Arthritis Knee Clinical Trial
Official title:
Preoperative Radiographic Evaluation of Medial Tibiofemoral Knee Osteoarthritis: Reproducibility, Reliability and Correlation With Ligament Injury
Observational study.
In advanced stage osteoarthritis or osteonecrosis of the articular bearing surfaces of the
knee, the surgical therapeutic solutions consist of a replacement of the articular surfaces
by prosthetic implants. Depending on whether these implants replace all or part of the
articular surfaces they are called "total" or "uni compartmental" knee prosthesis.
The uni-compartmental medial prosthesis replaces only the medial tibiofemoral compartment of
the knee and is therefore intended for patients with cartilaginous wear isolated from this
compartment.
The uni-compartmental medial prosthesis has advantages over the total knee arthroplasty of
being more economical in articular tissues of the knee, having better functional results and
lower complication rates. Although this is debated, the survival rate of uni-compartmental
prostheses in the international registers is lower than that of total knee prostheses.
One of the most common early failure factors of uni-compartmental prostheses is the absence
of a functional anterior cruciate ligament. Other factors have also been identified and are
sometimes highly debated such as the Kozinn and Scott criteria. The group of designers of the
unicompartmental Oxford Uni compartmental prosthesis Knee Arthroplasty (OUKA) (Zimmer Biomet,
Warsaw) proposed and validated expanded criteria. These criteria, exclusively radiographic,
are grouped in a document called "decision aid" to check the functional status of the
collateral ligaments medial and anterior cross, other compartments of the knee (lateral
femoro-tibial and femoro-patellar).
In decision aid, the functional status of the anterior cruciate ligament is judged on the
knee radiograph by the location of the osteoarthritic cup. If it is present and functional,
the cartilaginous wear is anterior with a respect of the posterior portion of the tibial
plateau.
After regular use of the French version of the decision aid, the assessment of the location
of osteoarthritis seems subjective to us however it is essential to validate the indication
of a uni-compartmental prosthesis. In case of poor evaluation, the risk is the intraoperative
discovery of the actual status of the anterior cruciate ligament that may result in a change
of indication and the installation of a total knee prosthesis. The investigators have not
found in the literature, studies evaluating the reliability and reproducibility of the
lateral radiograph to judge the functional status of the anterior cruciate ligament.
The hypothesis is that the lateral radiograph is unreliable and reproducible to judge the
functional status of the anterior cruciate ligament in a population of patients with medial
femoro-tibial knee osteoarthritis.
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