Hypoallergenic unicompartmental knee arthroplasty and return to sport: comparison between Oxidized Zirconium and Titanium Niobium Nitride

Hypoallergenic unicompartmental knee arthroplasty and return to sport: comparison between Oxidized Zirconium and Titanium Niobium Nitride


  • Lorenzo Monti Istituto Clinico Villa Aprica, GSD, Como, Italy.
  • Manuele Franchi Istituto Clinico Villa Aprica, GSD, Como, Italy.
  • Nicola Ursino IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
  • Ilaria Mariani Institute for Maternal and Child Health – IRCCS “Burlo Garofolo” – Trieste, Italy
  • Katia Corona Università degli Studi del Molise, Dipartimento di Medicina e Scienze della Salute Vincenzo, Tiberio, Campobasso, Italy
  • Filippo Maria Anghilieri Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
  • Riccardo D'Ambrosi a:1:{s:5:"en_US";s:34:"IRCCS Istituto Ortopedico Galeazzi";}


Unicompartmental Knee Arthroplasty, return to sport, metal allergy, hypoallergenic implants


Background: The present study aims to compare the rate of return to sports in patients who underwent surgery for mobile-bearing UKA with either hypoallergenic TiNbN or with oxidized zirconium alloy implants.

Methods: The records of two consecutive cohorts for a total of 90 hypoallergenic implants were prospectively analysed. The first cohort consisted of 41 consecutive series of medial mobile-bearing hypoallergenic TiNbN UKA, whereas the second cohort consisted of 49 consecutive medial fixed-bearing hypoallergenic Uni Oxinium.The clinical evaluation involved evaluating each patient’s University of California, Los Angeles (UCLA) activity scoresand the High-Activity Arthroplasty Score(HAAS). Each patient was clinically evaluated on the day before surgery (T0), then after a minimum follow-up period of 12 months (T1), and finally after 24 months (T2).  

Results:The only pre-operative difference between the two groups involved pre-operative BMI with significantly higher BMI in TiNbN Group (p<0.001). Both groups reported significant improvement at each follow-up compared with the previous and also at the final follow up with respect to UCLA and HAAS (p<0.05), except for UCLA in TiNbN between T1 and T2(p>0.05). Moreover, BMI improved significantly at the final follow up, but only in TiNbN group (p<0.05).

Conclusions:Both TiNbN and Oxinium UKA procedures enabled patients to return to an acceptable level of sports activity with excellent radiographic outcomes after the final follow up regardless of the age, gender, BMI, and bearing type.


Innocenti M, Carulli C, Matassi F, Carossino AM, Brandi ML, Civinini R. Total knee arthroplasty in patients with hypersensitivity to metals. Int Orthop. 2014;38:329-33.

Bravo D, Wagner ER, Larson DR, Davis MP, Pagnano MW, Sierra RJ. No Increased Risk of Knee Arthroplasty Failure in Patients With Positive Skin Patch Testing for Metal Hypersensitivity: A Matched Cohort Study. J Arthroplasty. 2016;31:1717-21.

Thienpont E, Berger Y. No allergic reaction after TKA in a chrome-cobalt-nickel-sensitive patient: case report and review of the literature. Knee Surg Sports Traumatol Arthrosc. 2013;21:636-40.

Bao W, He Y, Fan Y, Liao Y. Metal allergy in total-joint arthroplasty: Case report and literature review. Medicine (Baltimore). 2018;97:e12475.

Savarino L, Granchi D, Ciapetti G, Cenni E, Nardi Pantoli A, Rotini R, Veronesi CA, Baldini N, Giunti A. Ion release in patients with metal-on-metal hip bearings in total joint replacement: a comparison with metal-on-polyethylene bearings. J Biomed Mater Res. 2002;63:467-74.

Baumann CA, Crist BD. Nickel allergy to orthopaedic implants: A review and case series. J Clin Orthop Trauma. 2020;11(:S596-S603.

D'Ambrosi R, Anghilieri FM, Corona K, Mariani I, Valli F, Ursino N, Hirschmann MT. Similar rates of return to sports and BMI reduction regardless of age, gender and preoperative BMI as seen in matched cohort of hypoallergenic and standard Cobalt Chromium medial unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2021 Feb 7. doi: 10.1007/s00167-021-06467-1. Epub ahead of print.

Ragone V, Canciani E, Biffi CA, D'Ambrosi R, Sanvito R, Dellavia C, Galliera E. CoCrMo alloys ions release behavior by TiNbN coating: an in vitro study. Biomed Microdevices. 2019;21:61.

Spector BM, Ries MD, Bourne RB, Sauer WS, Long M, Hunter G. Wear performance of ultra-high molecular weight polyethylene on oxidized zirconium total knee femoral components. J Bone Joint Surg Am. 2001;83-A:80-6.

Jahnke A, Mende JK, Maier GS, Ahmed GA, Ishaque BA, Schmitt H, Rickert M, Clarius M, Seeger JB. Sports activities before and after medial unicompartmental knee arthroplasty using the new Heidelberg Sports Activity Score. Int Orthop. 2015;39:449-54.

Ethgen O, Bruyère O, Richy F, Dardennes C, Reginster JY. Health-related quality of life in total hip and total knee arthroplasty. A qualitative and systematic review of the literature. J Bone Joint Surg Am. 2004;86:963-74.

Canovas F, Dagneaux L. Quality of life after total knee arthroplasty. Orthop Traumatol Surg Res. 2018;104:S41-S46.

Papalia R, Zampogna B, Torre G, Diaz Balzani LA, Vasta S, Papalia G, De Vincentis A, Denaro V. Return to sport activity in the elderly patients after unicompartmental knee arthroplasty: a systematic review and meta-analysis. J Clin Med 2020;9:1756

Dagneaux L, Bourlez J, Degeorge B, Canovas F. Return to sport after total or unicompartmental knee arthroplasty: An informative guide for residents to patients. EFORT Open Rev. 2017;2:496-501.

Cuschieri S. The STROBE guidelines. Saudi J Anaesth. 2019;13:S31-S34.

Fransway AF, Zug KA, Belsito DV, Deleo VA, Fowler JF Jr, Maibach HI, Marks JG, Mathias CG, Pratt MD, Rietschel RL, Sasseville D, Storrs FJ, Taylor JS, Warshaw EM, Dekoven J, Zirwas M. North American Contact Dermatitis Group patch test results for 2007-2008. Dermatitis. 2013;24:10-21.

Zhang Q, Zhang Q, Guo W, Liu Z, Cheng L, Yue D, Zhang N. The learning curve for minimally invasive Oxford phase 3 unicompartmental knee arthroplasty: cumulative summation test for learning curve (LC-CUSUM). J Orthop Surg Res. 2014;9:81.

Hamilton TW, Pandit HG, Lombardi AV, Adams JB, Oosthuizen CR, Clavé A, Dodd CA, Berend KR, Murray DW. Radiological Decision Aid to determine suitability for medial unicompartmental knee arthroplasty: development and preliminary validation. Bone Joint J. 2016;98-B:3-10.

Monticone M, Capone A, Frigau L, Marongiu G, Abelli P, Mola F, Maffulli N, Foti C. Development of the Italian version of the High-Activity Arthroplasty Score (HAAS-I) following hip and knee total arthroplasty: cross-cultural adaptation, reliability, validity and sensitivity to change. J Orthop Surg Res. 2018;13:81.

Calistri A, Di Martino L, Gurzì MD, Bove M, De Smet K, Villani C. Italian version of University of California at Los Angeles (UCLA) Activity Score: cross-cultural adaptation. J Arthroplasty. 2014;29:1733-5.

Middleton S, Toms A. Allergy in total knee arthroplasty: a review of the facts. Bone Joint J. 2016;98-B:437-41.

Eftekhary N, Shepard N, Wiznia D, Iorio R, Long WJ, Vigdorchik J. Metal Hypersensitivity in Total Joint Arthroplasty. JBJS Rev. 2018;6:e1.

Atilla HA, Çevik HB, Akdoğan M, Aslan H. Self-reported metal hypersensitivity in patients undergoing unicondylar knee arthroplasty. J Clin Orthop Trauma. 2020;14:17-21

Thomas P, Hisgen P, Kiefer H, Schmerwitz U, Ottersbach A, Albrecht D, Summer B, Schinkel C. Blood cytokine pattern and clinical outcome in knee arthroplasty patients: comparative analysis 5 years after standard versus "hypoallergenic" surface coated prosthesis implantation. Acta Orthop. 2018;89:646-651.

Saccomanno MF, Sircana G, Masci G, Cazzato G, Florio M, Capasso L, Passiatore M, Autore G, Maccauro G, Pola E. Allergy in total knee replacement surgery: Is it a real problem? World J Orthop. 2019;10:63-70.

Kleeblad LJ, Strickland SM, Nwachukwu BU, Kerkhoffs GMMJ, Pearle AD. Satisfaction with return to sports after unicompartmental knee arthroplasty and what type of sports are patients doing. Knee. 2020;27:509-17.

Lo Presti M, Costa GG, Cialdella S, Agrò G, Grassi A, Caravelli S, Mosca M, Marcheggiani Muccioli GM, Zaffagnini S. Return to Sports after Unicompartmental Knee Arthroplasty: Reality or Utopia? A 48-Month Follow-Up Prospective Study. J Knee Surg. 2019;32:186-91.







How to Cite

Hypoallergenic unicompartmental knee arthroplasty and return to sport: comparison between Oxidized Zirconium and Titanium Niobium Nitride. Acta Biomed [Internet]. 2022 Jul. 1 [cited 2024 Jun. 24];93(3):e2022160. Available from: https://mattioli1885journals.com/index.php/actabiomedica/article/view/12677