The Mid- to Long-Term Outcomes of the Lateral Domed Oxford Unicompartmental Knee Replacement: An Analysis From the National Joint Registry for England, Wales, Northern Ireland, and the Isle of Man.

Abstract

BACKGROUND: Lateral unicompartmental knee replacement (UKR) is an alternative to total knee replacement for isolated lateral unicompartmental knee arthritis. The geometry and mechanics of the lateral compartment differ to the medial compartment with the Lateral Domed Oxford UKR designed to address this. We used the National Joint Registry (NJR) data to report the mid- to long-term outcomes of this device. METHODS: We performed a retrospective observational study using NJR data on 992 Lateral Domed Oxford UKRs implanted between 1st January 2005 and 31st December 2017. Outcomes of interest were implant survival and revision indications. RESULTS: The 10 year cumulative implant survival rates were 88.6% (CI 85.3-91.2). When compared with <55 year age group, the 55-64, 65-74 and ≥75 groups had significantly lower revision rates (hazard ratio (HR) = 0.56 (CI 0.32-0.98, P = .04), HR 0.40 (CI 0.22-0.72, P = .003), and HR 0.27 (CI 0.12-0.58, P = .001), respectively). The obese group had significantly (P = .04) increased revision risk compared with normal BMI (HR 2.33, CI 1.06-5.12). The commonest reasons for revision surgery were dislocation (n = 23, 2.3%), pain (n = 15, 1.5%), and aseptic loosening (n = 14, 1.4%). CONCLUSION: The Lateral Domed Oxford UKR provides a good option for isolated lateral compartment osteoarthritis. However, dislocation of the mobile bearing remains a problem, occurring in 2.3% of the patients and accounting for 30% of the revisions. To help prevent dislocation, it is now possible to assess bearing stability intraoperatively and if very unstable to implant a compatible fixed bearing tibial component, without the need for further bone preparation.