Advertisement for orthosearch.org.uk
Orthopaedic Proceedings Logo

Receive monthly Table of Contents alerts from Orthopaedic Proceedings

Comprehensive article alerts can be set up and managed through your account settings

View my account settings

Visit Orthopaedic Proceedings at:

Loading...

Loading...

Full Access

General Orthopaedics

REVISION OF UNICOMPARTMENTAL TO TOTAL KNEE REPLACEMENT: EXPERIENCE FROM A LARGE JOINT REPLACEMENT UNIT

12th Combined Meeting of the Orthopaedic Associations (AAOS, AOA, AOA, BOA, COA, NZOA, SAOA)



Abstract

Background

Unicompartmental knee replacement (UKR) is an established treatment for single compartment end-stage knee arthrosis with good recorded survivorship. Although often used in more active younger patients, patient selection remains controversial. To identify risk factors for early failure we compared patients with UKR failure requiring revision to total knee replacement (TKR) with a control group.

Methods & Results

Between September 2002 and 2008, 812 Oxford Mobile Bearing Medial UKRs were implanted. 21 implants (20 patients) required revision to TKR within 5 years. The leading cause for revision was lateral compartment disease progression (11 patients). In the revision group, 17 patients were female (81%), average age at index surgery was 64.1 (range 48-81) and average BMI 31.8 (range 24.4-41.5). In the control group of all patients who underwent UKR during this period, 348 patients were female (44%), average age was 65.0 (range 36-89) and average BMI 31.2 (range 21.0-61.0).

Radiological assessment of the tibiofemoral valgus (TFV) angle for revision patients was compared with an age and sex matched control group. In the revision group, average TFV angle was +1.5 pre-operatively and +6.1 post-operatively with an average change of +4.6. In the control group average TFV angle was -0.4 pre-operatively and +4.3 post-operatively with an average change of +4.7.

Conclusion

Our UKR patients with early failure requiring revision were far more likely to be female (p=0.0012) whilst age and BMI were similar between groups. Although the change in TFV angle was similar, control group patients started in varus becoming valgus post-operatively, whereas revision group patients started in valgus and became more valgus post-operatively. This might explain lateral compartment disease progression as our leading cause of early failure. We believe females with medial compartment disease but valgus alignment are at greater risk of early failure and it is particularly important not to overstuff the medial compartment.


A Palmer, Flat 6, Hill Top Court, Hill Top Road., Oxford OX4 1PB, UK