Abstract
Background
Recuts are sometimes needed in UKA because of inadequate posterior tibial cut thickness. We investigated the efficacy of a pre-milling technique (the first milling is done prior to the posterior condylar cut) in Oxford unicompartmental knee arthroplasty to enhance bone cut thickness and to minimize tibial recuts.
Patients and methods
Between January 2021 and January 2023, a posterior condyle cut was made before milling in 213 knees in 152 patients (conventional group), while the pre-milling technique was used in 198 knees in 140 patients (pre-milling group). The thickness of the posterior condyle and the rate of tibial recuts were compared between the groups.
Results
The bone cut thickness was thinner in the conventional group than in the pre-milling group in small-size (4.7 mm ± 0.6 mm and 5.0 mm ± 0.6 mm, P = 0.0001) and in medium-size (5.1 mm ± 0.5 mm and 5.4 mm ± 0.5 mm, 0.0001) femoral components, whereas there was no difference in large-size femoral components. However, the thickness was still less than the component thickness (5.17 mm for small, 5.57 mm for medium and 6.17 mm for large) in both groups. Tibial recuts were more prevalent in the conventional group than in the pre-milling group (14 knees, 7%, 3 knees 2%, P = 0.002).
Conclusions
The pre-milling technique was found to increase the bone cut thickness in small and medium femoral components, reducing the need for tibial recuts. Further research is warranted to optimize the pre-milling technique and to investigate its long-term impact on patient outcomes.
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References
Xue H, Tu Y, Ma T, Wen T, Yang T, Cai M (2017) Up to twelve year follow-up of the Oxford phase three unicompartmental knee replacement in China: seven hundred and eight knees from an independent centre. Int Orthop 41(8):1571–1577
Bitsch RG, von Keudell A, Losina E, Fitz W (2013) Good accuracy of the Phase III Oxford Mobile Bearing Unicompartmental Knee Instrumentation. Acta Orthop 84(4):406–409
Koh IJ, Kim JH, Jang SW, Kim MS, Kim C, In Y (2016) Are the Oxford(®) medial unicompartmental knee arthroplasty new instruments reducing the bearing dislocation risk while improving components relationships? A case control study. Orthopaedics & traumatology, surgery & research: OTSR. ;102(2):183 – 87
ZimmerBiomet Oxford Partial Knee Microplasty Instrumentation Surgical Technique. https://www.zimmerbiomet.com/content/dam/zimmer-biomet/medical-professionals/000-surgical-techniques/knee/oxford-partial-knee-microplasty-instrumentation-surgical-technique.pdf. Accessed 15.5.2022.
ZimmerBiomet Radiographic Assessment for Medial Oxford Partial Knee Replacement. https://www.oxfordpartialknee.net/content/dam/zb-minisites/oxford-partial-knee-hcp/documents/oxford-decision-aid-flyer.pdf. Accessed 25.9.2021.
Hamilton TW, Pandit HG, Lombardi AV, Adams JB, Oosthuizen CR, Clavé A et al (2016) Radiological decision aid to determine suitability for medial unicompartmental knee arthroplasty: development and preliminary validation. bone Joint J 98–B(10):3–10
Hiranaka T, Tanaka T, Fujishiro T, Okimura K, Shigemoto R, Araki S et al (2020) A novel technique for Varus Tibial cutting for Oxford Unicompartmental Knee Arthroplasty. Clin Orthop Surg 12(4):554–557
Kamenaga T, Hiranaka T, Nakano N, Hayashi S, Fujishiro T, Okamoto K et al Short distance from the keel to the posterior tibial cortex is associated with fracture after cementless Oxford UKA in Asian patients. https://doi.org/10.1007/s00167-021-06553-4
Acknowledgements
The authors thank Benjamin Phillis at the Clinical Study Support Center, Wakayama Medical University, for proofreading and editing.
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Hiranaka T contributed patient data, performed data analysis, and wrote the manuscript. Fukai Y, Tanaka S, Okajima T, Ishida Y, Koide M, Fujishiro T and Okamoto K reviewed and edited the manuscript.
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The corresponding author received honorarium from Zimmer Biomet for presentation and instruction.
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Hiranaka, T., Fukai, Y., Tanaka, S. et al. Pre-milling technique improves the accuracy of posterior femoral condyle cut and reduces the tibial recut in Oxford unicompartmental knee arthroplasty. Arch Orthop Trauma Surg (2024). https://doi.org/10.1007/s00402-024-05333-2
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DOI: https://doi.org/10.1007/s00402-024-05333-2