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A decreased tibial tuberosity-trochlear groove distance is associated with lateral patellofemoral joint degeneration after implantation of medial fixed-bearing unicompartmental knee arthroplasty — a minimum five year follow-up

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Abstract

Purpose

The influence of lateral patellofemoral osteoarthritis (PFOA) in medial unicompartmental knee arthroplasty (UKA) is controversial. Our aim was to identify radiographic factors that may lead to progressive PFOA after implantation of a fixed-bearing medial UKA and their impact on patient-reported outcomes (PROMs).

Methods

A retrospective consecutive cohort of patients undergoing medial UKA with a minimum follow-up of 60 months between September 2011 and January 2017 was identified. All UKAs had a fixed-bearing design with cemented femoral and tibial components. PROMs included documentation of the Oxford Knee Score (OKS). The following radiographic parameters were evaluated on conventional radiographs and computer tomography (CT) scans: patella tilt angle, patella congruence angle, Caton-Deschamps index, medial and lateral patellofemoral degeneration (Kellgren-Lawrence Classification (KL)), mechanical anteroposterior axis, femoral torsion, tibial tuberosity to trochlear groove distance (TTTG), anteroposterior translation of the femoral component. A hierarchical multiple regression analysis and partial Pearson correlation analysis (SPSS) were used to evaluate for predictors of progression of lateral PFOA.

Results

Forty-nine knees allowed PFOA assessment and had an average follow-up of 62 months (range 60–108). Twenty-three patients did not exhibit any progression of lateral PFOA. Twenty-two progressed with 1 stage, whereas four had progressed 2 stages according to the KL classification. TTTG negatively correlated with progressive lateral PFOA (r =  − 0.436, p = 0.01). Progression of lateral PFOA did not correlate with OKS at last follow-up (p = 0.613).

Conclusion

A decreased TTGT correlated with radiographic progression of lateral PFOA after medial fixed-bearing cemented UKA. PFOA however did not influence PROMs at a minimum of five years postoperatively.

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Authors and Affiliations

  1. Department of Traumatology and Orthopaedics, Bürgerspital Solothurn, Schöngrünstrasse, 42, Solothurn, Switzerland

    Octavian Andronic, Näder Helmy, Christoph Kellner & David Alexander Graf

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  1. Octavian Andronic
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  2. Näder Helmy
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  3. Christoph Kellner
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All the authors have made substantial contributions to all of the following: (1) the conception and design of the study, or acquisition of data, or analysis and interpretation of data; (2) drafting the article or revising it critically for important intellectual content; (3) final approval of the version to be submitted; (4) being accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Correspondence to Octavian Andronic.

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Ethical approval

The presented study was conducted in accordance with Swiss and international law requirements. This retrospective study was approved by the ethics commission board of northwest and central Switzerland and was conducted entirely at the authors’ institution: BASEC Nr 2022–01,280.

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All participants have given written consent to participate in the study after being provided with appropriate documentation. Participants also gave consent for publication of the study results.

Competing interests

The authors declare that they have no conflict of interest regarding this study. Prof. Dr. med. Näder Helmy is a medical advisor of Medacta International (Switzerland) and receives royalties from Medacta International (Switzerland). Prof. Helmy reports no conflict of interest in relation to this article.

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Andronic, O., Helmy, N., Kellner, C. et al. A decreased tibial tuberosity-trochlear groove distance is associated with lateral patellofemoral joint degeneration after implantation of medial fixed-bearing unicompartmental knee arthroplasty — a minimum five year follow-up. International Orthopaedics (SICOT) 47, 2225–2233 (2023). https://doi.org/10.1007/s00264-023-05812-y

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