than 60 years of age. J Bone Joint Surg Br 2005; 87 (11) 1488-1492
    PubMedGoogle Scholar
  • 12 Aleto TJ, Berend ME, Ritter MA, Faris PM, Meneghini RM. Early failure of unicompartmental knee arthroplasty leading to revision. J Arthroplasty 2008; 23 (02) 159-163
    CrossrefPubMedGoogle Scholar
  • 13 Arastu MH, Vijayaraghavan J, Chissell H, Hull JB, Newman JH, Robinson JR. Early failure of a mobile-bearing unicompartmental knee replacement. Knee Surg Sports Traumatol Arthrosc 2009; 17 (10) 1178-1183
    CrossrefPubMedGoogle Scholar
  • 14 Furnes O, Espehaug B, Lie SA, Vollset SE, Engesaeter LB, Havelin LI. Failure mechanisms after unicompartmental and tricompartmental primary knee replacement with cement. J Bone Joint Surg Am 2007; 89 (03) 519-525
    CrossrefPubMedGoogle Scholar
  • 15 Hamilton WG, Collier MB, Tarabee E, McAuley JP, Engh Jr CA, Engh GA. Incidence and reasons for reoperation after minimally invasive unicompartmental knee arthroplasty. J Arthroplasty 2006; 21 (06) (Suppl. 02) 98-107
    CrossrefPubMedGoogle Scholar
  • 16 Mariani EM, Bourne MH, Jackson RT, Jackson ST, Jones P. Early failure of unicompartmental knee arthroplasty. J Arthroplasty 2007; 22 (06) (Suppl. 02) 81-84
    CrossrefPubMedGoogle Scholar
  • 17 Naal FD, Neuerburg C, Salzmann GM. , et al. Association of body mass index and clinical outcome 2 years after unicompartmental knee arthroplasty. Arch Orthop Trauma Surg 2009; 129 (04) 463-468
    CrossrefPubMedGoogle Scholar
  • 18 Riebel GD, Werner FW, Ayers DC, Bromka J, Murray DG. Early failure of the femoral component in unicompartmental knee arthroplasty. J Arthroplasty 1995; 10 (05) 615-621
    CrossrefPubMedGoogle Scholar
  • 19 Rothwell AG, Hooper GJ, Hobbs A, Frampton CM. An analysis of the Oxford hip and knee scores and their relationship to early joint revision in the New Zealand Joint Registry. J Bone Joint Surg Br 2010; 92 (03) 413-418
    PubMedGoogle Scholar
  • 20 Saenz CL, McGrath MS, Marker DR, Seyler TM, Mont MA, Bonutti PM. Early failure of a unicompartmental knee arthroplasty design with an all-polyethylene tibial component. Knee 2010; 17 (01) 53-56
    CrossrefPubMedGoogle Scholar
  • 21 Schai PA, Suh JT, Thornhill TS, Scott RD. Unicompartmental knee arthroplasty in middle-aged patients: a 2- to 6-year follow-up evaluation. J Arthroplasty 1998; 13 (04) 365-372
    CrossrefPubMedGoogle Scholar
  • 22 Skyrme AD, Mencia MM, Skinner PW. Early failure of the porous-coated anatomic cemented unicompartmental knee arthroplasty: a 5- to 9-year follow-up study. J Arthroplasty 2002; 17 (02) 201-205
    CrossrefPubMedGoogle Scholar
  • 23 Song M-H, Kim B-H, Ahn S-J, Yoo SH, Lee MS. Early complications after minimally invasive mobile-bearing medial unicompartmental knee arthroplasty. J Arthroplasty 2009; 24 (08) 1281-1284
    CrossrefPubMedGoogle Scholar
  • 24 Vardi G, Strover AE. Early complications of unicompartmental knee replacement: the Droitwich experience. Knee 2004; 11 (05) 389-394
    CrossrefPubMedGoogle Scholar
  • 25 Niinimäki T, Eskelinen A, Mäkelä K, Ohtonen P, Puhto AP, Remes V. Unicompartmental knee arthroplasty survivorship is lower than TKA survivorship: a 27-year Finnish registry study. Clin Orthop Relat Res 2014; 472 (05) 1496-1501
    CrossrefPubMedGoogle Scholar
  • 26 Havelin LI, Engesaeter LB, Espehaug B, Furnes O, Lie SA, Vollset SE. The Norwegian Arthroplasty Register: 11 years and 73,000 arthroplasties. Acta Orthop Scand 2000; 71 (04) 337-353
    CrossrefPubMedGoogle Scholar
  • 27 Knight JL, Atwater RD, Guo J. Early failure of the porous coated anatomic cemented unicompartmental knee arthroplasty. Aids to diagnosis and revision. J Arthroplasty 1997; 12 (01) 11-20
    CrossrefPubMedGoogle Scholar
  • 28 Palmer SH, Morrison PJ, Ross AC. Early catastrophic tibial component wear after unicompartmental knee arthroplasty. Clin Orthop Relat Res 1998; (350) 143-148
    PubMedGoogle Scholar
  • 29 Skolnick MD, Bryan RS, Peterson LF. Unicompartmental polycentric knee arthroplasty: description and preliminary results. Clin Orthop Relat Res 1975; (112) 208-214
    PubMedGoogle Scholar
  • 30 Borus T, Thornhill T. Unicompartmental knee arthroplasty. J Am Acad Orthop Surg 2008; 16 (01) 9-18
    CrossrefPubMedGoogle Scholar
  • 31 Mont MA, Baumgarten KM, Rifai A, Bluemke DA, Jones LC, Hungerford DS. Atraumatic osteonecrosis of the knee. J Bone Joint Surg Am 2000; 82 (09) 1279-1290
    CrossrefPubMedGoogle Scholar
  • 32 Patel DV, Breazeale NM, Behr CT, Warren RF, Wickiewicz TL, O'Brien SJ. Osteonecrosis of the knee: current clinical concepts. Knee Surg Sports Traumatol Arthrosc 1998; 6 (01) 2-11
    CrossrefPubMedGoogle Scholar
  • 33 LaValley MP, McLaughlin S, Goggins J, Gale D, Nevitt MC, Felson DT. The lateral view radiograph for assessment of the tibiofemoral joint space in knee osteoarthritis: its reliability, sensitivity to change, and longitudinal validity. Arthritis Rheum 2005; 52 (11) 3542-3547
    CrossrefPubMedGoogle Scholar
  • 34 Argenson J-NA, Chevrol-Benkeddache Y, Aubaniac J-M. Modern unicompartmental knee arthroplasty with cement: a three to ten-year follow-up study. J Bone Joint Surg Am 2002; 84-A (12) 2235-2239
    PubMedGoogle Scholar
  • 35 Argenson J-NA, Parratte S, Flecher X, Aubaniac J-M. Unicompartmental knee arthroplasty: technique through a mini-incision. Clin Orthop Relat Res 2007; 464 (464) 32-36
    CrossrefPubMedGoogle Scholar
  • 36 Bruni D, Iacono F, Russo A. , et al. Minimally invasive unicompartmental knee replacement: retrospective clinical and radiographic evaluation of 83 patients. Knee Surg Sports Traumatol Arthrosc 2010; 18 (06) 710-717
    CrossrefPubMedGoogle Scholar
  • 37 Whiteside LA. Making your next unicompartmental knee arthroplasty last: three keys to success. J Arthroplasty 2005; 20 (04) (Suppl. 02) 2-3
    PubMedGoogle Scholar
  • 38 Bruni D, Iacono F, Raspugli G, Zaffagnini S, Marcacci M. Is unicompartmental arthroplasty an acceptable option for spontaneous osteonecrosis of the knee?. Clin Orthop Relat Res 2012; 470 (05) 1442-1451
    CrossrefPubMedGoogle Scholar
  • 39 Campbell D, Schuster AJ, Pfluger D, Hoffmann F. Unicondylar knee replacement with a new tensioner device: clinical results of a multicentre study on 168 cases. Arch Orthop Trauma Surg 2010; 130 (06) 727-732
    CrossrefPubMedGoogle Scholar
  • 40 Kasis AG, Pacheco RJ, Hekal W, Farhan MJ, Smith DM, Ali AM. The precision and accuracy of templating the size of unicondylar knee arthroplasty. Knee 2004; 11 (05) 395-398
    CrossrefPubMedGoogle Scholar
  • 41 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
  • 42 Iacono F, Lo Presti M, Bruni D. , et al. The adductor tubercle: a reliable landmark for analysing the level of the femorotibial joint line. Knee Surg Sports Traumatol Arthrosc 2013; 21 (12) 2725-2729
    CrossrefPubMedGoogle Scholar
  • 43 Iacono F, Raspugli GF, Bruni D. , et al. The adductor tubercle as an important landmark to determine the joint line level in total knee arthroplasty: from radiographs to surgical theatre. Knee Surg Sports Traumatol Arthrosc 2014; 22 (12) 3034-3038
    CrossrefPubMedGoogle Scholar
  • 44 Iacono F, Raspugli GF, Filardo G. , et al. The adductor tubercle: an important landmark to determine the joint line level in revision total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2016; 24 (10) 3212-3217
    CrossrefPubMedGoogle Scholar
  • 45 Inoue S, Akagi M, Asada S, Mori S, Zaima H, Hashida M. The valgus inclination of the tibial component increases the risk of medial tibial condylar fractures in unicompartmental knee arthroplasty. J Arthroplasty 2016; 31 (09) 2025-2030
    CrossrefPubMedGoogle Scholar
  • 46 Kuipers BM, Kollen BJ, Bots PCK. , et al. Factors associated with reduced early survival in the Oxford phase III medial unicompartment knee replacement. Knee 2010; 17 (01) 48-52
    CrossrefPubMedGoogle Scholar
  • 47 Woo YL, Chen YQ, Lai MC. , et al. Does obesity influence early outcome of fixed-bearing unicompartmental knee arthroplasty?. J Orthop Surg (Hong Kong) 2017; 25 (01) 2309499016684297 (Hong Kong)
    PubMedGoogle Scholar
  • 48 Konan S, Haddad FS. Does location of patellofemoral chondral lesion influence outcome after Oxford medial compartmental knee arthroplasty?. Bone Joint J 2016; 98-B (10, Supple B): 11-15
    CrossrefPubMedGoogle Scholar
  • 49 Griffin FM, Math K, Scuderi GR, Insall JN, Poilvache PL. Anatomy of the epicondyles of the distal femur: MRI analysis of normal knees. J Arthroplasty 2000; 15 (03) 354-359
    CrossrefPubMedGoogle Scholar
  • 50 Romero J, Seifert B, Reinhardt O, Ziegler O, Kessler O. A useful radiologic method for preoperative joint-line determination in revision total knee arthroplasty. Clin Orthop Relat Res 2010; 468 (05) 1279-1283
    CrossrefPubMedGoogle Scholar
  • 51 Servien E, Viskontas D, Giuffrè BM, Coolican MR, Parker DA. Reliability of bony landmarks for restoration of the joint line in revision knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2008; 16 (03) 263-269
    CrossrefPubMedGoogle Scholar
  • 52 Citak M, Suero EM, Citak M. , et al. Unicompartmental knee arthroplasty: is robotic technology more accurate than conventional technique?. Knee 2013; 20 (04) 268-271
    CrossrefPubMedGoogle Scholar
  • 53 Nicoll D, Rowley DI. Internal rotational error of the tibial component is a major cause of pain after total knee replacement. J Bone Joint Surg Br 2010; 92 (09) 1238-1244
    PubMedGoogle Scholar
  • 54 Tsukamoto I, Akagi M, Mori S, Inoue S, Asada S, Matsumura F. Anteroposterior rotational references of the tibia for medial unicompartmental knee arthroplasty in Japanese patients. J Arthroplasty 2017; 32 (10) 3169-3175
    CrossrefPubMedGoogle Scholar