Unicompartmental Knee Arthroplasty: Survivorship and Risk Factors for Revision: A Population-Based Cohort Study with Minimum 10-Year Follow-up.
Journal
The Journal of bone and joint surgery. American volume
ISSN: 1535-1386
Titre abrégé: J Bone Joint Surg Am
Pays: United States
ID NLM: 0014030
Informations de publication
Date de publication:
21 Sep 2021
21 Sep 2021
Historique:
entrez:
21
9
2021
pubmed:
22
9
2021
medline:
22
9
2021
Statut:
aheadofprint
Résumé
Operative management for end-stage knee osteoarthritis (OA) primarily consists of arthroplasty. Total knee arthroplasty (TKA) is the so-called gold standard for multicompartmental OA. In selected patients, specifically those with unicompartmental OA and no definite contraindications, realignment osteotomies and unicompartmental knee arthroplasty (UKA) are viable options. UKA offers several advantages over TKA, including preservation of both cruciate ligaments, faster recovery, and less osseous resection. The purpose of this study was to determine the survivorship of UKAs and risk factors for all-cause revision surgery in patients with a minimum follow-up of 10 years in a large population-based database. We performed a population-based cohort study using linked administrative databases in Ontario, Canada. We identified all UKAs performed from January 2002 through December 2006. All patients had a minimum 10-year follow-up. Demographic data and outcomes were summarized using descriptive statistics. We used a Cox proportional hazards model with the Fine and Gray method accounting for competing risks such as death to analyze the effect of surgical and patient factors on the risk of revision of UKA. A total of 4,385 patients were identified as having undergone primary UKA from 2002 through 2006 in Ontario. Of these patients, 779 underwent revision surgery, for a cumulative risk for all-cause revision of 16.5% at 10 years (95% confidence interval [CI]: 15.4% to 17.7%). Mechanical loosening was the reason for 83.4% of all revisions. Male sex, diabetes, an age younger than 50 years, and cementless implants were significant risk factors for revision surgery. Residence in a rural or urban setting, income quintile, discharge destination, and type of OA were not associated with the risk of revision. Survivorship at 1, 5, 10, and 15 years was 97.2%, 90.5%, 83.5%, and 81.9%, respectively. This study demonstrated a >80% long-term survivorship for UKA based on a large administrative database sample and identified important risk factors for failure including male sex, younger age, diabetes, and cementless fixation. This study found rates of survivorship similar to those previously reported in the literature, while identifying key risk factors for failure. Patient selection has always been identified as a key factor in ensuring successful UKA, and the risk factors identified in this study may help guide decision-making for surgeons and patients dealing with unicompartmental knee OA. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Sections du résumé
BACKGROUND
BACKGROUND
Operative management for end-stage knee osteoarthritis (OA) primarily consists of arthroplasty. Total knee arthroplasty (TKA) is the so-called gold standard for multicompartmental OA. In selected patients, specifically those with unicompartmental OA and no definite contraindications, realignment osteotomies and unicompartmental knee arthroplasty (UKA) are viable options. UKA offers several advantages over TKA, including preservation of both cruciate ligaments, faster recovery, and less osseous resection. The purpose of this study was to determine the survivorship of UKAs and risk factors for all-cause revision surgery in patients with a minimum follow-up of 10 years in a large population-based database.
METHODS
METHODS
We performed a population-based cohort study using linked administrative databases in Ontario, Canada. We identified all UKAs performed from January 2002 through December 2006. All patients had a minimum 10-year follow-up. Demographic data and outcomes were summarized using descriptive statistics. We used a Cox proportional hazards model with the Fine and Gray method accounting for competing risks such as death to analyze the effect of surgical and patient factors on the risk of revision of UKA.
RESULTS
RESULTS
A total of 4,385 patients were identified as having undergone primary UKA from 2002 through 2006 in Ontario. Of these patients, 779 underwent revision surgery, for a cumulative risk for all-cause revision of 16.5% at 10 years (95% confidence interval [CI]: 15.4% to 17.7%). Mechanical loosening was the reason for 83.4% of all revisions. Male sex, diabetes, an age younger than 50 years, and cementless implants were significant risk factors for revision surgery. Residence in a rural or urban setting, income quintile, discharge destination, and type of OA were not associated with the risk of revision. Survivorship at 1, 5, 10, and 15 years was 97.2%, 90.5%, 83.5%, and 81.9%, respectively.
CONCLUSIONS
CONCLUSIONS
This study demonstrated a >80% long-term survivorship for UKA based on a large administrative database sample and identified important risk factors for failure including male sex, younger age, diabetes, and cementless fixation. This study found rates of survivorship similar to those previously reported in the literature, while identifying key risk factors for failure. Patient selection has always been identified as a key factor in ensuring successful UKA, and the risk factors identified in this study may help guide decision-making for surgeons and patients dealing with unicompartmental knee OA.
LEVEL OF EVIDENCE
METHODS
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Identifiants
pubmed: 34547009
doi: 10.2106/JBJS.21.00346
pii: 00004623-990000000-00342
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2021 by The Journal of Bone and Joint Surgery, Incorporated.
Déclaration de conflit d'intérêts
Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJS/G715).
Références
Price A, Allum R. Management of osteoarthritis of the knee. Ann R Coll Surg Engl. 2010 Sep;92(6):459-62.
Delva ML, Samuel LT, Roth A, Yalçin S, Kamath AF. Contemporary Knee Osteotomy in the United States: High Tibial Osteotomy and Distal Femoral Osteotomy Have Comparable Complication Rates despite Differing Demographic Profiles. J Knee Surg. 2021 Jul;34(8):816-21.
Jennings JM, Kleeman-Forsthuber LT, Bolognesi MP. Medial unicompartmental arthroplasty of the knee. J Am Acad Orthop Surg. 2019 Mar 1;27(5):166-76.
Hamilton TW, Pandit HG, Jenkins C, Mellon SJ, Dodd CAF, Murray DW. Evidence-Based Indications for Mobile-Bearing Unicompartmental Knee Arthroplasty in a Consecutive Cohort of Thousand Knees. J Arthroplasty. 2017 Jun;32(6):1779-85.
van der List JP, Chawla H, Zuiderbaan HA, Pearle AD. The Role of Preoperative Patient Characteristics on Outcomes of Unicompartmental Knee Arthroplasty: A Meta-Analysis Critique. J Arthroplasty. 2016 Nov;31(11):2617-27.
Ventura A, Legnani C, Borgo E. Unicompartmental knee replacement in patients aged 70 years and older. Muscles Ligaments Tendons J. 2018 Apr 16;7(4):611-4.
Berger RA, Meneghini RM, Sheinkop MB, Della Valle CJ, Jacobs JJ, Rosenberg AG, Galante JO. The progression of patellofemoral arthrosis after medial unicompartmental replacement: results at 11 to 15 years. Clin Orthop Relat Res. 2004 Nov;(428):92-9.
Boissonneault A, Pandit H, Pegg E, Jenkins C, Gill HS, Dodd CA, Gibbons CL, Murray DW. No difference in survivorship after unicompartmental knee arthroplasty with or without an intact anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc. 2013 Nov;21(11):2480-6.
Mancuso F, Dodd CA, Murray DW, Pandit H. Medial unicompartmental knee arthroplasty in the ACL-deficient knee. J Orthop Traumatol. 2016 Sep;17(3):267-75.
Stern SH, Becker MW, Insall JN. Unicondylar knee arthroplasty. An evaluation of selection criteria. Clin Orthop Relat Res. 1993 Jan;(286):143-8.
Lim JW, Cousins GR, Clift BA, Ridley D, Johnston LR. Oxford unicompartmental knee arthroplasty versus age and gender matched total knee arthroplasty - functional outcome and survivorship analysis. J Arthroplasty. 2014 Sep;29(9):1779-83.
Lombardi AV Jr, Berend KR, Walter CA, Aziz-Jacobo J, Cheney NA. Is recovery faster for mobile-bearing unicompartmental than total knee arthroplasty? Clin Orthop Relat Res. 2009 Jun;467(6):1450-7.
Lyons MC, MacDonald SJ, Somerville LE, Naudie DD, McCalden RW. Unicompartmental versus total knee arthroplasty database analysis: is there a winner? Clin Orthop Relat Res. 2012. Jan;470(1):84-90.
Isaac SM, Barker KL, Danial IN, Beard DJ, Dodd CA, Murray DW. Does arthroplasty type influence knee joint proprioception? A longitudinal prospective study comparing total and unicompartmental arthroplasty. Knee. 2007 Jun;14(3):212-7.
Peersman G, Verhaegen J, Favier B. The forgotten joint score in total and unicompartmental knee arthroplasty: a prospective cohort study. Int Orthop. 2019 Dec;43(12):2739-45.
Luo TD, Hubbard JB. Arthroplasty Knee Unicompartmental. StatPearls Publishing; 2019.
Di Martino A, Bordini B, Barile F, Ancarani C, Digennaro V, Faldini C. Unicompartmental knee arthroplasty has higher revisions than total knee arthroplasty at long term follow-up: a registry study on 6453 prostheses. Knee Surg Sports Traumatol Arthrosc. 2020 Aug 1.
Schlueter-Brust K, Kugland K, Stein G, Henckel J, Christ H, Eysel P, Bontemps G. Ten year survivorship after cemented and uncemented medial Uniglide® unicompartmental knee arthroplasties. Knee. 2014 Oct;21(5):964-70.
Heyse TJ, Khefacha A, Peersman G, Cartier P. Survivorship of UKA in the middle-aged. Knee. 2012 Oct;19(5):585-91.
Niinimäki T, Eskelinen A, Mäkelä K, Ohtonen P, Puhto AP, Remes V. Unicompartmental knee arthroplasty survivorship is lower than TKA survivorship: a 27-year Finnish registry study. Clin Orthop Relat Res. 2014 May;472(5):1496-501.
Lim HC, Bae JH, Song SH, Kim SJ. Oxford phase 3 unicompartmental knee replacement in Korean patients. J Bone Joint Surg Br. 2012 Aug;94(8):1071-6.
Wilson HA, Middleton R, Abram SGF, Smith S, Alvand A, Jackson WF, Bottomley N, Hopewell S, Price AJ. Patient relevant outcomes of unicompartmental versus total knee replacement: systematic review and meta-analysis. BMJ. 2019 Feb 21;364:l352.
Benchimol EI, Smeeth L, Guttmann A, Harron K, Moher D, Petersen I, Sørensen HT, von Elm E, Langan SM; RECORD Working Committee. The REporting of studies Conducted using Observational Routinely-collected health Data (RECORD) statement. PLoS Med. 2015 Oct 6;12(10):e1001885.
von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, STROBE Initiative. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: Guidelines for reporting observational studies. Int J Surg. 2014 Dec;12(12):1495-9.
Hux JE, Ivis F, Flintoft V, Bica A. Diabetes in Ontario: determination of prevalence and incidence using a validated administrative data algorithm. Diabetes Care. 2002 Mar;25(3):512-6.
Chen G, Khan N, Walker R, Quan H. Validating ICD coding algorithms for diabetes mellitus from administrative data. Diabetes Res Clin Pract. 2010 Aug;89(2):189-95.
Fine JP, Gray RJ. A Proportional Hazards Model for the Subdistribution of a Competing Risk. J Am Stat Assoc. 1999;94(446):496-509.
R Core Team. R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing; 2011.
Naing L, Winn T, Rusli BN. Practical Issues in Calculating the Sample Size for Prevalence Studies. Arch Orofac Sci. 2006;1:9-14.
Howieson A, Farrington W. Unicompartmental knee replacement in the elderly: a systematic review. Acta Orthop Belg. 2015 Dec;81(4):565-71.
Ingale PA, Hadden WA. A review of mobile bearing unicompartmental knee in patients aged 80 years or older and comparison with younger groups. J Arthroplasty. 2013 Feb;28(2):262-267.e2.
Ghomrawi HM, Eggman AA, Pearle AD. Effect of age on cost-effectiveness of unicompartmental knee arthroplasty compared with total knee arthroplasty in the U.S. J Bone Joint Surg Am. 2015 Mar 4;97(5):396-402.
Johnstone SF, Tranovich MJ, Vyas D, Wright VJ. Unicompartmental arthritis in the aging athlete: osteotomy and beyond. Curr Rev Musculoskelet Med. 2013 Sep;6(3):264-72.
Rhee C, Lethbridge L, Richardson G, Dunbar M. Risk factors for infection, revision, death, blood transfusion and longer hospital stay 3 months and 1 year after primary total hip or knee arthroplasty. Can J Surg. 2018 Jun;61(3):165-76.
Jasper LL, Jones CA, Mollins J, Pohar SL, Beaupre LA. Risk factors for revision of total knee arthroplasty: a scoping review. BMC Musculoskelet Disord. 2016 Apr 26;17:182.
Law GW, Bin Abd Razak HR, Goh GSH, Wong KC, Chong HC, Lo NN, Yeo SJ. Diabetes mellitus does not negatively impact outcomes and satisfaction following unicompartmental knee arthroplasty in well-controlled disease. Asia Pac J Sports Med Arthrosc Rehabil Technol. 2019 Jan 3;16:24-9.
Martin ET, Kaye KS, Knott C, Nguyen H, Santarossa M, Evans R, Bertran E, Jaber L. Diabetes and risk of surgical site infection: A systematic review and meta-analysis. Infect Control Hosp Epidemiol. 2016 Jan;37(1):88-99.
Lenguerrand E, Whitehouse MR, Beswick AD, Kunutsor SK, Foguet P, Porter M, Blom AW; National Joint Registry for England, Wales, Northern Ireland and the Isle of Man. Risk factors associated with revision for prosthetic joint infection following knee replacement: an observational cohort study from England and Wales. Lancet Infect Dis. 2019 Jun;19(6):589-600.
Kunutsor SK, Whitehouse MR, Blom AW, Beswick AD; INFORM Team. Patient-related risk factors for periprosthetic joint infection after total joint arthroplasty: A systematic review and meta-analysis. PLoS One. 2016 Mar 3;11(3):e0150866.
Mohammad HR, Matharu GS, Judge A, Murray DW. Comparison of the 10-year outcomes of cemented and cementless unicompartmental knee replacements: data from the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man. Acta Orthop. 2020 Feb;91(1):76-81.
Ma J, Yan Y, Wang W, Wang B, Yue D, Guo W. Lower early revision rates after uncemented Oxford Unicompartmental Knee Arthroplasty (UKA) than cemented Oxford UKA: A meta-analysis. Orthop Traumatol Surg Res. 2021 May;107(3):102802.
Akan B, Karaguven D, Guclu B, Yildirim T, Kaya A, Armangil M, Cetin I. Cemented versus Uncemented Oxford Unicompartmental Knee Arthroplasty: Is There a Difference? Adv Orthop. 2013;2013:245915.
Gold PA, Garbarino L, Sodhi N, Barrack R, Springer BD, Mont MA. The case for cementless total knee arthroplasty. Surg Technol Int. 2020 May 28;36:388-96.
Aprato A, Risitano S, Sabatini L, Giachino M, Agati G, Massè A. Cementless total knee arthroplasty. Ann Transl Med. 2016 Apr;4(7):129.
Petterson SC, Blood KD, Plancher KD. Role of alignment in successful clinical outcomes following medial unicompartmental knee arthroplasty: current concepts. J ISAKOS. 2020;5:224-8.
Bell SW, Anthony I, Jones B, MacLean A, Rowe P, Blyth M. Improved Accuracy of Component Positioning with Robotic-Assisted Unicompartmental Knee Arthroplasty: Data from a Prospective, Randomized Controlled Study. J Bone Joint Surg Am. 2016 Apr 20;98(8):627-35.
Zhang F, Li H, Ba Z, Bo C, Li K. Robotic arm-assisted vs conventional unicompartmental knee arthroplasty: A meta-analysis of the effects on clinical outcomes. Medicine (Baltimore). 2019 Aug;98(35):e16968.
Mittal A, Meshram P, Kim WH, Kim TK. Unicompartmental knee arthroplasty, an enigma, and the ten enigmas of medial UKA. J Orthop Traumatol. 2020 Sep 2;21(1):15.
Zhang W, Wang J, Li H, Wang W, George DM, Huang T. Fixed- versus mobile-bearing unicompartmental knee arthroplasty: a meta-analysis. Sci Rep. 2020 Nov 5;10(1):19075.
Austin PC, Daly PA, Tu JV. A multicenter study of the coding accuracy of hospital discharge administrative data for patients admitted to cardiac care units in Ontario. Am Heart J. 2002 Aug;144(2):290-6.
Benchimol EI, Manuel DG, To T, Griffiths AM, Rabeneck L, Guttmann A. Development and use of reporting guidelines for assessing the quality of validation studies of health administrative data. J Clin Epidemiol. 2011 Aug;64(8):821-9.
Fiocchi A, Condello V, Madonna V, Bonomo M, Zorzi C. Medial vs lateral unicompartmental knee arthrroplasty: clinical results. Acta Biomed. 2017 Jun 7;88(2S):38-44.