{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T22:18:34Z","timestamp":1781648314379,"version":"3.54.5"},"reference-count":39,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2020,2,10]],"date-time":"2020-02-10T00:00:00Z","timestamp":1581292800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2020,2,10]],"date-time":"2020-02-10T00:00:00Z","timestamp":1581292800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,2,10]],"date-time":"2020-02-10T00:00:00Z","timestamp":1581292800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Orthopaedics Trust"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>The purpose of this study was to understand why the revision rate of unicompartmental knee replacement (UKR) in the National Joint Registry (NJR) is so high. Using radiographs, the appropriateness of patient selection for primary surgery, surgical technique, and indications for revision were determined. In addition, the alignment of the radiographs was assessed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Oxford UKR registered with the NJR between 2006 and 2010 and subsequently revised were identified by the NJR. A blinded review was undertaken of pre\u2010primary, post\u2010primary, and pre\u2010revision anteroposterior and lateral radiographs of a sample of 107 cases from multiple centres.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The recommended indications were satisfied in 70%, with 29% not demonstrating bone\u2010on\u2010bone arthritis. Major technical errors, likely leading to revision, were seen in 6%. Pre\u2010revision radiographs were malaligned and, therefore, difficult to interpret in 53%. No reason for revision was seen in 67%. Reasons for revision included lateral compartment arthritis (10%), tibial loosening (7%), bearing dislocation (7%), infection (6%), femoral loosening (3%), and peri\u2010prosthetic fracture (2%, one femoral, one tibial).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Only 20% of the revised UKR were implanted for the recommended indications, using appropriate surgical technique and had a mechanical problem necessitating revision. One\u2010third of primary surgeries were undertaken in patients with early arthritis, which is contraindicated. Two\u2010thirds were presumably revised for unexplained pain, which is not advised as it tends not to help the pain. This study suggests that variable and inappropriate indications for primary and revision surgery are responsible for the high rates of revision seen in registries.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of evidence<\/jats:title><jats:p>III, Therapeutic study.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00167-020-05861-5","type":"journal-article","created":{"date-parts":[[2020,2,10]],"date-time":"2020-02-10T07:02:50Z","timestamp":1581318170000},"page":"3926-3934","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":36,"title":["Most unicompartmental knee replacement revisions could be avoided: a radiographic evaluation of revised Oxford knees in the National Joint Registry"],"prefix":"10.1002","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2330-9743","authenticated-orcid":false,"given":"James A.","family":"Kennedy","sequence":"first","affiliation":[{"name":"<!--<label>1<\/label>--> Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences University of Oxford Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeya","family":"Palan","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences University of Oxford Oxford UK"},{"name":"<!--<label>2<\/label>--> Leeds Teaching Hospitals NHS Trust Leeds UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen J.","family":"Mellon","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences University of Oxford Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colin","family":"Esler","sequence":"additional","affiliation":[{"name":"<!--<label>3<\/label>--> Division of Orthopaedic Surgery, Department of Health Sciences University of Leicester Leicester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris A. F.","family":"Dodd","sequence":"additional","affiliation":[{"name":"<!--<label>4<\/label>--> Nuffield Orthopaedic Centre Oxford University Hospitals NHS Foundation Trust Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hemant G.","family":"Pandit","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences University of Oxford Oxford UK"},{"name":"<!--<label>5<\/label>--> Leeds Institute of Rheumatic and Musculoskeletal Medicine University of Leeds Leeds UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David W.","family":"Murray","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences University of Oxford Oxford UK"},{"name":"<!--<label>4<\/label>--> Nuffield Orthopaedic Centre Oxford University Hospitals NHS Foundation Trust Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,2,10]]},"reference":[{"key":"e_1_2_10_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(19)31281\u20104"},{"key":"e_1_2_10_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2012.03.022"},{"key":"e_1_2_10_4_2","doi-asserted-by":"publisher","DOI":"10.1007\/s41669\u2010017\u20100017\u20104"},{"key":"e_1_2_10_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.knee.2008.12.017"},{"key":"e_1_2_10_6_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301\u2010620X.98B10.BJJ\u20102016\u20100480.R1"},{"key":"e_1_2_10_7_2","volume-title":"Unicompartmental arthroplasty with the Oxford knee","author":"Goodfellow J","year":"2006"},{"key":"e_1_2_10_8_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301\u2010620X.92B12.25193"},{"key":"e_1_2_10_9_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301\u2010620X.91B7.21914"},{"key":"e_1_2_10_10_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301\u2010620X.99B4.BJJ\u20102016\u20101061.R1"},{"key":"e_1_2_10_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2016.12.036"},{"key":"e_1_2_10_12_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301\u2010620X.98B10.BJJ\u20102016\u20100432.R1"},{"issue":"3228","key":"e_1_2_10_13_2","first-page":"e3222","article-title":"The interaction of caseload and usage in determining outcomes of unicompartmental knee arthroplasty: a meta\u2010analysis","volume":"32","author":"Hamilton TW","year":"2017","journal-title":"J Arthroplasty"},{"key":"e_1_2_10_14_2","doi-asserted-by":"publisher","DOI":"10.2174\/1874325001812010017"},{"key":"e_1_2_10_15_2","unstructured":"HookS(2018) Radiography of the Oxford Knee.Imag Ther Pract12\u201318"},{"key":"e_1_2_10_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2014.10.015"},{"key":"e_1_2_10_17_2","doi-asserted-by":"publisher","DOI":"10.1097\/00003086-198801000-00012"},{"key":"e_1_2_10_18_2","doi-asserted-by":"publisher","DOI":"10.3109\/17453679209154722"},{"key":"e_1_2_10_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.otsr.2015.11.015"},{"key":"e_1_2_10_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(14)60419\u20100"},{"key":"e_1_2_10_21_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301\u2010620X.97B6.35155"},{"key":"e_1_2_10_22_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301\u2010620X.94B8.29372"},{"key":"e_1_2_10_23_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301\u2010620X.98B10.BJJ\u20102016\u20100474.R1"},{"key":"e_1_2_10_24_2","doi-asserted-by":"publisher","DOI":"10.4103\/ortho.IJOrtho_382_19"},{"key":"e_1_2_10_25_2","doi-asserted-by":"publisher","DOI":"10.1080\/17453674.2017.1367577"},{"key":"e_1_2_10_26_2","doi-asserted-by":"publisher","DOI":"10.1097\/00003086\u2010199610000\u201000030"},{"key":"e_1_2_10_27_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.knee.2012.10.019"},{"key":"e_1_2_10_28_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.knee.2010.08.004"},{"key":"e_1_2_10_29_2","volume-title":"15th Annual Report","author":"No authors listed","year":"2018"},{"key":"e_1_2_10_30_2","unstructured":"No authors listed (2018)Annual Report 2018.Swedish Knee Arthroplasty Register"},{"key":"e_1_2_10_31_2","unstructured":"No authors listed (2018)Annual Report.National Joint Replacement Registry: hip knee and shoulder arthroplasty. 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Mr. Dodd\u00a0and Prof. Murray report personal fees and other from Zimmer Biomet, outside the submitted work; In addition, Mr. Dodd\u00a0and Prof. Murray have various patents related to knee replacement with royalties paid. Mr. Kennedy reports grants from the Gwen Fish foundation during the conduct of the study; and an institutional grant from Zimmer\u00a0Biomet outside the submitted work.\u00a0Mr. Palan was supported by a NJR\/Royal College of Surgeons Fellowship during the study.\u00a0 A\/Prof. Esler and Dr. Mellon\u00a0report no conflicts of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"Ethical approval was sought but deemed unnecessary by the local research ethics council, as all investigations were part of routine care.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}]}}