Sonia Shamdasani1, Nicole Vogel2, Raphael Kaelin2, Achim Kaim3,4, Markus P Arnold5,6. 1. Emergency Department, Hirslanden Clinic Birshof, Reinacherstrasse 28, 4142, Münchenstein, Switzerland. 2. Practice LEONARDO, Hirslanden Clinic Birshof, Reinacherstrasse 28, 4142, Münchenstein, Switzerland. 3. Radiology Department, Hirslanden Clinic Birshof, Reinacherstrasse 28, 4142, Münchenstein, Switzerland. 4. University of Basel, Basel, Switzerland. 5. Practice LEONARDO, Hirslanden Clinic Birshof, Reinacherstrasse 28, 4142, Münchenstein, Switzerland. arnold.leonardo-ortho@hin.ch. 6. University of Basel, Basel, Switzerland. arnold.leonardo-ortho@hin.ch.
Abstract
PURPOSE: The purpose of this study is to analyse the change in knee alignment after customised individually made (CIM) bicompartmental knee arthroplasty (BKA) and the subsequent consequences for patellar tracking. METHODS: Medical records of 23 patients who received 26 CIM BKA (ConforMIS iDuo G2) at our clinic between November 2015 and July 2018 were reviewed. The objective part of the Knee Society Score (KSS), the hip-knee-ankle angle (HKA), the tibial mechanical angle (TMA) and femoral mechanical angle (FMA) were recorded preoperative and four months postoperative. Leg alignment was classified as neutral (HKA = 180° ± 3°), varus (HKA < 177°) or valgus (HKA > 183°). Furthermore, patellar tracking was determined on skyline view radiographs and adverse events were recorded. Implant survival rate was determined with the Kaplan-Meier method. Patient-reported outcome measures (PROMs) were pain, satisfaction, overall improvement and if the patient would undergo the surgery again. RESULTS: The mean KSS improved from 61 points preoperative [standard deviation (SD) 14] to 90 points postoperative (SD 7, p < 0.001). The mean change for HKA was 6.3° (SD 3.5), for TMA 1.5° (SD 1.2) and for FMA 3.8° (SD 2.3). Postoperative leg alignment was neutral in 13 CIM BKA (50%), varus in two (8%) and valgus in 11 (42%) and patella tracking was central in 19 CIM BKA (73%) and lateral in seven (27%), respectively. Adverse events occurred in five CIM BKA: three patients required a patella resurfacing and one patient with bilateral CIM BKA needed a revision to a total knee arthroplasty. Implant survival rate was 92.3% at a follow-up of 3.2 years (SD 0.8). PROMs for CIM BKA without revision surgery were available at a mean follow-up of 3.2 years (SD 0.8). Mean pain with level walking decreased to 0.8 points (SD 1.4, p < 0.001) and mean pain with stairs or inclines to 1.6 points (SD 1.3, p < 0.001). Patient satisfaction was very satisfied or satisfied (78%), neutral (17%) or unsatisfied (4%). Overall improvement was much better or considerably better for 91% of all patients; 87% would undergo the surgery again. CONCLUSION: A relevant change of the leg axis away from the treated femorotibial compartment due to overstuffing was observed. Although, neutral leg alignment was not restored in every case, clinical and patient-reported outcomes improved significantly. Further studies with long-term clinical and patient-reported outcomes are required to evaluate whether patients with bicompartmental knee osteoarthritis benefit from CIM BKA. LEVEL OF EVIDENCE: IV, case series.
PURPOSE: The purpose of this study is to analyse the change in knee alignment after customised individually made (CIM) bicompartmental knee arthroplasty (BKA) and the subsequent consequences for patellar tracking. METHODS: Medical records of 23 patients who received 26 CIM BKA (ConforMIS iDuo G2) at our clinic between November 2015 and July 2018 were reviewed. The objective part of the Knee Society Score (KSS), the hip-knee-ankle angle (HKA), the tibial mechanical angle (TMA) and femoral mechanical angle (FMA) were recorded preoperative and four months postoperative. Leg alignment was classified as neutral (HKA = 180° ± 3°), varus (HKA < 177°) or valgus (HKA > 183°). Furthermore, patellar tracking was determined on skyline view radiographs and adverse events were recorded. Implant survival rate was determined with the Kaplan-Meier method. Patient-reported outcome measures (PROMs) were pain, satisfaction, overall improvement and if the patient would undergo the surgery again. RESULTS: The mean KSS improved from 61 points preoperative [standard deviation (SD) 14] to 90 points postoperative (SD 7, p < 0.001). The mean change for HKA was 6.3° (SD 3.5), for TMA 1.5° (SD 1.2) and for FMA 3.8° (SD 2.3). Postoperative leg alignment was neutral in 13 CIM BKA (50%), varus in two (8%) and valgus in 11 (42%) and patella tracking was central in 19 CIM BKA (73%) and lateral in seven (27%), respectively. Adverse events occurred in five CIM BKA: three patients required a patella resurfacing and one patient with bilateral CIM BKA needed a revision to a total knee arthroplasty. Implant survival rate was 92.3% at a follow-up of 3.2 years (SD 0.8). PROMs for CIM BKA without revision surgery were available at a mean follow-up of 3.2 years (SD 0.8). Mean pain with level walking decreased to 0.8 points (SD 1.4, p < 0.001) and mean pain with stairs or inclines to 1.6 points (SD 1.3, p < 0.001). Patient satisfaction was very satisfied or satisfied (78%), neutral (17%) or unsatisfied (4%). Overall improvement was much better or considerably better for 91% of all patients; 87% would undergo the surgery again. CONCLUSION: A relevant change of the leg axis away from the treated femorotibial compartment due to overstuffing was observed. Although, neutral leg alignment was not restored in every case, clinical and patient-reported outcomes improved significantly. Further studies with long-term clinical and patient-reported outcomes are required to evaluate whether patients with bicompartmental knee osteoarthritis benefit from CIM BKA. LEVEL OF EVIDENCE: IV, case series.
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