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The 2nd Unicompartmental Arthritis Meeting
The Knee 7 Ž2000. 261᎐262
Meeting report
The 2nd Unicompartmental Arthritis Meeting
The 2nd Unicompartmental Arthritis meeting was held in the Postgraduate Centre, Avon Orthopaedic Centre, Southmead Hospital in Bristol on 16 May 2000. The program consisted of three symposia; the first on the pathology and natural history of osteoarthritis ŽOA.; the second on osteotomy and the third on unicompartmental replacement. The meeting allowed a great deal of discussion amongst participants and a lively exchange of views from the floor as well as a number of excellent presentations from which I would highlight the following. Professor Dieppe discussed the epidemiology of OA. He emphasized that the knee joint behaved as two distinct joints; the tibiofemoral and patellofemoral compartments. Until recently, epidemiological studies have often neglected the patellofemoral compartment. He cited one community study of people aged greater than 55 years of age in which 25% of those studied complained of knee pain. The medial compartment of the knee is affected much more frequently than the lateral and this may be because the cartilage in that compartment is much thinner. Approximately 24% of females aged greater than 55 years have some radiological evidence of isolated patellofemoral OA. Patients Ž12%. in this age group who are asymptomatic have radiological evidence of osteoarthritis. Professor Dieppe reiterated risk factors for progression. Obesity, injury and a past history of menisectomy are strongly associated with medial compartment progression but appear not to be associated with progression in the patellofemoral compartment where a family history and Heberden’s nodes are predictors of likely progression. In the past scintigraphy has been useful for identification of joints at risk of progressive osteoarthritis. In the future, identification of joints likely to deteriorate may be aided by blood or synovial fluid analysis. White and Porteous discussed the pathology of medial compartment osteoarthritis and debated whether the presence of an intact anterior cruciate
ligament determined whether or not the disease remained localised to the anterior part of the medial compartment or progressed to involve the other parts of the joint. Although not in total agreement, the available evidence suggests that the severest pathology does occur anteriomedially as long as the anterior cruciate ligament remains intact and spreads posteriorly with increasing ligament dysfunction. Weale presented data from studies examining the progression of OA after high tibial osteotomy ŽHTO. and unicompartmental replacement ŽUKR.. He suggested that progressive arthritis may be inevitable after HTO but that the risk of progression after UKR can be very low provided that patients are carefully selected for that procedure and that care is taken to avoid overcorrection of deformity at the time of operation. Thorpe presented interesting data from a study comparing the progression of OA 10 years after treatment with medial UKR and a control group of patients with OA treated medically. Preliminary results suggest that the incidence of progressive changes can be shown to diminish as a consequence of replacement. He had compared a group of patients in whom medial UKR had been performed more than 10 years previously with a matched group treated medically. Progressive osteoarthritis was identified in 14% of cases treated by UKR and in 29% of cases treated medically. The keynote speaker of the meeting was Professor Hernigou who presented his massive experience of various osteotomies around the knee. He reported the results of 245 opening wedge HTOs using a polymethylmethacrylate spacer which can control accurately the angular correction of coronal plane deformity. He presented outstanding results with excellent survival of the procedure and few complications. He recommended opening wedge HTO for medial compartment disease in young Žaged 40᎐50 years. patients with pain and high demands. Non- or delayed-union of the osteotomy has not been a significant problem.
0968-0160r00r$ - see front matter 䊚 2000 Elsevier Science B.V. All rights reserved. PII: S 0 9 6 8 - 0 1 6 0 Ž 0 0 . 0 0 0 6 9 - 7
262
Meeting Report
Professor Hernigou also discussed his experience of 57 supracondylar femoral osteotomies for lateral compartment OA. He described useful improvements in knee scores with the latter procedure and reported 92, 78 and 70% survival at 5, 10 and 15 years, respectively. Professor Hernigou recommends intercondylar femoral osteotomy for severe osteoarthritis associated with severe ligamentous laxity. He has performed 75 such procedures and reported survival of 88, 75 and 67% at 5, 10 and 15 years, respectively. He emphasized that the procedure was technically demanding and carried significant risks. Professor Hemigou also described proximal tibial varus osteotomy for lateral compartment OA and reported 5, 10 and 15 year survival rates of 80, 61 and 42%, respectively, but stressed that this procedure is only appropriate for very mild cases. The final two papers from Oxford presented some of their current thoughts on the role of Oxford meniscal bearing UKR. Price discussed indications for Oxford UKR and cited survival studies from Oxford and
Sweden with 10 year survival rates of 98 and 95%, respectively. Implant survival was worse in cases where the anterior cruciate ligament was absent but he presented data suggesting that minor attenuation of the anterior cruciate ligament did not necessarily lead to premature failure of the prosthesis. He presented data to indicate that the results of Oxford medial UKR were not influenced by age or obesity. Dodd described the Oxford experience with minimally invasive implantation using an accelerated rehabilitation regime with powerful post-operative analgesics permitting discharge from hospital within 24 h of operation. He cited a significantly reduced time to functional recovery as the principal advantage of the minimally invasive technique and discussed the future possibilities for daycase UKR. A. Weale Bristol Royal Infirmary, Marlborough Street, Bristol BS2 8HW, UK
Meeting report
The 2nd Unicompartmental Arthritis Meeting
The 2nd Unicompartmental Arthritis meeting was held in the Postgraduate Centre, Avon Orthopaedic Centre, Southmead Hospital in Bristol on 16 May 2000. The program consisted of three symposia; the first on the pathology and natural history of osteoarthritis ŽOA.; the second on osteotomy and the third on unicompartmental replacement. The meeting allowed a great deal of discussion amongst participants and a lively exchange of views from the floor as well as a number of excellent presentations from which I would highlight the following. Professor Dieppe discussed the epidemiology of OA. He emphasized that the knee joint behaved as two distinct joints; the tibiofemoral and patellofemoral compartments. Until recently, epidemiological studies have often neglected the patellofemoral compartment. He cited one community study of people aged greater than 55 years of age in which 25% of those studied complained of knee pain. The medial compartment of the knee is affected much more frequently than the lateral and this may be because the cartilage in that compartment is much thinner. Approximately 24% of females aged greater than 55 years have some radiological evidence of isolated patellofemoral OA. Patients Ž12%. in this age group who are asymptomatic have radiological evidence of osteoarthritis. Professor Dieppe reiterated risk factors for progression. Obesity, injury and a past history of menisectomy are strongly associated with medial compartment progression but appear not to be associated with progression in the patellofemoral compartment where a family history and Heberden’s nodes are predictors of likely progression. In the past scintigraphy has been useful for identification of joints at risk of progressive osteoarthritis. In the future, identification of joints likely to deteriorate may be aided by blood or synovial fluid analysis. White and Porteous discussed the pathology of medial compartment osteoarthritis and debated whether the presence of an intact anterior cruciate
ligament determined whether or not the disease remained localised to the anterior part of the medial compartment or progressed to involve the other parts of the joint. Although not in total agreement, the available evidence suggests that the severest pathology does occur anteriomedially as long as the anterior cruciate ligament remains intact and spreads posteriorly with increasing ligament dysfunction. Weale presented data from studies examining the progression of OA after high tibial osteotomy ŽHTO. and unicompartmental replacement ŽUKR.. He suggested that progressive arthritis may be inevitable after HTO but that the risk of progression after UKR can be very low provided that patients are carefully selected for that procedure and that care is taken to avoid overcorrection of deformity at the time of operation. Thorpe presented interesting data from a study comparing the progression of OA 10 years after treatment with medial UKR and a control group of patients with OA treated medically. Preliminary results suggest that the incidence of progressive changes can be shown to diminish as a consequence of replacement. He had compared a group of patients in whom medial UKR had been performed more than 10 years previously with a matched group treated medically. Progressive osteoarthritis was identified in 14% of cases treated by UKR and in 29% of cases treated medically. The keynote speaker of the meeting was Professor Hernigou who presented his massive experience of various osteotomies around the knee. He reported the results of 245 opening wedge HTOs using a polymethylmethacrylate spacer which can control accurately the angular correction of coronal plane deformity. He presented outstanding results with excellent survival of the procedure and few complications. He recommended opening wedge HTO for medial compartment disease in young Žaged 40᎐50 years. patients with pain and high demands. Non- or delayed-union of the osteotomy has not been a significant problem.
0968-0160r00r$ - see front matter 䊚 2000 Elsevier Science B.V. All rights reserved. PII: S 0 9 6 8 - 0 1 6 0 Ž 0 0 . 0 0 0 6 9 - 7
262
Meeting Report
Professor Hernigou also discussed his experience of 57 supracondylar femoral osteotomies for lateral compartment OA. He described useful improvements in knee scores with the latter procedure and reported 92, 78 and 70% survival at 5, 10 and 15 years, respectively. Professor Hernigou recommends intercondylar femoral osteotomy for severe osteoarthritis associated with severe ligamentous laxity. He has performed 75 such procedures and reported survival of 88, 75 and 67% at 5, 10 and 15 years, respectively. He emphasized that the procedure was technically demanding and carried significant risks. Professor Hemigou also described proximal tibial varus osteotomy for lateral compartment OA and reported 5, 10 and 15 year survival rates of 80, 61 and 42%, respectively, but stressed that this procedure is only appropriate for very mild cases. The final two papers from Oxford presented some of their current thoughts on the role of Oxford meniscal bearing UKR. Price discussed indications for Oxford UKR and cited survival studies from Oxford and
Sweden with 10 year survival rates of 98 and 95%, respectively. Implant survival was worse in cases where the anterior cruciate ligament was absent but he presented data suggesting that minor attenuation of the anterior cruciate ligament did not necessarily lead to premature failure of the prosthesis. He presented data to indicate that the results of Oxford medial UKR were not influenced by age or obesity. Dodd described the Oxford experience with minimally invasive implantation using an accelerated rehabilitation regime with powerful post-operative analgesics permitting discharge from hospital within 24 h of operation. He cited a significantly reduced time to functional recovery as the principal advantage of the minimally invasive technique and discussed the future possibilities for daycase UKR. A. Weale Bristol Royal Infirmary, Marlborough Street, Bristol BS2 8HW, UK