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.