The effect of activity on the outcome of cementless mobile bearing unicompartmental knee replacements

Hasan Raza Mohammad; Andrew Judge; Christopher Dodd; David Murray

doi:10.1016/j.knee.2023.03.005

The effect of activity on the outcome of cementless mobile bearing unicompartmental knee replacements

Hasan Raza Mohammad^*
, Andrew Judge
, Christopher Dodd
, David Murray

^*Corresponding author for this work

Bristol Medical School (THS)

Research output: Contribution to journal › Article (Academic Journal) › peer-review

3 Citations (Scopus)

72 Downloads (Pure)

Abstract

BACKGROUND: Many surgeons consider high activity levels a contraindication to Unicompartmental Knee Replacement (UKR). Cementless fixation is of particular concern given the lack of cement to augment primary stability. We assessed the effect of pre and post-operative activity levels on the outcomes of cementless UKRs.

METHODS: A prospective cohort of 1000 medial cementless mobile bearing UKR were analysed. Patients were categorised by their pre-operative and highest post-operative Tegner Activity Score (TAS) and results compared between groups. Outcomes of interest included implant survival, Oxford Knee Score (OKS) and the American Knee Society Score - Objective/Functional (AKSS-O/F).

RESULTS: Increasing post-operative activity were not associated with higher revision rates. The 10-year survival of the high activity group (TAS ≥ 5, 96.7% (CI 91.3-98.8), and low/medium activity group (TAS ≤ 4, 98.1% (CI 96.5-99.0)) were not significantly different (p = 0.57). The mean 10-year OKS of the high activity group (46.5, SD 3.1) was significantly (p < 0.001) higher than that of the low/medium activity group (41.3, SD 7.7). There was a significant trend for increasing activity being associated with increasing AKSS-F at 5-years (p < 0.001) and 10 years (p = 0.01) and increasing AKSS-O at 5 years (p < 0.001). Higher pre-operative activity did not significantly increase revision rates and resulted in significantly higher 5-year post-operative scores.

CONCLUSIONS: Neither higher pre-operative nor post-operative activity were associated with increased revision rates, but both were associated with better post-operative function. Therefore activity should not be considered a contraindication to cementless mobile bearing UKR and not be restricted post-operatively.

Original language	English
Pages (from-to)	153-160
Number of pages	8
Journal	The Knee
Volume	42
Early online date	30 Mar 2023
DOIs	https://doi.org/10.1016/j.knee.2023.03.005
Publication status	E-pub ahead of print - 30 Mar 2023

Bibliographical note

Funding Information:
An institutional grant to the University of Oxford was received from Zimmer Biomet not specific to this project. Zimmer Biomet played no role in the design, methodology, analysis of results or drafting the manuscript. This work acknowledges the support of the National Institute for Health Research Barts Biomedical Research Centre (NIHR203330). We would also like to thank Cathy Jenkins, Barbara Marks and Jo Brown who created and maintained our knee database.

Publisher Copyright:
© 2023 Elsevier B.V.

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Accepted author manuscript, 253 KBLicence: CC BY-NC-ND

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@article{1a78b038922d4b67ab4f403373c655fd,

title = "The effect of activity on the outcome of cementless mobile bearing unicompartmental knee replacements",

abstract = "BACKGROUND: Many surgeons consider high activity levels a contraindication to Unicompartmental Knee Replacement (UKR). Cementless fixation is of particular concern given the lack of cement to augment primary stability. We assessed the effect of pre and post-operative activity levels on the outcomes of cementless UKRs.METHODS: A prospective cohort of 1000 medial cementless mobile bearing UKR were analysed. Patients were categorised by their pre-operative and highest post-operative Tegner Activity Score (TAS) and results compared between groups. Outcomes of interest included implant survival, Oxford Knee Score (OKS) and the American Knee Society Score - Objective/Functional (AKSS-O/F).RESULTS: Increasing post-operative activity were not associated with higher revision rates. The 10-year survival of the high activity group (TAS ≥ 5, 96.7\% (CI 91.3-98.8), and low/medium activity group (TAS ≤ 4, 98.1\% (CI 96.5-99.0)) were not significantly different (p = 0.57). The mean 10-year OKS of the high activity group (46.5, SD 3.1) was significantly (p < 0.001) higher than that of the low/medium activity group (41.3, SD 7.7). There was a significant trend for increasing activity being associated with increasing AKSS-F at 5-years (p < 0.001) and 10 years (p = 0.01) and increasing AKSS-O at 5 years (p < 0.001). Higher pre-operative activity did not significantly increase revision rates and resulted in significantly higher 5-year post-operative scores.CONCLUSIONS: Neither higher pre-operative nor post-operative activity were associated with increased revision rates, but both were associated with better post-operative function. Therefore activity should not be considered a contraindication to cementless mobile bearing UKR and not be restricted post-operatively.",

author = "Mohammad, \{Hasan Raza\} and Andrew Judge and Christopher Dodd and David Murray",

note = "Funding Information: An institutional grant to the University of Oxford was received from Zimmer Biomet not specific to this project. Zimmer Biomet played no role in the design, methodology, analysis of results or drafting the manuscript. This work acknowledges the support of the National Institute for Health Research Barts Biomedical Research Centre (NIHR203330). We would also like to thank Cathy Jenkins, Barbara Marks and Jo Brown who created and maintained our knee database. Publisher Copyright: {\textcopyright} 2023 Elsevier B.V.",

year = "2023",

month = mar,

day = "30",

doi = "10.1016/j.knee.2023.03.005",

language = "English",

volume = "42",

pages = "153--160",

journal = "The Knee",

issn = "0968-0160",

publisher = "Elsevier B.V.",

}

TY - JOUR

T1 - The effect of activity on the outcome of cementless mobile bearing unicompartmental knee replacements

AU - Mohammad, Hasan Raza

AU - Judge, Andrew

AU - Dodd, Christopher

AU - Murray, David

N1 - Funding Information: An institutional grant to the University of Oxford was received from Zimmer Biomet not specific to this project. Zimmer Biomet played no role in the design, methodology, analysis of results or drafting the manuscript. This work acknowledges the support of the National Institute for Health Research Barts Biomedical Research Centre (NIHR203330). We would also like to thank Cathy Jenkins, Barbara Marks and Jo Brown who created and maintained our knee database. Publisher Copyright: © 2023 Elsevier B.V.

PY - 2023/3/30

Y1 - 2023/3/30

N2 - BACKGROUND: Many surgeons consider high activity levels a contraindication to Unicompartmental Knee Replacement (UKR). Cementless fixation is of particular concern given the lack of cement to augment primary stability. We assessed the effect of pre and post-operative activity levels on the outcomes of cementless UKRs.METHODS: A prospective cohort of 1000 medial cementless mobile bearing UKR were analysed. Patients were categorised by their pre-operative and highest post-operative Tegner Activity Score (TAS) and results compared between groups. Outcomes of interest included implant survival, Oxford Knee Score (OKS) and the American Knee Society Score - Objective/Functional (AKSS-O/F).RESULTS: Increasing post-operative activity were not associated with higher revision rates. The 10-year survival of the high activity group (TAS ≥ 5, 96.7% (CI 91.3-98.8), and low/medium activity group (TAS ≤ 4, 98.1% (CI 96.5-99.0)) were not significantly different (p = 0.57). The mean 10-year OKS of the high activity group (46.5, SD 3.1) was significantly (p < 0.001) higher than that of the low/medium activity group (41.3, SD 7.7). There was a significant trend for increasing activity being associated with increasing AKSS-F at 5-years (p < 0.001) and 10 years (p = 0.01) and increasing AKSS-O at 5 years (p < 0.001). Higher pre-operative activity did not significantly increase revision rates and resulted in significantly higher 5-year post-operative scores.CONCLUSIONS: Neither higher pre-operative nor post-operative activity were associated with increased revision rates, but both were associated with better post-operative function. Therefore activity should not be considered a contraindication to cementless mobile bearing UKR and not be restricted post-operatively.

AB - BACKGROUND: Many surgeons consider high activity levels a contraindication to Unicompartmental Knee Replacement (UKR). Cementless fixation is of particular concern given the lack of cement to augment primary stability. We assessed the effect of pre and post-operative activity levels on the outcomes of cementless UKRs.METHODS: A prospective cohort of 1000 medial cementless mobile bearing UKR were analysed. Patients were categorised by their pre-operative and highest post-operative Tegner Activity Score (TAS) and results compared between groups. Outcomes of interest included implant survival, Oxford Knee Score (OKS) and the American Knee Society Score - Objective/Functional (AKSS-O/F).RESULTS: Increasing post-operative activity were not associated with higher revision rates. The 10-year survival of the high activity group (TAS ≥ 5, 96.7% (CI 91.3-98.8), and low/medium activity group (TAS ≤ 4, 98.1% (CI 96.5-99.0)) were not significantly different (p = 0.57). The mean 10-year OKS of the high activity group (46.5, SD 3.1) was significantly (p < 0.001) higher than that of the low/medium activity group (41.3, SD 7.7). There was a significant trend for increasing activity being associated with increasing AKSS-F at 5-years (p < 0.001) and 10 years (p = 0.01) and increasing AKSS-O at 5 years (p < 0.001). Higher pre-operative activity did not significantly increase revision rates and resulted in significantly higher 5-year post-operative scores.CONCLUSIONS: Neither higher pre-operative nor post-operative activity were associated with increased revision rates, but both were associated with better post-operative function. Therefore activity should not be considered a contraindication to cementless mobile bearing UKR and not be restricted post-operatively.

U2 - 10.1016/j.knee.2023.03.005

DO - 10.1016/j.knee.2023.03.005

M3 - Article (Academic Journal)

C2 - 37003091

SN - 0968-0160

VL - 42

SP - 153

EP - 160

JO - The Knee

JF - The Knee

ER -

The effect of activity on the outcome of cementless mobile bearing unicompartmental knee replacements

Abstract

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