Minimal İnvaziv Unikompartmantal Diz Artroplasti (MİUCA) Oxford Grubu Radyolojik Değerlendirmesine göre Sık Uygulama Hataları

Murat Saylık; Nadir Şener

doi:10.31067/acusaglik.849564

EN TR

Radiological evaluation results of minimally invasive unicompartmental knee arthroplasty (MİUCA) in Oxford group

Abstract

Purpose:our aim is to reveal the technical errors and rnangular deformities related to the application in MİUCA, using the radiological evaluation criteria rnof the Oxford group, the most common implant application defects.rn Patients and Methods: 14 knee of 13 men and 90 knee of 80 women were included in the study. Average female age; 56.38 ( range: 46-74 ) and average male age; 57.80 ( range: 48-66 ). Average age; 57.12 ( range: 46-74 ) Average follow-up time: 58 months ( range: 3-104 ), 82 fix-beaing, 22 mobile-bearing MIUCA were applied. In the preoperative period: we evaluated the degree of OA in the medial joint with standard bilateral knee radiography and the flexibility of varus deformity with valgus stress test. In the postoperative evaluation; Radiological measurements recommended by the Oxford knee group were performed by routine two-way knee radiography. The knees applied to MIUCA were evaluated with 17 criteria suggested by the Oxford group as a whole. Results:Tibial component: Varus / Valgus: Two patients were found outside the range of -4 (valgus) and 8 (varus) degrees. Slope: In two knees ( 8 and 10 degrees ), slope was measured outside the normal limit. Overflow in the implant: 11 knee posterior, 2 knee anterior and 2 knee overflow from the medial plateau were seen. Femoral component: Valgus-Varus position: Average of 34 knee valgus: 5.41 ( range: 3-10 degrees ), 19 knee varus. Average: 4.58 ( range: 4-8 degrees ). Flexion-Esthesion status: 52 knee flexion, mean: 3.95 ( range: 2-35 degrees ) measured. 21 knees were measured over 5 degrees of flexion. Conclusion:In our patients, where we applied MUCA; Increased error in femoral component: application of the prosthesis in flexion ( above 21 knee-5 degrees ), the most common error in the tibial component: prosthesis overflow ( 11 knees ).

Keywords

Minimal İnvaziv Unikompartmantal Diz Artroplasti (MİUCA) Oxford Grubu Radyolojik Değerlendirmesine göre Sık Uygulama Hataları

Öz

Amaï¿½: Nisan 2010 ve Eylül 2019 tarihleri arasında aynı cerrah tarafından,aynı yöntem ile Minimal İnvaziv Unikompartmantal Diz Artroplastisi(MİUCA) uygulanmış 93 hastanın 104 dizi çalışmaya alındı. Bu çalışmada amacımız: MİUCA’da uygulamaya bağlı teknik hataların, Oxford gurubunun radyolojik değerlendirme kriterleri kullanılarak, sık yapılan implant uygulama kusurlarının ortaya konmasıdır. Hastalar ve Yï¿½ntem: Bu çalışmaya Nisan 2010 ve Temmuz 2017 arasında MİUCA uyguladığımız ve takiplerini kayıt altına alabildiğimiz 94 hastanın 104 dizi çalışmaya alındı, 13 erkeğin 14 dizi ve 80 kadının 90 dizi. Ortalama kadın yaşı; 56.38 (dağılım: 46-74) ve ortalama erkek yaşı; 57.80 (dağılım: 48-66). Ortalama yaş; 57.12 (dağılım:46-74). Ortalama takip süresi:58 ay (dağılım:3-104). 82 dize fix-bearing, 22 dize mobil-bearing MİUCA uygulandı. Preoperatif dönemde: standart iki yönlü diz grafisi ile medial eklemdeki OA derecesi ve valgus stres testi ile varus deformitesinin esnekliği değerlendirildi. Postoperatif değerlendirmede; hastalara rutin iki yönlü diz grafisi çekilerek, Oxford diz grubunun önerdiği radyolojik ölçümler yapıldı(8). MİUCA uygulanan dizler bir bütün olarak Oxford grubunun önerdiği 17 kriterin tamamı ile değerlendirildi. Bulgular: Tibial komponent; Varus-Valgus:-4 (valgus) ve 8 (varus) derece aralığı dışında iki hasta bulundu. Tibial posterior eğim: İki dizde (8 ve 10 derece) yüksek ölçüldü. İmplantta taşma durumu: 11 diz posterior, 2 diz anterior ve 2 dizde medial platodan 2 mm ve üstü taşma görüldü. Tibial sement taşma durumu: 12 dizde vardı.rn Femoral komponenet;varus-valgus: 34 diz valgusta, ortalama: 5.41 (dağılım:3-10 derece), 19 diz varusta, ortalama: 4.58 (dağılım:4-8 derece) kabul edilebilir sınırlardaydı. Fleksiyon-Estensiyon durumu; 52 diz fleksiyonda,ortalama: 3.95 (dağılım:2-35 derece) ölçüldü, bunlardan 21 diz 5 dereceden fazla fleksiyonda ölçüldü. 16 diz ekstensiyonda ortalama: 3 (dağılım:1-10 derece) ölçüldü, bunlardan 4 diz 5 dereceden fazla ekstensiyonda ölçüldü. rn Sonuï¿½:Oxford diz gurubunun postoperatif MİUCA değerlendirmedsine göre sık uygulama hatalarımız; Femoral komponentte protezin 5 derece üstünde fleksiyonda uygulanması(21 diz), femoral komponentin arka duvarında 2 mm gap varlığı(20 diz). Tibial komponentte protezin posteriore taşması(11 diz), tibial komponentteki sementin taşması(12 diz).

Anahtar Kelimeler

References

1. B Murat , S Akpınar, M Uysal, N Cesur, M A Hersekli, M Özalay, G Özkoç Unicondylar knee artroplasty in medial unicompartmantal osteoarthritis: Technical faults and difficults. Joint disease and related surgery. 2010; 21(1): 31-37.
2. Berger RA, Cross MB, Sanders S. Outpatient Hip and Knee Replacement: The Experience From the First 15 Years. Instr Course Lect. 2016; 65: 547-54.
3. Saylık M, Şener N. Learning Curve UCA. Acıbadem üniversity health sciense magazine. January.2013
4. Inoue Akagi M, Asada S, Mori S, Zaima H, Hashida M. The Valgus Inclination of the Tibial Component Increases the Risk of Medial Tibial Condylar Fractures in Unicompartmental Knee Arthroplasty. J Arthroplasty. 2016 Feb 27. pii: S0883-5403(16) 00189-3.doi: 10.1016/j.arth. 2016.02.043.
5. Braito M, Giesinger JM, Fischler S, Koller A, Niederseer D, Liebensteiner MC . Knee Extensor Strength and Gait Characteristics After MinimallyInvasive Unicondylar Knee Arthroplasty vs Minimally Invasive Total Knee Arthroplasty : A Nonrandomized Controlled Trial. J Arthroplasty. 2016 Feb 10. pii: S0883-5403 (16)00111-X . doi: 10. 1016/j.arth.2016.01.045
6. Koh IJ, Kim JH, Kim MS, Jang SW, Kim C, In Y. Is Routine Thromboprophylaxis Needed in Korean Patients Undergoing Unicompartmental Knee Arthroplasty? J Korean Med Sci. 2016 Mar; 31(3): 443-8. doi: 10.3346/jkms. 2016
7. Takayama K, Matsumoto T, Muratsu H, Ishida K, Araki D, Matsushita T, Kuroda R, Kurosaka M. The influence of posterior tibial slope changes on joint gap and range of motion in unicompartmental knee arthroplasty. Knee. 2016 Jan 29. pii: S0968-0160(16)00004-1. Doi: 10.1016/j.knee . 2016.01.003.
8. Shakespeare D, Ledger M, Kinzel V. Accuracy of implantation of components in the Oxford knee using the minimally invasive approach. Knee 2005; 12:405-9.

9. Chang W, Ding H. Research Progress Of Mınımally Invasıve Surgery For Unıcompartmental Knee Arthroplasty.Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2015 Oct; 29(10):1307-11.
10. Heyse TJ, Efe T, Rumpf S, Schofer MD, Fuchs, Winkelmann S, Schmitt J, Hauk C. Minimally invasive versus conventional unicompartmental knee arthroplasty. Arc Orthop Trauma Surg . 2011 Sep ; 131 (9): 1287 -90. doi.10.1007/s00402-011-1274-9.
11. Pandit H, Jenkins C, Gill HS, Barker K, Dodd CA. Murray DW.Minimally invasive Oxford phase 3 unicompartmental knee replacement: results of 1000 cases. J Bone Joint Surg Br. 2011 Feb; 93(2):198-204.doi: 10. 1302/0301-620X. 93B2.25767.
12. Kim KT, Lee S, Kim JH, Hong SW, Jung WS, Shin WS. The Survivorship and Clinical Results of Minimally Invasive Unicompartmental Knee Arthroplasty at 10 Year Follow up. Clin Orthop Surg. 2015 Jun; 7(2):199-206. doi: 10.4055/cios.2015.7.
13. Tsai TY, Dimitriou D, Liow MH , Rubash HE , Li G , Kwon YM. Three-Dimensional Imaging Analysis of Unicompartmental Knee Arthroplasty Evaluated in Standing Position: Component Alignment and In Vivo Articular Contact. J Arthroplasty. 2015 Nov 30.pii S0883-5403(15)01037-2. Doi: 10.1016/j.arth.2015.11.027.
14. Vasso M, Del Regno C, D Amelio A, Viggiano D, Corona K, Schiavone Panni A. Minor varus alignment provides better results than neutral alignment in medial UKA. Knee. 2015 Mar; 22(2):117-21. Doi:10.1016/j.knee. 2014. 12.004.Epub 2014 Dec 13.
15. Slaven SE, Cody JP, Sershon RA, Ho H, Hopper RH Jr, Fricka KB. The Impact of Coronal Alignment on Revision in Medial Fixed-Bearing Unicompartmental Knee Arthroplasty.J Arthroplasty. 2019 Sep 28.
16. Kamenaga T, Hiranaka T, Nakanishi Y, Takayama K, Kuroda R, Matsumoto T. Valgus Subsidence of the Tibial Component Caused by Tibial Component Malpositioning in Cementless Oxford Mobile-Bearing Unicompartmental Knee Arthroplasty.J Arthroplasty. 2019 Dec;34
17. Woiczinski M, Schröder C, Paulus A, Kistler M, Jansson V, Müller PE, Weber P. Varus or valgus positioning of the tibial component of a unicompartmental fixed-bearing knee arthroplasty does not increase wear. Knee Surg Sports Traumatol Arthrosc. 2019 Nov 5.
18. Koh YG, Hong HT, Kang KT. Biomechanical Effect of UHMWPE and CFR-PEEK Insert on Tibial Component in Unicompartmental Knee Replacement in Different Varus and Valgus Alignments. Materials (Basel). 2019 Oct 14;12(20).
19. Innocenti B, Pianigiani S, Ramundo G, Thienpont E. Biomechanical Effects of Different Varus and Valgus Alignments in Medial Unicompartmental Knee Arthroplasty. J Arthroplasty. 2016 Dec; 31(12):2685-2691. doi: 10.1016/j.arth.2016.07.006. Epub 2016 Jul 15.
20. Gulati A, Weston-Simons S, Evans D, Jenkins C, Gray H, Dodd CA, Pandit H, Murray DW. Radiographic evaluation of factors affecting bearing dislocation in the domed lateral Oxford unicompartmental knee replacement.Knee. 2014 Dec; 21(6):1254-7.
21. Monk AP, Keys GW, Murray DW. Loosening of the femoral component after unicompartmental knee replacement. J Bone Joint Surg (Br) 2009; 91(3):405–407
22. Weber P, Schröder C, Schmidutz F, Kraxenberger M, Utzschneider S, Jansson V, Müller PE. Increase of tibial slope reduces backside wear in medial mobile bearing unicompartmental knee arthroplasty. Clin Biomech (Bristol , Avon). 2013 Oct;28(8):904-9. Doi: 10.1016/j.clinbiomech.2013.08.006.
23. Suzuki T, Ryu K, Kojima K, Oikawa H, Saito S, Nagaoka M. The Effect of Posterior Tibial Slope on Joint Gap and Range of Knee Motion in Mobile-Bearing Unicompartmental Knee Arthroplasty. J Arthroplasty. 2019 Dec; 34(12):2909-2913.
24. Kang KT, Son J, Koh YG, Kwon OR, Kwon SK, Lee YJ, Park KK. Effect of femoral component position on biomechanical outcomes of unicompartmental knee arthroplasty.Knee. 2018 Jun;25(3):491-498.
25. Bozkurt M , Akmese R, Cay N, Isik Ç, Bilgetekin YG, Kartal MG, Tecimel O. Cam impimgement of the posterior femoral condyle in unicompartmental knee arthroplasty.Knee Surg Sports Traumatol Arthrosc. 2013 Nov; 21(11):2495-500. Doi. 10.1007/s00167
26. Boniforti F. Medial unicondylar knee arthroplasty: technical pearls.Joints. 2015 Nov 3;3(2):82-4. doi:10.11138/jts/2015.3.2.082.

Details

Primary Language

Turkish

Subjects

Orthopaedics

Journal Section

Research Article

Authors

Murat Saylık ^*
Türkiye

Nadir Şener
Türkiye

Publication Date

April 1, 2021

Submission Date

January 30, 2020

Acceptance Date

-

Published in Issue

Year 1970 Volume: 12 Number: 2

DOI

https://doi.org/10.31067/acusaglik.849564

IZ

https://izlik.org/JA37TF58RY

Cite

RIS / Bibtex

EndNote

Saylık M, Şener N (April 1, 2021) Minimal İnvaziv Unikompartmantal Diz Artroplasti (MİUCA) Oxford Grubu Radyolojik Değerlendirmesine göre Sık Uygulama Hataları. Acıbadem Üniversitesi Sağlık Bilimleri Dergisi 12 2 220–227.

Cited By

Fixed-Bearing versus Mobile-Bearing Unicondylar Knee Arthroplasty: Comparison of Patients with Similar Component and Mechanical Axis Alignment

Düzce Tıp Fakültesi Dergisi

https://doi.org/10.18678/dtfd.1182098