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Hybrid fixation of unicompartmental knee arthroplasty shows equivalent short-term implant survivorship and clinical scores compared to standard fixation techniques

  • Knee Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

There is a paucity of data regarding hybrid-fixated unicompartmental knee arthroplasty (UKA), and no study directly compared all three available fixation techniques (cementless, cemented, and hybrid). The hypothesis was that hybrid fixation might have a lower incidence of radiolucent lines (RLL) than cemented UKA, with equivalent outcomes to uncemented UKA.

Materials and methods

A total of 104 UKA with a minimal follow-up of 1 year were retrospectively included, of which 40 were cemented, 41 cementless, and 23 hybrid prostheses. The functional outcomes scores included the Oxford Knee (OKS), Subjective Knee (SKS), and Forgotten Joint scores (FJS). RLLs, subsidence, and component positioning were assessed on radiographs.

Results

At a mean follow-up of 28 months, the survival rate was 95% for cemented UKA and 100% for the cementless and hybrid UKA (n.s.), respectively. Postoperative FJS (93 vs. 82 points, p = 0.007) and SKS (4.7 vs. 4.1 points, p = 0.001) were better in cementless than cemented UKA, with hybrid-fixated UKA in between the two (90 and 4.4 points, n.s.). Improvement of OKS preoperatively to postoperatively did not differ between the groups (n.s.). RLLs were more frequent in cemented (23%) compared to cementless (5%, p = 0.021) and hybrid UKA (9%, n.s.). With an incidence of 12%, subsidence occurred more commonly in cementless UKA compared to cemented (5%) and hybrid (0%) (n.s.) UKA.

Conclusion

Hybrid fixation achieves equivalent results to standard UKA fixation techniques regarding implant survival and functional and radiological outcomes. Therefore, the hybrid fixation technique seems to be a valuable alternative as it combines the advantages of cemented tibial components with those of uncemented femoral components.

Level of evidence

III.

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Data availability

The datasets generated during and analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

UKA:

Unicompartmental knee arthroplasty

PSI:

Patient-specific instrumented

UIS:

Unicompartmental indication score

OKS:

Oxford knee score

FJS:

Forgotten joint score

SKS:

Subjective knee score

RLLs:

Radiolucent lines

RLL:

Radiolucent line

OA:

Osteoarthritis

TKA:

Total knee arthroplasty

SD:

Standard deviation

BMI:

Body mass index

ASA:

American Society of Anesthesiologists

ROM:

Range of motion

HKA:

Hip–knee–ankle angle

ICC:

Intraclass correlation coefficients

ANOVA:

Analysis of variance

n.s.:

Not significant

CT:

Computed tomography

C:

Cemented

UC:

Uncemented/Cementless

H:

Hybrid

FA:

Femoral anatomical axis

CM:

Component midline

TA:

Tibial mechanical axis

CU:

Component’s undersurface

PSC:

Posterior component surface

PROM:

Patient-reported outcome measure

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Orthopaedic and Traumatology Department, Bürgerspital Solothurn, Schöngrünstrasse 38, 4500, Solothurn, Switzerland

    Michael Grabherr, Dimitris Dimitriou, Johannes Schraknepper, Näder Helmy & Andreas Flury

  2. Orthopaedic Department, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland

    Dimitris Dimitriou & Andreas Flury

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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by all authors. The first draft of the manuscript was written by MG and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Michael Grabherr.

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Conflict of interest

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

Ethical approval

This retrospective study was performed in line with the principles of the Declaration of Helsinki and was approved by the institutional review board and the ethical committee (Project-ID 2020-01093). The study was entirely conducted at the authors’ institution.

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Grabherr, M., Dimitriou, D., Schraknepper, J. et al. Hybrid fixation of unicompartmental knee arthroplasty shows equivalent short-term implant survivorship and clinical scores compared to standard fixation techniques. Arch Orthop Trauma Surg 143, 4401–4409 (2023). https://doi.org/10.1007/s00402-022-04710-z

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