Röttinger Timon, Lisitano Leonard, Wiedl Andreas, Mayr Edgar, Röttinger Heinz
Department of Trauma Surgery, Orthopedics, Plastic and Hand Surgery, University Hospital of Augsburg, Augsburg, Germany.
Department of Athroplasty, München Klinik Neuperlach, Munich, Germany.
Arthroplast Today. 2022 Aug 19;17:94-100. doi: 10.1016/j.artd.2022.06.019. eCollection 2022 Oct.
Mobile-bearing unicompartmental knee arthroplasty (MB-UKA) is a proven implant that has reliably delivered excellent results for decades. Based on the constrained implant design in MB-UKA, the occasional occurrence of anterior impingement should be expected. However, surprisingly, there are no clinical reports.
From 2016 to 2020, 14 patients with anterior medial knee pain were admitted to our arthroplasty center after MB-UKA implantation elsewhere. After taking the medical history and clinical examination, radiological imaging of the implant in at least 2 planes, including a whole-leg anteroposterior view, was performed. The "Knee Society Score (KSS)" and the "Knee Injury and Osteoarthritis Outcome Score (KOOS)" were recorded. Anterior impingement was diagnosed by reviewing the typical findings and specific exclusion of other diagnoses.
The 14 patients showed a KSS of 46.6 and a KOOS of 51.5. The average pain level on the "Visual Analog Scale" was 7.8. The positioning of the implants showed consistently noticeable deviations from the standard recommendations. All 14 patients were treated by removing the MB-UKA and changing to a complete TKA. At the 12-month follow-up, the average Visual Analog Scale score was 1.8, and KOOS and KSS were 86 and 82, respectively.
The potential risk of anterior impingement in MB-UKA can be assumed. Diagnosis requires a detailed collection of medical history and clinical details combined with accurate radiological imaging. The cause of anterior impingement in MB-UKA is multifactorial and refers in our small group to the sum of minor deviations in implant positioning compared to the general recommendations.
活动平台单髁膝关节置换术（MB-UKA）是一种经过验证的植入物，几十年来一直可靠地带来优异的效果。基于MB-UKA中受限的植入物设计，偶尔出现前侧撞击是可以预料的。然而，令人惊讶的是，尚无临床报告。
2016年至2020年，14例膝关节前内侧疼痛患者在其他地方接受MB-UKA植入术后被收治到我们的关节置换中心。在采集病史和进行临床检查后，对植入物进行至少两个平面的放射学成像，包括全腿前后位片。记录“膝关节协会评分（KSS）”和“膝关节损伤与骨关节炎转归评分（KOOS）”。通过回顾典型表现并特别排除其他诊断来诊断前侧撞击。
14例患者的KSS为46.6，KOOS为51.5。“视觉模拟量表”上的平均疼痛水平为7.8。植入物的定位显示与标准建议始终存在明显偏差。所有14例患者均通过取出MB-UKA并更换为全膝关节置换术（TKA）进行治疗。在12个月的随访中，平均视觉模拟量表评分为1.8，KOOS和KSS分别为86和82。
可以认为MB-UKA存在前侧撞击的潜在风险。诊断需要详细收集病史和临床细节，并结合准确的放射学成像。MB-UKA前侧撞击的原因是多因素的，在我们的小样本中是指与一般建议相比植入物定位的微小偏差总和。
