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. 2023 Apr 18;24(1):302.
doi: 10.1186/s12891-023-06413-x.

Clinical outcomes of various types of revision surgeries after unicompartmental knee arthroplasty failure

Shih-Hui Peng  1   2   3 , Chun-Chieh Chen  1   2   3 , Sheng-Hsun Lee  1   2   3 , Yu-Chih Lin  1   2   3 , Jui-Fan Chiang  2 , Szu-Yuan Chen  1   2   3 , Chih-Chien Hu  1   2   3 , Yuhan Chang  1   2   3 , Pang-Hsin Hsieh  1   2   3 , Hsin-Nung Shih  1   2   3 , Chih-Hsiang Chang  4   5   6   7
Affiliations

Clinical outcomes of various types of revision surgeries after unicompartmental knee arthroplasty failure

Shih-Hui Peng et al. BMC Musculoskelet Disord. .

Abstract

Purpose: The advantages of unicompartmental knee arthroplasty (UKA) have led to the procedure being increasingly performed worldwide. However, revision surgery is required after UKA failure. According to the literature review, the choice of implant in revision surgery remains a debatable concern. This study analyzed the clinical results of different types of prostheses used in treating failed UKA.

Materials and methods: This is a retrospective review of 33 failed medial UKAs between 2006 and 2017. Demographic data, failure reason, types of revision prostheses, and the severity of bone defects were analyzed. The patients were classified into three groups: primary prosthesis, primary prosthesis with a tibial stem, and revision prosthesis. The implant survival rate and medical cost of the procedures were compared.

Results: A total of 17 primary prostheses, 7 primary prostheses with tibial stems, and 9 revision prostheses were used. After a mean follow-up of 30.8 months, the survival outcomes of the three groups were 88.2%, 100%, and 88.9%, respectively (P = 0.640). The common bone defect in tibia site is Anderson Orthopedic Research Institute [AORI] grade 1 and 2a (16 versus 17). In patients with tibial bone defects AORI grade 2a, the failure rates of primary prostheses and primary prostheses with tibial stems were 25% and 0%, respectively.

Conclusions: The most common cause for UKA failure was aseptic loosening. The adoption of a standardized surgical technique makes it easier to perform revision surgeries. Primary prostheses with tibial stems provided higher stability, leading to a lower failure rate due to less risk of aseptic loosening in patients with tibial AORI grade 2a. In our experience, we advise surgeons may try using primary prostheses in patients with tibial AORI grade 1 and primary prostheses with tibial stems in patients with tibial AORI grade 2a.

Keywords: Aseptic loosening; Failed unicompartmental knee arthroplasty; Revision surgery.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Anteroposterior radiograph of Patient A’s knee. Unicompartmental knee arthropasty (UKA) was performed in the past (left), procedure with primary prostheses and bone graft after UKA failure (center), and procedure with revision prostheses after primary prostheses failure due to tibia site loosening (right)
Fig. 2
Fig. 2
Anteroposterior radiograph of Patient B’s knee. Unicompartmental knee arthropasty (UKA) was performed in the past (left), procedure with revision prostheses because of bone defect after UKA failure (center), and procedure with revision prostheses after the failure of the original prosthesis because of periprosthetic joint infection (right)
Fig. 3
Fig. 3
Procedure duration of primary and revision prostheses. The mean procedure duration was longest in the primary prosthesis with a tibial stem group. But no significant difference in procedure duration was observed between three groups
See this image and copyright information in PMC

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