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ABOS Part 2 > UKA > Flashcards

UKA Flashcards

1
Q

advantages of UKA to TKA

A

faster rehab and quicker recovery, less morbidity, lower rates of PJI, preservation of kinematics in the knee

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2
Q

advantages of UKA to osteotomy

A

lasts longer, higher success rate, fewer short term complications, easier to convert to TKA

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3
Q

indications

A

classically reserved for older, lower demand, and thin patients (180 lbs)

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4
Q

contraindications

A

inflammatory arthritis, ACL deficiency, varus deformity >10 degrees, valgus deformity >5 degrees, arc of motion <90, flexion contracture >5-10, prior surgery in other compartmentment, global pain, younger high activity level patients and heavy laborers, severe anterior knee pain

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5
Q

goals of UKA alignment

A

1-4 degrees of varus??? resect minimal bone.

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6
Q

technical risks

A

Varus tibial cut. You should correct varus fdeformity to 1-5 degrees of valgus, but the mechanical axis should be 1-4 varus

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7
Q

Complications to UKA

A

Aseptic loosening (most common cause of early failure 5 years). Stress fractures (only on tibia, patient activity and weight, blood on aspiration, penetrating posterior tibial cortex with guidepin, replacing guidepin, under-sized tibial component). Intraoperative fracturesR

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8
Q

Revision rate of UKA

A

Worse than TKA

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9
Q

Late causes of UKA failure

A

progression of osteoarthritis, component failure from under-correction, component loosening, patella impingement on femoral component, poly wear.

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10
Q

UKA failure rates

A
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11
Q

Why did you do UKA on this patient.

A

He has grade 4 chondrosis isolated to the medial compartment, he has had over 6 months of non-operative management and he is refusing further non-op management, his pain is referable to the medial compartment, he is a correctable mild deformity on exam and good range of motion.

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12
Q

UKA subsidence papers

A
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13
Q

UKA underhang vs. overhang

A
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14
Q

UKA ligamentous damage

A
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15
Q

Long term outcomes of UKA

A
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16
Q

Obesity and UKA

A

A systematic review showed no increase in revision rate in patients BMI>30 so it is not a definite contraindication to UKA.

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17
Q

Obesity and UKA

A

a study in Jouirnal of Arthroplasty at UVA with James Browne 2014. The overall short-term revision rate in obese and morbidly obese patients undergoing UKA was almost twice as high as the revision rate in non-obese patients within 90 days.

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18
Q

Obesity and UKA

A

A study of 80,000 patients in a meta-analysis showed that there was overall a similar complication rate, infection rate, and revision surgery rate with mean follow up of 5.42 years.

Obesity does not adversely impact the outcome of unicompartmental knee arthroplasty for osteoarthritis: a meta-analysis of 80,798 subjects
Nikhil Agarwal, Kendrick To, Bridget Zhang & Wasim Khan
International Journal of Obesity volume 45, pages715–724 (2021)

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19
Q

Obesity and UKA

A

Significant improvement in pain and function, some studies have shown increased complication rates, particularly in the short term, however other studies have shown there to be no significant difference in complications or revision rate

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20
Q

TKA vs. UKA risks

A

A total of 2235 primary total knee arthroplasties (TKAs) and 605 unicompartmental knee arthroplasties performed at 3 institutions over 5 years were reviewed to compare the incidence of postoperative complications between these groups. The overall risk of complications for patients undergoing TKA was 11.0%, compared with 4.3% for patients undergoing unicompartmental knee arthroplasty (P < .0001). Total knee arthroplasty was associated with increased rates of manipulation (odds ratio [OR], 13.0; P < .0001), transfusion (OR, 8.5; P = .036), intensive care unit admission (OR, 7.4; P = .049), discharge to a rehabilitation facility (OR, 5.2; P < .0001) and had longer hospital stays (mean, 3.3 vs 2.0 days; P < .0001). There was a trend toward an increased risk of deep infection (0.8% vs 0.2%, P = .13), readmission (4.2% vs 2.7%, P = .0795), thromboembolic events (1.0% vs 0.64%, P = .398), and any reoperation (1.4% vs 0.6%; P = .064). The increased risk of perioperative complications after TKA should be considered when counseling patients if they are an appropriate candidate for either procedure.

Total Knee Arthroplasty Has Higher Postoperative Morbidity Than Unicompartmental Knee Arthroplasty: A Multicenter Analysis
Author links open overlay panelNicholas M. Brown MD ⁎, Neil P. Sheth MD †, Kenneth Davis MS ‡, Mike E. Berend MD ‡, Adolph V. Lombardi MD §, Keith R. Berend MD §, Craig J. Della Valle MD *
JOurnal of Arthroplasty

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21
Q

Five-Year Survival of 20,946 Unicondylar Knee Replacements and Patient Risk Factors for Failure
An Analysis of German Insurance Data
Jeschke, Elke PhD; Gehrke, Thorsten MD; Günster, Christian; Hassenpflug, Joachim MD; Malzahn, Jürgen; Niethard, Fritz Uwe MD; Schräder, Peter MD; Zacher, Josef MD; Halder, Andreas MD
Author Information
The Journal of Bone and Joint Surgery 98(20):p 1691-1698, October 19, 2016. | DOI: 10.2106/JBJS.15.01060

A

During the study period, a total of 20,946 unicondylar knee arthroplasties were included. The number of unicondylar knee arthroplasties per year increased during the study period from 2,527 in 2006 to 4,036 in 2012. The median patient age was 64 years (interquartile range, 56 to 72 years), and 60.4% of patients were female. During the time evaluated, the 1-year revision rate decreased from 14.3% in 2006 to 8.7% in 2011. The 5-year survival rate was 87.8% (95% CI, 87.3% to 88.3%). Significant risk factors (p < 0.05) for unicondylar knee arthroplasty revision were younger age (the HR was 2.93 [95% CI, 2.48 to 3.46] for patient age of <55 years, 1.86 [95% CI, 1.58 to 2.19] for 55 to 64 years, and 1.52 [95% CI, 1.29 to 1.79] for 65 to 74 years; patient age of >74 years was used as the reference); female sex (HR, 1.18 [95% CI, 1.07 to 1.29]); complicated diabetes (HR, 1.47 [95% CI, 1.03 to 2.12]); depression (HR, 1.29 [95% CI, 1.06 to 1.57]); obesity, defined as a body mass index of ≥30 kg/m2 (HR, 1.13 [95% CI, 1.02 to 1.26]); and low-volume hospitals, denoted as an annual hospital volume of ≤10 cases (HR, 1.60 [95% CI, 1.39 to 1.84]), 11 to 20 cases (HR, 1.47 [95% CI, 1.27 to 1.70]), and 21 to 40 cases (HR, 1.31 [95% CI, 1.14 to 1.51]) (>40 cases was used as the reference).

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22
Q

Benefits of UKA

A

. UKA offers several potential advantages over TKA including less-invasive surgical exposure, preservation of native bone stock, retention of cruciate ligaments, lower perioperative morbidity,1 enhanced postoperative recovery,1,2 and improved patient satisfactionIn addition, biomechanics of UKA more closely resembles native knee function with improved dynamic proprioception and postural control compared with that of TKA.4 Recent studies have demonstrated the cost-effectiveness when UKA is performed in the appropriate patient population.5 In addition, UKA is associated with less morbidity and mortality compared with TKA.2 With improved surgical technique and promising midterm outcomes, UKA use has great potential to increase over the next few decades.

Ten-year survival for UKA in cohort studies has shown to be >90% with outcomes after conversion to TKA being similar to outcomes for revision TKA. Registries have consistently shown lower implant survival for UKA compared with that for TKA, which is likely secondary to use of several different implants by surgeons of varying levels of experience. UKA has the potential to be a cost-effective alternative to TKA in certain patient populations when performed at high-volume centers with advanced surgical techniques.

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23
Q

Kozinn and SCott indications

A

In 1989, Kozinn and Scott7 established indications for patient selection which included age lower than 60 years, weight under 180 pounds, avoidance of heavy labor, minimal baseline pain, preoperative arc of motion of 90° with less than a 5° flexion contracture, and angular deformity under 15°. Contraindications included osteoarthritis of the patellofemoral joint (PFJ) or contralateral condyle, inflammatory arthropathy, presence of chondrocalcinosis, and cruciate ligament insufficiency.7

Except it is age >60 years

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24
Q

Journal of Arthroplasty The Role of Preoperative Patient Characteristics on Outcomes of Unicompartmental Knee Arthroplasty: A Meta-Analysis Critique
Author links open overlay panelJelle P. van der List MD a, Harshvardhan Chawla BS a, Hendrik A. Zuiderbaan MD b, Andrew D. Pearle MD a

A

In a meta-analysis of 6 national registries and 31 clinical studies, no increased risk for poor outcomes or revision was noted in patients with a BMI over 30.10

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25
Q

anterior knee pain and UKA

A

is not a contraindication becuase it is does not correlate to outcomes after UKA

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26
Q

underhang

A

The tibial component should be sized to maximize the tibial surface area because undersizing can place excess load on the tibial component predisposing to tibial fracture or implant subsidence.

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27
Q

Revision rate

A

They report 14.6% UKA revision rate at 10 years and 21% revision at 15 years, with the most common indications for revision being aseptic loosening (43.5%), progression of osteoarthritis (29.4%), and unexplained pain (9.5%).31 Risk factors for earlier revision include female gender and younger age. The lowest revision rate was seen in patients aged 65 to 74 years with the 10-year survival of 87%.31 The National Joint Registry (NJR) for England, Wales and Northern Ireland database reports data on FB (31.3% of UKAs) and MB (67.5%) implants separately.32 The 10-year survival for FB implant is slightly higher at 89.2% compared with 87.6% for MB implant.32 The overall risk for revision of UKAs is 2.9 times higher than what is observed for TKA. The New Zealand registry reports UKA survival of 89% at 10 years and 83.3% at 15 years.33 They recognized better performance for certain implants with the lowest revision rate seen in the uncemented Oxford (Zimmer Biomet) with 10-year survival of 96%. The Norwegian database reports very low UKA survival of 79% at 10 years and 72% at 20 years.34

The US Medicare database has demonstrated similar results.36 Revision rate for the UKA group was 4.7% at 5 years compared with 2.0% for TKA, with no improvement in risk after controlling for covariates.36 As registry reporting continues to improve, there will hopefully be better insight into the reason for these high failure rates and how UKA compares with TKA outcomes long-term.

Cohorts show high volume surgeon outcomes, registries is everyone else, including low volume

28
Q

Caseload and experince

A

Analysis of the National Joint Registry showed that optimal results were obtained by surgeons performing UKAs in 40% to 60% of their patients, with poorest results in those performing UKA <5% of the time.32 Survival rates for high-volume surgeons were 96% at 5 years compared with 90% in low-volume surgeons.32

29
Q

outcomes of revising UKA to TKA

A

same as a TKA revision, not a primary TKA outcome

30
Q

Modes of failure

A

A recent systematic review found that the most common reasons for UKA failure were aseptic loosening (36%), progression of osteoarthritis (20%), unexplained pain (11%), instability (6%), infection (5%), and polyethylene wear (4%).25 The majority of early failures (<5 years) were from aseptic loosening (25%), osteoarthritis progression (20%), and bearing dislocation (17%), whereas midterm and later revisions were performed primarily for osteoarthritis progression (38 to 40%), aseptic loosening (29%), and polyethylene wear (10%)

31
Q

revising UKA to TKA vs. revision TKA

A

not as good as primary TKA, but it has lower morbidity than a revision TKA

32
Q

Have a good answer for long term outcomes and survival

A
33
Q

Tibial spine impingement???

A
34
Q

Why did you not have a weightbearing film?

A

That is my mistake, I absolutely should have had a weightbearing film and there is no excuse for that. The weightbearing film is essential to assess accurate clinical joint space narrowing.

35
Q

Beard DJ, Davies LJ, Cook JA, MacLennan G, Price A, Kent S, Hudson J, Carr A, Leal J, Campbell H, Fitzpatrick R. The clinical and cost-effectiveness of total versus partial knee replacement in patients with medial compartment osteoarthritis (TOPKAT): 5-year outcomes of a randomised controlled trial. The Lancet. 2019 Aug 31;394(10200):746-56.

A

Findings
Between Jan 18, 2010, and Sept 30, 2013, we assessed 962 patients for their eligibility, of whom 431 (45%) patients were excluded (121 [13%] patients did not meet the inclusion criteria and 310 [32%] patients declined to participate) and 528 (55%) patients were randomly assigned to groups. 94% of participants responded to the follow-up survey 5 years after their operation. At the 5-year follow-up, we found no difference in OKS between groups (mean difference 1·04, 95% CI −0·42 to 2·50; p=0·159). In our within-trial cost-effectiveness analysis, we found that PKR was more effective (0·240 additional quality-adjusted life-years, 95% CI 0·046 to 0·434) and less expensive (−£910, 95% CI −1503 to −317) than TKR during the 5 years of follow-up. This finding was a result of slightly better outcomes, lower costs of surgery, and lower follow-up health-care costs with PKR than TKR.
Interpretation
Both TKR and PKR are effective, offer similar clinical outcomes, and result in a similar incidence of re-operations and complications. Based on our clinical findings, and results regarding the lower costs and better cost-effectiveness with PKR during the 5-year study period, we suggest that PKR should be considered the first choice for patients with late-stage isolated medial compartment osteoarthritis.

36
Q

name the classification system for arthroscopic cartilage defects

A

MODIFIED Outerbridge.

37
Q

OUterbridge calssification

A

0 is normal, 1 is focal small defect, Grade 2<50%, Grdae 3 >50%, Graee 4 100.

38
Q

grade 1 cartilage on MRI

A

surface intact and hterogenous with high singal intensity

39
Q

survival of UKA

A

Medial fixed bearing metaanalysis. 95.3% at 5 years and 91.3% at 10 years.

Heaps BM, Blevins JL, Chiu YF, Konopka JF, Patel SP, McLawhorn AS. Improving Estimates of Annual Survival Rates for Medial Unicompartmental Knee Arthroplasty, a Meta-Analysis. J Arthroplasty. 2019 Jul;34(7):1538-1545. doi: 10.1016/j.arth.2019.02.061. Epub 2019 Mar 6. PMID: 30954408.

40
Q

patellofemoral OA and UKA

A

Does not affect outcomes of fixed bearing UKA

41
Q

UKA with BMI >40 vs TKA

A

UKA was more frequently associated with clinical failure (29.2% vs 2.5%, P < .001) and component revision (15.7% vs 2.5%, P < .001), TKA was more frequently associated with extensor mechanism complications or knee manipulation (5.5% vs 0.0%, P = .02), and there was no difference in the infection rate (3.0% vs 2.2%, P = 1.0).

TKA is More Durable Than UKA for Morbidly Obese Patients: A Two-Year Minimum Follow-Up Study

42
Q

Morbid obesity classification

A

BMI >40 or BMI >35 with a comorbidity

43
Q

TOPKAT study

A

UKA vs. TKA no difference in Oxford knee scores at 5 years

44
Q

Does robotic change reviison reates for UKA

A

no different in revision rates of medial fixed bearing UKA at 3 years

45
Q

ACL deficiency

A

relative contraindciation for fixed bearing but absolute for mobile bearing. What you tell them: in my practice, it is a contraindication.

46
Q

Do you check for malnutrition?

A

I do in gastric bypass patients, I get vitamin levels as well as assess nutritional values…such as albumin (3.5 g/dL), pre-albumin, trasnferrin, and total lymphocyte count. malnutrition is associated with wound complications and infections

47
Q

smoking cessation

A

I asked patients to be smoking cessatino 6 weeks pre-op

48
Q

Cortisone injection

A

A pearl diver whoed that within 2 weeks is only interval associated with postop infection, I follow 3 monthsBioa

49
Q

Biologics surgery date

A

At the end of the dosing cycle, so if it is q2weeks then you may do it after 2 weeks elapsed so on week 3. If it is q6months then on the 7 month, need to let it go through the dosing cycle

50
Q

daily dosing biologics

A

Want it to be through 4 half lives so can operate on the 4th day. JAK inhibitors

51
Q

when to restart biologics

A

14 days after surgery if wound is healing well and all sutures are out and no signs of infection

52
Q

navigation vs. manual outcomes

A

no difference, although robotic may be able to help minimize outliers.

53
Q

pros of resurfacing

A

overall lower risk for revision surgery

54
Q

Pros of non-resurfacing

A

No difference in pain or function, less patellar implant complications

55
Q

cons of resurfacing

A

Patellar fracture

56
Q

cons of non-resurfacing

A

potential persistent pain, higher reoperation rate

57
Q

indications for patellar resurfacing

A

Absolute in patients with inflammatory arthritis, patellar bone deformity, if their primary pain is patellofemoral joint, adequate patellar thickness.

58
Q

non-surfacing requirements

A

no inflammaotry disease, lower activity level, no dysplasia or maltracking, no baja

59
Q

What does the AAOS say regarding resurfacing

A

No difference in pain or function with or without patellar resurfacing

60
Q

is asa less effective prophylaxis

A

No, it is as effective as other anticoagulants

61
Q

you didn’t think it was infected?

A

There was no drainage, it was some erythema that could be a stitch abscess vs. slowly healing wound. Wanted close followup

62
Q

CCK is also known as

A

Varus-Valgus-Constraint or Constrained Condylar Knee

63
Q

Risk of periprosthetic joint infection in UKA

A

????? Yours has night pain, how do you know he’s not infected.

64
Q
A
65
Q

how long wound drainage in TJA

A

only wait 5 days, after 5 days needs a washout.

66
Q
A

ABOS Part 2 (10 decks)

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