HSS Journal ®

, Volume 11, Issue 2, pp 112–116 | Cite as

An Analysis of Risk Factors for Short-Term Complication Rates and Increased Length of Stay Following Unicompartmental Knee Arthroplasty

  • Bryan D. HaughomEmail author
  • William W. Schairer
  • Michael D. Hellman
  • Benedict U. Nwachukwu
  • Brett R. Levine
Original Article



Unicompartmental knee arthroplasty (UKA) is an increasingly popular procedure, with excellent long-term outcomes. However, there are only a limited number of reports reporting its short-term morbidity and mortality.


We sought to analyze the reported 30-day morbidity, mortality, and risk factors for complications and prolonged length of stay (>4 days) following UKA.

Patients and Methods

Utilizing the National Surgical Quality Improvement Program (NSQIP) database, including patients (n = 2316) from 2005–2012, we correlated the reported 30-day complications and prolonged length of stay with patient demographics and risk factors.


The overall rate of complications was low (3.2%). The distribution of complications demonstrated 0.5% major systemic, 1.4% minor systemic, 0.7% major local, and 0.9% minor local complications, with a 2.1% readmission rate. Multivariate regression demonstrated increased BMI and a history of chronic obstructive pulmonary disease (COPD) as independent risk factors for complications. Furthermore, multivariate regression demonstrated increased BMI, ASA ≥ 3, history of COPD, recent operation, and postoperative transfusion as independent risk factors for prolonged length of hospitalization.


Utilizing the NSQIP, we present one of the largest studies to date evaluating complications following UKA. Our multivariate model demonstrated obesity and COPD to be the risk factors for complications while obesity, ASA ≥ 3, COPD, recent operation, and blood transfusion to be the risk factors for prolonged length of stay.


Unicompartmental Knee Arthroplasty NSQIP Short-Term Complications COPD Obesity Transfusion 



Conflict of Interest

Bryan D. Haughom, MD, William W. Schairer, MD, Michael D. Hellman, MD, Benedict U. Nwachukwu, MD and Brett R. Levine, MD, MS have declared that they have no conflict of interest.

Human/Animal Rights

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5).

Informed Consent

Informed consent was waived from all patients for being included in the study.

Required Author Forms

Disclosure forms provided by the authors are available with the online version of this article.

Supplementary material

11420_2014_9422_MOESM1_ESM.pdf (1.2 mb)
ESM 1 (PDF 1224 kb)


  1. 1.
    American college of surgeons website. Available at: Accessed December 18, 2013
  2. 2.
    Amin AK, Patton JT, Cook RE, Gaston M, Brenkel IJ. Unicompartmental or total knee arthroplasty?: Results from a matched study. Clin Orthop Relat Res. 2006; 101–106.Google Scholar
  3. 3.
    Argenson JN, Parratte S, Ashour A, Saintmard B, Aubaniac JM. The outcome of rotating-platform total knee arthroplasty with cement at a minimum of ten years of follow-up. J Bone Joint Surg Am. 2012; 7: 638-644.Google Scholar
  4. 4.
    Belmont PJ Jr, Goodman GP, Waterman BR, Bader JO, Schoenfeld AJ. Thirty-day postoperative complications and mortality following total knee arthroplasty: Incidence and risk factors among a national sample of 15,321 patients. J Bone Joint Surg Am. 2014; 1: 20-26.CrossRefGoogle Scholar
  5. 5.
    Berger RA, Meneghini RM, Jacobs JJ, et al. Results of unicompartmental knee arthroplasty at a minimum of ten years of follow-up. J Bone Joint Surg Am. 2005; 5: 999-1006.CrossRefGoogle Scholar
  6. 6.
    Bini S, Khatod M, Cafri G, Chen Y, Paxton EW. Surgeon, implant, and patient variables may explain variability in early revision rates reported for unicompartmental arthroplasty. J Bone Joint Surg Am. 2013; 24: 2195-2202.CrossRefGoogle Scholar
  7. 7.
    Bolognesi MP, Greiner MA, Attarian DE, et al. Unicompartmental knee arthroplasty and total knee arthroplasty among medicare beneficiaries, 2000 to 2009. J Bone Joint Surg Am. 2013; 22: e174.CrossRefGoogle Scholar
  8. 8.
    Bonutti PM, Goddard MS, Zywiel MG, Khanuja HS, Johnson AJ, Mont MA. Outcomes of unicompartmental knee arthroplasty stratified by body mass index. J Arthroplasty. 2011; 8: 1149-1153.CrossRefGoogle Scholar
  9. 9.
    Brown NM, Sheth NP, Davis K, et al. Total knee arthroplasty has higher postoperative morbidity than unicompartmental knee arthroplasty: A multicenter analysis. J Arthroplasty. 2012; 8(Suppl): 86-90.CrossRefGoogle Scholar
  10. 10.
    Cartier P, Sanouiller JL, Grelsamer RP. Unicompartmental knee arthroplasty surgery. 10-year minimum follow-up period. J Arthroplasty. 1996; 7: 782-788.CrossRefGoogle Scholar
  11. 11.
    Cavaignac E, Lafontan V, Reina N, et al. Obesity has no adverse effect on the outcome of unicompartmental knee replacement at a minimum follow-up of seven years. Bone Joint J. 2013; 8: 1064-1068.CrossRefGoogle Scholar
  12. 12.
    Data use agreement for the american college of surgeons national surgical quality improvement program. Available at: Accessed December 19, 2013.
  13. 13.
    Davenport DL, Holsapple CW, Conigliaro J. Assessing surgical quality using administrative and clinical data sets: A direct comparison of the university HealthSystem consortium clinical database and the national surgical quality improvement program data set. Am J Med Qual. 2009; 5: 395-402.CrossRefGoogle Scholar
  14. 14.
    Feng B, Weng X, Lin J, Jin J, Wang W, Qiu G. Long-term follow-up of cemented fixed-bearing total knee arthroplasty in a chinese population: A survival analysis of more than 10 years. J Arthroplasty. 2013; 10: 1701-1706.CrossRefGoogle Scholar
  15. 15.
    Fisher DA, Dalury DF, Adams MJ, Shipps MR, Davis K. Unicompartmental and total knee arthroplasty in the over 70 population. Orthopedics. 2010;9:668-20100722-05.Google Scholar
  16. 16.
    Foran JR, Brown NM, Della Valle CJ, Berger RA, Galante JO. Long-term survivorship and failure modes of unicompartmental knee arthroplasty. Clin Orthop Relat Res. 2013; 1: 102-108.CrossRefGoogle Scholar
  17. 17.
    Hernigou P, Deschamps G. Patellar impingement following unicompartmental arthroplasty. J Bone Joint Surg Am. 2002; 7: 1132-1137.Google Scholar
  18. 18.
    Jordan SW, Mioton LM, Smetona J, et al. Resident involvement and plastic surgery outcomes: An analysis of 10,356 patients from the american college of surgeons national surgical quality improvement program database. Plast Reconstr Surg. 2013; 4: 763-773.CrossRefGoogle Scholar
  19. 19.
    Kim YH, Kim JS, Choe JW, Kim HJ. Long-term comparison of fixed-bearing and mobile-bearing total knee replacements in patients younger than fifty-one years of age with osteoarthritis. J Bone Joint Surg Am. 2012; 10: 866-873.Google Scholar
  20. 20.
    Koskinen E, Eskelinen A, Paavolainen P, Pulkkinen P, Remes V. Comparison of survival and cost-effectiveness between unicondylar arthroplasty and total knee arthroplasty in patients with primary osteoarthritis: A follow-up study of 50,493 knee replacements from the finnish arthroplasty register. Acta Orthop. 2008; 4: 499-507.CrossRefGoogle Scholar
  21. 21.
    Koskinen E, Paavolainen P, Eskelinen A, Pulkkinen P, Remes V. Unicondylar knee replacement for primary osteoarthritis: A prospective follow-up study of 1,819 patients from the finnish arthroplasty register. Acta Orthop. 2007; 1: 128-135.CrossRefGoogle Scholar
  22. 22.
    Laurencin CT, Zelicof SB, Scott RD, Ewald FC. Unicompartmental versus total knee arthroplasty in the same patient. A comparative study. Clin Orthop Relat Res. 1991; 273: 151-156.PubMedGoogle Scholar
  23. 23.
    Lombardi AV Jr, Berend KR, Walter CA, Aziz-Jacobo J, Cheney NA. Is recovery faster for mobile-bearing unicompartmental than total knee arthroplasty? Clin Orthop Relat Res. 2009; 6: 1450-1457.CrossRefGoogle Scholar
  24. 24.
    Ma HM, Lu YC, Ho FY, Huang CH. Long-term results of total condylar knee arthroplasty. J Arthroplasty. 2005; 5: 580-584.CrossRefGoogle Scholar
  25. 25.
    Marmor L. Unicompartmental arthroplasty of the knee with a minimum ten-year follow-up period. Clin Orthop Relat Res. 1988; 228: 171-177.PubMedGoogle Scholar
  26. 26.
    Newman JH, Ackroyd CE, Shah NA. Unicompartmental or total knee replacement? Five-year results of a prospective, randomised trial of 102 osteoarthritic knees with unicompartmental arthritis. J Bone Joint Surg Br. 1998; 5: 862-865.CrossRefGoogle Scholar
  27. 27.
    Newman J, Pydisetty RV, Ackroyd C. Unicompartmental or total knee replacement: The 15-year results of a prospective randomised controlled trial. J Bone Joint Surg Br. 2009; 1: 52-57.CrossRefGoogle Scholar
  28. 28.
    Niinimaki T, Eskelinen A, Makela K, Ohtonen P, Puhto AP, Remes V. Unicompartmental knee arthroplasty survivorship is lower than TKA survivorship: A 27-year finnish registry study. Clin Orthop Relat Res. 2013.Google Scholar
  29. 29.
    Ong PH, Pua YH. A prediction model for length of stay after total and unicompartmental knee replacement. Bone Joint J. 2013; 11: 1490-1496.CrossRefGoogle Scholar
  30. 30.
    O’Rourke MR, Gardner JJ, Callaghan JJ, et al. The john insall award: Unicompartmental knee replacement: A minimum twenty-one-year followup, end-result study. Clin Orthop Relat Res. 2005; 27–37.Google Scholar
  31. 31.
    Pandit H, Liddle AD, Kendrick BJ, et al. Improved fixation in cementless unicompartmental knee replacement: Five-year results of a randomized controlled trial. J Bone Joint Surg Am. 2013; 15: 1365-1372.CrossRefGoogle Scholar
  32. 32.
    Price AJ, Waite JC, Svard U. Long-term clinical results of the medial oxford unicompartmental knee arthroplasty. Clin Orthop Relat Res. 2005; 435: 171-180.PubMedCrossRefGoogle Scholar
  33. 33.
    Riddle DL, Jiranek WA, McGlynn FJ. Yearly incidence of unicompartmental knee arthroplasty in the united states. J Arthroplasty. 2008; 3: 408-412.CrossRefGoogle Scholar
  34. 34.
    Svard UC, Price AJ. Oxford medial unicompartmental knee arthroplasty. A survival analysis of an independent series. J Bone Joint Surg Br. 2001; 2: 191-194.CrossRefGoogle Scholar
  35. 35.
    Woolson ST, Epstein NJ, Huddleston JI. Long-term comparison of mobile-bearing vs fixed-bearing total knee arthroplasty. J Arthroplasty. 2011; 8: 1219-1223.CrossRefGoogle Scholar
  36. 36.
    Yang KY, Wang MC, Yeo SJ, Lo NN. Minimally invasive unicondylar versus total condylar knee arthroplasty–early results of a matched-pair comparison. Singapore Med J. 2003; 11: 559-562.Google Scholar

Copyright information

© Hospital for Special Surgery 2015

Authors and Affiliations

  • Bryan D. Haughom
    • 1
    Email author
  • William W. Schairer
    • 2
  • Michael D. Hellman
    • 1
  • Benedict U. Nwachukwu
    • 2
  • Brett R. Levine
    • 1
  1. 1.Rush University, Department of Orthopaedic SurgeryChicagoUSA
  2. 2.Hospital for Special Surgery, Department of Orthopaedic SurgeryNew YorkUSA

Personalised recommendations