Complications and Rehabilitation after UKA Yazdi HR MD Associated Professor of IUMS Fellowship of Knee Reconstruction and Arthroscopic Surgery Jan, 2016 Isfahan

Complications of UKA UKA is a safe procedure with a low rate of perioperative complications More than 90% survivorship at 5-10 Case selection and surgical technique The Knee,Volume 20, Issue 3, June 2013, 218–220 Orhopedics.2007;3:15-18 J Arthroplasty.2006;21:13-17

The Most common Cx Component Dx Progression to arthritis Component loosening Subsidence of T component Polyethylene wear Periporestetic Fx

Less Common Cx Pseudomeniscal synovial impingement Metallosis Contralateral meniscal injury

Dx of Polyethylene Typically in mobile-bearing prosthesis Donk et al : 4 of 97 UKA KSSTA .2006;13:161-3 Vorlat et al:2 of 4 revisions of UKA KSSTA .2006;14:40-45 Dx: displacement of radio-opaque markers on X-Ray

Dx of Polyethylene

Wear A complication of all prostesis More common in Fixed-bearing Kendrick et al: 0.045 mm/y versus 0.07 mm/y JBJS Br.2011;93:470-475 JBJS Br.2010;92:367-373 J Arthroplasty, 2004:47-51

Contralateral Arthritis Typically due to overcorrection of the varus deformity Emerson et al: Overcorrection to valgus alignment More common in mobile- bearing CORR.2002;404:62-70

Proximal Tibia Fx Is rare but serious complication Intra or post operatively Van Loon et al: 2 cases of fx( one intra op and the other 6 days later) Can be prevented by: maintain tibial cortical integrity proper tibial component sizing avoid breaching of pos cortex avoid excessive tibial cut careful malleting during component fixation Acta Orthop Belg.2006;72:369-74 J Arthroplasty.2008;23:615-18

Proximal Tibia Stress Fx Improper sizing of tibial component Knee.2010;17(1):57-60 J.Arthroplasty.2007;22:148-150

Collapse after UKA Eng

Fracture of the medial femoral condyle Rare complication Reported by Kim et al A closed reduction and percutaneous fixation using 3 cannulated cancellous screws was performed J Arthroplasty. 2009 Oct;24(7)

PJI Infection rates reported for TKA range from 0.15% to 2.5% and for UKA is 0.58%. J Bone Joint Surg Br. 2006; 88: 54-60. Clin Orthop Relat Res. 2011 Jan;469(1):138-145. J Bone Joint Surg Am. 2007;89:780-785. Orthopedics. 2008;31:445.

Arthrofibrosis 0.58% after UKA versus 1.2% to 10.9% after TKA Is due to less damaging to the suprapatellar pouch and extensor mechanism JBJS Am. 2004;86:1479-1484. J Arthroplasty. 1998;13:896-900. JBJS Am.2006;88 Suppl 4:175-181 Knee. 2010;17:29-32

Femoral component malrotation In congruency of F component versus T component in flexion and extension Affect screw -home mechanism especially in Lat UKA Tibial spine impingement (Lat UKA) and painful extension Orthopaedics.2006;29:829-31 CORR.2008;466(11)2686-93

Limited Extension Thin femoral cut Mal rotation of F component Tibial spine Impingement Painful and limited extension Orthopaedics.2006;29:829-31 CORR.2008;466(11)2686-93

DVT &PTE Chan et al :proximal DVT,PTE, and death secondary to PE to be 0.9%, 1.9%, and 0.3% respectively in a study comparing bilateral simultaneous to bilateral staged medial UKA during the first 30 post-operative days (no prophylaxis) Morris et al: 1% rate of DVT and no PE( With prophylaxis. J Bone Joint Surg Br. 2009;91:1305-9. The Knee. 2013:20:218–220

Mortality Morris et al: no deaths during the 90-day follow-up period. This compares favorably to TKA in which 30- to 90-day mortality has been reported to be between 0.24 and 0.70% J Bone Joint Surg Am. 2001;83:1157-61. J Bone Joint Surg Am. 2003;85:432-5. J Bone Joint Surg Br. 2009;91:645-8. J Bone Joint Surg Am. 2004;86:1909-16. Anesthesiology 2002;96:1140-6.

Cement extrusion Is rare but could be seriously disabling, if not treated. Caused pain, a stucking sensation and decreased ROM after UKA Prevented by: Removing completely the extruded cement Two stage cementation Proper visualization using dental mirror Washing the surgical area Visualizing all compartments International Journal of Orthopaedics Sciences 2015; 1(1): 22-25

Rehabilitation PREHAB”: Post-operative recovery begins PRE-Operatively 1. Pre-operative patient education 2. Pre-operative rehabilitation 2 weeks prior to the surgical date focusing on achieving 3 main goals: a. Minimizing pain and swelling. b. Maximizing quadriceps strength. c. Maximizing knee range of motion with emphasis on hamstring stretching to restore full extension. J Strength Cond Res. 2011; 25(2): 318-325. Clinical Rehabilitation 2011; 00(0): 1-10.

Rehabilitation(cont.) Surgical Technique: 1. Minimally invasive techniques. 2. Short acting spinal anesthesia and deep and superficial peri-articular injection 3. A subcuticular skin closure. J Arthroplasty 2007; 22:33-38. J Arthroplasty 2008; 23: 502-508.

Rehabilitation(cont.) Pain Management: Peri-operative Multimodal 1. Celecoxib 400 mg per day starting 2 weeks pre-operatively and continuing for 6 weeks post-operatively 2. Ketorolac 15 mg IVP given in pre-op, and every 6 hours for 24 hours on a scheduled basis. 3. Hydrocodone 7.5 mg or Oxycodone, one or two tabs, given every 4 hours as needed. 4. Hydromorphone 0.5 mg IVP every 2 hours as needed for break through pain. 5. Ondansetron 4 mg IVP every 6 hours for 24 hours on a scheduled basis.

Rehabilitation(cont.) Post-op Rehab: The post-operative rehabilitation program begins on the day of surgery with emphasis on two main priorities: 1. Preventing and minimizing pain and swelling. 2. Early knee range of motion Maintaining full extension Frequent hamstring stretching exercises Quadriceps isometric exercises and range of motion CWFWB as tolerated Gait training, stair climbing and progressive ROM on day 2 Discharge on post-op day two Cane for 2-4 weeks Clinical Rehabilitation 2011; 00(0): 1-10.

Rehabilitation(cont.) Post-op Activity: The first two weeks of recovery are considered to be the most important phase of the rehabilitation process. Achieve appropriate wound healing Progressive recovery of motion Quadriceps muscle control Minimize soft tissue swelling Most patient will return to normal daily activities within 10 to 14 days and can be relatively active within 4 to 6 weeks after surgery J Bone Joint Surg (Am) 2008; 90: 2245-2252.

Accelerated Rehabilitation Pre-op education and rehabilitation 4 weeks before surgery Early Rom as soon as 2 h post op Good results Eur J Orthop Surg Traumatol .DOI 10.1007/s00590-011-0797-7

Take Home Massages Patient selection and surgical technique are the main actor to have goo results UKA may have less complications than TKA The complication rate of MB prosthesis is more than FB UKA has less mortality than TKA The rehabilitation is easy and fast

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