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Similar rates of return to sports and BMI reduction regardless of age, gender and preoperative BMI as seen in matched cohort of hypoallergenic and standard Cobalt Chromium medial unicompartmental knee arthroplasty

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To compare the rate of return to sports and body mass index (BMI) reduction in patients who underwent surgery for unicompartmental knee arthroplasty (UKA) with either Cobalt-Chromium (CoCr) alloy UKA or with hypoallergenic UKA, stratified by age, gender and BMI.

Methods

Two consecutive cohorts of patients with a total of 172 UKA and a minimum 2-year follow-up period were prospectively included in this comparative study. The first cohort consisted of 136 consecutive series of standard Cobalt-Chromium (CoCr Group). The second cohort consisted of 36 consecutive mobile-bearing hypoallergenic Titanium Niobium Nitride UKA, (TiNbN Group). The clinical evaluation was based on the University of California, Los Angeles (UCLA) activity scores and the High-Activity Arthroplasty Score (HAAS) evaluated on the day before surgery (T0) and after a minimum follow-up of 12 months (T1) and 24 months (T2). Radiographic evaluation performed at T2 included the femoral component position in varus/valgus, the tibial component in varus/valgus and the anteroposterior slope.

Results

No statistical differences were found between the groups at each follow-up, as shown by the UCLA and HAAS score (n.s.). Both groups showed a statistically significant improvement (p < 0.05) at each follow-up.. Both groups showed a statistically significant BMI reduction between T0 and T2 (p < 0.05). Radiographic analysis revealed no statistical differences between the two groups in terms of the three measures after the final follow-up (n.s.). All the subgroups showed a significant (p < 0.05) rate of return to sport if compared with the preoperative value (T2 versus T0), except for male in TiNbN group.

Conclusions

Both TiNbN and CoCr medial mobile-bearing UKA enabled patients to return to sports after the final follow-up, regardless of age, BMI, gender and metal sensitivity. These findings inform shared decision making and can help to manage patient expectations after surgery, in particular, in active patients with an overt metal allergy, a specific hypoallergenic implant should be considered the gold standard implant in partial knee replacement surgery.

Level of evidence

Cohort Study, Level III.

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References

  1. Affatato S, Caputo D, Bordini B (2019) Does the body mass index influence the long-term survival of unicompartmental knee prostheses? A retrospective multi-centre study. Int Orthop 43(6):1365–1370

    Article  Google Scholar 

  2. Calistri A, Di Martino L, Gurzì MD, Bove M, De Smet K, Villani C (2014) Italian version of University of California at Los Angeles (UCLA) Activity Score: cross-cultural adaptation. J Arthroplasty 29(9):1733–1735

    Article  Google Scholar 

  3. Chen Z, Klimentidis YC, Bea JW, Ernst KC, Hu C, Jackson R, Thomson CA (2017) Body mass index, waist circumference, and mortality in a large multiethnic postmenopausal cohort-results from the women’s health initiative. J Am Geriatr Soc 65(9):1907–1915

    Article  Google Scholar 

  4. D’Ambrosi R, Nuara A, Mariani I, Di Feo F, Ursino N, Hirschmann M (2021) Titanium niobium nitride mobile-bearing unicompartmental knee arthroplasty results in good to excellent clinical and radiographic outcomes in metal allergy patients with medial knee osteoarthritis. J Arthroplasty 36(1):140–147

    Article  Google Scholar 

  5. Dagneaux L, Bourlez J, Degeorge B, Canovas F (2017) Return to sport after total or unicompartmental knee arthroplasty: an informative guide for residents to patients. EFORT Open Rev 2(12):496–501

    Article  Google Scholar 

  6. Faschingbauer M, Renner L, Boettner F (2017) Allergy in total knee replacement does it exist: review article. HSS J 13(1):12–19

    Article  Google Scholar 

  7. Ford ES, Moriarty DG, Zack MM, Mokdad AH, Chapman DP (2001) Self-reported body mass index and health-related quality of life: findings from the Behavioral Risk Factor Surveillance System. Obes Res 9(1):21–31

    Article  CAS  Google Scholar 

  8. Hamilton TW, Pandit HG, Lombardi AV, Adams JB, Oosthuizen CR, Clavé A, Dodd CA, Berend KR, Murray DW (2016) Radiological Decision Aid to determine suitability for medial unicompartmental knee arthroplasty: development and preliminary validation. Bone Joint J 98-B(10 Supple B):3–10

    Article  CAS  Google Scholar 

  9. Harbourne AD, Sanchez-Santos MT, Arden NK, Filbay SR (2019) Predictors of return to desired activity 12 months following unicompartmental and total knee arthroplasty. Acta Orthop 90(1):74–80

    Article  Google Scholar 

  10. Holmgren M, Lindgren A, de Munter J, Rasmussen F, Ahlström G (2014) Impacts of mobility disability and high and increasing body mass index on health-related quality of life and participation in society: a population-based cohort study from Sweden. BMC Public Health 14:381

    Article  Google Scholar 

  11. Innocenti M, Carulli C, Matassi F, Carossino AM, Brandi ML, Civinini R (2014) Total knee arthroplasty in patients with hypersensitivity to metals. Int Orthop 38(2):329–333

    Article  Google Scholar 

  12. Innocenti M, Vieri B, Melani T, Paoli T, Carulli C (2017) Metal hypersensitivity after knee arthroplasty: fact or fiction? Acta Biomed 88(2S):78–83

    CAS  PubMed  PubMed Central  Google Scholar 

  13. Jämsen E, Kouri VP, Ainola M, Goodman SB, Nordström DC, Eklund KK, Pajarinen J (2017) Correlations between macrophage polarizing cytokines, inflammatory mediators, osteoclast activity, and toll-like receptors in tissues around aseptically loosened hip implants. J Biomed Mater Res A 105(2):454–463

    Article  Google Scholar 

  14. Janssen I, Mark AE (2007) Elevated body mass index and mortality risk in the elderly. Obes Rev 8(1):41–59

    Article  CAS  Google Scholar 

  15. Johal S, Nakano N, Baxter M, Hujazi I, Pandit H, Khanduja V (2018) Unicompartmental knee arthroplasty: the past, current controversies, and future perspectives. J Knee Surg 31(10):992–998

    Article  Google Scholar 

  16. Lidstone JS, Ells LJ, Finn P, Whittaker VJ, Wilkinson JR, Summerbell CD (2006) Independent associations between weight status and disability in adults: results from the Health Survey for England. Public Health 120(5):412–417

    Article  CAS  Google Scholar 

  17. Lo Presti M, Costa GG, Cialdella S, Agrò G, Grassi A, Caravelli S, Mosca M, Marcheggiani Muccioli GM, Zaffagnini S (2019) Return to sports after unicompartmental knee arthroplasty: reality or utopia? A 48-month follow-up prospective study. J Knee Surg 32(2):186–191

    Article  Google Scholar 

  18. Middleton S, Toms A (2016) Allergy in total knee arthroplasty: a review of the facts. Bone Joint J 98-B(4):437–441

    Article  CAS  Google Scholar 

  19. Monticone M, Capone A, Frigau L, Marongiu G, Abelli P, Mola F, Maffulli N, Foti C (2018) Development of the Italian version of the High-Activity Arthroplasty Score (HAAS-I) following hip and knee total arthroplasty: cross-cultural adaptation, reliability, validity and sensitivity to change. J Orthop Surg Res 13(1):81

    Article  Google Scholar 

  20. Mujika KM, Méndez JAJ, de Miguel AF (2018) Advantages and disadvantages in image processing with free software in radiology. J Med Syst 42(3):36

    Article  Google Scholar 

  21. Murray DW, Parkinson RW (2018) Usage of unicompartmental knee arthroplasty. Bone Joint J 100-B(4):432–435

    Article  CAS  Google Scholar 

  22. Nobili V, Marcellini M, Giovannelli L, Girolami E, Muratori F, Giannone G, Devito R, De Benedetti F (2004) Association of serum interleukin-8 levels with the degree of fibrosis in infants with chronic liver disease. J Pediatr Gastroenterol Nutr 39(5):540–544

    Article  CAS  Google Scholar 

  23. Papalia R, Zampogna B, Torre G, Diaz Balzani LA, Vasta S, Papalia G, De Vincentis A, Denaro V (2020) Return to sport activity in the elderly patients after unicompartmental knee arthroplasty: a systematic review and meta-analysis. J Clin Med 9(6):1756

    Article  Google Scholar 

  24. Polat AE, Polat B, Gürpınar T, Çarkçı E, Güler O (2019) The effect of morbid obesity (BMI ≥ 35 kg/m2) on functional outcome and complication rate following unicompartmental knee arthroplasty: a case-control study. J Orthop Surg Res 14(1):266

    Article  Google Scholar 

  25. Ragone V, Canciani E, Biffi CA, D’Ambrosi R, Sanvito R, Dellavia C, Galliera E (2019) CoCrMo alloys ions release behavior by TiNbN coating: an in vitro study. Biomed Microdevices 21(3):61

    Article  Google Scholar 

  26. Schetz M, De Jong A, Deane AM, Druml W, Hemelaar P, Pelosi P, Pickkers P, Reintam-Blaser A, Roberts J, Sakr Y, Jaber S (2019) Obesity in the critically ill: a narrative review. Intensive Care Med 45(6):757–769

    Article  Google Scholar 

  27. Sharkey PF, Hozack WJ, Rothman RH, Shastri S, Jacoby SM (2002) Insall Award paper. Why are total knee arthroplasties failing today? Clin Orthop Relat Res 404:7–13

    Article  Google Scholar 

  28. Soltoft F, Hammer M, Kragh N (2009) The association of body mass index and health-related quality of life in the general population: data from the 2003 Health Survey of England. Qual Life Res 18(10):1293–1299

    Article  CAS  Google Scholar 

  29. Sundaram K, Warren J, Anis H, George J, Murray T, Higuera CA, Piuzzi NS (2019) An increased body mass index was not associated with higher rates of 30-day postoperative complications after unicompartmental knee arthroplasty. Knee 26(3):720–728

    Article  Google Scholar 

  30. Talbot S, Hooper G, Stokes A, Zordan R (2010) Use of a new high-activity arthroplasty score to assess function of young patients with total hip or knee arthroplasty. J Arthroplasty 25(2):268–273

    Article  Google Scholar 

  31. Tanaka R, Yasunaga Y, Hisatome T, Yamasaki T, Iwamori H, Ochi M (2005) Serum interleukin 8 levels correlate with synovial fluid levels in patients with aseptic loosening of hip prosthesis. J Arthroplasty 20(8):1049–1054

    Article  Google Scholar 

  32. Thomas P, Hisgen P, Kiefer H, Schmerwitz U, Ottersbach A, Albrecht D, Summer B, Schinkel C (2018) Blood cytokine pattern and clinical outcome in knee arthroplasty patients: comparative analysis 5 years after standard versus “hypoallergenic” surface coated prosthesis implantation. Acta Orthop 89(6):646–651

    Article  Google Scholar 

  33. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, Initiative STROBE (2008) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol 61(4):344–349

    Article  Google Scholar 

  34. Waldstein W, Kolbitsch P, Koller U, Boettner F, Windhager R (2017) Sport and physical activity following unicompartmental knee arthroplasty: a systematic review. Knee Surg Sports Traumatol Arthrosc 25(3):717–728

    Article  Google Scholar 

  35. Walker T, Rutkowski L, Innmann M, Panzram B, Herre J, Gotterbarm T, Aldinger PR, Merle C (2019) Unicondylar knee arthroplasty using cobalt-chromium implants in patients with self-reported cutaneous metal hypersensitivity. Bone Joint J 101-B(2):227–232

    Article  CAS  Google Scholar 

  36. Zhang Q, Zhang Q, Guo W, Liu Z, Cheng L, Yue D, Zhang N (2014) The learning curve for minimally invasive Oxford phase 3 unicompartmental knee arthroplasty: cumulative summation test for learning curve (LC-CUSUM). J Orthop Surg Res 9:81

    Article  Google Scholar 

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Authors and Affiliations

  1. IRCCS Orthopedic Institute Galeazzi, Milan, Italy

    Riccardo D’Ambrosi, Federico Valli & Nicola Ursino

  2. Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy

    Filippo Maria Anghilieri

  3. Dipartimento di Medicina e Scienze della Salute Vincenzo Tiberio, Università degli Studi del Molise, Campobasso, Italy

    Katia Corona

  4. Institute for Maternal and Child Health, IRCCS “Burlo Garofolo”, Trieste, Italy

    Ilaria Mariani

  5. Department of Orthopaedic Surgery and Traumatology Kantonsspital, Baselland (Bruderholz, Liestal, Laufen), Liestal, Switzerland

    Michael Tobias Hirschmann

Authors
  1. Riccardo D’Ambrosi
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  3. Katia Corona
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  4. Ilaria Mariani
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  7. Michael Tobias Hirschmann
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Correspondence to Riccardo D’Ambrosi.

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D’Ambrosi, R., Anghilieri, F.M., Corona, K. et al. Similar rates of return to sports and BMI reduction regardless of age, gender and preoperative BMI as seen in matched cohort of hypoallergenic and standard Cobalt Chromium medial unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 30, 890–898 (2022). https://doi.org/10.1007/s00167-021-06467-1

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