UKA-to-TKA and TKA-to-TKA Revisions: Outcomes Same

Many surgeons recommend primary unilateral knee arthroplasty (UKA) over primary total knee arthroplasty (TKA) or tibial osteotomy for younger patients with unicompartmental knee osteoarthritis. Some do so believing that the results of any subsequent revision to TKA (UKA → TKA) will be better than a revision of a primary TKA to a second TKA (TKA → TKA).

A comparative, registry-based study by Leta et al. in the March 16, 2016 JBJS found that both revision categories yielded essentially the same outcomes. The authors found no significant differences between the two strategies in terms of overall implant survival rate or risk of re-revision, or in several patient-reported outcomes:  the EuroQol EQ-5D, KOOS, and VAS pain and satisfaction scores.  Two notable exceptions were as follows:

  • The risk of re-revision was twice as high for TKA → TKA patients who were older than 70 years of age
  • UKA → TKAs were more often re-revised because of a loose tibial component and pain alone, while TKA → TKAs were more often re-revised because of deep infection.

With few significant outcome differences, commentator Geoffrey Dervin, MD suggests that “patients facing the initial decision between UKA and TKA should focus more on differences in perioperative morbidity, clinical outcomes, and satisfaction” from the primary procedure rather than on the outcomes of revision should it be required.

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