Bi-unicondylar arthroplasty: a biomechanics and clinical outcomes study

Aims: Bi-unicondylar arthroplasty (Bi-UKA) is a bone and anterior cruciate ligament (ACL)-preserving alternative to total knee arthroplasty (TKA) when the patellofemoral joint is preserved. The aim of this study is to investigate the clinical outcomes and biomechanics of Bi-UKA. Methods: Bi-UKA subj...

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Autores principales:	Amy J. Garner, Oliver W. Dandridge, Andrew A. Amis, Justin P. Cobb, Richard J. van Arkel
Formato:	article
Lenguaje:	EN
Publicado:	The British Editorial Society of Bone & Joint Surgery 2021
Materias:	knee extensor biomechanics bi-unicondylar compartmental arthroplasty gait and functional outcomes arthroplasties unicompartmental knee arthroplasty (uka) total knee arthroplasty (tka) knees patient-reported outcomes oxford knee scores eq-5d scores anterior cruciate ligament (acl) patellofemoral joint flexion angles Diseases of the musculoskeletal system RC925-935
Acceso en línea:	https://doaj.org/article/b6b5c2e21e7b4fac9d343cc5e2ba59e2
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spelling	oai:doaj.org-article:b6b5c2e21e7b4fac9d343cc5e2ba59e22021-12-01T18:46:59ZBi-unicondylar arthroplasty: a biomechanics and clinical outcomes study2046-375810.1302/2046-3758.1011.BJR-2021-0151.R1https://doaj.org/article/b6b5c2e21e7b4fac9d343cc5e2ba59e22021-11-01T00:00:00Zhttps://online.boneandjoint.org.uk/doi/epdf/10.1302/2046-3758.1011.BJR-2021-0151.R1https://doaj.org/toc/2046-3758Aims: Bi-unicondylar arthroplasty (Bi-UKA) is a bone and anterior cruciate ligament (ACL)-preserving alternative to total knee arthroplasty (TKA) when the patellofemoral joint is preserved. The aim of this study is to investigate the clinical outcomes and biomechanics of Bi-UKA. Methods: Bi-UKA subjects (n = 22) were measured on an instrumented treadmill, using standard gait metrics, at top walking speeds. Age-, sex-, and BMI-matched healthy (n = 24) and primary TKA (n = 22) subjects formed control groups. TKA subjects with preoperative patellofemoral or tricompartmental arthritis or ACL dysfunction were excluded. The Oxford Knee Score (OKS) and EuroQol five-dimension questionnaire (EQ-5D) were compared. Bi-UKA, then TKA, were performed on eight fresh frozen cadaveric knees, to investigate knee extensor efficiency under controlled laboratory conditions, using a repeated measures study design. Results: Bi-UKA walked 20% faster than TKA (Bi-UKA mean top walking speed 6.7 km/h (SD 0.9),TKA 5.6 km/h (SD 0.7), p < 0.001), exhibiting nearer-normal vertical ground reaction forces in maximum weight acceptance and mid-stance, with longer step and stride lengths compared to TKA (p < 0.048). Bi-UKA subjects reported higher OKS (p = 0.004) and EQ-5D (p < 0.001). In vitro, Bi-UKA generated the same extensor moment as native knees at low flexion angles, while reduced extensor moment was measured following TKA (p < 0.003). Conversely, at higher flexion angles, the extensor moment of TKA was normal. Over the full range, the extensor mechanism was more efficient following Bi-UKA than TKA (p < 0.028). Conclusion: Bi-UKA had more normal gait characteristics and improved patient-reported outcomes, compared to matched TKA subjects. This can, in part, be explained by differences in extensor efficiency. Cite this article: Bone Joint Res 2021;10(11):723–733.Amy J. GarnerOliver W. DandridgeAndrew A. AmisJustin P. CobbRichard J. van ArkelThe British Editorial Society of Bone & Joint Surgeryarticleknee extensor biomechanicsbi-unicondylar compartmental arthroplastygait and functional outcomesarthroplastiesunicompartmental knee arthroplasty (uka)total knee arthroplasty (tka)kneespatient-reported outcomesoxford knee scoreseq-5d scoresanterior cruciate ligament (acl)patellofemoral jointflexion anglesDiseases of the musculoskeletal systemRC925-935ENBone & Joint Research, Vol 10, Iss 11, Pp 723-733 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	knee extensor biomechanics bi-unicondylar compartmental arthroplasty gait and functional outcomes arthroplasties unicompartmental knee arthroplasty (uka) total knee arthroplasty (tka) knees patient-reported outcomes oxford knee scores eq-5d scores anterior cruciate ligament (acl) patellofemoral joint flexion angles Diseases of the musculoskeletal system RC925-935
spellingShingle	knee extensor biomechanics bi-unicondylar compartmental arthroplasty gait and functional outcomes arthroplasties unicompartmental knee arthroplasty (uka) total knee arthroplasty (tka) knees patient-reported outcomes oxford knee scores eq-5d scores anterior cruciate ligament (acl) patellofemoral joint flexion angles Diseases of the musculoskeletal system RC925-935 Amy J. Garner Oliver W. Dandridge Andrew A. Amis Justin P. Cobb Richard J. van Arkel Bi-unicondylar arthroplasty: a biomechanics and clinical outcomes study
description	Aims: Bi-unicondylar arthroplasty (Bi-UKA) is a bone and anterior cruciate ligament (ACL)-preserving alternative to total knee arthroplasty (TKA) when the patellofemoral joint is preserved. The aim of this study is to investigate the clinical outcomes and biomechanics of Bi-UKA. Methods: Bi-UKA subjects (n = 22) were measured on an instrumented treadmill, using standard gait metrics, at top walking speeds. Age-, sex-, and BMI-matched healthy (n = 24) and primary TKA (n = 22) subjects formed control groups. TKA subjects with preoperative patellofemoral or tricompartmental arthritis or ACL dysfunction were excluded. The Oxford Knee Score (OKS) and EuroQol five-dimension questionnaire (EQ-5D) were compared. Bi-UKA, then TKA, were performed on eight fresh frozen cadaveric knees, to investigate knee extensor efficiency under controlled laboratory conditions, using a repeated measures study design. Results: Bi-UKA walked 20% faster than TKA (Bi-UKA mean top walking speed 6.7 km/h (SD 0.9),TKA 5.6 km/h (SD 0.7), p < 0.001), exhibiting nearer-normal vertical ground reaction forces in maximum weight acceptance and mid-stance, with longer step and stride lengths compared to TKA (p < 0.048). Bi-UKA subjects reported higher OKS (p = 0.004) and EQ-5D (p < 0.001). In vitro, Bi-UKA generated the same extensor moment as native knees at low flexion angles, while reduced extensor moment was measured following TKA (p < 0.003). Conversely, at higher flexion angles, the extensor moment of TKA was normal. Over the full range, the extensor mechanism was more efficient following Bi-UKA than TKA (p < 0.028). Conclusion: Bi-UKA had more normal gait characteristics and improved patient-reported outcomes, compared to matched TKA subjects. This can, in part, be explained by differences in extensor efficiency. Cite this article: Bone Joint Res 2021;10(11):723–733.
format	article
author	Amy J. Garner Oliver W. Dandridge Andrew A. Amis Justin P. Cobb Richard J. van Arkel
author_facet	Amy J. Garner Oliver W. Dandridge Andrew A. Amis Justin P. Cobb Richard J. van Arkel
author_sort	Amy J. Garner
title	Bi-unicondylar arthroplasty: a biomechanics and clinical outcomes study
title_short	Bi-unicondylar arthroplasty: a biomechanics and clinical outcomes study
title_full	Bi-unicondylar arthroplasty: a biomechanics and clinical outcomes study
title_fullStr	Bi-unicondylar arthroplasty: a biomechanics and clinical outcomes study
title_full_unstemmed	Bi-unicondylar arthroplasty: a biomechanics and clinical outcomes study
title_sort	bi-unicondylar arthroplasty: a biomechanics and clinical outcomes study
publisher	The British Editorial Society of Bone & Joint Surgery
publishDate	2021
url	https://doaj.org/article/b6b5c2e21e7b4fac9d343cc5e2ba59e2
work_keys_str_mv	AT amyjgarner biunicondylararthroplastyabiomechanicsandclinicaloutcomesstudy AT oliverwdandridge biunicondylararthroplastyabiomechanicsandclinicaloutcomesstudy AT andrewaamis biunicondylararthroplastyabiomechanicsandclinicaloutcomesstudy AT justinpcobb biunicondylararthroplastyabiomechanicsandclinicaloutcomesstudy AT richardjvanarkel biunicondylararthroplastyabiomechanicsandclinicaloutcomesstudy
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Bi-unicondylar arthroplasty: a biomechanics and clinical outcomes study

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