Unicompartmental knee arthroplasty survivorship is lower than TKA survivorship: a 27-year Finnish registry study

Abstract

Background: Balancing the relative advantages and disadvantages of unicompartmental knee arthroplasties (UKAs) against those for TKAs can be challenging. Survivorship is one important end point; arthroplasty registers repeatedly report inferior midterm survival rates, but longer-term data are sparse. Comparing survival directly by using arthroplasty register survival reports also may be inadequate because of differences in indications, implant designs, and patient demographics in patients having UKAs and TKAs.

Questions/purposes: The aims of this study were to assess the survivorship of UKA in the context of one large, northern European registry, and to compare the rates of survivorship with those of cemented TKAs performed for primary knee osteoarthritis during the same 27-year period.

Methods: From the Finnish Arthroplasty Register, we obtained the data for 4713 patients undergoing UKAs for primary osteoarthritis (mean age, 63.5 years; minimum followup, 0 years; mean, 6.0 years; range, 0-24 years) who had surgical revision between 1985 and 2011. From this cohort, we calculated the Kaplan-Meier survivorship for revision performed for any reason and compared it with the survivorship of 83,511 patients (mean age, 69.5 years; minimum followup 0 years; mean, 6.4 years; range, 0-27 years) with TKAs treated for primary osteoarthritis during the same period. Data were adjusted for age and sex in a comparative analysis.

Results: Kaplan-Meier survivorship of UKAs was 89.4% at 5 years, 80.6% at 10 years, and 69.6% at 15 years; the corresponding rates for TKAs were 96.3%, 93.3%, and 88.7%, respectively. UKAs had inferior long-term survivorship compared with cemented TKAs, even after adjusting for the age and sex of the patients (hazard ratio 2.2, p < 0.001).

Conclusions: A UKA offers tempting advantages compared with a TKA; however, the revision frequency for UKAs in widespread use, as measured in a large, national registry, was poorer than that of TKAs. When choosing between a UKA and a TKA, patients should be informed of advantages of both procedures, but they also should be advised about the generally higher revision risk after UKA.

Level of evidence: Level III, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.

Fig. 1

The numbers of UKAs performed for primary knee OA during the study are shown. Oxford^®, Biomet Inc, Warsaw, IN, USA; Duracon™, Stryker, Mahwah, NJ, USA; Miller-Galante, Zimmer, Warsaw, IN, USA; Porous Coated Anatomic (PCA^®), Howmedica, Rutherford, NJ, USA.

Fig. 2

The numbers of cemented, cruciate-retaining, or posterior-stabilized TKA designs implanted for primary knee OA during the study period are shown.

Fig. 3

The mean ages of patients undergoing UKAs and TKAs are shown.

Fig. 4

The overall Kaplan-Meier survivorship rates for UKAs and TKAs during the study period are shown. The end point was defined as any revision, including when either the whole implant or any one component was removed, exchanged, or implanted for any reason. Adjustments were made for age and sex.

Fig. 5

The Kaplan-Meier survivorship rates for different UKA designs used during the study period are shown. The end point was defined as any revision, including when either the whole implant or any one component was removed, exchanged, or implanted for any reason. Adjustments were made for age and sex. O = Oxford^® (Biomet Inc, Warsaw, IN, USA); M-G = Miller-Galante (Zimmer, Warsaw, IN, USA); D = Duracon™ (Stryker, Mahwah, NJ, USA); P = Porous Coated Anatomic (PCA^®) (Howmedica, Rutherford, NJ, USA).