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TKR For Failed Uniknee Replacement Surgery Dr Sandeep Agrawal Agrasen Hospital Gondia Maharashtra India
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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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Plans
Revision UKA
or revision TKA
Bone defect management
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Discussion of this case
Major problems:
1. Minimal invasive approach
2. Fixation technique
3. Indication of unicompartment knee
arthroplasty
4. Any other treatment choice
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 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
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
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
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
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
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
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
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
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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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
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
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
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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Dr.Sandeep Agrawal,Agrasen Hospital,Gondia MS28
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