Outcome of simultaneous bi-unicompartmental knee arthroplasty: a systematic review

Ibrahim Akkawi; Maurizio  Draghetti; Hassan Zmerly

doi:10.23750/abm.v94i6.15006

Outcome of simultaneous bi-unicompartmental knee arthroplasty: a systematic review

Authors

Ibrahim Akkawi Villa Erbosa Hospital 50/2, 40129, Bologna, Italy
Maurizio Draghetti Orthopaedics and Traumatology Unit, Villa Erbosa Hospital, Bologna, Italy
Hassan Zmerly Orthopaedics and Traumatology Unit, Villa Erbosa Hospital, Bologna, Italy

DOI: https://doi.org/10.23750/abm.v94i6.15006

Keywords:

Bi-unicompartimental knee arthroplasty; Total knee arthroplasty; Unicompartmental knee arthroplasty; Patellofemoral arthroplasty; Osteoarthritis; Clinial outcome

Abstract

Background and aim: Simultaneous medial and lateral tibiofemoral osteoarthritis (OA) could be treated with bi-unicompartmental knee arthroplasty (Bi-UKA) as an alternative to total knee arthroplasty (TKA). The present systematic review aims to assess if simultaneous Bi-UKA is a feasible option for treating medial and lateral tibiofemoral OA. Materials and Methods: A comprehensive search of PubMed, MEDLINE, Cochrane Library, and Google Scholar was performed to find studies that reported on the outcome of simultaneous Bi-UKA for both medial and lateral tibiofemoral OA. Results: Seven studies were considered eligible for inclusion in the present systematic review. Intraoperative fractures occurred 8 times. Overall, there were 22 revisions of the prosthetic components for any reason with a survival rate that ranged from 83 to 100%. Of these, 16 revisions were for the aseptic loosening of the prosthetic components. Out of 302 surgeries, three were revised due to symptomatic OA progression in the patello-femoral joint. All clinical scores improved at the latest follow-up compared to preoperative values. Moreover, there were no differences in clinical scores of Bi-UKA compared to unicompartmental knee arthroplasty (UKA), or medial UKA plus patello-femoral prosthesis. Whereas, compared to TKA, Bi-UKA patients had comparable or superior scores. Finally, the Bi-UKA group had a significantly shorter hospital stay compared to the TKA group. Conclusions: The use of simultaneous Bi-UKA is a valid option to address bicompartmental knee OA in selected patients with low intraoperative fracture rate, low revision rate, satisfactory clinical outcome, and fast recovery.

References

Garner AJ, Dandridge OW, Amis AA, Cobb JP, van Arkel RJ. Bi-unicondylar arthroplasty: a biomechanics and clinical outcomes study. Bone Joint Res. 2021 Nov;10(11):723-733. doi: 10.1302/2046-3758.1011.BJR-2021-0151.R1.

Biazzo A, Manzotti A, Confalonieri N. Bi-unicompartmental versus total knee arthroplasty: long term results. Acta Orthop Belg. 2018 Sep;84(3):237-244.

Confalonieri N, Manzotti A, Cerveri P, De Momi E. Bi-unicompartmental versus total knee arthroplasty: a matched paired study with early clinical results. Arch Orthop Trauma Surg. 2009 Sep;129(9):1157-63. doi: 10.1007/s00402-008-0713-8.

Romagnoli S, Petrillo S, Marullo M. Knee resurfacing with double unicompartimental arthroplasty: rationale, biomechanics, indications, surgical technique and outcomes. J Exp Orthop. 2021 Sep 15;8(1):78. doi: 10.1186/s40634-021-00402-6.

Banks SA, Fregly BJ, Boniforti F, Reinschmidt C, Romagnoli S. Comparing in vivo kinematics of unicondylar and bi-unicondylar knee replacements. Knee Surg Sports Traumatol Arthrosc. 2005 Oct;13(7):551-6. doi: 10.1007/s00167-004-0565-x.

Fuchs S, Tibesku CO, Genkinger M, Laass H, Rosenbaum D. Proprioception with bicondylar sledge prostheses retaining cruciate ligaments. Clin Orthop Relat Res. 2003 Jan;(406):148-54. doi: 10.1097/01.blo.0000038053.29678.a5.

Romagnoli S, Marullo M, Stucovitz E, Verde F, Corbella M. Biunicompartmental knee protheses. In: Scuderi G, Tria A (eds) Minimally invasive surgery in orthopedics. Springer, Cham. 2016 July; 651-670. doi: 10.1007/ 978-3-319-34109-5_57.

Confalonieri N, Manzotti A. Mini-invasive computer assisted bi-unicompartimental knee replacement. Int J Med Robot. 2005 Dec;1(4):45-50. doi: 10.1002/rcs.56.

Banger MS, Johnston WD, Razii N, et al. Robotic arm-assisted bi-unicompartmental knee arthroplasty maintains natural knee joint anatomy compared with total knee arthroplasty: a prospective randomized controlled trial. Bone Joint J. 2020 Nov;102-B(11):1511-1518. doi: 10.1302/0301-620X.102B11.BJJ-2020-1166.R1.

Wada K, Price A, Gromov K, Lustig S, Troelsen A. Clinical outcome of bi-unicompartmental knee arthroplasty for both medial and lateral femorotibial arthritis: a systematic review-is there proof of concept? Arch Orthop Trauma Surg. 2020 Oct;140(10):1503-1513. doi: 10.1007/s00402-020-03492-6.

Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009 Jul 21;6(7):e1000097. doi: 10.1371/journal.pmed.1000097.

Blyth MJG, Banger MS, Doonan J, Jones BG, MacLean AD, Rowe PJ. Early outcomes after robotic arm-assisted bi-unicompartmental knee arthroplasty compared with total knee arthroplasty: a prospective, randomized controlled trial. Bone Joint J. 2021 Oct;103-B(10):1561-1570. doi: 10.1302/0301-620X.103B10.BJJ-2020-1919.R2.

Parratte S, Pauly V, Aubaniac JM, Argenson JN. Survival of bicompartmental knee arthroplasty at 5 to 23 years. Clin Orthop Relat Res. 2010 Jan;468(1):64-72. doi: 10.1007/s11999-009-1018-0.

Dettmer, M., Kreuzer, S. W. Bi-unicompartmental, robot-assisted knee arthroplasty. Operative Techniques in Orthopaedics. 2015;25(2):155-162. doi: 10.1053/j.oto.2015.03.004

Garner AJ, Dandridge OW, van Arkel RJ, Cobb JP. The compartmental approach to revision of partial knee arthroplasty results in nearer-normal gait and improved patient reported outcomes compared to total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2023 Mar;31(3):1143-1152. doi: 10.1007/s00167-021-06691-9. Epub 2021 Aug 20.

Pandit H, Mancuso F, Jenkins C, et al. Lateral unicompartmental knee replacement for the treatment of arthritis progression after medial unicompartmental replacement. Knee Surg Sports Traumatol Arthrosc. 2017 Mar;25(3):669-674. doi: 10.1007/s00167-016-4075-4.

Stewart HD, Newton G. Long-term results of the Manchester knee. Surface arthroplasty of the tibiofemoral joint. Clin Orthop Relat Res. 1992 May;(278):138-46.

Banger MS, Doonan J, Jones BG, MacLean AD, Rowe PJ, Blyth MJG. Are there functional biomechanical differences in robotic arm-assisted bi-unicompartmental knee arthroplasty compared with conventional total knee arthroplasty? A prospective, randomized controlled trial. Bone Joint J. 2022 Apr;104-B(4):433-443. doi: 10.1302/0301-620X.104B4.BJJ-2021-0837.R1.

Stockley I, Douglas DL, Elson RA. Bicondylar St. Georg sledge knee arthroplasty. Clin Orthop Relat Res. 1990 Jun;(255):228-34.

Barrett DS, Biswas SP, MacKenney RP. The Oxford knee replacement. A review from an independent centre. J Bone Joint Surg Br. 1990 Sep;72(5):775-8. doi: 10.1302/0301-620X.72B5.2211754.

Gunston FH. Polycentric knee arthroplasty. Prosthetic simulation of normal knee movement. J Bone Joint Surg Br. 1971 May;53(2):272-7.

Goodfellow JW, O'Connor J. Clinical results of the Oxford knee. Surface arthroplasty of the tibiofemoral joint with a meniscal bearing prosthesis. Clin Orthop Relat Res. 1986 Apr;(205):21-42.

Walker SJ, Sharma P, Parr N, Cavendish ME. The long-term results of the Liverpool Mark II knee prosthesis. J Bone Joint Surg Br. 1986 Jan;68(1):111-6. doi: 10.1302/0301-620X.68B1.3941126.

Fuchs S, Tibesku CO, Frisse D, Genkinger M, Laass H, Rosenbaum D. Clinical and functional comparison of uni- and bicondylar sledge prostheses. Knee Surg Sports Traumatol Arthrosc. 2005 Apr;13(3):197-202. doi: 10.1007/s00167-004-0580-y.

Fuchs S, Tibesku CO, Genkinger M, Volmer M, Laass H, Rosenbaum D. Clinical and functional comparison of bicondylar sledge prostheses retaining all ligaments and constrained total knee replacement. Clin Biomech (Bristol, Avon). 2004 Mar;19(3):263-9. doi: 10.1016/j.clinbiomech.2003.11.004.

Lustig S, Servien E, Neyret P, Pereira H. An original indication for BiUnicondylar knee arthroplasty: subsequent contralateral unicondylar knee arthroplasty after degenerative changes of the opposite compartment. Techniques In Knee Surgery. 2008;7(4):240-250. doi: 10.1097/BTK.0b013e31818f8d31.

Stoddart JC, Dandridge O, Garner A, Cobb J, van Arkel RJ. The compartmental distribution of knee osteoarthritis - a systematic review and meta-analysis. Osteoarthr. Cartil. 2021 Apr;29(4):445-455. doi: 10.1016/j.joca.2020.10.011.