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Kim, Lee, Kim, Kang, and Koo: Complications of Mobile-Bearing Unicompartmental Knee Arthroplasty in Korean Patients
Original Article

J Korean Orthop Assoc 2017;52(4):327-335.

Published online: 1 December 2017

DOI: https://doi.org/10.4055/jkoa.2017.52.4.327

Complications of Mobile-Bearing Unicompartmental Knee Arthroplasty in Korean Patients

Kyung Tae Kim, M.D., Song Lee, M.D., Jeehyung Kim, M.D., Min Su Kang, M.D., Ki Hyuk Koo, M.D.

Department of Orthopedic Surgery, Seoul Sacred Heart General Hospital, Seoul, Korea

Correspondence to: Kyung Tae Kim, M.D. Department of Orthopedic Surgery, Seoul Sacred Heart General Hospital, 259 Wangsan-ro, Dongdaemoon-gu, Seoul 02448, Korea TEL: +82-2-966-1616 FAX: +82-2-968-2394 E-mail: kktkimos@hanmail.net

Received 31 January 2017       Revised 19 February 2017       Accepted 14 March 2017

Copyright © 2017 The Korean Orthopaedic Association

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the causes and modes of complications after unicompartmental knee arthroplasty (UKA) in Korean patients, and to identify the adaptability of mobile-bearing UKA for Korean patients by analyzing its complications.

Materials and Methods

Between January 2002 and December 2015, a total of 1,325 patients (1,560 cases) who underwent mobile-bearing medial UKA and were followed-up for more than 1 year were included in this study. We analyzed the complications of UKA retrospectively, and investigated the mode of complications, mean time to reoperation, and method of treatment.

Results

We observed a total of 101 complications (6.5%) after mobile-bearing UKA. The most prevalent complication was dislocation of mobile-bearing (n=52, 3.3%), accounting for more than half of the complications. Other complications include component loosening (n=16, 1.0%), progression of arthritis in lateral compartment (n=9, 0.6%), polyethylene wear and breakage (n=5, 0.3%), periprosthetic fracture (n=4, 0.3%), impingement (n=3, 0.2%), medial collateral ligament (MCL) injury (n=2, 0.1%), arthrofibrosis (n=1, 0.1%), unexplained pain (n=1, 0.1%) and infection (n=8, 0.5%). At a mean of 5.2 years post-UKA, complications occurred in our patients. The mean time interval from UKA to the development of mobile-bearing dislocation, component loosening, and progression of arthritis to the lateral compartment was a 4.3 years, 6.5 years, and 11.2 years, respectively. Complications were treated with a conversion to total knee arthroplasty in 68 cases, revision UKA in 1 case, and simple bearing change in 23 cases. Remaining complications were treated with arthroscopic management (n=3), MCL repair (n=2), open reduction and internal fixation (n=2), closed reduction and internal fixation (n=1), and manipulation (n=1).

Conclusion

The incidence of mobile-bearing dislocation after mobile-bearing UKA was especially higher in Korean patients. However, the progression of arthritis in the lateral compartment and polyethylene wear were relatively lower compared with Western counterparts. Therefore, it is encouraged that Korean patients are provided with sufficient preparation for mobile-bearing dislocation and education prior to surgery when performing mobile-bearing UKA.

Keywords: knee joint, osteoarthritis, unicompartmental knee arthroplasty, complications

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Table 1
Demographics of Study
Variable UKA Complication
Period (year. month.) 2002. 1.–2015. 12. 2002. 1.–2016. 12.
Total number 1,560 101
Gender (female:male) 1,409:151 98:3
Unilateral: Bilateral 1,090:235 85:8
Mean age at surgery (yr) 62 (43–86) 61 (46–81)
Mean age at reoperation (yr) - 67 (46–82)
Time to reoperation (mo) - 63 (0–163)
Mean follow-up period (mo) 87 (12–180)

Values are presented as range only, number only, or median (range). UKA, unicompartmental knee arthroplasty.

Table 2
Complications after UKA
Complication Case Time interval (mo) Treatment
Bearing dislocation 52 (3.3) 51.7±45.2 31 revision to TKA, 21 simple bearing change
Stem loosening 16 (1.0) 78.5±46.8 15 revision to TKA, 1 revision to UKA
Contralateral osteoarthritis 9 (0.6) 134.0±47.9 9 revision to TKA
Infection 8 (0.5) 56.6±47.5 8 revision to TKA
Polyethylene wear 5 (0.3) 101.0±34.2 3 revision to TKA, 2 simple bearing change
Periprosthetic fracture 4 (0.3) 28.3±30.6 2 OR/IF, 1 CR/IF, 1 revision to TKA
Impingement 3 (0.2) 12.7±7.2 3 arthroscopy
MCL injury 2 (0.1) 19.0±22.6 2 MCL repair
Unkown origin pain 1 (0.1) 21.0±0.0 1 revision to TKA
Arthrofibrosis 1 (0.1) 1.0±0.0 1 Manipulation
Total 101 (6.5) 62.6±51.4 68 revision to TKA, 23 simple bearing change, 1 revision to UKA, 3 arthroscopy, 2 MCL repair, 2 OR/IF, 1 CR/IF, 1 manipulation

Values are presented as number (%) or mean±standard deviation. UKA, unicompartmental knee arthroplasty; MCL, medial collateral ligament; TKA, total knee arthroplasty; OR/IF, open reduction and internal fixation; CR/IF, closed reduction and internal fixation.

Table 3
Incidence of Complications after Unicompartmental Knee Arthroplasty in Accordance with the Follow-Up Time
Year Follow-up (yr) Case Complication Cumulative of case Cumulative of complication
2015 1–2 150 5 (3.3) 150 5 (3.3)
2014 2–3 196 2 (1.0) 346 7 (2.0)
2013 3–4 245 5 (2.0) 591 12 (2.0)
2012 4–5 169 3 (1.8) 760 15 (2.0)
2011 5–6 75 8 (10.7) 835 23 (2.8)
2010 6–7 66 0 (0.0) 901 23 (2.6)
2009 7–8 28 3 (10.7) 929 26 (2.8)
2008 8–9 48 0 (0.0) 977 26 (2.7)
2007 9–10 41 0 (0.0) 1,018 26 (2.6)
2006 10–11 26 5 (19.2) 1,044 31 (3.0)
2005 11–12 87 7 (8.0) 1,131 38 (3.4)
2004 12–13 121 14 (11.6) 1,252 52 (4.2)
2003 13–14 128 19 (14.8) 1,380 71 (5.1)
2002 14–15 180 30 (16.7) 1,560 101 (6.5)
Total 1,560 101 (6.5)

Values are presented as range only, number only, or number (%).

Table 4
Incidence of Bearing Dislocation after Unicompartmental Knee Arthroplasty according to the Follow-Up Time
Year Follow-up (yr) Case Bearing dislocation Cumulative of case Cumulative of bearing dislocation
2015 1–2 150 4 (2.7) 150 4 (2.7)
2014 2–3 196 0 (0.0) 346 4 (1.2)
2013 3–4 245 4 (1.6) 591 8 (1.4)
2012 4–5 169 3 (1.8) 760 11 (1.4)
2011 5–6 75 5 (6.7) 835 16 (1.9)
2010 6–7 66 0 (0.0) 901 16 (1.8)
2009 7–8 28 3 (10.7) 929 19 (2.0)
2008 8–9 48 0 (0.0) 977 19 (1.9)
2007 9–10 41 0 (0.0) 1,018 19 (1.9)
2006 10–11 26 4 (15.4) 1,044 23 (2.2)
2005 11–12 87 4 (4.6) 1,131 27 (2.4)
2004 12–13 121 7 (5.8) 1,252 34 (2.7)
2003 13–14 128 8 (6.3) 1,380 42 (3.0)
2002 14–15 180 10 (5.6) 1,560 52 (3.3)
Total 1,560 52 (3.3)

Values are presented as range only, number only, or number (%).

Table 5
Incidence of Bearing Dislocation after Unicompartmental Knee Arthroplasty according to the Time Interval
Time (year) Case Treatment
0–1 16 (30.8) 11 simple bearing change, 5 revision to TKA
1–2 5 (9.6) 3 simple bearing change, 2 revision to TKA
2–3 5 (9.6) 2 simple bearing change, 3 revision to TKA
3–4 2 (3.85) 2 revision to TKA
4–5 4 (7.7) 2 simple bearing change, 2 revision to TKA
5–6 4 (7.7) 1 simple bearing change, 3 revision to TKA
6–7 2 (3.85) 2 revision to TKA
7–8 2 (3.85) 2 revision to TKA
8–9 4 (7.7) 2 simple bearing change, 2 revision to TKA
9–10 4 (7.7) 4 revision to TKA
10–11 1 (1.9) 1 revision to TKA
11–12 2 (3.85) 2 revision to TKA
12–13 0 (0.0) -
13–14 1 (1.9) 1 revision to TKA
Total 52 (100.0) 21 simple bearing change, 31 revision to TKA

Values are presented as range only or number (%). TKA, total knee arthroplasty.

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