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History

60 Year old female patient

Bilateral knee pain for months

Bilateral knee osteoarthritis with Varus

deformity

Right knee surgical procedure 6 months

ago

Difficult weight bearing

ROM limited: right 10*-100*

left 0*-140*

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5

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Plans

Revision UKA

or revision TKA

Bone defect management

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Discussion of this case

Major problems:

1. Minimal invasive approach

2. Fixation technique

3. Indication of unicompartment knee

arthroplasty

4. Any other treatment choice

New cutting jig allow a smaller wound

like 4cm length

But, is it really improved outcome ?

Minimally invasive surgery vs conventional exposure using the Miller-Galante unicompartmental knee arthroplasty: a randomized radiostereometric study

Carlsson et al. J Arthroplasty. 2006

41 cases, randomized

Significant difference: shorter hospitalization and faster rehabilitation

No difference in clinical or radiographic results

High tibial osteotomy versus

unicompartmental joint replacement in

unicompartmental knee joint osteoarthritis:

7-10-year follow-up prospective randomised

study

Stukenborg et al. knee 2001

32 HTO / 28 UKA

More intra- and postoperative complications

after HTO

Conclusion: advanced design UKA offers better

long-term success

Early failure of minimally invasive

unicompartmental knee arthroplasty is

associated with obesity

Berend et al. CORR 2005

16/79 failures: 6 tibial loosening, 3 plateau

fracture, 4 persistent medial pain, one

progressive arthritis, and 2 sepsis

Age, gender, disease severity and implant

design not predict failure

Body mass index (BMI) > 32 did predict failure

and associated with reduce survivorship

Conversion of failed

unicompartmental knee arthroplasty

to TKA

Springer et al. CORR 2006

modes of failure: polyethylene wear

(12), femoral loosening (4) or tibial

loosening (3), and osteoarthritis

progression (3)

Major problem: bone defect

Revision total knee arthroplasty after unicompartmental femorotibial prosthesis: 54 cases

Chatain et al.

Rev Chir Orthop Reparatrice Appar Mot. 2004

Mean time to failure: 4 years

Re-revision TKA: 5 cases

Tibial bone loss more frequent

Femoral bone loss more difficult to correct

Revision TKA after UKA get better results than revision TKA after HTO or TKA

Revision of failed unicompartmental

knee arthroplasty.

McAuley et al. CORR 2001

39 revision cases (9-204 months)

30 insert wear, 9 loosening

3 re-revision TKA

Result better than TKA revision

Revision surgery after failed

unicompartmental knee

arthroplasty: a study of 35 cases

Bohm et al. J arthroplasty 2000

Failure mechanism: loosening > wear

Revision duration: 1 weeks to 11 years

(23/35 < 5 years)

6 aseptic loosening after revision TKA

Modern Unicompartmental Knee

Arthroplasty with Cement. A Three

to Ten-Year Follow-up Study

Argenson et al. JBJSA 2002

147 cases

10 years survival rate 94%

3% revision rates (2 PF progressive

OA, 1 lateral FT OA, 2 insert wear)

patient selection affect result

Results of Unicompartmental

Knee Arthroplasty at a

Minimum of Ten Years of

Follow-up Richard A. Berger, MD. JBJSA 2005

38 cases, 49 UKAs F/U > 10 years

2 revisions to TKA (PF progressive OA)

No component loose, nor osteolysis

survival rate: 98.0% ± 2.0% (10 years)

95.7% ± 4.3% (13 years)

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2 most common causes of failure:

Tibial aseptic loosening

Accelerated polyethylene wear

Suggest undercorrection of the angular

deformity precludes overstuffing the

compartment, thus minimizes

polyethylene wear

Making your next unicompartmental

knee arthroplasty last: three keys to

success

Whiteside LA. J Arthroplasty 2005

Key factors:

Alignment: Intramedullary instruments

Ligament balance: Complete

osteophyte excision

Implant fixation: excellent bone stock, avoiding

tibial overresection

Cost-effectiveness analysis of

unicompartmental knee arthroplasty

as an alternative to total knee

arthroplasty for unicompartmental

osteoarthritis

Soohoo et al. JBJSA 2006

with appropriate patient selection, the

currently available literature supports

UKA as a cost-effective alternative to

TKA for single medial knee OA

Conclusion

Patient selection: single medial

compartment disease, not inflammatory

arthritis

Prevent MIS in obesity patient

Resurfacing >> Correct alignment

It is a cost-effective treatment choice

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Dr.Sandeep Agrawal,Agrasen Hospital,Gondia MS28

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