THE LIFETIME REVISION RISK OF UNICOMPARTMENTAL KNEE ARTHROPLASTY

Abstract

Unicompartmental knee arthroplasty (UKA) is associated with a higher risk of revision compared with total knee arthroplasty (TKA). The outcomes of knee arthroplasty are typically presented as implant survival or incidence of revision after a set number of years, which can be difficult for patients and clinicians to conceptualise. We aimed to calculate the ‘lifetime risk’ of revision for UKA as a more relatable estimate of risk projection over a patient's remaining lifetime, and make comparisons to TKA. All primary UKAS performed from 1999 to 2019 (n=13,481) captured by the New Zealand Joint Registry (NZJR) were included. The lifetime risk of revision was calculated and stratified by age, gender and American Society of Anesthesiologists (ASA) status. The lifetime risk of revision for UKA was highest in the youngest patients (46-50 years; 40.4%) and lowest in the oldest patients (86-90 years; 3.7%). Lifetime risk of revision was higher for females (range 4.3%-43.4% cf. males 2.9%-37.4%) and patients with higher ASA status (ASA 3-4 range 8.8%-41.2% cf. ASA 1 1.8%-29.8%), regardless of age. The lifetime risk of UKA was two-fold higher than TKA (ranging from 3.7%-40.4% UKA, 1.6%-22.4% TKA) across all age groups. Increased risk of revision in the younger patients was associated with aseptic loosening in both males and females, and pain in females. Periprosthetic joint infections (PJI) accounted for 4% of all UKA revisions, in contrast to 27% for TKA; risk of PJI was higher for males than females for both procedures. The lifetime risk of revision is a more meaningful measure of arthroplasty outcomes and can aid with patient counselling prior to UKA. Findings from this study show the increased lifetime risk of UKA revision for younger patients, females and those with higher ASA status.