Features of Anatomical and Functional Changes in the Patellofemoral Joint of Patients with Gonarthrosis

Summary. In 67-72% of patients with gonarthrosis, there is an angular deviation of the tibia towards the lesion. Prolonged functioning in such conditions is accompanied by patellofemoral arthrosis, in the development of which we found patterns during unicompartmental arthroplasty of the knee joint. Materials and Methods. This publication is based on the materials of a clinical and radiological examination of 106 patients with angular deviation of the tibia who were operated on using the method of unicompartmental arthroplasty. Conclusions. The degree of patellofemoral osteoarthritis is directly dependent on the duration of the disease and the magnitude of the angular deviation of the tibia. The most degenerative-dystrophic changes occur in the knee facet and the central facet, which are displaced in the projection of the patellofemoral joint, where cartilage degeneration, subchondral sclerosis with foci of bone destruction, pronounced marginal bone growths, and exostoses progress.

Functional results of total-knee arthroplasty versus medial unicompartmental arthroplasty: two-year results of a randomised, assessor-blinded multicentre trial

ObjectiveThe primary objective of the trial was to assess the clinical effectiveness of medial unicompartmental knee arthroplasty versus total knee arthroplasty in patients with isolated medial osteoarthritis of the knee.DesignProspective, randomised, 2 years, assessor-blind, multicentre, superiority trial.SettingThe patients were enrolled between December 2015 and May 2018 from the outpatient clinics of three public high-volume arthroplasty hospitals (Finland).ParticipantsWe recruited 143 patients with symptomatic-isolated medial osteoarthritis of the knee needing an arthroplasty procedure. All the patients were suitable for both unicompartmental and total knee arthroplasties. Population was selected as the end-stage-isolated medial osteoarthritis.InterventionsAll patients, randomized 1:1, received a medial unicompartmental arthroplasty or a total knee arthroplasty through a similar midline skin incision. Patients were blinded to the type of arthroplasty for the whole 2 years of follow-up.Main outcome measuresPrimary outcome measure was between-group differences in the Oxford Knee Score (OKS) and secondary outcome Knee injury and Osteoarthritis Score (KOOS) at 2 years postoperatively. The changes within and between the groups were analysed with analysis of variance for repeated measurements.ResultsThe primary outcome was comparable for medial unicompartmental arthroplasty and total knee arthroplasty at 2 years. The mean difference in the OKS between the groups was 1.6 points (95% CI −0.7 to 3.9). In the KOOS subscales, the mean difference between the groups was 0.1 points (95% CI −4.8 to 5.0) for pain, 7.8 points (95% CI 1.5 to 14.0) for symptoms, 4.3 points (95% CI −0.6 to 9.2) for function in daily living, 4.3 points (95% CI −3.0 to 11.6) for function in sports, and 2.1 points (95% CI −4.8 to 9.1) for knee-related quality of life.ConclusionsThe recovery after unicompartmental knee arthroplasty was faster compared with total knee arthroplasty, but unicompartmental arthroplasty did not provide a better patient-reported outcome at 2 years.Trial registration numberNCT02481427.

Actual analysis of complications after unicompartmental arthroplasty of the knee joint

Summary. In this literature review, a systematic analysis of modern data on the study of complications of unicompartmental arthroplasty of the knee, their prevalence, the main methods of treatment and prevention. Instability of the components of the endoprosthesis, wear of the polyethylene and progression of the degenerative process in the contralateral joint were found to have the highest frequency in the structure of complications. Additional factors for the development of negative effects of unicompartimental arthroplasty of the knee are local osteoporosis of the femur and tibia, periprosthetic fractures, infectious complications and pain syndrome.