Research progress in Oxford unicompartmental knee arthroplasty for partial thickness cartilage loss in medial compartment of knee joint_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

HUANG Wenbin , LIU Dianqi ,  LU Weijie

Department of Joint Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Guangdong, 510120, P. R. China;

Corresponding?author：

LU Weijie, Email: 13902280296@139.com

Keywords：

Knee joint; osteoarthritis; Oxford unicompartmental knee arthroplasty; partial thickness cartilage loss

DOI：

10.7507/1002-1892.202403091

Video：

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Objective To summarize the research progress of Oxford unicompartmental knee arthroplasty (UKA) in treating partial thickness cartilage loss (PTCL) in the medial compartment of the knee joint, aiming to further clarify the indications and optimize the effectiveness of Oxford UKA. Methods A comprehensive review of recent domestic and international literature on Oxford UKA for PTCL in the medial compartment of the knee joint was conducted to summarize its application and research advancements. Results Based on current researches, the main indication for Oxford UKA is full thinckness cartilage loss in the medial compartment of the knee joint. Although it has shown certain effectiveness in treating PTCL in the medial compartment of the knee joint, there are also reports of opposite conclusions. Therefore, there is still controversy over whether Oxford UKA can be chosen for PTCL, and the large-sample and multi-center studies are needed to further clarify the controversy. Studies indicate that accurate preoperative assessment of cartilage damage severity is crucial for selecting appropriate candidates for Oxford UKA to optimize postoperative effectiveness. Conclusion Oxford UKA may represent an effective treatment for patients with PTCL in the medial compartment of the knee joint. However, strict patient selection and precise preoperative evaluation are essential to ensure surgical success and long-term effectiveness.

Citation： HUANG Wenbin, LIU Dianqi, LU Weijie. Research progress in Oxford unicompartmental knee arthroplasty for partial thickness cartilage loss in medial compartment of knee joint. Chinese Journal of Reparative and Reconstructive Surgery, 2024, 38(9): 1138-1142. doi: 10.7507/1002-1892.202403091 Copy

1.	Murray DW, Parkinson RW. Usage of unicompartmental knee arthroplasty. Bone Joint J, 2018, 100-B(4): 432-435.
2.	李宇軒, 袁伶俐, 許志遠, 等. 單髁置換治療膝關節內側間室骨關節炎: 關節功能及炎性細胞因子變化. 中國組織工程研究, 2024, 28(36): 5828-5832.
3.	Kahan ME, Chen Z, Angerett NR, et al. Unicompartmental knee arthroplasty has lower infection, conversion, and complication rates compared to high tibial osteotomy. J Knee Surg, 2022, 35(14): 1518-1523.
4.	Uzun E, Misir A, Kizkapan TB, et al. Mid-term functional, clinical, and radiological outcomes with factors affecting revision of mobile-bearing medial unicompartmental knee arthroplasty. Knee, 2020, 27(2): 527-534.
5.	Kozinn SC, Scott R. Unicondylar knee arthroplasty. J Bone Joint Surg (Am), 1989, 71(1): 145-150.
6.	薛華明, 馬童, 文濤, 等. 再議膝關節單髁置換術的適應證. 中華醫學雜志, 2024, 104(5): 319-324.
7.	李鵬飛, Murray D, 曾意榮, 等. 內側活動平臺牛津單髁膝關節置換術的適應證和禁忌證. 中醫正骨, 2018, 30(10): 64-65, 73.
8.	Niinim?ki TT, Murray DW, Partanen J, et al. Unicompartmental knee arthroplasties implanted for osteoarthritis with partial loss of joint space have high re-operation rates. Knee, 2011, 18(6): 432-435.
9.	Li Z, Chen ZY, Wei JQ, et al. Excellent outcomes with Oxford uni-compartmental knee arthroplasty in anteromedial osteoarthritis patients (≤60 years) at mid-term follow-up. BMC Musculoskelet Disord, 2021, 22(1): 859. doi: 10.1186/s12891-021-04747-y.
10.	Goodfellow J, O’Connor J, Pandit H, et al. Unicompartmental arthroplasty with the oxford knee. 2nd ed. Oxford: Goodfellow Publishers, 2015.
11.	徐耿彬, 茹江英. 關節間隙寬度測量對內側膝關節單髁置換效果及預后的影響. 中國組織工程研究, 2024, 28(36): 5877-5883.
12.	唐杞衡, 周一新, 王兆倫, 等. 肥胖對膝骨關節炎內側單髁置換術療效的影響. 中國矯形外科雜志, 2022, 30(14): 1267-1271.
13.	Nejima S, Kumagai K, Kobayashi H, et al. Coronal shaft bowing of the femur affects varus inclination of the surgical transepicondylar axis in varus knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc, 2021, 29(3): 814-819.
14.	Panni AS, Vasso M, Cerciello S, et al. Unicompartmental knee replacement provides early clinical and functional improvement stabilizing over time. Knee Surg Sports Traumatol Arthrosc, 2012, 20(3): 579-585.
15.	Hamilton TW, Pandit HG, Jenkins C, et al. Evidence-based indications for mobile-bearing unicompartmental knee arthroplasty in a consecutive cohort of thousand knees. J Arthroplasty, 2017, 32(6): 1779-1785.
16.	Stern SH, Becker MW, Insall JN. Unicondylar knee arthroplasty. An evaluation of selection criteria. Clin Orthop Relat Res, 1993(286): 143-148.
17.	Ritter MA, Faris PM, Thong AE, et al. Intra-operative findings in varus osteoarthritis of the knee. An analysis of pre-operative alignment in potential candidates for unicompartmental arthroplasty. J Bone Joint Surg (Br), 2004, 86(1): 43-47.
18.	Kan HS, Chan PK, Chiu KY, et al. Non-surgical treatment of knee osteoarthritis. Hong Kong Med J, 2019, 25(2): 127-133.
19.	Michael JW, Schlüter-Brust KU, Eysel P. The epidemiology, etiology, diagnosis, and treatment of osteoarthritis of the knee. Dtsch Arztebl Int, 2010, 107(9): 152-162.
20.	郭磊, 齊巖松, 牛嘯博. 轉化生長因子β亞家族調控骨關節炎中的作用. 中國組織工程研究, 2024, 28(35): 5695-5701.
21.	張通, 蔡金池, 袁志發, 等. 基于透明質酸的復合水凝膠修復骨關節炎軟骨損傷: 應用與機制. 中國組織工程研究, 2022, 26(4): 617-625.
22.	Willers C, Wood DJ, Zheng MH. A current review on the biology and treatment of articular cartilage defects (part Ⅰ& part Ⅱ). J Musculoskelet Res, 2003, 7: 157-181.
23.	李晶, 葉清嵐, 蔡磊, 等. 膝關節韌帶、關節軟骨及半月板損傷的多層螺旋CT與MRI診斷分析. 實用放射學雜志, 2023, 39(8): 1314-1317.
24.	靳莉丹, 申瑞田. 三維CT聯合MRI分析膝關節ACL損傷重建術后移植物、周圍結構與膝關節穩定性關系. 影像科學與光化學, 2022, 40(2): 418-423.
25.	金文宇. 磁共振成像在不同分期的膝半月板及關節軟骨損傷中的診斷價值. 當代醫學, 2022, 28(2): 36-39.
26.	楊洪敏, 董華, 翟廷貴, 等. 高頻超聲與MRI用于膝關節軟骨退變診斷中的臨床意義. 醫療裝備, 2022, 35(14): 15-17.
27.	夏卿, 劉華龍, 葉勝豪. MRI在膝關節半月板及關節軟骨損傷中的應用價值研究. 浙江創傷外科, 2023, 28(5): 979-982.
28.	Krakowski P, Karpiński R, Jojczuk M, et al. Knee MRI underestimates the grade of cartilage lesions. Appl Sci, 2021, 11(4): 1552. doi: 10.3390/app11041552.
29.	Strickland C, Ibrahim M, McCarty E. Imaging of cartilage damage. Journal of Cartilage & Joint Preservation, 2024, 4(1): 100149. doi: https://doi.org/10.1016/j.jcjp.2023.100149.
30.	Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis, 1957, 16(4): 494-502.
31.	Hamilton TW, Pandit HG, Inabathula A, et al. Unsatisfactory outcomes following unicompartmental knee arthroplasty in patients with partial thickness cartilage loss: a medium-term follow-up. Bone Joint J, 2017, 99-B(4): 475-482.
32.	Nischal N, Iyengar KP, Herlekar D, et al. Imaging of cartilage and chondral defects: an overview. Life (Basel), 2023, 13(2): 363. doi: 10.3390/life13020363.
33.	涂意輝, 馬童, 薛華明, 等. 牛津單髁置換術應用于單間室部分軟骨損傷的療效研究. 生物骨科材料與臨床研究, 2023, 20(1): 25-30.
34.	Berend KR, Lombardi AV, Jacobs CA. The combination of preoperative bone marrow lesions and partial-thickness cartilage loss did not result in inferior outcomes after medial unicompartmental knee arthroplasty. J Arthroplasty, 2017, 32(10): 3000-3003.
35.	Maier MW, Kuhs F, Streit MR, et al. Unicompartmental knee arthroplasty in patients with full versus partial thickness cartilage loss (PTCL): equal in clinical outcome but with higher reoperation rate for patients with PTCL. Arch Orthop Trauma Surg, 2015, 135(8): 1169-1175.
36.	Pandit H, Gulati A, Jenkins C, et al. Unicompartmental knee replacement for patients with partial thickness cartilage loss in the affected compartment. Knee, 2011, 18(3): 168-171.
37.	Knifsund J, Hatakka J, Keemu H, et al. Unicompartmental knee arthroplasties are performed on the patients with radiologically too mild osteoarthritis. Scand J Surg, 2017, 106(4): 338-341.
38.	Sang W, Qiu H, Xu Y, et al. Malposition is main cause of failure of Oxford mobile-bearing medial unicompartmental knee arthroplasty. Bone Jt Open, 2023, 4(12): 914-922.
39.	劉沛, 夏子麒, 王洋, 等. 年輕人膝關節骨關節炎的保膝治療進展. 中國矯形外科雜志, 2020, 28(3): 248-251.
40.	Liddle AD, Judge A, Pandit H, et al. Adverse outcomes after total and unicompartmental knee replacement in 101, 330 matched patients: a study of data from the National Joint Registry for England and Wales. Lancet, 2014, 384(9952): 1437-1445.
41.	Smith TO, Drew BT, Toms AP, et al. Accuracy of magnetic resonance imaging, magnetic resonance arthrography and computed tomography for the detection of chondral lesions of the knee. Knee Surg Sports Traumatol Arthrosc, 2012, 20(12): 2367-2379.

1. Murray DW, Parkinson RW. Usage of unicompartmental knee arthroplasty. Bone Joint J, 2018, 100-B(4): 432-435.
2. 李宇軒, 袁伶俐, 許志遠, 等. 單髁置換治療膝關節內側間室骨關節炎: 關節功能及炎性細胞因子變化. 中國組織工程研究, 2024, 28(36): 5828-5832.
3. Kahan ME, Chen Z, Angerett NR, et al. Unicompartmental knee arthroplasty has lower infection, conversion, and complication rates compared to high tibial osteotomy. J Knee Surg, 2022, 35(14): 1518-1523.
4. Uzun E, Misir A, Kizkapan TB, et al. Mid-term functional, clinical, and radiological outcomes with factors affecting revision of mobile-bearing medial unicompartmental knee arthroplasty. Knee, 2020, 27(2): 527-534.
5. Kozinn SC, Scott R. Unicondylar knee arthroplasty. J Bone Joint Surg (Am), 1989, 71(1): 145-150.
6. 薛華明, 馬童, 文濤, 等. 再議膝關節單髁置換術的適應證. 中華醫學雜志, 2024, 104(5): 319-324.
7. 李鵬飛, Murray D, 曾意榮, 等. 內側活動平臺牛津單髁膝關節置換術的適應證和禁忌證. 中醫正骨, 2018, 30(10): 64-65, 73.
8. Niinim?ki TT, Murray DW, Partanen J, et al. Unicompartmental knee arthroplasties implanted for osteoarthritis with partial loss of joint space have high re-operation rates. Knee, 2011, 18(6): 432-435.
9. Li Z, Chen ZY, Wei JQ, et al. Excellent outcomes with Oxford uni-compartmental knee arthroplasty in anteromedial osteoarthritis patients (≤60 years) at mid-term follow-up. BMC Musculoskelet Disord, 2021, 22(1): 859. doi: 10.1186/s12891-021-04747-y.
10. Goodfellow J, O’Connor J, Pandit H, et al. Unicompartmental arthroplasty with the oxford knee. 2nd ed. Oxford: Goodfellow Publishers, 2015.
11. 徐耿彬, 茹江英. 關節間隙寬度測量對內側膝關節單髁置換效果及預后的影響. 中國組織工程研究, 2024, 28(36): 5877-5883.
12. 唐杞衡, 周一新, 王兆倫, 等. 肥胖對膝骨關節炎內側單髁置換術療效的影響. 中國矯形外科雜志, 2022, 30(14): 1267-1271.
13. Nejima S, Kumagai K, Kobayashi H, et al. Coronal shaft bowing of the femur affects varus inclination of the surgical transepicondylar axis in varus knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc, 2021, 29(3): 814-819.
14. Panni AS, Vasso M, Cerciello S, et al. Unicompartmental knee replacement provides early clinical and functional improvement stabilizing over time. Knee Surg Sports Traumatol Arthrosc, 2012, 20(3): 579-585.
15. Hamilton TW, Pandit HG, Jenkins C, et al. Evidence-based indications for mobile-bearing unicompartmental knee arthroplasty in a consecutive cohort of thousand knees. J Arthroplasty, 2017, 32(6): 1779-1785.
16. Stern SH, Becker MW, Insall JN. Unicondylar knee arthroplasty. An evaluation of selection criteria. Clin Orthop Relat Res, 1993(286): 143-148.
17. Ritter MA, Faris PM, Thong AE, et al. Intra-operative findings in varus osteoarthritis of the knee. An analysis of pre-operative alignment in potential candidates for unicompartmental arthroplasty. J Bone Joint Surg (Br), 2004, 86(1): 43-47.
18. Kan HS, Chan PK, Chiu KY, et al. Non-surgical treatment of knee osteoarthritis. Hong Kong Med J, 2019, 25(2): 127-133.
19. Michael JW, Schlüter-Brust KU, Eysel P. The epidemiology, etiology, diagnosis, and treatment of osteoarthritis of the knee. Dtsch Arztebl Int, 2010, 107(9): 152-162.
20. 郭磊, 齊巖松, 牛嘯博. 轉化生長因子β亞家族調控骨關節炎中的作用. 中國組織工程研究, 2024, 28(35): 5695-5701.
21. 張通, 蔡金池, 袁志發, 等. 基于透明質酸的復合水凝膠修復骨關節炎軟骨損傷: 應用與機制. 中國組織工程研究, 2022, 26(4): 617-625.
22. Willers C, Wood DJ, Zheng MH. A current review on the biology and treatment of articular cartilage defects (part Ⅰ& part Ⅱ). J Musculoskelet Res, 2003, 7: 157-181.
23. 李晶, 葉清嵐, 蔡磊, 等. 膝關節韌帶、關節軟骨及半月板損傷的多層螺旋CT與MRI診斷分析. 實用放射學雜志, 2023, 39(8): 1314-1317.
24. 靳莉丹, 申瑞田. 三維CT聯合MRI分析膝關節ACL損傷重建術后移植物、周圍結構與膝關節穩定性關系. 影像科學與光化學, 2022, 40(2): 418-423.
25. 金文宇. 磁共振成像在不同分期的膝半月板及關節軟骨損傷中的診斷價值. 當代醫學, 2022, 28(2): 36-39.
26. 楊洪敏, 董華, 翟廷貴, 等. 高頻超聲與MRI用于膝關節軟骨退變診斷中的臨床意義. 醫療裝備, 2022, 35(14): 15-17.
27. 夏卿, 劉華龍, 葉勝豪. MRI在膝關節半月板及關節軟骨損傷中的應用價值研究. 浙江創傷外科, 2023, 28(5): 979-982.
28. Krakowski P, Karpiński R, Jojczuk M, et al. Knee MRI underestimates the grade of cartilage lesions. Appl Sci, 2021, 11(4): 1552. doi: 10.3390/app11041552.
29. Strickland C, Ibrahim M, McCarty E. Imaging of cartilage damage. Journal of Cartilage & Joint Preservation, 2024, 4(1): 100149. doi: https://doi.org/10.1016/j.jcjp.2023.100149.
30. Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis, 1957, 16(4): 494-502.
31. Hamilton TW, Pandit HG, Inabathula A, et al. Unsatisfactory outcomes following unicompartmental knee arthroplasty in patients with partial thickness cartilage loss: a medium-term follow-up. Bone Joint J, 2017, 99-B(4): 475-482.
32. Nischal N, Iyengar KP, Herlekar D, et al. Imaging of cartilage and chondral defects: an overview. Life (Basel), 2023, 13(2): 363. doi: 10.3390/life13020363.
33. 涂意輝, 馬童, 薛華明, 等. 牛津單髁置換術應用于單間室部分軟骨損傷的療效研究. 生物骨科材料與臨床研究, 2023, 20(1): 25-30.
34. Berend KR, Lombardi AV, Jacobs CA. The combination of preoperative bone marrow lesions and partial-thickness cartilage loss did not result in inferior outcomes after medial unicompartmental knee arthroplasty. J Arthroplasty, 2017, 32(10): 3000-3003.
35. Maier MW, Kuhs F, Streit MR, et al. Unicompartmental knee arthroplasty in patients with full versus partial thickness cartilage loss (PTCL): equal in clinical outcome but with higher reoperation rate for patients with PTCL. Arch Orthop Trauma Surg, 2015, 135(8): 1169-1175.
36. Pandit H, Gulati A, Jenkins C, et al. Unicompartmental knee replacement for patients with partial thickness cartilage loss in the affected compartment. Knee, 2011, 18(3): 168-171.
37. Knifsund J, Hatakka J, Keemu H, et al. Unicompartmental knee arthroplasties are performed on the patients with radiologically too mild osteoarthritis. Scand J Surg, 2017, 106(4): 338-341.
38. Sang W, Qiu H, Xu Y, et al. Malposition is main cause of failure of Oxford mobile-bearing medial unicompartmental knee arthroplasty. Bone Jt Open, 2023, 4(12): 914-922.
39. 劉沛, 夏子麒, 王洋, 等. 年輕人膝關節骨關節炎的保膝治療進展. 中國矯形外科雜志, 2020, 28(3): 248-251.
40. Liddle AD, Judge A, Pandit H, et al. Adverse outcomes after total and unicompartmental knee replacement in 101, 330 matched patients: a study of data from the National Joint Registry for England and Wales. Lancet, 2014, 384(9952): 1437-1445.
41. Smith TO, Drew BT, Toms AP, et al. Accuracy of magnetic resonance imaging, magnetic resonance arthrography and computed tomography for the detection of chondral lesions of the knee. Knee Surg Sports Traumatol Arthrosc, 2012, 20(12): 2367-2379.

Chinese Journal of Reparative and Reconstructive Surgery

Research progress in Oxford unicompartmental knee arthroplasty for partial thickness cartilage loss in medial compartment of knee joint

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