Clinical outcome of bi-unicompartmental knee arthroplasty for both medial and lateral femorotibial arthritis: a systematic review—is there proof of concept?

Abstract

Introduction

Unicompartmental knee arthroplasty (UKA) is a well-accepted treatment for isolated unicompartmental osteoarthritis (OA) of the knee. In previous literature, it has been suggested that bi-unicompartmental knee arthroplasty (bi-UKA) which uses two UKA implants in both the medial and lateral compartments of the same knee is a feasible and viable option for the treatment of knee OA. Given the advantages of UKA treatment, it is warranted to review the literature of bi-UKA and discuss the evidence in terms of implant selection, indications, surgical techniques, and outcomes, respectively.

Materials and methods

Following the PRISMA guidelines, PubMed, Medline, Embase, CINAHL, Web of Science, and Cochrane Library were searched for studies presenting outcome of bi-UKA. Studies were included if they reported clinical outcomes using two unicompartmental prostheses for both medial and lateral femorotibial arthritis. Studies with the addition of patellofemoral arthroplasty or concomitant soft-tissue reconstruction and those not published in English were excluded.

Results

In the early literature, the procedure of bi-UKA were performed for very severe OA and rheumatoid arthritis, but indications have evolved to reflect a more contemporary case-mix of knee OA patients. Both mobile and fixed bearing implants have been used, with the latter being the most frequent choice. A medial parapatellar approach for incision and arthrotomy has been the most frequently used technique. The present review found a promising clinical outcome of both simultaneous and staged bi-UKA although the number of long-term follow-up studies was limited.

Conclusions

Both simultaneous and staged bi-UKA has demonstrated good functional outcomes. However, the volume and level of evidence in general is low for studies captured in this review, and the data on long-term outcomes remain limited. The present review indicates that bi-UKA is a feasible and viable surgical option for bicompartmental femorotibial OA in carefully selected patients.

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Fig. 1
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Abbreviations

UKA:

Unicompartmental knee arthroplasty

OA:

Osteoarthritis

TKA:

Total knee arthroplasty

PROMs:

Patient-reported outcome measures

bi-UKA:

Bi-unicompartmental knee arthroplasty

RA:

Rheumatoid arthritis

ROM:

Range of motion

ACL:

Anterior cruciate ligament

OKS:

Oxford Knee Score

IKSS/KSS:

International knee society score

WOMAC:

Western Ontario and McMaster Universities Arthritis Index

KOOS:

Knee Injury and Osteoarthritis Outcome Scores

HTO:

High tibial osteotomy

GIUM:

A dedicated UKR outcome score developed by the Italian Orthopaedic UKR’s Users Group

HSS:

Hospital for Special Surgery score

VAS:

Visual analog scale

AKSS:

American Knee Society Score

References

  1. 1.

    Argenson JN, Blanc G, Aubaniac JM, Parratte S (2013) Modern unicompartmental knee arthroplasty with cement: a concise follow-up, at a mean of twenty years, of a previous report. J Bone Jt Surg Am 95(10):905–909. https://doi.org/10.2106/JBJS.L.00963

    Article  Google Scholar 

  2. 2.

    Winnock de Grave P, Barbier J, Luyckx T, Ryckaert A, Gunst P, Van den Daelen L (2018) Outcomes of a fixed-bearing, medial, cemented unicondylar knee arthroplasty design: survival analysis and functional score of 460 cases. J Arthroplasty 33(9):2792–2799. https://doi.org/10.1016/j.arth.2018.04.031

    Article  Google Scholar 

  3. 3.

    Willis-Owen CA, Brust K, Alsop H, Miraldo M, Cobb JP (2009) Unicondylar knee arthroplasty in the UK National Health Service: an analysis of candidacy, outcome and cost efficacy. Knee 16(6):473–478. https://doi.org/10.1016/j.knee.2009.04.006

    Article  Google Scholar 

  4. 4.

    Lisowski LA, Meijer LI, van den Bekerom MP, Pilot P, Lisowski AE (2016) Ten- to 15-year results of the Oxford Phase III mobile unicompartmental knee arthroplasty: a prospective study from a non-designer group. Bone Jt J 98:41–47. https://doi.org/10.1302/0301-620X.98B10.BJJ-2016-0474.R1

    Article  Google Scholar 

  5. 5.

    Mohammad HR, Strickland L, Hamilton TW, Murray DW (2018) Long-term outcomes of over 8,000 medial Oxford Phase 3 Unicompartmental Knees-a systematic review. Acta Orthop 89(1):101–107. https://doi.org/10.1080/17453674.2017.1367577

    Article  Google Scholar 

  6. 6.

    Argenson JN, Parratte S, Bertani A, Flecher X, Aubaniac JM (2008) Long-term results with a lateral unicondylar replacement. Clin Orthop Relat Res 466(11):2686–2693. https://doi.org/10.1007/s11999-008-0351-z

    Article  PubMed Central  Google Scholar 

  7. 7.

    Pennington DW, Swienckowski JJ, Lutes WB, Drake GN (2006) Lateral unicompartmental knee arthroplasty. J Arthroplasty 21(1):13–17. https://doi.org/10.1016/j.arth.2004.11.021

    Article  Google Scholar 

  8. 8.

    Seo SS, Kim CW, Lee CR, Kwon YU, Oh M, Kim OG, Kim CK (2019) Long-term outcomes of unicompartmental knee arthroplasty in patients requiring high flexion: an average 10-year follow-up study. Arch Orthop Trauma Surg 139(11):1633–1639. https://doi.org/10.1007/s00402-019-03268-7

    Article  Google Scholar 

  9. 9.

    Mullaji AB, Sharma A, Marawar S (2007) Unicompartmental knee arthroplasty: functional recovery and radiographic results with a minimally invasive technique. J Arthroplasty 22(4 Suppl 1):7–11. https://doi.org/10.1016/j.arth.2006.12.109

    Article  Google Scholar 

  10. 10.

    Hauer G, Sadoghi P, Bernhardt GA, Wolf M, Ruckenstuhl P, Fink A, Leithner A, Gruber G (2020) Greater activity, better range of motion and higher quality of life following unicompartmental knee arthroplasty: a comparative case-control study. Arch Orthop Trauma Surg 140(2):231–237. https://doi.org/10.1007/s00402-019-03296-3

    Article  Google Scholar 

  11. 11.

    Argenson JN, Komistek RD, Aubaniac JM, Dennis DA, Northcut EJ, Anderson DT, Agostini S (2002) In vivo determination of knee kinematics for subjects implanted with a unicompartmental arthroplasty. J Arthroplasty 17(8):1049–1054. https://doi.org/10.1054/arth.2002.34527

    Article  Google Scholar 

  12. 12.

    Heyse TJ, El-Zayat BF, De Corte R, Chevalier Y, Scheys L, Innocenti B, Fuchs-Winkelmann S, Labey L (2014) UKA closely preserves natural knee kinematics in vitro. Knee Surg Sports Traumatol Arthrosc 22(8):1902–1910. https://doi.org/10.1007/s00167-013-2752-0

    Article  Google Scholar 

  13. 13.

    Isaac SM, Barker KL, Danial IN, Beard DJ, Dodd CA, Murray DW (2007) Does arthroplasty type influence knee joint proprioception? A longitudinal prospective study comparing total and unicompartmental arthroplasty. Knee 14(3):212–217. https://doi.org/10.1016/j.knee.2007.01.001

    CAS  Article  Google Scholar 

  14. 14.

    Liddle AD, Judge A, Pandit H, Murray DW (2014) Adverse outcomes after total and unicompartmental knee replacement in 101 330 matched patients: a study of data from the National Joint Registry for England and Wales. Lancet 384(9952):1437–1445. https://doi.org/10.1016/s0140-6736(14)60419-0

    Article  Google Scholar 

  15. 15.

    Liddle AD, Pandit H, Judge A, Murray DW (2015) Patient-reported outcomes after total and unicompartmental knee arthroplasty: a study of 14,076 matched patients from the National Joint Registry for England and Wales. Bone Jt J 97(6):793–801. https://doi.org/10.1302/0301-620X.97B6.35155

    Article  Google Scholar 

  16. 16.

    Gunston FH (1971) Polycentric knee arthroplasty. Prosthetic simulation of normal knee movement. J Bone Jt Surg Br 53(2):272–277

    CAS  Article  Google Scholar 

  17. 17.

    Goodfellow JW, O'Connor J (1986) Clinical results of the Oxford knee. Surface arthroplasty of the tibiofemoral joint with a meniscal bearing prosthesis. Clin Orthop Relat Res 205:21–42

    Google Scholar 

  18. 18.

    Walton MJ, Weale AE, Newman JH (2006) The progression of arthritis following lateral unicompartmental knee replacement. Knee 13(5):374–377. https://doi.org/10.1016/j.knee.2006.05.005

    CAS  Article  Google Scholar 

  19. 19.

    Pandit H, Mancuso F, Jenkins C, Jackson WFM, Price AJ, Dodd CAF, Murray DW (2017) Lateral unicompartmental knee replacement for the treatment of arthritis progression after medial unicompartmental replacement. Knee Surg Sports Traumatol Arthrosc 25(3):669–674. https://doi.org/10.1007/s00167-016-4075-4

    CAS  Article  Google Scholar 

  20. 20.

    Lustig S, Servien E, Neyret P, Pereira H (2008) An original indication for biunicondylar knee antroplasty: subsequent contralateral unicondylar knee arthroplasty after degenerative changes of the opposite compartment. Tech Knee Surg 7(4):240–250

    Article  Google Scholar 

  21. 21.

    Lustig S, Lording T, Frank F, Debette C, Servien E, Neyret P (2014) Progression of medial osteoarthritis and long term results of lateral unicompartmental arthroplasty: 10 to 18 year follow-up of 54 consecutive implants. Knee 21:S26–S32. https://doi.org/10.1016/s0968-0160(14)50006-3

    Article  Google Scholar 

  22. 22.

    Biazzo A, Manzotti A, Confalonieri N (2018) Bi-unicompartmental versus total knee arthroplasty: long term results. Acta Orthop Belg 84(3):237–244

    Google Scholar 

  23. 23.

    Dettmer M, Kreuzer SW (2015) Bi-unicompartmental, robot-assisted knee arthroplasty. Oper Techn Orthop 25(2):155–162. https://doi.org/10.1053/j.oto.2015.03.004

    Article  Google Scholar 

  24. 24.

    Parratte S, Pauly V, Aubaniac JM, Argenson JN (2010) Survival of bicompartmental knee arthroplasty at 5 to 23 years. Clin Orthop Relat Res 468(1):64–72. https://doi.org/10.1007/s11999-009-1018-0

    Article  Google Scholar 

  25. 25.

    Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6(7):e1000097. https://doi.org/10.1371/journal.pmed.1000097

    Article  PubMed Central  Google Scholar 

  26. 26.

    Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J (2003) Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg 73(9):712–716. https://doi.org/10.1046/j.1445-2197.2003.02748.x

    Article  Google Scholar 

  27. 27.

    Walker SJ, Sharma P, Parr N, Cavendish ME (1986) The long-term results of the Liverpool Mark II knee prosthesis. J Bone Jt Surg Br 68(1):111–116

    CAS  Article  Google Scholar 

  28. 28.

    Stockley I, Douglas DL, Elson RA (1990) Bicondylar St. Georg sledge knee arthroplasty. Clin Orthop Relat Res 255:228–234

    Google Scholar 

  29. 29.

    Fuchs S, Tibesku CO, Frisse D, Genkinger M, Laass H, Rosenbaum D (2005) Clinical and functional comparison of uni- and bicondylar sledge prostheses. Knee Surg Sports Traumatol Arthrosc 13(3):197–202. https://doi.org/10.1007/s00167-004-0580-y

    CAS  Article  Google Scholar 

  30. 30.

    Confalonieri N, Manzotti A, Cerveri P, De Momi E (2009) Bi-unicompartmental versus total knee arthroplasty: a matched paired study with early clinical results. Arch Orthop Trauma Surg 129(9):1157–1163. https://doi.org/10.1007/s00402-008-0713-8

    CAS  Article  Google Scholar 

  31. 31.

    Barrett DS, Biswas SP, MacKenney RP (1990) The Oxford knee replacement. A review from an independent centre. J Bone Jt Surg Br 72(5):775–778

    CAS  Article  Google Scholar 

  32. 32.

    Confalonieri N, Manzotti A (2005) Mini-invasive computer assisted bi-unicompartimental knee replacement. Int J Med Robot 1(4):45–50. https://doi.org/10.1002/rcs.56

    CAS  Article  Google Scholar 

  33. 33.

    Parratte S, Pauly V, Aubaniac J-M, Argenson J-NA (2011) No long-term difference between fixed and mobile medial unicompartmental arthroplasty. Clin Orthop Relat Res 470(1):61–68. https://doi.org/10.1007/s11999-011-1961-4

    Article  PubMed Central  Google Scholar 

  34. 34.

    Confalonieri N, Manzotti A, Pullen C (2004) Comparison of a mobile with a fixed tibial bearing unicompartmental knee prosthesis: a prospective randomized trial using a dedicated outcome score. Knee 11(5):357–362. https://doi.org/10.1016/j.knee.2004.01.003

    CAS  Article  Google Scholar 

  35. 35.

    Ernstbrunner L, Imam MA, Andronic O, Perz T, Wieser K, Fucentese SF (2018) Lateral unicompartmental knee replacement: a systematic review of reasons for failure. Int Orthop 42(8):1827–1833. https://doi.org/10.1007/s00264-017-3662-4

    Article  Google Scholar 

  36. 36.

    Parratte S, Ollivier M, Lunebourg A, Abdel MP, Argenson JN (2015) Long-term results of compartmental arthroplasties of the knee: long term results of partial knee arthroplasty. Bone Jt J 97:9–15. https://doi.org/10.1302/0301-620X.97B10.36426

    Article  Google Scholar 

  37. 37.

    Newman SDS, Altuntas A, Alsop H, Cobb JP (2017) Up to 10 year follow-up of the Oxford Domed Lateral Partial Knee Replacement from an independent centre. Knee 24(6):1414–1421. https://doi.org/10.1016/j.knee.2017.05.001

    Article  Google Scholar 

  38. 38.

    Romagnoli S, Marullo M, Massaro M, Rustemi E, D'Amario F, Corbella M (2015) Bi-unicompartmental and combined uni plus patellofemoral replacement: indications and surgical technique. Joints 3(1):42–48

    PubMed Central  Google Scholar 

  39. 39.

    Younger AS, Duncan CP, Masri BA (1998) Surgical exposures in revision total knee arthroplasty. J Am Acad Orthop Surg 6(1):55–64

    CAS  Article  Google Scholar 

  40. 40.

    Vince K, Chivas D, Droll KP (2007) Wound complications after total knee arthroplasty. J Arthroplasty 22(4 Suppl 1):39–44. https://doi.org/10.1016/j.arth.2007.03.014

    Article  Google Scholar 

  41. 41.

    Zhang Q, Zhang Q, Guo W, Gao M, Ding R, Wang W (2019) Risk factors of postoperative valgus malalignment in mobile-bearing medial unicompartmental knee arthroplasty. Arch Orthop Trauma Surg 139(2):241–248. https://doi.org/10.1007/s00402-018-3070-2

    Article  Google Scholar 

  42. 42.

    Ozcan C, Simsek ME, Tahta M, Akkaya M, Gursoy S, Bozkurt M (2018) Fixed-bearing unicompartmental knee arthroplasty tolerates higher variance in tibial implant rotation than mobile-bearing designs. Arch Orthop Trauma Surg 138(10):1463–1469. https://doi.org/10.1007/s00402-018-3005-y

    Article  Google Scholar 

  43. 43.

    Canetti R, Batailler C, Bankhead C, Neyret P, Servien E, Lustig S (2018) Faster return to sport after robotic-assisted lateral unicompartmental knee arthroplasty: a comparative study. Arch Orthop Trauma Surg 138(12):1765–1771. https://doi.org/10.1007/s00402-018-3042-6

    CAS  Article  Google Scholar 

  44. 44.

    Fuchs S, Tibesku CO, Genkinger M, Laass H, Rosenbaum D (2003) Proprioception with bicondylar sledge prostheses retaining cruciate ligaments. Clin Orthop Relat Res 406:148–154. https://doi.org/10.1097/01.blo.0000038053.29678.a5

    Article  Google Scholar 

  45. 45.

    Fuchs S, Tibesku CO, Genkinger M, Volmer M, Laass H, Rosenbaum D (2004) Clinical and functional comparison of bicondylar sledge prostheses retaining all ligaments and constrained total knee replacement. Clin Biomech (Bristol, Avon) 19(3):263–269. https://doi.org/10.1016/j.clinbiomech.2003.11.004

    CAS  Article  Google Scholar 

  46. 46.

    Banks SA, Fregly BJ, Boniforti F, Reinschmidt C, Romagnoli S (2005) Comparing in vivo kinematics of unicondylar and bi-unicondylar knee replacements. Knee Surg Sports Traumatol Arthrosc 13(7):551–556. https://doi.org/10.1007/s00167-004-0565-x

    Article  Google Scholar 

  47. 47.

    Watanabe T, Abbasi AZ, Conditt MA, Christopher J, Kreuzer S, Otto JK, Banks SA (2014) In vivo kinematics of a robot-assisted uni- and multi-compartmental knee arthroplasty. J Orthop Sci 19(4):552–557. https://doi.org/10.1007/s00776-014-0578-3

    Article  Google Scholar 

  48. 48.

    Lewold S, Robertsson O, Knutson K, Lidgren L (1998) Revision of unicompartmental knee arthroplasty: outcome in 1,135 cases from the Swedish Knee Arthroplasty study. Acta Orthop Scand 69(5):469–474

    CAS  Article  Google Scholar 

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Correspondence to Keizo Wada.

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AP is a consultant of Zimmer-Biomet Company. All other authors declare that they have no conflicts of interest.

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Wada, K., Price, A., Gromov, K. et al. Clinical outcome of bi-unicompartmental knee arthroplasty for both medial and lateral femorotibial arthritis: a systematic review—is there proof of concept?. Arch Orthop Trauma Surg (2020). https://doi.org/10.1007/s00402-020-03492-6

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Keywords

  • Knee
  • Osteoarthritis
  • Arthroplasty
  • Bi-unicompartmental knee arthroplasty
  • Unicompartmental knee arthroplasty