There's still an art to it, and becoming an "artist" comes only from expe-
rience.
3
Revisions
One of the drawbacks of the uni is that early on it has a slightly
higher revision rate than a total knee. Part of that may be due
to the very nature of the surgery, because other parts of the knee that
were not replaced could develop arthritis or because there is less sur-
face area for fixation of the implant to the bone. If you're proficient in
arthroplasty, your revision rate after 10 years might be marginally
higher for a uni, but it's much simpler and less expensive to convert a
uni to a primary knee than to have to completely redo a total knee.
Many patients tend to be more satisfied with how a uni knee feels
compared with a total knee. A uni is a more accurate reproduction of
the kinematics of the knee; you're saving more of the native tissue and
proprioception, so it's bound to feel more natural.
4
Reimbursements
A lot of insurers, including Medicare, are eager to push unis to
an outpatient setting because they don't want to pay to admit
the patient; your reimbursement is likely to be the same regardless, so
it behooves you to do them in an ambulatory setting. The good news
is that unis are typically less involved than total knee replacements —
figure 1 to 2 hours for the surgery — and as long as you've done the
work up front to properly evaluate the candidate, you can perform
them safely and easily to maximize cost savings.
Coming full circle
Unis may have gotten a bad name several years ago when a number of
them failed prematurely, likely the result of poor patient selection,
J U N E 2 0 1 7 • O U T PA T I E N TS U R G E R Y. N E T • 1 1 7
