Midterm Outcomes in Lateral Unicompartment Knee Replacement: The Effect of Patient Age and Bearing Choice

Abstract

Isolated lateral compartment knee osteoarthritis (OA) affects between 7 and 10% of patients with knee OA. Although lateral unicompartmental knee arthroplasty (UKA) is an accepted treatment to manage this condition, it is performed relatively infrequently. The aim of this study was to evaluate the mid-term survivorship, radiographic outcomes, and patient-reported outcome measures (PROMs). We performed a retrospective review of a prospectively maintained database of consecutive isolated lateral UKAs performed by a single surgeon at an academic institution between September 2007 and December 2015. Our primary outcome was failure defined as revision surgery to total knee arthroplasty (TKA). Secondary outcomes included any additional surgery for any other reason. Forty-nine consecutive patients (27 females) with median age of 54.7 years (45.2–82.2) met the inclusion criteria. The survival rate for the whole cohort was 86.1% (95% confidence interval [CI]: 73.2–99.0) at 10 years as defined by conversion to TKA. There were a total of four lateral UKAs (all mobile bearings) revised to TKAs. The entire cohort demonstrated statistically significant improvements from preoperative PROMs compared with the most recent postoperative PROMs including the Western Ontario and McMaster Universities Osteoarthritis Index, Knee injury and Osteoarthritis Outcome Score, and Tegner activity scale at a median 8.8 (1.7–12.2) years follow-up. Patients with mobile bearing underwent higher revision to TKA and reoperation for all indications compared with fixed-bearing lateral UKA. In this relatively young cohort, lateral UKA yielded acceptable long-term survival and satisfactory improvement in functional outcomes. Patients who had fixed-bearing implants had similar improvement and trended toward lower revision rates than those with mobile-bearing implants. Level III therapeutic: retrospective Study was performed.