Unicompartmental Knee Arthroplasty. Clinical-Radiographic Results and Analysis of Implant Survival
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Published:
Dec 31, 2022
Keywords:
Unicompartmental prosthesis, knee, unicompartmental involvement, survival
Main Article Content
Abstract
Objective: To assess the clinical and radiological outcomes of patients who underwent a unicompartmental knee arthroplasty (UKA), as well as the complication rate and implant survival.
Materials and Methods: We present a retrospective descriptive study of 68 consecutive patients (70 knees) who underwent UKA between 2013 and 2020, with an average follow-up of 57.7 months (range 24-105) and an average age of 61 years (range 34-79). 46.5% of the patients were male. The average BMI was 29.9 (range 20-39). The most frequent etiology was osteoarthritis of the medial femorotibial compartment with a varus <7°. To assess the outcomes, the visual analog scale (VAS) for pain and the Knee Society Score (KSS) were used. The complication and implant survival rates were evaluated.
Results: The average decrease in the VAS pain scale was 4.4±1.9. The average score on the postoperativeKSS functional and clinical scales were 77.4±13.7 and 70.2±17.7, respectively. The postoperative complication rate was 7% (5 cases). The surgical reoperation rate was 15.5% (11 patients): nine cases for persistent pain, one case for joint stiffness, and one case for aseptic loosening.
Conclusions: UKA is an effective therapeutic option for patients with unicompartmental knee osteoarthritis, providing good clinical results with an acceptable rate of complications; however, it provides a considerable implant revision rate.
Level of Evidence: IV
Materials and Methods: We present a retrospective descriptive study of 68 consecutive patients (70 knees) who underwent UKA between 2013 and 2020, with an average follow-up of 57.7 months (range 24-105) and an average age of 61 years (range 34-79). 46.5% of the patients were male. The average BMI was 29.9 (range 20-39). The most frequent etiology was osteoarthritis of the medial femorotibial compartment with a varus <7°. To assess the outcomes, the visual analog scale (VAS) for pain and the Knee Society Score (KSS) were used. The complication and implant survival rates were evaluated.
Results: The average decrease in the VAS pain scale was 4.4±1.9. The average score on the postoperativeKSS functional and clinical scales were 77.4±13.7 and 70.2±17.7, respectively. The postoperative complication rate was 7% (5 cases). The surgical reoperation rate was 15.5% (11 patients): nine cases for persistent pain, one case for joint stiffness, and one case for aseptic loosening.
Conclusions: UKA is an effective therapeutic option for patients with unicompartmental knee osteoarthritis, providing good clinical results with an acceptable rate of complications; however, it provides a considerable implant revision rate.
Level of Evidence: IV
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How to Cite
Marquina Moraleda, V., Gastaldi, G., Fuentes, S., Colomina, R., Jover, P., & Hernández, L. (2022). Unicompartmental Knee Arthroplasty. Clinical-Radiographic Results and Analysis of Implant Survival. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 87(6), 772-780. https://doi.org/10.15417/issn.1852-7434.2022.87.6.1540
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Clinical Research
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References
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primary total knee arthroplasty. J Orthop Surg Res 2018;13(1):158. https://doi.org/10.1186/s13018-018-0859-1
2. Pollock M, Somerville L, Firth A, Lanting B. Outpatient total hip arthroplasty, total knee arthroplasty, and
unicompartmental knee arthroplasty: A systematic review of the literature. JBJS Rev 2016;4(12):e4.
https://doi.org/10.2106/JBJS.RVW.16.00002
3. Ford MC, Walters JD, Mulligan RP, Dabov GD, Mihalko WM, Mascioli AM, et al. Safety and cost-effectiveness of
outpatient unicompartmental knee arthroplasty in the ambulatory surgery center: A matched cohort study. Orthop Clin North Am 2020;51(1):1-5. https://doi.org/10.1016/j.ocl.2019.08.001
4. Arirachakaran A, Choowit P, Putananon C, Muangsiri S, Kongtharvonskul J. Is unicompartmental knee arthroplasty (UKA) superior to total knee arthroplasty (TKA)? A systematic review and meta-analysis of randomized controlled trial. Eur J Orthop Surg Traumatol 2015;25(5):799-806. https://doi.org/10.1007/s00590-015-1610-9
5. Fernández Fernández R, Ordóñez Parra JM. El papel actual de la osteotomía de rodilla en la artrosis. Rev Esp Cir
Ortopédica Traumatol 2002;46(5):465-75. IBECS ID: 18542
6. Brucker PU, Braun S, Imhoff AB. Mega-OATS technique – Autologous osteochondral transplantation as a salvage procedure for large osteochondral defects of the femoral condyle. Orthop Traumatol 2008;20:188-98.
https://doi.org/10.1007/s00064-008-1301-3
7. Schaefer R. Prótesis unicompartimental de rodilla. Rev Asoc Argent Ortop Traumatol 1999;64(4):290-5. Disponible en: http://aaot.org.ar/revista/1993_2002/1999/1999_4/640406.pdf
8. Johal S, Nakano N, Baxter M, Hujazi I, Pandit H, Khanduja V. Unicompartmental knee arthroplasty: The past,
current controversies, and future perspectives. J Knee Surg 2018;31(10):992-8. https://doi.org/10.1055/s-0038-1625961
9. Kalra S, Smith TO, Berko B, Walton NP. Assessment of radiolucent lines around the Oxford unicompartmental knee replacement: sensitivity and specificity for loosening. J Bone Joint Surg Br 2011;93(6):777-81.
https://doi.org/10.1302/0301-620X.93B6.26062
10. Martínez JP, Arango AS, Castro AM, Martínez Rondanelli A. Validación de la versión en español de las escalas de Oxford para rodilla y cadera. Rev Colomb Ortop Traumatol 2016;30(2):61-6. https://doi.org/10.1016/j.rccot.2016.07.004
11. Jennings JM, Kleeman-Forsthuber LT, Bolognesi MP. Medial unicompartmental arthroplasty of the knee. J Am Acad Orthop Surg 2019;27(5):166-76. https://doi.org/10.5435/JAAOS-D-17-00690
12. Murray DW, Liddle AD, Judge A, Pandit H. Bias and unicompartmental knee arthroplasty. Bone Joint J 2017;99-
B(1):12-5. https://doi.org/10.1302/0301-620X.99B1.BJJ-2016-0515.R1
13. Kozinn SC, Scott R. Unicondylar knee arthroplasty. J Bone Joint Surg Am 1989;71(1):145-50. PMID: 2643607
14. van der List JP, Chawla H, Zuiderbaan HA, Pearle AD. The role of preoperative patient characteristics on outcomes of unicompartmental knee arthroplasty: A meta-analysis critique. J Arthroplasty 2016;31(11):2617-27.
https://doi.org/10.1016/j.arth.2016.04.001
15. Thienpont E. Conversion of a unicompartmental knee arthroplasty to a total knee arthroplasty: can we achieve a primary result? Bone Joint J 2017;99-B(1 Suppl A):65-9. https://doi.org/10.1302/0301-620X.99B1.BJJ-2016-0272
16. Isaac SM, Barker KL, Danial IN, Beard DJ, Dodd CA, Murray DW. Does arthroplasty type influence knee joint
proprioception? A longitudinal prospective study comparing total and unicompartmental arthroplasty. Knee
2007;14(3):212-7. https://doi.org/10.1016/j.knee.2007.01.001
17. Insall J, Aglietti P. A five to seven-year follow-up of unicondylar arthroplasty. J Bone Joint Surg Am
1980;62(8):1329-37. PMID: 7440612
18. Wilson HA, Middleton R, Abram SGF, Smith S, Alvand A, Jackson WF, et al. Patient relevant outcomes of
unicompartmental versus total knee replacement: systematic review and meta-analysis. BMJ 2019;364:1352.
https://doi.org/10.1136/bmj.l352
19. van der List JP, McDonald LS, Pearle AD. Systematic review of medial versus lateral survivorship in
unicompartmental knee arthroplasty. Knee 2015;22(6):454-60. https://doi.org/10.1016/j.knee.2015.09.011
20. Hang JR, Stanford TE, Graves SE, Davidson DC, de Steiger RN, Miller LN. Outcome of revision of
unicompartmental knee replacement. Acta Orthop 2010;81(1):95-8. https://doi.org/10.3109/17453671003628731
21. Murray DW, Parkinson RW. Usage of unicompartmental knee arthroplasty. Bone Joint J 2018;100-B(4):432-5.
https://doi.org/10.1302/0301-620X.100B4.BJJ-2017-0716.R1
22. Lombardi AV, Kolich MT, Berend KR, Morris MJ, Crawford DA, Adams JB. Revision of unicompartmental knee
arthroplasty to total knee arthroplasty: Is it as good as a primary result? J Arthroplasty 2018;33(7S):S105-8.
https://doi.org/10.1016/j.arth.2018.03.023
23. van der List JP, Zuiderbaan HA, Pearle AD. Why do medial unicompartmentalknee arthroplastiesfail today? J
Arthroplasty 2016;31(5):1016-21. https://doi.org/10.1016/j.arth.2015.11.030
24. Baker PN, Petheram T, Avery PJ, Gregg PJ, Deehan DJ. Revision for unexplained pain following unicompartmental and total knee replacement. J Bone Joint Surg Am 2012;94(17):e126. https://doi.org/10.2106/JBJS.K.00791
25. Leta TH, Lygre SHL, Skredderstuen A, Hallan G, Gjertsen JE, Rokne B, et al. Outcomes of unicompartmental knee arthroplasty after aseptic revision to total knee arthroplasty: A comparative study of 768 TKAs and 578 UKAs revised to TKAs from the Norwegian Arthroplasty Register (1994 to 2011). J Bone Joint Surg Am 2016;98(6):431-40. https://doi.org/10.2106/JBJS.O.00499
26. Liddle AD, Pandit H, Judge A, Murray DW. Effect of surgical caseload on revision rate following total and
unicompartmental knee replacement.J Bone Joint Surg Am 2016;98(1):1-8. https://doi.org/10.2106/JBJS.N.00487
27. Hamilton TW, Rizkalla JM, Kontochristos L, Marks BE, Mellon SJ, Dodd CAF, et al. The interaction of caseload
and usage in determining outcomes of unicompartmental knee arthroplasty: A meta-Analysis. J Arthroplasty
2017;32(10):3228-37.e2. https://doi.org/10.1016/j.arth.2017.04.063
primary total knee arthroplasty. J Orthop Surg Res 2018;13(1):158. https://doi.org/10.1186/s13018-018-0859-1
2. Pollock M, Somerville L, Firth A, Lanting B. Outpatient total hip arthroplasty, total knee arthroplasty, and
unicompartmental knee arthroplasty: A systematic review of the literature. JBJS Rev 2016;4(12):e4.
https://doi.org/10.2106/JBJS.RVW.16.00002
3. Ford MC, Walters JD, Mulligan RP, Dabov GD, Mihalko WM, Mascioli AM, et al. Safety and cost-effectiveness of
outpatient unicompartmental knee arthroplasty in the ambulatory surgery center: A matched cohort study. Orthop Clin North Am 2020;51(1):1-5. https://doi.org/10.1016/j.ocl.2019.08.001
4. Arirachakaran A, Choowit P, Putananon C, Muangsiri S, Kongtharvonskul J. Is unicompartmental knee arthroplasty (UKA) superior to total knee arthroplasty (TKA)? A systematic review and meta-analysis of randomized controlled trial. Eur J Orthop Surg Traumatol 2015;25(5):799-806. https://doi.org/10.1007/s00590-015-1610-9
5. Fernández Fernández R, Ordóñez Parra JM. El papel actual de la osteotomía de rodilla en la artrosis. Rev Esp Cir
Ortopédica Traumatol 2002;46(5):465-75. IBECS ID: 18542
6. Brucker PU, Braun S, Imhoff AB. Mega-OATS technique – Autologous osteochondral transplantation as a salvage procedure for large osteochondral defects of the femoral condyle. Orthop Traumatol 2008;20:188-98.
https://doi.org/10.1007/s00064-008-1301-3
7. Schaefer R. Prótesis unicompartimental de rodilla. Rev Asoc Argent Ortop Traumatol 1999;64(4):290-5. Disponible en: http://aaot.org.ar/revista/1993_2002/1999/1999_4/640406.pdf
8. Johal S, Nakano N, Baxter M, Hujazi I, Pandit H, Khanduja V. Unicompartmental knee arthroplasty: The past,
current controversies, and future perspectives. J Knee Surg 2018;31(10):992-8. https://doi.org/10.1055/s-0038-1625961
9. Kalra S, Smith TO, Berko B, Walton NP. Assessment of radiolucent lines around the Oxford unicompartmental knee replacement: sensitivity and specificity for loosening. J Bone Joint Surg Br 2011;93(6):777-81.
https://doi.org/10.1302/0301-620X.93B6.26062
10. Martínez JP, Arango AS, Castro AM, Martínez Rondanelli A. Validación de la versión en español de las escalas de Oxford para rodilla y cadera. Rev Colomb Ortop Traumatol 2016;30(2):61-6. https://doi.org/10.1016/j.rccot.2016.07.004
11. Jennings JM, Kleeman-Forsthuber LT, Bolognesi MP. Medial unicompartmental arthroplasty of the knee. J Am Acad Orthop Surg 2019;27(5):166-76. https://doi.org/10.5435/JAAOS-D-17-00690
12. Murray DW, Liddle AD, Judge A, Pandit H. Bias and unicompartmental knee arthroplasty. Bone Joint J 2017;99-
B(1):12-5. https://doi.org/10.1302/0301-620X.99B1.BJJ-2016-0515.R1
13. Kozinn SC, Scott R. Unicondylar knee arthroplasty. J Bone Joint Surg Am 1989;71(1):145-50. PMID: 2643607
14. van der List JP, Chawla H, Zuiderbaan HA, Pearle AD. The role of preoperative patient characteristics on outcomes of unicompartmental knee arthroplasty: A meta-analysis critique. J Arthroplasty 2016;31(11):2617-27.
https://doi.org/10.1016/j.arth.2016.04.001
15. Thienpont E. Conversion of a unicompartmental knee arthroplasty to a total knee arthroplasty: can we achieve a primary result? Bone Joint J 2017;99-B(1 Suppl A):65-9. https://doi.org/10.1302/0301-620X.99B1.BJJ-2016-0272
16. Isaac SM, Barker KL, Danial IN, Beard DJ, Dodd CA, Murray DW. Does arthroplasty type influence knee joint
proprioception? A longitudinal prospective study comparing total and unicompartmental arthroplasty. Knee
2007;14(3):212-7. https://doi.org/10.1016/j.knee.2007.01.001
17. Insall J, Aglietti P. A five to seven-year follow-up of unicondylar arthroplasty. J Bone Joint Surg Am
1980;62(8):1329-37. PMID: 7440612
18. Wilson HA, Middleton R, Abram SGF, Smith S, Alvand A, Jackson WF, et al. Patient relevant outcomes of
unicompartmental versus total knee replacement: systematic review and meta-analysis. BMJ 2019;364:1352.
https://doi.org/10.1136/bmj.l352
19. van der List JP, McDonald LS, Pearle AD. Systematic review of medial versus lateral survivorship in
unicompartmental knee arthroplasty. Knee 2015;22(6):454-60. https://doi.org/10.1016/j.knee.2015.09.011
20. Hang JR, Stanford TE, Graves SE, Davidson DC, de Steiger RN, Miller LN. Outcome of revision of
unicompartmental knee replacement. Acta Orthop 2010;81(1):95-8. https://doi.org/10.3109/17453671003628731
21. Murray DW, Parkinson RW. Usage of unicompartmental knee arthroplasty. Bone Joint J 2018;100-B(4):432-5.
https://doi.org/10.1302/0301-620X.100B4.BJJ-2017-0716.R1
22. Lombardi AV, Kolich MT, Berend KR, Morris MJ, Crawford DA, Adams JB. Revision of unicompartmental knee
arthroplasty to total knee arthroplasty: Is it as good as a primary result? J Arthroplasty 2018;33(7S):S105-8.
https://doi.org/10.1016/j.arth.2018.03.023
23. van der List JP, Zuiderbaan HA, Pearle AD. Why do medial unicompartmentalknee arthroplastiesfail today? J
Arthroplasty 2016;31(5):1016-21. https://doi.org/10.1016/j.arth.2015.11.030
24. Baker PN, Petheram T, Avery PJ, Gregg PJ, Deehan DJ. Revision for unexplained pain following unicompartmental and total knee replacement. J Bone Joint Surg Am 2012;94(17):e126. https://doi.org/10.2106/JBJS.K.00791
25. Leta TH, Lygre SHL, Skredderstuen A, Hallan G, Gjertsen JE, Rokne B, et al. Outcomes of unicompartmental knee arthroplasty after aseptic revision to total knee arthroplasty: A comparative study of 768 TKAs and 578 UKAs revised to TKAs from the Norwegian Arthroplasty Register (1994 to 2011). J Bone Joint Surg Am 2016;98(6):431-40. https://doi.org/10.2106/JBJS.O.00499
26. Liddle AD, Pandit H, Judge A, Murray DW. Effect of surgical caseload on revision rate following total and
unicompartmental knee replacement.J Bone Joint Surg Am 2016;98(1):1-8. https://doi.org/10.2106/JBJS.N.00487
27. Hamilton TW, Rizkalla JM, Kontochristos L, Marks BE, Mellon SJ, Dodd CAF, et al. The interaction of caseload
and usage in determining outcomes of unicompartmental knee arthroplasty: A meta-Analysis. J Arthroplasty
2017;32(10):3228-37.e2. https://doi.org/10.1016/j.arth.2017.04.063