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LETTER TO THE EDITOR Revision of Unicondylar to Total Knee Arthoplasty: A Systematic Review
DEAR PROF. HERNIGOU,
To assess revision rates after knee arthroplasty we compared cumulative results from world wide clinical studies and arthroplasty registers from the 1960 up to now in one of the largest reviews ever [1Pabinger C, Berghold A, Boehler N, Labek G. Revision rates after knee replacement. Cumulative results from worldwide clinical studies versus joint registers Osteoarthritis Cartil 2013; 21(2): 263-8.]. We found, the overall revision rate at ten years was 6% for total knee arthroplasty (TKA) and17%for unicondylar protheses (UKA). Literature from non-register studies are biased regarding UKA [2Pabinger C, Lumenta DB, Cupak D, Berghold A, Boehler N, Labek G. Quality of outcome data in knee arthroplasty Acta Orthop 2014; 1-5.]. After the first revision, the five year revision rate was 3% for TKR and 9% for UKR [3David E. 7th Annual Report National Joint Registry for England and Wales Available at: http://www.jrcentre.org.uk/ 2010; 93.].
Therefore, it can be calculated that revision rate after 15 years for TKA is 9% (6% + 3%) and rate for UKR is 26% (17%+9%). We therefore compared two treatments options with a different outcome.
Since the average patients receiving UKRare younger than the average patients receiving TKR, it is therefore questionable to treat the younger patients with a treatment option with a 3-fold higher revision rate (26% instead of 9%). In my opion, UKR shall be reserved for older patients and not for younger patients.
CONFLICT OF INTEREST
The author confirms that this article content has no conflict of interest.
Pabinger C, Berghold A, Boehler N, Labek G. Revision rates after knee replacement. Cumulative results from worldwide clinical studies versus joint registers Osteoarthritis Cartil 2013; 21(2): 263-8.
Pabinger C, Lumenta DB, Cupak D, Berghold A, Boehler N, Labek G. Quality of outcome data in knee arthroplasty Acta Orthop 2014; 1-5.