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1
2
History
 60 Year old female patient
 Bilateral knee pain for months
 Bilateral knee osteoarthritis with Varus
deformity...
4
5
6
Plans
 Revision UKA
 or revision TKA
 Bone defect management
8
9
10
Discussion of this case
 Major problems:
 1. Minimal invasive approach
 2. Fixation technique
 3. Indication of unicom...
 New cutting jig allow a smaller wound
like 4cm length
 But, is it really improved outcome ?
 Minimally invasive surgery vs
conventional exposure using the
Miller-Galante unicompartmental
knee arthroplasty: a rando...
 High tibial osteotomy versus
unicompartmental joint replacement in
unicompartmental knee joint osteoarthritis:
7-10-year...
 Early failure of minimally invasive
unicompartmental knee arthroplasty is
associated with obesity
Berend et al. CORR 200...
 Conversion of failed
unicompartmental knee arthroplasty
to TKA
Springer et al. CORR 2006
 modes of failure: polyethylen...
 Revision total knee arthroplasty after
unicompartmental femorotibial
prosthesis: 54 cases
Chatain et al.
Rev Chir Orthop...
 Revision of failed unicompartmental
knee arthroplasty.
McAuley et al. CORR 2001
 39 revision cases (9-204 months)
 30 ...
 Revision surgery after failed
unicompartmental knee
arthroplasty: a study of 35 cases
Bohm et al. J arthroplasty 2000
 ...
 Modern Unicompartmental Knee
Arthroplasty with Cement. A Three
to Ten-Year Follow-up Study
Argenson et al. JBJSA 2002
 ...
 Results of Unicompartmental
Knee Arthroplasty at a
Minimum of Ten Years of
Follow-up
Richard A. Berger, MD. JBJSA 2005
...
22
 2 most common causes of failure:
 Tibial aseptic loosening
 Accelerated polyethylene wear
 Suggest undercorrection of...
 Making your next unicompartmental
knee arthroplasty last: three keys to
success
Whiteside LA. J Arthroplasty 2005
Key fa...
 Cost-effectiveness analysis of
unicompartmental knee arthroplasty
as an alternative to total knee
arthroplasty for unico...
Conclusion
 Patient selection: single medial
compartment disease, not inflammatory
arthritis
 Prevent MIS in obesity pat...
27
Dr.Sandeep Agrawal,Agrasen Hospital,Gondia MS
28
29
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TKR For Failed Uniknee Replacement Surgery Dr Sandeep Agrawal Agrasen Hospital Gondia Maharashtra India

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TKR For Failed Uniknee Replacement Surgery Dr Sandeep Agrawal Agrasen Hospital Gondia Maharashtra India

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TKR For Failed Uniknee Replacement Surgery Dr Sandeep Agrawal Agrasen Hospital Gondia Maharashtra India

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  3. 3. History  60 Year old female patient  Bilateral knee pain for months  Bilateral knee osteoarthritis with Varus deformity  Right knee surgical procedure 6 months ago  Difficult weight bearing  ROM limited: right 10*-100* left 0*-140*
  4. 4. 4
  5. 5. 5
  6. 6. 6
  7. 7. Plans  Revision UKA  or revision TKA  Bone defect management
  8. 8. 8
  9. 9. 9
  10. 10. 10
  11. 11. Discussion of this case  Major problems:  1. Minimal invasive approach  2. Fixation technique  3. Indication of unicompartment knee arthroplasty  4. Any other treatment choice
  12. 12.  New cutting jig allow a smaller wound like 4cm length  But, is it really improved outcome ?
  13. 13.  Minimally invasive surgery vs conventional exposure using the Miller-Galante unicompartmental knee arthroplasty: a randomized radiostereometric study Carlsson et al. J Arthroplasty. 2006  41 cases, randomized  Significant difference: shorter hospitalization and faster rehabilitation  No difference in clinical or radiographic results
  14. 14.  High tibial osteotomy versus unicompartmental joint replacement in unicompartmental knee joint osteoarthritis: 7-10-year follow-up prospective randomised study Stukenborg et al. knee 2001  32 HTO / 28 UKA  More intra- and postoperative complications after HTO  Conclusion: advanced design UKA offers better long-term success
  15. 15.  Early failure of minimally invasive unicompartmental knee arthroplasty is associated with obesity Berend et al. CORR 2005  16/79 failures: 6 tibial loosening, 3 plateau fracture, 4 persistent medial pain, one progressive arthritis, and 2 sepsis  Age, gender, disease severity and implant design not predict failure  Body mass index (BMI) > 32 did predict failure and associated with reduce survivorship
  16. 16.  Conversion of failed unicompartmental knee arthroplasty to TKA Springer et al. CORR 2006  modes of failure: polyethylene wear (12), femoral loosening (4) or tibial loosening (3), and osteoarthritis progression (3)  Major problem: bone defect
  17. 17.  Revision total knee arthroplasty after unicompartmental femorotibial prosthesis: 54 cases Chatain et al. Rev Chir Orthop Reparatrice Appar Mot. 2004  Mean time to failure: 4 years  Re-revision TKA: 5 cases  Tibial bone loss more frequent  Femoral bone loss more difficult to correct  Revision TKA after UKA get better results than revision TKA after HTO or TKA
  18. 18.  Revision of failed unicompartmental knee arthroplasty. McAuley et al. CORR 2001  39 revision cases (9-204 months)  30 insert wear, 9 loosening  3 re-revision TKA  Result better than TKA revision
  19. 19.  Revision surgery after failed unicompartmental knee arthroplasty: a study of 35 cases Bohm et al. J arthroplasty 2000  Failure mechanism: loosening > wear  Revision duration: 1 weeks to 11 years (23/35 < 5 years)  6 aseptic loosening after revision TKA
  20. 20.  Modern Unicompartmental Knee Arthroplasty with Cement. A Three to Ten-Year Follow-up Study Argenson et al. JBJSA 2002  147 cases  10 years survival rate 94%  3% revision rates (2 PF progressive OA, 1 lateral FT OA, 2 insert wear)  patient selection affect result
  21. 21.  Results of Unicompartmental Knee Arthroplasty at a Minimum of Ten Years of Follow-up Richard A. Berger, MD. JBJSA 2005  38 cases, 49 UKAs F/U > 10 years  2 revisions to TKA (PF progressive OA)  No component loose, nor osteolysis  survival rate: 98.0% ± 2.0% (10 years) 95.7% ± 4.3% (13 years)
  22. 22. 22
  23. 23.  2 most common causes of failure:  Tibial aseptic loosening  Accelerated polyethylene wear  Suggest undercorrection of the angular deformity precludes overstuffing the compartment, thus minimizes polyethylene wear
  24. 24.  Making your next unicompartmental knee arthroplasty last: three keys to success Whiteside LA. J Arthroplasty 2005 Key factors:  Alignment: Intramedullary instruments  Ligament balance: Complete osteophyte excision  Implant fixation: excellent bone stock, avoiding tibial overresection
  25. 25.  Cost-effectiveness analysis of unicompartmental knee arthroplasty as an alternative to total knee arthroplasty for unicompartmental osteoarthritis Soohoo et al. JBJSA 2006  with appropriate patient selection, the currently available literature supports UKA as a cost-effective alternative to TKA for single medial knee OA
  26. 26. Conclusion  Patient selection: single medial compartment disease, not inflammatory arthritis  Prevent MIS in obesity patient  Resurfacing >> Correct alignment  It is a cost-effective treatment choice
  27. 27. 27
  28. 28. Dr.Sandeep Agrawal,Agrasen Hospital,Gondia MS 28
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