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

2. 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

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

4. Less Common Cx
Pseudomeniscal synovial impingement Metallosis Contralateral meniscal injury

5. 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

6. Dx of Polyethylene

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

8. 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

9. 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

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

11. Collapse after UKA
Eng

12. 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 Oct;24(7)

13. 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:
Clin Orthop Relat Res Jan;469(1):
J Bone Joint Surg Am. 2007;89:
Orthopedics. 2008;31:445.

14. 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:
J Arthroplasty. 1998;13:
JBJS Am.2006;88 Suppl 4:
Knee. 2010;17:29-32

15. 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)

16. 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)

17. 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:
The Knee. 2013:20:218–220

18. 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:
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:
Anesthesiology 2002;96:

19. 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

21. 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):
Clinical Rehabilitation 2011; 00(0): 1-10.

22. 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:

23. 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.

24. 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.

25. 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:

26. 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 /s

27. 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

28. Thank You