Optimal usage of unicompartmental knee arthroplasty: a study of 41,986 cases from the National Joint Registry for England and Wales

A.D. Liddle, H. Pandit, A. Judge, D.W. Murray

Research output: Contribution to journalArticle (Academic Journal)

Abstract

Unicompartmental knee arthroplasty (UKA) has advantages over total knee arthroplasty but national joint registries report a significantly higher revision rate for UKA. As a result, most surgeons are highly selective, offering UKA only to a small proportion (up to 5%) of patients requiring arthroplasty of the knee, and consequently performing few each year. However, surgeons with large UKA practices have the lowest rates of revision. The overall size of the practice is often beyond the surgeon's control, therefore case volume may only be increased by broadening the indications for surgery, and offering UKA to a greater proportion of patients requiring arthroplasty of the knee. The aim of this study was to determine the optimal UKA usage (defined as the percentage of knee arthroplasty practice comprised by UKA) to minimise the rate of revision in a sample of 41 986 records from the for National Joint Registry for England and Wales (NJR). UKA usage has a complex, non-linear relationship with the rate of revision. Acceptable results are achieved with the use of 20% or more. Optimal results are achieved with usage between 40% and 60%. Surgeons with the lowest usage (up to 5%) have the highest rates of revision. With optimal usage, using the most commonly used implant, five-year survival is 96% (95% confidence interval (CI) 94.9 to 96.0), compared with 90% (95% CI 88.4 to 91.6) with low usage (5%) previously considered ideal. The rate of revision of UKA is highest with low usage, implying the use of narrow, and perhaps inappropriate, indications. The widespread use of broad indications, using appropriate implants, would give patients the advantages of UKA, without the high rate of revision.
Original languageEnglish
Pages (from-to)1506-1511
Number of pages6
JournalBone and Joint Journal
Volume97-B
Issue number11
DOIs
Publication statusPublished - Nov 2015

Bibliographical note

M1 - Print

Keywords

  • Humans
  • Osteoarthritis, Knee
  • Prosthesis Failure
  • Arthroplasty, Replacement, Knee
  • Reoperation
  • Registries
  • Cohort Studies
  • Knee Prosthesis
  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Middle Aged
  • Health Services Research
  • Workload
  • England
  • Wales
  • Female
  • Male
  • Young Adult
  • Kaplan-Meier Estimate

Fingerprint Dive into the research topics of 'Optimal usage of unicompartmental knee arthroplasty: a study of 41,986 cases from the National Joint Registry for England and Wales'. Together they form a unique fingerprint.

  • Cite this