Cementless unicompartmental knee replacement allows early return to normal activity

Background: Physical activity and regular participation in recreational sports gain importance in patients’ lifestyle after knee arthroplasty. Cementless unicompartimental Knee replacement with the Oxford System has been introduced into clinical routine. Currently there is no data reporting on the physical activity, return to sports rate and quality of live after medial cementless Oxford Unicompartimental Knee Replacement (OUKR). Methods: This retrospective cohort study reports on the functional outcome of the first 27 consecutive patients (30 knees) that were consecutively treated with a cementless medial OUKR between 2007 and 2009 in our hospital. Physical activity and quality of life were measured using the Tegner-Score, the UCLA-Activity Score, the Schulthess Clinical Activity Questionnaire and the SF-36 Score. The patients’ satisfaction with the outcome was measured using a visual analogue scale. Results: Mean age at surgery was 62.5 years. Patients showed a rapid recovery with 17 out of 27 patients returning to sports within 3 months, 24 within 6 months after surgery. The Return-to-activity-rate was 100%. 10 out of 27 patients showed a high activity level (UCLA ≥7 points) with a mean postoperative UCLA-Score of 6.1 points. Conclusions: Patients recover rapidly after cementless OUKR with a return to sports rate of 100% and patients are able to participate in high impact sports disciplines

Cementless Oxford Medial Unicompartmental Knee Replacement—Clinical and Radiological Results of 228 Knees with a Minimum 2-Year Follow-Up

(1) Background: Studies show several advantages of unicompartmental knee replacement (UKR) over total knee replacements (TKR), whereas registry based revision rates of UKR are significantly higher than for TKA. Registry data report lower revision rates for cementless UKR compared to cemented UKR. The aim of this study was to assess clinical and radiological results of cementless Oxford UKR (OUKR) in an independent cohort. (2) Methods: This retrospective cohort study examines a consecutive series of 228 cementless OUKR. Clinical outcome was measured using functional scores (Oxford Knee Score (OKS), American Knee Society Score (AKSS), Hannover Functional Ability Questionnaire for Osteoarthritis (FFbH-OA), range of motion (ROM)), pain and satisfaction. Radiographs were analyzed regarding the incidence of radiolucent lines (RL), implant positioning, and their possible impact on clinical outcome. (3) Results: At a mean follow-up of 37.1 months, the two and three year revision free survival-rates were 97.5% and 96.9%. Reasons for revision surgery were progression of osteoarthritis, inlay dislocation and pain. All clinical outcome scores showed a significant improvement from pre- to postoperative. The incidence of RL around the implant was highest within the first year postoperatively (36%), and decreased (5%) within the second year. Their presence was not correlated with inferior clinical outcome. Implant positioning showed no influence on clinical outcome. (4) Conclusion: Cementless OUKR showed excellent clinical outcome and survival rates, with reliable osteointegration. Neither the incidence of radiolucent lines nor implant positioning were associated with inferior clinical outcome

Clinical and Functional Results of Cementless Unicompartmental Knee Arthroplasty with a Minimum Follow Up of 5 Years—A Consecutive Cohort of 201 Patients

The number of unicompartmental knee replacements (UKR) is increasing. Alongside various advantages, the revision rate of cemented UKR is higher compared to total knee arthroplasty (TKR). In contrast, cementless fixation shows reduced revision rates, compared to the cemented UKR. However, most of the recent literature is based on designer-dependent studies. In this retrospective, single-center cohort study, we investigated patients who underwent cementless Oxford UKR (OUKR) between 2012 and 2016 in our hospital with a minimum follow-up of five years. Clinical outcome was evaluated using the OKS, AKSS-O, AKSS-F, FFbH-OA, UCLA, SF-36, EQ-5D-3L, FJS, ROM, pain, and satisfaction measures. Survival analysis was performed with reoperation and revision as endpoints. We included 201 patients (216 knees) for clinical evaluation. All outcome parameters increased significantly from pre- to postoperative stages. The five-year survival rate was 96.1% for revision surgery and 94.9% for reoperation. The main reasons for revision were the progression of osteoarthritis, inlay dislocation, and tibial overstuffing. Two iatrogenic tibial fractures appeared. Cementless OUKR shows excellent clinical outcome and high survival rates after five years. The tibial plateau fracture in cementless UKR represents a serious complication and requires modification of the surgical technique

Physical Activity of Young Patients following Minimally Invasive Lateral Unicompartmental Knee Replacement

Unicompartmental knee replacement (UKR) has increased in popularity in recent years, especially in young patients with high demands on their athletic ability. To date, there are no data available on the physical activity of young patients following lateral UKR. The aim of this study was to demonstrate return-to-activity rate and sporting activity of patients aged 60 years or younger following lateral UKR with a fixed-bearing (FB) prosthesis. Thirty-seven patients aged 60 years or younger after lateral FB-UKR were included. Sporting activities were assessed using the University of California Los Angeles activity scale (UCLA) and the Tegner activity score (TAS). Clinical outcome was measured using the Oxford Knee Score (OKS), range of motion (ROM) and visual analogue scale (VAS). The mean follow-up (FU) was 3.1 ± 1.5 years and the mean age at surgery was 52.8 ± 3.1 years. The return-to-activity rate was 87.5% and 49% of patients were highly active postoperatively as defined by an UCLA score of 7 or higher. All clinical parameters increased significantly postoperatively. We demonstrated a high return-to-activity rate with nearly half of the patients achieving high activity levels. Longer FU periods are necessary to evaluate the effect of activity on implant survival

A Systematic Review and Illustrative Case Presentation of Low-Grade Myofibroblastic Sarcoma (LGMS) of the Extremities

Introduction: Low-grade myofibroblastic sarcoma (LGMS) is a rare tumor entity which occurs in the subcutaneous and deep soft tissues; it is less common in the bone with a predilection for the extremities and the head and neck region. As confirming the diagnosis is difficult and treatment strategies are not standardized, we aimed to identify patient and tumor characteristics, and to summarize treatment strategies and their clinical outcomes to guide surgeons. Methods: Included were full articles reporting patients with histology of LGMS in the extremities, excluding tumors of the trunk. All patients underwent surgery but with different extend, from marginal to wide resection. Included studies should inform about local recurrence, metastasis, or evidence of disease, depending on the surgical treatment. We conducted a structured search using MEDLINE (via PubMed), Web of Science, EMBASE and Cochrane Central Register of Controlled Trials (CENTRAL) to identify studies on low-grade myofibroblastic sarcoma of the extremities. Study designs like randomized controlled trials, systematic reviews, prospective trials, retrospective studies, and case reports were included. Prospective studies and comparative studies were not available at all. Therefore, meta-analysis was not possible and statistical analysis was purely descriptive. Results: Of the 789 studies identified from our initial search, 17 studies including 59 cases reported LGMS of the extremities with the surgical treatment and clinical outcome and were therefore analyzed. In addition, we present the rare case and surgical management of a 28-year-old male patient with residual LGMS of the thumb after an initial incomplete resection. The current literature suggests that a wide excision with R0 margins should be considered the standard treatment for LGMS. In cases where surgery leads to significant functional impairment, individual options like free tissue transfer from a donor site have to be considered. Therefore, we also present an illustrative case. For all selected case series and case reports, a high risk of confounding, selection bias, information bias, and reporting bias must be anticipated. Nevertheless, this systematic review provides a comprehensive overview on surgical treatment and clinical outcomes in LGMS surgery of the extremities

Zones affected by RL 5 years after surgery, cementless.

<p>Zones affected by RL 5 years after surgery, cementless.</p

Tibial RL five years after surgery.

<p>Tibial RL five years after surgery.</p

Matching-criteria for the cemented and cementless patient group.

<p>Matching-criteria for the cemented and cementless patient group.</p