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three, using the implant that offers the best
chance of success without excessive trade off
in constraint. As seen in Table 3, what denotes
a ‘revision’ TKR prosthesis as opposed to a
‘straightforward’ TKR prosthesis is poorly
defined, but the use of grafts, augments and
stemmed prosthesis is not uncommon for UKA
to TKR procedures. The SFHG study (which
reported on 426 revisions – 88% Medial UKA
Vs 12% Lateral UKA) reported the use of
standard TKR prostheses in only 50% of cases
[56], while other authors report usage of
revision type prostheses for UKA to TKR from
anywhere between 11% and 85% [7, 13, 14, 43,
48, 49, 52, 55, 60].
Summary
Although Medial and Lateral UKA have
different indications and pathoanatomical
features, revision of UKA to TKA is like any
revision case; cause of failure for either Medial
or Lateral UKA is frequently related to
suboptimal patient selection, technical errors
intra-operatively, as well as patient specific,
prosthetic and mechanical factors. Intra-
operative technical difficulties must be
anticipated pre-operatively to plan the optimal
surgical strategy. Meticulous planning of the
approach must be undertaken, taking into
account previous incisions. Preparation for the
type of implants required is essential, including
the decision between primary or revision
prosthesis, the use of stemmed components,
the degree of constraint required and the
necessity for either autograft, allograft or
metallic augments. However, avoiding
excessive tibial resection is paramount, and
this must be done from the primary intervention.
Although there is insufficient evidence
regarding the effect of laterality, revision of
UKA to TKA procedures are not the same as a
primary TKR, as evidenced by the escalation of
bone loss and the frequent use of revision-type
prostheses.
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