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Dervan simultaneous surgical protocol complete relief of lower limb neuralgic & arthritic pain

Authors:
  • BKL Walawalkar medical college
  • BKL WALAWALKAR MEDICAL COLLEGE AND RESEARCH INSTITUTE

Abstract

Abstract Introduction: Surgery has made tremendous advances in the fields of joint Arthroplasty & Spine. Major advances in both these fields have made patient care more nature friendly & less morbid, thus allowing smaller incisions, day care procedures like endoscopic spine surgeries, minimally invasive joint replacement and so on. However, both these specialties have remained diverse and separate. Thus, in the typical modern-day specialty-based practice era, a patient consulting an Arthroplasty surgeon will seldom have a detailed spine examination or vice versa. This may lead to scenarios where the pain generator is from for example radiculopathy to the knee and below & the recommended procedure is a joint replacement due to incidental wear of the joints seen on the X ray. (1) The international data shows that there are 20% dissatisfied arthroplasty patients worldwide. (2) We have found concomitant knee & spine pathologies in more than 90% of our patients& published our research on the same topic. (1, 3, 4, 5) Thus the need arises for taking care of both pain generators i.e. from the spinal stenosis (central & or lateral) & knee arthritis for complete pain relief to the lower limbs. The developed protocol is the first of its kind for a more Holistic diagnosis & treatment of lower limb pain. It also saves interval dissatisfaction of the patient, healthcare costs & is a step towards a more team based surgical care between specialized spine & arthroplasty surgeons. Specialization should no more be a cause of separation between treating surgical teams & continued pain for the patient. A more Holistic clinical & surgical approach is hereby proposed. Methods: In this pilot study, twenty two patients were selected who underwent simultaneous & single sitting surgical treatment for leg pain, unilateral or bilateral. After detailed clinical examination & imaging studies, Simultaneous, Single stage Surgery was carried out in needy patients. Step one was Transforaminal Endoscopic Lumbar discectomy of the L4-5 disc in 17 patients, 2 level L3-4 & L4-5 in 3 patients & L5-S1 in 2 patients under local anesthesia in an awake & aware patient. After completion of the Percutaneous Endoscopic Lumbar Discectomy, an epidural catheter was inserted through the endoscope under vision in the epidural space by the spine surgeon (Dr. Sunil Nadkarni) & patient turned supine after checking the position of the catheter with radiolucent dye & securing the catheter. The anesthetist pushed the drug, patient was turned supine and painting & draping was done to begin the second part of the procedure i.e. single side or bilateral unicondylar joint replacement. Results: Results were classified by VAS, ODI, Oxford knee score, SF 12 before & after the procedure. Conclusion: The proposed “Dervan Simultaneous Surgical protocol “for Lower Limb pain, is a satisfying procedure with good to excellent outcomes in more than 90% patients. It provides the way for a holistic patient centered approach to treating all the main pain generators of the lower limb in one sitting. It is time saving & cost effective. Rehabilitation can start for the entire physiological neuromuscular unit and provide more holistic therapy.
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International Journal of Orthopaedics Sciences 2019; 5(1): 303-310
ISSN: 2395-1958
IJOS 2019; 5(1): 303-310
© 2019 IJOS
www.orthopaper.com
Received: 11-11-2018
Accepted: 15-12-2018
Pavankumar Kohli
Professors, Department of
Orthopedics, BKL Walawalkar
Hospital, Ratnagiri,
Maharashtra, India
Sunil Nadkarni
Professors, Department of
Orthopedics, BKL Walawalkar
Hospital, Ratnagiri,
Maharashtra, India
Sushant Chavan
Professors, Department of
Orthopedics, BKL Walawalkar
Hospital, Ratnagiri,
Maharashtra, India
Ankush Nawale
Fellow in Spine Surgery,
Dept. of Orthopaedics, BKL
Walawalkar Medical College,
Dervan, Chiplun, Ratnagiri,
Maharashtra, India
Poorv Patel
Dept. of Orthopaedics, BKL
Walawalkar Medical College,
Dervan, Chiplun, Ratnagiri,
Maharashtra, India
Ashok Mali
Dept. of Orthopaedics, BKL
Walawalkar Medical College,
Dervan, Chiplun, Ratnagiri,
Maharashtra, India
Satishchandra Gore
Professors, Department of
Orthopedics, BKL Walawalkar
Hospital, Ratnagiri,
Maharashtra, India
Correspondence
Sunil Nadkarni
Professors, Department of
Orthopedics, BKL Walawalkar
Hospital, Ratnagiri,
Maharashtra, India
Dervan simultaneous surgical protocol complete relief
of lower limb neuralgic & arthritic pain
Pavankumar Kohli, Sunil Nadkarni, Sushant Chavan, Ankush Nawale,
Poorv Patel, Ashok Mali and Satishchandra Gore
DOI: https://doi.org/10.22271/ortho.2019.v5.i1f.55
Abstract
Introduction: Surgery has made tremendous advances in the fields of joint Arthroplasty & Spine. Major
advances in both these fields have made patient care more nature friendly & less morbid, thus allowing
smaller incisions, day care procedures like endoscopic spine surgeries, minimally invasive joint
replacement and so on. However, both these specialties have remained diverse and separate. Thus, in the
typical modern-day specialty-based practice era, a patient consulting an Arthroplasty surgeon will seldom
have a detailed spine examination or vice versa. This may lead to scenarios where the pain generator is
from for example radiculopathy to the knee and below & the recommended procedure is a joint
replacement due to incidental wear of the joints seen on the X ray. (1) The international data shows that
there are 20% dissatisfied arthroplasty patients worldwide. (2) We have found concomitant knee & spine
pathologies in more than 90% of our patients& published our research on the same topic. (1, 3, 4, 5) Thus
the need arises for taking care of both pain generators i.e. from the spinal stenosis (central & or lateral) &
knee arthritis for complete pain relief to the lower limbs. The developed protocol is the first of its kind
for a more Holistic diagnosis & treatment of lower limb pain. It also saves interval dissatisfaction of the
patient, healthcare costs & is a step towards a more team based surgical care between specialized spine &
arthroplasty surgeons. Specialization should no more be a cause of separation between treating surgical
teams & continued pain for the patient. A more Holistic clinical & surgical approach is hereby proposed.
Methods: In this pilot study, twenty two patients were selected who underwent simultaneous & single
sitting surgical treatment for leg pain, unilateral or bilateral. After detailed clinical examination &
imaging studies, Simultaneous, Single stage Surgery was carried out in needy patients. Step one was
Transforaminal Endoscopic Lumbar discectomy of the L4-5 disc in 17 patients, 2 level L3-4 & L4-5 in 3
patients & L5-S1 in 2 patients under local anesthesia in an awake & aware patient. After completion of
the Percutaneous Endoscopic Lumbar Discectomy, an epidural catheter was inserted through the
endoscope under vision in the epidural space by the spine surgeon (Dr. Sunil Nadkarni) & patient turned
supine after checking the position of the catheter with radiolucent dye & securing the catheter. The
anesthetist pushed the drug, patient was turned supine and painting & draping was done to begin the
second part of the procedure i.e. single side or bilateral unicondylar joint replacement.
Results: Results were classified by VAS, ODI, Oxford knee score, SF 12 before & after the procedure.
Conclusion: The proposed “Dervan Simultaneous Surgical protocol “for Lower Limb pain, is a
satisfying procedure with good to excellent outcomes in more than 90% patients. It provides the way for
a holistic patient centered approach to treating all the main pain generators of the lower limb in one
sitting. It is time saving & cost effective. Rehabilitation can start for the entire physiological
neuromuscular unit and provide more holistic therapy.
Keywords: spine endoscopy, knee arthroplasty, simultaneous surgery, dermatome, holistic approach
Introduction
Lower limb pain has been an enigma for long. The exact cause of pain, the origin of the main
pain generator has confused many an astute clinician. To confuse matters more, coexistence of
the pain generator in both knee joints & spine is often noted [1-4]. The surgeons practicing
specialized knee Arthroplasty are often faced with dissatisfied patients complaining of
lingering pain in the knee, often behind the knee [5, 6]. We clinicians are aware that the site of
pain is not necessarily the source of pain.
It is only on closer questioning that they will reveal that the pain is not exactly on the joint line
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International Journal of Orthopaedics Sciences
as before but behind the knee or more on the lateral side,
going to the calf. The “Umbrella term” of knee pain is to
blame for this and the patient’s forgivable lack of anatomy &
possible pain generators. If the clinician is at fault it may be
only for not identifying All the possible causes of the
‘Umbrella term ‘knee pain before the surgery & counselling
on the rehabilitation, possibility of need of surgery at Spine as
a contributor to the perceived pain Around the knee,
preoperatively. Considering the frequent coexistence of pain
generators at the Spine in form of central/lateral canal stenosis
& Arthritis of the knee, we have developed a surgical protocol
for Simultaneous, Single sitting complete relief of lower limb
pain. Not only are all the pain generators tackled at a single
shot, Rehabilitation is easier & Holistic, the patient &
Healthcare system saves considerably by the single admission
and prevention of repetition in drugs etc. Not only are Skill &
Logistics considered in this protocol, the surgeries are also
performed in the most Nature friendly way with all Minimally
Invasive Surgery based principles, enabling quick return to
activity. None of our patients have been mobilized later than
12 hours postop after the simultaneous spine & joints surgery
or have gone home later than 3/4 days postop.
There the need to consider anesthetic risks and make the
surgery not just efficient & single sitting but also SAFE, as all
patients were senior citizens with co morbidities.
To our knowledge, this is the first described surgical protocol
for simultaneous addressal of all common pain generators to
the lower limb.
Methods
This Pilot study was carried out in 22 patients. All patients
were selected from a cohort of opd patients attending a Joint
care & Arthroplasty center. The primary presenting complaint
in all patients was pain around the knee. Of the 60 patients
who attended the OPD for knee pain, closer questioning
revealed, pain only on the medial side was 15% i.e. 9 patients,
undefined pain over the anterior knee with medial knee pain
was 60% i.e. 36 patients, Pain over knee along with pain at
the back of knee & calf was 25% i.e. 15 patients.
Sr.
Site of pain
Patient number
Percentage
1
Medial knee
9
15
2
Unidentified pain over knee
36
60
3
Knee pain with radiation to calf
15
25
All patients were investigated radiologically with standing
views of Radiograph of both knees, along with standing
Radiograph of Lumbosacral spine in Lateral. All those with
possible surgical intervention were further advised MRI of LS
Spine with scout view of whole spine.
Of the above 60 patients 42 showed radiological damage to
the medial condyle/both condyles.
32 patients out of 42 showed primarily medial condyle
affliction. 10 patients had bicondylar/tricompartmental
osteoarthritis. Two of the 10 patients with tricompartmental
disease had signs of inflammatory joint disease.
Patients were counselled according to their clinical signs;
radiological correlation & consent was taken along with
verification of understanding of full spectrum of the disease &
its treatment both in the disc space & joint contributing to
lower limb pain.
22 patients consented for Simultaneous Surgery Protocol, the
others were put on surgical waiting list of staged surgeries &
or Rehabilitation (20 patients).
Of the above 22.
14 had primarily symptomatic L4-5 disc prolapse on the
symptomatic leg side.
5 patients had bilateral leg symptoms with confirmed
radiological signs on radiograph of Unicondylar knee arthritis
2 patients had L 4-5 prolapsed disc affection with unilateral
tricompartmental arthritis.
1 patient had two level prolapsed discs L4-5, L5-S1 with
bilateral unicompartmental disease.
Total Patients
L4-5 disease unilateral symptoms
L4-5 with L5-S1 disease concomitant
Disc disease with bilateral symptoms
L4-5 disease with tricompartmental arthritis
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International Journal of Orthopaedics Sciences
Patient selection: Although patients complained primarily of
knee pain, or pain around the knee, each was carefully
examined by proper mapping of pain, sensory and or motor
dermatomes affected, radiological studies like standing views
of Knees, standing views of spine especially lateral in flexion
& extension. MRI’s were not taken as the final decision
maker tool, rather just an aid to confirm clinical findings
along with pain dermatome distribution. MRI was also use as
an important tool to plan entry, location of fragment & areas
to be addressed in the spine endoscopy.
The newly described Dervan Rim Sign was an important tool
to note non bone on bone medial compartment arthritis and
explain cause of non-bone on bone contact arthritic pain [7].
Counselling, planning & explaining surgical protocol,
Rehabilitation as per the Dervan Protocol [8].
Surgical Protocol was planned as per symptoms, evaluation &
Radiological imaging [9].
It is pertinent that All Surgeries Were in Awake & Aware
State, All Knee Surgeries Were Minimally Invasive; All Post-
Operative Mobilisations Was First Aimed For Within 7-8
Hours of Surgery.
Surgical Protocol
1. Patient is positioned prone on the OT table.
2. Marking of the level of endoscopic surgery is done with
aid of the C Arm Image intensifier, of the relevant
surgical level. Patient is Awake & Aware At All Times.
3. This paper does not include fine points of needle
placement & entry for which papers from the senior
contributors of this publication may be referred to. (Dr. S
Gore, Dr. S Nadkarni).
Fine modifications are made as to the trajectory of the
needle & bevel orientation till satisfactory entry to the
affected disc space is gained, as verified by the C Arm.
4. Further steps of the Transforaminal endoscopic
discectomy proceed with replacement of the cannulated
needle with the guide wire, Threading of the dilator over
the guide wire, Insertion of the sheath over the dilator &
the insertion of Endoscope with irrigation.
5. Further surgical steps of procedure follow annulotomy &
Discectomy with verification of decompression of
relevant areas e.g. exiting root, tip of superior articular
process etc.
6. Important Step: An epidural catheter is then held with an
endoscopic disc forceps & gently guided into the cleared
epidural space.
7. 3-4 cc of radiopaque dye (omnipaque) is pushed into the
catheter to verify the location & smooth delivery of the
fluid.
8. Epidural dose is injected as per the instructions of the
anaesthetist.
9. Platelet Rich Fibrin Plug (Dervan Plug) is inserted at the
discectomy site as per our standard protocol for
Transforaminal endoscopic surgeries [10].
10. Cannula is removed & the Epidural catheter is fixed to
the skin.
11. Patient is turned supine & positioned for Knee surgery
after verification of lower limb anesthesia.
12. Unicondylar or Total knee replacement, of one or both
knees is carried out as per plan by minimally invasive
techniques.
Rehabilitation Protocol
Patients are mobilized within 7-8 hours of the surgery as per
The Dervan mobilization protocol [8].
Patients are discharged on day 3 or 4 after stair climbing &
independent control of daily living ergonomics.
Results
Pre & postoperative results of all patients were calibrated at 3
months by
Oswestry disability index
Pre 41.8%
Post 87.9%
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International Journal of Orthopaedics Sciences
Modified Oxford knee score
Pre 27.5
Post 46.7
Quality of Life by SF 12
Pre 48
Post 79
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International Journal of Orthopaedics Sciences
Two patients of the total 22 complained of recurrence of
lateral side knee pain radiating to the Lower 3rd of the leg at
the first review at stitch removal on 14th day. They were
evaluated & corrected in the faulty ergonomic technique in
activities of daily living. Both improved within 2-3 days.
Incidentally both these patients were obese, had poor core
stability & had overlooked the advice of wearing a
Lumbosacral belt during mobilization till adequate control of
the core was gained. There were no other complications.
Cost savings on account of simultaneous surgery was
Cost of rehospitalization for 4 days: Rs 14,000
Cost of repeat medication (Antibiotics, NSAIDS, Anesthetic
drugs): Rs 23,000
Continued disability costs to patient: Incalculable
Cost of time & repeat load on Healthcare personnel:
Incalculable
Average minimum cost savings to patient were Rs 37,000
which formed approximately 30% of the hospital expenses
sans medical fees & care for 3-4 days.
Continued pain & suffering, physical & psychological costs to
both patient & doctor cannot unfortunately be calculated.
Pre-Op Photos
Discussion
Pre-Operative X-ray of knee joint
Pre-Operative MRI of LS Spine
Pre-operative position and markings
C arm guided endoscopic discectomy
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International Journal of Orthopaedics Sciences
Epidural catheterization through endoscope
Confirmation of epidural space with dye
Platelets rich fibrin plug passage in disc space (PRF)
Epidural Cathedral
Positioning of knee for unicondylar knee replacement
Unicondylar Knee intraOp
Post-operative Incision Size for endoscopic spine &
Unicondylar knee
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International Journal of Orthopaedics Sciences
Post-Operative Incision Size
Post-Operative X Ray
Squatting on post-operative day 12
Discussion
The primary center of development of this protocol is a
Tertiary care rural hospital in coastal India. Authors number 7
& 2 were the first to pioneer the technique of Transforaminal
endoscopic surgery in India [6]. Valuable results were obtained
with quick recovery in an awake & aware patient as the best
form of biofeedback intraoperatively. Patient satisfaction was
extremely high.
Osteoarthritis is a common malady &with increasing life
expectancy, the above Tertiary center is amongst the first to
pioneer the use of Unicondylar knee replacements as the
‘Natural Knee Replacement’ most suitable for Asiatic
lifestyle. It is more functional allowing squatting, sitting cross
legged, has longer survival & is more cost effective with
faster recovery, lessor hospital stay etc. [11-15].
In a previous publication from this institute, on investigation
of causes of dissatisfied patients of knee Arthroplasty, it was
found that although the patient complained of pain around the
knee, the source & pain generator were mostly from the
spine1. It was thereafter made mandatory for all patients of
knee osteoarthritis to undergo spine investigations & detailed
clinical examination preoperatively. Furthermore it was found
that great concomitant affliction existed between spinal disc
disease & knee Osteoarthritis [1].
Both lead to pain around the Knee.
Hence a more Holistic approach was developed where the
patient was not examined separately by super specialty but
holistically from all clinical points of view. This Holistic
approach extends to all phases of treatment i.e. clinical
examination, counseling, physiotherapy, staged or
Simultaneous surgical approach & postop Rehabilitation. Not
only is the patient more knowledgeable and responsible but
also more committed & less litigious. The Surgeon has a
broader view of the patient’s condition & is able to advise
more appropriately as to possible options of treatment, their
sequence & expectations.
Cost savings, Ease of rehabilitation, Skill development,
Propagation of a holistic attitude to patient care& a deeper
understanding of the integrated functioning of the human
body are promoted [2]. Specialization need not lead to
separation. In fact it is felt by those of us fortunate enough to
serve at this center that, Holistic approach is the need of the
hour …as a specialization in itself.
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International Journal of Orthopaedics Sciences
Conclusion
The Dervan Surgical Protocol for simultaneous surgery of
spine & knee is a minimally invasive, beneficial & effective
technique for complete treatment of the commonly occurring
clinical pain around the knee, addressing pain generators from
both spine & knee. It can be useful in many select situations.
Practical implications of healthcare cost & time saving along
with complete long term relief to the patient are valuable
inputs of this surgery.
The time has probably come when instead of Spine or
Arthroplasty surgeons, there can be a trained section of new
‘Dermatome surgeons ‘who can treat all causes of pain in that
dermatome, whether from spine or joints Holistically & with
easy skill.
Acknowledgements
This is a pilot study involving 22 patients. Although the
quantum & speed of relief of common pain generators of knee
pain are addressed in a single sitting, the surgeries for both
areas was carried out by surgeons with large experience on
both respective fields. It remains to be seen with larger studies
done elsewhere whether same results are capable of being
reproduced.
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Background Total knee arthroplasty (TKA) is the most common joint replacement surgery in Canada. Earlier Canadian work reported 1 in 5 TKA patients expressing dissatisfaction following surgery. A better understanding of satisfaction could guide program improvement. We investigated patient satisfaction post-TKA in British Columbia (BC). Methods A cohort of 515 adult TKA patients was recruited from across BC. Survey data were collected preoperatively and at 6 and 12 months, supplemented by administrative health data. The primary outcome measure was patient satisfaction with outcomes. Potential satisfaction drivers included demographics, patient-reported health, quality of life, social support, comorbidities, and insurance status. Multivariable growth modeling was used to predict satisfaction at 6 months and change in satisfaction (6 to 12 months). Results We found dissatisfaction rates (“very dissatisfied”, “dissatisfied” or “neutral”) of 15% (6 months) and 16% (12 months). Across all health measures, improvements were seen post-surgery. The multivariable model suggests satisfaction at 6 months is predicted by: pre-operative pain, mental health and physical health (odds ratios (ORs) 2.65, 3.25 and 3.16), and change in pain level, baseline to 6 months (OR 2.31). Also, improvements in pain, mental health and physical health from 6 to 12 months predicted improvements in satisfaction (ORs 1.24, 1.30 and 1.55). Conclusions TKA is an effective intervention for many patients and most report high levels of satisfaction. However, if the TKA does not deliver improvements in pain and physical health, we see a less satisfied patient. In addition, dissatisfied TKA patients typically see limited improvements in mental health.
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Objective. To compare patients with knee osteoarthritis (OA) who have and do not have back pain, and evaluate the prevalence, characteristics, and consequences of back pain among knee OA patients. Methods. During a 3-year period, consecutive patients attending an outpatient rheumatology clinic were evaluated for the presence of back pain, and 368 were found to have OA of the knee. Clinical status was evaluated by the Clinical Health Assessment Questionnaire, radiographs, and joint examinations. Results. Back pain was present in 54.6% of patients with OA of the knee. Almost every clinical status measure was worse among those reporting back pain, including Health Assessment Questionnaire (HAQ) disability, pain, global severity, fatigue, and psychological status. Back pain was more common in women and the obese, but was not associated with age, marital status, formal education, smoking history, or knee radiographic scores in multivariate analyses the strongest correlates of back pain in knee OA patients were anxiety, night pain, HAQ disability, and global severity. Conclusion. Back pain is prevalent among OA clinic patients, more common than in rheumatoid arthritis or population studies, is linked to body mass index, and is associated with clinically significant increases in pain and other measures of clinical distress.
Article
To evaluate the association between knee pain and lumbar disorders. The case-control study was conducted at Physical Medicine and Rehabilitation Department, Tabriz University of Medical Sciences, Iran, from December 2009 to March 2011, and comprised patients with primary complaint of knee pain. A separate group worked as controls. The coincidence of knee pain and lumbar disorders were assessed and compared between the two groups SPSS 15 was used for statistical analysis. Of the 170 patients, 90(53%) were in the case group having 20(22.2%) males and 70(77.7%) females, and 80(47%) in the control group having 18(22.5%) males and 62(77.5%) females. The overall mean age was 46.9±8.9 (range: 25-61years). Age and gender difference between two groups was not significant (p>0.05 each). Lifetime prevalence of radicular, chronic and recurrent low back pain and its point prevalence in the case group were significantly higher than the control group (p<0.05 each). Range of movement of the lower limb and lumbar region in the case group was less than the controls (p<0.05). Local subcutaneous tissue oedema of the lumbar region was more prevalent in the case group (p<0.05). There was no significant difference in vertebral column posture between the two groups (p>0.05). The relationship between lumbar and knee pain disorders should be considered in the assessment and management of patients with knee pain.
Article
The American Society of Anesthesiologists' (ASA) Physical Status Classification was tested for consistency of use by a questionnaire sent to 304 anesthesiologists. They were requested to classify ten hypothetical patients. Two hundred fifty-five (77.3 percent) responded to two mailings. The mean number of patients rated consistently was 5.9. Four patients elicited wide ranges of responses. Age, obesity, previous myocardial infarction, and anemia provoked controversy. There was no significant difference in responses from different regions of the country. Academic anesthesiologists rated a greater number identical than did those in private practice (P less than 0.01). There was no difference in ratings between those who used the classification for billing purposes and those who did not. The ASA Physical Status Classification is useful but suffers from a lack of scientific precision.
Article
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)
Article
There are few direct comparative studies evaluating results after unicompartmental knee arthroplasty and total knee arthroplasty. We determined the active range of motion, Knee Society score, and 5-year survivorship rate after 54 consecutive unilateral unicompartmental knee arthroplasties compared with a matched group of 54 unilateral total knee arthroplasties. The two groups of patients were matched for age, gender, body mass index, preoperative active range of movement, and preoperative Knee Society scores. All patients had osteoarthritis of the knee. Patients were assessed prospectively at 6, 18, 36, and 60 months postoperatively, and the mean followup was 59 months in both groups. The mean postoperative active range of motion was greater after unicompartmental knee arthroplasty, but there were no differences in the overall Knee Society knee and function scores. The 5-year survivorship rate based on revision for any reason was 88% for unicompartmental knee arthroplasty and 100% for total knee arthroplasty. The worst case 5-year survivorship rate, assuming all patients lost to followup had revision surgery, was 85% for unicompartmental knee arthroplasty and 98% for total knee arthroplasty. Total knee arthroplasty was a more reliable procedure. Midterm clinical outcomes were similar for both procedures, but the complication rate may be greater for unicompartmental knee arthroplasty.