High Failure Rates for Unicompartmental Knee Arthroplasty in Morbidly Obese Patients: A Two-Year Minimum Follow-Up Study

Dec 5, 2019The Journal of arthroplasty

High failure rates of partial knee replacement in severely obese patients after at least two years

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Abstract

Major revision surgery occurred in 15.7% of morbidly-obese patients undergoing unicompartmental knee arthroplasty (UKA), compared to 3.0% in non-obese patients.

The study included 152 patients with 190 knees, followed for a mean duration of 3.4 years.
Morbidly-obese patients (BMI ≥ 40 kg/m) experienced a significantly higher rate of major revisions compared to those without obesity.
Rates of minor secondary surgeries and infections were similar between morbidly-obese and non-obese groups.
The primary reasons for failure in the morbid-obesity group were disease progression in other knee compartments and mobile-bearing instability.
Further research is needed before recommending UKA for morbidly-obese patients.

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BACKGROUND: Several recent studies have recommended offering unicompartmental knee arthroplasty (UKA) to all patients regardless of body mass index (BMI). The aim of this investigation was to evaluate the proposition that UKA can indeed be offered to the morbidly-obese and super-obese (morbidly-obese, BMI ≥ 40 kg/m) without compromising results or survivorship. 2

METHODS: We retrospectively reviewed mobile-bearing medial UKA procedures performed at our facility from January 2012 to May 2015 with a minimum of 2-year follow-up. The study cohort was divided into patients with morbid obesity (BMI ≥ 40 kg/m) and those without morbid obesity (BMI < 40 kg/m). A detailed medical record review was performed. Extracted outcome data included the frequency of (1) major revision procedures (components revised), (2) minor secondary procedures (components not revised), (3) infection procedures, and (4) recommendations for revision. 2 2

RESULTS: We found 152 patients (190 knees) who met criteria for inclusion. Mean follow-up duration was 3.4 years (range: 2.0-6.8 years). Major revision surgery occurred more frequently in the morbid-obesity UKA group (15.7% vs 3.0%, P < .01). Rates of minor secondary surgery and infection were comparable for both groups. Most failures in the morbid-obesity UKA group (85.7%) were due to disease progression involving other compartments or mobile-bearing instability.

CONCLUSION: We found the rate of early major revision surgery in morbidly-obese patients undergoing UKA to be over 5-times greater than that of other patients. Failure was predominantly due to disease progression in other compartments or mobile-bearing instability. Further study is warranted and needed before expanding UKA indications to the morbidly-obese population.

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High Failure Rates for Unicompartmental Knee Arthroplasty in Morbidly Obese Patients: A Two-Year Minimum Follow-Up Study

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