Comparison of early effectiveness and safety of simultaneous and staged bilateral unicompartmental knee arthroplasty for bilateral anteromedial compartment osteoarthritis_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

SU Zhiyuan ¹ , LIU Juncai ¹ , DENG Xiangtian ¹ , AO Yunong ¹ , WEI Daiqing ¹ , LUO Yun ² ,  LI Zhong ¹

1. Department of Orthopaedics and Joint Surgery, the Affiliated Hospital of Southwest Medical University, Luzhou Sichuan, 646000, P.R.China;
2. Department of Neurology, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu Sichaun, 610072, P.R.China;

Corresponding?author：

LI Zhong, Email: 545890312@qq.com

Keywords：

Unicompartmental knee arthroplasty; knee; osteoarthritis; simultaneous operation; staged operation; early effectiveness; safety

DOI：

10.7507/1002-1892.201810030

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Objective To compare the early effectiveness and safety of simultaneous bilateral and staged bilateral unicompartmental knee arthroplasty (UKA) in treatment of anteromedial compartment osteoarthritis.Methods The clinical data of 31 patients with bilateral anteromedial compartment osteoarthritis who underwent bilateral UKAs between January 2015 and January 2017 was retrospectively analyzed. Of them, 17 patients were treated with simultaneous bilateral UKAs (simultaneous group) and 14 patients with staged bilateral UKAs (staged group). There was no significant difference in gender, age, body mass index, osteoarthritis grading, and preoperative hip-knee-ankle angle, knee society score (KSS), visual analogue scale (VAS) score, and range of motion (ROM) of knee between the two groups (P>0.05). The operation time, blood loss, hospitalization stay, minimum hemoglobin value during 10 days after operation, and hospitalization cost were recorded. The staged group was compared by the sum of two operations. The effectiveness was evaluated by KSS score, VAS score, ROM at 3, 6, 12 months after operation, and patient satisfaction scores were recorded at 12 months after operation.Results The operation time, hospitalization stay, and hospitalization cost of the simultaneous group were significantly lower than those of the staged group (P<0.05). There was no significant difference in blood loss and the minimum hemoglobin value during 10 days after operation between the two groups (P>0.05). Superficial infection occurred in 1 side of 1 case (7.1%) in staged group. Postoperative delirium occurred in 1 case (5.9%) in simultaneous group. There was no significant difference in incidence of postoperative complications between the two groups (P=1.000). Patients in both groups were followed up 12-32 months (mean, 24.7 months). There was no significant difference in KSS score between the two groups at 3 months after operation (t=0.896, P=0.392). KSS scores were significanly higher in simultaneous group than in staged group at 6 and 12 months after operation (P<0.05). There was no significant difference in ROM and VAS scores between the two groups at 3, 6, and 12 months after operation (P>0.05). At 12 months after operation, the patient satisfaction scores were significantly higher in simultaneous group than in staged group (P<0.05). X-ray films showed no loosening of the prosthesis in the two groups.Conclusion Simultaneous bilateral UKAs has the same security as staged bilateral UKAs. Meanwhile knee function recovery was better, hospitalization stay and hospitalization cost reduced, and patient satisfaction was higher in simultaneous bilateral UKAs.

Citation： SU Zhiyuan, LIU Juncai, DENG Xiangtian, AO Yunong, WEI Daiqing, LUO Yun, LI Zhong. Comparison of early effectiveness and safety of simultaneous and staged bilateral unicompartmental knee arthroplasty for bilateral anteromedial compartment osteoarthritis. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(7): 854-859. doi: 10.7507/1002-1892.201810030 Copy

1.	中華醫學會骨科學分會關節外科學組. 骨關節炎診療指南(2018年版). 中華骨科雜志, 2018, 38(12): 705-715.
2.	王亮, 伍驥, 鄭超, 等. 單髁與全膝置換治療老年單間室骨關節炎比較. 中國矯形外科雜志, 2017, 25(15): 1372-1377.
3.	鄧迎杰, 梁治權, 方銳. 單髁置換術治療膝骨性關節炎 227 例臨床報道. 中國矯形外科雜志, 2018, 26(17): 1555-1559.
4.	Arirachakaran A, Choowit P, Putananon C, et al. Is unicompartmental knee arthroplasty (UKA) superior to total knee arthroplasty (TKA)? A systematic review and meta-analysis of randomized controlled trial. Eur J Orthop Surg Traumatol, 2015, 25(5): 799-806.
5.	Kulshrestha V, Kumar S, Datta B, et al. Ninety-day morbidity and mortality in risk-screened and optimized patients undergoing two-team fast-track simultaneous bilateral TKA compared with unilateral TKA-A prospective study. J Arthroplasty, 2018, 33(3): 752-760.
6.	Mont MA, Mitzner DL, Jones LC, et al. History of the contralateral knee after primary knee arthroplasty for osteoarthritis. Clin Orthop Relat Res, 1995, (321): 145-150.
7.	趙東方, 孔祥朋, 王毅, 等. 第三代 Oxford 單髁假體安放位置對人工單髁關節置換的影響. 中國修復重建外科雜志, 2018, 32(12): 1518-1523.
8.	楊濤, 薛華明, 馬童, 等. 膝關節單髁置換術脛骨假體術前定位的臨床研究. 中國矯形外科雜志, 2017, 25(7): 590-595.
9.	喬國艷, 林顯文, 曾良幫, 等. 偏頭痛患者及其家屬心理狀態與門診就醫滿意度的評估. 中國現代醫學雜志, 2019[2019-05-16]. http://kns.cnki.net/kcms/detail/43.1225.r.20190515.1001.036.html.
10.	Berend KR, Morris MJ, Skeels MD, et al. Perioperative complications of simultaneous versus staged unicompartmental knee arthroplasty. Clin Orthop Relat Res, 2011, 469(1): 168-173.
11.	Akhtar KS, Somashekar N, Willis-Owen CA, et al. Clinical outcomes of bilateral single-stage unicompartmental knee arthroplasty. Knee, 2014, 21(1): 310-314.
12.	Chan WC, Musonda P, Cooper A, et al. One-stage versus two-stage bilateral unicompartmental knee replacement: a comparison of immediate post-operative complications. J Bone Joint Surg (Br), 2009, 91(10): 1305-1309.
13.	Ma T, Tu Y, Xue HM, et al. Clinical outcomes and risks of single-stage bilateral unicompartmental knee arthroplasty via Oxford phase Ⅲ. Chin Med J (Engl), 2015, 128(21): 2861-2865.
14.	Clavé A, Gauthier E, Nagra NS, et al. 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): 943-947.
15.	Siedlecki C, Beaufils P, Lemaire B, et al. Complications and cost of single-stage vs. two-stage bilateral unicompartmental knee arthroplasty: A case-control study. Orthop Traumatol Surg Res, 2018, 104(7): 949-953.
16.	Romagnoli S, Zacchetti S, Perazzo P, et al. Onsets of complications and revisions are not increased after simultaneous bilateral unicompartmental knee arthroplasty in comparison with unilateral procedures. Int Orthop, 2015, 39(5): 871-877.
17.	Chen JY, Lo NN, Jiang L, et al. Simultaneous versus staged bilateral unicompartmental knee replacement. Bone Joint J, 2013, 95-B(6): 788-792.
18.	Lisowski LA, van den Bekerom MP, Pilot P, et al. Oxford Phase 3 unicompartmental knee arthroplasty: medium-term results of a minimally invasive surgical procedure. Knee Surg Sports Traumatol Arthrosc, 2011, 19(2): 277-284.

1. 中華醫學會骨科學分會關節外科學組. 骨關節炎診療指南(2018年版). 中華骨科雜志, 2018, 38(12): 705-715.
2. 王亮, 伍驥, 鄭超, 等. 單髁與全膝置換治療老年單間室骨關節炎比較. 中國矯形外科雜志, 2017, 25(15): 1372-1377.
3. 鄧迎杰, 梁治權, 方銳. 單髁置換術治療膝骨性關節炎 227 例臨床報道. 中國矯形外科雜志, 2018, 26(17): 1555-1559.
4. Arirachakaran A, Choowit P, Putananon C, et al. Is unicompartmental knee arthroplasty (UKA) superior to total knee arthroplasty (TKA)? A systematic review and meta-analysis of randomized controlled trial. Eur J Orthop Surg Traumatol, 2015, 25(5): 799-806.
5. Kulshrestha V, Kumar S, Datta B, et al. Ninety-day morbidity and mortality in risk-screened and optimized patients undergoing two-team fast-track simultaneous bilateral TKA compared with unilateral TKA-A prospective study. J Arthroplasty, 2018, 33(3): 752-760.
6. Mont MA, Mitzner DL, Jones LC, et al. History of the contralateral knee after primary knee arthroplasty for osteoarthritis. Clin Orthop Relat Res, 1995, (321): 145-150.
7. 趙東方, 孔祥朋, 王毅, 等. 第三代 Oxford 單髁假體安放位置對人工單髁關節置換的影響. 中國修復重建外科雜志, 2018, 32(12): 1518-1523.
8. 楊濤, 薛華明, 馬童, 等. 膝關節單髁置換術脛骨假體術前定位的臨床研究. 中國矯形外科雜志, 2017, 25(7): 590-595.
9. 喬國艷, 林顯文, 曾良幫, 等. 偏頭痛患者及其家屬心理狀態與門診就醫滿意度的評估. 中國現代醫學雜志, 2019[2019-05-16]. http://kns.cnki.net/kcms/detail/43.1225.r.20190515.1001.036.html.
10. Berend KR, Morris MJ, Skeels MD, et al. Perioperative complications of simultaneous versus staged unicompartmental knee arthroplasty. Clin Orthop Relat Res, 2011, 469(1): 168-173.
11. Akhtar KS, Somashekar N, Willis-Owen CA, et al. Clinical outcomes of bilateral single-stage unicompartmental knee arthroplasty. Knee, 2014, 21(1): 310-314.
12. Chan WC, Musonda P, Cooper A, et al. One-stage versus two-stage bilateral unicompartmental knee replacement: a comparison of immediate post-operative complications. J Bone Joint Surg (Br), 2009, 91(10): 1305-1309.
13. Ma T, Tu Y, Xue HM, et al. Clinical outcomes and risks of single-stage bilateral unicompartmental knee arthroplasty via Oxford phase Ⅲ. Chin Med J (Engl), 2015, 128(21): 2861-2865.
14. Clavé A, Gauthier E, Nagra NS, et al. 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): 943-947.
15. Siedlecki C, Beaufils P, Lemaire B, et al. Complications and cost of single-stage vs. two-stage bilateral unicompartmental knee arthroplasty: A case-control study. Orthop Traumatol Surg Res, 2018, 104(7): 949-953.
16. Romagnoli S, Zacchetti S, Perazzo P, et al. Onsets of complications and revisions are not increased after simultaneous bilateral unicompartmental knee arthroplasty in comparison with unilateral procedures. Int Orthop, 2015, 39(5): 871-877.
17. Chen JY, Lo NN, Jiang L, et al. Simultaneous versus staged bilateral unicompartmental knee replacement. Bone Joint J, 2013, 95-B(6): 788-792.
18. Lisowski LA, van den Bekerom MP, Pilot P, et al. Oxford Phase 3 unicompartmental knee arthroplasty: medium-term results of a minimally invasive surgical procedure. Knee Surg Sports Traumatol Arthrosc, 2011, 19(2): 277-284.

Chinese Journal of Reparative and Reconstructive Surgery

Comparison of early effectiveness and safety of simultaneous and staged bilateral unicompartmental knee arthroplasty for bilateral anteromedial compartment osteoarthritis

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