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Andrew D Pearle - One of the best experts on this subject based on the ideXlab platform.
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Robotic-Assisted Unicompartmental Knee Arthroplasty: State-of-the Art and Review of the Literature.
The Journal of arthroplasty, 2018Co-Authors: Alexander B. Christ, Andrew D Pearle, David J. Mayman, Steven B. HaasAbstract:Abstract Background Unicompartmental Knee Arthroplasty is a successful treatment for Unicompartmental Knee osteoarthritis that has lower complication rates, faster recovery, and a more natural feeling Knee compared to total Knee Arthroplasty. However, long-term survival has been a persistent concern. As more surgeon-controlled variables have been linked to survival, interest in robotic-assisted surgery has continued to grow. Methods A review and synthesis of the literature on the subject of robotic-assisted Unicompartmental Knee Arthroplasty was performed. Results We present the driving factors behind the development of robotic-assisted techniques in Unicompartmental Knee Arthroplasty and the current state-of-the art. The ability of surgeons to achieve intraoperative targets with robotic assistance and the outcomes of robotic-assisted surgery are also described. Conclusion Robotic-assisted surgery has become increasingly popular in Unicompartmental Knee Arthroplasty, as it allows surgeons to more accurately and reproducibly plan and achieve operative targets during surgery. Cost remains a concern, and it remains to be seen whether robotic-assisted surgery will improve long-term survivorship after Unicompartmental Knee Arthroplasty.
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Role of magnetic resonance imaging in the diagnosis of the painful Unicompartmental Knee Arthroplasty.
The Knee, 2015Co-Authors: Caroline Park, Andrew D Pearle, Hendrik A. Zuiderbaan, Anthony Chang, Saker Khamaisy, Anil S. RanawatAbstract:Abstract Background Unicompartmental Knee Arthroplasty (UKA) is a well established method for the treatment of single compartment arthritis; however, a subset of patients still present with continued pain after their procedure in the setting of a normal radiographic examination. This study investigates the effectiveness of magnetic resonance imaging (MRI) in guiding the diagnosis of the painful Unicompartmental Knee Arthroplasty. Methods An IRB-approved retrospective review identified 300 consecutive UKAs performed over a three years period with 28 cases of symptomatic UKA (nine percent) with normal radiographic images. Results MRI examination was instrumental in finding a diagnosis that went undetected on radiographs. Based on MRI findings, 10 (36%) patients underwent surgery whilst 18 (64%) were treated conservatively. Conclusion This study supports the use of MRI as a valuable imaging modality for managing symptomatic Unicompartmental Knee Arthroplasty. Level of evidence Case series
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Effect of age on cost-effectiveness of Unicompartmental Knee Arthroplasty compared with total Knee Arthroplasty in the U.S.
Journal of Bone and Joint Surgery American Volume, 2015Co-Authors: Hassan M.k. Ghomrawi, Ashley A. Eggman, Andrew D PearleAbstract:Unicompartmental Knee Arthroplasty, which replaces only the Knee compartment affected by osteoarthritis, is an alternative to total Knee Arthroplasty, a procedure that replaces the entire Knee joint. Unicompartmental Knee Arthroplasty preserves bone tissue that will be valuable if prosthetic revision is needed1,2. In addition, Unicompartmental Knee Arthroplasty has fewer complications, requires less rehabilitation, and may provide a better range of motion and superior function compared with total Knee Arthroplasty3. Because it is associated with a higher risk of revision compared with that of total Knee Arthroplasty, Unicompartmental Knee Arthroplasty remains a controversial procedure that may be underutilized. Retrospective studies indicate that 12.0% to 21.0% of patients who undergo total Knee Arthroplasty were candidates for Unicompartmental Knee Arthroplasty4, whereas
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effect of age on cost effectiveness of Unicompartmental Knee Arthroplasty compared with total Knee Arthroplasty in the u s
Journal of Bone and Joint Surgery American Volume, 2015Co-Authors: Hassan M.k. Ghomrawi, Ashley A. Eggman, Andrew D PearleAbstract:Unicompartmental Knee Arthroplasty, which replaces only the Knee compartment affected by osteoarthritis, is an alternative to total Knee Arthroplasty, a procedure that replaces the entire Knee joint. Unicompartmental Knee Arthroplasty preserves bone tissue that will be valuable if prosthetic revision is needed1,2. In addition, Unicompartmental Knee Arthroplasty has fewer complications, requires less rehabilitation, and may provide a better range of motion and superior function compared with total Knee Arthroplasty3. Because it is associated with a higher risk of revision compared with that of total Knee Arthroplasty, Unicompartmental Knee Arthroplasty remains a controversial procedure that may be underutilized. Retrospective studies indicate that 12.0% to 21.0% of patients who undergo total Knee Arthroplasty were candidates for Unicompartmental Knee Arthroplasty4, whereas <8.0% of Knee arthroplasties are Unicompartmental5. Trade-offs between upfront benefits and later risk of revision of Unicompartmental Knee Arthroplasty compared with those of total Knee Arthroplasty are poorly understood. The few available cost-effectiveness studies of which we are aware were limited to older populations (sixty-five years of age or older)6-8. By 2020, total Knee Arthroplasty utilization is expected to exceed one million annually9 and, unlike today, approximately half of these procedures will be performed in patients younger than sixty-five years of age10. With changing utilization trends, we compared the cost-effectiveness of Unicompartmental Knee Arthroplasty with that of total Knee Arthroplasty in patients forty-five through eighty-five years of age in the U.S.
Richard D. Scott - One of the best experts on this subject based on the ideXlab platform.
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Unicompartmental Knee Arthroplasty in octogenarians: survival longer than the patient.
Clinical orthopaedics and related research, 2006Co-Authors: Alexander P. Sah, Bryan D. Springer, Richard D. ScottAbstract:The Unicompartmental Knee Arthroplasty continues to gain popularity as a viable treatment option for disease isolated to one compartment. It has been reported to provide decreased perioperative morbidity, faster recovery, and excellent long-term survival. We hypothesized that the Unicompartmental Knee Arthroplasty is durable enough to benefit octogenarians, and may be a viable alternative to total Knee Arthroplasty as the definitive treatment of localized arthritis in this age group. From 1978 to 1990, 28 consecutive patients (38 Knees) 80 years or older had Unicompartmental Knee arthroplasties. Knee Society Knee and function scores improved at an average of 4 years followup (range, 2-9 years). Family members reported 90% patient satisfaction regarding expectations and desire to have the surgery again. The mean postoperative survival was 11.9 years, and only two of the 38 Knees (5%) required surgical intervention. At final followup, 25 patients had died with all but one patient having the index Unicompartmental Knee Arthroplasty in place and functioning well. Of the three living patients, one required surgery for femoral component fracture 10 years after the index procedure. The Unicompartmental Knee Arthroplasty can be expected to provide reliable and durable results in certain octogenarians, and should be regarded as a definitive treatment option in appropriated selected patients of this age group. Level of Evidence: Level IV Therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
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Unicompartmental Knee Arthroplasty for younger patients: an alternative view.
Clinical orthopaedics and related research, 2002Co-Authors: Rahul Deshmukh, Richard D. ScottAbstract:Unicompartmental Knee Arthroplasty has been a controversial operation for the past 3 decades. Many surgeons in the 1980s and 1990s found little or no indication for the procedure. Others were enthusiastic for its use in selected patients with osteoarthritis who had Unicompartmental disease. Initially, Unicompartmental Knee Arthroplasty was thought to be appropriate for the elderly patient who was sedentary. With the advent of minimally invasive techniques, indications have expanded to include its use in younger patients (especially females) as an alternative to osteotomy or tricompartmental Knee Arthroplasty. Advantages over osteotomy include higher initial success, greater longevity, and fewer early complications. If done conservatively, salvage is not difficult. The extent of safe postoperative activity levels has yet to be established. Failure rates seem to be higher in heavy active males. A metallic interposition hemiArthroplasty in the form of a McKeever or Macintosh prosthesis has been available for 50 years as a Unicompartmental Arthroplasty, but with limited use. It still may have a role in selected patients as a conservative temporizing procedure.
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Unicompartmental Knee Arthroplasty: long-term results.
Clinical Orthopaedics and Related Research, 2001Co-Authors: Rahul Deshmukh, Richard D. ScottAbstract:Unicompartmental Knee Arthroplasty has been controversial since its introduction in the early 1970s. Some initial reports suggested that medial compartment replacement did not yield good enough early results to be a viable long-term option, although lateral compartment replacement seemed to be promising. By the early 1980s, however, good initial results were being published for medial and lateral replacements and enthusiasm for the procedure began to increase. Refinements were made in patient selection, surgical technique, and prosthetic design. Ten-year followup studies were reported that showed survivorship was slightly less than that reported for total Knee Arthroplasty but acceptable considering the theoretically conservative nature of Unicompartmental surgery. Unicompartmental Knee Arthroplasty now can be characterized as a procedure with a reliable 8- to 10-year outcome in properly selected patients with osteoarthritis who receive a skillfully implanted proper design. Unicondylar Knee Arthroplasty can be an attractive alternative to osteotomy or total Knee Arthroplasty especially some middle-aged women. Approximately all studies with followups of 10 years or greater show that Unicompartmental Knee Arthroplasty will have inferior survivorship to total Knee Arthroplasty whether from loosening, prosthetic wear, or secondary degeneration of the opposite compartment in the second decade. Recently published 10-year results from two centers (one using a mobile-bearing design, the other using a fixed-bearing design) are comparable with those of total Knee Arthroplasty. This suggests that enhanced second-decade survivorship and therefore an expansion of the indications for Unicompartmental Knee Arthroplasty are possibilities.
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Unicompartmental Knee Arthroplasty
Clinical Orthopaedics and Related Research, 2001Co-Authors: Rahul Deshmukh, Richard D. ScottAbstract:Unicompartmental Knee Arthroplasty has been controversial since its introduction in the early 1970s. Some initial reports suggested that medial compartment replacement did not yield good enough early results to be a viable long-term option, although lateral compartment replacement seemed to be promi
Khaled J. Saleh - One of the best experts on this subject based on the ideXlab platform.
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Review of Unicompartmental Knee Arthroplasty in Younger Patients
Seminars in Arthroplasty, 2007Co-Authors: Terence P. Murphy, Shawn M. Brubaker, Khaled J. Saleh, William M. Mihalko, Kevin J MulhallAbstract:There has in recent times been a resurgence of interest in Unicompartmental Knee Arthroplasty. As experience has broadened, the precise indications, technical expertise, and implants have all undergone substantial development. Additionally, although it has been traditionally reserved for elderly or low-demand patients, recent evidence increasingly suggests an important role for Unicompartmental Knee Arthroplasty in younger patients. We review recent literature on this topic and the indications for performing Unicompartmental Knee Arthroplasty.
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Outcomes of total and Unicompartmental Knee Arthroplasty for secondary and spontaneous osteonecrosis of the Knee.
The Journal of bone and joint surgery. American volume, 2006Co-Authors: Thomas G Myers, William M. Mihalko, Quanjun Cui, Michael Kuskowski, Khaled J. SalehAbstract:The reported outcomes of patients who underwent total or Unicompartmental Knee Arthroplasty for secondary and spontaneous osteonecrosis of the Knee are often from studies that lack the number of subjects necessary to generate meaningful conclusions. We systematically reviewed the available literature in order to define the outcomes of patients after total Knee Arthroplasty for secondary osteonecrosis and after total or Unicompartmental Knee Arthroplasty for spontaneous osteonecrosis of the Knee. A literature review yielded twenty cohorts with demographic patient information and outcome scores (global Knee scores, radiographic outcomes, and revision rates) for patients who had Knee Arthroplasty as treatment for either secondary or spontaneous osteonecrosis of the Knee. The mean preoperative and postoperative global Knee scores, the mean revision rate, and the categorization of the mean "poor" and mean "good" outcomes for the Knees with each underlying disease were tabulated and reported. The demographic data and the reported mean global Knee scores were weighted by the number of Knees in each study. Total Knee Arthroplasty was performed in 150 Knees with secondary osteonecrosis and 148 Knees with spontaneous osteonecrosis, and Unicompartmental Knee Arthroplasty was performed in sixty-four Knees with spontaneous osteonecrosis. Total Knee Arthroplasty for spontaneous osteonecrosis of the Knee was associated with the best outcomes (higher "good" and postoperative global Knee scores and lower revision [3%] and "poor" outcome [6%] rates compared with the other two groups). The outcomes after total Knee Arthroplasty in Knees with secondary osteonecrosis as well as in Knees with spontaneous osteonecrosis were better in the cohorts operated on during or after 1985 than in those operated on before 1985. Similarly, the outcomes after Unicompartmental Knee Arthroplasty in Knees with spontaneous osteonecrosis of the Knee were also better in the cohorts operated on during or after 1985 than in those operated on before 1985. Total Knee Arthroplasty performed as treatment for either secondary osteonecrosis or spontaneous osteonecrosis and Unicompartmental Knee Arthroplasty performed as treatment for spontaneous osteonecrosis were associated with improved outcomes in cohorts with more recent operative dates. The evidence suggests that the use of contemporary cemented implants in total Knee Arthroplasty and the selective use of stems and augments in patients who have development of secondary osteonecrosis after total Knee Arthroplasty are producing outcomes that are comparable to those seen after total Knee Arthroplasty for osteoarthritis. Although the outcomes of patients who have total Knee Arthroplasty for the treatment of spontaneous osteonecrosis of the Knee have historically been favorable, such outcomes have also shown particular improvement in the studies from more recent operative periods. Although poor outcomes were seen after Unicompartmental Knee Arthroplasty in earlier studies of patients with spontaneous osteonecrosis of the Knee, it is possible that those results were secondary to inappropriate patient selection, as the authors of the most recent and, to our knowledge, the only study to follow established operative indications regarding the use of Unicompartmental Knee Arthroplasty reported excellent results. Therapeutic Level IV. See Instructions to Authors on jbjs.org for a complete description of levels of evidence.
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Outcomes of total and Unicompartmental Knee Arthroplasty for secondary and spontaneous osteonecrosis of the Knee
Journal of Bone and Joint Surgery, 2006Co-Authors: Thomas G Myers, William M. Mihalko, Quanjun Cui, Michael Kuskowski, Khaled J. SalehAbstract:Background: The reported outcomes of patients who underwent total or Unicompartmental Knee Arthroplasty for secondary and spontaneous osteonecrosis of the Knee are often from studies that lack the number of subjects necessary to generate meaningful conclusions. We systematically reviewed the available literature in order to define the outcomes of patients after total Knee Arthroplasty for secondary osteonecrosis and after total or Unicompartmental Knee Arthroplasty for spontaneous osteonecrosis of the Knee. Methods: A literature review yielded twenty cohorts with demographic patient information and outcome scores (global Knee scores, radiographic outcomes, and revision rates) for patients who had Knee Arthroplasty as treatment for either secondary or spontaneous osteonecrosis of the Knee. The mean preoperative and postoperative global Knee scores, the mean revision rate, and the categorization of the mean “poor” and mean “good” outcomes for the Knees with each underlying disease were tabulated and reported. The demographic data and the reported mean global Knee scores were weighted by the number of Knees in each study. Results: Total Knee Arthroplasty was performed in 150 Knees with secondary osteonecrosis and 148 Knees with spontaneous osteonecrosis, and Unicompartmental Knee Arthroplasty was performed in sixty-four Knees with spontaneous osteonecrosis. Total Knee Arthroplasty for spontaneous osteonecrosis of the Knee was associated with the best outcomes (higher “good” and postoperative global Knee scores and lower revision [3%] and “poor” outcome [6%] rates compared with the other two groups). The outcomes after total Knee Arthroplasty in Knees with secondary osteonecrosis as well as in Knees with spontaneous osteonecrosis were better in the cohorts operated on during or after 1985 than in those operated on before 1985. Similarly, the outcomes after Unicompartmental Knee Arthroplasty in Knees with spontaneous osteonecrosis of the Knee were also better in the cohorts operated on during or after 1985 than in those operated on before 1985. Conclusions: Total Knee Arthroplasty performed as treatment for either secondary osteonecrosis or spontaneous osteonecrosis and Unicompartmental Knee Arthroplasty performed as treatment for spontaneous osteonecrosis were associated with improved outcomes in cohorts with more recent operative dates. The evidence suggests that the use of contemporary cemented implants in total Knee Arthroplasty and the selective use of stems and augments in patients who have development of secondary osteonecrosis after total Knee Arthroplasty are producing outcomes that are comparable to those seen after total Knee Arthroplasty for osteoarthritis. Although the outcomes of patients who have total Knee Arthroplasty for the treatment of spontaneous osteonecrosis of the Knee have historically been favorable, such outcomes have also shown particular improvement in the studies from more recent operative periods. Although poor outcomes were seen after Unicompartmental Knee Arthroplasty in earlier studies of patients with spontaneous osteonecrosis of the Knee, it is possible that those results were secondary to inappropriate patient selection, as the authors of the most recent and, to our knowledge, the only study to follow established operative indications regarding the use of Unicompartmental Knee Arthroplasty reported excellent results. Level of Evidence: Therapeutic Level IV. See Instructions to Authors on [jbjs.org][1] for a complete description of levels of evidence. [1]: http://jbjs.org
David W. Murray - One of the best experts on this subject based on the ideXlab platform.
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Oxford domed lateral Unicompartmental Knee Arthroplasty.
The bone & joint journal, 2020Co-Authors: James A. Kennedy, Christopher Dodd, Hemant Pandit, Hasan Raza Mohammad, Irene Yang, Stephen J. Mellon, David W. MurrayAbstract:Aims To report mid- to long-term results of Oxford mobile bearing domed lateral Unicompartmental Knee Arthroplasty (UKA), and determine the effect of potential contraindications on outcome. Methods...
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Usage of Unicompartmental Knee Arthroplasty.
Journal of Bone and Joint Surgery-british Volume, 2018Co-Authors: David W. Murray, R. W. ParkinsonAbstract:Unicompartmental Knee Arthroplasty (UKA) has numerous advantages over total Knee Arthroplasty (TKA) and one disadvantage, the higher revision rate. The best way to minimize the revision rate is for surgeons to use UKA for at least 20% of their Knee arthroplasties. To achieve this, they need to learn and apply the appropriate indications and techniques. This would decrease the revision rate and increase the number of UKAs which were implanted, which would save money and patients would benefit from improved outcomes over their lifetime. Cite this article: Bone Joint J 2018;100-B:432–5.
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Unicompartmental Knee Arthroplasty: Mobile Magic
Seminars in Arthroplasty, 2011Co-Authors: Hemant Pandit, David W. Murray, Christopher DoddAbstract:Unicompartmental Knee Arthroplasty has many advantages over total Knee Arthroplasty, including better function, restoration of normal kinematics, and less morbidity. This paper outlines the design features, indications, contraindications, principles of surgical technique, and long-term results of the Oxford Knee, a mobile-bearing Unicompartmental Knee Arthroplasty. Approximately 1 in 3 patients requiring a Knee replacement are appropriate for the Oxford Knee. The Oxford Group believes that this is a definitive and not a pre-total Knee Arthroplasty option provided that appropriate indications and correct surgical technique are used.
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The Oxford Unicompartmental Knee Arthroplasty: a radiological perspective.
Clinical radiology, 2008Co-Authors: K. Mukherjee, Hemant Pandit, C. A. F. Dodd, Simon Ostlere, David W. MurrayAbstract:Unicompartmental Knee Arthroplasty (UKA) is increasingly being performed in both specialist centres as well as district hospitals. The radiologists should be aware of the required preoperative imaging, the normal appearance, and complications of this procedure. Unfortunately, very little is available in the radiology literature. This review aims to provide a radiological perspective to an already widely used procedure.
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Radiolucency and migration after Oxford Unicompartmental Knee Arthroplasty.
Orthopedics, 2007Co-Authors: Paul Rea, Hemant Pandit, Andrew Short, Andrew Price, Peter J. Kyberd, David J Beard, Harinderjit Gill, David W. MurrayAbstract:Radiolucent lines frequently appear on radiographs around Unicompartmental Knee arthroplasties. It is unknown why this occurs, although the lines usually appear during the first year following the procedure. Knee Arthroplasty implants are also known to migrate during the first year. Considering the similarity in the timing of appearance of radiolucency and implant migration, it seems that they could be related. The aim of this study was to determine whether there is a correlation between presence of radiolucency and the migration of Oxford Unicompartmental Knee Arthroplasty implants.
Keith R. Berend - One of the best experts on this subject based on the ideXlab platform.
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The Mobile Bearing in Unicompartmental Knee Arthroplasty
Unicompartmental Knee Arthroplasty, 2019Co-Authors: Nicholas J. Greco, Kojo A. Marfo, Keith R. BerendAbstract:The Oxford mobile-bearing Unicompartmental Knee Arthroplasty is a well-known solution for the treatment of anteromedial osteoarthritis. The appropriate preoperative selection criteria combined with surgical precision enables this operation to succeed well into the second decade. With the mobile-bearing implant, there is an exceptionally low wear rate. The design has evolved over time, and new instrumentation has made the procedure more reproducible and efficient. This chapter focuses on the improved techniques, instrumentation, and surgical pearls that make mobile-bearing Unicompartmental Knee Arthroplasty such an excellent operation.
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Management of the Failed Medial Unicompartmental Knee Arthroplasty
The Journal of the American Academy of Orthopaedic Surgeons, 2018Co-Authors: David A. Crawford, Keith R. Berend, Adolph V. LombardiAbstract:With recent design modifications, proper patient selection, and sound surgical technique, medial Unicompartmental Knee Arthroplasty has demonstrated long-term success in the management of degenerative joint disease. Nevertheless, complications do occur, most often aseptic loosening, tibial fracture, polyethylene wear, bearing dislocation, disease progression, infection, and unexplained pain. Some failures can be managed with retention of the implant, whereas others require revision to total Knee Arthroplasty (TKA), possibly including augments and stems. Although outcomes of Unicompartmental Knee Arthroplasty may not match those of a primary TKA, they tend to exceed results of revision of a previous TKA.
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Unicompartmental Knee Arthroplasty and total Knee Arthroplasty among Medicare beneficiaries, 2000 to 2009.
Journal of Bone and Joint Surgery American Volume, 2013Co-Authors: Michael P Bolognesi, David E. Attarian, Melissa A Greiner, Lesley H Curtis, Samuel S Wellman, Keith R. Berend, Tyler Steven Watters, Soko SetoguchiAbstract:Background: Unicompartmental Knee Arthroplasty is a less-invasive alternative to total Knee Arthroplasty for patients with arthritis affecting only the medial or lateral compartment. However, little is known about recent trends in the use of these procedures and the associated outcomes among older patients. Methods: With use of a nationally representative 5% sample of Medicare beneficiaries who were sixty-five years of age or older and who had undergone either unilateral Unicompartmental Knee Arthroplasty or unilateral total Knee Arthroplasty from 2000 to 2009, we assessed trends in the use of Unicompartmental and total Knee Arthroplasty, associated durations of hospital stay, and postoperative outcomes. The outcome measures were the rates of implant revision or removal within five years and the rates of periprosthetic infection, thromboembolic events, myocardial infarction, and all-cause mortality within one year. We conducted Kaplan-Meier analyses to assess the cumulative incidence of unadjusted outcomes and used Cox proportional-hazards regression to understand the relative risks of the outcomes for each procedure. Results: A total of 68,603 patients underwent unilateral total Knee Arthroplasty (n = 65,505) or unilateral Unicompartmental Knee Arthroplasty (n = 3098) from 2000 to 2009. The mean age was seventy-five years; 34% of the patients were men, and 92% were white. The procedure rate was twenty-one times higher for total Knee Arthroplasty (597 per 100,000 person-years) than Unicompartmental Knee Arthroplasty (twenty-nine per 100,000 person-years). The use of total Knee Arthroplasty increased 1.7-fold, and the use of Unicompartmental Knee Arthroplasty increased 6.2-fold. The mean length of stay (and standard deviation [SD]) was 3.9 ± 2.1 days for total Knee Arthroplasty and 2.4 ± 1.7 days for Unicompartmental Knee Arthroplasty. The five-year revision rate was 3.7% for total Knee Arthroplasty and 8.0% for Unicompartmental Knee Arthroplasty. After multivariable adjustment, the risk of revision remained 2.4 times higher for Unicompartmental Knee Arthroplasty than for total Knee Arthroplasty (95% confidence interval [CI] = 2.03 to 2.83). After multivariable adjustment, patients who underwent Unicompartmental Knee Arthroplasty had no significant differential one-year risk of infection (adjusted hazard ratio [HR] = 0.74; 95% CI = 0.55 to 1.01), thromboembolic events (adjusted HR =0.86; 95% CI = 0.57 to 1.29), or mortality (adjusted HR = 0.75; 95% CI = 0.50 to 1.11). Conclusions: Although Unicompartmental Knee Arthroplasty accounted for only 4.5% of the unilateral Knee replacements among Medicare beneficiaries, the use of this procedure has increased dramatically. Compared with those who had total Knee Arthroplasty, patients who underwent Unicompartmental Knee Arthroplasty had higher revision rates but shorter durations of stay and tended to have lower rates of perioperative complications. These findings need to be confirmed by studies that incorporate detailed clinical information. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Perioperative complications of simultaneous versus staged Unicompartmental Knee Arthroplasty.
Clinical Orthopaedics and Related Research, 2010Co-Authors: Keith R. Berend, Michael D. Skeels, Michael J. Morris, Adolph V. Lombardi, Joanne B. AdamsAbstract:Background The complication risk of staged versus simultaneous total Knee Arthroplasty continues to be debated in the literature. Previous reports suggest Unicompartmental Knee Arthroplasty provides a more rapid functional recovery than total Knee Arthroplasty. However, little data exist on whether simultaneous Unicompartmental Knee Arthroplasty can be performed without increasing the perioperative risk compared with staged Unicompartmental Knee Arthroplasty.
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The incidence and prevention of symptomatic thromboembolic disease following Unicompartmental Knee Arthroplasty.
Orthopedics, 2007Co-Authors: Adolph V. Lombardi, Keith R. Berend, Tawnya L TuckerAbstract:Deep venous thrombosis (DVT) and pulmonary embolism (PE) are significant concerns following lower extremity Arthroplasty. Many prevention protocols exist. This study investigates the rate of venous thromboembolic disease (DVT and PE) in 423 patients undergoing consecutive Unicompartmental Knee arthroplasties by two surgeons (A.V.L., K.R.B.) using a multimodal prophylactic strategy. Risk stratification by the medical consulting team determined appropriate anticoagulation level. Eighty-two percent (Knees) were managed with an aspirin-based program, 8% with 2 weeks of low molecular weight heparin followed by aspirin, and 8% with warfarin. No patient experienced symptomatic DVT or PE. Radiographic investigations revealed no asymptomatic venous thromboembolic disease. A risk stratification and multimodal venous thromboembolic disease prevention program based on the efficacy and safety of aspirin may prove to be the safest, most effective method in patients undergoing Unicompartmental Knee Arthroplasty. The minimally invasive nature and rapid recovery associated with Unicompartmental Knee Arthroplasty may support approaching the procedure more as an arthroscopy than an Arthroplasty in terms of venous thromboembolic disease prevention.
