The Influence of Patellofemoral Degenerative Changes on the Outcome of the Unicompartmental Knee Replacement: A Prospective Study

Abstract

Unicompartmental knee arthroplasty (UKA) is a recognized procedure for treatment of medial compartment osteoarthritis. Patellofemoral (PF) joint degeneration is widely considered to be a contraindication to medial compartment UKA. We examined the validity of this preconception using information gathered prospectively on 147 consecutive patients who underwent the Repicci II UKA for medial compartment osteoarthritis between July 1999 and September 2000 by the same surgeon. The status of the PF joint was assessed intraoperatively in all patients, and accordingly patients were divided into two groups. Among them, 69 had associated PF osteoarthritis (group A), while 78 patients had a normal PF compartment (group B). Variables measured included the International Knee Society (IKS) score, limb alignment, and range of motion. Radiographs, demographic data, length of hospital stay, perioperative complications were also measured. All subsequent surgery and survivorship at 10 years were recorded. The mean follow-up was 9.4 years (range: 5–10.7 years) and results of the two groups were compared. We found no significant differences in terms of IKS scores, alignment, and flexion between the two groups. However, measured extension was significantly increased postoperatively in those patients with minimal or no PF joint degenerative disease (p < 0.05).

Keywords

patellofemoral - arthroplasty - unicompartmental - knee - arthritis

Publication History

Received: 16 July 2019

Accepted: 31 March 2020

Article published online:
25 May 2020

• References

• 1 Marmor L. Unicompartmental knee arthroplasty. Ten- to 13-year follow-up study. Clin Orthop Relat Res 1988; 226 (226) 14-20
• 2 Borus T, Thornhill T. Unicompartmental knee arthroplasty. J Am Acad Orthop Surg 2008; 16 (01) 9-18
• 3 Hanson GR, Moynihan AL, Suggs JF, Kwon Y-M, Johnson T, Li G. Kinematics of medial unicondylar knee arthroplasty: an in vivo investigation. J Knee Surg 2009; 22 (03) 237-242
• 4 Newman J, Pydisetty RV, Ackroyd C. Unicompartmental or total knee replacement: the 15-year results of a prospective randomised controlled trial. J Bone Joint Surg Br 2009; 91 (01) 52-57
• 5 Mullaji AB, Sharma A, Marawar S. Unicompartmental knee arthroplasty: functional recovery and radiographic results with a minimally invasive technique. J Arthroplasty 2007; 22 (04, Suppl 1): 7-11
• 6 Larsen K, Sørensen OG, Hansen TB, Thomsen PB, Søballe K. Accelerated perioperative care and rehabilitation intervention for hip and knee replacement is effective: a randomized clinical trial involving 87 patients with 3 months of follow-up. Acta Orthop 2008; 79 (02) 149-159
• 7 McAllister CM. The role of unicompartmental knee arthroplasty versus total knee arthroplasty in providing maximal performance and satisfaction. J Knee Surg 2008; 21 (04) 286-292
• 8 Newman JH, Ackroyd CE, Shah NA. Unicompartmental or total knee replacement? Five-year results of a prospective, randomised trial of 102 osteoarthritic knees with unicompartmental arthritis. J Bone Joint Surg Br 1998; 80 (05) 862-865
• 9 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 (273) 151-156
• 10 Berend KR, Lombardi Jr AV. Liberal indications for minimally invasive oxford unicondylar arthroplasty provide rapid functional recovery and pain relief. Surg Technol Int 2007; 16: 193-197
• 11 Willis-Owen CA, Brust K, Alsop H, Miraldo M, Cobb JP. Unicondylar knee arthroplasty in the UK National Health Service: an analysis of candidacy, outcome and cost efficacy. Knee 2009; 16 (06) 473-478
• 12 Soohoo NF, Sharifi H, Kominski G, Lieberman JR. Cost-effectiveness analysis of unicompartmental knee arthroplasty as an alternative to total knee arthroplasty for unicompartmental osteoarthritis. J Bone Joint Surg Am 2006; 88 (09) 1975-1982
• 13 Kozinn SC, Scott R. Unicondylar knee arthroplasty. J Bone Joint Surg Am 1989; 71 (01) 145-150
• 14 Stern SH, Becker MW, Insall JN. Unicondylar knee arthroplasty. An evaluation of selection criteria. Clin Orthop Relat Res 1993; 286 (286) 143-148
• 15 Goodfellow JW, O'Connor J. Clinical results of the Oxford knee. Surface arthroplasty of the tibiofemoral joint with a meniscal bearing prosthesis. Clin Orthop Relat Res 1986; 205 (205) 21-42
• 16 Pennington DW, Swienckowski JJ, Lutes WB, Drake GN. Unicompartmental knee arthroplasty in patients sixty years of age or younger. J Bone Joint Surg Am 2003; 85 (10) 1968-1973
• 17 Ahlbäck S. Osteoarthrosis of the knee. A radiographic investigation. Acta Radiol Diagn (Stockh) 1968; 277: 7-72
• 18 Altman R, Asch E, Bloch D. et al; Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Arthritis Rheum 1986; 29 (08) 1039-1049
• 19 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
• 20 Borm GF, Fransen J, Lemmens WA. A simple sample size formula for analysis of covariance in randomized clinical trials. J Clin Epidemiol 2007; 60 (12) 1234-1238
• 21 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) 32-34
• 22 Brown NM, Sheth NP, Davis K. et al. Total knee arthroplasty has higher postoperative morbidity than unicompartmental knee arthroplasty: a multicenter analysis. J Arthroplasty 2012; 27 (08) 86-90
• 23 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
• 24 Graves SE, Davidson D, Ingerson L. et al. The Australian Orthopaedic Association National Joint Replacement Registry. Med J Aust 2004; 180 (S5) S31-S34
• 25 Lidgren LRO, W-Dahl A. Available at: http://www.knee.nko.se/english/online/thePages/index.php . Accessed April 13, 2020
• 26 Beard DJ, Pandit H, Ostlere S, Jenkins C, Dodd CA, Murray DW. Pre-operative clinical and radiological assessment of the patellofemoral joint in unicompartmental knee replacement and its influence on outcome. J Bone Joint Surg Br 2007; 89 (12) 1602-1607
• 27 Kang SN, Smith TO, Sprenger De Rover WB, Walton NP. Pre-operative patellofemoral degenerative changes do not affect the outcome after medial Oxford unicompartmental knee replacement: a report from an independent centre. J Bone Joint Surg Br 2011; 93 (04) 476-478
• 28 Laskin RS. Unicompartmental knee replacement: some unanswered questions. Clin Orthop Relat Res 2001; 392 (392) 267-271
• 29 Hernigou P, Deschamps G. Alignment influences wear in the knee after medial unicompartmental arthroplasty. Clin Orthop Relat Res 2004; (423) 161-165
• 30 Mullaji AB, Shetty GM, Kanna R. Postoperative limb alignment and its determinants after minimally invasive Oxford medial unicompartmental knee arthroplasty. J Arthroplasty 2011; 26 (06) 919-925
• 31 Pabinger C, Berghold A, Boehler N, Labek G. Revision rates after knee replacement. Cumulative results from worldwide clinical studies versus joint registers. Osteoarthritis Cartilage 2013; 21 (02) 263-268
• 32 Tabor Jr. OB, Tabor OB. Unicompartmental arthroplasty: a long-term follow-up study. J Arthroplasty 1998; 13 (04) 373-379
• 33 Emery IH, Meachim G. Surface morphology and topography of patello-femoral cartilage fibrillation in Liverpool necropsies. J Anat 1973; 116 (Pt 1): 103-120