Bilateral Simultaneous Unicompartmental Knee Arthroplasty. Medium-term Outcomes in 86 Arthroplasties with an Average Follow-up of 6.2 Years
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Published:
Apr 24, 2023
Keywords:
Unicompartmental knee arthroplasty, bilateral UKA (bUKA), bilateral knee osteoarthritis, bilateral knee arthroplasty, simultaneous unicompartmental arthroplasty
Main Article Content
Abstract
Objective: The purpose of this article is to examine the functional outcomes, complications, and medium-term survivorship of medial or lateral bilateral simultaneous unicompartmental knee arthroplasty (bUKA) for the treatment of bilateral knee osteoarthritis.
Materials and Methods: Retrospective report of patients who underwent a medial or lateral bUKA for treatment of bilateral knee osteoarthritis between April 2004 and April 2020, with a minimum follow-up of 1 year. The KSS 2011 was used for the clinical-functional evaluation of each patient. The duration of surgery, length of hospital stay, and transfusion requirements were determined. The short-term and medium-term complications were analyzed, as well as the revision rate and the prosthesis survivorship.
Results: We evaluated 86 bUKAs in 43 patients with a mean follow-up of 6.1 years. The clinical and functional KSS improved from 46.1 ± 10.2 to 80.9 ± 15.9 and 22.8 ± 11.9 to 89.8 ± 18.9 respectively. Postoperative maximal flexion improved from 106.3º ± 5.2º to 125.1º ± 4.2º and flexion contracture improved from 7.5º ± 2.2º to 2.3º ± 1.6º. The mean surgical time was 178.6 minutes and the hospital staym was 39.8 hours. Two patients required transfusions. The complication rate was 6.9%. Three knees (3.5%) required revision surgeryfor aseptic loosening after 7, 8.6 and 12 years. The survivorship rate was 96.5%.
Conclusion: Simultaneous medial or lateral bUKA provides excellent clinical-functional outcomes with a low rate of complications in patients with bilateral knee osteoarthritis.
Materials and Methods: Retrospective report of patients who underwent a medial or lateral bUKA for treatment of bilateral knee osteoarthritis between April 2004 and April 2020, with a minimum follow-up of 1 year. The KSS 2011 was used for the clinical-functional evaluation of each patient. The duration of surgery, length of hospital stay, and transfusion requirements were determined. The short-term and medium-term complications were analyzed, as well as the revision rate and the prosthesis survivorship.
Results: We evaluated 86 bUKAs in 43 patients with a mean follow-up of 6.1 years. The clinical and functional KSS improved from 46.1 ± 10.2 to 80.9 ± 15.9 and 22.8 ± 11.9 to 89.8 ± 18.9 respectively. Postoperative maximal flexion improved from 106.3º ± 5.2º to 125.1º ± 4.2º and flexion contracture improved from 7.5º ± 2.2º to 2.3º ± 1.6º. The mean surgical time was 178.6 minutes and the hospital staym was 39.8 hours. Two patients required transfusions. The complication rate was 6.9%. Three knees (3.5%) required revision surgeryfor aseptic loosening after 7, 8.6 and 12 years. The survivorship rate was 96.5%.
Conclusion: Simultaneous medial or lateral bUKA provides excellent clinical-functional outcomes with a low rate of complications in patients with bilateral knee osteoarthritis.
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Gaggiotti, G., Gaggiotti, S., Gaggiotti, S., & Ringa, J. C. (2023). Bilateral Simultaneous Unicompartmental Knee Arthroplasty. Medium-term Outcomes in 86 Arthroplasties with an Average Follow-up of 6.2 Years. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 88(2), 164-176. https://doi.org/10.15417/issn.1852-7434.2023.88.2.1574
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Clinical Research
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References
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10. Berend K, Morris M, Skeels M, Lombardi A Jr, Adams J. Perioperative complications of simultaneous versus staged unicompartmental knee arthroplasty. Clin Orthop Relat Res 2011;469(1):168-73.
https://doi.org/10.1007/s11999-010-1492-4
11. Chen J, Lo N, Jiang L, Chong H, Tay D, Chin P, et al. Simultaneous versus staged bilateral unicompartmental knee replacement. Bone Joint J 2013;95-B(6):788-92. https://doi.org/10.1302/0301-620X.95B6.30440
12. Chan W, Musonda P, Cooper A, Glasgow M, Donell S, Walton N. One-stage versus two-stage bilateral
unicompartmental knee replacement: a comparison of immediate post-operative complications. J Bone Joint Surg Br 2009;91(10):1305-9. https://doi.org/10.1302/0301-620X.91B10.22612
13. Biazzo A, Masia F, Verde F. Bilateral unicompartmental knee arthroplasty: one stage or two stages? Musculoskelet Surg 2019;103(3):231-6. https://doi.org/10.1007/s12306-018-0579-z
14. Feng S, Yang Z, Sun J, Zhu L, Wang S, Guo K, et al. Comparison of the therapeutic effect between the simultaneous and staged unicompartmental knee arthroplasty (UKA) for bilateral knee medial compartment arthritis. BMC Musculoskelet Disord 2019;20(1):340. https://doi.org/10.1186/s12891-019-2724-8
15. Siedlecki C, Beaufils P, Lemaire B, Pujol N. Complications and cost of single-stage vs. two-stage bilateral unicompartmental knee arthroplasty: A case-control study. Orthop Traumatol Surg Res 2018;104(7):949-53. https://doi.org/10.1016/j.otsr.2018.01.021
16. Kwan H, To K, Bojanic C, Romain K, Khan W. A meta-analysis of clinical and radiological outcomes in
simultaneous bilateral unicompartmental knee arthroplasty. J Orthop 2021;14(23):128-37.
https://doi.org/10.1016/j.jor.2020.12.033
17. Ma T, Tu Y, Xue H, Wen T, Cai M. Clinical outcomes and risks of single-stage bilateral unicompartmental knee arthroplasty via Oxford phase III. Chin Med J (Engl) 2015;128(21):2861-5.
https://doi.org/10.4103/0366-6999.168042
18. Marullo M, Vitale J, Stucovitz E, Romagnoli S. Simultaneous bilateral unicompartmental knee replacement improves gait parameters in patients with bilateral knee osteoarthritis. Knee 2019;26(6):1413-20. https://doi.org/10.1016/j.knee.2019.08.014
19. Cartier P, Sanouiller JL, Grelsamer RP. Unicompartmental knee arthroplasty surgery. 10-year minimum follow-up period. J Arthroplasty 1996;11(7):782-8. https://doi.org/10.1016/s0883-5403(96)80177-x
20. Sakka B, Shiinoki A, Morikawa L, Mathews K, Andrews S, Nakasone C. Comparison of early post-operative complications following unilateral or single-stage bilateral unicompartmental knee arthroplasty. Knee 2020;27(5):1406-10. https://doi.org/10.1016/j.knee.2020.07.096
21. Akhtar KS, Somashekar N, Willis-Owen CA, Houlihan-Burne DG. Clinical outcomes of bilateral single-stage unicompartmental knee arthroplasty. Knee 2014;21(1):310-4. https://doi.org/10.1016/j.knee.2013.05.015
22. Clavé A, Gauthier E, Nagra N, Fazilleau F, Le Sant A, Dubrana F. Single-stage bilateral medial Oxford
Unicompartmental Knee Arthroplasty: A case-control study of perioperative blood loss, complications and functional results. Orthop Traumatol Surg Res 2018;104(7):943-7. https://doi.org/10.1016/j.otsr.2018.03.012
23. Yildiz F, Erden T, Uzer G, Tuncay I. Comparison of clinical outcomes and safety of single-stage bilateral and unilateral unicompartmental knee arthroplasty. Bezmialem Science 2019;7(1):47-51.
https://doi.org/10.14235/bas.galenos.2018.2400
24. Thienpont E. Conversion of a unicompartmental knee arthroplasty to a total knee arthroplasty can we achieve a primary result? Bone Joint J 2017;99B(1):65-9. https://doi.org/10.1302/0301-620X.99B1.BJJ-2016-0272
25. Lecuire F, Galland A, Basso M, Vinel H, Rubini J. Partial or total replacement of a unicompartmental knee prosthesis by another unicompartmental knee prosthesis: a reasonable option? About 22 cases. Eur J Orthop Surg Traumatol 2013;23(8):933-8. https://doi.org/10.1007/s00590-012-1099-4
2. Pandit H, Hamilton TW, Jenkins C, Mellon SJ, Dodd CA, Murray DW. The clinical outcome of minimally invasive Phase 3 Oxford unicompartmental knee arthroplasty: a 15-year follow-up of 1000 UKAs. Bone Joint J 2015;97-B(11):1493-500. https://doi.org/10.1302/0301-620X.97B11.35634
3. Ahn J, Kang D, Choi K. Bilateral simultaneous unicompartmental knee arthroplasty versus unilateral total knee arthroplasty: A comparison of the amount of blood loss and transfusion, perioperative complications, hospital stay, and functional recovery. Orthop Traumatol Surg Res 2017;103(7):1041-5. https://doi.org/10.1016/j.otsr.2017.06.014
4. Hamilton T, Pandit H, Lombardi A, Adams J, Oosthuizen C, Clavé A, et al. Radiological decision aid to determine suitability for medial unicompartmental knee arthroplasty: development and preliminary validation. Bone Joint J 2016;98-B(10 Suppl B):3-10. https://doi.org/10.1302/0301-620X.98B10.BJJ-2016-0432.R1
5. Liddle A, Pandit H, Judge A, Murray D. Patient-reported outcomes after total and unicompartmental knee arthroplasty: a study of 14,076 matched patients from the National Joint Registry for England and Wales. Bone Joint J 2015;97-B(6):793-801. https://doi.org/10.1302/0301-620X.97B6.35155
6. Lee C, Su E, Cross M, Carli A, Landy D, Chalmers B. Unicompartmental knee arthroplasty is associated with a lower rate of periprosthetic joint infection compared to total knee arthroplasty. Arthroplast Today 2021;10:117-22. https://doi.org/10.1016/j.artd.2021.06.006
7. Steele R, Hutabarat S, Evans R, Ackroyd C, Newman J. Survivorship of the St Georg Sled medial unicompartmental knee replacement beyond ten years. J Bone Joint Surg Br 2006;88(9):1164-8.
https://doi.org/10.1302/0301-620X.88B9.18044
8. Romagnoli S, Zacchetti S, Perazzo P, Verde F, Banfi G, Viganò M. Onsets of complications and revisions are not increased after simultaneous bilateral unicompartmental knee arthroplasty in comparison with unilateral procedures. Int Orthop 2015;39(5):871-7. https://doi.org/10.1007/s00264-014-2545-1
9. Sayeed S, Sayeed Y, Barnes S, Pagnano M, Trousdale R. The risk of subsequent joint arthroplasty after primary unilateral total knee arthroplasty, a 10-year study. J Arthroplasty 2011;26(6):842-6.
https://doi.org/10.1016/j.arth.2010.08.016
10. Berend K, Morris M, Skeels M, Lombardi A Jr, Adams J. Perioperative complications of simultaneous versus staged unicompartmental knee arthroplasty. Clin Orthop Relat Res 2011;469(1):168-73.
https://doi.org/10.1007/s11999-010-1492-4
11. Chen J, Lo N, Jiang L, Chong H, Tay D, Chin P, et al. Simultaneous versus staged bilateral unicompartmental knee replacement. Bone Joint J 2013;95-B(6):788-92. https://doi.org/10.1302/0301-620X.95B6.30440
12. Chan W, Musonda P, Cooper A, Glasgow M, Donell S, Walton N. One-stage versus two-stage bilateral
unicompartmental knee replacement: a comparison of immediate post-operative complications. J Bone Joint Surg Br 2009;91(10):1305-9. https://doi.org/10.1302/0301-620X.91B10.22612
13. Biazzo A, Masia F, Verde F. Bilateral unicompartmental knee arthroplasty: one stage or two stages? Musculoskelet Surg 2019;103(3):231-6. https://doi.org/10.1007/s12306-018-0579-z
14. Feng S, Yang Z, Sun J, Zhu L, Wang S, Guo K, et al. Comparison of the therapeutic effect between the simultaneous and staged unicompartmental knee arthroplasty (UKA) for bilateral knee medial compartment arthritis. BMC Musculoskelet Disord 2019;20(1):340. https://doi.org/10.1186/s12891-019-2724-8
15. Siedlecki C, Beaufils P, Lemaire B, Pujol N. Complications and cost of single-stage vs. two-stage bilateral unicompartmental knee arthroplasty: A case-control study. Orthop Traumatol Surg Res 2018;104(7):949-53. https://doi.org/10.1016/j.otsr.2018.01.021
16. Kwan H, To K, Bojanic C, Romain K, Khan W. A meta-analysis of clinical and radiological outcomes in
simultaneous bilateral unicompartmental knee arthroplasty. J Orthop 2021;14(23):128-37.
https://doi.org/10.1016/j.jor.2020.12.033
17. Ma T, Tu Y, Xue H, Wen T, Cai M. Clinical outcomes and risks of single-stage bilateral unicompartmental knee arthroplasty via Oxford phase III. Chin Med J (Engl) 2015;128(21):2861-5.
https://doi.org/10.4103/0366-6999.168042
18. Marullo M, Vitale J, Stucovitz E, Romagnoli S. Simultaneous bilateral unicompartmental knee replacement improves gait parameters in patients with bilateral knee osteoarthritis. Knee 2019;26(6):1413-20. https://doi.org/10.1016/j.knee.2019.08.014
19. Cartier P, Sanouiller JL, Grelsamer RP. Unicompartmental knee arthroplasty surgery. 10-year minimum follow-up period. J Arthroplasty 1996;11(7):782-8. https://doi.org/10.1016/s0883-5403(96)80177-x
20. Sakka B, Shiinoki A, Morikawa L, Mathews K, Andrews S, Nakasone C. Comparison of early post-operative complications following unilateral or single-stage bilateral unicompartmental knee arthroplasty. Knee 2020;27(5):1406-10. https://doi.org/10.1016/j.knee.2020.07.096
21. Akhtar KS, Somashekar N, Willis-Owen CA, Houlihan-Burne DG. Clinical outcomes of bilateral single-stage unicompartmental knee arthroplasty. Knee 2014;21(1):310-4. https://doi.org/10.1016/j.knee.2013.05.015
22. Clavé A, Gauthier E, Nagra N, Fazilleau F, Le Sant A, Dubrana F. Single-stage bilateral medial Oxford
Unicompartmental Knee Arthroplasty: A case-control study of perioperative blood loss, complications and functional results. Orthop Traumatol Surg Res 2018;104(7):943-7. https://doi.org/10.1016/j.otsr.2018.03.012
23. Yildiz F, Erden T, Uzer G, Tuncay I. Comparison of clinical outcomes and safety of single-stage bilateral and unilateral unicompartmental knee arthroplasty. Bezmialem Science 2019;7(1):47-51.
https://doi.org/10.14235/bas.galenos.2018.2400
24. Thienpont E. Conversion of a unicompartmental knee arthroplasty to a total knee arthroplasty can we achieve a primary result? Bone Joint J 2017;99B(1):65-9. https://doi.org/10.1302/0301-620X.99B1.BJJ-2016-0272
25. Lecuire F, Galland A, Basso M, Vinel H, Rubini J. Partial or total replacement of a unicompartmental knee prosthesis by another unicompartmental knee prosthesis: a reasonable option? About 22 cases. Eur J Orthop Surg Traumatol 2013;23(8):933-8. https://doi.org/10.1007/s00590-012-1099-4