Medial Unicompartmental Arthroplasty of the Knee

Jason M. Jennings, MD, DPT; Lindsay T. Kleeman-Forsthuber, MD; Michael P. Bolognesi, MD

Disclosures

J Am Acad Orthop Surg. 2019;27(5):166-176. 

In This Article

Abstract and Introduction

Abstract

Indications for medial unicompartmental knee arthroplasty (UKA) have expanded over the past two decades. Proposed advantages include faster recovery, improved kinematics, and better functional outcomes compared with total knee arthroplasty (TKA) in age-matched control subjects. A focused preoperative examination and imaging is essential to identify appropriate surgical candidates. No difference has been demonstrated between fixed- and mobile-bearing implants for implant survivorship or patient-reported outcomes. The most common reasons for conversion to a TKA are aseptic loosening and progression of osteoarthritis. Ten-year survival for UKA in cohort studies has shown to be >90% with outcomes after conversion to TKA being similar to outcomes for revision TKA. Registries have consistently shown lower implant survival for UKA compared with that for TKA, which is likely secondary to use of several different implants by surgeons of varying levels of experience. UKA has the potential to be a cost-effective alternative to TKA in certain patient populations when performed at high-volume centers with advanced surgical techniques.

Introduction

Unicompartmental knee arthroplasty (UKA) is an attractive alternative to total knee arthroplasty (TKA) for patients with isolated medial knee arthritis. UKA offers several potential advantages over TKA including less-invasive surgical exposure, preservation of native bone stock, retention of cruciate ligaments, lower perioperative morbidity,[1] enhanced postoperative recovery,[1,2] and improved patient satisfaction.[2,3] In addition, biomechanics of UKA more closely resembles native knee function with improved dynamic proprioception and postural control compared with that of TKA.[4] Recent studies have demonstrated the cost-effectiveness when UKA is performed in the appropriate patient population.[5] In addition, UKA is associated with less morbidity and mortality compared with TKA.[2] With improved surgical technique and promising midterm outcomes, UKA use has great potential to increase over the next few decades.

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