Unicompartmental Knee Arthroplasty — Clin Ortho, October 1999
Unicompartmental Knee Arthroplasty Surgery — J Arthroplasty, October 1996
Cartier P, Sanouiller JL, Grelsamer RP, Clinique des Lilas, Paris, France
Abstract — Sixty knees in 54 patients were followed a minimum of 10 years after unicompartmental knee arthroplasty [partial knee resurfacing] surgery. Follow-up periods ranged from 10 to 18 years (average, 12 years). Two patients required arthroplasty surgery after the 10-year mark. Seven knees required revision prior to 10 years, and the 10- to 12-year survivorship for the entire cohort was 93%. Slight undercorrection of varus alignment and adequate polyethylene thickness of the tibial component appear to be important contributors to a successful outcome.
J Arthroplasty, 11(7):782-8, October 1996
Unicompartmental Knee Arthroplasty for Medial Gonarthrosis — Arch Orthop Trauma Surg, 1998
Hasegawa Y, Ooishi Y, Shimizu T, Sugiura H, Takahashi S, Ito H, Iwata H Department of Orthopaedic Surgery, Nagoya University School of Medicine, Japan
Abstract —A total of 77 knees in 60 consecutive patients were operated on for medial gonarthrosis using a cemented porous coated anatomical unicompartmental knee arthroplasty [ partial knee resurfacing]. Their average age was 71.3 years; 11 were men and 49 women. Clinically, the results in 67 knees were rated as being good to excellent, with mean preoperative and postoperative flexion of 123 and 122 degrees, respectively. No deep infections or deep venous thrombosis occurred, but there was one dislocation of the femoral component. Overall clinical and radiographic results were satisfactory in 88% at 7.0 years’ follow-up. Kaplan-Meier survivorship analysis indicated that the failure rate of unicompartmental knee arthroplasty was 12% at average follow-up. In patients aged 70 years or more, unicompartmental knee arthroplasty [partial knee resurfacing] for medial gonarthrosis should be considered an excellent alternative to high tibial osteotomy.
Arch Orthop Trauma Surg, 117(4-5):183-7, 1998
Unicompartmental Arthroplasty of the Knee J Bone Joint Surg [Br], November 1984
Inglis GS
Abstract — A retrospective review of medial compartment arthroplasty in 22 patients (22 knees) is reported. The operations were performed between 1973 and 1978. Eighty-six per cent were rated good or excellent using the knee rating system devised by the Hospital for Special Surgery, New York. Excellent or good results were achieved in six patients who had previously had a high tibial osteotomy. At the time of follow-up significant loosening had not occurred, although progression of patellofemoral disease was noted. This study supports the promising results reported for unicompartmental resurfacing arthroplasty in the elderly.
J Bone Joint Surg [Br], 66(5):682-4, November 1984
Unicompartmental Arthroplasty of the Knee — J Arthroplasty [Br], 1989
A 4.5-6-year follow-up study with a metal-backed tibial component.
Kozinn SC, Marx C, Scott RD, Brigham Women’s Hospital, Boston, Massachusetts.
Abstract — The results in the first 50 patients to receive an improved-design unicompartmental knee prosthesis [partial knee resurfacing] were reviewed after an average follow-up period of 5.5 years. The prosthesis is composed of a metal-backed polyethylene tibial component and a wide femoral surface replacement that are fixed to bone with acrylic cement. Forty-five patients with 55 unicompartmental knee arthroplasties were available for clinical study. Ninety-two percent of the knees were rated as having a good or excellent result, and 94% had lasting relief of pain. There have been no failures requiring revision. A radiographic review demonstrated that no tibial component was bordered by a complete radiolucent line. There was no subsidence or loosening of either the tibial or femoral components, and there was no instance of local osteolysis. These results, coupled with a 14-year follow-up experience with the original-design unicondylar prosthesis, encourages the authors to remain advocates of this procedure in selected patients with unicompartmental osteoarthritis.
J Arthroplasty 1989;4 Suppl:S1-10
Unicompartmental Arthroplasty of the Knee — Clin Orthop [Br], July 1988
Larsson SE, Larsson S, Lundkvist S Department of Orthopaedic Surgery, University Hospital, Linkoping, Sweden.
Abstract — A consecutive prospective series of 102 knees (90 patients) had unicompartmental knee arthroplasty [partial knee resurfacing] between 1973 and 1979 for gonarthrosis, Stages 2-4. Total clinical and roentgenographical evaluation was undertaken after 5-11 years (mean, 8.1 years) and included all 75 surviving patients. There were no early revisions but five late revisions; two due to loosening, one late infection, one instability, and one intractable pain. Complete loosening occurred in four patients (4%). Functional score (Hospital for Special Surgery method) averaged 77 points (preoperative, 43) with no tendency of deterioration with time. Loss of initially achieved alignment was generally associated with bone resorption around the tibial component. Minor arthritic changes of the non-operated compartment occurred in 4% of the cases.
Clin Orthop (232):174-81 July 1988
Unicompartmental Arthroplasty of the Knee — Clin Orthop [Br], January 1988
Marmor L
Abstract — In the past decade, two concepts have caused considerable controversy in orthopedic surgery of the knee. Some orthopedic centers contend that osteotomy of the tibia is the procedure of choice for unicompartmental gonarthrosis of the knee and resist the concept of unicompartmental arthroplasty. The other concept is that if unicompartmental arthroplasty [ partial knee resurfacing] is necessary, the entire joint should be replaced, since the uninvolved compartment may develop arthritis in the future. This concept is illogical and contrary to the basic orthopedic principle of preserving normal structures whenever possible. It is obvious that joint replacements may not last the life of the patient and the need for revision must be considered; therefore, the original procedure should preserve as much bone stock as possible. The purposes of this review of unicompartmental replacement are to resolve these questions with data on long-term results of unicompartmental arthroplasty [partial knee resurfacing] compared with data on high tibial osteotomy, to evaluate the cause of failures, and to improve future results. Eighty-seven consecutive unicompartmental arthroplasties [partial knee resurfacing] were performed between November 1972 and April 1976. There were 60 knees available for study, with a minimum ten-year (average, 11-year) follow-up period. The results were evaluated using the Hospital for Special Surgery rating system, with 30 excellent, eight good, four fair, and 18 poor results. Seventy percent of the patients had satisfactory results, and pain relief was accomplished in 86.6% of patients. Of the 21 failures, the majority was due to material or technical problems and improper selection of the patients.
Clinical Orthopaedics, January 1988(226):14-20
The Oxford medial unicompartimental arthroplasty — The Journal of Bone and Joint Surgery [Br], 1998
Murray D.W., Goodfelow J.W., O’Connor J.J. From the Nuffield Orthopedic Centre, Oxford, England
Abstract — Retrieval studies have shown that the use of fully congruent meniscal bearings reduces wear in knee replacements. We report the outcome of 143 knees with anteromedial osteoarthritis and normal anterior cruciate ligaments treated by unicompartmental arhroplasty [partial knee resurfacing] using fully congruous mobile polyethylene bearings. We reviewed 109 patients, mean time since operation was 7.6 years (maximum 13.8). We established the status of all but one knee. There had been five revision operations giving a cumulative prosthetic survival rate at ten years (33 knees at risk) of 98%. Considering the knee lost to follow-up as a failure, the ‘worst-case’ survival rate was 97%. No failures were due to polyethylene wear or aseptic loosening of the tibial component. One bearing which dislocated at four years was reduced by closed manipulation. The ten-year survival rate is the best of those reported for unicompartmental arthroplasty [partial knee resurfacing] and not significantly different from the best rates for total knee replacement.
The Journal of Bone and Joint Surgery (Br),1998:no 80-B, pag 983-9
Unicompartimental or total knee replacement?) — The Journal of Bone and Joint Surgery [Br], 1998
John H Newman MD, Christopher E Ackroyd MD, Nilen A. Shah MD From the Avon Orthopedic Centre, Bristol, England
Abstract — We randomised 102 knees suitable for a unicompartmental replacement [partial knee resurfacing] to receive either a unicompartmental (UKR) or total knee replacement (TKR) after arthrotomy. Both groups were well matched with a predominance of females and a mean age of 69 years. Patients in the UKR group showed less perioperative morbidity, but regained knee movement more rapidly and were discharged from hospital sooner. At five years, two PKRs and one TKR had been revised; another TKR was radiologically loose. All other knees appeared to be clinically and radiologically sound. Pain relief was good in both groups but the number of knees able to flex >120′ was significantly higher in the PKR group (p < 0.001) and there were more excellent results in this group. Our findings have shown that PKR gives better results than TKR and that this superiority is maintained for at least five years.
The Journal of Bone and Joint Surgery (Br),1998 , no 80-B, pgs 862-5
Unicompartimental arthroplasty — The Journal of Arthroplasty, 1998
AU: Owen B. Tabor, Jr, MD and Owen B. Tabor, MD
Abstract — From Department of Orthopedic Surgery, Carolinas Medical Center, Charlotte, North Carolina Seventy-three consecutive unicompartimental knee arthroplasties (PKRs – [partial knee resurfacing] ) using a Marmor-style non-metal-backed cemented tibial component were perfomed from 1975 to 1990. Sixty-seven knees (58 patients) were evaluated with minimum 5 year follow-up (mean, 9.7 years; range 5-20 years). Knee rating and patient function were assessed using the updated Knee Society scoring system.Survivorship and functional outcome were not affected by body habitus, age, gender, or tibial component thickness. PKR’s offers long term relief of symptoms and excellent knee function in a high percentage of carefully selected patients with single compartiment gonarthrosis. KEY WORDS: unicompartimental knee arthroplasty , gonarthrosis, obesity, long-term follow-up.
The Journal of Arthroplasty, Vol 13, no 4, 1998
Rougraff BT, Heck DA, Gibson AE
Abstract — Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis 46202. An historical prospective study was performed to compare two surgical management alternatives in the treatment of patients with knee arthritis. There were 120 unicompartmental and 81 total knee arthroplasties in 98 and 66 patients, respectively. All living patients were available for follow-up observation, and survivorship data on all arthroplasties were obtained. The average follow-up interval was 78 months (range, eight-162 months) in the unicompartmental series and 68 months (range, two- 186 months) in the total group. Patients receiving the unicompartmental arthroplasty were treated with nonmetal-backed polyethylene tibial components. Prosthetic survivorship was 92% at ten years in the unicompartmental patient group. There were no statistically significant differences in aseptic loosening between these two patient groups. In appropriately selected patients unicompartmental arthroplasty was associated with better range of motion and ambulatory function than patients being treated with total knee replacement.
Clinical Orthopaedics, (367):50-60, October 1999
Scott RD, Santore RF
Abstract — Unicompartmental knee replacement [partial knee resurfacing] is an attractive concept that offers several potential advantages over bicompartmental or total replacement, including preservation of bone stock, of the anterior and posterior cruciate ligaments, of the patellofemoral joint, and of the normal opposite compartment. Of our first 100 consecutive knees that had unicompartmental arthroplasty [ partial knee resurfacing] for osteoarthritis and were followed for two to six years (average, three and one-half years), eighty-eight were medial and twelve were lateral replacements. The ages of the patients at the time of operation ranged from forty-six to eighty-five years, with an average age of seventy-one years. At follow-up, pain relief was good to excellent in 92 per cent of the knees. The average amount of flexion was 114 degrees (range, 90 to 140 degrees); one-half of the knees had at least 120 degrees of flexion. The average flexion contracture was 1 degree. There were no infections and no peroneal palsies. At the time of writing, three failures had required revision. Radiolucent lines at the bone-cement interface were present around 8 per cent of the femoral components and 27 per cent of the tibial components. Two femoral components subsided in obese patients. There was no tibial loosening in the series. The most common complications, pes anserinus bursitis, occurred in 12 per cent of the knees and was treated satisfactorily by injection of local anesthetics and steroids. Surgical technique must be precise to prevent subluxation of the tibia on the femur due to either improper positioning of the components or too tight a fit (too much pressure) between them.
J Bone Joint Surg [Am], 63(4):536-44, April 1981
Unicompartimental Knee Arthroplasty. — Clinical Orthopedics and Related Research, no 271, October 1991
Richard D Scott MD, Andrew G Cobb MB,BS,FRCS, Frederick G McQueary MD, Thomas S Thornhill MD
Abstract — From Brigham and Women’s Hospital, Boston, Massachusetts One hundred consecutive unicondylar knee arthroplasties [partial knee resurfacing] were reviewed after eight to 12 years of follow-up evaluation. Survivorship analysis revealed 90% survivorship of the prostheses at nine years, 85% at ten years, and 82% at 11 years. Sixty-four knees in 5l patients were studied clinically and roentgenographically at final follow-up study. Of these, 87% had no significant pain. The average knee flexion was 115 degrees. Anatomic knee alignment averaged 3 degrees of valgus for the knees with preoperative varus alignment and 8 degrees of valgus for knees with preoperative valgus alignment. Fifteen percent of these elderly patients (mean age, 80 years) used a cane outdoors, but only 8% because of their knee. Sixty percent had radiolucent lines at the tibial bone-cement interface, and these lines were incomplete in 96% of cases.
Clinical Orthopedics and Related Research, no 271, October 1991
Unicompartimental knee replacement. — Clinical Orthopedics, October 1999
Squire MW, Callaghan JJ, Goetz DD, Sullivan PM, Johnston RC Department of Orthopaedic Surgery, University of Iowa College of Medicine, Iowa City 52242, USA.
Abstract — One hundred forty cemented unicompartmental knee replacements [partial knee resurfacing] were inserted in 103 patients between 1975 and 1982. Fifty-two patients were women and 51 were men. One hundred twenty-five were medial compartment knee replacements and 15 were lateral knee replacements. At minimum 15 year follow-up 34 patients with 48 knee replacements were living; only four patients with four knee replacements were lost to follow-up. Average preoperative and final follow-up Hospital for Special Surgery knee scores were 57 and 82 points, respectively for the knees of living patients. Average preoperative and final follow-up Knee Society clinical and Knee Society functional scores were 31 and 42, and 85 and 71 points, respectively. For all knees, 10.2% (14 knees) were revised [4.4% (six knees) for tibial loosening, 5.1% (seven knees) for disease progression, and .7% (one knee) for pain]. For patients living 15 years, 12.5% (six knees) were revised [2.1% (one knee) for tibial loosening, and 10.4% (five knees) for disease progression]. Revision for failure of fixation of these unicompartmental replacements was comparable with that reported for fixed bearing total knee replacement. Disease progression (46%; 62 of 136 knees) and tibial subsidence with wear (10.4%; 15 of 136 knees, five of which required revision) were the major long term problems in this group of patients.
Clinical Orthopaedics, (367):61-72 , October 1999
