The influence of degeneration of the lateral patellofemoral joint on outcome of medial unicompartmental knee replacement

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1 ORTHOPAEDIC BIOMECHANICS MATERIALS AND CLINICAL STUDY.29. doi: /j.issn swgk * * 1 1 [ ] Oxford (104 ) Ahlback Weidow 5 1 Hospital for Special Surgery (N ) (L ) (M ) 118 (98 ) % (L ) 11 (M ) 70 1 HSS M N L N L M 88 N 28 M 52 L 8 9 N 2 L 1 M 6 Oxford [ ] [ ] R687.4 [ ] B The influence of degeneration of the lateral patellofemoral joint on outcome of medial unicompartmental knee replacement He Chuan1, Yan Yufei1, Feng Jianmin2, et al. 1 Department of Orthopedics, the Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, , China [Abstract] Objective Degeneration of lateral patellofemoral joint is considered be contraindications to medial unicompartmental knee replacement. We therefore examined the validity of this preconception using information gathered prospectively before surgery and on the intra-operative status of the patellofemoral joint in chinese patients who underwent Oxford unicondylar knee replacement for anteromedial osteoarthritis. Methods The study group comprised 126consecutive knees (108 patients). All operations were performed between August 2009 and December Location of pre-operative knee pain was recorded and the radiological status of the patellofemoral joint were defined using the Ahlback systems. The Weidow five-point grading system classified degeneration of the patellofemoral joint from none to full-thickness cartilage loss according to intra-operative observation. The location of cartilage loss was recorded and based on that the affected knees were divided into three groups, central-medial cartilage loss group (M group), lateral cartilage loss group (L group) and none cartilage loss group (N group). Outcome was evaluated at one years with Hospital for Special Surgery knee score and ability of deep squat. And the complications were collected respectively. Results 118 knees (98 patients) were included in the analysis. Cartilage loss on the trochlear surface was observed in 81 knees (68.6%), on the medial trochlear in 57 knees (48.3%), on the central trochlear in 13 knees (11%) and on the lateral trochlear in 11 knees (7.6%), on the both side in 2 knees (1.7%). As for the HSS score improvement, there is no difference between group M and N, as the same between group L and N. But patients in group L presented a slim better changed in HSS knee score than those in group M. The number of patients with ability to deep squat and independent rising are 28 in group N, 8 in group L, 52 in group M respectively, and did not produce a significantly difference. There was no difference in the light *: (: ) : anterior knee pain exists among three groups (2 in group

2 .30. ORTHOPAEDIC BIOMECHANICS MATERIALS AND CLINICAL STUDY N, 1ingroupL and6ingroupm). Conclusion Neitherradiologically-demonstratedlateralpatellofemoraljoint degeneration nor cartilage loss at lateral patellofemoral joint should be considered a contraindication to Oxford medial unicompartmental knee replacement. [Key words] Arthroplasty; Unicompartment; Knee; Patellafemoral; Outcome 10 85%~98% [1-3] " " "" " 90 Kozinn Scott [4] [5] Oxford (Biomet, USA) [6,7] 6~8cm Oxford 1 : A Ahlback I B MRI. Ahlback I HSS MRI [7] ~ Oxford ( 1) Ahlback (Biomet, USA) 104 (126 0 I ) II <5mm III >5mm IV 63.2 (47~90 ) 34 Weidow (42 ) 70 (84 ) 4 [9] [5,6] Ahlback I~III 1 HSS

3 ORTHOPAEDIC BIOMECHANICS MATERIALS AND CLINICAL STUDY.31. (5.4%) ( >0.05) 88 (74.6%) L 8 (72.7%) M 52 (74.3%) N 28 (75.8%) (L ) ( 2 = 0.05 >0.05) (M ) (N ) 1 M SAS 8.0 1mm 1 (M ) 1 SNK Pearson 2 X < (7 ) 1 (1 ) 1 1 (n=118) 98 (118 ) N(%) 62.4 (47~86 ) 31 (38 ) 67 (80 ) 73 73(61.9%) 45 45(38.1%) HSS (41.7±7.2) 1 Ahlback I II (90.1± 4.6) (47.2± 5.1) 59(50%) 68 (57.6%) Ahlback I 57 II 9(7.6%) Weidow (68.6%) Weidow I 23 II 35 III 18 IV 5 I II 23(19.5%) 35(29.7%) III 18(15.3%) IV 5(4.2%) 9 2 MRI 57(48.3%) MRI 13(11%) MRI 9(7.6%) 2(1.7%) (L ) 11 2 (n=118) (M ) 70 (N ) (37 N(%) ) Weidow I 2 II 5 III 9(7.6%) 3 IV 1 Weidow I 21 II 30 L 1(1/11) III 15 IV 4 M 5(5/70) L HSS (40.4±8.5) N 2(2/37) (89.9±5.4) (49.5±6.2) M HSS 0 (41.9±7.3) (90.4±4.8) (48.5±6.2) 88(74.6%) N HSS (42.1±6.2) (90.8±6.6) L 8(72.7%) (48.7±5.2) (F=4.85 <0.05) L M N ( >0.05) L M ( <0.05) M N 52(74.3%) 28(75.8%) 1(M ) 1 9 (7.6%) TKA 1(M ) L 1 (9.1%) M 6 (8.6%) N 2 1 (N ) 1(N )

4 .32. ORTHOPAEDIC BIOMECHANICS MATERIALS AND CLINICAL STUDY Oxford [3] Oxford Oxford Munk [13] 30% [5] 1 Oxford 23% [6,7] " " 90 " " H SS " " 71.8% Oxford Oxford MRI ( ) MRI Munk HSS 55% 3% [1] Pandit H, Jenkins C, Gill H S, Barker K, Dodd C A F, Murray D W. Minimally invasive Oxford phase 3 unicompartmental knee replacement. Results of 1000 cases. J Bone Joint Surg Br, 2011, 93: Beard Oxford 36

5 32 [2] Naudie D, Guerin J, Parker DA, et al. Medial unicompartmental knee arthroplasty with the Miller-Galante prosthesis. J Bone Joint Surg Am, 2004, 86: [3] Price AJ, Svard U. A second decade lifetable survival analysis of the Oxford unicompartmental knee arthroplasty. Clin Orthop Relat Res, 2011, 469(1): [4] Stern S H, Becker M W, Insall J N. Unicondylar knee arthroplasty : an evaluation of selection criteria. Clin Orthop Relat Res, 1993, 286: [5] Berend KR, Lombardi AV Jr, Morris MJ, et al. Does preoperative patellofemoral joint state affect medial unicompartmental arthroplasty survival? Orthopedics, 2011, 9, 34(9): [6] Beard D J, Pandit H, Gill H S, et al. Murray D W. Pre-operative clinical and radiological assessment of the patellofemoral joint in unicompartmental knee replacement and its influence on outcome. J Bone Joint Surg Br, 2007, 89: [7] Munk S, Odgaard A, Madsen F, et al. Preoperative lateral subluxation of the patella is a predictor of poor early outcome of Oxford phase-iii medial unicompartmental knee arthroplasty. Acta Orthop, 2011, 82(5): Oxford. ( ) (4):19-22 [9] Weidow J, Park J, Kaerrholm J. Different patterns of cartilage Wear in medial and lateral gonarthrosis. Acta Orthop Scand, 2002, 73 (3): [ ] (1971-) *[ ] (1963-) : ( : )