Abstract
Background
Isolated antero-medial osteoarthritis (AMOA) of the knee is a distinct pattern of arthritis. Medial arthritis of the knee in select patients can be managed with uni-compartmental arthroplasty (UKA), with studies showing shorter hospital stay, faster rehabilitation and reduced medical complications in the post-operative period compared to TKA. However, the prevalence of AMOA in Indian patients with osteoarthritis of the knee is unknown. The aim of this study was to evaluate the prevalence of AMOA in patients undergoing primary TKA for OA.
Methods
This was a prospective evaluation of 2518 knees in 1936 patients who were selected for primary TKA. Pre-operative radiographs were screened based on the Oxford UKA Radiological decision aid and diagnosis of AMOA was established. All 2518 knees underwent primary total knee arthroplasty and cases of AMOA were confirmed intra-operatively based on ACL integrity, lateral compartment wear and medial compartment wear pattern. Cases with AMOA arthritic wear pattern were considered amenable for UKA if radiographs showed intact lateral joint space, intra-operatively those with intact and functional ACL, acceptable patellofemoral wear (Outerbridge I–II).
Results
We report a prevalence of 46.94% of AMOA, who were amenable for UKA. Obese patients were more likely to have a damaged or non-functional ACL and more likely to have a high degree of wear, not amenable for UKA (p < 0.05). Non-functional ACL was associated with higher prevalence of posterior extension of arthritic wear.
Conclusion
This study demonstrated a high prevalence (46.94%) of antero-medial osteoarthritis (AMOA), amenable for UKA. Patient selection is important for improving outcomes after TKA or UKA. Future studies are warranted to compare outcomes of both UKA and TKA in patients with isolated AMOA of the knee.
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References
White, S. H., Ludkowski, P. F., & Goodfellow, J. W. (1991). Anteromedial osteoarthritis of the knee. Journal of Bone and Joint Surgery. British Volume, 73, 582–586.
Lankester, B. J., Cottam, H. L., Pinskerova, V., et al. (2008). Variation in the anatomy of the tibial plateau: A possible factor in the development of anteromedial osteoarthritis of the knee. Journal of Bone and Joint Surgery. British Volume, 90, 330–333.
Rout, R., McDonnell, S., Price, A., et al. (2013). The pattern of cartilage damage in antero-medial osteoarthritis of the knee and its relationship to the anterior cruciate ligament. Journal of Orthopaedic Research, 31(6), 908–913.
Pandit, H., Hamilton, T. W., Jenkins, C., et al. (2015). The clinical outcome of minimally invasive Phase 3 Oxford unicompartmental knee arthroplasty: a 15-year follow-up of 1000 UKAs. The Bone & Joint Journal, 97, 1493–1500.
Borus, T., & Thornhill, T. (2008). Unicompartmental knee arthroplasty. Journal of the American Academy of Orthopaedic Surgeons, 16(1), 9–18.
Deshmukh, R. V., & Scott, R. D. (2001). Unicompartmental knee arthroplasty: long-term results. Clinical Orthopaedics and Related Research, 392, 272–278.
Berger, R. A., Meneghini, R. M., & Jacobs, J. J., et al. (2005). Results of unicompartmental knee arthroplasty at a minimum of ten years of followup. The Journal of Bone and Joint Surgery. 87(5):999–1006.
Pandit, H., Jenkins, C., Barker, K., Dodd, C. A. F., & Murray, D. W. (2006). The Oxford medial unicompartmental knee replacement using a minimally-invasive approach. The Journal of Bone and Joint Surgery. British volume, 88-B(1), 54–60.
Rougraff, B. T., Heck, D. A., & Gibson, A. E. (1991). A comparison of tricompartmental and unicompartmental arthroplasty for the treatment of gonarthrosis. Clinical Orthopaedics and Related Research, 273, 157–164.
Lombardi, A. V., Jr., Kolich, M. T., Berend, K. R., Morris, M. J., Crawford, D. A., & Adams, J. B. (2018). Revision of unicompartmental knee arthroplasty to total knee arthroplasty: Is it as good as a primary result? Journal of Arthroplasty, 33(7S), S105–S108. https://doi.org/10.1016/j.arth.2018.03.023
Campi, S., Tibrewal, S., Cuthbert, R., & Tibrewal, S. B. (2018). Unicompartmental knee replacement—Current perspectives. J Clin Orthop Trauma., 9(1), 17–23. https://doi.org/10.1016/j.jcot.2017.11.013
Laurencin, C. T., Zelicof, S. B., Scott, R. D., & Ewald, F. C. (1991). Unicompartmental versus total knee arthroplasty in the same patient. A comparative study. Clinical Orthopaedics and Related Research, 273, 151–156.
Liddle, A. D., Pandit, H., Judge, A., & Murray, D. W. (2015). Patient-reported outcomes after total and unicompartmental knee arthroplasty: A study of 14,076 matched patients from the National Joint Registry for England and Wales. The Bone and Joint Journal., 97-B(6), 793–801. https://doi.org/10.1302/0301-620X.97B6.35155
Swank, M., Stulberg, S. D., Jiganti, J., & Machairas, S. (1993). The natural history of unicompartmental arthroplasty. An eight-year follow-up study with survivorship analysis. Clinical Orthopaedics and Related Research., 286(286), 130–142.
Murray, D. W., Liddle, A. D., Dodd, C. A., & Pandit, H. (2015). Unicompartmental knee arthroplasty: Is the glass half full or half empty? The Bone and Joint Journal, 97-B(10 Suppl A), 3–8. https://doi.org/10.1302/0301-620X.97B10.36542
Kozinn, S. C., & Scott, R. (1989). Unicondylar knee arthroplasty. The Bone and Joint Journal [Am], 71-A, 145–150.
Pandit, H., Jenkins, C., Gill, H. S., Smith, G., Price, A. J., Dodd, C. A., & Murray, D. W. (2011). Unnecessary contraindications for mobile-bearing unicompartmental knee replacement. Journal of Bone and Joint Surgery. British Volume, 93, 622–628.
Harman, M. K., Markovich, G. D., Banks, S. A., & Hodge, W. A. (1998). Wear patterns on tibial plateaus from varus and valgus osteoarthritic knees. Clinical Orthopaedics and Related Research, 352, 149–158.
Takahashi, T. S., Naomi, S., Takeshi, S., Kohji, S., & Gerard, C. G. (2017). Patterns of patellofemoral articular cartilage wear in Japanese cadavers. Journal of the Anatomical Society of India., 66(2), 83–90.
Hodge, W. A., Harman, M. K., & Banks, S. A. (2009). Patterns of knee osteoarthritis in Arabian and American knees. Journal of Arthroplasty, 24(3), 448–453. https://doi.org/10.1016/j.arth.2007.12.012
Mullaji, A. B., Marawar, S. V., & Luthra, M. (2008). Tibial articular cartilage wear in varus osteoarthritic knees: Correlation with anterior cruciate ligament integrity and severity of deformity. Journal of Arthroplasty, 23(1), 128–135.
Waldstein, W., Merle, C., Monsef, J. B., & Boettner, F. (2015). Varus knee osteoarthritis: How can we identify ACL insufficiency? Knee Surgery, Sports Traumatology, Arthroscopy, 23(8), 2178–2184. https://doi.org/10.1007/s00167-014-2994-5
Outerbridge, R. E. (1961). The etiology of chondromalacia patellae. The Journal of Bone and Joint Surgery British volume., 43-B, 752–757.
Thienpont, E., & Parvizi, J. (2016). A new classification for the varus knee. Journal of Arthroplasty, 31(10), 2156–2160. https://doi.org/10.1016/j.arth.2016.03.034
Goodfellow, J. W., O’Connor, J. J., Dodd, C. A. F., et al. (2006). Oxford unicompartmental knee replacement (1st ed.). Oxford University Press.
Cloutier, J. M. (1983). Results of total knee arthroplasty with a non-constrained prosthesis. Journal of Bone and Joint Surgery. American Volume, 65, 906–919.
Jenny, J. Y., & Jenny, G. (1998). Preservation of anterior cruciate ligament in total knee arthroplasty. Archives of Orthopaedic and Trauma Surgery, 118, 145–148.
Cloutier, J. M., Sabouret, P., & Deghrar, A. (1999). Total knee arthroplasty with retention of both cruciate ligaments. A nine to eleven-year fol-low-up study. The Journal of Bone & Joint Surgery., 81, 697–702.
Lee, G. C., Cushner, F. D., Vigoritta, V., Scuderi, G. R., Insall, J. N., & Scott, W. N. (2005). Evaluation of the anterior cruciate ligament integrity and degenerative arthritic patterns in patients undergoing total knee arthroplasty. Journal of Arthroplasty, 20, 59–65.
Trompeter, A. J., Gill, K., Appleton, M. A., & Palmer, S. H. (2009). Predicting anterior cruciate ligament integrity in patients with osteoarthritis. Knee Surgery, Sports Traumatology, Arthroscopy, 17(6), 595–599.
Dodd, M., Trompeter, A., Harrison, T., & Palmer, S. (2010). The pivot shift test is of limited clinical relevance in the arthritic anterior cruciate ligament-deficient knee. The Journal of Knee Surgery, 23, 131–135.
Douglas, M. J., Hutchinson, J. D., & Sutherland, A. G. (2010). Anterior cruciate ligament integrity in osteoarthritis of the knee in patients undergoing total knee replacement. Journal of Orthopaedics and Traumatology, 11(3), 149–154.
Johnson, A. J., Howell, S. M., Costa, C. R., et al. (2013). The ACL in the arthritic knee: How often is it present and can preoperative tests predict its presence? Clinical Orthopaedics and Related Research, 471(1), 181–188.
Ishii, Y., Noguchi, H., & Sato, J. (2016). Macroscopic evaluation of the anterior cruciate ligament in osteoarthritic patients undergoing total knee arthroplasty. European Journal of Orthopaedic Surgery & Traumatology, 26(2), 205.
Beard, D. J., Pandit, H., Gill, H. S., et al. (2007). The influence of the presence and severity of pre-existing patellofemoral degenerative changes on the outcome of the Oxford medial unicompartmental knee replacement. The Journal of Bone and Joint Surgery British Volume, 89-B, 1597–1601.
Beard, D. J., Pandit, H., Ostlere, S., et al. (2007). Pre-operative clinical and radiological assessment of the patellofemoral joint in unicompartmental knee replacement and its influence on outcome. The Journal of Bone and Joint Surgery British Volume, 89-B, 1602–1607.
Hamilton, T. W., Pandit, H. G., et al. (2017). Anterior knee pain and evidence of osteoarthritis of the patellofemoral joint should not be considered contraindications to mobile-bearing unicompartmental knee arthroplasty. The Bone and Joint Journal, 99-B, 632–639.
Noble, P. C., Conditt, M. A., Cook, K. F., & Mathis, K. B. (2006). The John Insall Award: Patient expectations affect satisfaction with total knee arthroplasty. Clinical Orthopaedics and Related Research, 452, 35–43.
Bourne, R. B., Chesworth, B. M., Davis, A. M., Mahomed, N. N., & Charron, K. D. J. (2010). Patient satisfaction after total knee arthroplasty: Who is satisfied and who is not? Clinical Orthopaedics and Related Research, 468(1), 57–63.
Suda, A. J., Seeger, J. B., Bitsch, R. G., Krueger, M., & Clarius, M. (2010). Are patients’ expectations of hip and knee arthroplasty fulfilled? A prospective study of 130 patients. Orthopedics, 33(2), 76–80.
Dalury, D. F., Fisher, D. A., Adams, M. J., & Gonzales, R. A. (2009). Unicompartmental knee arthroplasty compares favorably to total knee arthroplasty in the same patient. Orthopedics. https://doi.org/10.3928/01477447-20090401-21
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Conceptualization: AVGR, AA; Methodology: DD, AA; Formal Analysis and Investigation: DD, VK, PM; Writing—Original Draft: DD, VK; Writing—Review and Editing: PM, SRS, KKE; Resources: AVGR; Supervision: AVGR, KKE.
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Annapareddy, A., Daultani, D., Mulpur, P. et al. High Prevalence of Isolated Antero-medial Osteoarthritis (AMOA) in Indian Patients Undergoing Primary Total Knee Arthroplasty. JOIO 56, 1774–1781 (2022). https://doi.org/10.1007/s43465-022-00710-8
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DOI: https://doi.org/10.1007/s43465-022-00710-8