2017 ISAKOS Biennial Congress ePoster #1232
A Systematic Review of Unicondylar Knee Arthroplasty in the Young Patient: Current Concepts
Ciaran McGarvey, MA, MSc, FRCS(Tr&Orth), London UNITED KINGDOM
Fabian Wong, MRCS, MBBS, BSc, London UNITED KINGDOM
Zameer Shah, MBBS MBA FRCS(Tr&Orth), London UNITED KINGDOM
Diane L. Back, FRCS Ed, Chesham, Bucks UNITED KINGDOM
Andrew Davies, FRCS, London UNITED KINGDOM
Adil Ajuied, MBBS, BSc(Hons), MSc, FRCS(Tr&Orth), London UNITED KINGDOM
Guy's and St Thomas' NHS Foundation Trust, Kings Health Partners, London, UNITED KINGDOM
FDA Status Not Applicable
Summary
A systematic review of UKA in patients under 60 shows better survivorship and fewer revisions for unexplained pain compared to registry data
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Abstract
Background
Data from joint registries does not appear to reflect the survivorship and functional outcomes reported by single-centre studies, particularly in younger patients.
Method
Systematic review of the PubMed and Cochrane databases identified 15 series reporting unicondylar knee arthroplasty (UKA) in patients under sixty, either exclusively or as a case-matched analysis. Three series comprised subgroup-analysis or earlier reports of another cohort and were excluded. Authors were requested to supply missing data. Methodological assessment was performed.
Results
Twelve cohorts, comprising 905 knees were included. Mean age was 49-56.4. Mean BMI was 28-32. Bearing type was fixed in eight studies and mobile in four. Ten studies included medial UKA only. Two studies included fewer than 10% lateral UKA. The other study reported outcomes for medial and lateral UKA separately. Mean follow-up was 3-11.9 years. Considering medial UKA, pre-operative mean Knee Society Clinical and Functional Scores were 43-54 and 48-60. Post-operative mean Knee Society Clinical and Functional Scores were 87-95.1 and 84-96. Considering revision for any reason (excluding bearing exchange) survivorship was 97% at five years and 92-94% at 12-16 years. Considering revision for any reason (including bearing exchange), survivorship was 83-96.5% at 8-12 years, though only one study reported 8-year survivorship below 90%. Mean range-of-motion was 108-120 pre-operatively and 124-134 post-operatively. Bearing exchange, aseptic loosening and progression of arthritis each accounted for 23-25% of revisions, while unexplained pain accounted for 17%.
Conclusion
UKA results in sustained clinical and functional benefit in patients under 60. Survivorship in these series exceeds that seen in registries. Unexplained pain as a reason for revision appears less frequently in these series than in registry data.