Revision of Failed Unicompartmental Knee Arthroplasty

Abstract

Little information has been published on the salvage of failed unicompartmental knee arthroplasty. The current authors examined the failure mechanisms, complexity of surgery, and complications in such revisions. Of 39 consecutive unicompartmental knee revisions, two patients died within 2 years of surgery, four had inadequate followup, and one was excluded because of infection before revision. Therefore, 30 patients (32 knees) were followed up a mean 53 months. The patients were a mean age of 59 years at the time of unicompartmental knee arthroplasty and were predominantly male (60%). Revisions were done 9 to 204 months after the unicompartmental knee arthroplasty. The predominant failure mechanism was polyethylene wear; however, nine failed because of loosening. The mean polyethylene thickness of the failed arthroplasties was 7.3 mm. Revision procedures were straightforward. Ten patients required local autograft but no allografts were used. Primary femoral components were used in all patients; 25 were cruciate-retaining. Fourteen patients had stemmed tibial components; eight had wedge augments. The mean range of motion after revision was 111°. Six patients had complications not requiring intervention. Three patients had rerevision surgery for polyethylene wear at 76, 77, and 102 months, respectively, two of whom required polyethylene insert and patellar component revision. The third patient also required tibial component revision for osteolysis. Although this is a small series, the simplicity of the procedure and the complications encountered compare favorably with those of total knee revision.