Short-term effectiveness of unicompartmental knee arthroplasty for knee osteoarthritis in super-age patients_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANG Fangxing , XUE Huaming , MA Tong , WEN Tao , YANG Tao , XUE Long ,  TU Yihui

Department of Joint Surgery, Yangpu Hospital Affiliated to Tongji University, Shanghai, 200082, P.R.China;

Corresponding?author：

TU Yihui, Email: dongying3124@126.com

Keywords：

Unicompartmental knee arthroplasty; knee; osteoarthritis; super-age patient

DOI：

10.7507/1002-1892.201811061

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Objective To investigate the short-term effectiveness of unicompartmental knee arthroplasty (UKA) in the treatment of knee osteoarthritis of super-age patients over 85 years old.Methods Senile patients with unilateral compartment osteoarthritis of the knee who received UKA between November 2013 and May 2017 and met the inclusion criteria were enrolled as the research objects. Among them, 40 patients (50 knees) were more than 85 years old (super-age group) and 44 patients (50 knees) were 52-81 years old (control group). There was significant difference in age between the two groups (t=17.33, P=0.00). There was no significant difference in body mass index, degenerative classification of medial and lateral compartments, varus deformity of knee, disease duration, complicating diseases, and preoperative hemoglobin, hematocrit (HCT), American Hospital for Special Surgery (HSS) score, range of motion (ROM) of knee, visual analogue scale (VAS) score, and femoral-tibial angle (FTA) between the two groups (P>0.05). Hospital stay, hemoglobin, and HCT of the two groups were recorded before operation and on the first day after operation. The changes of hemoglobin and HCT after operation were calculated. During follow-up period, the ROM of the knee, HSS score, and VAS score were measured; the position of the prosthesis and FTA were observed by X-ray films.Results There was no significant difference in hospital stay between the two groups (t=1.05, P=0.29). Hemoglobin and HCT of the two groups on the first day after operation were significantly lower than those before operation (P<0.05). There was no significant difference in the postoperative changes of hemoglobin and HCT between the two groups (P>0.05). All the patients were followed up completely except 4 cases (5 knees) in the super-age group. The follow-up time ranged from 14 to 44 months of super-age group (mean, 29 months) and 21 to 33 months of control group (mean, 24 months). There were significant differences in HSS score, VAS score, ROM of the knee, and FTA between pre-operation and last follow-up in the two groups (P<0.05). There was significant difference in HSS score between the two groups (P<0.05), and no significant difference was found in ROM, VAS score, and FTA between the two groups (P>0.05). X-ray film showed no adverse position of the prosthesis, infection around the prosthesis, prosthesis loosening, or pathological bright lines.Conclusion UKA combined with reasonable perioperative management in the treatment of super-age patients over 85 years with knee osteoarthritis is safe and feasible, and can obtain satisfactory short-term effectiveness.

Citation： WANG Fangxing, XUE Huaming, MA Tong, WEN Tao, YANG Tao, XUE Long, TU Yihui. Short-term effectiveness of unicompartmental knee arthroplasty for knee osteoarthritis in super-age patients. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(8): 947-952. doi: 10.7507/1002-1892.201811061 Copy

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2.	Fautrel B, Hilliquin P, Rozenberg S, et al. Impact of osteoarthritis: results of a nationwide survey of 10, 000 patients consulting for OA. Joint Bone Spine, 2005, 72(3): 235-240.
3.	Sharma L, Kapoor D, Issa S. Epidemiology of osteoarthritis: an update. Curr Opin Rheumatol, 2006, 18(2): 147-156.
4.	Price AJ, Rees JL, Beard DJ, et al. Sagittal plane kinematics of a mobile-bearing unicompartmental knee arthroplasty at 10 years: a comparative in vivo fluoroscopic analysis. J Arthroplasty, 2004, 19(5): 590-597.
5.	Berger RA, Meneghini RM, Jacobs JJ, et al. Results of unicompartmental knee arthroplasty at a minimum of ten years of follow-up. J Bone Joint Surg (Am), 2005, 87(5): 999-1006.
6.	Naudie D, Guerin J, Parker DA, et al. Medial unicompartmental knee arthroplasty with the Miller-Galante prosthesis. J Bone Joint Surg (Am), 2004, 86(9): 1931-1935.
7.	Zhang Q, Zhang Q, Guo W, et al. The learning curve for minimally invasive Oxford phase 3 unicompartmental knee arthroplasty: cumulative summation test for learning curve (LC-CUSUM). J Orthop Surg Res, 2014, 9(1): 81.
8.	郭萬首, 張啟棟, 劉朝暉, 等. 小切口單髁置換術治療膝關節內側間室骨關節炎 94 膝的中短期療效研究. 中國矯形外科雜志, 2011, 19(17): 1412-1415.
9.	張啟棟, 郭萬首, 劉朝暉, 等. 內翻畸形膝骨關節炎軟骨磨損的臨床研究. 中國矯形外科雜志, 2013, 21(23): 2345-2350.
10.	Liddle AD, Judge A, Pandit H, et al. Determinants of revision and functional outcome following unicompartmental knee replacement. Osteoarthritis Cartilage, 2014, 22(9): 1241-1250.
11.	張啟棟, 郭萬首, 劉朝暉, 等. 80 歲以上高齡膝關節骨關節炎應用單髁關節置換治療的臨床研究. 生物骨科材料與臨床研究, 2015, 12(2): 21-24.
12.	張啟棟, 郭萬首, 劉朝暉, 等. 單髁與全膝關節置換術治療高齡患者的配對病例對照研究. 中華關節外科雜志(電子版), 2017, 11(1): 4-8.
13.	Clagett GP, Anderson FA Jr, Heit J, et al. Prevention of venous thromboembolism. Chest, 1995, 108(4 Suppl): 312S-334S.
14.	White RH, Gettner S, Newman JM, et al. Predictors of rehospitalization for symptomatic venous thromboembolism after total hip arthroplasty. N Engl J Med, 2000, 343: 1758-1764.
15.	de Thomasson E, Strauss C, Girard P, et al. Detection of asymptomatic venous thrombosis after lower limb prosthetic surgery. Retrospective evaluation of a systematic approach using Doppler ultrasonography: 400 cases. Presse Med, 2000, 29(7): 351-356.
16.	Stern SH, Becker MW, Insall JN. Unicondylar knee arthroplasty-An evaluation of selection criteria. Clin Orthop Relat Res, 1993, (286): 143-148.
17.	Beard DJ, Pandit H, Ostlere S, et al. Pre-operative clinical and radiological assessment of the patellofemoral joint in unicompartmental knee replacement and its influence on outcome. Journal of Bone Joint Surg (Br), 2007, 89(12): 1602-1607.
18.	Pandit H, Jenkins C, Gill HS, et al. Minimally invasive Oxford phase 3 unicompartmental knee replacement: results of 1000 cases. J Bone Joint Surg (Br), 2011, 93(2): 198-204.
19.	Murray DW, Goodfellow JW, O’Connor JJ. The Oxford medial unicompartmental arthroplasty: a ten-year survival study. J Bone Joint Surg (Br), 1998, 80(6): 983-989.
20.	Liddle AD, Pandit H, Jenkins C, et al. Preoperative pain location is a poor predictor of outcome after Oxford unicompartmental knee arthroplasty at 1 and 5 years. Knee Surg Sports Traumatol Arthrosc, 2013, 21(11): 2421-2426.
21.	Tai TW, Lin CJ, Jou IM, et al. Tourniquet use in total knee arthroplasty: a meta-analysis. Knee Surg Sports Traumatol Arthrosc, 2011, 19(7): 1121-1130.

1. Lawrence RC, Felson DT, Helmick CG, et al. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part Ⅱ. Arthritis Rheum, 2008, 58(1): 26-35.
2. Fautrel B, Hilliquin P, Rozenberg S, et al. Impact of osteoarthritis: results of a nationwide survey of 10, 000 patients consulting for OA. Joint Bone Spine, 2005, 72(3): 235-240.
3. Sharma L, Kapoor D, Issa S. Epidemiology of osteoarthritis: an update. Curr Opin Rheumatol, 2006, 18(2): 147-156.
4. Price AJ, Rees JL, Beard DJ, et al. Sagittal plane kinematics of a mobile-bearing unicompartmental knee arthroplasty at 10 years: a comparative in vivo fluoroscopic analysis. J Arthroplasty, 2004, 19(5): 590-597.
5. Berger RA, Meneghini RM, Jacobs JJ, et al. Results of unicompartmental knee arthroplasty at a minimum of ten years of follow-up. J Bone Joint Surg (Am), 2005, 87(5): 999-1006.
6. Naudie D, Guerin J, Parker DA, et al. Medial unicompartmental knee arthroplasty with the Miller-Galante prosthesis. J Bone Joint Surg (Am), 2004, 86(9): 1931-1935.
7. Zhang Q, Zhang Q, Guo W, et al. The learning curve for minimally invasive Oxford phase 3 unicompartmental knee arthroplasty: cumulative summation test for learning curve (LC-CUSUM). J Orthop Surg Res, 2014, 9(1): 81.
8. 郭萬首, 張啟棟, 劉朝暉, 等. 小切口單髁置換術治療膝關節內側間室骨關節炎 94 膝的中短期療效研究. 中國矯形外科雜志, 2011, 19(17): 1412-1415.
9. 張啟棟, 郭萬首, 劉朝暉, 等. 內翻畸形膝骨關節炎軟骨磨損的臨床研究. 中國矯形外科雜志, 2013, 21(23): 2345-2350.
10. Liddle AD, Judge A, Pandit H, et al. Determinants of revision and functional outcome following unicompartmental knee replacement. Osteoarthritis Cartilage, 2014, 22(9): 1241-1250.
11. 張啟棟, 郭萬首, 劉朝暉, 等. 80 歲以上高齡膝關節骨關節炎應用單髁關節置換治療的臨床研究. 生物骨科材料與臨床研究, 2015, 12(2): 21-24.
12. 張啟棟, 郭萬首, 劉朝暉, 等. 單髁與全膝關節置換術治療高齡患者的配對病例對照研究. 中華關節外科雜志(電子版), 2017, 11(1): 4-8.
13. Clagett GP, Anderson FA Jr, Heit J, et al. Prevention of venous thromboembolism. Chest, 1995, 108(4 Suppl): 312S-334S.
14. White RH, Gettner S, Newman JM, et al. Predictors of rehospitalization for symptomatic venous thromboembolism after total hip arthroplasty. N Engl J Med, 2000, 343: 1758-1764.
15. de Thomasson E, Strauss C, Girard P, et al. Detection of asymptomatic venous thrombosis after lower limb prosthetic surgery. Retrospective evaluation of a systematic approach using Doppler ultrasonography: 400 cases. Presse Med, 2000, 29(7): 351-356.
16. Stern SH, Becker MW, Insall JN. Unicondylar knee arthroplasty-An evaluation of selection criteria. Clin Orthop Relat Res, 1993, (286): 143-148.
17. Beard DJ, Pandit H, Ostlere S, et al. Pre-operative clinical and radiological assessment of the patellofemoral joint in unicompartmental knee replacement and its influence on outcome. Journal of Bone Joint Surg (Br), 2007, 89(12): 1602-1607.
18. Pandit H, Jenkins C, Gill HS, et al. Minimally invasive Oxford phase 3 unicompartmental knee replacement: results of 1000 cases. J Bone Joint Surg (Br), 2011, 93(2): 198-204.
19. Murray DW, Goodfellow JW, O’Connor JJ. The Oxford medial unicompartmental arthroplasty: a ten-year survival study. J Bone Joint Surg (Br), 1998, 80(6): 983-989.
20. Liddle AD, Pandit H, Jenkins C, et al. Preoperative pain location is a poor predictor of outcome after Oxford unicompartmental knee arthroplasty at 1 and 5 years. Knee Surg Sports Traumatol Arthrosc, 2013, 21(11): 2421-2426.
21. Tai TW, Lin CJ, Jou IM, et al. Tourniquet use in total knee arthroplasty: a meta-analysis. Knee Surg Sports Traumatol Arthrosc, 2011, 19(7): 1121-1130.

Chinese Journal of Reparative and Reconstructive Surgery

Short-term effectiveness of unicompartmental knee arthroplasty for knee osteoarthritis in super-age patients

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