DOS BULLETIN - Dansk Ortopædisk Selskab

2010-378_DOS nr. 3 2010 29/09/10 10:08 Side 73
UNICAP® focal knee operations – Who are these for?
J. O. Laursen
Orthopedic Department, County Hospital Soenderborg
Background: Introduction: In 2003, a new type of knee hemi-prosthesis was introduced
in USA and Europe. HemiCAP was primary developed for articular cartilage lesions in
knee, toe, shoulder and hips. In 2006, it was introduced to the Danish market (distributed
by Ortotech). By then there was clinical follow up in USA and Europe at 3 years in
around 5.000 patients, and the results were promising. 4 years later, the UNICAP was
introduced for more advanced cartilage lesions om both femoral and tibial side. Over the
years if you deal with surgery of the knee - arthroscopies or total knee replacements- you
have seen many patients with minor cartilage lesions and perhaps have tried to inforate,
transplant cartilage or utilize chondrocyte transplantation with more or less success. I
introduced this implant in 2009, and have so far implanted 45 of these, just using the
femoral part!
Purpose: Follow-up kohorte study of a new implant concerning focal cartilage lesions
in the knee- joint.
Methods: Material and methods: There was a protocol for the operations: all patients
had preoperative x-rays and MRI taken and all operations started with arthroscopy to
confirm the cartilage damage was suitable for further UNICAP surgery and to deal with
other damage to meniscus or cartilage. All operations were done with spinal or GA. PC
preoperatively and using a tourniquet. Midincision –miniarthrotomy. Postoperative full
weight-bearing and range of motion. Discharge 1-3 day postoperatively and controlled
by x-rays postop. At 6, 12 weeks and 1 and 2 years including clinically controls with
assessing of KSS. All patients were registered in the Danish Knee Society register. VAS
– score was registered preoperatively and at follow-ups including KSS, complications
and revisions.
Findings: 11 women and 12 men is operated till now, with mean age men: 57 years (40-
65); women 62 years (40 – 83). 15 performed in spinal anesthesia and 8 in GA. Operating
time (knife time) were average 45 minutes (35 – 80 minutes) including arthroscopy
and the UNICAP operation. 12 of the patients were still at work – but had been out of
work for an average of 6 months. 7 women and four men were retired. All the workers
were at work again in average of 6 months (2 – 12 months). The hospital stay was on
average 3 days (2 – 4 days). There were seen no pre- or postoperative complications and
no deep infections.One patient had the UNICAP revised to a TKA 6 month’s later. 15 ptt.
had more than 3 months follow up and among these, 11 hand meniscus lesions – 11
medial and 3 lateral lesion. KSS knee and functional scores were preoperatively at 56
(30-60) and 38 (30- 70) respectively. And at controls ( >12 weeks ) at 91 ( 50-95 ) and
81 ( 30-90 )( fig 1 ). VAS-score were preoperatively at 7 (6-8) and at control (> 12 weeks)
at 2 (1-7). Painkillers were reduced from (1, 2, and 3) to (1, 2) or less. Untill now 45
patients are operated, 27 have passed 3 month's control and 15 one year. 2 patients are
revised to a TKA because of progressing arthrosis.
Conclusion: So far I have found the UNICAP promishing for restoration of the medial
chamber of the knee in patients with isolated focal cartilage lesions or onechamber
arthrosis. Further study and follow-ups are nessesary to confirm this.
73