Revision of unicompartmental knee arthroplasty: Outcome in 1, 135 cases from the Swedish Knee Arthroplasty study (original) (raw)
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Ortopedia, traumatologia, rehabilitacja
Background. Since the introduction minimally invasive techniques, interest in unicompartmental knee arthroplasty (UKA) has rapidly increased. This minimally invasive approach preserves the anatomy of the knee with less damage to extensor mechanisms, less morbidity, and quicker post-operative recovery. The purpose of our study was to evaluate this new treatment option for anteromedial osteoarthritis, both clinically and radiographically, and to identify any possible drawbacks. Material and methods. Between January 1999 and August 2003 88 consecutive Oxford Phase 3 UKAs were implanted by a single surgeon. All patients with a minimal follow-up (FU) period of 2 years were pre- and post- operatively clinically evaluated by the American Knee Society (AKS) Score and radiographically according to the Oxford Centre criteria, including fluoroscopy. Results. Twenty-eight patients with 30 prostheses with a minimal follow-up period 2 years (2.54 +/- 0.48 yrs) were included in this study. The AKS...
Knee Surgery, Sports Traumatology, Arthroscopy, 2011
Purpose In the last decade, a major increase in the use of and interest in unicompartmental knee arthroplasty (UKA) has developed. The Oxford Phase 3 UKA is implanted with a minimally invasive technique using newly developed instruments. The objective of this prospective study was to evaluate the outcome of UKA in patients with medial osteoarthritis of the knee in a high-volume unit. Methods Two-hundred and forty-four UKAs were performed with a minimally invasive approach. The median age was 72 (43-91) years. The median follow-up was 4.2 years (range 1-10.4 years). Fourteen patients died, and nine were considered to be lost to follow-up, but all had a well-functioning prosthesis in situ until their last follow-up. Pain, function and health-related quality of life were evaluated pre-and postoperatively using patient-and assessor-based outcome scores, as well as radiographic evidence.
Outcome of revision of unicompartmental knee replacement
Acta Orthopaedica, 2010
Background and purpose Despite concerns regarding a higher risk of revision, unicompartmental knee arthroplasty (UKA) continues to be used as an alternative to total knee arthroplasty (TKA). There are, however, limited data on the subsequent outcome when a UKA is revised. We examined the survivorship for primary UKA procedures that have been revised.
Unicompartmental knee arthroplasty
Journal of Bone and Joint Surgery-british Volume, 2004
Despite mixed results with unicompartmental knee arthroplasty (UKA) in the 1970s, the UKA was established as a reliable procedure in the low-demand, elderly patient. Dependable results up to a decade prompted the idea that UKA may work equally well in the younger patient. Expanded indications for UKA are being evaluated: might higher failure rates and difficult revisions emerge from younger, more active patients? Key words: unicompartmental knee arthroplasty, new indications, long-term follow-up.
Unicompartmental knee arthroplasty provides early improvements
Journal of Orthopaedics and Traumatology, 2013
Background: The cases of patients with medial compartment osteoarthritis who were £55 years old and had a proximal tibial osteotomy (PTO) or medial unicompartmental knee arthroplasty (UKA) were compared. Outcomes included postoperative activity level, function, and survivorship free of revision to total knee arthroplasty. Methods: Between 1998 and 2013, data were available for 240 patients between 18 and 55 years old with medial compartment arthritis and varus malalignment who were treated either with PTO (57 patients) or with UKA (183 patients). The mean age was 42.7 years for the 57 patients (41 men and 16 women) in the PTO group versus 49.2 years for the 183 patients (82 men and 101 women) in the UKA group. The Tegner activity level and Lysholm knee scores were evaluated at 3 months and at 1, 2, and 5 years postoperatively as well as at the time of the final follow-up. The end point for survival was defined as revision to total knee arthroplasty. A Wilcoxon rank-sum test was used to evaluate the difference between the groups with respect to the Tegner and Lysholm scores at the respective follow-up intervals. Multivariate regression was used to assess potential confounders. Results: Preoperatively, the PTO and UKA groups had similar Tegner (3.0 ± 1.3 and 2.6 ± 0.09, respectively) and Lysholm scores (69.5 ± 7.3 and 71.6 ± 5.4). Postoperatively, the UKA group had significantly superior mean Tegner scores compared with the PTO group at 3 months (3.82 and 2.02, respectively), at 2 years (4.33 and 3.75), and at the time of the final follow-up (4.48 and 3.08), while the Lysholm scores were higher at 3 months (88.0 and 76.3) and at the final follow-up (90.0 and 80.2) (p < 0.01 for all). Multivariate analysis showed UKA to be an independent predictor of activity level at 3 months, 1 year, and 2 years, as well as at the final follow-up. The survivorship was 77% in the PTO group at an average of 7.2 years and 94% in the UKA group at an average of 5.8 years (p < 0.01). The average time to failure was 98 months (range, 38 to 169 months) in the PTO group and 42 months (range, 2 to 123 months) in the UKA group (p < 0.01). Conclusions: In this comparative cohort study of young patients with isolated unicompartmental arthritis, those treated with UKA reached a higher level of activity early after surgery and it persisted at mid-term follow-up. The UKA group had earlier, but less frequent, revision to total knee arthroplasty. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence. U nicompartmental knee arthroplasty (UKA) and proximal tibial osteotomy (PTO) are common treatments for painful unicompartmental knee arthritis in younger and active patients 1. Conventionally, PTO has been recommended for younger, more active patients, as UKA poses concern for wear or loosening of the prosthesis 1,2. Some studies Disclosure: No external funding was used for this study. On the Disclosure of Potential Conflicts of Interest forms, which are provided with the online version of the article, one or more of the authors checked "yes" to indicate that the author had a relevant financial relationship in the biomedical arena outside the submitted work and "yes" to indicate that the author had other relationships or activities that could be perceived to influence, or have the potential to influence, what was written in this work.
Bezmialem Science, 2019
Unicompartmental knee artroplasty (UKA) is a method with high patient satisfaction and successful results, which is used in the surgical treatment of medial joint osteoarthritis accompanied by complete thickness cartilage loss (1,2). It is a less invasive procedure with shorter operation time (3), less blood loss, and without touching cartilage, bone, and ligaments in other parts of the knee, compared with total knee arthroplasty (TKA). In addition, stay in hospital is shorter and rehabilitation of the patients are faster with UKA (4-6). Although long-term results reveal that revision rate is a bit higher in UKA; UKA have important advantages such as lower morbidity and mortality rate and providing a more physiological joint compared with TKA (1,7).
Orthopaedics & Traumatology: Surgery & Research, 2020
Introduction: Isolated lateral compartment osteoarthritis of the knee (LCOA) is 10 times less frequent than medial compartment involvement. Long-term assessments of unicompartmental knee arthroplasty (UKA) in this indication are rare, with small series. Hypothesis: Survival and functional outcome of lateral UKA in a large series are quite acceptable; the strategy is suited for isolated LCOA. Material and method: A multicenter retrospective study in 6 French health establishments included all lateral UKAs performed between January 1988 and September 2014. Clinical data (range of motion, International Knee Society (IKS) knee and function scores, satisfaction), paraclinical data (radiologic angles) and complications were prospectively entered in medical files during follow-up and analyzed retrospectively at end of follow-up. Results: During the study period, 311 lateral UKAs were performed in 295 patients, using 5 fixed-bearing implant models. Twenty-eight patients died within 5 years, and 15 (4.8%) were lost to follow-up. The series thus comprised 268 lateral UKAs in 63 male and 205 female patients, with a mean age of 68.8 ± 10.5 years, including 7 cases of post-traumatic osteoarthritis and 4 of aseptic osteonecrosis. Mean follow-up was 9.1 years (range, 5-23 years), implant survivorship with failure defined as all-cause revision surgery was 85.4% at 10 years and 79.4% at 20 years. At last follow-up, IKS knee score was 87.0 and IKS function score 80.2. Maximal flexion was 125 •. 94.3% of patients were satisfied or very satisfied. The main cause of revision surgery was osteoarthritis in another knee compartment (66,7%, n = 26). Conclusion: Lateral UKA showed good survivorship, comparable to medial UKA, with good functional results and excellent long-term satisfaction.
Unicompartmental Knee Arthroplasty: Modes of Failure and Conversion to Total Knee Arthroplasty
Joints
Despite the excellent success rates of the modern unicompartmental knee arthroplasty (UKA), results of knee replacement registries still shows a relatively high revision and failure rate for UKA, especially when compared with traditional total knee arthroplasty (TKA). Bearing dislocation continues to be advocated as the predominant mechanism of failure in mobile UKA, whereas polyethylene wear and aseptic loosening remains the main cause of failure of fixed UKA. Degeneration of the unreplaced compartments has been reported in both mobile and fixed designs. When the revision is required, most of failed UKAs are converted to TKAs. Surgical challenges of the UKA revision, and outcomes of UKA converted to TKA are still debated in literature.
Unicompartmental Knee Arthroplasty: The Past, Current Controversies, and Future Perspectives
The Journal of Knee Surgery, 2018
Unicompartmental knee arthroplasty (UKA) is a bone conserving and ligament-sparing procedure that reliably restores normal knee kinematics and function for arthritis limited either to the medial or the lateral compartment of the knee. Although there is enough evidence to demonstrate that the UKA offers good medium to long-term success given the correct patient selection, prosthesis design, and implantation technique, there are several reports to suggest inferior survival rates in comparison with the total knee arthroplasty (TKA). Furthermore, it is a specialized procedure which works well in the hands of the experienced operator and therefore different authors' tend to draw different conclusions based on the same evidence, and as a result, there is great variability in the usage of the UKA. The aim of this current concept's review is to present to the readers the history of the UKA especially with reference to implant design, discuss current controversies, and outline the fu...
Cureus, 2019
The popularity of unicompartmental knee arthroplasty (UKA) for the treatment of isolated compartment osteoarthritis of the knee has risen over the past two decades. Currently, UKA covers a considerable amount of all knee arthroplasties worldwide. The aim of this study was to present the clinical and radiological outcomes of UKA in patients with medial compartment osteoarthritis. Methods Between January 2010 and January 2014, mobile-bearing UKA was applied to 44 knees of 37 (three men, 34 women) patients with isolated medial compartment osteoarthritis. The mean age, body mass index (BMI), and follow-up were 54 ± 6.1, 26.3± 2.2, and 48 ± 9.4, respectively. Oxford Knee Score (OKS), Knee Society Score (KSS), visual analog scale (VAS), and range of motion (ROM) were used for clinical assessment, and the Oxford Radiological Evaluation Criteria were used for radiological assessment. Results Compared to preoperative values, knee flexion increased from 116° to 123°(p<0.001). Statistically significant increases in OKS and KSS and decrease in VAS was obtained postoperatively (p<0.001). All of the components were aligned within the acceptable ranges radiologically. One bearing dislocation was revised and one conversion to TKA was performed during the 5.9-year follow-up. No major complications occurred, including infection, deep vein thrombosis, pulmonary emboli, and neurovascular injury. Conclusion The mid-term clinical and radiological outcomes of UKA were excellent in this study, and our results demonstrate that Oxford mobile-bearing UKA for the proper indication is effective, with considerable success in the treatment of medial compartmental knee osteoarthritis, regardless of age.