A comparison of revision risk between lateral knee replacement and total knee replacement: results from the Dutch Arthroplasty Register
DOI:
https://doi.org/10.2340/17453674.2026.46374Keywords:
Arthroplasty, KneeAbstract
Background and purpose: Lateral knee replacement is not commonly performed. Possible explanations are the lower incidence of lateral knee osteoarthritis, relative technical complexity, and different biomechanics, which may affect failure modes and survival rates. We aimed to analyze the difference in risk of revision between lateral and total knee replacements (TKRs) using the Dutch Arthroplasty Register data.
Methods: From 2007 to 2021, procedures were selected from the Dutch Arthroplasty Register. Unique patients based on their first procedure were identified. Procedures performed between 2014 and 2021 were analyzed separately because BMI and Charnley score were collected from 2014 onwards. We used ATT (Average Treatment effect on the Treated) weights based on the propensity score to estimate the average treatment effect in the lateral knee replacement group. The endpoint was revision, censored for death. Kaplan–Meier survival analyses were performed in propensity-based ATT-weighted cohorts of lateral knee replacement and TKR patients. Weighted univariable Cox regression models were used to estimate revision hazard ratios (HR).
Results: In the total cohort, 847 lateral knee replacements and 240,047 TKR patients were included. In the subgroup, 560 lateral knee replacements and 155,621 TKR patients were included. The risk of revision in both the total cohort and the subgroup was higher for lateral knee replacements compared with TKRs with an ATT-adjusted HR for the total cohort of 2.15 (95% confidence interval [CI] 1.74–2.64, P < 0.001) and for the subgroup an ATT-adjusted HR of 1.55 (CI 1.08–2.21, P = 0.02). Comparison of these ATT-weighted effects with the conditional effect estimates from a regular multivariable Cox proportional hazards regression did not show large differences in this study.
Conclusion: This study showed a significantly higher risk of revision for lateral knee replacements compared with TKRs.
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References
Laurencin C T, Zelicof S B, Scott R D, Ewald F C. Unicompartmental versus total knee arthroplasty in the same patient: a comparative study. Clin Orthop Relat Res 1991; (273): 151-6. PMID: 1959264.
Walker T, Gotterbarm T, Bruckner T, Merle C, Streit M R. Total versus unicompartmental knee replacement for isolated lateral osteoarthritis: a matched-pairs study. Int Orthop 2014; 38(11): 2259-64. doi: 10.1007/s00264-014-2473-0.
Liddle A D, Judge A, Pandit H, Murray D W. Determinants of revision and functional outcome following unicompartmental knee replacement. Osteoarthritis Cartilage 2014; 22(9): 1241-50. doi: 10.1016/j.joca.2014.07.006.
Beard D J, Davies L J, Cook J A, MacLennan G, Price A, Kent S, et al. The clinical and cost-effectiveness of total versus partial knee replacement in patients with medial compartment osteoarthritis (TOPKAT): 5-year outcomes of a randomised controlled trial. Lancet 2019; 394(10200): 746-56. doi: 10.1016/S0140-6736(19)31281-4.
Liddle A D, Judge A, Pandit H, Murray D W. Adverse outcomes after total and unicompartmental knee replacement in 101330 matched patients: a study of data from the National Joint Registry for England and Wales. Lancet 2014; 384(9952): 1437-45. doi: 10.1016/S0140-6736(14)60419-0.
Riddle D L, Jiranek W A, Neff R S, Whitaker D, Hull J R. Extent of tibiofemoral osteoarthritis before knee arthroplasty: multicenter data from the osteoarthritis initiative knee. Clin Orthop Relat Res 2012; 470(10): 2836-42. doi: 10.1007/s11999-012-2328-1.
Bunyoz K I, Jørgensen C C, Petersen P B, Kehlet H, Gromov K, Troelsen A, et al. Complications after lateral unicompartmental knee arthroplasty in a fast-track setting: a prospective cohort study of 170 procedures. Acta Orthop 2023; 94: 316-20. doi: 10.2340/17453674.2023.13653.
Johal S, Nakano N, Baxter M, Hujazi I, Pandit H, Khanduja V. Unicompartmental knee arthroplasty: the past, current controversies and future perspecitves. J Knee Surg 2018; 31(10): 992-8. doi: 10.1055/s-0038-1625961.
John J, Mauffrey C, May P. Unicompartmental knee replacements with Miller–Galante prosthesis: two to 16-year follow-up of a single surgeon series. Int Orthop 2011; 35(4): 507-13. doi: 10.1007/s00264-010-1006-8.
Kagan R, Anderson M B, Bailey T, Hofmann A A, Pelt C E. Ten-year survivorship, patient-reported outcomes, and satisfaction of a fixed-bearing unicompartmental knee arthroplasty. Arthroplast Today 2020; 6(2): 267-73. doi: 10.1016/j.artd.2020.02.016.
Mohammad H R, Kennedy J A, Mellon S J, Judge A, Dodd C A, Murray D W. Ten-year clinical and radiographic results of 1000 cementless Oxford unicompartmental knee replacements. Knee Surg Sports Traumatol Arthrosc 2020; 28(5): 1479-87. doi: 10.1007/s00167-019-05544-w.
Burger J A, Kleeblad L J, Sierevelt I N, Horstmann W G, van Geenen R C I, van Steenbergen L N, et al. A comprehensive evaluation of lateral unicompartmental knee arthroplasty short to mid-term survivorship, and the effect of patient and implant characteristics: an analysis of data from the Dutch Arthroplasty Register. J Arthroplasty 2020; 35(7): 1813-18. doi: 10.1016/j.arth.2020.02.027.
Van Steenbergen L N, Denissen G A W, Spooren A, Van Rooden S M, Van Oosterhout F J, Morrenhof J W, et al. More than 95% completeness of reported procedures in the population-based Dutch Arthroplasty Register. Acta Orthop 2015; 86(4): 498-505. doi: 10.3109/17453674.2015.1028307.
Dutch Arthroplasty Register. Annual report 2023. LROI. Landelijke Registratie Orthopedisch Interventies [Internet]. Available from: https://wwwlroinl/jaarrapportage/data-quality/completeness/#Overall-completeness-per-procedure.
Hajage D, Tubach F, Steg P G, Bhatt D L, De Rycke Y. On the use of propensity scores in case of rare exposure. BMC Med Res Methodol 2016; 16(1). doi: 10.1186/s12874-016-0135-1.
Baker P N, Jameson S S, Deehan D J, Gregg P J, Porter M, Tucker K. Mid-term equivalent survival of medial and lateral unicondylar knee replacement: an analysis of data from a national joint registry. J Bone Joint Surg Br 2012; 94(12): 1641-9. doi: 10.1302/0301-620X.94B12.29416.
Tay M L, Young S W, Frampton C M, Hooper G J. The lifetime revision risk of unicompartmental knee arthroplasty. Bone Joint J 2022; 104(B(6)): 672-9. doi: 10.1302/0301-620X.104B6.BJJ-2021-1744.R1.
Servien E, Merini A, Lustig S, Neyret P. Lateral uni-compartmental knee replacement: current concepts and future directions. Knee Surg Sports Traumatol Arthrosc 2013; 21: 2501-8. doi: 10.1007/s00167-013-2585-x.
van der List J P, Chawla H, Villa J C, Pearle A D. Different optimal alignment but equivalent functional outcomes in medial and lateral unicompartmental knee arthroplasty. Knee 2016; 23(6): 987-95. doi: 10.1016/j.knee.2016.08.008.
Ranawat A S, Ranawat C S, Elkus M, Rasquinha V J, Rossi R, Babhulkar S. Total knee arthroplasty for severe valgus deformity: surgical technique. J Bone Joint Surg Am 2005;87 Suppl 1(Pt 2): 271-84. doi: 10.2106/JBJS.E.00308.
Alesi D, Meena A, Fratini S, Rinaldi V G, Cammisa E, Lullini G, et al. Total knee arthroplasty in valgus knee deformity: is it still a challenge in 2021? Musculoskelet Surg 2022; 106(1): 1-8. doi: 10.1007/s12306-021-00695-x.
Witjes S, Hoorntje A, Koenraadt K L M, Kerkhoffs G M M J, Van Geenen R C I. Higher function scores and satisfaction in patients with anteromedial osteoarthritis compared with other wear patterns of the knee: 2 years after both total and unicondylar knee arthroplasties. J Knee Surg 2020; 33(7): 629-35. doi: 10.1055/s-0039-1683925.
Kennedy J A, Mohammad H R, Yang I, Mellon S J, Dodd C A F, Pandit H G, et al. Oxford domed lateral unicompartmental knee arthroplasty: ten-year survival and seven-year clinical outcome. Bone Joint J 2020; 102(8): 1033-40. doi: 10.1302/0301-620X.102B8.BJJ-2019-1330.R2.
Mazzotti A, Perna F, Golinelli D, Quattrini I, Stea S, Bordini B, et al. Preoperative valgus deformity has twice the risk of failure as compared to varus deformity after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2019; 27(9): 3041-7. doi: 10.1007/s00167-018-5331-6.
Mohammad H R, Matharu G S, Judge A, Murray D W. The mid- to long-term outcomes of the lateral domed Oxford unicompartmental knee replacement: an analysis from the National Joint Registry for England, Wales, Northern Ireland, and the Isle of Man. J Arthroplasty 2021; 36(1): 107-11. doi: 10.1016/j.arth.2020.07.031.
van Oost I, Koenraadt K L M, van Steenbergen L N, Bolder S B T, van Geenen R C I. Higher risk of revision for partial knee replacements in low absolute volume hospitals: data from 18,134 partial knee replacements in the Dutch Arthroplasty Register. Acta Orthop 2020; 91(4): 426-32. doi: 10.1080/17453674.2020.1752017.
Baker P, Jameson S, Critchley R, Reed M, Gregg P, Deehan D. Center and surgeon volume influence the revision rate following unicondylar knee replacement. J Bone Joint Surg Am 2013; 95(8): 702-9. doi: 10.2106/JBJS.L.00520.
Liddle A D, Pandit H, Judge A, Murray D W. Effect of surgical caseload on revision rate following total and unicompartmental knee replacement. J Bone Joint Surg Am 2016; 98(1): 1-8. doi: 10.2106/JBJS.N.00487.
Bunyoz K I, Gromov K, Troelsen A. Starting up a lateral unicompartmental knee arthroplasty practice: is outcome affected? J Arthroplasty 2025; 40(1): 22-27.e1. doi: 10.1016/j.arth.2024.07.005.
Berend K R, Turnbull N J, Howell R E, Lombardi A V. The current trends for lateral unicondylar knee arthroplasty. Orthop Clin North Am 2015; 46(2): 177-84. doi: 10.1016/j.ocl.2014.10.001.
Hariri M, Zahn N, Mick P, Jaber A, Reiner T, Renkawitz T, et al. Fixed-bearing is superior to mobile-bearing in lateral unicompartmental knee replacement: a retrospective matched-pairs analysis. Knee Surg Sports Traumatol Arthrosc 2023; 31(9): 3947-55. doi: 10.1007/s00167-023-07417-9.
Harrington I J. Static and dynamic loading patterns in knee joints with deformities. J Bone Joint Surg Am 1983; 65(2): 247-59. doi: 10.2106/00004623-198365020-00016.
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Copyright (c) 2026 Iris Koenraadt-van Oost, Leonieke C van Boekel, Alexander Hoorntje, Gino M M J Kerkhoffs, Paul G H Mulder, Liza N van Steenbergen, Rutger C I van Geenen
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