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TKR For Failed Uniknee Replacement Surgery Dr Sandeep Agrawal Agrasen Hospital Gondia Maharashtra India
The document discusses a 60-year-old female patient with bilateral knee osteoarthritis and outlines various surgical options and considerations for her condition. It reviews successes and failures of unicompartmental knee arthroplasty (UKA) compared to total knee arthroplasty (TKA), focusing on factors such as surgical approach, complication rates, and patient selection. Ultimately, it suggests that UKA can be a cost-effective and beneficial option for appropriate candidates, particularly with careful attention to alignment and fixation.
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TKR For Failed Uniknee Replacement Surgery Dr Sandeep Agrawal Agrasen Hospital Gondia Maharashtra India
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- 3. History 60 Yearold 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 thiscase Major problems: 1. Minimal invasive approach 2. Fixation technique 3. Indication of unicompartment knee arthroplasty 4. Any other treatment choice
- 12. New cuttingjig allow a smaller wound like 4cm length But, is it really improved outcome ?
- 13. Minimally invasivesurgery 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 tibialosteotomy 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 failureof 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 offailed 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 totalknee 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 offailed 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 surgeryafter 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 UnicompartmentalKnee 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 ofUnicompartmental 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 mostcommon 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 yournext 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 analysisof 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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