Abstract
Purpose
Indications for unicompartmental knee arthroplasty (UKA) vary between units. Some authors have suggested, and many surgeons believe, that medial UKA should only be performed in patients who localise their pain to the medial joint line. This is despite research showing a poor correlation between patient-reported location of pain and radiological or operative findings in osteoarthritis. The aim of this study is to determine the effect of patient-reported preoperative pain location and functional outcome of UKA at 1 and 5 years.
Methods
Preoperative pain location data were collected for 406 knees (380 patients) undergoing Oxford medial UKA. Oxford Knee Score, American Knee Society Scores and Tegner activity scale were recorded preoperatively and at follow-up; 272/406 (67 %) had pure medial pain, 25/406 (6 %) had pure anterior knee pain, and 109/406 (27 %) had mixed or generalised pain. None had pure lateral pain. The primary outcome interval is 1 year; 132/406 patients had attained 5 years by the time of analysis, and their 5-year data are presented.
Results
At 1 and 5 years, each group had improved significantly by each measure [mean ΔOKS 15.6 (SD 8.9) at year 1, 16.3 (9.3) at year 5]. There was no difference between the groups, nor between patients with and without anterior knee pain or isolated medial pain.
Conclusions
No correlation is demonstrated between preoperative pain location and outcome. We conclude that localised medial pain should not be a prerequisite to UKA and that it may be performed in patients with generalised or anterior knee pain.
Level of evidence
Therapeutic, Level II.
Similar content being viewed by others
References
Argenson JN, Komistek RD, Aubaniac JM, Dennis DA, Northcut EJ, Anderson DT, Agostini S (2002) In vivo determination of knee kinematics for subjects implanted with a unicompartmental arthroplasty. J Arthroplasty 17(8):1049–1054
Beard DJ, Pandit H, Gill HS, Hollinghurst D, Dodd CA, Murray DW (2007) The influence of the presence and severity of pre-existing patellofemoral degenerative changes on the outcome of the Oxford medial unicompartmental knee replacement. J Bone Joint Surg Br 89(12):1597–1601
Beard DJ, Pandit H, Ostlere S, Jenkins C, Dodd CA, Murray DW (2007) Pre-operative clinical and radiological assessment of the patellofemoral joint in unicompartmental knee replacement and its influence on outcome. J Bone Joint Surg Br 89(12):1602–1607
Berger RA, Meneghini RM, Sheinkop MB, Della Valle CJ, Jacobs JJ, Rosenberg AG, Galante JO (2004) The progression of patellofemoral arthrosis after medial unicompartmental replacement: results at 11 to 15 years. Clin Orthop Relat Res 428:92–99
Bert J (2008) Unicompartmental arthroplasty for unicompartmental knee arthritis. Tech Knee Surg 7(1):51–60
Breeman S, Campbell M, Dakin H, Fiddian N, Fitzpatrick R, Grant A, Gray A, Johnston L, Maclennan G, Morris R, Murray D (2011) Patellar resurfacing in total knee replacement: five-year clinical and economic results of a large randomized controlled trial. J Bone Joint Surg Am 93(16):1473–1481
Chau R, Gulati A, Pandit H, Beard DJ, Price AJ, Dodd CA, Gill HS, Murray DW (2009) Tibial component overhang following unicompartmental knee replacement—does it matter? Knee 16(5):310–313
Creamer P, Lethbridge-Cejku M, Hochberg MC (1998) Where does it hurt? Pain localization in osteoarthritis of the knee. Osteoarthr Cartil 6(5):318–323
Dawson J, Fitzpatrick R, Murray D, Carr A (1998) Questionnaire on the perceptions of patients about total knee replacement. J Bone Joint Surg Br 80(1):63–69
Deschamps G, Chol C (2011) Fixed-bearing unicompartmental knee arthroplasty. Patients’ selection and operative technique. Orthop Traumatol Surg Res 97(6):648–661
Goodfellow J, O’Connor J, Dodd CA, Murray D (2006) Unicompartmental arthroplasty with the Oxford knee, 1st edn. Oxford University Press, Oxford
Han I, Chang CB, Lee S, Lee MC, Seong SC, Kim TK (2005) Correlation of the condition of the patellar articular cartilage and patellofemoral symptoms and function in osteoarthritic patients undergoing total knee arthroplasty. J Bone Joint Surg Br 87(8):1081–1084
Hernigou P, Deschamps G (2002) Patellar impingement following unicompartmental arthroplasty. J Bone Joint Surg Am 84-A(7):1132–1137
Heyse TJ, Khefacha A, Peersman G, Cartier P (2012) Survivorship of UKA in the middle-aged. Knee 19(5):585–591
Hollinghurst D, Stoney J, Ward T, Gill HS, Newman JH, Murray DW, Beard DJ (2006) No deterioration of kinematics and cruciate function 10 years after medial unicompartmental arthroplasty. Knee 13(6):440–444
Inaba Y, Numazaki S, Koshino T, Saito T (2003) Provoked anterior knee pain in medial osteoarthritis of the knee. Knee 10(4):351–355
Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the knee society clinical rating system. Clin Orthop Relat Res 248:13–14
Kozinn SC, Scott R (1989) Unicondylar knee arthroplasty. J Bone Joint Surg Am 71(1):145–150
Munk S, Odgaard A, Madsen F, Dalsgaard J, Jorn LP, Langhoff O, Jepsen CF, Hansen TB (2011) Preoperative lateral subluxation of the patella is a predictor of poor early outcome of Oxford phase-III medial unicompartmental knee arthroplasty. Acta Orthop 82(5):582–588
Murray DW, Fitzpatrick R, Rogers K, Pandit H, Beard DJ, Carr AJ, Dawson J (2007) The use of the Oxford hip and knee scores. J Bone Joint Surg Br 89(8):1010–1014
Pandit H, Jenkins C, Gill HS, Barker K, Dodd CA, Murray DW (2011) Minimally invasive Oxford phase 3 unicompartmental knee replacement: results of 1,000 cases. J Bone Joint Surg Br 93(2):198–204
Pandit H, Jenkins C, Gill HS, Smith G, Price AJ, Dodd CA, Murray DW (2011) Unnecessary contraindications for mobile-bearing unicompartmental knee replacement. J Bone Joint Surg Br 93(5):622–628
Pynsent PB, Adams DJ, Disney SP (2005) The Oxford hip and knee outcome questionnaires for arthroplasty. J Bone Joint Surg Br 87(2):241–248
Schindler OS, Scott WN, Scuderi GR (2010) The practice of unicompartmental knee arthroplasty in the United Kingdom. J Orthop Surg (Hong Kong) 18(3):312–319
Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 198:43–49
Thompson LR, Boudreau R, Hannon MJ, Newman AB, Chu CR, Jansen M, Nevitt MC, Kwoh CK (2009) The knee pain map: reliability of a method to identify knee pain location and pattern. Arthritis Rheum 61(6):725–731
Tria A (2011) Classical patient selection for unicondylar knee arthroplasty. In: Berend KR, Cushner FD (eds) Partial knee arthroplasty: techniques for optimal outcomes. Elsevier Saunders, Philadelphia, pp 11–17
Acknowledgments
The authors would like to thank Mrs Jo Brown, Ms Jenny Ferris and Mrs Barbara Marks for their assistance with the collection of data and the assembly of the manuscript.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Liddle, A.D., Pandit, H., Jenkins, C. et al. Preoperative pain location is a poor predictor of outcome after Oxford unicompartmental knee arthroplasty at 1 and 5 years. Knee Surg Sports Traumatol Arthrosc 21, 2421–2426 (2013). https://doi.org/10.1007/s00167-012-2211-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00167-012-2211-3