Notas / Notes - Active Congress.......

JUEVES / THURSDAY
130
minimal erosive changes in the patellofemoral articulation.
Anterior knee pain, thought to be a sign of significant patellofemoral
involvement, has also been an exclusion criterion.
Applying these conservative indications, the percentage of
patients with osteoarthritic knees who may be candidates
for unicompartmental knee arthroplasty has been reported
to be between 2% and 15%. In July 2004, the U.S. Food and
Drug Administration approved the use of the Oxford Phase
3 unicondylar prosthesis (Biomet, Warsaw, IN) for implantation
in unicompartmental knee arthroplasty. Using more liberal
indications, the implant has proven to be a conservative and
bone preserving yet long-lasting intervention for anteromedial
arthritis of the knee.
The purpose of this study is to investigate the early outcomes
of Oxford medial unicompartmental knee arthroplasty in
patients in the United States who do not meet the standard
inclusion criteria. Spe-cifically, the current study investigates
the role of obesity, young age, patellofemoral arthritis, and
isolated medial knee pain on the early outcomes and failures
of this device. In a large series of 318 unicompartmental knee
arthroplasties performed in 268 patients, these standard
preoperative contraindications had no influence on the successful
outcome of the procedure using the Oxford Phase
3 device. The con-servative, bone preserving nature and
long-term survivorship of the Oxford Phase 3 device warrant
its position at the top of the list of alternatives for treating
medial disease in the growing middle age population. In
addition, by restoring the knee to the pre-disease state with
ligamentous balance and functional kinematics, activity and
lifestyle are considerably improved to near normal in many
patients following this con-servative procedure.
The current series supports the elimi-nation of age, weight,
presence of patellofemoral joint disease, and anterior knee
pain from the list of contraindications to unicompartmental
knee arthroplasty when the Oxford Phase 3 device is used.
SUGGESTED READING
1. Kozinn SC, Scott R. Unicondylar knee arthroplasty. J Bone
Joint Surg Am. 1989; 71:145-150.
2. Goodfellow J, O’Connor J, Murray DW. The Oxford meniscal
unicompartmental knee. J Knee Surg. 2002; 15:240-246.
3. Price AJ, Waite JC, Svard U. Long-term clinical results of
the medial Oxford unicompartmental knee arthroplasty. Clin
Orthop Relat Res. 2005; 435:171-180.
4. Vorlat P, Putzeys G, Cottenie D, et al. The Oxford unicompartmental
knee prosthesis: an independent 10-year
survival analysis. Knee Surg Sports Traumatol Arthrosc.
2006;14:40-45.
5. Price AJ, Dodd CA, Svard UG, Murray DW. Oxford medial
unicompartmental knee arthroplasty in patients younger
and older than 60 years of age. J Bone Joint Surg Br. 2005;
87:1488-1492.
6. Rajasekhar C, Das S, Smith A. Unicompartmental knee
arthroplasty: 2- 12-year results in a community hospital.
J Bone Joint Surg Br. 2004; 86:983-985.
7. Pandit H, Jenkins C, Barker K, Dodd CA, Murray DW. The
Oxford medial unicompartmental knee replacement using
a minimally-invasive approach. J Bone Joint Surg Br.
2006; 88:54-60.
BI-COMPARTMENTAL KNEE
Alois Franz
Hospital for Orthopedic Surgery and Sportmedicine
Marienkrankenhaus,
Siegen (Germany)
Total Knee Prostheses have evolved over the years to the
current mechanically superior anatomic designs and thus
converting Total Knee Arthroplasty into one of the most successful
surgical procedures. Future success in improving TKA
requires attention to the knee prostheses design but also to
the patient profile and its expectations. Stratification of the
patients based on different activity levels (demand) and
pathologies (severity of osteoarthritis, compartmental distribution
and Soft Tissue affection) must be done in order to
find the best solution to relief the original symptoms and restore
the normal motion of the knee. Therefore, following the
same principle, stratification on the knee port-folios should
also be driven in order to meet in every single pathological
case its ideal solution. The Journey DEUCE is the first knee
device that treats Bi-Compartmental Knee Arthritis while
leaving the pristine lateral condyle intact (Bone sparing) and
preserving both ACL and PCL (Soft Tissue sparing) in order
to improve the proprioception.
The Surgical Technique has been designed based on a
Primary TKA in order to facilitate as much as possible the
procedure. On the tibial side, the medial tibial plateau is
resected with the aid of an Extramedullary Alignment System.
On the femoral preparation first the IM canal is opened. The
Whiteside line or/and Epicondylar lines can be marked to act
as landmarks for the positioning of the anterior cutting block
and the determination of the external rotation. After the release
of the anterior cutting block, the transition point has to be
marked. This is the most distal part of the lateral condyle
(where the resection meets the lateral cartilage). This point
acts as reference for the positioning of the Distal Cutting Block
system (for its varus/valgus position). After having re-sected
the medial distal condyle, a 3-in-1 cutting block (anterior
chamfer, posterior chamfer and posterior condyle cuts) has
to be placed against the distal and anterior cuts of the femur.
Once all the cuts are done, the Trial Reduction can be
performed. If the desired stability has been achieved, the peg
holes of both femur and tibia are performed.