Initial Experience of the Journey-Deuce Bicompartmental Knee Prosthesis: A Review of 36 Cases

doi:10.1016/j.arth.2011.03.026

The Journal of Arthroplasty

Volume 26, Issue 6, Supplement, September 2011, Pages 40-45

https://doi.org/10.1016/j.arth.2011.03.026 Get rights and content

Abstract

We evaluated the effectiveness of a novel bicompartmental knee arthroplasty prosthesis for the treatment of degenerative disease affecting the medial and patellofemoral compartments. The study included 36 knees in 32 patients with a mean follow-up of 21 months. The mean Knee Society functional survey and Western Ontario McMaster Osteoarthritic Index Survey scores were 65.4 and 75.8, respectively. Thirty-one percent of patients were unsatisfied with the surgery, and 53% stated that they would not repeat the surgery. We report an overall survival rate of 86% with one catastrophically failed tibial baseplate. We conclude that this prosthesis provides inconsistent pain relief and unacceptable functional results for bicompartmental arthritis. Short-term survival of this prosthesis was unacceptably low, and therefore, we no longer implant it at our institution.

Section snippets

Materials and Methods

From January 2008 to January 2009, 36 BKAs (Smith & Nephew) were implanted in 32 patients. All procedures were performed at a single institution by one surgeon (S. J. R.). Institutional investigational approval was obtained before initiation of the study.

Candidacy for BKA required patients to have bicompartmental osteoarthritis or osteonecrosis affecting the medial and PF compartments with no clinical or radiographic evidence of degenerative changes in the lateral compartment. Inclusion and

Clinical Results

The mean operative time was 87 minutes (range, 60-120 minutes), and the mean length of hospital stay was 2 days (range, 1-5 days). There were no intraoperative complications, and no patient received blood transfusion postoperatively. One patient was transferred to the intensive care unit on postoperative day 2 because of respiratory depression from narcotic use but was discharged home without further sequelae 3 days later. One patient developed a superficial surgical site infection 7 days after

Discussion

This report of 36 Journey-Deuce BKAs is the largest series to date. Over a 2-year period, the device demonstrated poor short-term survival with a revision rate of 14%. These results are inferior to those reported for TKA as well as contemporary methods of individualized medial UKA/PFA resurfacing 17, 23, 24, 25, 26, 27. Importantly, 1 knee was revised because of catastrophic failure of the tibial baseplate 15 months after arthroplasty (Fig. 3); this is the first report of its kind in the

Acknowledgment

Aditya Ancha, a medical student at the University of South Florida, made a valuable contribution to this study.

References (35)

D. Riddle et al.
Yearly incidence of unicompartmental knee arthroplasty in the United States
J Arthroplasty
(2008)
S. Isaac et al.
Does arthroplasty type influence knee joint proprioception? A longitudinal prospective study comparing total and unicompartmental arthroplasty
Knee
(2007)
L. Rolston et al.
Assessment of knee alignment after bicompartmental knee arthroplasty
J Arthroplasty
(2009)
E. Huskisson
Measurement of pain
Lancet
(1974)
F. Ewald et al.
Kinematic total knee arthroplasty: a 10- to 14-year prospective follow-up review
J Arthroplasty
(1999)
L. Ryd et al.
On the correlation between micromotion and histology of the bone-cement interface. Report of three cases of knee arthroplasty followed by roentgen stereophotogrammetric analysis
J Arthroplasty
(1989)
R. Soavi et al.
A roentgen stereophotogrammetric analysis of unicompartmental knee arthroplasty
J Arthroplasty
(2002)
J. Argenson et al.
Modern unicompartmental knee arthroplasty with cement: a three to ten-year follow-up study
J Bone Joint Surg Am
(2002)
R. Berger et al.
Unicompartmental knee arthroplasty. Clinical experience at 6- to 10-year follow-up
Clin Orthop Relat Res
(1999)
N. Mercier et al.
Long-term clinical results of the Oxford medial unicompartmental knee arthroplasty
Int Orthop
(2009)

A. Price et al.

Long-term clinical results of the medial Oxford unicompartmental knee arthroplasty

Clin Orthop Relat Res

(2005)

A. Sah et al.

Unicompartmental knee arthroplasty in octogenarians: survival longer than the patient

Clin Orthop Relat Res

(2006)

J. Skowronski et al.

The Oxford II medial unicompartmental knee replacement. A minimum 10-year follow-up study

Ortop Traumatol Rehabil

(2005)

O. Tabor et al.

Unicompartmental knee arthroplasty: long-term success in middle-age and obese patients

J Surg Orthop Adv

(2005)

T. Heyse et al.

UKA in combination with PFR at average 12-year follow-up

Arch Orthop Trauma Surg

(2009)

J. Lonner

Modular bicompartmental knee arthroplasty with robotic arm assistance

Am J Orthop (Belle Mead NJ)

(2009)

A.L. Malkani et al.

Total knee arthroplasty with the kinematic condylar prosthesis. A ten-year follow-up study

J Bone Joint Surg

(1995)

Cited by (60)

Disease Progression After Unicompartmental Arthroplasty: Add a Compartment or Revise to Total Knee Arthroplasty?
2022, Journal of Arthroplasty
Citation Excerpt :
If symptoms involved 2 compartments, revision to TKA was performed instead of UKA-BCA. Two patients, however, received a combined medial and patellofemoral prosthesis (Deuce; Smith & Nephew, Memphis, TN) (Fig. 2A and B) [19]. These 2 patients were included as UKA-BCA rather than UKA-TKA because the original UKA was left in place.
Five percent to 7% of unicompartmental knee arthroplasties (UKA) require revision for disease progression in untreated compartment(s), most commonly to total knee arthroplasty (TKA). TKA requires removal of bone and usually the anterior cruciate ligament. Preserving the UKA and converting to a bicompartmental arthroplasty (BCA) by performing a second UKA is an alternative.
The results of 73 UKA-BCA patients were compared to 75 patients treated by UKA-TKA revision. Knee Society, Knee Osteoarthritis Outcome Score Joint Replacement, and patient satisfaction scores were collected by a blinded therapist. Patients were asked about their implant preference and recovery. Twenty-two UKA-BCA revision patients had a UKA (6) or TKA (16) in the contralateral knee; thus, a direct comparison of UKA-BCA to both UKA and TKA was possible.
Of the UKA-BCA patients, 69 (94%) had excellent or good, 2 (3%) fair, and 2 (3%) poor outcomes with 1 patient requiring revision to TKA. Of patients with a TKA in the contralateral knee, 13 (81%) preferred the UKA-BCA replacement and 3 (19%) preferred the TKA. All patients said the UKA-BCA revision recovery was similar or easier than their initial UKA. Of UKA-TKA revisions, 59 (79%) had excellent or good, 9 (12%) fair, and 7 (9%) poor outcomes. There was 1 wound infection and 1 re-revision in the UKA-BCA group and 1 wound infection and 3 re-revisions in the UKA-TKA group. The Knee Osteoarthritis Outcome Score Joint Replacement and Knee Society Scores were better for UKA-BCA compared to UKA-TKA.
UKA-BCA is a successful treatment for disease progression following UKA.
What is the Level of Evidence Substantiating Commercial Payers’ Coverage Policies for Total Joint Arthroplasty?
2021, Journal of Arthroplasty
The prevalence of total joint arthroplasty (TJA) in the United States has drawn the attention of health care stakeholders. The payers have also used a variety of strategies to regulate the medical necessity of these procedures. The purpose of this study was to examine the level of evidence of the coverage policies being used by commercial payers in the United States.
The references of the coverage policies of four commercial insurance companies were reviewed for type of document, level of evidence, applicability to a TJA population, and success of nonoperative treatment in patients with severe degenerative joint disease.
282 documents were reviewed. 45.8% were primary journal articles, 14.2% were level I or II, 41.2% were applicable to patients who were candidates for TJA, and 9.9% discussed the success of nonoperative treatment in patients who would be candidates for TJA.
Most of the references cited by commercial payers are of a lower level of scientific evidence and not applicable to patients considered to be candidates for TJA. This is relatively uniform across the reviewed payers. The dearth of high-quality literature cited by commercial payers reflects the lack of evidence and difficulty in conducting high level studies on the outcomes of nonoperative versus operative treatment for patients with severe, symptomatic osteoarthritis. Patients, surgeons, and payers would all benefit from such studies and we encourage professional societies to strive toward that end through multicenter collaboration.
Knee replacement: Clinical perspectives
2021, Joint Replacement Technology
Total knee arthroplasty (TKA) has evolved over the past five decades into one of the most successful surgical procedures performed in medicine, and the projected increase in demand by 2030 indicates its functional and financial benefits to patients and society. Reported results with TKA remain ‘good to excellent’, but most clinicians will agree that the results of TKA are not as good or predictable as those of total hip arthroplasty (THA). Research and development has increasingly focused on issues surrounding the procedure, including the use of patient-specific data, new technologies for component placement, multimodal pain management strategies, and infection prevention and control measures. However, at least a 20% deficit in patient satisfaction scores persists when compared with THA scores. This chapter describes current knee arthroplasty designs, reinforces the classic TKA principles, discusses TKA design principles that may need to be reexamined and elucidates current TKA principles.
Ten year outcomes for the prospective randomised trial comparing unlinked, modular bicompartmental knee arthroplasty and total knee arthroplasty
2020, Knee
Citation Excerpt :
This can be done with either monolithic implant designs or modular implants with a unicompartmental arthroplasty in combination with a patellofemoral arthroplasty. Having said that, previous studies have shown that the older monolithic BCA design had unacceptably high revision rates and lower post-operative satisfaction rates compared to TKA [18–20]. This could have been due to how the valgus/varus alignment of the implant would be affected by the alignment of the lateral transitional edge of the trochlear component with the lateral femoral condyle.
A sizeable proportion of knee osteoarthritis is limited to the medial and patellofemoral compartments. Whilst short- and medium-term studies comparing bicompartmental knee arthroplasty (BCA) and total knee arthroplasty (TKA) have shown similar outcome scores, there are no studies comparing long-term outcomes. This study aims to determine which procedure resulted in superior long-term outcome scores.
Forty-eight patients with medial and patellofemoral compartment knee osteoarthritis were randomised to receive treatment in two groups: unlinked, modular BCA and TKA. The main outcome measures compared were the range of motion, Knee Society Function Score, Knee Society Knee Score, Oxford Knee Score, Physical Component Score and Mental Component Score of SF-36 pre-operatively and post-operatively up to 10 years. Radiographs of the operated knees were taken pre-operatively, post-operatively and at 10-year follow-up.
Twenty-six underwent BCA and 22 underwent TKA. Overall improvement was seen in both groups compared to pre-operatively, however there were no significant differences detected between the groups at 10 years. The median Hip–Knee–Ankle (HKA) angle was 183.38 (175.17–187.94) in the BCA group and 180.73 (174.96–185.65) in the TKA group. One patient from the BCA group had a peri-prosthetic fracture necessitating revision surgery to a TKA.
Outcome scores for BCA results were comparable to TKA at long-term follow-up. BCA is an alternative arthroplasty option in selected patients.
Systematic Review of Modular Bicompartmental Knee Arthroplasty for Medio-Patellofemoral Osteoarthritis
2020, Journal of Arthroplasty
We aimed to locate, appraise, and synthesize the available literature to assess the functional outcome of modular bicompartmental knee arthroplasty (BKA) compared to total knee arthroplasty (TKA) for medio-patellofemoral osteoarthritis.
After an extensive literature search based on electronic databases such as MEDLINE, EMBASE, CINAHL, and PubMed, and grey literature, 9 articles satisfied our selection criteria which included 1 randomized controlled trial, 1 prospective cohort, 3 retrospective cohort, and 4 case series. Narrative synthesis was performed due to clinical, methodological, and statistical heterogeneity among the included studies.
There were 331 participants (341 knees) in this systematic review. BKA group included 229 patients (239 knees) and TKA group included 102 patients (102 knees). The quality of included studies ranged from moderate to very low as per GRADE (grading of recommendations, assessment, development, and evaluation working group) score with low to high risk of bias. Most of the studies showed comparable functional outcome in BKA compared to TKA such as Knee Society Score, Knee Osteoarthritis and Outcome Score, Short Form-36 score, and revision surgery in short-term to midterm follow-up. BKA patients achieved better range of movement and forgotten knee status than TKA patients. It resulted in longer operative time, but less intraoperative blood loss. Long-term series showed 95.1% survivorship of BKA at 5 years and 58% at 17 years.
Current evidence suggests that modular BKA provides comparable functional outcome to TKA at short-term to midterm follow-up, however, with poor long-term survivorship.
The Combination of Inlay Patellofemoral Arthroplasty and Medial Unicompartmental Knee Arthroplasty Versus Total Knee Arthroplasty for Mediopatellofemoral Osteoarthritis: A Comparison of Mid-Term Outcomes
2019, Journal of Arthroplasty
To the best of our knowledge, there have been no studies in the literature related to the use of second-generation inlay patellofemoral arthroplasty and unicompartmental knee arthroplasty combination (inlay PFA/UKA) in the treatment of mediopatellofemoral osteoarthritis (MPFOA). The aim of this study is to evaluate the efficacy of inlay PFA/UKA in MPFOA.
The study included 49 patients applied with inlay PFA/UKA because of MPFOA and 49 patients applied with TKA, matched one-to-one according to age, gender, body mass index, follow-up period, preoperative Knee Society Score, and range of motion. All the patients were evaluated clinically using the Knee Society Score, Knee Injury Osteoarthritis Outcome Score, and range of motion, and were also evaluated radiologically. Complication rates and length of hospital stay were compared.
The mean follow-up period was 54 ± 4 and 54.4 ± 3.9 months in inlay PFA/UKA and TKA groups, respectively. (P = .841). No statistically significant difference was determined between the 2 groups in respect of the mean clinical scores at the final follow-up examination (P ≥ .129). Total complications were fewer and length of hospital stay was shorter in the inlay PFA/UKA group than in the TKA group (P = .037 and P = .002). There was no radiographic evidence of progression of lateral compartment osteoarthritis according to Kellgren-Lawrence in any patient in the inlay PFA/UKA group.
In selected patient groups, inlay PFA/UKA is an alternative to TKA, with lower complication rates, shorter length of hospital stay, and clinical and functional results similar to those of TKA without osteoarthritis progression in the unresurfaced lateral compartment in the mid-term.
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: The Conflict of Interest statement associated with this article can be found at doi:10.1016/j.arth.2011.03.026.

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Initial Experience of the Journey-Deuce Bicompartmental Knee Prosthesis: A Review of 36 Cases

Abstract

Section snippets

Materials and Methods

Clinical Results

Discussion

Acknowledgment

J Arthroplasty

Knee

J Arthroplasty

Lancet

J Arthroplasty

J Arthroplasty

J Arthroplasty

Modern unicompartmental knee arthroplasty with cement: a three to ten-year follow-up study

J Bone Joint Surg Am

Unicompartmental knee arthroplasty. Clinical experience at 6- to 10-year follow-up

Clin Orthop Relat Res

Long-term clinical results of the Oxford medial unicompartmental knee arthroplasty

Int Orthop

Long-term clinical results of the medial Oxford unicompartmental knee arthroplasty

Clin Orthop Relat Res

Unicompartmental knee arthroplasty in octogenarians: survival longer than the patient

Clin Orthop Relat Res

The Oxford II medial unicompartmental knee replacement. A minimum 10-year follow-up study

Ortop Traumatol Rehabil

Unicompartmental knee arthroplasty: long-term success in middle-age and obese patients

J Surg Orthop Adv

UKA in combination with PFR at average 12-year follow-up

Arch Orthop Trauma Surg

Modular bicompartmental knee arthroplasty with robotic arm assistance

Am J Orthop (Belle Mead NJ)

Total knee arthroplasty with the kinematic condylar prosthesis. A ten-year follow-up study

J Bone Joint Surg