Femoral Coronal Malalignment is Associated With Failure in Mobile-Bearing Medial Unicompartmental Knee Arthroplasty.

Femur-first technique (FF) for mobile-bearing medial unicompartmental knee arthroplasty (UKA) has been described as an alternative to tibia first-technique (TF). The aim of this study was to compare the radiographic results in UKAs using FF or TF techniques and their influence on failure rates. We retrospectively reviewed 288 UKAs with a minimum 2-year follow-up. There were 147 knees in the TF and 141 knees in the FF cohorts. Alignment parameters and overhang were assessed as outliers and far outliers. The mean follow-up was six years (range, 2 to 16), the mean age was 63 years (range, 27 to 92), and 45% of patients were women. Univariate and multivariate statistical analyses were carried out with Cox regression models. There were 13 and 6 revisions in the TF and FF cohorts, respectively. The FF had lower rates of femoral coronal alignment (FCA) or femoral sagittal alignment (FSA) outliers compared to the TF (5.7 versus 19%, P = 0.011). Tibial coronal alignment (TCA) and tibial sagittal alignment (TSA) did not significantly differ between the techniques (22.7% in FF versus 29.9% in TF, P = 0.119). Overhang outliers did not differ significantly between the groups. Younger age was associated with a higher revision rate (P = 0.006), while FF versus TF, sex, BMI, and postoperative mechanical axis did not show significant associations. In multivariate analysis, FCA outliers and younger age were significantly associated with revision. The FF technique in mobile-bearing UKA resulted in fewer FCA outliers compared to TF. Despite improved knee alignment with the FF technique, FCA outliers and younger age were associated with a higher revision rate, independent of technique.

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