Primary total joint arthroplasty (TJA), including total hip arthroplasty (THA) and total knee arthroplasty (TKA), are highly successful, reproducible surgical procedures. The demand for TJA is increasing globally, with projections
been associated with a range of adverse post-operative outcomes ( 3 ), and there is a high incidence of deficiency reported in patients undergoing total hip (THR) or knee (TKR) arthroplasty ( 4 ). Previous systematic reviews ( 4 , 5 , 6 , 7 ) have
been shown to incur some of the highest costs of care as reflected by reimbursements during the 90-day global period ( 2 ). With projected annual rates of total hip arthroplasty (THA) and total knee arthroplasty (TKA) expected to increase exponentially
It is debatable whether or not previous high tibial osteotomy (HTO) has negative effects on the results of subsequent medial unicompartmental knee replacement (UKR). The purpose of this study is to report, through a systematic review of the literature, the outcomes of medial UKR after failed HTO. It was hypothesized that this procedure would be safe and effective in providing satisfactory postoperative functional outcomes.
A systematic review was performed by searching Pubmed/MEDLINE, Embase and CINAHL. Only studies in English pertaining to all levels of evidence reporting on subjects undergoing UKR following HTO were considered. Review articles and expert opinion or editorial pieces were excluded. Outcomes of interest included indications, surgical technique and associated procedures, type of prosthesis, clinical and functional outcomes, rate of complications, revision surgery and failure rate.
Overall, six studies met all the inclusion criteria for this review. All were published between 2006 and 2021. The search resulted in one prospective comparative study, four retrospective comparative cohort studies, and one retrospective cohort study. Average follow-up periods ranged from 1 to 13 years. From these studies, 115 patients (117 knees) were identified. Overall, most studies reported satisfying postoperative clinical and functional outcomes. Implant survivorship ranged from 66 to 97.6%. In 15 patients, revision surgery was performed due to persistent pain.
Medial UKR performed after failed HTO appears as a feasible procedure providing satisfying outcomes and limited complications in most cases. Further prospective comparative studies reporting long-term outcomes are needed, as high-level studies on this topic are lacking.
Emmanuel AudenaertDepartment of Orthopaedics, University Hospital of Ghent, Ghent, Belgium Department of Electromechanics, InViLab research group, University of Antwerp, Antwerp, Belgium Department of Trauma and Orthopedics, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
short and long term ( 5 , 6 , 10 , 11 , 12 , 13 , 14 ). At present, osteotomy surgeries around the knee are preoperatively planned with a focus on the hip–knee–ankle (HKA) axis. As this HKA axis stops at the tibial plafond, the hindfoot is not
Richard E. HughesDepartment of Orthopaedic Surgery, Michigan Medicine, Ann Arbor, Michigan, USA Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA Department of Industrial & Operations Engineering, University of Michigan, Michigan, USA
National arthroplasty registries have existed for decades and are used around the world. The Swedish Knee Arthroplasty Register
and Swedish Hip Arthroplasty Register
were started in 1975 and 1979, respectively, and additional national
review on the outcomes of total hip arthroplasty and TKA, and found higher risks of complications and mortality in older patients. In 2016, Kuperman et al 17 published a meta-analysis of comparative studies performed over the two preceding decades and
outpatient TKA than inpatient TKA, including component failure, surgical site infection, knee stiffness and deep vein thrombosis.
According to Gogineni et al, outpatient total hip arthroplasty (THA) and TKA in a well-selected patient is feasible in
Vikki WyldeMusculoskeletal Research Unit, Bristol Medical School, University of Bristol, UK. National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, UK.
Ashley BlomMusculoskeletal Research Unit, Bristol Medical School, University of Bristol, UK. National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, UK. North Bristol NHS Trust, Southmead Hospital, Bristol, UK.
Rachael Gooberman-HillMusculoskeletal Research Unit, Bristol Medical School, University of Bristol, UK. National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, UK.
found to be associated with an almost three-fold risk of moderate to severe chronic pain after surgery compared with other surgical procedures.
Within orthopaedics, the prevalence of chronic pain after TKA is much higher than after total hip