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

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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*

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7. Plans
 Revision UKA
 or revision TKA
 Bone defect management

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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.  New cutting jig allow a smaller wound
like 4cm length
 But, is it really improved outcome ?

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.  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.  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.  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.  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.  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.  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.  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.  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)

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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.  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.  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. 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

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28. Dr.Sandeep Agrawal,Agrasen Hospital,Gondia MS
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