autoregulation or self-regulation. Thanks Kevin, thanks Sabrina for putting this on. I think this might be the last talk of the last day. My disclosures are listed in the Academy site. In general, the more athletically active patients are before arthroplasty, the more active they are after arthroplasty, that's a generality I think we all can understand. High impact activities may cause an increase where? It's the coat hanger phenomena. If you do more with the same amount as someone else does less, you're gonna pay the price. This is a pickleball court surrounded by a chicken restaurant in San Antonio called Chicken and Pickle. Anytime you add good food to an athletic endeavor, I should hang a shield outside of this place. Every Monday I get two to three injuries from Chicken and Pickle. It's on our questionnaire now. Chicken and Pickle, yes. It's unbelievable. I'm a pickleball aficionado now. I got killed by three 70-year-olds over 70 at 7,000 feet outside of Vail last weekend. They beat my ass. Mostly because there was no air. Unicompartmental knee arthritis is it increasingly affects younger patients, have a higher expectation of concerning their level of activity. They come in going, can you get me back to playing tennis? Can you get me back to triathletics or triathlete events? The answer is they ought to regulate themselves. And this is a study from Zimmerer and they reported sport activities after a fixed-bearing lateral UNI, much rarer, 10 to one according to UNIs, at two years, that's a fly. And they looked at just 19 patients surveyed regarding their sporting activities. 15 of 19 were active in at least one sport compared to 13 of 19 after surgery. And they used the term, actually I used the term in reading between the lines, auto-regulation, high-impact activity showed a decreasing existence after arthroplasty. Patients come in with a big story and big demands and then you just kind of let them walk through the system. They're in PT, they see the other patients with the same thing, they talk, they talk way more than they talk to us and they do auto-regulate, I think. I've had very few patients that have kind of broke that barrier and just literally run their knee into the ground after a UNI. They seem to come back at six months and they go, you were right. Here's another study about pop polya, systematic look at collecting available evidence concerning return to sports in the elderly patients after UNI, so the over 65 crowd and data concerning the evaluation of return to sports in patients after a UNI. They looked at same level return to sports in elderly patients was 86% and that was pooled. They looked at UNI as a valid and reliable option for elderly patients and the rate of return to sports is higher than a total. So that's a common thread too and most of the, or the few studies that are out there comparing return to sports between totals and UNIs. Diabrogia saw no difference in return to amateur sports after medial and lateral UNIs in patients less than 65. So the patients were in contention like, should I do a UNI or should I just send them down in the hall to do a total? And I obviously don't do totals from what I just said. They did a power analysis to ensure that sample sizes were about the same considering the 10 to one ratio of laterals to medial UNIs. They found that UNI should always be considered for the treatment of isolated arthritis in younger and active patients with high functional demand. So if you do a total and someone who comes in saying, I'm a hiker, a biker, a swimmer and I like to travel all over and I walk the 18 hole golf course, they're gonna be in that 20% of total needs that are looking really good radiographically but feel miserably clinically. Satisfaction return to sports around Sabrina Strickland and her group. Satisfaction after UNIs was type of sports or what are they doing? So they did a survey study and this is an important because indications for UNIs have expanded and younger and more active patients are coming into the clinic not only demanding but indicated for these procedures. Patients who received the UNI were contacted at 12 to 24 months after surgery. They looked at descriptive statistical analysis and focused on influence of patient sex, age and regression model was fitted to assess their satisfaction post-operatively. They looked at a lot of patients as far as the few studies in this category go, 132 patients, 81% participated in sports which increased to 147 patients after UNI so they actually saw an increase so people got back in the game after a UNI. So a higher return or similar level in 85% which is good, at least they didn't go backwards and the regression analysis showed that male sex, preoperative UCLA score so higher activity and sports participation preoperatively predicted higher activity scores post-operatively and they felt that the vast majority of patients undergoing a UNI returned to sports post-operatively and over 80% were satisfied with the restoration so that's pretty good if you get 80%. This study offers valuable information to help manage our patients expectations regarding the ability to return to sports based on demographics and type of preoperative sporting activity. So again it's like the HTO versus the UNI conundrum. If they come in higher demand and you put the thumb up don't go yeah they are higher demand, they're gonna require more and be more demanding of this prosthesis, maybe I should do a UNI if it's indicated. Here's a patient case study to wrap this up. A 63-year-old female swimmer and hiker, she was a college swimmer and still swam in the community pool and was very competitive at the senior level. Multiple prior meniscal resections referred for bilateral knee pain and right down the hall was my total joint partner to the right and the left and she thankfully for my sake went straight ahead and I think for hers too. She's now three months status post bilateral UNI spaced out by about eight months and she emailed me on the plane ride here and I asked her what are you up to these days? She said I'm hiking in Central America right now. So she's somewhere down in South America, actually I said Central and South America. So she's doing really good. This is another guy, he's a 58-year-old retired army vet, prior avid skier, chronic debilitating bilateral patellofemoral pain in isolation, truly in isolation. He underwent bilateral PFAs over the past one to two years. He just moved to Steamboat last year during COVID because he was just trying to escape civilization and he knocked out a full ski season, he hadn't skied in 10 years. So he was very happy with his results. Here's his little video real quick because I think I got another 30 seconds or so. Good morning, Phillip. Hi, Doc. Thank you for your service, first of all. It's Memorial Day weekend just passed and we're both veterans and thank you for your service. You're a veteran under TRICARE and we're happy we could help you. Tell us a little bit about your story. So my knees have been getting worse and worse. I've been a lifelong snow skier and I had to give up skiing a few years ago. So came in and saw you, you decided you wanted to change out my kneecaps. It's a tire change. From there, we did the right knee two years ago, around 4th of July, and the left knee a year ago, January, so about 18 months ago. And last winter, called you back up, you cleared me to go skiing and I moved to Steamboat Springs for a month and skied my buns off and they worked beautifully. Skied hard, did 15,000 feet of vertical in a day in a few hours. That's awesome. And 14 runs. And I'm finally back into what I used to love to do. I'm envious. I need to get my butt up on the hill and ski. So you had bilateral patella-femoral arthroplasty. That's rare and you're doing great. So we're really happy for you. And they work fine too. Look at that. Good. Good morning, Phillip. Oh, get out of there, Phillip. All right. The more athletically active patients are before total or unis or PFAs even, the more active they are after arthroplasty. That's what we started with. That's what we're ending up with. High impact activities may cause increased wear. That's been documented. Some of them were scientific reports. Uni and PFA patients appear to get back the same or higher level of activities compared to their counterparts in the total category. And I played my first pickleball tournament at 7,000 feet, as I said. Now I understand the craze. Thank you very much. Thank you.

autoregulation

arthroplasty

return to sports

patient case study

high-impact activities