Lifetime revision risk for medial unicompartmental knee replacement is lower than expected

Kennedy, James A.; Burn, Edward; Mohammad, Hasan R; Mellon, Stephen; Judge, Andrew; Murray, David

doi:10.1007/s00167-020-05863-3

Cited by 6 publications

(6 citation statements)

References 38 publications

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“…Our estimates were double that from a recent study. Kennedy et al 30 reported lower lifetime risk of revision for UKA across all age groups (15% at 55 years to 3.7% at 85 years), although these were based on national population-based statistics. Our dataset was linked directly to individual patient mortality data and may therefore reflect a more accurate mortality profile specific to UKA patients.…”

Section: Discussionmentioning

confidence: 99%

“…33 UKA is often performed as a conservative treatment for younger patients, 32 with lower incidence of infections, compared with TKA-TKA revision. 18,30,32 It is important to note, however, that TKA conversion of a failed UKA has inferior outcomes to primary TKA, therefore lifetime risk of revision estimates may be informative when deciding between the two procedures for a specific patient. 34 Females have a higher lifetime risk of revision for UKA compared with males, in contrast to TKA where males have a higher lifetime risk of revision.…”

Section: Discussionmentioning

confidence: 99%

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The lifetime revision risk of unicompartmental knee arthroplasty

Tay

Young

Frampton

et al. 2022

The Bone & Joint Journal

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Aims Unicompartmental knee arthroplasty (UKA) has a higher risk of revision than total knee arthroplasty (TKA), particularly for younger patients. The outcome of knee arthroplasty is typically defined as implant survival or revision incidence after a defined number of years. This can be difficult for patients to conceptualize. We aimed to calculate the ‘lifetime risk’ of revision for UKA as a more meaningful estimate of risk projection over a patient’s remaining lifetime, and to compare this to TKA. Methods Incidence of revision and mortality for all primary UKAs performed from 1999 to 2019 (n = 13,481) was obtained from the New Zealand Joint Registry (NZJR). Lifetime risk of revision was calculated for patients and stratified by age, sex, and American Society of Anesthesiologists (ASA) grade. Results The lifetime risk of revision was highest in the youngest age group (46 to 50 years; 40.4%) and decreased sequentially to the oldest (86 to 90 years; 3.7%). Across all age groups, lifetime risk of revision was higher for females (ranging from 4.3% to 43.4% vs males 2.9% to 37.4%) and patients with a higher ASA grade (ASA 3 to 4, ranging from 8.8% to 41.2% vs ASA 1 1.8% to 29.8%). The lifetime risk of revision for UKA was double that of TKA across all age groups (ranging from 3.7% to 40.4% for UKA, and 1.6% to 22.4% for TKA). The higher risk of revision in younger patients was associated with aseptic loosening in both sexes and pain in females. Periprosthetic joint infection (PJI) accounted for 4% of all UKA revisions, in contrast with 27% for TKA; the risk of PJI was higher for males than females for both procedures. Conclusion Lifetime risk of revision may be a more meaningful measure of arthroplasty outcomes than implant survival at defined time periods. This study highlights the higher lifetime risk of UKA revision for younger patients, females, and those with a higher ASA grade, which can aid with patient counselling prior to UKA. Cite this article: Bone Joint J 2022;104-B(6):672–679.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The lifetime revision risk of unicompartmental knee arthroplasty

Tay

Young

Frampton

et al. 2022

The Bone & Joint Journal

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“…Intense and regular athletic activity may lead to an increase in stress on the implant–bone interface, causing an acceleration in wear and, therefore, can lead to higher revision rates in young and active patients after total joint replacement [ 17 , 32 ]. As the patients who are suitable for implantation of UKR tend to be younger and more active than those suitable for implantation of TKR and the fact that lifetime risk of revision surgery in UKR is higher with younger age at surgery [ 33 ], surgeons encourage patients to engage in low-impact activities such as cycling and swimming. However, there is no study reporting on the relationship between use and wear in UKR [ 10 , 32 , 34 ].…”

Section: Discussionmentioning

confidence: 99%

Physical Activity of Young Patients following Minimally Invasive Lateral Unicompartmental Knee Replacement

Hariri

Hagemann

Mick

et al. 2023

JCM

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Unicompartmental knee replacement (UKR) has increased in popularity in recent years, especially in young patients with high demands on their athletic ability. To date, there are no data available on the physical activity of young patients following lateral UKR. The aim of this study was to demonstrate return-to-activity rate and sporting activity of patients aged 60 years or younger following lateral UKR with a fixed-bearing (FB) prosthesis. Thirty-seven patients aged 60 years or younger after lateral FB-UKR were included. Sporting activities were assessed using the University of California Los Angeles activity scale (UCLA) and the Tegner activity score (TAS). Clinical outcome was measured using the Oxford Knee Score (OKS), range of motion (ROM) and visual analogue scale (VAS). The mean follow-up (FU) was 3.1 ± 1.5 years and the mean age at surgery was 52.8 ± 3.1 years. The return-to-activity rate was 87.5% and 49% of patients were highly active postoperatively as defined by an UCLA score of 7 or higher. All clinical parameters increased significantly postoperatively. We demonstrated a high return-to-activity rate with nearly half of the patients achieving high activity levels. Longer FU periods are necessary to evaluate the effect of activity on implant survival.

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“…9-14 The majority of these studies have made assumptions of life expectancy based upon mortality rates from the general population. 9-11 However, patients undergoing primary KA may have different mortality rates compared to the general population. 15 Therefore, estimates using general population mortality rates may underestimate the risk of revision in patients undergoing primary KA, especially in younger patient groups.…”

Section: Introductionmentioning

confidence: 99%

“…7,8 Previous authors have sought to estimate the lifetime risk of revision KA. [9][10][11][12][13][14] The majority of Health Scotland (PHS) performs data-linkage by using a unique identifier assigned to every patient in Scotland from birth -the community health index (CHI) number. The completeness of the SMR01 datasets is subject to annual audit and the Information Services Division of PHS undertakes quality assessments of all SMR01 data every four years.…”

Section: Introductionmentioning

confidence: 99%

The estimated lifetime risk of revision after primary knee arthroplasty is influenced by age, sex, and indication

Yapp

Clement

Moran

et al. 2022

The Bone & Joint Journal

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Aims The aim of this study was to assess factors associated with the estimated lifetime risk of revision surgery after primary knee arthroplasty (KA). Methods All patients from the Scottish Arthroplasty Project dataset undergoing primary KA during the period 1 January 1998 to 31 December 2019 were included. The cumulative incidence function for revision and death was calculated up to 20 years. Adjusted analyses used cause-specific Cox regression modelling to determine the influence of patient factors. The lifetime risk was calculated as a percentage for patients aged between 45 and 99 years using multiple-decrement life table methodology. Results The estimated lifetime risk of revision ranged between 32.7% (95% confidence interval (CI) 22.6 to 47.3) for patients aged 45 to 49 years and 0.6% (95% CI 0.1 to 4.5) for patients aged over 90 years. At 20 years, the overall cumulative incidence of revision (6.8% (95% CI 6.6 to 7.0)) was significantly less than that of death (66.3% (95% CI 65.4 to 67.1)). Adjusted analyses demonstrated converse effect of increasing age on risk of revision (hazard ratio (HR) 0.5 (95% CI 0.5 to 0.6)) and death (HR 3.6 (95% CI 3.4 to 3.7)). Male sex was associated with increased risks of revision (HR 1.1 (95% CI 1.1 to 1.2); p < 0.001) and death (HR 1.4 (95% CI 1.3 to 1.4); p < 0.001). Compared to patients undergoing primary KA for osteoarthritis, patients with inflammatory arthropathy had a higher risk of death (HR 1.7 (95% CI 1.7 to 1.8); p < 0.001), but were less likely to be revised (HR 0.9 (95% CI 0.7 to 1.0); p < 0.001). Patients with a greater number of comorbidities (HR 1.4 (95% CI 1.3 to 1.4)) and greater levels of socioeconomic deprivation (HR 1.4 (95% CI 1.4 to 1.5)) were at increased risk of death, but neither increased the risk of revision. Conclusion The estimated lifetime risk of revision KA varied depending on patient sex, age, and underlying diagnosis. Patients aged between 45 and 49 years had a one in three risk of undergoing revision surgery within their lifetime, which decreased with age to one in 159 in those aged 90 years or more. Cite this article: Bone Joint J 2022;104-B(12):1313–1322.

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Lifetime revision risk for medial unicompartmental knee replacement is lower than expected

Cited by 6 publications

References 38 publications

The lifetime revision risk of unicompartmental knee arthroplasty

The lifetime revision risk of unicompartmental knee arthroplasty

Physical Activity of Young Patients following Minimally Invasive Lateral Unicompartmental Knee Replacement

The estimated lifetime risk of revision after primary knee arthroplasty is influenced by age, sex, and indication

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