Revision surgery after failure of lateral unicompartmental knee replacement with a mobile-bearing device: a retrospective non -designer case-series

IF 2.1 3区医学 Q2 ORTHOPEDICS Archives of Orthopaedic and Trauma Surgery Pub Date : 2025-03-21 DOI:10.1007/s00402-025-05822-y

Mustafa Hariri, Jakob Freytag, Kevin-Arno Koch, Paul Mick, Timo Nees, Kevin Knappe, Tobias Renkawitz, Tilman Walker

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Abstract

Introduction

Failure of lateral unicompartmental knee replacement (UKR) with a mobile-bearing (MB) device often occurs due to bearing dislocation. The effectiveness of various treatment options for revision surgery is not clear. Therefore, the purpose of this study was to report on the failure modes in lateral MB-UKR, as well as the results of different revision strategies.

Materials and methods

Patients who experienced failure of lateral MB-UKR and required revision surgery at a single-center between 2008 and 2020 were included in this retrospective study. The aim of the study was to report the reasons for failure and to document all treatment strategies employed. Survivorship analysis was conducted using the Kaplan-Meier estimator, with the endpoint defined as ‘re-revision for any reason’. Survival rates among various treatment strategies were compared using the log-rank test.

Results

A total of 13 patients were included in the study, with a mean follow-up (FU) period of 94.7 ± 36.4 months. The reasons for failure included bearing dislocation in 69.2%, progression of osteoarthritis (OA) in 23.1%, and periprosthetic joint infection in 7.7%. Treatment options included replacement of the tibial component with a fixed-bearing (FB) device in 23.1% of cases, solitary exchange of the bearing in 53.8%, or conversion to an unconstrained total knee replacement (TKR) in 23.1%. The re-dislocation rate in patients who underwent a bearing exchange as a treatment for bearing dislocation was 100%, with a mean FU period of 8.4 ± 11 months. Therefore, survivorship for the treatment of bearing dislocation differed significantly in these patients compared to those who received an exchange to a FB device (0% vs. 100%, p = 0.014).

Conclusions

Addressing the recurring issue of bearing dislocation in lateral MB-UKR demands a more comprehensive approach than merely replacing the bearing. Effective solutions include replacing the tibial component with an FB design or converting to an unconstrained TKR.

Level of evidence

Retrospective cohort study, Level IV.

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外侧单室膝关节置换术失败后的翻修手术：回顾性非设计病例系列

采用移动轴承（MB）装置进行外侧单室膝关节置换术（UKR）的失败通常是由于轴承脱位造成的。各种翻修手术治疗方案的有效性尚不清楚。因此，本研究的目的是报道侧向MB-UKR的失效模式，以及不同修复策略的结果。材料和方法本回顾性研究纳入了2008年至2020年间在单中心经历侧位MB-UKR失败并需要翻修手术的患者。该研究的目的是报告失败的原因，并记录所有采用的治疗策略。使用Kaplan-Meier估计器进行生存分析，终点定义为“任何原因的重新修订”。采用log-rank检验比较不同治疗策略的生存率。结果共纳入13例患者，平均随访时间（FU）为94.7±36.4个月。失败的原因包括：69.2%的患者发生轴承脱位，23.1%的患者发生骨关节炎（OA）， 7.7%的患者发生假体周围关节感染。治疗方案包括23.1%的病例用固定轴承（FB）装置替换胫骨假体，53.8%的病例单独更换轴承，或23.1%的病例改用无约束全膝关节置换术（TKR）。接受轴承置换治疗的患者再脱位率为100%，平均FU时间为8.4±11个月。因此，与接受FB装置置换的患者相比，这些患者治疗轴承脱位的生存率有显著差异（0% vs 100%, p = 0.014）。结论：解决侧向MB-UKR中反复出现的轴承脱位问题需要更全面的方法，而不仅仅是更换轴承。有效的解决方案包括用FB设计替代胫骨构件或转换为无约束TKR。证据水平：回顾性队列研究，四级。

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来源期刊

Archives of Orthopaedic and Trauma Surgery 医学-外科

CiteScore

4.30

自引率

13.00%

发文量

424

审稿时长

2 months

期刊介绍： "Archives of Orthopaedic and Trauma Surgery" is a rich source of instruction and information for physicians in clinical practice and research in the extensive field of orthopaedics and traumatology. The journal publishes papers that deal with diseases and injuries of the musculoskeletal system from all fields and aspects of medicine. The journal is particularly interested in papers that satisfy the information needs of orthopaedic clinicians and practitioners. The journal places special emphasis on clinical relevance. "Archives of Orthopaedic and Trauma Surgery" is the official journal of the German Speaking Arthroscopy Association (AGA).