The clinical outcomes of cementless unicompartmental knee replacement in patients with reduced bone mineral density

Hasan R Mohammad, James A Kennedy, Stephen J Mellon, Andrew Judge, Christopher A Dodd, David W Murray, Hasan R Mohammad, James A Kennedy, Stephen J Mellon, Andrew Judge, Christopher A Dodd, David W Murray

Abstract

Background: Osteoporosis and osteopenia are conditions characterised by reduced bone mineral density (BMD). There is concern that bone with reduced BMD may not provide sufficient fixation for cementless components which primarily rely on the quality of surrounding bone. The aim of our study was to report the midterm clinical outcomes of patients with reduced BMD undergoing cementless unicompartmental knee replacements (UKR). Our hypothesis was that there would be no difference in outcome between patients with normal bone and those with reduced BMD.

Methods: From a prospective cohort of 70 patients undergoing cementless UKR surgery, patients were categorised into normal (n = 20), osteopenic (n = 38) and osteoporotic groups (n = 12) based on their central dual-energy X-ray absorptiometry (DEXA) scans according to the World Health Organization criteria. Patients were followed up by independent research physiotherapists and outcome scores; Oxford Knee Score (OKS), Tegner score, American Knee Society Score Functional (AKSS-F) and Objective (AKSS-O) were recorded preoperatively and at a mean of 4 years postoperatively. The prevalence of reoperations, revisions and mortality was also recorded at a mean of 5 years postoperatively.

Results: There were no significant differences in the midterm postoperative OKS (P = 0.83), Tegner score (P = 0.17) and AKSS-O (P = 0.67). However, the AKSS-F was significantly higher (P = 0.04) in normal (90, IQR 37.5) compared to osteoporotic (65, IQR 35) groups. There were no significant differences (P = 0.82) between normal and osteopenic bone (80, IQR 35). The revision prevalence was 5%, 2.6% and 0% in the normal, osteopenic and osteoporotic groups respectively. The reoperation prevalence was 5%, 7.9% and 0% respectively. There were no deaths in any group related to the implant.

Conclusions: We found that patients with reduced BMD could safely undergo cementless UKR surgery and have similar clinical outcomes to those with normal BMD. However, larger studies with longer follow-up are needed to confirm our findings and ensure that cementless fixation is safe in patients with reduced BMD.

Keywords: Bone mineral density; Cementless; Oxford UKR.

Conflict of interest statement

HRM reports the Henni Mester Scholarship from University of Oxford, Royal College of Surgeons research grant and the Goodfellow Fellowship. JAK reports a grant to the University of Oxford from Zimmer Biomet. CAD and DM report royalties, consultancy payments related to knee replacements and a grant to the University of Oxford from Zimmer Biomet. AJ and SJM have no potential conflict of interest.

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