Revision total knee arthroplasty for unexplained pain after unicompartmental knee arthroplasty: a case report

In this report, we present a case of a 64-year-old woman who underwent revision of knee arthroplasty after failed unicompartmental knee arthroplasty (UKA). She underwent UKA (Biomet Oxford Phase 3) for right localized medial knee pain at the age of 53 and the postoperative course had been uneventful. Eight years after UKA, she had right knee pain that gradually worsened. Tenderness was present over the medial femorotibial and patellofemoral (PF) joints. Plain radiograph showed small osteophytes on the intercondylar eminence and in the lateral compartment. However, these findings were not severe. Although several causes of knee pain after UKA have been reported, none of those causes were found in this case, so the diagnosis of unexplained pain was made. We performed knee arthroscopy and it revealed severe osteoarthritis of the PF joint, bone attrition and exposure of subchondral bone of the medial part of the lateral condyle together with severe synovitis. Revision surgery was performed in the same operation. The postoperative course was excellent and the severe knee pain resolved after surgery. Several registries revealed that revision for unexplained pain was more common after UKA than after total knee arthroplasty. We pointed out the possible causes of unexplained pain including pathological conditions, which were present in our case. Revision surgery may be unsuccessful if the cause of failure is not adequately considered.