Abstract
Purpose
The alignment obtained after unicompartmental knee arthroplasty (UKA) influences the risk of failure. Kinematic alignment after UKA based on Cartier angle restauration is likely to improve clinical outcomes compared with mechanical alignment. The purpose of this study is to analyze the influence of implant alignment and native knee restoration after UKA using the conventional techniques on clinical outcomes.
Methods
This retrospective study included 144 medial UKA patients from 2015 to 2020. Radiographic measurements were performed pre- and postoperatively. Outliers were defined as follows: Δ Cartier > 3° (difference between the preoperative and postoperative Cartier angle); Δ MPTA (Medial Proximal Tibial angle) and postoperative TCA (Tibial Coronal component Angle) > 3° (difference between the positioning of the tibial implant and the preoperative proximal tibial deformity). The Knee injury and Osteoarthritis Outcome Score (KOOS), the International Knee Society (IKS) Function and Knee score, the Forgotten Joint Score (FJS), and the Subjective Knee Value (SKV) were evaluated.
A Student t test or a non-parametric Wilcoxon test was used for non-normal data to compare pre- and postoperative values for functional scores and angular measurements. The correlation of postoperative angles with functional outcomes was assessed by the Spearman’s rank correlation coefficient.
Results
During the inclusion period, 214 patients underwent medial UKA, 71 patients were excluded, and 19 were lost to follow-up leaving 124 patients with 144 knees (20 bilateral UKA) included for analysis with a mean follow-up of 54.7 months ± 22.1 (24–95). The Δ Cartier was significantly correlated with IKS function (R2 = 0.06, p < 0.001) and FJS (R2 = 0.05, p < 0.01) scores. The Δ preoperative MPTA–TCA was significantly correlated (p < 0.001) with KOOS (R2 = 0.38), IKS Knee (R2 = 0.17), IKS function (R2 = 0.34), SKV (R2 = 0.08), and FJS (R2 = 0.37) scores. In subgroup analysis, non-outliers (< 3°) for Δ preoperative MPTA–TCA had better KOOS score (Δ = 23.5, p < 0.001) and IKS Function (Δ = 17.7, p < 0.001) compared to outliers (> 3°) patients.
Conclusion
Functional results after medial UKA can be influenced by implant alignment in the coronal plane with slight clinical improvement when positioning the tibial implant close to the preoperative tibial deformity, rather than by restoring the Cartier angle. This series suggests the interest of a more personalized alignment strategy, but these results will have to be confirmed by other controlled studies.
Level of evidence
IV, retrospective case series.
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LM and GM wrote the manuscript, AM and PS performed the inter-observer angle measurements, and JE, JFG, NB, and RBdD corrected the different versions. GM designed the protocol and performed statistical analysis. All authors approved the final manuscript.
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Dr. Ernat is a paid consultant for Johnson & Johnson Depuy Mitek Sports Medicine. He has received research grants and educational supports from Arthrex, Inc. He has received educational support from Gemini Mountain Medical and Smith & Nephew. He has received travel expenses from Medical Device Business Services. He is a committee member for the Arthroscopy Association of North American and the American Orthopedic Society for Sports Medicine. He is an editorial board member for Arthroscopy Journal. Pr Gonzalez is a paid consultant for Amplitude. The other authors have no conflicts of interest.
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All procedures were performed in accordance with the ethical standards of the institutional and/or national research committee, the 1964 Declaration of Helsinki and its subsequent amendments, or comparable ethical standards. This study was approved by the advisory ethics committee (Ethics Committee of the Côte d'Azur University) under the number IRB 2023–032.
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Micicoi, L., Machado, A., Ernat, J. et al. Restoration of preoperative tibial alignment improves functional results after medial unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 31, 5171–5179 (2023). https://doi.org/10.1007/s00167-023-07588-5
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DOI: https://doi.org/10.1007/s00167-023-07588-5