Unicompartmental knee arthroplasty (UKA) is a bone- and ligament-sparing alternative to total knee arthroplasty in the patients with end-stage single-compartment degeneration of the knee. Despite ...being a successful procedure, the multiple advantages of UKA do not correlate with its usage, most likely due to the concerns regarding prosthesis survivability, patient selection, ideal bearing design, and judicious use of advanced technology among many others. Therefore, the purpose of this study is to review and summarize the debated literature and discuss the controversies as “Ten Enigmas of UKA.”
Abstract
Purpose
The aim of this article was to highlight various terminologies and methods of calculation of minimal clinically important difference (MCID) and summarize MCID values of frequently ...used patient-reported outcome measures (PROMs) evaluating total knee arthroplasty (TKA).
Materials and methods
PubMed and EMBASE databases were searched through May 2019. Of 71 articles identified, 18 articles matched and underwent a comprehensive analysis for terminologies used to indicate clinical significance, method of calculation, and reported MCID values.
Results
MCID was the most common terminology (67% studies) and anchor-based methods were most commonly employed (67% studies) to calculate it. The analytical methods used to calculate and the estimated values of MCID for clinical use are highly variable. MCID values reported for WOMAC scores are 20.5 to 36.0, 17.6 to 33.0 and 12.9 to 25.0 for pain, function and stiffness sub-scales, respectively, and 4.7 to 10.0 for OKS.
Conclusion
There was lack of standardization in the methodology employed to calculate MCID in the available studies. MCID values reported in this review could be used for patients undergoing TKA, although caution is advised in their interpretation and application.
One of the technical challenges during arthroscopic rotator cuff repair is bone deficiency in proximal humerus to get adequate fixation of suture anchors. The typical scenarios that result in bone ...deficiency at rotator cuff footprint are older individuals, females, osteoporosis, and revision rotator cuff repairs with failed anchors from previous surgery. One of the ways to secure fixation of suture anchors in deficient bone is augmentation with polymethyl methacrylate cement. We present a stepwise technique of cement augmentation of suture anchor during arthroscopic rotator cuff repair to achieve secure fixation of suture anchor and avoid spillage of cement in the subacromial space.
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Unicompartmental knee arthroplasty (UKA) is a successful treatment modality in selected patients having advanced, single-compartment osteoarthritis of the knee. The bone and ligament preservation ...leading to shorter recovery periods, better functional outcomes, lower perioperative complication rates, and easier revision, if needed, are proposed as some of the advantages of UKA over total knee arthroplasty (TKA). Despite several advantages, UKA is reported to have higher failure rates as compared to TKA. The prosthesis failure of UKA is directly correlated to intraoperative technique-related factors like malpositioning of components and the inability to replicate the target-limb alignment as per preoperative planning. An evidence-based surgical technique for UKA may help surgeons to avoid the intraoperative technique-related errors. The purpose of this paper is to describe a stepwise surgical technique for the fixed-bearing medial UKA.
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