Survival of Medial Unicondylar Arthroplasties Placed by One Surgeon 1984-1998

Unicondylar arthroplasty survival rates have varied widely. Implant- and patient-specific factors may be contributory. One surgeon placed 411 medial compartment arthroplasties of 12 designs from 1984 to 1998. In most cases, the fixed bearing tibial component was placed with cement and featured gamma-sterilized-in-air polyethylene and a metal backing. Tibial component initial thickness averaged 8.5 ± 1.4 mm. Polyethylene shelf age averaged 1.3 ± 1.2 years. Age and weight at arthroplasty averaged 67 ± 8 years and 83 ± 15 kg, respectively. Survival (no revision) at 9 years was 80%. Revision was more common in younger patients, in those with a thinner tibial component or longer polyethylene shelf age, and when some designs were used rather than others; weight and gender were not associated with revision. Nine-year survival improved to 94% when tibial component thickness was > 7 mm and polyethylene shelf age was < 1 year (154 knees). Per our experience, placement of a thin or shelf-aged gamma-irradiated-in-air polyethylene bearing into a young or active subject could explain most failures of unicondylar arthroplasties done in the 1980s and 1990s. Unicondylar patients of that era who were fortunate enough to avoid a thin or aged oxidation-prone polyethylene bearing probably have enjoyed superior outcomes.

Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.