Impact of Wiberg Patellar Morphology on Patient-Reported Outcomes Following Unicompartmental Knee Arthroplasty: A 3~5 Year Retrospective Cohort Analysis

Impact of Wiberg Patellar Morphology on Patient-Reported Outcomes Following Unicompartmental Knee Arthroplasty: A 3~5 Year Retrospective Cohort Analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Impact of Wiberg Patellar Morphology on Patient-Reported Outcomes Following Unicompartmental Knee Arthroplasty: A 3~5 Year Retrospective Cohort Analysis Cong Wang, Feiyang Ma, Zhengcheng Wang, Zhigang Bai, Yuqi Liang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7743193/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 23 Dec, 2025 Read the published version in BMC Musculoskeletal Disorders → Version 1 posted 16 You are reading this latest preprint version Abstract Background Postoperative outcomes and patient satisfaction following unicompartmental knee arthroplasty (UKA) are influenced by multiple factors, with patellofemoral joint pain being a predominant concern. Nevertheless, whether the Wiberg patellar classification system affects functional outcomes and satisfaction remains unclear. This study aimed to evaluate the impact of different patellar types on UKA outcomes. Methods A retrospective analysis was conducted on 327 clinical cases from January 1, 2020, to December 31, 2023. The cohort comprised 59 cases of Type I patella, 200 cases of Type II patella, and 68 cases of Type III patella, with follow-up durations ranging from 18 to 63 months. This study evaluated the effects of the three patient groups on the following parameters: age, body mass index (BMI), American Society of Anesthesiologists (ASA) classification, Hospital for Special Surgery (HSS) knee score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Forgotten Joint Score-12 (FJS-12), Feller score, and patient satisfaction. Results The three patient groups exhibited statistically significant differences in satisfaction, FJS-12, and Feller scores. Postoperative knee function improved significantly in all groups compared to preoperative levels. Further analysis of the Feller score components revealed notable distinctions between Type II and Type III patellar morphologies, particularly in satisfaction, FJS-12 scores, and Feller subscores (including anterior knee pain [AKP], stair-climbing ability, and sit-up capacity). However, no significant intergroup differences were observed in age, BMI, ASA classification, HSS score, WOMAC index, or quadriceps strength (Feller assessment). Conclusion UKA effectively improves knee osteoarthritis symptoms. While patellar classification did not influence overall functional outcomes, Type III patellae had inferior patient-reported outcomes. Preoperative planning should address patellar morphology in Type III cases. Trial registration Our clinical trial was approved by the Ethics Committee of the People's Hospital of Ningxia Hui Autonomous Region, and the ethical code was No.2025WJW004 Unicompartmental knee arthroplasty wiberg classfication knee osteoarthritis Figures Figure 1 Figure 2 Figure 3 Figure 4 Background Knee osteoarthritis has poses a major health burden for middle-aged and elderly populations owing to its high disability. Statistics indicate that the incidence of osteoarthritis will continue to rise in the future( 1 ). Currently, UKA has emerged as one of the effective solutions( 2 ). The uneven development of bony structures, soft tissues and biomedical factors in the knee leads to medial onset with a trend toward younger patients( 3 ). Early-stage symptoms primarily affect the inner knee area. Since the invention of UKA in 1957, Kozinn and Scott have proposed strict contraindications including obesity, intact anterior cruciate ligament (ACL)and patellar arthritis( 4 , 5 ). With advancing surgical techniques and extensive follow-up studies, no significant functional limitations or satisfaction issues have been observed( 5 ). Compared to Total Knee Arthroplasty(TKA), UKA offers advantages such as a more flexible knee extension mechanism, intact ACL function( 6 ), earlier postoperative ambulation, faster recovery and higher knee flexion range during rehabilitation( 7 ). Currently, there are two types of knee prosthesis: rotating platforms and fixed platforms. The fixed platform is simpler to operate and requires shorter surgery time. Although the mobile platform offers better flexion-extension mobility, the risk of liner dislocation persists throughout the patient's life( 8 ). A 10-year postoperative study on UKA revealed that mild patellar joint degeneration does not constitute a contraindication for UKA( 9 ). Nevertheless, postoperative function and satisfaction remain influenced by multiple factors. Particularly regarding patellar morphology differences based on the Wiberg classification, Sun ( 10 ) et al found that Type III patella with mobile platforms demonstrates poorer functionality, with patellar joint instability being the primary cause of UKA failure in fixed platforms( 11 ). Yet, whether different patellar classifications affect postoperative knee function and satisfaction remains unreported. Thus, we retrospectively collected clinical data from 327 patients undergoing UKA. Through an average follow-up of 35 months post-surgery, we investigated how different patellar classifications impact the functional outcomes and satisfaction of UKA procedures. Methods Design and setting Statistical analysis demonstrated significant intergroup differences in satisfaction, FJS-12, and Feller scores (all p < 0.05), with all groups showing marked postoperative functional improvement versus preoperative baselines (p < 0.01). Type II and III morphologies exhibited particularly divergent Feller subscores (AKP severity, stair-climbing performance, and sit-up capacity), FJS-12 outcomes, and satisfaction ratings, whereas age, BMI, ASA class, HSS/WOMAC indices, and quadriceps strength (Feller-assessed) showed no significant variation (p > 0.05).(Fig. 1 ) Participants All patients underwent comprehensive preoperative evaluations including complete imaging studies. Inclusion criteria, established by consensus between two independent orthopedic surgeons, required: ( 1 ) radiographically and clinically confirmed medial knee osteoarthritis; ( 2 ) absence of significant coronal deformity (varus ≤ 15° or valgus < 10°) with patellofemoral Kellgren-Lawrence (K-L) grade < 4; ( 3 ) implantation of a fixed-bearing unicompartmental knee arthroplasty (Link® Gemini MK); and ( 4 ) written informed consent from patients and family members. Exclusion criteria comprised: ( 1 ) inflammatory arthropathies (rheumatoid arthritis or severe synovitis); ( 2 ) severe coronal malalignment; ( 3 ) use of mobile-bearing Oxford prostheses or presence of advanced patellar degeneration; or ( 4 ) loss to follow-up or revision surgery for infection/loosening. Prior to enrollment, all participants provided explicit consent for survey participation after being informed of their right to withdraw without consequence, with all personal data maintained under strict confidentiality protocols. Wiberg classification : There are two physicians evaluated the patella using 90° axial X-ray films, knee CT scans and MRI images according to the Wiberg classification system. Wiberg Type I: Both medial and lateral patellar articular surfaces are essentially symmetrical (I); Wiberg Type II: The lateral articular surface is larger than the medial one (Group II); Wiberg Type III: The medial articular surface is extremely small or absent (Group III).(Fig. 2 ) Surgical procedure Following successful anesthesia induction, the patient is positioned supine with standard sterile preparation and draping. A 7-cm longitudinal curvilinear incision is made along the medial aspect of the anterior knee. Sequential dissection is performed through skin, subcutaneous tissue, and deep fascia. The joint capsule is opened along the medial patellar border, with lateral patellar retraction providing adequate joint exposure. Surgical debridement includes removal of osteophytes, hyperplastic synovium, and the medial meniscus while carefully preserving both cruciate ligaments.The arthroplasty procedure commences with tibial preparation using an intramedullary alignment guide for precise osteotomy. Following medial tibial plateau resection, the femoral condyle is correspondingly osteotomized. Trial components (Link® sled medial unicompartmental fixation platform) are inserted for assessment of alignment, stability, and range of motion. After satisfactory trialing, the joint is irrigated and definitive components are cemented in place. Results Demographic and baseline clinical characteristics, including gender distribution, age, BMI, ASA classification, symptom duration, HSS scores, and WOMAC indices, showed no significant intergroup differences (all p > 0.05). However, statistically significant variations were observed in both preoperative and postoperative functional outcomes across groups. Satisfaction analysis revealed significant differences among all three cohorts (p < 0.05), with Bonferroni-adjusted post hoc tests confirming specific distinctions between Type II and III patellar morphologies.(p 0.0125* I-III 56–59 3–9 > 0.0125 II-III 193 − 59 7–9 < 0.0125* *:Fisher’s exact test; "—" = Not While HSS and WOMAC scores remained comparable, FJS-12 demonstrated significant intergroup variability (p < 0.05). Postoperative multiple comparisons (significance threshold p < 0.0167) further highlighted functional differences between Type II and III morphologies(Fig. 3 ). Analysis of Feller score components showed significant postoperative improvement in three domains: anterior knee pain (AKP), stair-climbing performance, and sit-up capacity (Fig. 4 ), whereas quadriceps strength showed no significant change. Post hoc analysis (adjusted α = 0.017) of the significant dimensions confirmed clinically relevant differences between Type II and III morphologies.Table 1 ,Table 2 ,Table 3 . Table 1 Comparison of general patient data and knee function score I(n = 59) II(n = 200) III(n = 68) t/x 2 P gender man 21 64 21 0.361 0.835 female 38 136 47 satisfied satisfied 56 193 59 — 0.018 * not satisfied 3 7 9 Age(y) 46.90 ± ± 7.63 65.40 ± 7.89 63.68 ± 7.37 1.253 0.287 BMI(kg/m 2) 25.87 ± 2.50 26.50 ± 3.02 25.96 ± 2.77 1.444 0.238 ASA 2.19 ± 0.39 2.19 ± 0.41 2.18 ± 0.68 0.029 0.971 Medical History 2.67 ± 2.92 6.16 ± 2.85 5.68 ± 2.81 1.11 0.331 HSS 85.71 ± 6.23 84.09 ± 8.94 84.35 ± 4.87 0.989 0.373 WOMAC 44.37 ± 13.04 43.31 ± 11.68 45.01 ± 11.58 0.583 0.559 FJS-12 76.62 ± 5.40 82.06 ± 10.29 75.70 ± 5.82 17.827 < 0.001 Feller 24.83 ± 3.61 26.06 ± 2.79 23.71 ± 3.06 16.585 < 0.001 *:Fisher’s exact test; "—" = Not Table 2 Comparison of knee joint function scores Preoperative postoperative t p HSS I 52.63 ± 11.43 85.71 ± 6.23 19.515 < 0.001 II 54.39 ± 11.58 84.09 ± 8.54 -28.713 < 0.001 III 49.13 ± 11.05 84.35 ± 4.87 24.042 < 0.001 WOMAC I 106.18 ± 19.02 44.74 ± 13.13 20.153 0.006 II 108.06 ± 16.54 43.31 ± 11.68 32.996 0.008 III 108.85 ± 16.29 45.01 ± 11.58 -26.336 0.039 Table 3 Comparison of specific contents of Feller score I(n = 59) II(n = 200) III(n = 68) t P AKP 12.17 ± 3.73 12.9 ± 2.62 11.69 ± 2.94 4.925 0.008 Quadrice muscle strength 4.63 ± 0.78 4.84 ± 0.54 4.68 ± 0.74 3.42 0.034 Sit-To-Stand 3.78 ± 1.34 4.78 ± 1.03 4.47 ± 1.15 11.221 < 0.001 Stair Climbing 4.05 ± 0.68 4.14 ± 0.65 3.87 ± 0.69 4.294 0.014 AKP: anterior knee pain Statistical methods All analyses were performed using SPSS 26.0 (IBM Corp.) and GraphPad prism 9.5.0. Continuous variables following normal distribution were compared using: ( 1 ) independent samples t-test for two-group comparisons (significance threshold p < 0.05), or ( 2 ) one-way ANOVA for three-group comparisons with Bonferroni-adjusted significance level (α = 0.017, accounting for multiple comparisons). Categorical variables were analyzed using Pearson's chi-square test (p < 0.05). Post hoc pairwise comparisons utilized the Bonferroni correction, with p < 0.0125 considered statistically significant. Discussion Patients with knee osteoarthritis typically receive early intervention through oral medications, functional exercises and physical therapy, though these measures only provide partial symptom relief. As the condition progresses, knee flexion deformity and stiffness gradually develop. Knee replacement surgery remains one of the most effective solutions for osteoarthritis, rheumatoid arthritis and Kashin-Beck disease( 12 ). Nevertheless, knee prostheses also face limitations in longevity. Current studies indicate a 10-year survival rate exceeding 90%, with over 80% surviving beyond 25 years( 13 , 14 ). Our study found that only 10 patients required revision due to various reasons, while the short-term prosthetic survival rate reached 96.9%, demonstrating that UKA can significantly alleviate symptoms in knee osteoarthritis patients. The fixation platform also showed notable effectiveness. Asian patients exhibit higher patellar cushion dislocation rates compared to Western counterparts( 8 , 15 ), and given our region's greater demand for knee flexion positions, we predominantly selected fixation platforms in this research. All patients underwent MRI-assessed patellar cartilage degeneration. While Song et al considered patellar degeneration a contraindication for fixed platforms( 16 ), our findings contradict this view. Our research demonstrates that fixed platforms can significantly improve knee function, as nearly all osteoarthritis patients exhibited mild to moderate patellar degeneration. Through the "One-Finger Test(The patient was asked to point with any finger to the most painful position of the knee) preoperatively, we accurately identified patients' most painful areas, thereby validating whether UKA could alleviate symptoms. The research conclusively proves the feasibility of this approach, evidenced by an average 35-month postoperative follow-up showing a 94% satisfaction rate, with 91% remaining satisfied after 10 years( 17 ). The high short-term satisfaction stems from two factors: surgeons being senior chief physicians with over 30 years of knee replacement experience, possessing extensive technical expertise, and the need for extended observation periods to assess long-term satisfaction. The patellar classification, first proposed by Gunnar Wiberg in 1941, describes patellar surface morphology and predicts risks of patellofemoral joint abnormalities (e.g., anterior knee pain, patellar instability, patellofemoral arthritis). Variations in patellar classification reflect uneven stress distribution across the articular surface, particularly during knee flexion. Type III patellar lateral femoral condyle presents with significant lateral prominence, minimal medial coverage, and a markedly inwardly displaced central ridge. This configuration results in substantially increased lateral pressure( 18 ) and reduced medial stress, predisposing to lateral patellar hyperpressure syndrome (ELPS) and full-thickness cartilage loss (Outerbridge Grade IV) ( 19 ). Concurrent changes in the Q angle contribute to early-stage patellofemoral joint degeneration. Notably, Type III patellae may exhibit "tendinofemoral contact" (patellar ligament-femur adhesion) to reduce localised cartilage stress. Sun( 10 ) et al. found that patients using mobile-bearing UKA demonstrated statistically lower joint scores for Type III patellae compared to other classifications, with higher patellar inclination angles and smaller lateral angles than other types. Although Type III patellae exhibit developmental abnormalities in both bony and soft tissue structures, postoperative HSS and WOMAC knee function scores showed no significant difference from other types. Clinical analysis revealed that most patients primarily experience medial knee pain. When knee pain symptoms subside, secondary adjustments to patellar height and trajectory may be considered. Regarding patellar joint issues, our study found that patellar classification showed statistically significant differences in Feller scores, anterior knee pain, sitting ability, and stair-climbing performance. Comparative analysis between groups revealed distinct differences between Type I and Type III patellae. Type III patella exhibits complete disappearance of the medial articular surface, disrupting the patellofemoral congruence and posing a risk of patellar dislocation. Konan et al. also reported a strong correlation between degenerative changes on the lateral articular surface and poorer knee joint function( 20 ). Early Beard studies documented full-thickness cartilage loss in 16% of patients, yet achieved excellent functional outcomes and satisfaction rates( 21 ). In this Feller scoring analysis, quadriceps strength showed no statistically significant impact. We believe that for medial knee osteoarthritis patients, resolving medial knee pain may alter the mechanical distribution of the knee joint and modify the patellar tendon's trajectory, thereby exerting limited influence on quadriceps strength. Current research indicates that Type III patellae can be effectively managed through patellar retinaculum release( 22 ) or patellar reconstruction surgery( 10 ). For post-arthroplasty patients, we emphasise that functional rehabilitation is as crucial as nutritional support. A recent prospective study found that over 90% of knee replacement patients achieved satisfactory flexion-extension outcomes without specialised rehabilitation guidance( 23 ). While knee replacement surgery significantly improves patients 'quality of life post-surgery, it may also cause a rapid decline in physical skills, muscle strength, and mass ( 24 ). Although some functional recovery can be achieved later, the remaining capacity still falls short compared to the healthy side, which increases the risk of sarcopenia ( 25 ). Notably, sarcopenia has been linked to postoperative periprosthetic infections in knee replacements ( 26 ). Our follow-up study revealed that knee weakness was the second most frequently reported symptom after pain, making postoperative quadriceps strength training essential for patients. Although we didn't assess muscle mass, we consider weakness a manifestation of sarcopenia—particularly with UKA. Incorporating progressive resistance training during the first 4 weeks post-surgery is crucial ( 27 ), which aligns with our ongoing clinical efforts. FJS-12, a patient-reported subjective assessment free from implant-related confounding factors and ceiling effect ( 28 ), shows that UKA demonstrates superior functional outcomes and satisfaction rates compared to total knee replacement within 2 years ( 29 , 30 ). A validation of the 2015 Forgotten Score confirmed that FJS-12 should serve as a core scoring indicator for post-knee replacement surgery, showing positive correlation with satisfaction levels ( 31 ). Three types of patella showed statistically significant differences in FJS-12 scores, with Type III patella demonstrating the poorest forgotten score and statistically different satisfaction levels compared to Type II patella, consistent with previous studies ( 32 ). We attribute these outcomes to four principal factors: ( 1 ) While knee mobility improved postoperatively, Type III patellar morphology requires extended adaptation to long-term structural changes; ( 2 ) Older Type III patients experience delayed neuromuscular recovery, potentially prolonging prosthesis awareness during rehabilitation; ( 3 ) Lower baseline patellar scores in Type III cases heighten prosthesis awareness and documentation focus; ( 4 ) Pronounced lateral facet prominence in Type III patellae may cause abnormal tracking and lateral compartment overload, exacerbating joint perception. Study limitations include: ( 1 ) Incomplete 1-month functional data limiting dynamic analysis of final outcomes, particularly regarding Type III morphological adaptation; ( 2 ) Absence of validated metrics correlating symptom improvement with satisfaction changes; ( 3 ) Potential residual confounding despite rigorous retrospective controls, warranting future gait analysis validation In summary, UKA effectively alleviates knee osteoarthritis symptoms across Wiberg classifications without significant functional differences. However, Type III patellae demonstrated inferior outcomes in sit-up capacity, stair-climbing performance, anterior knee pain, satisfaction, and FJS-12 scores (all p < 0.017). Orthopaedic surgeons should therefore implement morphology-specific rehabilitation protocols for these patients to optimize functional outcomes. Abbreviations Unicompartmental KneeArthroplasty UKA Total Knee Arthroplasty TKA Body Mass Index BMI American Society of Anesthesiologists ASA Hospital for Special Surgery Knee （HSS） Western Ontario and McMaster universities osteoarthritis index （WOMAC） Forgotten Joint Score-12 FJS-12 Anterior knee pain AKP Anterior Cruciate Ligament ACL Kellgren-Lawrence grading scale K-L Lateral patellar hyperpressure syndrome ELPS Declarations Acknowledgements The authors thank all of the collaborators and participants of the study. We are also grateful to artificial intelligence, for the contribution of touching up the English text of this manuscript. Author contributions W C wrote the main manuscript text , M Fy and W Zc visit patient and collect basic information ,B Zg operate surgery,L Yq responsible for the most popular review. All authors reviewed the manuscript. Funding This trial was partially funded by the Ningxia Health Commission (No. 2025-NWZC-B006). Ningxia Science and Technology Transformation Project 2025 (Application and promotion of remote precision medical system for hip and knee joints based on surgical robots：NO.2025CJE09011）The funding source did not play any role in the study design. See Additional Data availability All data generated or analysed during this study are included in this published article and its supplementary information files. Ethics approval and consent to participate This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Ningxia Hui Autonomous Region(Approval No.2025-WJW-004). Informed consent was obtained from all individual participants included in the study. Consent for publication Not Applicable Competing interests The authors declare no competing interests. References Chengwei Q, Yonghua Z, Zhe T, Yaohua S, Pengfei L. 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Cite Share Download PDF Status: Published Journal Publication published 23 Dec, 2025 Read the published version in BMC Musculoskeletal Disorders → Version 1 posted Editorial decision: Revision requested 27 Nov, 2025 Reviews received at journal 25 Nov, 2025 Reviews received at journal 24 Nov, 2025 Reviews received at journal 19 Nov, 2025 Reviewers agreed at journal 06 Nov, 2025 Reviewers agreed at journal 06 Nov, 2025 Reviewers agreed at journal 06 Nov, 2025 Reviewers agreed at journal 05 Nov, 2025 Reviewers agreed at journal 05 Nov, 2025 Reviewers agreed at journal 05 Nov, 2025 Reviewers agreed at journal 05 Nov, 2025 Reviewers invited by journal 05 Nov, 2025 Editor invited by journal 04 Nov, 2025 Editor assigned by journal 13 Oct, 2025 Submission checks completed at journal 10 Oct, 2025 First submitted to journal 10 Oct, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Wang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5UlEQVRIiWNgGAWjYDAD++Pthx98MLCxI0HPmTNphjMK0pJJ0HIjwUCa58MhxgZCCg2Onz384kfFHbvGngMJxjYGB5gZ2A8f3YBXy5m8NMueM8+Sm9kbDzzOMbjDx8CTlnYDnxazAzlmxoxth5PZeIC25Bg8Y2aQ4DHDr+X8G4gWHgmgXywMDjM2ENRyI8f4MVCLnQRICwMxWuxvvDFj7DlzOMGABxjIPQZpQBcS8Itkf47xhx8Vh+0N2IFR+eOPjR0/++FjeLUAAZsEkEhsgHMJKAcB5g8gBxKhcBSMglEwCkYqAAA6pVF4GvTAbQAAAABJRU5ErkJggg==","orcid":"","institution":"People's Hospital of Ningxia Hui Autonomous Region, Ningxia Medical University","correspondingAuthor":true,"prefix":"","firstName":"Cong","middleName":"","lastName":"Wang","suffix":""},{"id":541421972,"identity":"0fc671bd-9f91-4fa2-9829-a6351fe85fdc","order_by":1,"name":"Feiyang Ma","email":"","orcid":"","institution":"People's Hospital of Ningxia Hui Autonomous Region, Ningxia Medical University","correspondingAuthor":false,"prefix":"","firstName":"Feiyang","middleName":"","lastName":"Ma","suffix":""},{"id":541421976,"identity":"a6f3e864-0ac1-49c7-912e-fddba90bf7b7","order_by":2,"name":"Zhengcheng Wang","email":"","orcid":"","institution":"People's Hospital of Ningxia Hui Autonomous Region, Ningxia Medical University","correspondingAuthor":false,"prefix":"","firstName":"Zhengcheng","middleName":"","lastName":"Wang","suffix":""},{"id":541421978,"identity":"d7af1f1d-5b09-47e6-b98d-0b0931760a78","order_by":3,"name":"Zhigang Bai","email":"","orcid":"","institution":"People's Hospital of Ningxia Hui Autonomous Region, Ningxia Medical University","correspondingAuthor":false,"prefix":"","firstName":"Zhigang","middleName":"","lastName":"Bai","suffix":""},{"id":541421980,"identity":"536155f3-0864-447a-9c1e-c6cc3dee5e6a","order_by":4,"name":"Yuqi Liang","email":"","orcid":"","institution":"People's Hospital of Ningxia Hui Autonomous Region, Ningxia Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yuqi","middleName":"","lastName":"Liang","suffix":""}],"badges":[],"createdAt":"2025-09-29 14:38:33","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7743193/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7743193/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12891-025-09396-z","type":"published","date":"2025-12-23T15:57:23+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":96049479,"identity":"1d99f2f1-5b4a-438a-a932-675849b5f3e3","added_by":"auto","created_at":"2025-11-17 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07:26:07","extension":"html","order_by":12,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":101886,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7743193/v1/100a08ac73acb5f39b66e0e2.html"},{"id":96049468,"identity":"4b8b6d70-a484-4208-bb94-58ad7bfec8a1","added_by":"auto","created_at":"2025-11-17 06:33:06","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":54361,"visible":true,"origin":"","legend":"\u003cp\u003eFlowchart of participants through research\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7743193/v1/c6ecd50000234f72b874651f.png"},{"id":96246672,"identity":"4bd0df77-2e00-4b0d-b683-9eab4efee105","added_by":"auto","created_at":"2025-11-19 07:26:28","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":264644,"visible":true,"origin":"","legend":"\u003cp\u003eWiberg Classfication\u003c/p\u003e\n\u003cp\u003ea: Knee 90° axial view b; Knee CT c: knee MRI\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7743193/v1/4dedd2752ed9a57e5f035f4b.png"},{"id":96049473,"identity":"4a130397-fb7f-4904-b3b9-eab102211cb0","added_by":"auto","created_at":"2025-11-17 06:33:06","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":188602,"visible":true,"origin":"","legend":"\u003cp\u003ePatients were compared between Feller and FJS-12\u003c/p\u003e\n\u003cp\u003e(a：feller score b：FJS-12 score ns：not significant *P \u0026lt; 0.05, **P \u0026lt; 0.01, ***P \u0026lt; 0.001)\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7743193/v1/cb0e6ed3a6218e00ca9b7528.png"},{"id":96049470,"identity":"c6afeb4b-4e71-4d74-b297-fc6cace7100e","added_by":"auto","created_at":"2025-11-17 06:33:06","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":373635,"visible":true,"origin":"","legend":"\u003cp\u003eFeller score subgroup analysis\u003c/p\u003e\n\u003cp\u003e(a：AKP b：sit-to-sand c：muscle strength d：stair climbing ns：not significant *P \u0026lt; 0.05, **P \u0026lt; 0.01, ***P \u0026lt; 0.001)\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-7743193/v1/ad8db72f59b4c3a2af6f59be.png"},{"id":99172429,"identity":"a38d6d7f-46eb-4d06-8de0-5a2bcc3c48de","added_by":"auto","created_at":"2025-12-29 16:09:22","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1509580,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7743193/v1/0cfca894-9008-4155-a773-0c00ef41d292.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Impact of Wiberg Patellar Morphology on Patient-Reported Outcomes Following Unicompartmental Knee Arthroplasty: A 3~5 Year Retrospective Cohort Analysis","fulltext":[{"header":"Background","content":"\u003cp\u003eKnee osteoarthritis has poses a major health burden for middle-aged and elderly populations owing to its high disability. Statistics indicate that the incidence of osteoarthritis will continue to rise in the future(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Currently, UKA has emerged as one of the effective solutions(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). The uneven development of bony structures, soft tissues and biomedical factors in the knee leads to medial onset with a trend toward younger patients(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Early-stage symptoms primarily affect the inner knee area. Since the invention of UKA in 1957, Kozinn and Scott have proposed strict contraindications including obesity, intact anterior cruciate ligament (ACL)and patellar arthritis(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). With advancing surgical techniques and extensive follow-up studies, no significant functional limitations or satisfaction issues have been observed(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Compared to Total Knee Arthroplasty(TKA), UKA offers advantages such as a more flexible knee extension mechanism, intact ACL function(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e), earlier postoperative ambulation, faster recovery and higher knee flexion range during rehabilitation(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eCurrently, there are two types of knee prosthesis: rotating platforms and fixed platforms. The fixed platform is simpler to operate and requires shorter surgery time. Although the mobile platform offers better flexion-extension mobility, the risk of liner dislocation persists throughout the patient's life(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). A 10-year postoperative study on UKA revealed that mild patellar joint degeneration does not constitute a contraindication for UKA(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Nevertheless, postoperative function and satisfaction remain influenced by multiple factors. Particularly regarding patellar morphology differences based on the Wiberg classification, Sun (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e) et al found that Type III patella with mobile platforms demonstrates poorer functionality, with patellar joint instability being the primary cause of UKA failure in fixed platforms(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Yet, whether different patellar classifications affect postoperative knee function and satisfaction remains unreported. Thus, we retrospectively collected clinical data from 327 patients undergoing UKA. Through an average follow-up of 35 months post-surgery, we investigated how different patellar classifications impact the functional outcomes and satisfaction of UKA procedures.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eDesign and setting\u003c/h2\u003e\u003cp\u003eStatistical analysis demonstrated significant intergroup differences in satisfaction, FJS-12, and Feller scores (all p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), with all groups showing marked postoperative functional improvement versus preoperative baselines (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Type II and III morphologies exhibited particularly divergent Feller subscores (AKP severity, stair-climbing performance, and sit-up capacity), FJS-12 outcomes, and satisfaction ratings, whereas age, BMI, ASA class, HSS/WOMAC indices, and quadriceps strength (Feller-assessed) showed no significant variation (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).(Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eParticipants\u003c/h3\u003e\n\u003cp\u003eAll patients underwent comprehensive preoperative evaluations including complete imaging studies. Inclusion criteria, established by consensus between two independent orthopedic surgeons, required: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) radiographically and clinically confirmed medial knee osteoarthritis; (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) absence of significant coronal deformity (varus\u0026thinsp;\u0026le;\u0026thinsp;15\u0026deg; or valgus\u0026thinsp;\u0026lt;\u0026thinsp;10\u0026deg;) with patellofemoral Kellgren-Lawrence (K-L) grade\u0026thinsp;\u0026lt;\u0026thinsp;4; (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) implantation of a fixed-bearing unicompartmental knee arthroplasty (Link\u0026reg; Gemini MK); and (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) written informed consent from patients and family members. Exclusion criteria comprised: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) inflammatory arthropathies (rheumatoid arthritis or severe synovitis); (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) severe coronal malalignment; (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) use of mobile-bearing Oxford prostheses or presence of advanced patellar degeneration; or (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) loss to follow-up or revision surgery for infection/loosening. Prior to enrollment, all participants provided explicit consent for survey participation after being informed of their right to withdraw without consequence, with all personal data maintained under strict confidentiality protocols.\u003c/p\u003e\u003cp\u003e\u003cb\u003eWiberg classification\u003c/b\u003e: There are two physicians evaluated the patella using 90\u0026deg; axial X-ray films, knee CT scans and MRI images according to the Wiberg classification system. Wiberg Type I: Both medial and lateral patellar articular surfaces are essentially symmetrical (I); Wiberg Type II: The lateral articular surface is larger than the medial one (Group II); Wiberg Type III: The medial articular surface is extremely small or absent (Group III).(Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eSurgical procedure\u003c/strong\u003e\u003cp\u003eFollowing successful anesthesia induction, the patient is positioned supine with standard sterile preparation and draping. A 7-cm longitudinal curvilinear incision is made along the medial aspect of the anterior knee. Sequential dissection is performed through skin, subcutaneous tissue, and deep fascia. The joint capsule is opened along the medial patellar border, with lateral patellar retraction providing adequate joint exposure. Surgical debridement includes removal of osteophytes, hyperplastic synovium, and the medial meniscus while carefully preserving both cruciate ligaments.The arthroplasty procedure commences with tibial preparation using an intramedullary alignment guide for precise osteotomy. Following medial tibial plateau resection, the femoral condyle is correspondingly osteotomized. Trial components (Link\u0026reg; sled medial unicompartmental fixation platform) are inserted for assessment of alignment, stability, and range of motion. After satisfactory trialing, the joint is irrigated and definitive components are cemented in place.\u003c/p\u003e\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eDemographic and baseline clinical characteristics, including gender distribution, age, BMI, ASA classification, symptom duration, HSS scores, and WOMAC indices, showed no significant intergroup differences (all p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). However, statistically significant variations were observed in both preoperative and postoperative functional outcomes across groups. Satisfaction analysis revealed significant differences among all three cohorts (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), with Bonferroni-adjusted post hoc tests confirming specific distinctions between Type II and III patellar morphologies.(p\u0026thinsp;\u0026lt;\u0026thinsp;0.0125)(Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e4\u003c/span\u003e )\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSatisfaction comparison results\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003esatisfactied\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003enot satisfactied\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ex\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eI-II\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e56\u0026ndash;193\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3\u0026ndash;7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;0.0125*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eI-III\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e56\u0026ndash;59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3\u0026ndash;9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;0.0125\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eII-III\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e193\u0026thinsp;\u0026minus;\u0026thinsp;59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7\u0026ndash;9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.0125*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003e*:Fisher\u0026rsquo;s exact test; \"\u0026mdash;\" = Not\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eWhile HSS and WOMAC scores remained comparable, FJS-12 demonstrated significant intergroup variability (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Postoperative multiple comparisons (significance threshold p\u0026thinsp;\u0026lt;\u0026thinsp;0.0167) further highlighted functional differences between Type II and III morphologies(Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Analysis of Feller score components showed significant postoperative improvement in three domains: anterior knee pain (AKP), stair-climbing performance, and sit-up capacity (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e), whereas quadriceps strength showed no significant change. Post hoc analysis (adjusted α\u0026thinsp;=\u0026thinsp;0.017) of the significant dimensions confirmed clinically relevant differences between Type II and III morphologies.Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e1\u003c/span\u003e,Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e2\u003c/span\u003e,Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of general patient data and knee function score\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eI(n\u0026thinsp;=\u0026thinsp;59)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eII(n\u0026thinsp;=\u0026thinsp;200)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eIII(n\u0026thinsp;=\u0026thinsp;68)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003et/x\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003egender\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eman\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.361\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.835\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003efemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e136\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e47\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003esatisfied\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003esatisfied\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e193\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.018\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003enot satisfied\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eAge(y)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e46.90\u0026thinsp;\u0026plusmn;\u0026thinsp;\u0026plusmn;\u0026thinsp;7.63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e65.40\u0026thinsp;\u0026plusmn;\u0026thinsp;7.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e63.68\u0026thinsp;\u0026plusmn;\u0026thinsp;7.37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.253\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.287\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eBMI(kg/m\u003csup\u003e2)\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25.87\u0026thinsp;\u0026plusmn;\u0026thinsp;2.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e26.50\u0026thinsp;\u0026plusmn;\u0026thinsp;3.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e25.96\u0026thinsp;\u0026plusmn;\u0026thinsp;2.77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.444\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.238\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eASA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.19\u0026thinsp;\u0026plusmn;\u0026thinsp;0.39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.19\u0026thinsp;\u0026plusmn;\u0026thinsp;0.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.18\u0026thinsp;\u0026plusmn;\u0026thinsp;0.68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.029\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.971\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eMedical History\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.67\u0026thinsp;\u0026plusmn;\u0026thinsp;2.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.16\u0026thinsp;\u0026plusmn;\u0026thinsp;2.85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5.68\u0026thinsp;\u0026plusmn;\u0026thinsp;2.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.331\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eHSS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e85.71\u0026thinsp;\u0026plusmn;\u0026thinsp;6.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e84.09\u0026thinsp;\u0026plusmn;\u0026thinsp;8.94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e84.35\u0026thinsp;\u0026plusmn;\u0026thinsp;4.87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.989\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.373\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eWOMAC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e44.37\u0026thinsp;\u0026plusmn;\u0026thinsp;13.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e43.31\u0026thinsp;\u0026plusmn;\u0026thinsp;11.68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e45.01\u0026thinsp;\u0026plusmn;\u0026thinsp;11.58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.583\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.559\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eFJS-12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e76.62\u0026thinsp;\u0026plusmn;\u0026thinsp;5.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e82.06\u0026thinsp;\u0026plusmn;\u0026thinsp;10.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e75.70\u0026thinsp;\u0026plusmn;\u0026thinsp;5.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e17.827\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eFeller\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24.83\u0026thinsp;\u0026plusmn;\u0026thinsp;3.61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e26.06\u0026thinsp;\u0026plusmn;\u0026thinsp;2.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e23.71\u0026thinsp;\u0026plusmn;\u0026thinsp;3.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e16.585\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e\u003cp\u003e*:Fisher\u0026rsquo;s exact test; \"\u0026mdash;\" = Not\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of knee joint function scores\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePreoperative\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003epostoperative\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003et\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eHSS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e52.63\u0026thinsp;\u0026plusmn;\u0026thinsp;11.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e85.71\u0026thinsp;\u0026plusmn;\u0026thinsp;6.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e19.515\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eII\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e54.39\u0026thinsp;\u0026plusmn;\u0026thinsp;11.58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e84.09\u0026thinsp;\u0026plusmn;\u0026thinsp;8.54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-28.713\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIII\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e49.13\u0026thinsp;\u0026plusmn;\u0026thinsp;11.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e84.35\u0026thinsp;\u0026plusmn;\u0026thinsp;4.87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e24.042\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eWOMAC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e106.18\u0026thinsp;\u0026plusmn;\u0026thinsp;19.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e44.74\u0026thinsp;\u0026plusmn;\u0026thinsp;13.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e20.153\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.006\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eII\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e108.06\u0026thinsp;\u0026plusmn;\u0026thinsp;16.54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e43.31\u0026thinsp;\u0026plusmn;\u0026thinsp;11.68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e32.996\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.008\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIII\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e108.85\u0026thinsp;\u0026plusmn;\u0026thinsp;16.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e45.01\u0026thinsp;\u0026plusmn;\u0026thinsp;11.58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-26.336\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.039\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of specific contents of Feller score\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eI(n\u0026thinsp;=\u0026thinsp;59)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eII(n\u0026thinsp;=\u0026thinsp;200)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eIII(n\u0026thinsp;=\u0026thinsp;68)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003et\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAKP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12.17\u0026thinsp;\u0026plusmn;\u0026thinsp;3.73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12.9\u0026thinsp;\u0026plusmn;\u0026thinsp;2.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11.69\u0026thinsp;\u0026plusmn;\u0026thinsp;2.94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4.925\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.008\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQuadrice muscle strength\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.63\u0026thinsp;\u0026plusmn;\u0026thinsp;0.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.84\u0026thinsp;\u0026plusmn;\u0026thinsp;0.54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.68\u0026thinsp;\u0026plusmn;\u0026thinsp;0.74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3.42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.034\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSit-To-Stand\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.78\u0026thinsp;\u0026plusmn;\u0026thinsp;1.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.78\u0026thinsp;\u0026plusmn;\u0026thinsp;1.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.47\u0026thinsp;\u0026plusmn;\u0026thinsp;1.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e11.221\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStair Climbing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.05\u0026thinsp;\u0026plusmn;\u0026thinsp;0.68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.14\u0026thinsp;\u0026plusmn;\u0026thinsp;0.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.87\u0026thinsp;\u0026plusmn;\u0026thinsp;0.69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4.294\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.014\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003eAKP: anterior knee pain\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003eStatistical methods\u003c/h3\u003e\n\u003cp\u003eAll analyses were performed using SPSS 26.0 (IBM Corp.) and GraphPad prism 9.5.0. Continuous variables following normal distribution were compared using: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) independent samples t-test for two-group comparisons (significance threshold p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), or (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) one-way ANOVA for three-group comparisons with Bonferroni-adjusted significance level (α\u0026thinsp;=\u0026thinsp;0.017, accounting for multiple comparisons). Categorical variables were analyzed using Pearson's chi-square test (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Post hoc pairwise comparisons utilized the Bonferroni correction, with p\u0026thinsp;\u0026lt;\u0026thinsp;0.0125 considered statistically significant.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003ePatients with knee osteoarthritis typically receive early intervention through oral medications, functional exercises and physical therapy, though these measures only provide partial symptom relief. As the condition progresses, knee flexion deformity and stiffness gradually develop. Knee replacement surgery remains one of the most effective solutions for osteoarthritis, rheumatoid arthritis and Kashin-Beck disease(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Nevertheless, knee prostheses also face limitations in longevity. Current studies indicate a 10-year survival rate exceeding 90%, with over 80% surviving beyond 25 years(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Our study found that only 10 patients required revision due to various reasons, while the short-term prosthetic survival rate reached 96.9%, demonstrating that UKA can significantly alleviate symptoms in knee osteoarthritis patients. The fixation platform also showed notable effectiveness. Asian patients exhibit higher patellar cushion dislocation rates compared to Western counterparts(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e), and given our region's greater demand for knee flexion positions, we predominantly selected fixation platforms in this research. All patients underwent MRI-assessed patellar cartilage degeneration. While Song et al considered patellar degeneration a contraindication for fixed platforms(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e), our findings contradict this view. Our research demonstrates that fixed platforms can significantly improve knee function, as nearly all osteoarthritis patients exhibited mild to moderate patellar degeneration. Through the \"One-Finger Test(The patient was asked to point with any finger to the most painful position of the knee) preoperatively, we accurately identified patients' most painful areas, thereby validating whether UKA could alleviate symptoms. The research conclusively proves the feasibility of this approach, evidenced by an average 35-month postoperative follow-up showing a 94% satisfaction rate, with 91% remaining satisfied after 10 years(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). The high short-term satisfaction stems from two factors: surgeons being senior chief physicians with over 30 years of knee replacement experience, possessing extensive technical expertise, and the need for extended observation periods to assess long-term satisfaction.\u003c/p\u003e\u003cp\u003eThe patellar classification, first proposed by Gunnar Wiberg in 1941, describes patellar surface morphology and predicts risks of patellofemoral joint abnormalities (e.g., anterior knee pain, patellar instability, patellofemoral arthritis). Variations in patellar classification reflect uneven stress distribution across the articular surface, particularly during knee flexion. Type III patellar lateral femoral condyle presents with significant lateral prominence, minimal medial coverage, and a markedly inwardly displaced central ridge. This configuration results in substantially increased lateral pressure(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e) and reduced medial stress, predisposing to lateral patellar hyperpressure syndrome (ELPS) and full-thickness cartilage loss (Outerbridge Grade IV) (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Concurrent changes in the Q angle contribute to early-stage patellofemoral joint degeneration. Notably, Type III patellae may exhibit \"tendinofemoral contact\" (patellar ligament-femur adhesion) to reduce localised cartilage stress. Sun(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e) et al. found that patients using mobile-bearing UKA demonstrated statistically lower joint scores for Type III patellae compared to other classifications, with higher patellar inclination angles and smaller lateral angles than other types. Although Type III patellae exhibit developmental abnormalities in both bony and soft tissue structures, postoperative HSS and WOMAC knee function scores showed no significant difference from other types. Clinical analysis revealed that most patients primarily experience medial knee pain. When knee pain symptoms subside, secondary adjustments to patellar height and trajectory may be considered. Regarding patellar joint issues, our study found that patellar classification showed statistically significant differences in Feller scores, anterior knee pain, sitting ability, and stair-climbing performance. Comparative analysis between groups revealed distinct differences between Type I and Type III patellae. Type III patella exhibits complete disappearance of the medial articular surface, disrupting the patellofemoral congruence and posing a risk of patellar dislocation. Konan et al. also reported a strong correlation between degenerative changes on the lateral articular surface and poorer knee joint function(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Early Beard studies documented full-thickness cartilage loss in 16% of patients, yet achieved excellent functional outcomes and satisfaction rates(\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). In this Feller scoring analysis, quadriceps strength showed no statistically significant impact. We believe that for medial knee osteoarthritis patients, resolving medial knee pain may alter the mechanical distribution of the knee joint and modify the patellar tendon's trajectory, thereby exerting limited influence on quadriceps strength. Current research indicates that Type III patellae can be effectively managed through patellar retinaculum release(\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e) or patellar reconstruction surgery(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eFor post-arthroplasty patients, we emphasise that functional rehabilitation is as crucial as nutritional support. A recent prospective study found that over 90% of knee replacement patients achieved satisfactory flexion-extension outcomes without specialised rehabilitation guidance(\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). While knee replacement surgery significantly improves patients 'quality of life post-surgery, it may also cause a rapid decline in physical skills, muscle strength, and mass (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). Although some functional recovery can be achieved later, the remaining capacity still falls short compared to the healthy side, which increases the risk of sarcopenia (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). Notably, sarcopenia has been linked to postoperative periprosthetic infections in knee replacements (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Our follow-up study revealed that knee weakness was the second most frequently reported symptom after pain, making postoperative quadriceps strength training essential for patients. Although we didn't assess muscle mass, we consider weakness a manifestation of sarcopenia\u0026mdash;particularly with UKA. Incorporating progressive resistance training during the first 4 weeks post-surgery is crucial (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e), which aligns with our ongoing clinical efforts.\u003c/p\u003e\u003cp\u003eFJS-12, a patient-reported subjective assessment free from implant-related confounding factors and ceiling effect (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e), shows that UKA demonstrates superior functional outcomes and satisfaction rates compared to total knee replacement within 2 years (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). A validation of the 2015 Forgotten Score confirmed that FJS-12 should serve as a core scoring indicator for post-knee replacement surgery, showing positive correlation with satisfaction levels (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). Three types of patella showed statistically significant differences in FJS-12 scores, with Type III patella demonstrating the poorest forgotten score and statistically different satisfaction levels compared to Type II patella, consistent with previous studies (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). We attribute these outcomes to four principal factors: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) While knee mobility improved postoperatively, Type III patellar morphology requires extended adaptation to long-term structural changes; (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) Older Type III patients experience delayed neuromuscular recovery, potentially prolonging prosthesis awareness during rehabilitation; (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) Lower baseline patellar scores in Type III cases heighten prosthesis awareness and documentation focus; (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) Pronounced lateral facet prominence in Type III patellae may cause abnormal tracking and lateral compartment overload, exacerbating joint perception.\u003c/p\u003e\u003cp\u003eStudy limitations include: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) Incomplete 1-month functional data limiting dynamic analysis of final outcomes, particularly regarding Type III morphological adaptation; (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) Absence of validated metrics correlating symptom improvement with satisfaction changes; (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) Potential residual confounding despite rigorous retrospective controls, warranting future gait analysis validation\u003c/p\u003e\u003cp\u003eIn summary, UKA effectively alleviates knee osteoarthritis symptoms across Wiberg classifications without significant functional differences. However, Type III patellae demonstrated inferior outcomes in sit-up capacity, stair-climbing performance, anterior knee pain, satisfaction, and FJS-12 scores (all p\u0026thinsp;\u0026lt;\u0026thinsp;0.017). Orthopaedic surgeons should therefore implement morphology-specific rehabilitation protocols for these patients to optimize functional outcomes.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eUnicompartmental KneeArthroplasty \u0026nbsp;UKA\u003c/p\u003e\n\u003cp\u003eTotal Knee Arthroplasty \u0026nbsp;TKA\u003c/p\u003e\n\u003cp\u003eBody Mass Index BMI\u003c/p\u003e\n\u003cp\u003eAmerican Society of Anesthesiologists ASA\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHospital for Special Surgery Knee\u0026nbsp;（HSS）\u003c/p\u003e\n\u003cp\u003eWestern Ontario and McMaster universities osteoarthritis index\u0026nbsp;（WOMAC）\u003c/p\u003e\n\u003cp\u003eForgotten Joint Score-12\u003cstrong\u003e\u0026nbsp;\u0026nbsp;\u003c/strong\u003eFJS-12\u003c/p\u003e\n\u003cp\u003eAnterior knee pain \u0026nbsp; AKP\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAnterior Cruciate Ligament \u0026nbsp; ACL\u003c/p\u003e\n\u003cp\u003eKellgren-Lawrence grading scale \u0026nbsp; K-L\u003c/p\u003e\n\u003cp\u003eLateral patellar hyperpressure syndrome \u0026nbsp; ELPS\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors thank all of the collaborators and participants of the study. We are also grateful to artificial intelligence, for the contribution of touching up the English text of this manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eW C wrote the main manuscript text , M Fy and W Zc visit patient and collect basic information ,B Zg operate surgery,L Yq responsible for the most popular review. All authors reviewed the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis trial was partially funded by the Ningxia Health Commission (No. 2025-NWZC-B006). Ningxia Science and Technology Transformation Project 2025 (Application and promotion of remote precision medical system for hip and knee joints based on surgical robots：NO.2025CJE09011）The funding source did not play any role in the study design. See Additional \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analysed during this study are included in this published article and its supplementary information files.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Ningxia Hui Autonomous Region(Approval No.2025-WJW-004). Informed consent was obtained from all individual participants included in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp skip=\"true\"\u003eNot Applicable\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eChengwei Q, Yonghua Z, Zhe T, Yaohua S, Pengfei L. Prevalence and correlation analysis of lateral discoid Meniscus with degeneration or injury of the Meniscus and articular cartilage in the entire tibiofemoral joint. BMC Musculoskelet Disord. 2025;26(1).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eIgnacio P, Nickelas H, Sarah FK, John PM, Robert MM, Matthew ED et al. Team Approach: Bone Health Optimization in Orthopaedic Surgery. JBJS Rev. 2023;11(12).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJingkai D, Jiang B, Junrui Z, Jiaoyang C, Yuxuan H, Jiaqi B et al. Regional disparities, age-related changes and sex-related differences in knee osteoarthritis. BMC Musculoskelet Disord. 2024;25(1).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eR D S SDM. T S T. Current concepts of total knee arthroplasty. J Orthop Sports Phys Ther. 1998;28(4).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDaniel EG, Scott RS, Wesley GL, Joshua LC, Michael EB. What Role Does Patello-Femoral Joint Degeneration Have on Pain and Function After Unicompartmental Knee Arthroplasty? A Prospective Observational Cohort Study. J Arthroplasty. 2023;39(1).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFilippo M, Arne D, Francesco O, Gayle DM, Markus T, Nicola M. Better outcomes and reduced failures for arthroplasty over osteotomy for advanced compartmental knee osteoarthritis in patients older than 50 years. J Orthop Surg Res. 2020;15(1).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZhou Q, Liu J, Sun Y, Chen X, Zhang X, Ding X. [Correlation between traditional Chinese medicine and reduced risk of readmission in rheumatoid arthritis patients with hypoproteinemia:a retrospective cohort study]. Zhongguo Zhong yao za zhi\u0026thinsp;=\u0026thinsp;Zhongguo zhongyao zazhi\u0026thinsp;=\u0026thinsp;China. J Chin materia Med. 2023;48(8):2241\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eXiaowei S, Pei L, Feifan L, Weiguo W, Wanshou G, Qidong Z. Bearing dislocation of mobile bearing unicompartmental knee arthroplasty in East Asian countries: a systematic review with meta-analysis. J Orthop Surg Res. 2021;16(1).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKevin DP, Karen KB, Erin ET, Philip Z, Stephanie CP. The Role of Severe Lateral Facet Patellar Osteoarthritis in Patient Selection for Success of a Medial Unicompartmental Knee Arthroplasty: Mean Follow-Up of 10 Years. J Arthroplasty. 2023;38(0).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYing-Jin S, Ning L, Long H, Xiang-Yang C, Cheng L, Shuo F. The influence of patellar morphology on clinical outcomes after unicompartmental knee arthroplasty. Int Orthop. 2024;48(12).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJean-Noel AA, Guillaume B, Jean-Manuel A, Sebastien P. Modern unicompartmental knee arthroplasty with cement: a concise follow-up, at a mean of twenty years, of a previous report. J Bone Joint Surg Am. 2013;95(10).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJean-Philippe B. Knee Pain from Osteoarthritis: Pathogenesis, Risk Factors, and Recent Evidence on Physical Therapy Interventions. J Clin Med. 2022;11(12).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSylvain G, Alessandra M, Sebastien L. Long-term outcomes of a 3D printed cementless fixed bearing unicompartmental knee arthroplasty. Arch Orthop Trauma Surg. 2025;145(1).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJonathan TE, Robert WW, Jonathan PE, Ashley WB, Adrian S, Michael RW. How long does a knee replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up. Lancet. 2019;393(10172).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJi-Hoon B, Jae Gyoon K, Seung-Yup L, Hong Chul L, Yong I. Epidemiology of Bearing Dislocations After Mobile-Bearing Unicompartmental Knee Arthroplasty: Multicenter Analysis of 67 Bearing Dislocations. J Arthroplasty. 2019;35(1).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEun-Kyoo S, Ju-Kwon P, Chan-Hee P, Min-Cheol K, Pranav RA, Jong Keun S. No difference in anterior knee pain after medial unicompartmental knee arthroplasty in patients with or without patellofemoral osteoarthritis. Knee Surg Sports Traumatol Arthrosc. 2014;24(1).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTarik B, Laura JK, Todd AB, Thomas MC, Jon D, Joseph TN et al. Ten-Year Survivorship and Patient Satisfaction Following Robotic-Arm-Assisted Medial Unicompartmental Knee Arthroplasty: A Prospective Multicenter Study. J Bone Joint Surg Am. 2023;105(12).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLi M, Liu Q, Cui G. Lateral patellar tilting can also result in cartilage lesions of tibial plateau - the characteristic features of excessive lateral pressure syndrome: a retrospective study of 141 cases. BMC Musculoskelet Disord. 2025;26(1).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRodolfo M-A, Caterina C, Christopher C-C, Gerardo C-J, Judith G-L, Carlos F, O-G, et al. Femoral maltorsion influences both patellofemoral and tibiofemoral contact pressures. A biomechanical evaluation. J ISAKOS. 2025;12:0.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eF SK. S H. Does location of patellofemoral chondral lesion influence outcome after Oxford medial compartmental knee arthroplasty? Bone Joint J 2016(0).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eH S G DJBHP, C A F D, D W DH. M. 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;89(12).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDo Young P, Jun Young C, Yong Jun J, Ha Seung Y, Byoung-Hyun M, Jae-Young P et al. Lateral Retinacular Release During Medial Unicompartmental Knee Arthroplasty in the Presence of Patello-Femoral Joint Arthritis Relieves Patello-Femoral Joint Pressure and Improves Associated Symptoms. J Arthroplasty. 2023;38(11).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJonathan L, Drew C, Mohammad D, Noah G, John M, Eric MC et al. Formal physical therapy may be unnecessary following total knee arthroplasty: A prospective randomized study. J Orthop. 2025;65(0).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDana LJ, Donald GE, Jennifer ES-L. Muscle strength loss in the lower limb after total knee arthroplasty. Am J Phys Med Rehabil. 2012;91(3).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMaggie L, Ahmed N, George I, Danielle P, Mitchell W, Jonathan DA et al. Identifying Patients with Osteoarthritis at Risk of Sarcopenia using the SARC-F. Can Geriatr J. 2021;24(1).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMha AJMB, Valentin Antoci BSKBWD, C A. Sarcopenia as a Risk Factor for Prosthetic Infection After Total Hip or Knee Arthroplasty. J Arthroplast. 2019;34(1):116\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAlejandra PM, Pieter E, Luc JC, vL, Lex BV. Resistance exercise training to improve post-operative rehabilitation in knee arthroplasty patients: A narrative review. Eur J Sport Sci. 2024;24(7).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRobert GM, Edward CJ, Nawal CA, Robert FC, Eduardo AS, Thomas PS. Measuring improvement following total hip and knee arthroplasty using patient-based measures of outcome. J Bone Joint Surg Am. 2005;87(9).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHendrik AZ, Jelle P, vdL, Saker K, Danyal HN, Ran T, C I et al. Unicompartmental knee arthroplasty versus total knee arthroplasty: Which type of artificial joint do patients forget? Knee Surg Sports Traumatol Arthrosc. 2015;25(3).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGeert P, Jeroen V, Barbara F. The forgotten joint score in total and unicompartmental knee arthroplasty: a prospective cohort study. Int Orthop. 2019;43(12).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eA X H RRSX, M H L XL, H N P, et al. 15-year validation of the forgotten joint score after unicompartmental knee arthroplasty: A reliable indicator of long-term patient satisfaction and joint awareness. J Orthop. 2025;66:0.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLimin W, Quan C, Haibo S, Yuangang W, Yi Z, Mingyang L et al. Influence of patellofemoral joint degeneration on clinical outcomes after medial unicompartmental knee arthroplasty. Chin Med J (Engl). 2023;136(13).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-musculoskeletal-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmsd","sideBox":"Learn more about [BMC Musculoskeletal Disorders](http://bmcmusculoskeletdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12891","title":"BMC Musculoskeletal Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Unicompartmental knee arthroplasty, wiberg classfication, knee osteoarthritis","lastPublishedDoi":"10.21203/rs.3.rs-7743193/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7743193/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003ePostoperative outcomes and patient satisfaction following unicompartmental knee arthroplasty (UKA) are influenced by multiple factors, with patellofemoral joint pain being a predominant concern. Nevertheless, whether the Wiberg patellar classification system affects functional outcomes and satisfaction remains unclear. This study aimed to evaluate the impact of different patellar types on UKA outcomes.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA retrospective analysis was conducted on 327 clinical cases from January 1, 2020, to December 31, 2023. The cohort comprised 59 cases of Type I patella, 200 cases of Type II patella, and 68 cases of Type III patella, with follow-up durations ranging from 18 to 63 months. This study evaluated the effects of the three patient groups on the following parameters: age, body mass index (BMI), American Society of Anesthesiologists (ASA) classification, Hospital for Special Surgery (HSS) knee score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Forgotten Joint Score-12 (FJS-12), Feller score, and patient satisfaction.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe three patient groups exhibited statistically significant differences in satisfaction, FJS-12, and Feller scores. Postoperative knee function improved significantly in all groups compared to preoperative levels. Further analysis of the Feller score components revealed notable distinctions between Type II and Type III patellar morphologies, particularly in satisfaction, FJS-12 scores, and Feller subscores (including anterior knee pain [AKP], stair-climbing ability, and sit-up capacity). However, no significant intergroup differences were observed in age, BMI, ASA classification, HSS score, WOMAC index, or quadriceps strength (Feller assessment).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eUKA effectively improves knee osteoarthritis symptoms. While patellar classification did not influence overall functional outcomes, Type III patellae had inferior patient-reported outcomes. Preoperative planning should address patellar morphology in Type III cases.\u003c/p\u003e\u003ch2\u003eTrial registration\u003c/h2\u003e\u003cp\u003e Our clinical trial was approved by the Ethics Committee of the People's Hospital of Ningxia Hui Autonomous Region, and the ethical code was No.2025WJW004\u003c/p\u003e","manuscriptTitle":"Impact of Wiberg Patellar Morphology on Patient-Reported Outcomes Following Unicompartmental Knee Arthroplasty: A 3~5 Year Retrospective Cohort Analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-17 06:33:01","doi":"10.21203/rs.3.rs-7743193/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-11-27T08:11:41+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-26T03:53:03+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-24T14:48:04+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-20T04:04:57+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"294281981803767154310385184528197034687","date":"2025-11-07T01:52:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"51939019562067321211235430025111117853","date":"2025-11-06T19:51:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"238016201054071732060142524355708158744","date":"2025-11-06T14:36:35+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"106161290822401759168361498526087377321","date":"2025-11-05T14:44:16+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"293375495147332868023855605985918311619","date":"2025-11-05T09:21:23+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"311759051845361281241227221231492112678","date":"2025-11-05T08:05:25+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"17301567905339790794361212267025268976","date":"2025-11-05T08:03:28+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-11-05T07:58:24+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-11-05T04:08:01+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-13T04:08:04+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-10T15:41:17+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Musculoskeletal Disorders","date":"2025-10-10T15:19:14+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-musculoskeletal-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmsd","sideBox":"Learn more about [BMC Musculoskeletal Disorders](http://bmcmusculoskeletdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12891","title":"BMC Musculoskeletal Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"cd7d7adf-1176-4497-80b6-13e395649f3b","owner":[],"postedDate":"November 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-12-29T16:03:29+00:00","versionOfRecord":{"articleIdentity":"rs-7743193","link":"https://doi.org/10.1186/s12891-025-09396-z","journal":{"identity":"bmc-musculoskeletal-disorders","isVorOnly":false,"title":"BMC Musculoskeletal Disorders"},"publishedOn":"2025-12-23 15:57:23","publishedOnDateReadable":"December 23rd, 2025"},"versionCreatedAt":"2025-11-17 06:33:01","video":"","vorDoi":"10.1186/s12891-025-09396-z","vorDoiUrl":"https://doi.org/10.1186/s12891-025-09396-z","workflowStages":[]},"version":"v1","identity":"rs-7743193","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7743193","identity":"rs-7743193","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}