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Review
. 2025 Dec 8.
doi: 10.1002/ksa.70228. Online ahead of print.

Periprosthetic joint infection risk is comparable between unicompartmental knee arthroplasty to total knee arthroplasty conversion and primary total knee arthroplasty: A systematic review and meta-analysis

Maximilian Budin  1 , Matthew De Ruyter  2   3 , Zachary Christopher Lum  2 , Jürgen Slapar  1 , Jochen Gerhard Hofstaetter  4   5 , Georg Hauer  1 , Andreas Leithner  1 , Patrick Sadoghi  1
Affiliations
Review

Periprosthetic joint infection risk is comparable between unicompartmental knee arthroplasty to total knee arthroplasty conversion and primary total knee arthroplasty: A systematic review and meta-analysis

Maximilian Budin et al. Knee Surg Sports Traumatol Arthrosc. .

Abstract

Purpose: Unicompartmental knee arthroplasty (UKA) offers benefits over total knee arthroplasty (TKA), but some studies indicated higher revision rates, often involving conversion to TKA. The infection risk associated with UKA to TKA conversion compared to primary TKA is not definitively established. This systematic review and meta-analysis aimed to determine if patients undergoing UKA to TKA conversion had a higher rate of periprosthetic joint infection (PJI) compared to primary TKA.

Methods: Following preferred reporting items for systematic reviews and meta-analysis guidelines, PubMed, EMBASE and SCOPUS were searched for clinical studies comparing PJI rates in adult patients undergoing UKA to TKA conversion versus primary TKA. Data on reoperations and component use were also extracted. A random-effects model was used for the meta-analysis.

Results: Six retrospective studies involving 456 UKA to TKA conversion and 719 primary TKAs were included. No significant difference in the rate of PJI was found between the UKA to TKA conversion cohort (0.66%) and the primary TKA cohort (0.70%) (odds ratio [OR] 1.21, 95% confidence interval [CI] [0.27, 4.46]; p = 0.91). However, UKA to TKA conversion was associated with a significantly higher likelihood of requiring augments (15.6% vs. 3.9%; OR 8.71, 95% CI [1.29, 58.80]; p = 0.03) and stems (36.6% vs. 1.7%; OR 45.83, 95% CI [9.53, 220.55]; p < 0.00001), indicating greater surgical complexity.

Conclusion: Based on current literature, UKA to TKA conversion is associated with a similar surgical site infection/PJI rate compared to primary TKA. UKA to TKA conversion procedures necessitated significantly more revision-specific components.

Level of evidence: Level III.

Keywords: TKA; conversion UKA; knee arthroplasty revision; unicompartmental knee arthroplasty (UKA).

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References

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