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Cemented versus Uncemented Oxford Unicompartmental Knee Arthroplasty: Is There a Difference?

DOI: 10.1155/2013/245915

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Purpose. The use of uncemented unicompartmental knee prostheses has recently increased. However, few studies on the outcomes of uncemented unicompartmental knee prostheses have been performed. The purpose of this study was to compare the outcomes of cemented and uncemented Oxford unicompartmental knee arthroplasty. Materials and Methods. This retrospective observational study evaluated the clinical and radiological outcomes of 263 medial Oxford unicompartmental prostheses (141 cemented, 122 uncemented) implanted in 235 patients. The mean follow-up was 42 months in the cemented group and 30 months in the uncemented group. Results. At the last follow-up, there were no significant differences in the clinical results or survival rates between the two groups. However, the operation time in the uncemented unicompartmental knee arthroplasty group was shorter than that in the cemented unicompartmental knee arthroplasty group. In addition, the cost of uncemented arthroplasty was greater. Conclusion. Despite the successful midterm results in the uncemented unicompartmental knee arthroplasty group, a longer follow-up period is required to determine the best fixation mode. 1. Introduction Unicompartmental knee replacement arthroplasty (UKA) has been a popular treatment of osteoarthritis since the 1970s. Initial reports showed high failure rates in short-term follow-ups [1]. Because of these high failure rates and instrumentation problems, the use of these implants decreased in the 1990s. However, during the last 20 years, UKA has become a well-established treatment method for unicompartmental osteoarthritis of the knee. Recent reports have described success rates of 90% or higher at a minimum 10-year follow-up [2, 3]. These higher success rates have been attributed to better surgical techniques, new implant designs, improved instrumentation, and careful patient selection [4]. With the improvements in surgical techniques and instruments, this procedure has many advantages over total knee replacement such as a smaller incision, less soft tissue injury, preservation of bone stock, preservation of normal knee kinematics, less morbidity because of minimal postoperative blood loss, lower infection rate, shortened hospital stay, and rapid recovery [5]. However, controversy on the validity and durability of UKA remains. Although UKA is associated with better clinical results than total knee replacement arthroplasty (TKA), registry data show higher revision rates [6]. On the other hand, Goodfellow et al. reported that the revision rate is a poor and misleading outcome and

References

[1]  R. S. Laskin, “Unicompartmental tibiofemoral resurfacing arthroplasty,” The Journal of Bone & Joint Surgery A, vol. 60, no. 2, pp. 182–185, 1978.
[2]  D. W. Murray, J. W. Goodfellow, and J. J. O'Connor, “The oxford medial unicompartmental arthroplasty. A ten-year survival study,” The Journal of Bone & Joint Surgery B, vol. 80, no. 6, pp. 983–989, 1998.
[3]  M. W. Squire, J. J. Callaghan, D. D. Goetz, P. M. Sullivan, and R. C. Johnston, “Unicompartmental knee replacement: a minimum 15 year followup study,” Clinical Orthopaedics and Related Research, no. 367, pp. 61–72, 1999.
[4]  C. L. Saenz, M. S. McGrath, D. R. Marker, T. M. Seyler, M. A. Mont, and P. M. Bonutti, “Early failure of a unicompartmental knee arthroplasty design with an all-polyethylene tibial component,” Knee, vol. 17, no. 1, pp. 53–56, 2010.
[5]  J. H. Newman, C. E. Ackroyd, and N. A. Shah, “Unicompartmental or total knee replacement: the 15-year results of a prospective randomised controlled trial,” The Journal of Bone & Joint Surgery B, vol. 80, no. 5, pp. 862–865, 1998.
[6]  O. Furnes, B. Espehaug, S. A. Lie, S. E. Vollset, L. B. Enges?ter, and L. I. Havelin, “Failure mechanisms after unicompartmental and tricompartmental primary knee replacement with cement,” The Journal of Bone & Joint Surgery A, vol. 89, no. 3, pp. 519–525, 2007.
[7]  J. W. Goodfellow, J. J. O'Connor, and D. W. Murray, “A critique of revision rate as an outcome measure: re-interpretation of knee joint registry data,” The Journal of Bone & Joint Surgery B, vol. 92, no. 12, pp. 1628–1631, 2010.
[8]  H. Pandit, C. Jenkins, D. J. Beard et al., “Cementless Oxford unicompartmental knee replacement shows reduced radiolucency at one year,” The Journal of Bone & Joint Surgery B, vol. 91, no. 2, pp. 185–189, 2009.
[9]  ?. Carlsson, A. Bj?rkman, J. Besjakov, and I. ?nsten, “Cemented tibial component fixation performs better than cementless fixation: a randomized radiostereometric study comparing porous-coated, hydroxyapatite-coated and cemented tibial components over 5 years,” Acta Orthopaedica, vol. 76, no. 3, pp. 362–369, 2005.
[10]  M. A. Ritter and R. M. Meneghini, “Twenty-year survivorship of cementless anatomic graduated component total knee arthroplasty,” Journal of Arthroplasty, vol. 25, no. 4, pp. 507–513, 2010.
[11]  C. S. Ranawat, M. Meftah, E. N. Windsor, and A. S. Ranawat, “Cementless fixation in total knee arthroplasty: down the boulevard of broken dreams—affirms,” The Journal of Bone & Joint Surgery B, vol. 94, pp. 82–84, 2012.
[12]  K. Daniilidis, A. Skwara, A. Skuginna, F. Fischer, and C. O. Tibesku, “Comparison of medium-term clinical and radiological outcome between cemented and cementless medial unicompartmental knee arthroplasty,” Zeitschrift für Orthop?die und Unfallchirurgie, vol. 147, no. 2, pp. 188–193, 2009.
[13]  J. W. Goodfellow, C. J. Kershaw, M. K. D'A Benson, and J. J. O'Connor, “The Oxford knee for unicompartmental osteoarthritis. The first 103 cases,” The Journal of Bone & Joint Surgery B, vol. 70, no. 5, pp. 692–701, 1988.
[14]  H. Pandit, C. Jenkins, H. S. Gill et al., “Unnecessary contraindications for mobile-bearing unicompartmental knee replacement,” The Journal of Bone & Joint Surgery B, vol. 93, no. 5, pp. 622–628, 2011.
[15]  S. C. Kozinn and R. Scott, “Current concepts review unicondylar knee arthroplasty,” The Journal of Bone & Joint Surgery A, vol. 71, no. 1, pp. 145–150, 1989.
[16]  J. Goodfellow, J. O'Connor, and D. W. Murray, “The Oxford meniscal unicompartmental knee,” The Journal of Knee Surgery, vol. 15, no. 4, pp. 240–246, 2002.
[17]  W. P. Barrett and R. D. Scott, “Revision of failed unicondylar unicompartmental knee arthroplasty,” The Journal of Bone & Joint Surgery A, vol. 69, no. 9, pp. 1328–1335, 1987.
[18]  P. Vorlat, R. Verdonk, and H. Schauvlieghe, “The Oxford unicompartmental knee prosthesis: a 5-year follow-up,” Knee Surgery, Sports Traumatology, Arthroscopy, vol. 8, no. 3, pp. 154–158, 2000.
[19]  F. M. Khaw, L. M. G. Kirk, R. W. Morris, and P. J. Gregg, “A randomised, controlled trial of cemented versus cementless press-fit condylar total knee replacement. Ten-year survival analysis,” The Journal of Bone & Joint Surgery B, vol. 84, no. 5, pp. 658–666, 2002.
[20]  A. J. Price and U. Svard, “A second decade lifetable survival analysis of the oxford unicompartmental knee arthroplasty,” Clinical Orthopaedics and Related Research, vol. 469, no. 1, pp. 174–179, 2011.
[21]  H. Pandit, C. Jenkins, H. S. Gill, K. Barker, C. A. F. Dodd, and D. W. Murray, “Minimally invasive Oxford phase 3 unicompartmental knee replacement: results of 1000 cases,” The Journal of Bone & Joint Surgery B, vol. 93, no. 2, pp. 198–204, 2011.
[22]  J. W. Goodfellow, J. J. O’Connor, C. Dodd, and D. W. Murray, Unicompartmental Arthroplasty with the Oxford Knee, Goodfellow Publishers, Oxford, UK, 1st edition, 2006.
[23]  G. J. Hooper, A. R. Maxwell, B. Wilkinson et al., “The early radiological results of the uncemented Oxford medial compartment knee replacement,” The Journal of Bone & Joint Surgery B, vol. 94, no. 3, pp. 334–338, 2012.
[24]  M. Clarius, D. Haas, P. R. Aldinger, S. Jaeger, E. Jakubowitz, and J. B. Seeger, “Periprosthetic tibial fractures in unicompartmental knee arthroplasty as a function of extended sagittal saw cuts: an experimental study,” Knee, vol. 17, no. 1, pp. 57–60, 2010.
[25]  H. C. Lim, J. H. Bae, S. H. Song, and S. J. Kim, “Oxford phase 3 unicompartmental knee replacement in Korean patients,” The Journal of Bone & Joint Surgery B, vol. 94, pp. 1071–1076, 2012.
[26]  J. B. Seeger, D. Haas, S. J?ger, E. R?hner, S. Tohtz, and M. Clarius, “Extended sagittal saw cut significantly reduces fracture load in cementless unicompartmental knee arthroplasty compared to cemented tibia plateaus: an experimental cadaver study,” Knee Surgery, Sports Traumatology, Arthroscopy, vol. 20, no. 6, pp. 1087–1091, 2012.
[27]  B. Akan, T. Yildirim, and D. Karaguven, “Medial femoral condyle fracture after cementless unicompartmental knee replacement: a rare complication,” Knee, vol. 20, pp. 295–297, 2013.

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