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Does location of patellofemoral chondral lesion influence outcome after Oxford medial compartmental knee arthroplasty?

Konan, S; Haddad, FS; (2016) Does location of patellofemoral chondral lesion influence outcome after Oxford medial compartmental knee arthroplasty? Bone & Joint Journal , 98-B (10) pp. 11-15. 10.1302/0301-620X.98B10.BJJ-2016-0403.R1. Green open access

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Abstract

AIMS: Medial unicompartmental knee arthroplasty (UKA) is associated with successful outcomes in carefully selected patient cohorts. We hypothesised that severity and location of patellofemoral cartilage lesions significantly influences functional outcome after Oxford medial compartmental knee arthroplasty. PATIENTS AND METHODS: We reviewed 100 consecutive UKAs at minimum eight-year follow-up (96 to 132). A single surgeon performed all procedures. Patients were selected based on clinical and plain radiographic assessment. All patients had end-stage medial compartment osteoarthritis (OA) with sparing of the lateral compartment and intact anterior cruciate ligaments. None of the patients had end-stage patellofemoral OA, but patients with anterior knee pain or partial thickness chondral loss were not excluded. There were 57 male and 43 female patients. The mean age at surgery was 69 years (41 to 82). At surgery the joint was carefully inspected for patellofemoral chondral loss and this was documented based on severity of cartilage loss (0 to 4 Outerbridge grading) and topographic location (medial, lateral, central, and superior or inferior). Functional scores collected included Oxford Knee Score (OKS), patient satisfaction scale and University College Hospital (UCH) knee score. Intraclass correlation was used to compare chondral damage to outcomes. RESULTS: All patients documented significant improvement in pain and improved functional scores at mid-term follow-up. There were four revisions (mean 2.9 years, 2 to 4; standard deviation (sd) 0.9) in this cohort, three for tibial loosening and one for femoral loosening. There was one infection that was treated with debridement and insert exchange. The mean OKS improved from 23.2 (sd 7.1) to 39.1 (sd 6.9); p < 0.001. The cohort with central and lateral grade 3 patellofemoral OA documented lower mean satisfaction with pain (90, sd 11.8) and function (87.5, sd 10.3) on the patient satisfaction scale. On the UCH scale, patients reported significantly decreased mean overall scores (7.3, sd 1.2 vs 9, sd 2.3) as well as stair climb task (3.5, sd 0.3 vs 5, sd 0.1) when cartilage lesions were located centrally or laterally on the PFJ. Patients with medial chondral PFJ lesions behave similar to patients with no chondral lesions. CONCLUSION: Topographical location and severity of cartilage damage of the patella can significantly influence function after successful Oxford medial UKA. Surgeons should factor this in when making their operative decision, and undertake to counsel patients appropriately. Cite this article: Bone Joint J 2016;98-B(10 Suppl B):11-15.

Type: Article
Title: Does location of patellofemoral chondral lesion influence outcome after Oxford medial compartmental knee arthroplasty?
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1302/0301-620X.98B10.BJJ-2016-0403.R1
Publisher version: http://doi.org/10.1302/0301-620X.98B10.BJJ-2016-04...
Language: English
Additional information: ©2016 Konan and Haddad. This is an open-access article distributed under the terms of the Creative Commons Attributions licence (CC-BY-NC), which permits unrestricted use, distribution, and reproduction in any medium, but not for commercial gain, provided the original author and source are credited.
Keywords: Knee outcomes, Oxford unicompartmental knee arthroplasty, Adult, Aged, Aged, 80 and over, Arthrography, Arthroplasty, Replacement, Knee, Cartilage, Articular, Female, Follow-Up Studies, Humans, Male, Middle Aged, Osteoarthritis, Knee, Patellofemoral Joint, Patient Satisfaction, Prospective Studies, Recovery of Function, Severity of Illness Index, Treatment Outcome
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci
URI: https://discovery-pp.ucl.ac.uk/id/eprint/1526494
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