ISAKOS Congress 2021

2021 ISAKOS Biennial Congress Paper

 

Bone Marrow Lesion In All Compartment Does Not Affect The Long-Term Clinical Follow-Up After Medial Unicompartmental Knee Arthroplasty

Kyung Jun Min, MD, Seoul, Seoul KOREA, REPUBLIC OF
Byoung-Hyun Min, MD, PhD, Suwon, Gyeonggi-Do KOREA, REPUBLIC OF
Do-Young Park, MD, PhD, Suwon, Gyeonggi-do KOREA, REPUBLIC OF
Jun-Young Chung, MD, Suwon, Gyeonggi-do KOREA, REPUBLIC OF
Keun Soo Kim, MD KOREA, REPUBLIC OF
Sumin Lim, MD, Gyeonggi-Do KOREA, REPUBLIC OF

Ajou University Hospital, Suwon, Gyeonggi-Do, KOREA, REPUBLIC OF

FDA Status Not Applicable

Summary

Evaluation of correlation between bone marrow lesion and medial unicompartmental knee arthroplasty outcomes.

Abstract

Background

Bone marrow lesion is significantly related to pain in knee osteoarthritis. New or enlarging bone marrow lesions are associated with accelerated cartilage loss. Unfortunately, the size of the bone marrow lesions of the natural history rarely decreases (0.6%), often remains unchanged (73%), and sometimes increases (27%). In a few previous literature, conflicting results have been raised regarding the effect of preoperative bone marrow lesions on course after unicompartmental knee arthroplasty. The purpose of this study is to compare pain and functional outcomes between patients with medial unicompartmental knee replacement based on the location and size of bone marrow lesions at long-term follow-up

Method

We retrospectively evaluated patients who underwent medial unicompartmental knee arthroplasty in our institution between 2002 and 2015. Preoperative MRI was evaluated, and 6 compartments (medial femoral condyle, lateral femoral condyle, medial tibial condyle, lateral tibial condyle, trochlea, and patella) were recorded as 4 grades (0, 1, 2, 3) each. Preoperative and postoperative WOMAC index and range of motion (ROM) were compared between patients based on the location and sized of bone marrow lesion. We also evaluated the effect of medial unicompartmental knee arthroplasty comparing with patients who had bone marrow lesions and kept on conservative care.

Results

A total of 158 patients (167 knees) had a mean follow-up period of 10.02 years. The medial femoral condyle and medial tibial condyle showed high prevalence of bone marrow lesions of 86% and 81%, respectively. The presence of bone marrow lesions was associated with preoperative WOMAC in all compartments except lateral femoral condyle compartment. The bone marrow lesions of lateral femoral condyle, lateral tibial condyle, trochlea, and patella were related to preoperative range of motion (p= .001, p=.05, p=.06, and p=.03, respectively). The presence and severity of bone marrow lesions in all compartments did not significantly adversely affect the postoperative WOMAC index.

Conclusion

Bone marrow lesions in all compartments were not associated with inferior outcomes at long-term follow-up after unicompartmental knee arthroplasty. These findings suggest that unicompartmental knee arthroplasty is associated with a reduction in pain and dysfunction in daily life from bone marrow lesions. Therefore, osteoarthritis with bone marrow lesions may be an appropriate indication for unicompartmental knee arthroplasty.

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