Revision of Unicompartmental to Total Knee Arthroplasty: Does the Unicompartmental Implant (Metal-Backed vs All-Polyethylene) Impact the Total Knee Arthroplasty?

Abstract

Background: The aim of this study is to investigate differences in implant requirement, outcomes, and re-revision when total knee arthroplasty (TKA) was performed following unicompartmental knee arthroplasties (UKAs) with metal-backed (MB) compared to all-polyethylene (AP) tibial components.

Methods: Retrospective study of 60 UKAs converted to 60 TKAs at mean 7.3 years (0.1 to 17) after implantation in 55 patients (mean age, 64 [49-83]; 44% male): 44 MB and 16 AP. TKA implant requirement was investigated in addition to mode of failure, Oxford Knee Score, and TKA survival at mean 5.4 years (0.5 to 17).

Results: Progression of osteoarthritis was the commonest mode of failure in MB UKAs (P = .03) and unexplained pain in AP (P = .011) where revisions were performed earlier (4.8 ± 3.2 vs 8.2 ± 4.5, P = .012). In 56 of 60 (93%) cases, unconstrained TKA implants were used. The use of standard cruciate-retaining TKAs without augments or stems was less likely following MB UKA compared to AP (12 of 38 [32%] vs 10/14 [71%], P = .013). Specifically MB UKA implants were associated with more tibial stem use (P = .04) and more use of cruciate-substituting polyethylene (P = .05). There was no difference in the use of constrained implants. Multivariate analysis showed tibial resection depth to predict stem requirement. Seven were re-revised giving 7-year TKA survival: from MB UKA 70.3 (95% CI, 47.0 to 93.6) and from AP UKA 87.5 (95% CI, 64.6 to 100; P = .191).

Conclusion: MB UKA implants increase the chances of a complex revision requiring tibial stems and cruciate substitution but reduce the chances of early revision compared to AP UKA which often fail early with pain.

Keywords: all-polyethylene tibia; metal-backed tibia; patient reported outcomes; revision knee arthroplasty; unicompartmental knee arthroplasty.