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. 2009 Aug;33(4):969-74.
doi: 10.1007/s00264-008-0585-0. Epub 2008 Jun 18.

Revision of 33 unicompartmental knee prostheses using total knee arthroplasty: strategy and results

Dominique Saragaglia  1 , Gilles Estour, Charbel Nemer, Pierre-Emmanuel Colle
Affiliations

Revision of 33 unicompartmental knee prostheses using total knee arthroplasty: strategy and results

Dominique Saragaglia et al. Int Orthop. 2009 Aug.

Abstract
in English, French

The purpose of this study was twofold: to evaluate the radiological and clinical results of 33 total knee arthroplasties (TKA) implanted between January 1993 and March 2005, to replace failed medial unicompartmental knee arthroplasty (UKA), and to develop a strategy to deal with bone defects in the tibial plateau. Failure was due to: tibial loosening (15 cases), femoral loosening (five cases), femoral and tibial loosening (two cases), polyethylene wear (five cases), lateral compartment osteoarthritis (two cases), patellofemoral osteoarthritis (two cases), laxity and PE dislocation (one case), and sepsis in one case. In 12 cases the tibial bone defect was filled with a metallic wedge, in seven we used an allograft (femoral head), and in one we used both. We report the results of 27 cases (five patients died and one was lost to follow-up). The mean follow-up was 73+/-41.7 months (range, 8-153) and the global IKS score was 166.72+/-21.3 points (range, 128-200). X-rays of the eight allografts showed osteointegration in all cases and no radiolucency was noted.

Le propos de cette étude a deux objets, d’une part d’évaluer les résultats de 33 prothèses totales du genou, réalisées entre janvier 1993 et mars 2005, mises en place pour échec de prothèses uni-compartimentales, deuxièmement de développer une stratégie permettant de compenser les défects osseux des plateaux tibiaux. L’échec de ces prothèses était dû à un descellement tibial (15 cas), fémoral (5 cas), fémoral et tibial (2 cas), d’usure du polyéthylène (5 cas), d’arthrose du compartiment contro-latéral externe (2 cas), d’arthrose fémoro-patellaire (2 cas), un cas de laxité avec dislocation prothétique (1 cas), enfin un cas de sepsis. Dans 12 cas le défect tibial osseux a été compensé par une cale métallique et dans 7 cas nous avons utilisé une allogreffe de tête fémorale. Enfin dans un cas nous avons utilisé à la fois une cale et une greffe. Nous rapportons les résultats de 27 cas, 5 patients étant décédés et un perdu de vue. Le suivi moyen a été de 73+/- 41,7 mois, (8 à 153 mois), le score IKS global de 166,72,+/- 21,3 points (128 à 200). Les résultats radiographiques ont montré pour les 8 allogreffes qu’elles avaient été ostéointégrées sans liseré.

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Figures

Fig. 1
Fig. 1
Severe bone loss at the level of the tibial plateau
Fig. 2
Fig. 2
Step resection of the medial tibial plateau
Fig. 3
Fig. 3
Preparation of the femoral head for bone grafting
Fig. 4
Fig. 4
Temporary fixation of the bone graft in its proper position using Kirschner wires
Fig. 5
Fig. 5
Placing the trial prosthesis on top of the reconstructed tibial plateau
Fig. 6
Fig. 6
Postoperative X-ray to check the prosthesis and the bone graft
See this image and copyright information in PMC

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