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Minimal İnvaziv Unikompartmantal Diz Artroplasti (MİUCA) Oxford Gurubu Radyolojik Değerlendirmesine Göre Sık Uygulama Hataları

Amaç: Nisan 2010 ve Eylül 2019 tarihleri arasında aynı cerrah tarafından,aynı yöntem ile Minimal İnvaziv Unikompartmantal Diz Artroplastisi(MİUCA) uygulanmış 93 hastanın 104 dizi çalışmaya alındı. Bu çalışmada amacımız: MİUCA’da uygulamaya bağlı teknik hataların, Oxford gurubunun radyolojik değerlendirme kriterleri kullanılarak, sık yapılan implant uygulama kusurlarının ortaya konmasıdır. Gereç ve Yöntem: Bu çalışmaya Nisan 2010 ve Temmuz 2017 arasında MİUCA uyguladığımız ve takiplerini kayıt altına alabildiğimiz 94 hastanın 104 dizi çalışmaya alındı, 13 erkeğin 14 dizi ve 80 kadının 90 dizi. Ortalama kadın yaşı; 56.38 (dağılım: 46-74) ve ortalama erkek yaşı; 57.80 (dağılım: 48-66). Ortalama yaş; 57.12 (dağılım:46-74). Ortalama takip süresi:58 ay (dağılım:3-104). 82 dize fix-bearing, 22 dize mobil-bearing MİUCA uygulandı. Preoperatif dönemde: standart iki yönlü diz grafisi ile medial eklemdeki OA derecesi ve valgus stres testi ile varus deformitesinin esnekliği değerlendirildi. Postoperatif değerlendirmede; hastalara rutin iki yönlü diz grafisi çekilerek, Oxford diz grubunun önerdiği radyolojik ölçümler yapıldı(8). MİUCA uygulanan dizler bir bütün olarak Oxford grubunun önerdiği 17 kriterin tamamı ile değerlendirildi. Femoral komponent 10 derece altında varus-valgus açısı, 5 derece altında fleksiyon-ekstensiyon açısı olmalı. Tibial komponent 10 derece altında varus-valgus açısı , medial platoda 2 mm den az taşma , posterior slop 7 ve -5 derece arası olmalı. İnsörtte komponentler arası uyum olmalı. Bulgular: Tibial komponent; Varus/Valgus:-4 (valgus) ve 8 (varus) derece aralığı dışında iki hasta bulundu. Slope: İki dizde (8 ve 10 derece) slope normal sınırın dışında ölçüldü. İmplantta taşma durumu: 11 diz posterior, 2 diz anterior ve 2 dizde medial platodan 2 mm ve üstü taşma görüldü. Tibial sement taşma durumu: 12 dizde vardı.Femoral komponenet, Valgus-Varus pozisyonu: 34 diz valgusta, ortalama: 5.41 (dağılım:3-10 derece), 19 diz varusta, ortalama: 4.58 (dağılım:4-8 derece) olarak ölçüldü tamamı kabul edilebilir sınırlardaydı. Fleksiyon-Estensiyon durumu: 52 diz fleksiyonda,ortalama: 3.95 (dağılım:2-35 derece) ölçüldü, bunlardan 21 diz 5 dereceden fazla fleksiyonda ölçüldü.16 diz ekstensiyonda ortalama: 3 (dağılım:1-10 derece) ölçüldü, bunlardan 4 diz 5 dereceden fazla ekstensiyonda ölçüldü. Bir dizde polietilen insört ve komponenetler arası uyumsuzluk vardı (Mobil UCA). 20 dizde femoral komponentin arka duvarında 2 mm gap vardı. Sonuç: Oxford diz gurubunun postoperatif MİUCA değerlendirmedsine göre sık uygulama hatalarımız; Femoral komponentte protezin 5 derece üstünde fleksiyonda uygulanması(21 diz), femoral komponentin arka duvarında 2 mm gap varlığı(20 diz). Tibial komponentte protezin posteriore taşması(11 diz), tibial komponentteki sementin taşması(12 diz).Anahtar Kelimeler: Gonartroz, Unicompartmental diz protezi

Common Errors in The Practice According to Oxford Group Radiological Assessment Criteria in Minimally Invasive Unicompartmental Knee Arthroplasty

Objective: 104 knees from 93 patients, who received minimally invasive unicompartmental knee arthroplasty (MIUKA) from the same surgeon using the same method from April 2010 to September 2019, were reviewed. The main objective of our study is to pinpoint the errors seen frequently in implant applications such as technical errors in practice and angular deformities in MIUKA by using criteria from Oxford Group. Materials and Methods: The study included 104 knees from 94 patients with accessible patient record files who received MIUKA treatment between April 2010 and July 2017; with 14 knees from 13 males and 90 knees from 80 female patients. The mean age in females was calculated as 56.38 (46 - 74) and as 57.80 (48 - 66) in male patients. The patients’ mean age was 57.12 (46-74). The mean follow-up period was 58 months (Range: 3-104). 82 knees received fixed-bearing and 22 knees received mobile-bearing MIUKA. During the preoperative period, a standard AP knee x-ray was used to assess OA degree in the medial joint and the varus deformity flexibility using valgus stress test. The post-operative assessment was done over routine AP knee x-ray results using radiological measurements recommended by Oxford knee group. All the knees treated with MIUKA were assessed as a whole using all 17 criteria recommended by Oxford group. The femoral component should show a varusvalgus angle below 10 degrees with a flexion-extension angle below 5 degrees. The tibial component should show the varus-valgus angle below 10 degrees with an overlap of less than 2 degrees in the medial plateau and the posterior slope between 7 to -5 degrees. Components should be compatible in the insert. Results: Tibial component: Varus Valgus; 2 patients were found to have a knee result outside of the recommended -4 (varus) and 8 (valgus) degrees. Slope: Slope was out of bounds in 2 knees (8 and 10 degrees, respectively). Implant overlap: 11 knees showed posterior, 2 knees showed anterior and 2 knees in medial plateau showed an overlap of 2 mm and over. Tibial cement overflow was seen in 12 knees.Femoral component: Valgus-Varus position; in 34 knees, the mean valgus degree was 5.41 (spread: 3-10 degrees) and the mean varus in 19 knees was measured as 4.58 (spread:4-8 degrees), which were within acceptable values. Flexion-Extension status: Mean flexion angle in 52 knees was measured as 3.95 (spread: 2-35 degrees), with 21 knees over 5 degrees of flexion. Mean knee extension angle was measured as 3 (spread: 1-10 degrees), with 4 knees over 5 degrees in extension. One knee showed an incompatibility between polyethylene insert and components (Mobile UCA). A 2-mm gap was seen on the back wall of the femoral component in 20 knees. Conclusion: The most commonly seen practice errors we came across in the postoperative MIUKA Oxford knee group assessment were the application of the prosthesis with over 5 degrees of flexion in the femoral component (21 knees) and a 2-mm gap on the back wall of the femoral component (20 knees). In the tibial component, the most commonly seen errors were the prosthesis overlap towards the posterior (11 knees) and the overflow of tibial cement (12 knees).Keywords: Gonartroz, Unicompartmental knee arthroplasty

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