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Revision indications for medial unicompartmental knee arthroplasty: a systematic review

  • Knee Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Unicompartmental knee arthroplasty (UKA) has advantages over total knee arthroplasty including fewer complications and faster recovery; however, UKAs also have higher revision rates. Understanding reasons for UKA failure may, therefore, allow for optimized clinical outcomes. We aimed to identify failure modes for medial UKAs, and to examine differences by implant bearing, cement use and time.

Materials and methods

A systematic review was conducted by searching MedLine, EMBASE, CINAHL and Cochrane databases from 2000 to 2020. Studies were selected if they included ≥ 250 participants, ≥ 10 failures and reported all failure modes of medial UKA performed for osteoarthritis (OA).

Results

A total of 24 cohort and 2 registry-based studies (levels II and III) were selected. The most common failure modes were aseptic loosening (24%) and OA progression (30%). Earliest failures (< 6 months) were due to infection (40%), bearing dislocation (20%), and fracture (20%); mid-term failures (> 2 years to 5 years) were due to OA progression (33%), aseptic loosening (17%) and pain (21%); and late-term (> 10 years) failures were mostly due to OA progression (56%). Rates of failure from wear were higher with fixed-bearing prostheses (5% cf. 0.3%), whereas rates of bearing dislocations were higher with mobile-bearing prostheses (14% cf. 0%). With cemented components, there was a high rate of failure due to aseptic loosening (27%), which was reduced with uncemented components (4%).

Conclusions

UKA failure modes differ depending on implant design, cement use and time from surgery. There should be careful consideration of implant options and patient selection for UKA.

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Acknowledgements

The authors would like to thank Mr. Greg Gamble and Dr. Arier Lee for statistical advice for this study.

Funding

MLT is supported by a University of Auckland Doctoral Scholarship. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, North Shore Hospital, 124 Shakespeare Road, Takapuna, 0622, Auckland, New Zealand

    Mei Lin Tay & Simon W. Young

  2. Department of Anatomy and Medical Imaging, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, 1023, Auckland, New Zealand

    Mei Lin Tay & Sue R. McGlashan

  3. Department of Orthopaedic Surgery, Auckland City Hospital, 2 Park Road, Grafton, 1023, Auckland, New Zealand

    A. Paul Monk

  4. Auckland Bioengineering Institute, University of Auckland, 70 Symonds Street, Auckland, 1010, New Zealand

    A. Paul Monk

  5. Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, 28 Park Ave, 1023, Auckland, New Zealand

    Simon W. Young

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  2. Sue R. McGlashan
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  3. A. Paul Monk
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  4. Simon W. Young
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Contributions

MLT and SWY conceived this research and designed study methodology; MLT carried out systematic search, data collection and analysis; SWY participated in analysis validation/review; SWY, SRM and APM participated in the interpretation of the data; MLT wrote original draft; SWY, SRM and APM reviewed manuscript and participated in revisions. All authors read and approved the final manuscript.

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Correspondence to Mei Lin Tay.

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APM is a paid consultant for Zimmer and Johnson & Johnson. SWY is a paid consultant and receives research support from Stryker. All other authors declare that they have no conflict of interest.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Tay, M.L., McGlashan, S.R., Monk, A.P. et al. Revision indications for medial unicompartmental knee arthroplasty: a systematic review. Arch Orthop Trauma Surg 142, 301–314 (2022). https://doi.org/10.1007/s00402-021-03827-x

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  • DOI: https://doi.org/10.1007/s00402-021-03827-x

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