Session 18: Knee Arthroplasty

17. November
12:45 - 13:45
Lokale: 202-205
Chair: Per W Kristensen and Ann Ganestam

145. The feasibility and safety of lateral unicompartmental knee arthroplasty in a fast-track setting – a prospective cohort study of 170 procedures.
Kristine Ifigenia Bunyoz1, Christoffer Calov Jørgensen1, Pelle Baggesgaard Petersen2, Henrik Kehlet2, Kirill Gromov1, Anders Troelsen1
1. Department of Orthopaedic Surgery, Clinical Orthopaedic Research Hvidovre (CORH), Copenhagen University Hospital Hvidovre, Denmark 2. Section for Surgical Pathophysiology, Rigshospitalet, Copenhagen University Hospital, Denmark On behalf of the Lundbeck Foundations Centre for Fast-track Hip and Knee Replacement Collaborative Group

Background: In existing studies on fast-track unicompartmental knee arthroplasty (UKA), the majority of surgeries are medial UKA. There are substantial differences between lateral and medial UKA surgery, why outcomes cannot automatically be compared. To gain information about the feasibility and safety of fast-track protocols in lateral UKAs, we investigated length of stay (LOS) and early complications after lateral UKA, performed using a fast-track protocol in well-established fast-track centers.
Aim: To investigate the length of stay (LOS) and early complications after lateral UKA, performed using a fast-track protocol in well-established fast-track centers.
Materials and Methods: We retrospectively evaluated prospectively collected data on patients undergoing lateral UKA in a fast- track setup from 2010-2018, at seven Danish fast- track centers. Data on patient characteristics, LOS, complications, reoperations, and revisions, were analyzed using descriptive statistics.
Results: We included 170 of patients with a mean age of 65.5 years (SD 12.3). Median LOS was 1 day (Interquartile range IQR 1-1), which was unchanged from 2012-2018. 17.6% were discharged on the day of surgery. Within 90 days, seven patients (4.1%) experienced medical complications and five patients (2.9%) experienced surgical complications. Three patients (1.8%) were reoperated. Two of the reoperations were soft tissue revisions and the third was the removal of an exostosis due to catching of the patella. One patient (0.6%) was revised due to a bearing dislocation.
Interpretation / Conclusion: Our findings suggest that lateral UKA in a fast-track setting is feasible and safe. However, the performance of surgeries with lateral UKAs is potentially underutilized and therefore also holds potential benefits for this group of patients. This is the first study reporting on lateral UKA and enhanced recovery. The results should encourage orthopedic centers to implement fast-track protocols in this subgroup of patients.

146. Are changes in clinical and functional knee scores in patients undergoing primary arthroplasty for knee osteoarthritis influenced by preoperative multimorbidity?
Katrine Glintborg Iversen1,2, Rikke Sommer Haaber1,2, Martin Bækgaard Stisen2,3, André Sejr Klenø1,3, Martin Lindberg-Larsen4, Alma Becic Pedersen1,3, Inger Mechlenburg2,3
1. Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark; 2. Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus N, Denmark; 3. Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; 4. Department of Orthopaedic Surgery, Odense University Hospital, Odense, Denmark.

Background: Patients undergoing primary total knee arthroplasty (TKA) due to osteoarthritis (OA) are known to have a high prevalence of multimorbidity. Only few studies have examined the impact of multimorbidity on clinical and functional knee scores after TKA, and there is inconsistency among the results. Hence, the question remains whether multimorbidity impacts functional- and knee impairment in patients undergoing TKA.
Aim: To investigate the impact of multimorbidity on changes in clinical and functional knee scores following TKA due to OA.
Materials and Methods: We conducted a population-based cohort study including 22,881 TKA patients identified in the Danish Knee Arthroplasty Register from 1997 to 2021. Patients were classified as having low, medium, or high multimorbidity based on the Charlson Comorbidity Index. The outcome was defined as the mean change (from preoperative to one-year post-TKA) in clinical and functional knee scores measured by the two components in the American Knee Society Score (AKSS) (0 worst to 100 best). The association between multimorbidity and outcome was analyzed using multiple linear regression adjusting for sex, age, cohabiting status, and baseline AKSS.
Results: Overall, the prevalence of patients with low, medium, and high multimorbidity was 75%, 21%, and 4%, respectively. Mean change scores in the clinical AKSS for patients with medium and high multimorbidity were 0.6 points (95%CI: 0.1;1.1) and -1.1 points (95%CI: -2.1;0.0) compared with patients with low multimorbidity. The mean change scores in functional AKSS for patients with medium and high multimorbidity were -2.5 points (95%CI: -3.1; -1.8) and -6.10points (95%CI: -7.3;-4.9) compared with patients with low multimorbidity. These differences were not clinically significant.
Interpretation / Conclusion: TKA patients with knee OA and medium or high multimorbidity can expect similar improvements in clinical and functional AKSS as patients with low multimorbidity.

147. Starting up a Lateral Unicompartmental Knee Arthroplasty practice
Kristine Ifigenia Bunyoz1, Kirill Gromov1, Anders Troelsen1
1. Department of Orthopaedic Surgery, Copenhagen University Hospital Amager Hvidovre, Denmark

Background: Historically, registry studies have reported unsuccessful results of treatment with lateral unicompartmental knee arthroplasty (UKA). Identifying patients for the procedure has been less clear and the procedure has been perceived to be technically more challenging than medial UKA. Achieving a steep learning curve and good results can therefore be difficult.
Aim: We aim to present the preliminary results and learning curve of our first performed lateral UKAs by two surgeons already experienced in performing medial UKAs.
Materials and Methods: We present our first 60 primary fixed-bearing lateral Oxford UKAs (57 patients) performed between 2016 and 2021 with a minimum of 1- year follow-up. The indication for lateral UKA was posttraumatic (n=4) and isolated lateral osteoarthritis (n=56). Two patients had a lateral UKA supplemental to a primary medial UKA. Mean age and BMI were 67.8 (SD ±12.7) and 29.3 (±5,6). 75% were females, and 70% had ASA 2. The median pre-surgery Oxford Knee Score (OKS) was 23 (IQR 19.5-27.5). Patients completed the Oxford Knee Score (OKS) (primary outcome), the Activity and Participation Questionnaire (OKS-APQ), and the Forgotten Joint Score (FJS) at 3-, 12-, and, 24-months after surgery.
Results: 86.7% of patients were discharged within 48 hours after surgery. One patient required a soft tissue revision due to infection. There were no other reoperations. One patient died from an unrelated reason. At 1-year follow-up, the median (interquartile range) OKS, APQ, and the FJS were 43,5 (36-46), 81 (44-100), and 75 (55-90).
Interpretation / Conclusion: Starting up a lateral UKA practice is safe and efficient, provided that the surgeons are already experienced in performing medial UKA and do the surgeries on a regular basis in well-indicated patients with isolated lateral knee osteoarthritis at short-term follow-up.

148. 1- Inertial measurement units with low sampling frequency can differentiate between osteoarthritic and non-osteoarthritic knees
Arash Ghaffari1, John Rasmussen2, Søren Kold1, Rikke Emilie Kildahl Lauritsen1, Andreas Kappel1, Ole Rahbek
1. Interdisciplinary Orthopaedics, Aalborg University Hospital; 2. Department of Materials and Production, Aalborg University.

Background: Inertial measurement units (IMUs) can objectively measure gait quality in real-life situations, but they provide limited data compared to gold-standard gait labs. Thus, appropriate data analysis is critical to exploit this technology in clinical settings. In this regard, the Fourier representation of a signal, despite many advantages, has not been entirely investigated.
Aim: This study aimed to differentiate between the Fourier representation of gait signals in individuals with and without knee OA.
Materials and Methods: We included 27 patients with unilateral knee osteoarthritis (15 females) and 18 healthy controls (11 females). Gait acceleration signals were recorded during overground walking. We obtained the frequency features of the signals using the Fourier transform. The logistic LASSO regression was employed to distinguish between the acceleration data from individuals with and without knee OA using the features from the frequency domain of the signals as well as the participant's age, sex, and BMI. The model's accuracy was estimated by 10-fold cross-validation.
Results: We could demonstrate that the frequency contents of the signals were different between the two groups. The average accuracy of classifying the gait signals using the frequency features was 0.91 ± 0.01. In addition, the distribution of the selected features in the final model differed between patients with different severity of knee OA.
Interpretation / Conclusion: In conclusion, using logistic LASSO regression on the Fourier representation of acceleration signals can accurately determine the presence of knee OA. The features in the model were also different between patients with different severity of knee OA.

149. Inducible micromotion during step-up test evaluated in stabile and continuous migrating medial unicompartmental knee arthroplasties. A dynamic and static RSA study with minimum 5 years follow-up.
Jonathan Hugo Jürgens-Lahnstein, Emil Toft Petersen, Tobias Dahl Vind, Søren Rytter, Maiken Stilling
1. Department of Orthopaedics, Aarhus University Hospital; 2. AutoRSA Research Group, Aarhus University Hospital

Background: Static radiostereometric analysis (static RSA) is a method to evaluate knee prosthesis stability post-operatively by use of several RSA images obtained over a minimum of 2 years. Based on MTPM migration from 1 to 2 years follow-up knee prostheses can be classified as stable or continuous migrating. Dynamic radiostereometric analysis (dynamic RSA) records the inducible displacement of a loaded knee prosthesis during a single step- up examination. The predictive power of inducible displacement on knee prosthesis revision surgery is unknown.
Aim: Investigate the association of inducible displacement (dynamic RSA) and continuous migration (static RSA) of medial unicompartmental knee arthroplasty (UKA).
Materials and Methods: 55 patients with a medial UKA and static unloaded RSA follow-up to either 2 years or 5 years follow-up (n=8 at 2 years, n=47 at 5 years) were examined with dynamic RSA during a step-up test in addition to standing Hip-Knee-Ankle radiographs (for the mechanical loading axis) and static RSA. Patients with tibial component static RSA migration between 1 and 2 years above 0.2mm MTPM were classified as continuous migrators. For both static and dynamic RSA we recorded translations and rotations along all 3 axis (x, y, z) as well as total translation (TT) and MTPM (implant coordinate system).
Results: 10 patients had UKA tibial components that were classified with continuous migration. The UKA tibial components showed a pattern of inducible displacement during the stand phase of the examination with subsidence of -0.04 mm (95% CI -0.06; -0.01) for stable implants and of -0.08 mm (95%CI -0.16; 0.00) for continuous migrating. The mean TT during the stand phase of the examination was 0.02 mm (95%CI:0.00; 0.05) for stable implants and 0.07 mm (95%CI -0.01; 0.13) for continuous migrating. Varus and valgus alignment of the knee did not influence the inducible displacement pattern of the tibial component UKA (p>0.05).
Interpretation / Conclusion: We did not find a statistically significant inducible displacement difference of tibial components in UKA classified as stable or continuous migrators on static RSA. UKA inducible migration for prediction of later revision should be investigated in larger studies.

150. The knee arthroplasty usage profile of orthopaedic surgeons and the association with patient-reported outcome: A cohort study of 2045 patients
Julie Kristine Steen Møller1, Kristine Ifigenia Bunyoz1, Cecilie Henkel1, Christian Bredgaard Jensen1, Kirill Gromov1, Anders Troelsen1
Clinical Orthopaedic Research Hvidovre (CORH), Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Copenhagen, Denmark

Background: It has been shown that a usage rate of medial unicompartmental knee arthroplasty (UKA) of more than 20% is associated with low revisions rates. Also, medial UKA have been shown to have superior patient-reported outcomes measures (PROMs) compared with total knee arthroplasty (TKA).
Aim: As it remains unknown how differences in knee arthroplasty usage profile (the mix of total and unicompartmental surgeries) of the orthopaedic surgeons relates to the PROM improvements of all treated knee osteoarthritis patients we aimed to investigate this.
Materials and Methods: We included 2045 patients who had primary knee arthroplasty between August 2016 and August 2021 with min. 1 year follow-up. The Oxford Knee Score (OKS), the Forgotten Joint Score (FJS) and the Activity and Participation Questionnaire (APQ) were assessed pre- and postoperatively at 3 and 12 months. Arthroplasty usage profiles were defined based on the yearly surgeries performed by the surgeons: 1) only TKA, 2) TKA +<20% medial UKA, 3) TKA +>20% medial UKA, and 4) TKA +>20% medial UKA + lateral UKA + patellofemoral UKA. Changes in mean PROM scores were calculated and linear regression models were used to calculate crude estimates and estimates adjusted for sex, age, BMI, and preoperative PROM score.
Results: Both profile 3 and 4 had a higher change in mean score in OKS, FJS, and APQ at 3 and 12-month follow-up compared to profile 1. In the 12-month adjusted analysis profile 4 had 1.6 points (CI 0.63- 2.6) higher OKS change, 7.1 points (CI 4.0-10.2) higher FJS change, and 7.2 points (CI 3.5-10.6) higher APQ change than profile 1. There were no significant differences between profile 1 and 2 at any follow-up. Nor were there significant differences between type 3 and 4. Percentage of patients who obtained an excellent OKS (OKS>41) was 41.8% for profile 3+4 versus 32.4% for profile 1+2 (p<0.001).
Interpretation / Conclusion: These findings suggest that an orthopaedic surgeon performing >20% medial UKAs results in a higher postoperative change in mean PROM score among all treated knee osteoarthritis patients. Together with previously established benefits of medial UKA our findings further support that knee arthroplasty surgeons should integrate medial UKA in their practices.

151. KKR 2023: The usage of patella resurfacing in total knee replacement (TKA).
Mikkel Rathsach Andersen1, Julie Ringstrøm Brandt2, Ann Ganestam3
1. Gentofte Hospital; 2. Sygehus Lillbælt/DSHK; 3. Hvidovre Hospital/DSHK

Background: The usage of patella resurfacing in total knee replacement (TKA) is optional and the two methods are considered equals. In Denmark in 2020 71.8 % of total knee replacement was made with patella resurfacing. The high percentage of resurfacing reflects the assumption that the revision rate due to anterior knee pain is higher with the patella not resurfaced. DSHK (Danish society of hip and knee arthroplasty) therefore decided to assess the literature and make recommendations in a short clinical guideline (KKR).
Aim: To investigate if patella resurfacing in primary TKA has better results concerning short and long term follow up revision rate, patient reported outcome and pain score, than non-resurfaced primary TKA.
Materials and Methods: Two meta-analysis was found, publiced in 2021 and 2023. Both included the same 30 RCT studys and no further RCT studys has been publiced since. AMSTAR II critical appraisal tool was used to assess the quality of the meta-analysis. GRADE assessment was used to evaluate the strength of evidence for the relevant outcomes.
Interpretation / Conclusion: This KKR is a weak recommendation towards using patella resurfacing in TKA due to a significant lower revision rate after 5 years follow up.