J Knee Surg 2021; 34(04): 406-414
DOI: 10.1055/s-0039-1696734
Original Article

Revision of a Medial UKA to a Kinematic Aligned TKA: Comparison of Operative Complexity, Postoperative Alignment, and Outcome Scores to a Primary TKA

1   Department of Orthopaedic Surgery, University of California, Davis, Sacramento, California
,
Manpreet Gill
2   Adventist Health Lodi Memorial Hospital, Lodi, California
,
Gurbir Athwal
3   California Northstate University College of Medicine, Elk Grove, California
,
Stephen M. Howell
4   Department of Biomedical Engineering, University of California, Davis, Davis, California
,
Maury L. Hull
1   Department of Orthopaedic Surgery, University of California, Davis, Sacramento, California
4   Department of Biomedical Engineering, University of California, Davis, Davis, California
5   Department of Mechanical Engineering, University of California, Davis, Davis, California
› Author Affiliations

Abstract

Revision of a medial unicompartmental knee arthroplasty (UKA) to a mechanically aligned total knee arthroplasty (MA TKA) is inferior to a primary TKA; however, revision with kinematic alignment (KA) has not been well studied. The present study determined whether patients revised with KA had a higher use of revision components, different postoperative alignment, and different clinical outcome scores from patients with a primary KA TKA. From 2006 to 2017, all patients suitable for a revision of a failed medial UKA to a TKA and a primary TKA were treated with KA. Reasons for the revision performed in ten females and six males at a mean age 67 ± 8 years included progression of osteoarthritis in the lateral hemi-joint (n = 6), aseptic loosening (n = 4), unremitting medial pain without loosening (n = 4), and insert wear (n = 2). Patients with a revision were matched 1:3 with a control cohort treated with a primary KA TKA. Revisions were performed with primary components without augments, stem extensions, or bone grafts. Seven postoperative alignment parameters of the limb and components were comparable to the control cohort (p > 0.05). At a mean follow-up of 5 years (1–10), implant survival was 100%, and the revision/primary group clinical outcome scores were 39/43 points for the Oxford Knee Score (OKS), 2.2/1.0 cm for the Visual Analog Pain Score, and 12/7 points for the Western Ontario and McMaster Universities Osteoarthritis Index score. When compared with primary KA TKA, surgeons that revise a failed medial UKA to a TKA with use of KA can expect similar operative complexity, comparable postoperative alignments, and a mean OKS of 39 points, which is higher than the mean 27 to 30 point range reported for revision of a failed UKA to a TKA with the use of MA.

Note

The study was approved by our ethical committee.




Publication History

Received: 29 December 2018

Accepted: 22 July 2019

Article published online:
09 September 2019

© 2019. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 Chawla H, van der List JP, Christ AB, Sobrero MR, Zuiderbaan HA, Pearle AD. Annual revision rates of partial versus total knee arthroplasty: a comparative meta-analysis. Knee 2017; 24 (02) 179-190
  • 2 Chou DT, Swamy GN, Lewis JR, Badhe NP. Revision of failed unicompartmental knee replacement to total knee replacement. Knee 2012; 19 (04) 356-359
  • 3 Craik JD, El Shafie SA, Singh VK, Twyman RS. Revision of unicompartmental knee arthroplasty versus primary total knee arthroplasty. J Arthroplasty 2015; 30 (04) 592-594
  • 4 Järvenpää J, Kettunen J, Miettinen H, Kröger H. The clinical outcome of revision knee replacement after unicompartmental knee arthroplasty versus primary total knee arthroplasty: 8-17 years follow-up study of 49 patients. Int Orthop 2010; 34 (05) 649-653
  • 5 Jonas SC, Shah R, Mitra A, Deo SD. 5-Year cost/benefit analysis of revision of failed unicompartmental knee replacements (UKRs); not “just” a primary total knee replacement (TKR). Knee 2014; 21 (04) 840-842
  • 6 Lunebourg A, Parratte S, Ollivier M, Abdel MP, Argenson JN. Are revisions of unicompartmental knee arthroplasties more like a primary or revision TKA?. J Arthroplasty 2015; 30 (11) 1985-1989
  • 7 Calliess T, Bauer K, Stukenborg-Colsman C, Windhagen H, Budde S, Ettinger M. PSI kinematic versus non-PSI mechanical alignment in total knee arthroplasty: a prospective, randomized study. Knee Surg Sports Traumatol Arthrosc 2017; 25 (06) 1743-1748
  • 8 Courtney PM, Lee GC. Early outcomes of kinematic alignment in primary total knee arthroplasty: a meta-analysis of the literature. J Arthroplasty 2017; 32 (06) 2028-2032.e1
  • 9 Dossett HG, Estrada NA, Swartz GJ, LeFevre GW, Kwasman BG. A randomised controlled trial of kinematically and mechanically aligned total knee replacements: two-year clinical results. Bone Joint J 2014; 96-B (07) 907-913
  • 10 Lee YS, Howell SM, Won YY. et al. Kinematic alignment is a possible alternative to mechanical alignment in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2017; 25 (11) 3467-3479
  • 11 Li Y, Wang S, Wang Y, Yang M. Does kinematic alignment improve short-term functional outcomes after total knee arthroplasty compared with mechanical alignment? A systematic review and meta-analysis. J Knee Surg 2018; 31 (01) 78-86
  • 12 Matsumoto T, Takayama K, Ishida K, Hayashi S, Hashimoto S, Kuroda R. Radiological and clinical comparison of kinematically versus mechanically aligned total knee arthroplasty. Bone Joint J 2017; 99-B (05) 640-646
  • 13 Nakamura S, Tian Y, Tanaka Y. et al. The effects of kinematically aligned total knee arthroplasty on stress at the medial tibia: a case study for varus knee. Bone Joint Res 2017; 6 (01) 43-51
  • 14 Nam D, Nunley RM, Barrack RL. Patient dissatisfaction following total knee replacement: a growing concern?. Bone Joint J 2014; 96-B (11, Supple A): 96-100
  • 15 Yoon JR, Han SB, Jee MK, Shin YS. Comparison of kinematic and mechanical alignment techniques in primary total knee arthroplasty: a meta-analysis. Medicine (Baltimore) 2017; 96 (39) e8157
  • 16 Waterson HB, Clement ND, Eyres KS, Mandalia VI, Toms AD. The early outcome of kinematic versus mechanical alignment in total knee arthroplasty: a prospective randomised control trial. Bone Joint J 2016; 98-B (10) 1360-1368
  • 17 Young SW, Walker ML, Bayan A, Briant-Evans T, Pavlou P, Farrington B. The Chitranjan S. Ranawat Award: no difference in 2-year functional outcomes using kinematic versus mechanical alignment in TKA: a randomized controlled clinical trial. Clin Orthop Relat Res 2017; 475 (01) 9-20
  • 18 Coughlin KM, Incavo SJ, Churchill DL, Beynnon BD. Tibial axis and patellar position relative to the femoral epicondylar axis during squatting. J Arthroplasty 2003; 18 (08) 1048-1055
  • 19 Dossett HG, Swartz GJ, Estrada NA, LeFevre GW, Kwasman BG. Kinematically versus mechanically aligned total knee arthroplasty. Orthopedics 2012; 35 (02) e160-e169
  • 20 Hollister AM, Jatana S, Singh AK, Sullivan WW, Lupichuk AG. The axes of rotation of the knee. Clin Orthop Relat Res 1993; 290 (290) 259-268
  • 21 Iranpour F, Merican AM, Dandachli W, Amis AA, Cobb JP. The geometry of the trochlear groove. Clin Orthop Relat Res 2010; 468 (03) 782-788
  • 22 Nedopil AJ, Singh AK, Howell SM, Hull ML. Does calipered kinematically aligned TKA restore native left to right symmetry of the lower limb and improve function?. J Arthroplasty 2018; 33 (02) 398-406
  • 23 Howell SM, Papadopoulos S, Kuznik K, Ghaly LR, Hull ML. Does varus alignment adversely affect implant survival and function six years after kinematically aligned total knee arthroplasty?. Int Orthop 2015; 39 (11) 2117-2124
  • 24 Howell SM, Shelton TJ, Hull ML. Implant survival and function ten years after kinematically aligned total knee arthroplasty. J Arthroplasty 2018; 33 (12) 3678-3684
  • 25 Nam D, Lin KM, Howell SM, Hull ML. Femoral bone and cartilage wear is predictable at 0° and 90° in the osteoarthritic knee treated with total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2014; 22 (12) 2975-2981
  • 26 Shelton TJ, Nedopil AJ, Howell SM, Hull ML. Do varus or valgus outliers have higher forces in the medial or lateral compartments than those which are in-range after a kinematically aligned total knee arthroplasty? limb and joint line alignment after kinematically aligned total knee arthroplasty. Bone Joint J 2017; 99-B (10) 1319-1328
  • 27 Shelton TJ, Howell SM, Hull ML. Is there a force target that predicts early patient-reported outcomes after kinematically aligned TKA?. Clin Orthop Relat Res 2019; ; 9; 477 (05) 1200-1207
  • 28 Howell SM, Hull ML, Mahfouz MR. Kinematically aligned total knee arthroplasty. In: Scott S. ed. Insall and Scott Surgery of the Knee. 6th ed. Philadelphia, PA: Elsevier; 2017: 1784-1796
  • 29 Roth JD, Howell SM, Hull ML. Native knee laxities at 0°, 45°, and 90° of flexion and their relationship to the goal of the gap-balancing alignment method of total knee arthroplasty. J Bone Joint Surg Am 2015; 97 (20) 1678-1684
  • 30 Howell SM, Kuznik K, Hull ML, Siston RA. Longitudinal shapes of the tibia and femur are unrelated and variable. Clin Orthop Relat Res 2010; 468 (04) 1142-1148
  • 31 Nedopil AJ, Howell SM, Hull ML. Does malrotation of the tibial and femoral components compromise function in kinematically aligned total knee arthroplasty?. Orthop Clin North Am 2016; 47 (01) 41-50
  • 32 Nedopil AJ, Howell SM, Rudert M, Roth J, Hull ML. How frequent is rotational mismatch within 0° ± 10° in kinematically aligned total knee arthroplasty?. Orthopedics 2013; 36 (12) e1515-e1520
  • 33 Nunley RM, Ellison BS, Zhu J, Ruh EL, Howell SM, Barrack RL. Do patient-specific guides improve coronal alignment in total knee arthroplasty?. Clin Orthop Relat Res 2012; 470 (03) 895-902
  • 34 Labek G, Neumann D, Agreiter M, Schuh R, Böhler N. Impact of implant developers on published outcome and reproducibility of cohort-based clinical studies in arthroplasty. J Bone Joint Surg Am 2011; 93 (03) (Suppl. 03) 55-61
  • 35 Toliopoulos P, LeBlanc MA, Hutt J, Lavigne M, Desmeules F, Vendittoli PA. Anatomic versus mechanically aligned total knee arthroplasty for unicompartmental knee arthroplasty revision. Open Orthop J 2016; 10: 357-363
  • 36 Johnson JM, Mahfouz MR, Midillioğlu MR, Nedopil AJ, Howell SM. Three-dimensional analysis of the tibial resection plane relative to the arthritic tibial plateau in total knee arthroplasty. J Exp Orthop 2017; 4 (01) 27
  • 37 Shelton TJ, Howell SM, Hull ML. A total knee arthroplasty is stiffer when the intraoperative tibial force is greater than the native knee. J Knee Surg 2018
  • 38 Niki Y, Nagura T, Nagai K, Kobayashi S, Harato K. Kinematically aligned total knee arthroplasty reduces knee adduction moment more than mechanically aligned total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2018; 26 (06) 1629-1635