Charles Rivière1,2,3,4, Sivan Sivaloganathan5, Loic Villet6,7, Philippe Cartier7, Sébastien Lustig7,8, Pascal-André Vendittoli7,9, Justin Cobb10,7. 1. MSK Lab-Imperial College London, White City Campus, London, W12 0BZ, UK. c.riviere@imperial.ac.uk. 2. The Lister Hospital, Chelsea Bridge Rd, London, SW1W 8RH, UK. c.riviere@imperial.ac.uk. 3. Centre de L'Arthrose-Clinique de Sport, 4 Rue Georges Negrevergne, 33700, Mérignac, France. c.riviere@imperial.ac.uk. 4. Personalized Arthroplasty Society, London, UK. c.riviere@imperial.ac.uk. 5. South West London Elective Orthopaedic Centre, Dorking Rd, Epsom, KT18 7EG, UK. 6. Centre de L'Arthrose-Clinique de Sport, 4 Rue Georges Negrevergne, 33700, Mérignac, France. 7. Personalized Arthroplasty Society, London, UK. 8. Centre Albert Trillat, Groupement Hospitalier Nord, Université Lyon 1, Villeurbanne, France. 9. Département de Chirurgie, Université de Montréal, Hôpital Maisonneuve-Rosemont, 5415 Boul L'Assomption, Montréal, Québec, H1T 2M4, Canada. 10. MSK Lab-Imperial College London, White City Campus, London, W12 0BZ, UK.
Abstract
PURPOSE: Owing to the improved understanding of knee kinematics and the successful introduction of the kinematic alignment (KA) technique for implanting total knee arthroplasty (TKA), it was recently understood that the "Cartier angle technique" corresponds to a kinematic implantation of the uni-compartmental knee arthroplasty (UKA) components. When compared to the universally spread mechanical alignment (MA) technique for implanting UKA, the KA method generates a more anatomic prosthetic knee that may be clinically advantageous. The aims of this study are to determine if KA UKAs are associated with acceptable functional performance and patient satisfaction (question 1), rates of residual pain and tibia plateau fracture (question 2), and rates of reoperation and revision (question 3), and to define the component orientation and limb alignment as measured on radiograph (question 4), and the stress shielding related bone loss in the proximal tibia (question 5) with KA UKA, and where possible to compare with MA UKA. STUDY HYPOTHESIS: KA UKA generates good clinical outcomes, similar or superior to the ones of MA UKA. METHOD: Systematic review of literature databases were primarily searched using Healthcare Databases Advanced Search (HDAS). Two primary searches were conducted using the electronic databases MEDLINE, EMBASE, and PubMed, and a secondary search was conducted using review articles and bibliography of obtained papers in order to ascertain more material. RESULTS: Nine eligible non-comparative prospective (3) or retrospective (6) cohort studies, which cumulated 593 KA UKAs with follow-up between 3.2 and 12 years, fulfilled the inclusion criteria for this systematic review. The findings demonstrated high Knee Society Score (KSS) (from 87 to 95) and function scores (from 81 to above 91) in addition to patient satisfaction scores of 88%. There was no revision for tibia plateau fracture, 0.8% (5 cases) for unexplained pain tibia, 2.0% (12 cases) for component loosening, and 5.6% (33 cases) for any causes of aseptic failures reported for KA UKA. The prosthetic lower limb and tibia implant alignments were both found to be in slight varus (means between 3 and 5°), and the postoperative joint line and tibia component was shown to be parallel to the floor when standing. The KA UKA components migration, as measured on radiostereometry, was acceptable. DISCUSSION/ CONCLUSION: The KA technique is an alternative, personalised, more physiological method for implanting UKA, which could be clinically advantageous when compared to the MA technique. The literature supports the good mid- to long-term clinical safety and good efficacy of KA UKA; however, comparison between KA and MA techniques for UKA was not performed due to limited literature. Further investigations are needed to better define the clinical impact of KA UKA, and the acceptable limits for KA of the UKA tibial component. LEVEL OF EVIDENCE: Level 4; systematic review of level 4 studies.
PURPOSE: Owing to the improved understanding of knee kinematics and the successful introduction of the kinematic alignment (KA) technique for implanting total knee arthroplasty (TKA), it was recently understood that the "Cartier angle technique" corresponds to a kinematic implantation of the uni-compartmental knee arthroplasty (UKA) components. When compared to the universally spread mechanical alignment (MA) technique for implanting UKA, the KA method generates a more anatomic prosthetic knee that may be clinically advantageous. The aims of this study are to determine if KA UKAs are associated with acceptable functional performance and patient satisfaction (question 1), rates of residual pain and tibia plateau fracture (question 2), and rates of reoperation and revision (question 3), and to define the component orientation and limb alignment as measured on radiograph (question 4), and the stress shielding related bone loss in the proximal tibia (question 5) with KA UKA, and where possible to compare with MA UKA. STUDY HYPOTHESIS: KA UKA generates good clinical outcomes, similar or superior to the ones of MA UKA. METHOD: Systematic review of literature databases were primarily searched using Healthcare Databases Advanced Search (HDAS). Two primary searches were conducted using the electronic databases MEDLINE, EMBASE, and PubMed, and a secondary search was conducted using review articles and bibliography of obtained papers in order to ascertain more material. RESULTS: Nine eligible non-comparative prospective (3) or retrospective (6) cohort studies, which cumulated 593 KA UKAs with follow-up between 3.2 and 12 years, fulfilled the inclusion criteria for this systematic review. The findings demonstrated high Knee Society Score (KSS) (from 87 to 95) and function scores (from 81 to above 91) in addition to patient satisfaction scores of 88%. There was no revision for tibia plateau fracture, 0.8% (5 cases) for unexplained pain tibia, 2.0% (12 cases) for component loosening, and 5.6% (33 cases) for any causes of aseptic failures reported for KA UKA. The prosthetic lower limb and tibia implant alignments were both found to be in slight varus (means between 3 and 5°), and the postoperative joint line and tibia component was shown to be parallel to the floor when standing. The KA UKA components migration, as measured on radiostereometry, was acceptable. DISCUSSION/ CONCLUSION: The KA technique is an alternative, personalised, more physiological method for implanting UKA, which could be clinically advantageous when compared to the MA technique. The literature supports the good mid- to long-term clinical safety and good efficacy of KA UKA; however, comparison between KA and MA techniques for UKA was not performed due to limited literature. Further investigations are needed to better define the clinical impact of KA UKA, and the acceptable limits for KA of the UKA tibial component. LEVEL OF EVIDENCE: Level 4; systematic review of level 4 studies.
Authors: Michael Clarius; Christian Hauck; Joern B Seeger; Maria Pritsch; Christian Merle; Peter R Aldinger Journal: Int Orthop Date: 2009-10-09 Impact factor: 3.075
Authors: Matthew B Collier; Thomas H Eickmann; Fumio Sukezaki; James P McAuley; Gerard A Engh Journal: J Arthroplasty Date: 2006-09 Impact factor: 4.757
Authors: Abdulaziz M Almaawi; Jonathan R B Hutt; Vincent Masse; Martin Lavigne; Pascal-Andre Vendittoli Journal: J Arthroplasty Date: 2017-02-20 Impact factor: 4.757
Authors: Omar K Alnachoukati; John W Barrington; Keith R Berend; Michael C Kolczun; Roger H Emerson; Adolph V Lombardi; David R Mauerhan Journal: J Arthroplasty Date: 2017-10-16 Impact factor: 4.757
Authors: P Barbadoro; A Ensini; A Leardini; M d'Amato; A Feliciangeli; A Timoncini; F Amadei; C Belvedere; S Giannini Journal: Knee Surg Sports Traumatol Arthrosc Date: 2014-06-28 Impact factor: 4.342