Indelli Pier Francesco, Risitano Salvatore, Pipino Gennaro, Ghirardelli Stefano, Violante Bruno
European Knee Associates (EKA), Luxembourg.
Orthop Rev (Pavia). 2021 Jan 27;12(4):8806. doi: 10.4081/or.2020.8806. eCollection 2020 Dec 31.
Unicompartmental Knee Arthroplasty (UKA) is an effective surgical option for managing unicompartmental knee osteoarthritis; it represents 10% of all knee arthroplasties worldwide, increasing 32.5% annually in the United States alone. Despite evolution in surgical technique and implant design, success rate and long-term survivorship of UKA have been historically lower than Total Knee Arthroplasty (TKA). The most common causes of UKA failure leading to revision are polyethylene wear, progression of arthritis, aseptic loosening and patella-femoral symptoms due to poor patient selection in many cases. Historically, UKA revisions have presented technical challenges mainly related to managing residual bone defects and ligament insufficiency ultimately leading to knee instability: the fear of instability has often pushed surgeons to lower the threshold for an increase of the intra-articular level of constraint. Unfortunately, the use of more constrained implants requires sacrificing bone stock and has been related to higher rates of re-revision secondary to recurrence of aseptic loosening. Because of these challenges, the authors developed a surgical technique that could combine balancing the knee during revision surgery with the use of the less constrained polyethylene option. To achieve this, we started evaluating a novel device (VERASENSE, Orthosensor, FL) designed to support soft tissue balancing during primary TKA. This intraoperative sensing technology dynamically quantifies intra-articular loads during TKA trial with the goal of correcting any residual imbalance in real time. Herein we propose a novel surgical technique, which might allow use of a primary TKA design characterized by a lower level of constraint, instead of a constrained or hinged revision knee system, during UKA revision. A key aspect of this technique is the use of sensing technology during intraoperative stability testing.
单髁膝关节置换术（UKA）是治疗单髁膝关节骨关节炎的一种有效手术选择；它占全球所有膝关节置换术的10%，仅在美国每年就增长32.5%。尽管手术技术和植入物设计有所发展，但UKA的成功率和长期生存率历来低于全膝关节置换术（TKA）。导致翻修的UKA失败的最常见原因是聚乙烯磨损、关节炎进展、无菌性松动以及在许多情况下由于患者选择不当导致的髌股症状。从历史上看，UKA翻修存在技术挑战，主要与处理残留骨缺损和韧带不足最终导致膝关节不稳定有关：对不稳定的担忧常常促使外科医生降低增加关节内约束水平的阈值。不幸的是，使用更多约束性植入物需要牺牲骨量，并且与无菌性松动复发导致的更高翻修率有关。由于这些挑战，作者开发了一种手术技术，该技术可以在翻修手术中平衡膝关节的同时使用约束性较小的聚乙烯选项。为了实现这一目标，我们开始评估一种新型设备（VERASENSE，Orthosensor，佛罗里达州），该设备旨在支持初次TKA期间的软组织平衡。这种术中传感技术在TKA试验期间动态量化关节内负荷，目的是实时纠正任何残留的不平衡。在此，我们提出一种新型手术技术，该技术可能允许在UKA翻修期间使用具有较低约束水平的初次TKA设计，而不是使用约束性或铰链式翻修膝关节系统。该技术的一个关键方面是在术中稳定性测试期间使用传感技术。
