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Long-term functional success and robust implant survival in lateral unicompartmental knee arthroplasty: A case series with a mean follow-up of twenty two and a half years

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Abstract

Purpose

Lateral unicompartmental knee arthroplasty (UKA) is an accepted treatment option in cases of end-stage lateral osteoarthritis. While lateral UKA has many proposed advantages compared to total knee arthroplasty, its technical challenges and relatively small number of cases make this an uncommon procedure. The aim of this study was to report the survivorship and functional outcomes beyond 20 years of follow-up of isolated UKA.

Methods

Between January 1988 and October 2003, 54 lateral UKAs were performed in a single center. The fitted prosthesis was a fixed plate and cemented polyethylene (PE). All patients had isolated lateral tibiofemoral osteoarthritis, including five open meniscectomies, three arthroscopies, and three open reductions of lateral tibial plateau fractures. Patients with a minimum of 20 years of follow-up were included in the final analysis.

Results

Of the 54 UKA, 22 died before reaching the minimum follow-up period and four were lost to follow-up. Twenty-eight were included in the final analysis. Among them, 21 patients remained alive and an additional seven were deceased after 20 years. The mean age at the last follow-up was 84.8 ± 11.9 years with a mean follow-up duration of 22.5 ± 2.1 years. Of the 28 knees, eight underwent revision surgery (5 for the progression of osteoarthritis; 2 for aseptic loosening; 1 for PE wear). Kaplan–Meier survival analysis revealed a survival rate at 20 and 25 years of 72.3% (CI 59.1; 88.6). The average time to revision was 14.9 ± 4.9 years. At the last follow-up, the mean function Knee Society Score (KSS) was 41.5 ± 32.9 and the mean objective KSS score was 79.4 ± 9.7. In the unrevised population, 94.7% of patients (n = 18) reported being satisfied or very satisfied with the surgery.

Conclusion

Lateral UKA remains a viable treatment option for patients with isolated lateral tibiofemoral osteoarthritis, providing satisfactory 20-year implant survivorship and high patient satisfaction.

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Abbreviations

BMI:

Body Mass Index

FMA:

Femoral mechanical axis

HKA:

Hip Knee Ankle

IKDC:

International Knee Documentation Committee

KSS:

Knee Society Score

LTFO:

Lateral tibiofemoral osteoarthritis

OA:

Osteoarthitis

PE:

Polyethylene

TKA:

Total Knee Arthroplasty

TMA:

Tibial mechanical axis

UKA:

Unicompartmental Knee Arthroplasty

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Authors and Affiliations

  1. Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon North University Hospital, 103 Grande Rue de La Croix-Rousse, 69004, Lyon, France

    Clément Favroul, Cécile Batailler, Clara Thouvenin, Elvire Servien & Sébastien Lustig

  2. Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406, 69622, Lyon, France

    Cécile Batailler & Sébastien Lustig

  3. Sydney Orthopedic Research Institute, University of Notre Dame Australia, Hornsby and Ku‐Ring Hospital, Sydney, Australia

    Jobe Shatrov

  4. Infirmerie Protestante, Caluire, France

    Philippe Neyret

  5. LIBM-EA 7424, Interuniversity Laboratory of Biology of Mobility, Claude Bernard Lyon 1 University, Lyon, France

    Elvire Servien

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  1. Clément Favroul
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Contributions

CF: statistical analysis, literature review and manuscript writing. CB: study design, manuscript editing and supervision. CT: study design, data collection, statistical analysis and manuscript writing. JS: manuscript editing. PhN: manuscript editing. ES: study design, literature review and manuscript editing. SL: study design, supervision, literature review and manuscript editing. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Clément Favroul.

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Ethical approval

All procedures were performed in accordance with the ethical standards of the institutional and/or national research committee, the 1964 Helsinki declaration and its later amendments, or comparable ethical standards. Strengthening the Reporting of Observational studies in Epidemiology (STROBE) guidelines for observational cohort studies were used to conduct this study. The Advisory Committee on Research Information Processing in the Field of Health (CCTIRS) granted approval for this study in Paris on February 17, 2016, under the reference number 16–140.

Informed consent

As per our institutional standards, formal patient consent is not required for this type of study.

Conflict of interest

CF, CB, CT, and JS declare that they have no conflict of interest. PhN: receives research funding and royalties from Tornier. ES: consultant for Corin. SL: consultant for Stryker, Smith Nephew, Heraeus, Depuy Synthes; Institutional research support from Groupe Lepine, Amplitude; Editorial Board for Journal of Bone and Joint Surgery (Am).

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Level of evidence: retrospective, case series study, Level IV.

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Favroul, C., Batailler, C., Thouvenin, C. et al. Long-term functional success and robust implant survival in lateral unicompartmental knee arthroplasty: A case series with a mean follow-up of twenty two and a half years. International Orthopaedics (SICOT) (2024). https://doi.org/10.1007/s00264-024-06215-3

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