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Complications of medial unicompartmental knee arthroplasty.

Ji JH, Park SE, Song IS, Kang H, Ha JY, Jeong JJ - Clin Orthop Surg (2014)

Bottom Line: Among the 6 intraoperative complications, one fracture of the medial tibial condyle, two fractures of the intercondylar eminence, one rupture of the medial collateral ligament, one widening of the peg hole leading to femoral component malposition and late failure, and one total knee arthroplasty (TKA) conversion of a large bony defect of tibial avascular necrosis were observed.The mid-term clinical outcomes of UKA were excellent in our study.However, the incidence of complications was very high (9.8%).

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Daejeon, Korea.

ABSTRACT

Background: We report intra- and postoperative complications of unicompartmental knee arthroplasty (UKA).

Methods: This study was conducted on 246 cases of UKA which were performed for degenerative osteoarthritis confined to the medial compartment, from May 2002 to May 2010, for which follow-up periods longer than one year were available. Complications were divided into intra- and postoperative complications. Pre- and postoperative clinical scores, the range of motion, and radiologic findings were analyzed.

Results: Complications developed in a total of 24 cases (9.8%, 24/246). Among them, 6 cases had intraoperative complications while 18 had postoperative complications. Among the 6 intraoperative complications, one fracture of the medial tibial condyle, two fractures of the intercondylar eminence, one rupture of the medial collateral ligament, one widening of the peg hole leading to femoral component malposition and late failure, and one total knee arthroplasty (TKA) conversion of a large bony defect of tibial avascular necrosis were observed. Among the 18 postoperative complications, four cases of aseptic loosening of the femoral component, one soft tissue impingement due to malalignment, nine cases of polyethylene bearing dislocation, one case of suprapatellar bursitis, one periprosthetic fracture, one TKA conversion due to medial component overhanging, and one TKA conversion due to pain of unexplained cause were observed.

Conclusions: The mid-term clinical outcomes of UKA were excellent in our study. However, the incidence of complications was very high (9.8%). To prevent intra- and postoperative complications, proper selection of the patients and accurate surgical techniques are required.

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(A) Recurrent suprapatellar bursitis developed along the hemovac site (arrow). (B) Open excision was performed 4 months later.
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Figure 4: (A) Recurrent suprapatellar bursitis developed along the hemovac site (arrow). (B) Open excision was performed 4 months later.

Mentions: In the case of conversion to TKA, a 5-mm overhang of the medial compartment caused irritation of the medial aspect of the knee, resulting in cellulitis-like symptoms. We have experienced several cases of tibial component overhang, owing to the smaller posteromedial tibia size of the Korean population. However, in this case, conservative treatment such as rest and intravenous antibiotics was performed, but the pain continued. TKA conversion was performed 16 months later (Fig. 3). In another case, suprapatellar bursitis developed, and bursectomy of the suprapatellar bursa was performed (Fig. 4). After the arthroscopy which was performed before the UKA procedure, the suprapatellar bursitis was developed in the drain site. It was supposed that the cause was irritation of the bursa after intra-articular bleeding from the UKA procedure. One case of soft tissue impingement due to malalignment, and one case of unexplained severe pain also resulted in TKA conversion (Fig. 5). One periprosthetic fracture occurred in the distal femur, after which minimal invasive osteosynthesis was performed using the plate.


Complications of medial unicompartmental knee arthroplasty.

Ji JH, Park SE, Song IS, Kang H, Ha JY, Jeong JJ - Clin Orthop Surg (2014)

(A) Recurrent suprapatellar bursitis developed along the hemovac site (arrow). (B) Open excision was performed 4 months later.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4233213&req=5

Figure 4: (A) Recurrent suprapatellar bursitis developed along the hemovac site (arrow). (B) Open excision was performed 4 months later.
Mentions: In the case of conversion to TKA, a 5-mm overhang of the medial compartment caused irritation of the medial aspect of the knee, resulting in cellulitis-like symptoms. We have experienced several cases of tibial component overhang, owing to the smaller posteromedial tibia size of the Korean population. However, in this case, conservative treatment such as rest and intravenous antibiotics was performed, but the pain continued. TKA conversion was performed 16 months later (Fig. 3). In another case, suprapatellar bursitis developed, and bursectomy of the suprapatellar bursa was performed (Fig. 4). After the arthroscopy which was performed before the UKA procedure, the suprapatellar bursitis was developed in the drain site. It was supposed that the cause was irritation of the bursa after intra-articular bleeding from the UKA procedure. One case of soft tissue impingement due to malalignment, and one case of unexplained severe pain also resulted in TKA conversion (Fig. 5). One periprosthetic fracture occurred in the distal femur, after which minimal invasive osteosynthesis was performed using the plate.

Bottom Line: Among the 6 intraoperative complications, one fracture of the medial tibial condyle, two fractures of the intercondylar eminence, one rupture of the medial collateral ligament, one widening of the peg hole leading to femoral component malposition and late failure, and one total knee arthroplasty (TKA) conversion of a large bony defect of tibial avascular necrosis were observed.The mid-term clinical outcomes of UKA were excellent in our study.However, the incidence of complications was very high (9.8%).

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Daejeon, Korea.

ABSTRACT

Background: We report intra- and postoperative complications of unicompartmental knee arthroplasty (UKA).

Methods: This study was conducted on 246 cases of UKA which were performed for degenerative osteoarthritis confined to the medial compartment, from May 2002 to May 2010, for which follow-up periods longer than one year were available. Complications were divided into intra- and postoperative complications. Pre- and postoperative clinical scores, the range of motion, and radiologic findings were analyzed.

Results: Complications developed in a total of 24 cases (9.8%, 24/246). Among them, 6 cases had intraoperative complications while 18 had postoperative complications. Among the 6 intraoperative complications, one fracture of the medial tibial condyle, two fractures of the intercondylar eminence, one rupture of the medial collateral ligament, one widening of the peg hole leading to femoral component malposition and late failure, and one total knee arthroplasty (TKA) conversion of a large bony defect of tibial avascular necrosis were observed. Among the 18 postoperative complications, four cases of aseptic loosening of the femoral component, one soft tissue impingement due to malalignment, nine cases of polyethylene bearing dislocation, one case of suprapatellar bursitis, one periprosthetic fracture, one TKA conversion due to medial component overhanging, and one TKA conversion due to pain of unexplained cause were observed.

Conclusions: The mid-term clinical outcomes of UKA were excellent in our study. However, the incidence of complications was very high (9.8%). To prevent intra- and postoperative complications, proper selection of the patients and accurate surgical techniques are required.

Show MeSH
Related in: MedlinePlus