Oxford Partial Knee Replacement as a Gateway to Outpatient Arthroplasty “Lessons Learned along the Journey”
DOI:
https://doi.org/10.15438/rr.6.3.147Keywords:
partial knee replacement, surgical technique, outpatient arthroplasty, patient satisfactionAbstract
The Oxford Partial Knee Replacement was approved for implantation in the US in 2004 after the surgeon completed an educational training requirement. Since then my knee practiced has expanded to over 50% partial knee. This experience coupled with refinement of surgical techniques, anesthesia protocols, and patient selection has facilitated the transformation to same day discharge for partial knee cases and has quickly transitioned to total hip, total knee, and selected revision surgeries. Patient selection has also expanded for outpatient joints and is now based on medical screening criteria and insurance access. Over a two-year period we have performed over 1,000 outpatient arthroplasty procedures with no readmissions for pain control. Overall readmission rate for all reasons was 2%. Patient satisfaction scores were 98% Great-Good for 2014-15. The combination of a partial knee replacement practice and an outpatient joint program brings the best VALUE to the patients, surgeons, and the arthroplasty system and represents the future of arthroplasty care.
References
Ritter MA, Faris PM, Thong AE, Davis KE, Meding JB, Berend ME. Intra-operative findings in varus osteoarthritis of the knee. An analysis of pre-operative alignment in potential candidates for unicompartmental arthroplasty. J Bone Joint Surg Br. 2004 Jan;86(1):43-7.
White SH, Ludkowski PF, Goodfellow JW. Anteromedial osteoarthritis of the knee. J Bone Joint Surg Br. 1991 Jul;73(4):582-6.
Clarius M, Hauck C, Seeger JB, James A, Murray DW, Aldinger PR. Pulsed lavage reduces the incidence of radiolucent lines under the tibial tray of Oxford unicompartmental knee arthroplasty: pulsed lavage versus syringe lavage. Int Orthop. 2009 Dec;33(6):1585-90. Epub 2009 Feb 14.
Pandit H, Jenkins C, Beard DJ, Gallagher J, Price AJ, Dodd CA, Goodfellow JW, Murray DW. Cementless Oxford unicompartmental knee replacement shows reduced radiolucency at one year. J Bone Joint Surg Br. 2009 Feb;91(2):185-9.
Koh IJ, Kim JH, Jang SW, Kim MS, Kim C, In Y.Are the Oxford(®) medial unicompartmental knee arthroplasty new instruments reducing the bearing dislocation risk while improving components relationships? A case control study. Orthop Traumatol Surg Res. 2016 Apr;102(2):183-7.
Hurst JM1, Berend KR2, Adams JB1, Lombardi AV Jr. Radiographic comparison of mobile-bearing partial knee single-peg versus twin-peg design. J Arthroplasty. 2015 Mar;30(3):475-8. doi: 10.1016/j.arth.2014.10.015. Epub 2014 Oct 23.
Bergeson AG, Berend KR, Lombardi AV Jr, Hurst JM, Morris MJ, Sneller MA. Medial mobile bearing unicompartmental knee arthroplasty: early survivorship and analysis of failures in 1000 consecutive cases. J Arthroplasty. 2013 Oct;28(9 Suppl):172-5.
Brown NM, Sheth NP, Davis K, Berend ME, Lombardi AV, Berend KR, Della Valle CJ. Total knee arthroplasty has higher postoperative morbidity than unicompartmental knee arthroplasty: a multicenter analysis. J Arthroplasty. 2012 Sep;27(8 Suppl):86-90.
Liddle AD, Judge A, Pandit H, Murray DW.Adverse outcomes after total and unicompartmental knee replacement in 101,330 matched patients: a study of data from the National Joint Registry for England and Wales. Lancet. 2014 Oct 18;384(9952):1437-45.
McGovern TF, Ammeen DJ, Collier JP, Currier BH, Engh GA. Rapid polyethylene failure of unicondylar tibial components sterilized with gamma irradiation in air and implanted after a long shelf life. J Bone Joint Surg Am. 2002 Jun;84-A(6):901-6.
Kendrick BJ, Longino D, Pandit H, Svard U, Gill HS, Dodd CA, Murray DW, Price AJ. Polyethylene wear in Oxford unicompartmental knee replacement: a retrieval study of 47 bearings. J Bone Joint Surg Br. 2010 Mar;92(3):367-73.
Psychoyios V, Crawford RW, O'Connor JJ, Murray DW. Wear of congruent meniscal bearings in unicompartmental knee arthroplasty: a retrieval study of 16 specimens. J Bone Joint Surg Br. 1998 Nov;80(6):976-82.
Lombardi AV Jr, Barrington JW, Berend KR, Berend ME, Dorr LD, Hamilton W, Hurst JM, Morris MJ, Scuderi GR. Outpatient Arthroplasty is Here Now. Instr Course Lect. 2016;65:531-46.
Berend ME, Berend KR, Lombardi AV Jr. Advances in pain management: game changers in knee arthroplasty. Bone Joint J. 2014 Nov;96-B(11 Supple A):7-9.
Berend, ME, Lackey, WG, Carter, JL. Outpatient TJA: “Drive-Thru” Surgery – Affirms, JBJS-B. CCJR proceedings. 2016.
Berend KR, Lombardi, Jr. AV, Hurst JM, Morris M, Indications for UKA, Is there any science, AAOS OLC presentation, Oct 2010.
Berend KR, Lombardi AV Jr, Adams JB.: Obesity, young age, patellofemoral disease, and anterior knee pain: identifying the unicondylar arthroplasty patient in the United States. Orthopedics. 2007 May;30(5 Suppl): 19-23.
Kozinn SC, Scott R. Unicondylar Knee Arthroplsty. JBJS 1989, 71Am; 145-150.
Price AJ, Waite JC, Svard U.: Long-term clinical results of the medial Oxford unicompartmental knee arthroplasty. Clin Orthop Relat Res. 2005 Jun;(435):171-80.
Price AJ, Svard U. A second decade lifetable survival analysis of the Oxford unicompartmental knee arthroplasty. Clin Orthop Relat Res 2010 Aug 13 (epub ahead of print).
Svärd UC, Price AJ. Oxford medial unicompartmental knee arthroplasty. A survival analysis of an independent series. J Bone Joint Surg Br. 2001 Mar;83(2):191-4.
Berend KR, Berend ME, Dalury DF, Argenson JN, Dodd CA, Scott RD. Consensus Statement on Indications and Contraindications for Medial Unicompartmental Knee Arthroplasty. J Surg Orthop Adv. 2015 Winter;24(4):252-6.
Beard DJ, Pandit H, Ostlere S, Jenkins C, Dodd CA, Murray DW.Pre-operative clinical and radiological assessment of the patellofemoral joint in unicompartmental knee replacement and its influence on outcome. J Bone Joint Surg Br. 2007 Dec;89(12):1602-7.
Beard DJ, Pandit H, Gill HS, Hollinghurst D, Dodd CA, Murray DW. The influence of the presence and severity of pre-existing patellofemoral degenerative changes on the outcome of the Oxford medial unicompartmental knee replacement. J Bone Joint Surg Br. 2007 Dec;89(12):1597-601.
Berend KR, Lombardi AV Jr, Mallory TH, Adams JB, Groseth KL.: Early failure of minimally invasive unicompartmental knee arthroplasty is associated with obesity. Clin Orthop Relat Res. 2005 Nov; 440: 60-6.
Edwards, et al. Avoiding Readmsisions – Support Systems Required after Discharge to Continue Rapid Recovery. J Arthoplasty 2015.
Published
How to Cite
Issue
Section
License
Copyright (c) 2016 Michael E Berend
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Copyright and License Agreement:
Authors who publish with the Reconstructive Review agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work. Reconstructive Review follows the Creative Commons Attribution-NonCommercial CC BY-NC. This license allows anyone to download works, build upon the material, and share them with others for non-commercial purposes as long as they credit the senior author, Reconstructive Review, and the Joint Implant Surgery & Research Foundation (JISRF). An example credit would be: "Courtesy of (senior author's name), Reconstructive Review, JISRF, Chagrin Falls, Ohio". While works can be downloaded and shared they cannot be used commercially.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
