Skip to main content
Top
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 12/2020

01-12-2020 | Osteoarthrosis | KNEE

Excellent survival and outcomes with fixed-bearing medial UKA in young patients (≤ 60 years) at minimum 10-year follow-up

Authors: Ashim Mannan, Richard W. D. Pilling, Katy Mason, Patrick Stirling, David Duffy, Nick London

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 12/2020

Login to get access

Abstract

Purpose

To evaluate whether long-term (10-year minimum) patient outcomes and survival of fixed-bearing medial unicompartmental knee arthroplasty (UKA) in patients aged  ≤ 60 years were favorable despite non-conventional age criteria.

Methods

The authors reviewed the records of 91 consecutive medial UKAs performed in patients aged ≤ 60 by a single surgeon. All patients received the same fixed-bearing M/G Unicompartmental Knee System. Patients records were updated, noting complications or revisions, and Oxford Knee Scores and overall satisfaction collected. If deceased, the general practitioner or next of kin provided data.

Results

Of the initial 91 knees, 10 were revised, 6 were deceased, and 1 was lost to follow-up. The final cohort of 74 knees was aged 54.3 ± 4.3 years (range 41.8–60.6) at index surgery. Using revision of any component as endpoint, the present series had a KM survival of 92.9% (CI 84.8–96.7%) at 10 years, and 87.8% (CI 78.4–93.2%) at 15 years, and a single non-fatal DVT was reported. At final follow-up of 15 ± 1.3 years (range 11–18), OKS (available for all 74 knees) was 38.4 ± 8.4 (range 18–48). Overall patients were pleased or very pleased with 72 of the knees (97%).

Conclusion

Fixed-bearing medial UKA yields favorable results in the treatment of single compartment osteoarthritis of the knee in patients ≤ 60 years. The present study demonstrates low complication rates, good-to-excellent long-term patient outcomes, and satisfactory implant survival for this age group considering the advantages of UKA.

Level of evidence

Level IV, retrospective cohort study.
Literature
1.
go back to reference Arirachakaran A, Choowit P, Putananon C, Muangsiri S, Kongtharvonskul J (2015) Is unicompartmental knee arthroplasty (UKA) superior to total knee arthroplasty (TKA)? A systematic review and meta-analysis of randomized controlled trial. Eur J Orthop Surg Traumatol 25(5):799–806CrossRef Arirachakaran A, Choowit P, Putananon C, Muangsiri S, Kongtharvonskul J (2015) Is unicompartmental knee arthroplasty (UKA) superior to total knee arthroplasty (TKA)? A systematic review and meta-analysis of randomized controlled trial. Eur J Orthop Surg Traumatol 25(5):799–806CrossRef
2.
go back to reference Austin PC, Steyerberg EW (2015) The number of subjects per variable required in linear regression analyses. J Clin Epidemiol 68(6):627–636CrossRef Austin PC, Steyerberg EW (2015) The number of subjects per variable required in linear regression analyses. J Clin Epidemiol 68(6):627–636CrossRef
3.
go back to reference Beard DJ, Davies LJ, Cook JA, MacLennan G, Price A et al (2019) The clinical and cost-effectiveness of total versus partial knee replacement in patients with medial compartment osteoarthritis (TOPKAT): 5-year outcomes of a randomised controlled trial. Lancet 394(10200):746–756CrossRef Beard DJ, Davies LJ, Cook JA, MacLennan G, Price A et al (2019) The clinical and cost-effectiveness of total versus partial knee replacement in patients with medial compartment osteoarthritis (TOPKAT): 5-year outcomes of a randomised controlled trial. Lancet 394(10200):746–756CrossRef
4.
go back to reference Bourne RB, Chesworth BM, Davis AM, Mahomed NN, Charron KDJ (2010) Patient satisfaction after total knee arthroplasty: who is satisfied and who is not? Clin Orthop Relat Res 468(1):57–63CrossRef Bourne RB, Chesworth BM, Davis AM, Mahomed NN, Charron KDJ (2010) Patient satisfaction after total knee arthroplasty: who is satisfied and who is not? Clin Orthop Relat Res 468(1):57–63CrossRef
5.
go back to reference Brown NM, Sheth NP, Davis K, Berend ME, Lombardi AV et al (2012) Total knee arthroplasty has higher postoperative morbidity than unicompartmental knee arthroplasty: a multicenter analysis. J Arthroplasty 27(8 Suppl):86–90CrossRef Brown NM, Sheth NP, Davis K, Berend ME, Lombardi AV et al (2012) Total knee arthroplasty has higher postoperative morbidity than unicompartmental knee arthroplasty: a multicenter analysis. J Arthroplasty 27(8 Suppl):86–90CrossRef
6.
go back to reference Burn E, Liddle AD, Hamilton TW, Pai S, Pandit HG et al (2017) Choosing between unicompartmental and total knee replacement: what can economic evaluations tell us? A systematic review. Pharmacoecon Open 1(4):241–253CrossRef Burn E, Liddle AD, Hamilton TW, Pai S, Pandit HG et al (2017) Choosing between unicompartmental and total knee replacement: what can economic evaluations tell us? A systematic review. Pharmacoecon Open 1(4):241–253CrossRef
7.
go back to reference Chawla H, van der List JP, Christ AB, Sobrero MR, Zuiderbaan HA et al (2017) Annual revision rates of partial versus total knee arthroplasty: A comparative meta-analysis. Knee 24(2):179–190CrossRef Chawla H, van der List JP, Christ AB, Sobrero MR, Zuiderbaan HA et al (2017) Annual revision rates of partial versus total knee arthroplasty: A comparative meta-analysis. Knee 24(2):179–190CrossRef
8.
go back to reference Clement ND, Weir DJ, Holland J, Deehan DJ (2019) Is there a threshold preoperative womac score that predicts patient satisfaction after total knee arthroplasty? J Knee Surg Clement ND, Weir DJ, Holland J, Deehan DJ (2019) Is there a threshold preoperative womac score that predicts patient satisfaction after total knee arthroplasty? J Knee Surg
9.
go back to reference Dyrhovden GS, Lygre SHL, Badawy M, Gothesen O, Furnes O (2017) Have the causes of revision for total and unicompartmental knee arthroplasties changed during the past two decades? Clin Orthop Relat Res 475(7):1874–1886CrossRef Dyrhovden GS, Lygre SHL, Badawy M, Gothesen O, Furnes O (2017) Have the causes of revision for total and unicompartmental knee arthroplasties changed during the past two decades? Clin Orthop Relat Res 475(7):1874–1886CrossRef
10.
go back to reference Felix J, Becker C, Vogl M, Buschner P, Plotz W et al (2019) Patient characteristics and valuation changes impact quality of life and satisfaction in total knee arthroplasty—results from a German prospective cohort study. Health Qual Life Outcomes 17(1):180CrossRef Felix J, Becker C, Vogl M, Buschner P, Plotz W et al (2019) Patient characteristics and valuation changes impact quality of life and satisfaction in total knee arthroplasty—results from a German prospective cohort study. Health Qual Life Outcomes 17(1):180CrossRef
11.
go back to reference Felts E, Parratte S, Pauly V, Aubaniac JM, Argenson JN (2010) Function and quality of life following medial unicompartmental knee arthroplasty in patients 60 years of age or younger. Orthop Traumatol Surg Res 96(8):861–867CrossRef Felts E, Parratte S, Pauly V, Aubaniac JM, Argenson JN (2010) Function and quality of life following medial unicompartmental knee arthroplasty in patients 60 years of age or younger. Orthop Traumatol Surg Res 96(8):861–867CrossRef
12.
go back to reference Goh GS, Bin Abd Razak HR, Tay DK, Chia SL, Lo NN et al (2018) Unicompartmental knee arthroplasty achieves greater flexion with no difference in functional outcome, quality of life, and satisfaction vs total knee arthroplasty in patients younger than 55 years. A propensity score-matched cohort analysis. J Arthroplasty 33(2):355–361CrossRef Goh GS, Bin Abd Razak HR, Tay DK, Chia SL, Lo NN et al (2018) Unicompartmental knee arthroplasty achieves greater flexion with no difference in functional outcome, quality of life, and satisfaction vs total knee arthroplasty in patients younger than 55 years. A propensity score-matched cohort analysis. J Arthroplasty 33(2):355–361CrossRef
13.
go back to reference Hamilton TW, Pandit HG, Jenkins C, Mellon SJ, Dodd CAF et al (2017) Evidence-based Indications for mobile-bearing unicompartmental knee arthroplasty in a consecutive cohort of thousand knees. J Arthroplasty 32(6):1779–1785CrossRef Hamilton TW, Pandit HG, Jenkins C, Mellon SJ, Dodd CAF et al (2017) Evidence-based Indications for mobile-bearing unicompartmental knee arthroplasty in a consecutive cohort of thousand knees. J Arthroplasty 32(6):1779–1785CrossRef
14.
go back to reference Hansen EN, Ong KL, Lau E, Kurtz SM, Lonner JH (2019) Unicondylar knee arthroplasty has fewer complications but higher revision rates than total knee arthroplasty in a study of large united states databases. J Arthroplasty 34(8):1617–1625CrossRef Hansen EN, Ong KL, Lau E, Kurtz SM, Lonner JH (2019) Unicondylar knee arthroplasty has fewer complications but higher revision rates than total knee arthroplasty in a study of large united states databases. J Arthroplasty 34(8):1617–1625CrossRef
15.
go back to reference Heaps BM, Blevins JL, Chiu YF, Konopka JF, Patel SP et al (2019) Improving estimates of annual survival rates for medial unicompartmental knee arthroplasty, a meta-analysis. J Arthroplasty 34(7):1538–1545CrossRef Heaps BM, Blevins JL, Chiu YF, Konopka JF, Patel SP et al (2019) Improving estimates of annual survival rates for medial unicompartmental knee arthroplasty, a meta-analysis. J Arthroplasty 34(7):1538–1545CrossRef
16.
go back to reference Hefti F, Muller W, Jakob RP, Staubli HU (1993) Evaluation of knee ligament injuries with the IKDC form. Knee Surg Sports Traumatol Arthrosc 1(3–4):226–234CrossRef Hefti F, Muller W, Jakob RP, Staubli HU (1993) Evaluation of knee ligament injuries with the IKDC form. Knee Surg Sports Traumatol Arthrosc 1(3–4):226–234CrossRef
17.
go back to reference Heyse TJ, El-Zayat BF, De Corte R, Chevalier Y, Scheys L et al (2014) UKA closely preserves natural knee kinematics in vitro. Knee Surg Sports Traumatol Arthrosc 22(8):1902–1910CrossRef Heyse TJ, El-Zayat BF, De Corte R, Chevalier Y, Scheys L et al (2014) UKA closely preserves natural knee kinematics in vitro. Knee Surg Sports Traumatol Arthrosc 22(8):1902–1910CrossRef
18.
go back to reference Heyse TJ, Khefacha A, Peersman G, Cartier P (2012) Survivorship of UKA in the middle-aged. Knee 19(5):585–591CrossRef Heyse TJ, Khefacha A, Peersman G, Cartier P (2012) Survivorship of UKA in the middle-aged. Knee 19(5):585–591CrossRef
19.
go back to reference Hurst JM, Berend KR (2014) Mobile-bearing unicondylar knee arthroplasty: the Oxford experience. Clin Sports Med 33(1):105–121CrossRef Hurst JM, Berend KR (2014) Mobile-bearing unicondylar knee arthroplasty: the Oxford experience. Clin Sports Med 33(1):105–121CrossRef
20.
go back to reference Kleeblad LJ, van der List JP, Zuiderbaan HA, Pearle AD (2018) Larger range of motion and increased return to activity, but higher revision rates following unicompartmental versus total knee arthroplasty in patients under 65: a systematic review. Knee Surg Sports Traumatol Arthrosc 26(6):1811–1822CrossRef Kleeblad LJ, van der List JP, Zuiderbaan HA, Pearle AD (2018) Larger range of motion and increased return to activity, but higher revision rates following unicompartmental versus total knee arthroplasty in patients under 65: a systematic review. Knee Surg Sports Traumatol Arthrosc 26(6):1811–1822CrossRef
21.
go back to reference Kozinn SC, Marx C, Scott RD (1989) Unicompartmental knee arthroplasty. A 4.5-6-year follow-up study with a metal-backed tibial component. J Arthroplasty 4:S1–S10CrossRef Kozinn SC, Marx C, Scott RD (1989) Unicompartmental knee arthroplasty. A 4.5-6-year follow-up study with a metal-backed tibial component. J Arthroplasty 4:S1–S10CrossRef
22.
go back to reference Lee M, Chen J, Shi LuC, Lo NN, Yeo SJ (2019) No differences in outcomes scores or survivorship of unicompartmental knee arthroplasty between patients younger or older than 55 years of age at minimum 10-year followup. Clin Orthop Relat Res 477(6):1434–1446CrossRef Lee M, Chen J, Shi LuC, Lo NN, Yeo SJ (2019) No differences in outcomes scores or survivorship of unicompartmental knee arthroplasty between patients younger or older than 55 years of age at minimum 10-year followup. Clin Orthop Relat Res 477(6):1434–1446CrossRef
23.
go back to reference Liddle AD, Judge A, Pandit H, Murray DW (2014) Adverse outcomes after total and unicompartmental knee replacement in 101,330 matched patients: a study of data from the National Joint Registry for England and Wales. Lancet 384(9952):1437–1445CrossRef Liddle AD, Judge A, Pandit H, Murray DW (2014) Adverse outcomes after total and unicompartmental knee replacement in 101,330 matched patients: a study of data from the National Joint Registry for England and Wales. Lancet 384(9952):1437–1445CrossRef
24.
go back to reference Liddle AD, Pandit H, Judge A, Murray DW (2016) Effect of surgical caseload on revision rate following total and unicompartmental knee replacement. J Bone Joint Surg Am 98(1):1–8CrossRef Liddle AD, Pandit H, Judge A, Murray DW (2016) Effect of surgical caseload on revision rate following total and unicompartmental knee replacement. J Bone Joint Surg Am 98(1):1–8CrossRef
25.
go back to reference Lyons MC, MacDonald SJ, Somerville LE, Naudie DD, McCalden RW (2012) Unicompartmental versus total knee arthroplasty database analysis: is there a winner? Clin Orthop Relat Res 470(1):84–90CrossRef Lyons MC, MacDonald SJ, Somerville LE, Naudie DD, McCalden RW (2012) Unicompartmental versus total knee arthroplasty database analysis: is there a winner? Clin Orthop Relat Res 470(1):84–90CrossRef
26.
go back to reference Mohammad HR, Strickland L, Hamilton TW, Murray DW (2018) Long-term outcomes of over 8,000 medial Oxford Phase 3 Unicompartmental Knees-a systematic review. Acta Orthop 89(1):101–107CrossRef Mohammad HR, Strickland L, Hamilton TW, Murray DW (2018) Long-term outcomes of over 8,000 medial Oxford Phase 3 Unicompartmental Knees-a systematic review. Acta Orthop 89(1):101–107CrossRef
27.
go back to reference Niinimaki T, Eskelinen A, Makela K, Ohtonen P, Puhto AP et al (2014) Unicompartmental knee arthroplasty survivorship is lower than TKA survivorship: a 27-year Finnish registry study. Clin Orthop Relat Res 472(5):1496–1501CrossRef Niinimaki T, Eskelinen A, Makela K, Ohtonen P, Puhto AP et al (2014) Unicompartmental knee arthroplasty survivorship is lower than TKA survivorship: a 27-year Finnish registry study. Clin Orthop Relat Res 472(5):1496–1501CrossRef
28.
go back to reference NJR (2016) National Joint Registry for England, Wales, Northern Ireland and the Isle of Man. vol 13. Annual report National Joint Registry NJR (2016) National Joint Registry for England, Wales, Northern Ireland and the Isle of Man. vol 13. Annual report National Joint Registry
29.
go back to reference Pandit H, Jenkins C, Gill HS, Smith G, Price AJ et al (2011) Unnecessary contraindications for mobile-bearing unicompartmental knee replacement. J Bone Joint Surg Br 93(5):622–628CrossRef Pandit H, Jenkins C, Gill HS, Smith G, Price AJ et al (2011) Unnecessary contraindications for mobile-bearing unicompartmental knee replacement. J Bone Joint Surg Br 93(5):622–628CrossRef
30.
go back to reference Pennington DW, Swienckowski JJ, Lutes WB, Drake GN (2003) Unicompartmental knee arthroplasty in patients sixty years of age or younger. J Bone Joint Surg Am 85(10):1968–1973CrossRef Pennington DW, Swienckowski JJ, Lutes WB, Drake GN (2003) Unicompartmental knee arthroplasty in patients sixty years of age or younger. J Bone Joint Surg Am 85(10):1968–1973CrossRef
31.
go back to reference Schai PA, Suh JT, Thornhill TS, Scott RD (1998) Unicompartmental knee arthroplasty in middle-aged patients: a 2- to 6-year follow-up evaluation. J Arthroplasty 13(4):365–372CrossRef Schai PA, Suh JT, Thornhill TS, Scott RD (1998) Unicompartmental knee arthroplasty in middle-aged patients: a 2- to 6-year follow-up evaluation. J Arthroplasty 13(4):365–372CrossRef
32.
go back to reference Swienckowski JJ, Pennington DW (2004) Unicompartmental knee arthroplasty in patients sixty years of age or younger. J Bone Joint Surg Am 86(1):131–142CrossRef Swienckowski JJ, Pennington DW (2004) Unicompartmental knee arthroplasty in patients sixty years of age or younger. J Bone Joint Surg Am 86(1):131–142CrossRef
33.
go back to reference van der List JP, Kleeblad LJ, Zuiderbaan HA, Pearle AD (2017) Mid-term outcomes of metal-backed unicompartmental knee arthroplasty show superiority to all-polyethylene unicompartmental and total knee arthroplasty. HSS J 13(3):232–240CrossRef van der List JP, Kleeblad LJ, Zuiderbaan HA, Pearle AD (2017) Mid-term outcomes of metal-backed unicompartmental knee arthroplasty show superiority to all-polyethylene unicompartmental and total knee arthroplasty. HSS J 13(3):232–240CrossRef
34.
go back to reference van der List JP, Sheng DL, Kleeblad LJ, Chawla H, Pearle AD (2017) Outcomes of cementless unicompartmental and total knee arthroplasty: a systematic review. Knee 24(3):497–507CrossRef van der List JP, Sheng DL, Kleeblad LJ, Chawla H, Pearle AD (2017) Outcomes of cementless unicompartmental and total knee arthroplasty: a systematic review. Knee 24(3):497–507CrossRef
35.
go back to reference Wilson HA, Middleton R, Abram SGF, Smith S, Alvand A et al (2019) Patient relevant outcomes of unicompartmental versus total knee replacement: systematic review and meta-analysis. BMJ 364:l352CrossRef Wilson HA, Middleton R, Abram SGF, Smith S, Alvand A et al (2019) Patient relevant outcomes of unicompartmental versus total knee replacement: systematic review and meta-analysis. BMJ 364:l352CrossRef
Metadata
Title
Excellent survival and outcomes with fixed-bearing medial UKA in young patients (≤ 60 years) at minimum 10-year follow-up
Authors
Ashim Mannan
Richard W. D. Pilling
Katy Mason
Patrick Stirling
David Duffy
Nick London
Publication date
01-12-2020
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 12/2020
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-020-05870-4

Other articles of this Issue 12/2020

Knee Surgery, Sports Traumatology, Arthroscopy 12/2020 Go to the issue