Ten-year survival and patient-reported outcomes of a medial unicompartmental knee arthroplasty incorporating an all-polyethylene tibial component

Arch Orthop Trauma Surg. 2018 May;138(5):719-729. doi: 10.1007/s00402-018-2908-y. Epub 2018 Feb 23.

Abstract

Introduction: Biomechanical studies have suggested that proximal tibial strain is elevated in UKAs incorporating all-polyethylene tibial components with concern that this leads to premature failure. This study reports minimum 10-year outcomes for a UKA incorporating an all-polyethylene tibial component to determine whether these concerns were realised.

Materials and methods: 109 fixed bearing UKAs (97 patients, mean age 68 (range 48-87), 54/97 (56%) female) with all-polyethylene tibial components were followed up for ≥ 10 years with Oxford Knee Scores, Forgotten Joint Scores and Kaplan-Meier analysis. 106/109 implants were 7 mm, 3 were 9.5 mm.

Results: Ten-year survival was 85.5% (78.6-92.4 95% CI) with the end-point failure for any reason. Unexplained pain was the commonest mode of failure (6/17) followed by lateral compartment osteoarthritis (5/17) and tibial subsidence/loosening (4/17). Revision rate was highest at 2-5 years due to revisions for unexplained pain. Ten-year survival was worse in patients < 65 years old (p = 0.035), in those with BMI > 30 (p = 0.017) and in those with postoperative increases in medial tibial sclerosis (p < 0.001 log-rank). Implant malalignment was not significantly associated with failure. Radioisotope bone scans in 16 patients all remained "hot" at mean 6.1 years (range 2.1-11.5). Relative risk of failure in patients < 65 years was 2.9 (1.2-7.0 95% CI) and when BMI > 30 was 2.9 (1.2-6.9 95% CI). In those with intact UKAs at 10 years, mean Oxford Knee Score was 34.8 ± 10.7, Forgotten Joint Score was 37.9 ± 26.7 and 96% were satisfied with their knee.

Conclusion: The high rate of early failure between 2 and 5 years in this all-polyethylene tibial component UKA did not persist in the long term. Though medial proximal tibial metabolic changes appear to persist they are not necessarily symptomatic. BMI > 30 and age < 65 years were significant risk factors for revision.

Keywords: All-polyethylene tibia; Long-term survival; Unicompartmental knee arthroplasty.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Arthroplasty, Replacement, Knee* / instrumentation
  • Arthroplasty, Replacement, Knee* / mortality
  • Arthroplasty, Replacement, Knee* / statistics & numerical data
  • Female
  • Humans
  • Kaplan-Meier Estimate
  • Knee Prosthesis*
  • Male
  • Middle Aged
  • Patient Reported Outcome Measures
  • Polyethylene / therapeutic use*
  • Tibia / surgery*
  • Treatment Outcome

Substances

  • Polyethylene