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      Fracture of the Tibial Baseplate in Bicompartmental Knee Arthroplasty

      case-report

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          Abstract

          Introduction. Bicompartmental knee arthroplasty (BKA) addresses combined medial and patellofemoral compartment osteoarthritis, which is relatively common, and has been proposed as a bridge between unicompartmental and total knee arthroplasty (TKA). Case Presentation. We present the case report of a young active man treated with BKA after unsuccessful conservative therapy. Four years later, loosening with fracture of the tibial baseplate was identified and the patient was revised to TKA. Discussion. Although our case is only the second fractured tibial baseplate to be reported, we believe that the modular titanium design, with two fixation pegs, is too thin to withstand daily cyclic loading powers. Light daily routine use, rather than high-impact sports, is therefore advised. Failures may also be related to the implant being an early generation and known to be technically complex, with too few implant sizes. We currently use TKA for the treatment of medial and patellofemoral compartment osteoarthritis.

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          Participation in sporting activities following knee replacement: total versus unicompartmental.

          Graeme Hopper, M Leach (2008)
          Few studies have been published assessing patients sporting activity after total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA). Common concerns of patients undergoing TKA or UKA are whether they can continue with sporting activities after surgery. This study compares the sporting activity of TKA and UKA patients preoperatively and postoperatively. A total of 110 patients were surveyed by questionnaire. Seventy-six patients had undergone TKA and 34 patients had undergone UKA. They were assessed for their participation in low-impact sport preoperatively and postoperatively at a mean follow up of 21.6 +/- 5.3 and 22.3 +/- 7.8 months, respectively. Low-impact sports are those which a surgeon would expect patients to be able to participate in postoperatively. Data were separately analysed for older and younger patients and women and men, respectively. The results were as follows: before surgery, 55 of 76 patients in the TKA group participated in an average of 1.3 different sports and postoperatively, 35 of 76 patients participated in an average of 0.7 different sports. In the UKA group, 30 of 34 patients participated in an average of 1.5 different sports preoperatively and postoperatively, 29 of 34 patients participated in an average of 1.4 different sports. The return to sport rate was 96.7% in the UKA group and 63.6% in the TKA group. In the TKA group, the average frequency of sport preoperatively was 3.0 sessions per week (62.7 min) and postoperatively it decreased to 2.0 sessions per week (37.5 minutes). In the UKA group, the average frequency of sport preoperatively was 3.2 sessions per week (85.0 min) and postoperatively it increased to 3.4 sessions per week (92.1 min). The average time before resuming sport after surgery was 4.1 months in the TKA group and 3.6 months in the UKA group; 42.9% of patients in the TKA group and 24.1% of patients in the UKA group reported pain during sports after surgery; 80.3% of the patients in the TKA group and 88.2% of the patients in the UKA group felt that surgery had increased or maintained their sporting ability. Oxford knee scores decreased significantly one year after surgery in both the TKA group and the UKA group. In conclusion, the patients in our study had a significantly greater return to sport rate after UKA than patients who had undergone TKA. A large proportion of patients in the TKA group did not return to sport which their surgeon would have expected them to including golf and bowls. Patients in the UKA group also took part in more sporting sessions and for a longer period of time than patients in the TKA group. Moreover, patients undergoing UKA also returned to sport more quickly than patients undergoing TKA.
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            Return to sports and recreational activity after unicompartmental knee arthroplasty.

            F. Knoch, Joerg Goldhahn, Stefan Preiss … (2007)
            There is a lack of detailed information concerning patients' sports and recreational activities after unicompartmental knee arthroplasty. Patients treated by unicompartmental knee arthroplasty will be able to return to sports and activity. Case series; Level of evidence, 4. The authors surveyed 83 patients by postal questionnaires to determine their sporting and recreational activities at a mean follow-up of 18 +/- 4.6 months (range, 12-28) after unicompartmental knee arthroplasty. For data analysis, patients were divided into groups of women and men, and older and younger patients (those above and below the median age of the group). The authors also assessed the state of general health (SF-36) of the patients at the time of the survey and compared the results with those of a matched (for age and side-diagnoses) reference population. Before surgery, 77 of 83 patients were engaged in an average of 5.0 sports and recreational disciplines; postoperatively, 73 (88%) participated in an average of 3.1 different sports disciplines, resulting in a return to activity rate of 95%. The frequency of activities (sessions per week) was 2.9 preoperatively and remained constant at the time of survey (2.8). The group of older patients (mean age 73.0 y) revealed a significantly higher frequency than the group of younger patients (mean age 57.8 y). The minimum session length decreased from 66 minutes before surgery to 55 minutes after surgery. The most common activities after surgery were hiking, cycling, and swimming. Several high-impact activities, as well as the winter disciplines of downhill- and cross-country skiing had a significant decrease in participating patients. The majority of the patients (90.3%) stated that surgery had maintained or improved their ability to participate in sports or recreational activities. The patients generally scored very high on the SF-36 compared with the matched reference population. Higher SF-36 values in the physical-related domains correlated with an increased level of activity (r = 0.425). The preoperative body mass index showed a weak, negative correlation with the postoperative extent of activities (r = -0.282). The majority of patients returned to sports and recreational activity after unicompartmental knee arthroplasty. However, the numbers of different disciplines patients were engaged in decreased as well as the extent of activities. The activities in which most patients participated were primarily low- or midimpact. The patients scored higher on the SF-36 than age-related norms, which might be due to the patient-selection process for unicompartmental knee arthroplasty and geographical differences.
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              Unicompartmental versus total knee arthroplasty in the same patient. A comparative study.

              F Ewald, S Zelicof, C Laurencin … (1991)
              The purpose of this study was to compare unicompartmental knee arthroplasty (UKA) with total knee arthroplasty (TKA) and more specifically to evaluate the role of the patella in patient preference between UKA and TKA. A group of 23 patients were chosen, each with a UKA in one knee and a TKA in the opposite knee. As a subset of the group, 13 patients were compared who had not had patellar resurfacing on their TKA side (Group A) versus ten patients who had patellar resurfacing (Group B). Each patient had a UKA and TKA performed during the same hospitalization. Each patient's resurfacing was performed by the same surgical team. Moreover, inpatient care and physical therapy for each patient's respective UKA and TKA were the same. Patient evaluation consisted of chart review, joint registry data, and telephone interviews that focused on patient preference regarding pain, stability, "feel," and ability to climb stairs. The 23 patients studied had an average follow-up period of 81 months (range, 38-153 months). There were 14 men and ten women with an average age of 67 years. Preoperative diagnosis was osteoarthritis in 22 patients and rheumatoid arthritis in one patient. Range of motion (ROM) improved from a preoperative mean of 106 degrees to 123 degrees postoperatively on the UKA side. Mean ROM for the Group A TKAs improved from 104 degrees to 109 degrees, whereas the Group B TKAs remained unchanged at 113 degrees. For patients surveyed in Group A, 31% stated that their UKA knee was their better knee overall, 15% stated that their TKA knee was their better knee overall, and 54% could find no difference.(ABSTRACT TRUNCATED AT 250 WORDS)
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                Author and article information

                Journal
                Journal ID (nlm-ta): Case Rep Orthop
                Journal ID (iso-abbrev): Case Rep Orthop
                Journal ID (publisher-id): CRIOR
                Title: Case Reports in Orthopedics
                Publisher: Hindawi Publishing Corporation
                ISSN (Print): 2090-6749
                ISSN (Electronic): 2090-6757
                Publication date (Print): 2015
                Publication date (Electronic): 30 December 2015
                Volume: 2015
                Electronic Location Identifier: 693025
                Affiliations
                1Sint-Augustinus Hospital, 2610 Wilrijk, Belgium
                2Sint-Jozef Hospital, 2390 Malle, Belgium
                3Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium
                Author notes

                Academic Editor: Ali F. Ozer

                Article
                DOI: 10.1155/2015/693025
                PMC ID: 4710956
                PubMed ID: 26843998
                SO-VID: 873c7d3b-47e4-42b5-a4ac-afc116d01e7f
                Copyright © Copyright © 2015 Bart Stuyts et al.
                License:

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 21 September 2015
                Date revision received : 14 December 2015
                Date accepted : 17 December 2015
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Orthopedics
                Data availability:
                ScienceOpen disciplines: Orthopedics

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