Skip to main content
SpringerLink
Log in

Risk Mitigation for Unicompartmental Knee Arthroplasty

  • Chapter
  • First Online:
Unicompartmental Knee Arthroplasty

  • 693 Accesses

Abstract

Unicompartmental knee arthroplasty (UKA) can be complicated by early postoperative adverse events. With the improvement in UKA functional outcomes over the last decade, mitigating the risk for these events through optimization of the host has become a top surgical priority. Obesity, diabetes, malnutrition, atherosclerosis, tobacco use, intra-articular injections, and hypercoagulability represent seven areas with opportunities for intervention. Each is discussed here in terms of its epidemiology, association with postoperative events, and potential for perioperative optimization.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Riddle DL, Jiranek WA, McGlynn FJ. Yearly incidence of unicompartmental knee arthroplasty in the United States. J Arthroplast. 2008;23:408–12.

    Article  Google Scholar 

  2. Kulshrestha V, Datta B, Kumar S, Mittal G. Outcome of unicondylar knee arthroplasty vs total knee arthroplasty for early medial compartment arthritis: a randomized study. J Arthroplast. 2017;32:1460–9.

    Article  Google Scholar 

  3. Adult Obesity Facts | Overweight & Obesity | CDC. (2018). https://www.cdc.gov/obesity/data/adult.html. Accessed 23 Nov 2018.

  4. Bovonratwet P, Ondeck NT, Tyagi V, Nelson SJ, Rubin LE, Grauer JN. Outpatient and inpatient unicompartmental knee arthroplasty procedures have similar short-term complication profiles. J Arthroplast. 2017;32:2935–40.

    Article  Google Scholar 

  5. Liabaud B, Patrick DA Jr, Geller JA. Higher body mass index leads to longer operative time in total knee arthroplasty. J Arthroplast. 2013;28:563–5.

    Article  Google Scholar 

  6. Stern SH, Insall JN. Total knee arthroplasty in obese patients. J Bone Joint Surg. 1990;72:1400–4.

    Article  CAS  PubMed  Google Scholar 

  7. Workgroup of the American Association of Hip and Knee Surgeons Evidence Based Committee. Obesity and total joint arthroplasty: a literature based review. J Arthroplasty. 2013;28:714–21.

    Article  Google Scholar 

  8. Jämsen E, Nevalainen P, Eskelinen A, Huotari K, Kalliovalkama J, Moilanen T. Obesity, diabetes, and preoperative hyperglycemia as predictors of periprosthetic joint infection: a single-center analysis of 7181 primary hip and knee replacements for osteoarthritis. J Bone Joint Surg Am. 2012;94:e101.

    Article  PubMed  Google Scholar 

  9. Abdel MP, Ast MP, Lee Y-Y, Lyman S, González Della Valle A. All-cause in-hospital complications and urinary tract infections increased in obese patients undergoing total knee arthroplasty. J Arthroplast. 2014;29:1430–4.

    Article  Google Scholar 

  10. Baker P, Petheram T, Jameson S, Reed M, Gregg P, Deehan D. The association between body mass index and the outcomes of total knee arthroplasty. J Bone Joint Surg Am. 2012;94:1501–8.

    Article  PubMed  Google Scholar 

  11. D’Apuzzo MR, Novicoff WM, Browne JA. The John Insall Award: morbid obesity independently impacts complications, mortality, and resource use after TKA. Clin Orthop Relat Res. 2014;473:57–63.

    Article  PubMed Central  Google Scholar 

  12. Schwarzkopf R, Thompson SL, Adwar SJ, Liublinska V, Slover JD. Postoperative complication rates in the “super-obese” hip and knee arthroplasty population. J Arthroplast. 2012;27:397–401.

    Article  Google Scholar 

  13. Werner BC, Evans CL, Carothers JT, Browne JA. Primary total knee arthroplasty in super-obese patients: dramatically higher postoperative complication rates even compared to revision surgery. J Arthroplast. 2015;30:849–53.

    Article  Google Scholar 

  14. Schwartz AJ. CORR insights ®: bariatric orthopaedics: total knee arthroplasty in super-obese patients (BMI > 50 kg/m2). Survivorship and complications. Clin Orthop Relat Res. 2013;471:3531–2.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Suleiman LI, Ortega G, Ong’uti SK, Gonzalez DO, Tran DD, Onyike A, Turner PL, Fullum TM. Does BMI affect perioperative complications following total knee and hip arthroplasty? J Surg Res. 2012;174:7–11.

    Article  PubMed  Google Scholar 

  16. Naziri Q, Issa K, Malkani AL, Bonutti PM, Harwin SF, Mont MA. Bariatric orthopaedics: total knee arthroplasty in super-obese patients (BMI > 50 kg/m2). Survivorship and complications. Clin Orthop Relat Res. 2013;471:3523–30.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Kandil A, Werner BC, Gwathmey WF, Browne JA. Obesity, morbid obesity and their related medical comorbidities are associated with increased complications and revision rates after unicompartmental knee arthroplasty. J Arthroplast. 2015;30:456–60.

    Article  Google Scholar 

  18. Bonutti PM, Goddard MS, Zywiel MG, Khanuja HS, Johnson AJ, Mont MA. Outcomes of unicompartmental knee arthroplasty stratified by body mass index. J Arthroplast. 2011;26:1149–53.

    Article  Google Scholar 

  19. Affatato S, Caputo D, Bordini B. Does the body mass index influence the long-term survival of unicompartmental knee prostheses? A retrospective multi-Centre study. Int Orthop. 2018;43:1365. https://doi.org/10.1007/s00264-018-4217-z.

    Article  PubMed  Google Scholar 

  20. Molloy J, Kennedy J, Jenkins C, Mellon S, Dodd C, Murray D. Obesity should not be considered a contraindication to medial Oxford UKA: long-term patient-reported outcomes and implant survival in 1000 knees. Knee Surg Sports Traumatol Arthrosc. 2018;27:2259. https://doi.org/10.1007/s00167-018-5218-6.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Deshmukh RG, Hayes JH, Pinder IM. Does body weight influence outcome after total knee arthroplasty? A 1-year analysis. J Arthroplast. 2002;17:315–9.

    Article  CAS  Google Scholar 

  22. Severson EP, Singh JA, Browne JA, Trousdale RT, Sarr MG, Lewallen DG. Total knee arthroplasty in morbidly obese patients treated with bariatric surgery: a comparative study. J Arthroplasty. 2012;27:1696–700.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Werner BC, Kurkis GM, Winston Gwathmey F, Browne JA. Bariatric surgery prior to total knee arthroplasty is associated with fewer postoperative complications. J Arthroplast. 2015;30:81–5.

    Article  Google Scholar 

  24. Parvizi J, Trousdale RT, Sarr MG. Total joint arthroplasty in patients surgically treated for morbid obesity. J Arthroplast. 2000;15:1003–8.

    Article  CAS  Google Scholar 

  25. Kulkarni A, Jameson SS, James P, Woodcock S, Muller S, Reed MR. Does bariatric surgery prior to lower limb joint replacement reduce complications? Surgeon. 2011;9:18–21.

    Article  CAS  PubMed  Google Scholar 

  26. McLawhorn AS, Southren D, Claire Wang Y, Marx RG, Dodwell ER. Cost-effectiveness of bariatric surgery prior to total knee arthroplasty in the morbidly obese. J Bone Joint Surg. 2016;98:e6.

    Article  PubMed  Google Scholar 

  27. Benotti PN, Still CD, Craig Wood G, et al. Surgical weight-loss to improve functional status trajectories following total knee arthroplasty: SWIFT trial: rationale, design, and methods. Contemp Clin Trials. 2018;69:1–9.

    Article  PubMed  Google Scholar 

  28. National Diabetes Statistics Report | Data & Statistics | Diabetes | CDC. (2018). https://www.cdc.gov/diabetes/data/statistics/statistics-report.html. Accessed 23 Nov 2018.

  29. Drager J, Hart A, Khalil JA, Zukor DJ, Bergeron SG, Antoniou J. Shorter hospital stay and lower 30-day readmission after unicondylar knee arthroplasty compared to total knee arthroplasty. J Arthroplast. 2016;31:356–61.

    Article  Google Scholar 

  30. Maradit Kremers H, Lewallen LW, Mabry TM, Berry DJ, Berbari EF, Osmon DR. Diabetes mellitus, hyperglycemia, hemoglobin A1C and the risk of prosthetic joint infections in total hip and knee arthroplasty. J Arthroplast. 2015;30:439–43.

    Article  Google Scholar 

  31. Marchant MH Jr, Viens NA, Cook C, Vail TP, Bolognesi MP. The impact of glycemic control and diabetes mellitus on perioperative outcomes after total joint arthroplasty. J Bone Joint Surg Am. 2009;91:1621–9.

    Article  PubMed  Google Scholar 

  32. Chrastil J, Anderson MB, Stevens V, Anand R, Peters CL, Pelt CE. Is hemoglobin A1c or perioperative hyperglycemia predictive of periprosthetic joint infection or death following primary total joint arthroplasty? J Arthroplast. 2015;30:1197–202.

    Article  Google Scholar 

  33. Cross MB, Yi PH, Thomas CF, Garcia J, Della Valle CJ. Evaluation of malnutrition in orthopaedic surgery. J Am Acad Orthop Surg. 2014;22:193–9.

    Article  PubMed  Google Scholar 

  34. Bohl DD, Shen MR, Kayupov E, Cvetanovich GL, Della Valle CJ. Is hypoalbuminemia associated with septic failure and acute infection after revision total joint arthroplasty? A study of 4517 patients from the National Surgical Quality Improvement Program. J Arthroplast. 2016;31:963–7.

    Article  Google Scholar 

  35. Bohl DD, Shen MR, Kayupov E, Della Valle CJ. Hypoalbuminemia independently predicts surgical site infection, pneumonia, length of stay, and readmission after total joint arthroplasty. J Arthroplast. 2016;31:15–21.

    Article  Google Scholar 

  36. Maier GS, Horas K, Seeger JB, Roth KE, Kurth AA, Maus U. Is there an association between periprosthetic joint infection and low vitamin D levels? Int Orthop. 2014;38:1499–504.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Yi PH, Frank RM, Vann E, Sonn KA, Moric M, Della Valle CJ. Is potential malnutrition associated with septic failure and acute infection after revision total joint arthroplasty? Clin Orthop Relat Res. 2015;473:175–82.

    Article  PubMed  Google Scholar 

  38. Lawson RM, Doshi MK, Barton JR, Cobden I. The effect of unselected post-operative nutritional supplementation on nutritional status and clinical outcome of orthopaedic patients. Clin Nutr. 2003;22:39–46.

    Article  CAS  PubMed  Google Scholar 

  39. Delmi M, Rapin CH, Bengoa JM, Delmas PD, Vasey H, Bonjour JP. Dietary supplementation in elderly patients with fractured neck of the femur. Lancet. 1990;335:1013–6.

    Article  CAS  PubMed  Google Scholar 

  40. Eneroth M, Olsson U-B, Thorngren K-G. Nutritional supplementation decreases hip fracture-related complications. Clin Orthop Relat Res. 2006;451:212–7.

    Article  PubMed  Google Scholar 

  41. Bohl DD, Ondeck NT, Basques BA, Levine BR, Grauer JN. What is the timing of general health adverse events that occur after total joint arthroplasty? Clin Orthop Relat Res. 2017;475:2952–9.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Fleisher LA, Fleischmann KE, Auerbach AD, et al. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. Developed in collaboration with the American College of Surgeons, American Society of Anesthesiologists, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Anesthesiologists, and Society of Vascular Medicine Endorsed by the Society of Hospital Medicine. J Nucl Cardiol. 2015;22:162–215.

    Article  PubMed  Google Scholar 

  43. Lee TH, Marcantonio ER, Mangione CM, et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation. 1999;100:1043–9.

    Article  CAS  Google Scholar 

  44. Devereaux PJ, Mrkobrada M, Sessler DI, et al. Aspirin in patients undergoing noncardiac surgery. N Engl J Med. 2014;370:1494–503.

    Article  CAS  PubMed  Google Scholar 

  45. Prevention of pulmonary embolism and deep vein thrombosis with low dose aspirin: Pulmonary Embolism Prevention (PEP) trial. Lancet. 2000;355:1295–302.

    Google Scholar 

  46. Mont MA, Jacobs JJ. AAOS clinical practice guideline: preventing venous thromboembolic disease in patients undergoing elective hip and knee arthroplasty. J Am Acad Orthop Surg. 2011;19:777–8.

    Article  PubMed  Google Scholar 

  47. Lindenauer PK, Pekow P, Wang K, Gutierrez B, Benjamin EM. Lipid-lowering therapy and in-hospital mortality following major noncardiac surgery. JAMA. 2004;291:2092–9.

    Article  CAS  PubMed  Google Scholar 

  48. POISE Study Group, Devereaux PJ, Yang H, et al. Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial. Lancet. 2008;371:1839–47.

    Article  CAS  Google Scholar 

  49. Flu W-J, van Kuijk J-P, Chonchol M, Winkel TA, Verhagen HJM, Bax JJ, Poldermans D. Timing of pre-operative Beta-blocker treatment in vascular surgery patients: influence on post-operative outcome. J Am Coll Cardiol. 2010;56:1922–9.

    Article  PubMed  Google Scholar 

  50. CDC’s Office on Smoking, Health (2009). Smoking and tobacco use; Data and statistics.

    Google Scholar 

  51. Singh JA, Houston TK, Ponce BA, Maddox G, Bishop MJ, Richman J, Campagna EJ, Henderson WG, Hawn MT. Smoking as a risk factor for short-term outcomes following primary total hip and total knee replacement in veterans. Arthritis Care Res. 2011;63:1365–74.

    Article  Google Scholar 

  52. Duchman KR, Gao Y, Pugely AJ, Martin CT, Noiseux NO, Callaghan JJ. The effect of smoking on short-term complications following total hip and knee arthroplasty. J Bone Joint Surg Am. 2015;97:1049–58.

    Article  PubMed  Google Scholar 

  53. Lim CT, Goodman SB, Huddleston JI 3rd, Harris AHS, Bhowmick S, Maloney WJ, Amanatullah DF. Smoking is associated with earlier time to revision of total knee arthroplasty. Knee. 2017;24:1182–6.

    Article  PubMed  Google Scholar 

  54. Khullar D, Maa J. The impact of smoking on surgical outcomes. J Am Coll Surg. 2012;215:418–26.

    Article  PubMed  Google Scholar 

  55. Lindström D, Azodi OS, Wladis A, Tønnesen H, Linder S, Nåsell H, Ponzer S, Adami J. Effects of a perioperative smoking cessation intervention on postoperative complications. Ann Surg. 2008;248:739–45.

    Article  PubMed  Google Scholar 

  56. Møller AM, Villebro N, Pedersen T, Tønnesen H. Effect of preoperative smoking intervention on postoperative complications: a randomised clinical trial. Lancet. 2002;359:114–7.

    Article  PubMed  Google Scholar 

  57. Truntzer J, Vopat B, Feldstein M, Matityahu A. Smoking cessation and bone healing: optimal cessation timing. Eur J Orthop Surg Traumatol. 2015;25:211–5.

    Article  PubMed  Google Scholar 

  58. Charalambous CP, Prodromidis AD, Kwaees TA. Do intra-articular steroid injections increase infection rates in subsequent arthroplasty? A systematic review and meta-analysis of comparative studies. J Arthroplast. 2014;29:2175–80.

    Article  Google Scholar 

  59. Cancienne JM, Werner BC, Luetkemeyer LM, Browne JA. Does timing of previous intra-articular steroid injection affect the post-operative rate of infection in total knee arthroplasty? J Arthroplast. 2015;30:1879–82.

    Article  Google Scholar 

  60. Papavasiliou AV, Isaac DL, Marimuthu R, Skyrme A, Armitage A. Infection in knee replacements after previous injection of intra-articular steroid. J Bone Joint Surg Br. 2006;88:321–3.

    Article  CAS  PubMed  Google Scholar 

  61. Ogonda L, Hill J, Doran E, Dennison J, Stevenson M, Beverland D. Aspirin for thromboprophylaxis after primary lower limb arthroplasty: early thromboembolic events and 90 day mortality in 11,459 patients. Bone Joint J. 2016;98-B:341–8.

    Article  CAS  PubMed  Google Scholar 

  62. Deirmengian GK, Heller S, Smith EB, Maltenfort M, Chen AF, Parvizi J. Aspirin can be used as prophylaxis for prevention of venous thromboembolism after revision hip and knee arthroplasty. J Arthroplast. 2016;31:2237–40.

    Article  Google Scholar 

  63. Parvizi J, Huang R, Restrepo C, Chen AF, Austin MS, Hozack WJ, Lonner JH. Low-dose aspirin is effective chemoprophylaxis against clinically important venous thromboembolism following total joint arthroplasty: a preliminary analysis. J Bone Joint Surg Am. 2017;99:91–8.

    Article  PubMed  Google Scholar 

  64. Huang RC, Parvizi J, Hozack WJ, Chen AF, Austin MS. Aspirin is as effective as and safer than warfarin for patients at higher risk of venous thromboembolism undergoing total joint arthroplasty. J Arthroplast. 2016;31:83–6.

    Article  Google Scholar 

  65. Huang R, Buckley PS, Scott B, Parvizi J, Purtill JJ. Administration of aspirin as a prophylaxis agent against venous thromboembolism results in lower incidence of periprosthetic joint infection. J Arthroplast. 2015;30:39–41.

    Article  Google Scholar 

  66. Bohl DD, Maltenfort MG, Huang R, Parvizi J, Lieberman JR, Della Valle CJ. Development and validation of a risk stratification system for pulmonary embolism after elective primary total joint arthroplasty. J Arthroplast. 2016;31:187–91.

    Article  Google Scholar 

  67. Parvizi J, Huang R, Raphael IJ, Arnold WV, Rothman RH. Symptomatic pulmonary embolus after joint arthroplasty: stratification of risk factors. Clin Orthop Relat Res. 2014;472:903–12.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA

    Daniel D. Bohl

  2. Adult Reconstruction Division, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA

    Tad L. Gerlinger

Authors
  1. Daniel D. Bohl
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tad L. Gerlinger
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Adult Reconstruction Division, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA

    Tad L. Gerlinger

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Bohl, D.D., Gerlinger, T.L. (2020). Risk Mitigation for Unicompartmental Knee Arthroplasty. In: Gerlinger, T. (eds) Unicompartmental Knee Arthroplasty. Springer, Cham. https://doi.org/10.1007/978-3-030-27411-5_4

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-27411-5_4

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-27410-8

  • Online ISBN: 978-3-030-27411-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation