This work was completed at the Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford.
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The purpose of this study was to understand why the revision rate of unicompartmental knee replacement (UKR) in the National Joint Registry (NJR) is so high. Using radiographs, the appropriateness of patient selection for primary surgery, surgical technique, and indications for revision were determined. In addition, the alignment of the radiographs was assessed.
Oxford UKR registered with the NJR between 2006 and 2010 and subsequently revised were identified by the NJR. A blinded review was undertaken of pre-primary, post-primary, and pre-revision anteroposterior and lateral radiographs of a sample of 107 cases from multiple centres.
The recommended indications were satisfied in 70%, with 29% not demonstrating bone-on-bone arthritis. Major technical errors, likely leading to revision, were seen in 6%. Pre-revision radiographs were malaligned and, therefore, difficult to interpret in 53%. No reason for revision was seen in 67%. Reasons for revision included lateral compartment arthritis (10%), tibial loosening (7%), bearing dislocation (7%), infection (6%), femoral loosening (3%), and peri-prosthetic fracture (2%, one femoral, one tibial).
Only 20% of the revised UKR were implanted for the recommended indications, using appropriate surgical technique and had a mechanical problem necessitating revision. One-third of primary surgeries were undertaken in patients with early arthritis, which is contraindicated. Two-thirds were presumably revised for unexplained pain, which is not advised as it tends not to help the pain. This study suggests that variable and inappropriate indications for primary and revision surgery are responsible for the high rates of revision seen in registries.
III, Therapeutic study.
Beard DJ, Davies LJ, Cook JA, MacLennan G, Price A, Kent S 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 394:746–756 CrossRef
Brown NM, Sheth NP, Davis K, Berend ME, Lombardi AV, Berend KR et al (2012) Total knee arthroplasty has higher postoperative morbidity than unicompartmental knee arthroplasty: a multicenter analysis. J Arthroplasty 27:86–90 CrossRef
Burn E, Liddle AD, Hamilton TW, Pai S, Pandit HG, Murray DW et al (2017) Choosing between unicompartmental and total knee replacement: What can economic evaluations tell us? A systematic review. Pharmacoecon Open 1:241–253 CrossRef
Chau R, Gulati A, Pandit H, Beard DJ, Price AJ, Dodd CA et al (2009) Tibial component overhang following unicompartmental knee replacement–does it matter? Knee 16:310–313 CrossRef
Emerson RH, Alnachoukati O, Barrington J, Ennin K (2016) The results of Oxford unicompartmental knee arthroplasty in the United States: a mean ten-year survival analysis. Bone Joint J 98-B:34–40 CrossRef
Goodfellow J, O'Connor J, Dodd C, Murray DW (2006) Unicompartmental arthroplasty with the Oxford knee, vol 190. Oxford University Press, Oxford
Goodfellow JW, O'Connor JJ, Murray DW (2010) A critique of revision rate as an outcome measure: re-interpretation of knee joint registry data. J Bone Joint Surg Br 92:1628–1631 CrossRef
Gulati A, Chau R, Pandit HG, Gray H, Price AJ, Dodd CA et al (2009) The incidence of physiological radiolucency following Oxford unicompartmental knee replacement and its relationship to outcome. J Bone Joint Surg Br 91:896–902 CrossRef
Hamilton TW, Pandit HG, Inabathula A, Ostlere SJ, Jenkins C, Mellon SJ et al (2017) Unsatisfactory outcomes following unicompartmental knee arthroplasty in patients with partial thickness cartilage loss: a medium-term follow-up. Bone Joint J 99-B:475–482 CrossRef
Hamilton TW, Pandit HG, Jenkins C, Mellon SJ, Dodd CAF, Murray DW (2017) Evidence-based indications for mobile-bearing unicompartmental knee arthroplasty in a consecutive cohort of thousand knees. J Arthroplasty 32:1779–1785 CrossRef
Hamilton TW, Pandit HG, Lombardi AV, Adams JB, Oosthuizen CR, Clave A et al (2016) Radiological Decision Aid to determine suitability for medial unicompartmental knee arthroplasty: development and preliminary validation. Bone Joint J 98-B:3–10 CrossRef
Hamilton TW, Rizkalla JM, Kontochristos L, Marks BE, Mellon SJ, Dodd CAF et al (2017) The interaction of caseload and usage in determining outcomes of unicompartmental knee arthroplasty: a meta-analysis. J Arthroplasty 32(3228–3237):e3222
He Y, Xiao L, Zhai W, Kasparek MF, Ouyang G, Boettner F (2018) What percentage of patients is a candidate for unicompartmental knee replacement at a chinese arthroplasty center? Open Orthop J 12:17 CrossRef
Hook S (2018) Radiography of the Oxford Knee. Imag Ther Pract 12–18
Hurst JM, Berend KR, Adams JB, Lombardi AV Jr (2015) Radiographic comparison of mobile-bearing partial knee single-peg versus twin-peg design. J Arthroplasty 30:475–478 CrossRef
Jacobs MA, Hungerford DS, Krackow KA, Lennox DW (1988) Revision total knee arthroplasty for aseptic failure. Clin Orthop Relat Res 226:78–85
Keyes GW, Carr AJ, Miller RK, Goodfellow JW (1992) The radiographic classification of medial gonarthrosis: correlation with operation methods in 200 knees. Acta Orthop Scand 63:497–501 CrossRef
Koh I, Kim J, Jang S, Kim M, Kim C, In Y (2016) Are the Oxford® medial unicompartmental knee arthroplasty new instruments reducing the bearing dislocation risk while improving components relationships? A case control study. Orthop Traumatol Surg Res 102:183–187 CrossRef
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 384:1437–1445 CrossRef
Liddle AD, Pandit H, Judge A, Murray DW (2015) Patient-reported outcomes after total and unicompartmental knee arthroplasty: a study of 14,076 matched patients from the national joint registry for England and Wales. Bone Joint J 97-B:793–801 CrossRef
Lim HC, Bae JH, Song SH, Kim SJ (2012) Oxford phase 3 unicompartmental knee replacement in Korean patients. J Bone Joint Surg Br 94:1071–1076 CrossRef
Lisowski LA, Meijer LI, van den Bekerom MP, Pilot P, Lisowski AE (2016) Ten- to 15-year results of the Oxford Phase III mobile unicompartmental knee arthroplasty: a prospective study from a non-designer group. Bone Joint J 98-B:41–47 CrossRef
Malhotra R, Kumar V, Wahal N, Clave A, Kennedy JA, Murray DW et al (2019) New instrumentation improves patient satisfaction and component positioning for mobile-bearing medial unicompartmental knee replacement. Indian J Orthop 53:289–296 CrossRef
Mohammad HR, Strickland L, Hamilton TW, Murray DW (2018) Long-term outcomes of over 8000 medial Oxford Phase 3 unicompartmental knees-a systematic review. Acta Orthop 89:101–107 CrossRef
Mont MA, Serna FK, Krackow KA, Hungerford DS (1996) Exploration of radiographically normal total knee replacements for unexplained pain. Clin Orthop Relat Res 331:216–220 CrossRef
Morris MJ, Molli RG, Berend KR, Lombardi AV Jr (2013) Mortality and perioperative complications after unicompartmental knee arthroplasty. Knee 20:218–220 CrossRef
Niinimaki TT, Murray DW, Partanen J, Pajala A, Leppilahti JI (2011) Unicompartmental knee arthroplasties implanted for osteoarthritis with partial loss of joint space have high re-operation rates. Knee 18:432–435 CrossRef
No authors listed (2018) 15th Annual Report. National Joint Registry for England, Wales (Northern Ireland and the Isle of Man)
No authors listed (2018) Annual Report 2018. Swedish Knee Arthroplasty Register
No authors listed (2018) Annual Report. National Joint Replacement Registry: hip, knee and shoulder arthroplasty. Australian Orthopaedic Association
No authors listed (2018) The New Zealand Joint Registry: Nineteen year report. New Zealand Orthopaedic Association
Pandit H, Hamilton TW, Jenkins C, Mellon SJ, Dodd CA, Murray DW (2015) The clinical outcome of minimally invasive Phase 3 Oxford unicompartmental knee arthroplasty: a 15-year follow-up of 1000 UKAs. Bone Joint J 97-B:1493–1500 CrossRef
Psychoyios V, Crawford RW, O'Connor JJ, Murray DW (1998) Wear of congruent meniscal bearings in unicompartmental knee arthroplasty: a retrieval study of 16 specimens. J Bone Joint Surg Br 80:976–982 CrossRef
Saldanha KA, Keys GW, Svard UC, White SH, Rao C (2007) Revision of Oxford medial unicompartmental knee arthroplasty to total knee arthroplasty—results of a multicentre study. Knee 14:275–279 CrossRef
Toms AD, Mandalia V, Haigh R, Hopwood B (2009) The management of patients with painful total knee replacement. J Bone Joint Surg Br 91:143–150 CrossRef
Tu Y, Xue H, Ma T, Wen T, Yang T, Zhang H et al (2017) Superior femoral component alignment can be achieved with Oxford microplasty instrumentation after minimally invasive unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 25:729–735 CrossRef
White SH, Ludkowski PF, Goodfellow JW (1991) Anteromedial osteoarthritis of the knee. J Bone Joint Surg Br 73:582–586 CrossRef
Willis-Owen CA, Brust K, Alsop H, Miraldo M, Cobb JP (2009) Unicondylar knee arthroplasty in the UK National Health Service: an analysis of candidacy, outcome and cost efficacy. Knee 16:473–478 CrossRef
Yoshida K, Tada M, Yoshida H, Takei S, Fukuoka S, Nakamura H (2013) Oxford phase 3 unicompartmental knee arthroplasty in Japan–clinical results in greater than one thousand cases over ten years. J Arthroplasty 28:168–171 CrossRef
- Most unicompartmental knee replacement revisions could be avoided: a radiographic evaluation of revised Oxford knees in the National Joint Registry
James A. Kennedy
Stephen J. Mellon
Chris A. F. Dodd
Hemant G. Pandit
David W. Murray
- Springer Berlin Heidelberg
Knee Surgery, Sports Traumatology, Arthroscopy
Print ISSN: 0942-2056
Elektronische ISSN: 1433-7347
Neu im Fachgebiet Orthopädie und Unfallchirurgie
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