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 mobilebearing
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 90day 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 PREOperatively
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
Thank You