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Study identifies factors for revision following UKA

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COPENHAGEN — Surgeon experience and operation time are factors that influence the risk of revision after unicompartmental knee arthroplasty, according to a presenter at the 12th EFORT Congress 2011 here.

Lars Solgaard, MD, presented his team’s findings, which used database information on all knee arthroplasties performed at their institution.

“In general, the most experienced surgeon taking the necessary time for the operation has the best prosthesis survival rates,” Solgaard said. “In contrast to that, a relatively inexperienced surgeon who uses less than 90 minutes displays a 7-year survival rate of [about] 75%.”

Solgaard’s team analyzed data from patients who underwent unicompartmental knee arthroplasty (UKA) using the Oxford knee (Biomet, Inc.) from 1997 to 2006, as well as any revision cases through 2008. The procedures were categorized into three groups based on surgeon experience: those performed by a surgeon who had completed less than 20 UKAs; those performed by a surgeon who had completed 20 to 40 UKA; and those performed by a surgeon who completed more than 40 UKAs.

Revisions performed exclusively to deal with pain were excluded from analysis. Factors analyzed included patient age and gender, previous surgical intervention, operation time and experience of the surgeon. The study group included 445 primary knee arthroplasties and 46 revisions.

According to Solgaard, patient age and gender were not associated with risk of revision. The investigators found that the risk of revision risk decreased as operation time and surgeon experience increased. This was evidenced by a 97.5% 6-year survival rate for experienced surgeons using operating times of 90 minutes or more compared with a 78.7% survival rate for inexperienced surgeons using operation times of less than 90 minutes.

Solgaard noted that performing a UKA with the prosthesis is, “a technically demanding procedure that can be relatively time-consuming. There appears to be a significant learning curve. This investigation shows the importance of these basics and the consequences of ignoring these facts.”

Reference:

• Solgaard L, Moeller L, Sandberg T. Risk of revision following Oxford unicompartmental knee arthroplasty. Paper #1478. Presented at the 12th EFORT Congress 2011. June 1-4. Copenhagen.

That was a very nice presentation. There are two very clear messages here: You should not hurry too much when doing these operations, and not too many surgeons should be doing these operations.

— Anders Odgaard, MD, DMSc
Session moderator

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