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Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 22, Issue 8, pp 1895–1901 | Cite as

Causes of revision following Oxford phase 3 unicompartmental knee arthroplasty

  • Seung-Ju Kim
  • Ricardo Postigo
  • Sowon Koo
  • Jong Hun KimEmail author
Knee

Abstract

Purpose

Revision of unicompartmental knee arthroplasty (UKA) is relatively rare, but there is concern that the minimally invasive approach might result in more complications and a higher rate of revision. Current data regarding the revision of UKA using the Oxford phase 3 prosthesis are confined to a few reviews of single-institution experience. The purpose of this study was to provide an evidence-based summarisation of the revision of UKA with a pooled analysis of the reported cases.

Methods

A systematic review of published studies that evaluated the causes that required further surgical intervention after UKA using the Oxford phase 3 prosthesis was performed. A structured literature review of multiple databases referenced articles from 1998 to 2012. The revision rates between Asian population and western population were compared.

Results

A total of 2,683 patients (3,138 knees) from 17 published studies were assessed. The median age of the patients was 62.5 (range 32–93) years. The median follow-up period was 5.6 (range 0.1–11) years. Postoperative revision was necessary in 146 knees with a pooled percentage of 4.6 %. Bearing dislocation was found to be the single most important predisposing cause of revision, with a pooled percentage of 1.5 % (47/3,138 knees). The rate of bearing dislocation was significantly higher in Asian population than that in western population (p < 0.001).

Conclusions

Mobile bearing UKA seems to be less appropriate for the Asian population as extreme knee flexion is required for cultural purposes.

Level of evidence

Retrospective case series, Level IV.

Keywords

Unicompartmental knee arthroplasty Oxford phase 3 Revision 

Notes

Conflict of interest

All authors report that there was no conflict of interest.

References

  1. 1.
    Assor M, Aubaniac JM (2006) Influence of rotatory malposition of femoral implant in failure of unicompartmental medial knee prosthesis. Rev Chir Orthop Reparatrice Appar Mot 92(5):473–484PubMedCrossRefGoogle Scholar
  2. 2.
    Baker PN, Petheram T, Avery PJ, Gregg PJ, Deehan DJ (2012) Revision for unexplained pain following unicompartmental and total knee replacement. J Bone Jt Surg Am 94(17):e126CrossRefGoogle Scholar
  3. 3.
    Barrett WP, Scott RD (1987) Revision of failed unicondylar unicompartmental knee arthroplasty. J Bone Jt Surg Am 69(9):1328–1335Google Scholar
  4. 4.
    Berend KR, Lombardi AV Jr, Adams JB (2007) Obesity, young age, patellofemoral disease, and anterior knee pain: identifying the unicondylar arthroplasty patient in the United States. Orthopedics 30(5 Suppl):19–23PubMedGoogle Scholar
  5. 5.
    Choy WS, Kim KJ, Lee SK, Yang DS, Kim CM, Park JS (2011) Medial unicompartmental knee arthroplasty in patients with spontaneous osteonecrosis of the knee. Clin Orthop Surg 3(4):279–284PubMedCentralPubMedCrossRefGoogle Scholar
  6. 6.
    Choy WS, Kim KJ, Lee SK, Yang DS, Lee NK (2011) Mid-term results of oxford medial unicompartmental knee arthroplasty. Clin Orthop Surg 3(3):178–183PubMedCentralPubMedCrossRefGoogle Scholar
  7. 7.
    Clement ND, Duckworth AD, MacKenzie SP, Nie YX, Tiemessen CH (2012) Medium-term results of Oxford phase-3 medial unicompartmental knee arthroplasty. J Orthop Surg 20(2):157–161Google Scholar
  8. 8.
    Cool S, Victor J, De Baets T (2006) Does a minimally invasive approach affect positioning of components in unicompartmental knee arthroplasty? Early results with survivorship analysis. Acta Orthop Belg 72(6):709–715PubMedGoogle Scholar
  9. 9.
    Emerson RH Jr (2005) Unicompartmental mobile-bearing knee arthroplasty. Instr Course Lect 54:221–224PubMedGoogle Scholar
  10. 10.
    Emerson RH Jr, Hansborough T, Reitman RD, Rosenfeldt W, Higgins LL (2002) Comparison of a mobile with a fixed-bearing unicompartmental knee implant. Clin Orthop Relat Res 404:62–70PubMedCrossRefGoogle Scholar
  11. 11.
    Gleeson RE, Evans R, Ackroyd CE, Webb J, Newman JH (2004) Fixed or mobile bearing unicompartmental knee replacement? A comparative cohort study. Knee 11(5):379–384PubMedCrossRefGoogle Scholar
  12. 12.
    Goodfellow JW, Kershaw CJ, Benson MK, O’Connor JJ (1988) The Oxford Knee for unicompartmental osteoarthritis. The first 103 cases. J Bone Jt Surg Br 70(5):692–701Google Scholar
  13. 13.
    Goodfellow JW, O’Connor JJ, Murray DW (2010) A critique of revision rate as an outcome measure: re-interpretation of knee joint registry data. J Bone Jt Surg Br 92(12):1628–1631CrossRefGoogle Scholar
  14. 14.
    Heller S, Fenichel I, Salai M, Luria T, Velkes S (2009) The Oxford unicompartmental knee prosthesis for the treatment of medial compartment knee disease: 2 to 5 year follow-up. Isr Med Assoc J 11(5):266–268PubMedGoogle Scholar
  15. 15.
    Jung KA, Lee SC, Hwang SH (2009) Pseudomeniscal synovial impingement after unicondylar knee arthroplasty. Orthopedics 32(5):361PubMedCrossRefGoogle Scholar
  16. 16.
    Keys GW (1999) Reduced invasive approach for Oxford II medial unicompartmental knee replacement—a preliminary study. Knee 6(3):193–196CrossRefGoogle Scholar
  17. 17.
    Kim KT, Lee S, Park HS, Cho KH, Kim KS (2007) A prospective analysis of Oxford phase 3 unicompartmental knee arthroplasty. Orthopedics 30(5 Suppl):15–18PubMedGoogle Scholar
  18. 18.
    Kort NP, van Raay JJ, Cheung J, Jolink C, Deutman R (2007) Analysis of Oxford medial unicompartmental knee replacement using the minimally invasive technique in patients aged 60 and above: an independent prospective series. Knee Surg Sports Traumatol Arthrosc 15(11):1331–1334PubMedCentralPubMedCrossRefGoogle Scholar
  19. 19.
    Koshino T, Morii T, Wada J, Takahashi S (1991) Unicompartmental replacement with the Marmor Modular knee: operative procedure and results. Bull Hosp Jt Dis Orthop Inst 51(2):119–131PubMedGoogle Scholar
  20. 20.
    Koshino T, Saito T, Orito K, Mitsuhashi S, Takeuchi R, Kurosaka T (2002) Increase in range of knee motion to obtain floor sitting after high tibial osteotomy for osteoarthritis. Knee 9(3):189–196PubMedCrossRefGoogle Scholar
  21. 21.
    Koskinen E, Paavolainen P, Eskelinen A, Harilainen A, Sandelin J, Ylinen P, Tallroth K, Remes V (2009) Medial unicompartmental knee arthroplasty with Miller-Galante II prosthesis: mid-term clinical and radiographic results. Arch Orthop Trauma Surg 129(5):617–624PubMedCrossRefGoogle Scholar
  22. 22.
    Kuipers BM, Kollen BJ, Bots PC, Burger BJ, van Raay JJ, Tulp NJ, Verheyen CC (2010) Factors associated with reduced early survival in the Oxford phase III medial unicompartment knee replacement. Knee 17(1):48–52PubMedCrossRefGoogle Scholar
  23. 23.
    Labek G, Sekyra K, Pawelka W, Janda W, Stockl B (2011) Outcome and reproducibility of data concerning the Oxford unicompartmental knee arthroplasty: a structured literature review including arthroplasty registry data. Acta Orthop 82(2):131–135PubMedCentralPubMedCrossRefGoogle Scholar
  24. 24.
    Laubenthal KN, Smidt GL, Kettelkamp DB (1972) A quantitative analysis of knee motion during activities of daily living. Phys Ther 52(1):34–43PubMedGoogle Scholar
  25. 25.
    Lewold S, Goodman S, Knutson K, Robertsson O, Lidgren L (1995) Oxford meniscal bearing knee versus the Marmor knee in unicompartmental arthroplasty for arthrosis. A Swedish multicenter survival study. J Arthroplast 10(6):722–731CrossRefGoogle Scholar
  26. 26.
    Lim HC, Bae JH, Song SH, Kim SJ (2012) Oxford phase 3 unicompartmental knee replacement in Korean patients. J Bone Jt Surg Br 94(8):1071–1076CrossRefGoogle Scholar
  27. 27.
    Lisowski LA, van den Bekerom MP, Pilot P, van Dijk CN, Lisowski AE (2011) Oxford Phase 3 unicompartmental knee arthroplasty: medium-term results of a minimally invasive surgical procedure. Knee Surg Sports Traumatol Arthrosc 19(2):277–284PubMedCentralPubMedCrossRefGoogle Scholar
  28. 28.
    Lisowski LA, Verheijen PM, Lisowski AE (2004) Oxford phase 3 unicompartmental knee arthroplasty (UKA): clinical and radiological results of minimum follow-up of 2 years. Ortop Traumatol Rehabil 6(6):773–776PubMedGoogle Scholar
  29. 29.
    Lombardi AV, Berend KR, Walter CA, Aziz-Jacobo J, Cheney NA (2009) Is recovery faster for mobile-bearing unicompartmental than total knee arthroplasty? Clin Orthop Relat Res 467:1450–1457PubMedCentralPubMedCrossRefGoogle Scholar
  30. 30.
    Luscombe KL, Lim J, Jones PW, White SH (2007) Minimally invasive Oxford medial unicompartmental knee arthroplasty. A note of caution! Int Orthop 31(3):321–324PubMedCentralPubMedCrossRefGoogle Scholar
  31. 31.
    Mullaji AB, Sharma A, Marawar S (2007) Unicompartmental knee arthroplasty: functional recovery and radiographic results with a minimally invasive technique. J Arthroplast 22(4 Suppl 1):7–11CrossRefGoogle Scholar
  32. 32.
    Mullaji AB, Shetty GM, Kanna R (2011) Postoperative limb alignment and its determinants after minimally invasive Oxford medial unicompartmental knee arthroplasty. J Arthroplast 26(6):919–925CrossRefGoogle Scholar
  33. 33.
    Noble PC, Gordon MJ, Weiss JM, Reddix RN, Conditt MA, Mathis KB (2005) Does total knee replacement restore normal knee function? Clin Orthop Relat Res 431:157–165PubMedCrossRefGoogle Scholar
  34. 34.
    Pandit H, Jenkins C, Barker K, Dodd CA, Murray DW (2006) The Oxford medial unicompartmental knee replacement using a minimally-invasive approach. J Bone Jt Surg Br 88(1):54–60CrossRefGoogle Scholar
  35. 35.
    Pandit H, Jenkins C, Gill HS, Barker K, Dodd CA, Murray DW (2011) Minimally invasive Oxford phase 3 unicompartmental knee replacement: results of 1000 cases. J Bone Jt Surg Br 93(2):198–204CrossRefGoogle Scholar
  36. 36.
    Price AJ, O’Connor JJ, Murray DW, Dodd CA, Goodfellow JW (2007) A history of Oxford unicompartmental knee arthroplasty. Orthopedics 30(5 Suppl):7–10PubMedGoogle Scholar
  37. 37.
    Price AJ, Webb J, Topf H, Dodd CA, Goodfellow JW, Murray DW, Oxford H, Knee G (2001) Rapid recovery after oxford unicompartmental arthroplasty through a short incision. J Arthroplast 16(8):970–976CrossRefGoogle Scholar
  38. 38.
    Rees JL, Price AJ, Beard DJ, Dodd CA, Murray DW (2004) Minimally invasive Oxford unicompartmental knee arthroplasty: functional results at 1 year and the effect of surgical inexperience. Knee 11(5):363–367PubMedCrossRefGoogle Scholar
  39. 39.
    Riebel GD, Werner FW, Ayers DC, Bromka J, Murray DG (1995) Early failure of the femoral component in unicompartmental knee arthroplasty. J Arthroplast 5:615–621CrossRefGoogle Scholar
  40. 40.
    Robertsson O, Knutson K, Lewold S, Lidgren L (2001) The routine of surgical management reduces failure after unicompartmental knee arthroplasty. J Bone Jt Surg Br 83B(1):45–49CrossRefGoogle Scholar
  41. 41.
    Siddiqui NA, Ahmad ZM (2012) Revision of unicondylar to total knee arthroplasty: a systematic review. Open Orthop J 6:268–275PubMedCentralPubMedCrossRefGoogle Scholar
  42. 42.
    Song MH, Kim BH, Ahn SJ, Yoo SH, Lee MS (2009) Early complications after minimally invasive mobile-bearing medial unicompartmental knee arthroplasty. J Arthroplast 24(8):1281–1284CrossRefGoogle Scholar
  43. 43.
    Steele RG, Hutabarat S, Evans RL, Ackroyd CE, Newman JH (2006) Survivorship of the St Georg Sled medial unicompartmental knee replacement beyond 10 years. J Bone Jt Surg Br 88B(9):1164–1168CrossRefGoogle Scholar
  44. 44.
    Sun PF, Jia YH (2012) Mobile bearing UKA compared to fixed bearing TKA: a randomized prospective study. Knee 19(2):103–106PubMedCrossRefGoogle Scholar
  45. 45.
    Vardi G, Strover AE (2004) Early complications of unicompartmental knee replacement: the Droitwich experience. Knee 11(5):389–394PubMedCrossRefGoogle Scholar
  46. 46.
    W-Dahl A, Robertsson O, Lidgren L, Miller L, Davidson D, Graves S (2010) Unicompartmental knee arthroplasty in patients aged less than 65. Acta Orthop 81(1):90–94PubMedCentralPubMedCrossRefGoogle Scholar
  47. 47.
    Weiss JM, Noble PC, Conditt MA, Kohl HW, Roberts S, Cook KF, Gordon MJ, Mathis KB (2002) What functional activities are important to patients with knee replacements? Clin Orthop Relat Res 404:172–188PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Seung-Ju Kim
    • 1
  • Ricardo Postigo
    • 2
  • Sowon Koo
    • 3
  • Jong Hun Kim
    • 2
    Email author
  1. 1.Department of OrthopaedicsNew Jersey Medical SchoolNewarkUSA
  2. 2.Division of Infectious Diseases, Department of Internal MedicineUniversity of UtahSalt Lake CityUSA
  3. 3.Division of Business AdministrationASA CollegeNew YorkUSA

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