Management of aseptic failure of the mobile-bearing Oxford unicompartmental knee arthroplasty

• Published in: The knee Vol. 27; no. 6; pp. 1721 - 1728
• Main Authors: Sabah, Shiraz A., Lim, Chin Tat, Middleton, Robert, von Fritsch, Lennart, Bottomley, Nicholas, Jackson, William F.M., Price, Andrew J., Alvand, Abtin
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.12.2020; Elsevier Limited
• Subjects: Adult; Aged; Aged, 80 and over; Arthritis; Arthroplasty (knee); Arthroplasty, Replacement, Knee; Bone implants; Clinical outcome; Cohort Studies; Female; Humans; Infections; Joint replacement surgery; Joint surgery; Knee; Knee Prosthesis - adverse effects; Ligaments; Male; Medical referrals; Middle Aged; Osteoarthritis; Osteoarthritis, Knee - surgery; Pain; Patient Outcome Assessment; Patient-reported outcome measures; Patients; Prosthesis Failure; Quality of life; Reoperation; Retrospective Studies; Revision TKA; Revision UKA; Revisions; Surgeons; Surgery; Surgical characteristics; Surgical outcomes; Wound healing; United Kingdom > UK; Clinical outcome; Surgical characteristics; Revision UKA; Patient-reported outcome measures; Revision TKA
• ISSN: 0968-0160; 1873-5800
• DOI: 10.1016/j.knee.2020.10.003

•Aseptic revision UKA associated to good outcomes at a high-volume center.•Bicompartmental knee replacement an excellent alternative to TKA for failed UKA.•Failed UKA for aseptic loosening or instability? Consider revision prostheses.•Unexplained pain after UKA? MDT essential; counsel patients outcomes unpredictable. Unicompartmental knee arthroplasty (UKA) accounts for 9.1% of primary knee arthroplasties (KAs) in the UK. However, wider uptake is limited by higher revision rates compared with total knee arthroplasties (TKA) and concerns over subsequent poor function. The aim of this study was to understand the revision strategies and clinical outcomes for aseptic, failed UKAs at a high-volume centre. This was a retrospective, single-centre cohort study of 48 patients (31 female, 17 male) with 52 revision UKAs from 2006 to 2018. Median time to revision was 67 (range 4–180) months. Indications for revision were progression of osteoarthritis (n = 31 knees, 59.6%), unexplained pain (n = 10 knees, 19.2%), aseptic loosening (n = 6 knees, 11.5%), medial collateral ligament incompetence (n = 3 knees, 5.8%) and recurrent bearing dislocation (n = 2 knees, 3.8%). Technical details of surgery, complications and functional outcome were recorded. Failed UKAs were revised to primary TKAs (n = 29 knees, 55.8%), revision TKAs (n = 9 knees, 17.3%), bicompartmental KAs (n = 11 knees, 21.2%), or unicompartmental-to-unicompartmental KAs (n = 3 knees, 5.8%). Median follow up was 81 (range 24–164) months. Four patients (7.7%) died from unrelated causes. No re-revisions were identified. Surgical complications required re-operation in five knees (9.6%). Median Oxford Knee Score at latest follow up was 38 (range 9–48) points and median EQ5D3L index 0.707 (range −0.247 to 1.000). Aseptic, revision UKA at a high-volume centre had good clinical outcomes. Bicompartmental KA demonstrated excellent function and should be considered an alternative to TKA for progression of osteoarthritis for appropriately trained surgeons.