Skip to main content
SpringerLink
Log in

Unicompartmental knee arthroplasty in patients over 75 years: a definitive solution?

  • Knee Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

The purpose of this study was to perform a mid-long-term clinical and radiographic evaluation of the results obtained in patients older than 75 years treated with minimally invasive unicompartmental knee arthroplasty (UKA). The hypothesis was that UKA is a viable solution for the definitive treatment of localized disease in this age group, with good results and a low failure rate.

Methods

An all-poly tibial component UKA was applied with a minimally invasive technique. Sixty-seven knees in patients with a minimum age of 75 years were evaluated at mean 9 years’ follow-up. The Oxford knee score, Knee Society Score, WOMAC score, Visual Analogue Scale (VAS) for pain self-assessment and range of motion (ROM) were determined, as well as weight-bearing antero-posterior and laterolateral radiographs.

Results

All clinical scores, as well as VAS and ROM, improved significantly at 9-year follow-up, and the outcome was considered good or excellent in 92.6 % of the patients. Radiographic results showed that both tibial plateau angle and posterior tibial slope angles were maintained, whereas femoro-tibial angle was significantly changed at follow-up. Further analysis showed no significant correlation between clinical scores and body mass index, whereas the clinical outcome was correlated with the ROM obtained. Only two failures and one major post-operative complication were observed.

Conclusions

UKA is a viable option for treating unicompartmental knee osteoarthritis. With the proper indications and an accurate technique UKA may be indicated also in very elderly patients with reduced complications and morbidity, and excellent survivorship.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Bruni D, Iacono F, Raspugli G, Zaffagnini S, Marcacci M (2012) Is unicompartmental arthroplasty an acceptable option for spontaneous osteonecrosis of the knee? Clin Orthop Relat Res 470(5):1442–1451

    Article  PubMed  PubMed Central  Google Scholar 

  2. Bruni D, Iacono F, Russo A, Zaffagnini S, Marcheggiani Muccioli GM, Bignozzi S, Bragonzoni L, Marcacci M (2010) Minimally invasive unicompartmental knee replacement: retrospective clinical and radiographic evaluation of 83 patients. Knee Surg Sports Traumatol Arthrosc 18(6):710–717

    Article  PubMed  Google Scholar 

  3. Newman J, Pydisetty RV, Ackroyd C (2009) Unicompartmental or total knee replacement: the 15-year results of a prospective randomised controlled trial. J Bone Joint Surg Br 91(1):52–57

    Article  PubMed  CAS  Google Scholar 

  4. Pandit H, Jenkins C, Gill HS, Barker K, Dodd CA, Murray DW (2011) Minimally invasive Oxford phase 3 unicompartmental knee replacement: results of 1000 cases. J Bone Joint Surg Br 93(2):198–204

    Article  PubMed  CAS  Google Scholar 

  5. Suzuki T, Ryu K, Kojima K, Iriuchishima T, Saito S, Nagaoka M, Tokuhashi Y (2015) Evaluation of spacer block technique using tensor device in unicompartmental knee arthroplasty. Arch Orthop Trauma Surg 135(7):1011–1016

    Article  PubMed  Google Scholar 

  6. Griffin T, Rowden N, Morgan D, Atkinson R, Woodruff P, Maddern G (2007) Unicompartmental knee arthroplasty for the treatment of unicompartmental osteoarthritis: a systematic study. ANZ J Surg 77(4):214–221

    Article  PubMed  Google Scholar 

  7. Newman JH, Ackroyd CE, Shah NA (1998) Unicompartmental or total knee replacement? Five-year results of a prospective, randomised trial of 102 osteoarthritic knees with unicompartmental arthritis. J Bone Joint Surg Br 80(5):862–865

    Article  PubMed  CAS  Google Scholar 

  8. Robertsson O, Borgquist L, Knutson K, Lewold S, Lidgren L (1999) Use of unicompartmental instead of tricompartmental prostheses for unicompartmental arthrosis in the knee is a cost-effective alternative. 15,437 primary tricompartmental prostheses were compared with 10,624 primary medial or lateral unicompartmental prostheses. Acta Orthop Scand 70(2):170–175

    Article  PubMed  CAS  Google Scholar 

  9. Ackroyd CE, Whitehouse SL, Newman JH, Joslin CC (2002) A comparative study of the medial St Georgsled and kinematic total knee arthroplasties. Ten-year survivorship. J Bone Joint Surg Br 84(5):667–672

    Article  PubMed  CAS  Google Scholar 

  10. Weale AE, Murray DW, Newman JH, Ackroyd CE (1999) The length of the patellar tendon after unicompartmental and total knee replacement. J Bone Joint Surg Br 81(5):790–795

    Article  PubMed  CAS  Google Scholar 

  11. Parratte S, Pauly V, Aubaniac JM, Argenson JN (2012) No long-term difference between fixed and mobile medial unicompartmental arthroplasty. Clin Orthop Relat Res 470(1):61–68

    Article  PubMed  PubMed Central  Google Scholar 

  12. Sierra RJ, Kassel CA, Wetters NG, Berend KR, Della Valle CJ, Lombardi AV (2013) Revision of unicompartmental arthroplasty to total knee arthroplasty: not always a slam dunk! J Arthroplasty 28(8 Suppl):128–132

    Article  PubMed  Google Scholar 

  13. Argenson JN, Parratte S, Flecher X, Aubaniac JM (2007) Unicompartmental knee arthroplasty: technique through a mini-incision. Clin Orthop Relat Res 464:32–36

    PubMed  Google Scholar 

  14. Joshi AB, Markovic L, Gill G (2003) Knee arthroplasty in octogenarians: results at 10 years. J Arthroplasty 18(3):295–298

    Article  PubMed  Google Scholar 

  15. Zicat B, Rorabeck CH, Bourne RB, Devane PA, Nott L (1993) Total knee arthroplasty in the octogenarian. J Arthroplasty 8(4):395–400

    Article  PubMed  CAS  Google Scholar 

  16. Birdsall PD, Hayes JH, Cleary R, Pinder IM, Moran CG, Sher JL (1999) Health outcome after total knee replacement in the very elderly. J Bone Joint Surg Br 81(4):660–662

    Article  PubMed  CAS  Google Scholar 

  17. Hosick WB, Lotke PA, Baldwin A (1994) Total knee arthroplasty in patients 80 years of age and older. Clin Orthop Relat Res 299:77–80

    PubMed  Google Scholar 

  18. Ankersley WS, Hungerford DS (1995) Total knee arthroplasty in the very aged. Clin Orthop Relat Res 316:45–49

    Google Scholar 

  19. Gill GS, Mills D, Joshi AB (2003) Mortality following primary total knee arthroplasty. J Bone Joint Surg Am 85(3):432–435

    PubMed  Google Scholar 

  20. Kreder HJ, Berry GK, McMurtry IA, Halman SI (2005) Arthroplasty in the octogenarian: quantifying the risks. J Arthroplasty 20(3):289–293

    Article  PubMed  Google Scholar 

  21. Pagnano MW, McLamb LA, Trousdale RT (2004) Total knee arthroplasty for patients 90 years of age and older. Clin Orthop Relat Res 418:179–183

    Article  PubMed  Google Scholar 

  22. Perka C, Arnold U, Buttgereit F (2000) Influencing factors on perioperative morbidity in knee arthroplasty. Clin Orthop Relat Res 378:183–191

    Article  PubMed  Google Scholar 

  23. Miner AL, Lingard EA, Wright EA, Sledge CB, Katz JN; Kinemax Outcomes Group (2003) Knee range of motion after total knee arthroplasty: how important is this as an outcome measure? J Arthroplasty 18(3):286–294

    Article  Google Scholar 

  24. Berger RA, Meneghini RM, Jacobs JJ, Sheinkop MB, Della Valle CJ, Rosenberg AG, Galante JO (2005) Results of unicompartmental knee arthroplasty at a minimum of ten years of follow-up. J Bone Joint Surg Am 87(5):999–1006

    Article  PubMed  Google Scholar 

  25. Marya S, Thukral R (2009) Unicompartmental knee arthroplasty for tricompartment osteoarthritis in octogenarians. Indian J Orthop 43(4):361–366

    Article  PubMed  PubMed Central  Google Scholar 

  26. Sah AP, Springer BD, Scott RD (2006) Unicompartmental knee arthroplasty in octogenarians: survival longer than the patient. Clin Orthop Relat Res 451:107–112

    Article  PubMed  Google Scholar 

  27. Amin AK, Patton JT, Cook RE, Gaston M, Brenkel IJ (2006) Unicompartmental or total knee arthroplasty?: results from a matched study. Clin Orthop Relat Res 451:101–106

    Article  PubMed  Google Scholar 

  28. Yang KY, Wang MC, Yeo SJ, Lo NN (2003) Minimally invasive unicondylar versus total condylar knee arthroplasty–early results of a matched-pair comparison. Singapore Med J 44(11):559–562

    PubMed  CAS  Google Scholar 

  29. Stukenborg-Colsman C, Wirth CJ, Lazovic D, Wefer A (2001) High tibial osteotomy versus unicompartmental joint replacement in unicompartmental knee joint osteoarthritis: 7-10-year follow-up prospective randomised study. Knee 8(3):187–194

    Article  PubMed  CAS  Google Scholar 

  30. Gioe TJ, Novak C, Sinner P, Ma W, Mehle S (2007) Knee arthroplasty in the young patient: survival in a community registry. Clin Orthop Relat Res 464:83–87

    PubMed  Google Scholar 

  31. Maier MW, Kuhs F, Streit MR, Schuhmacher P, Walker T, Ewerbeck V, Gotterbarm T (2015) Unicompartmental knee arthroplasty in patients with full versus partial thickness cartilage loss (PTCL): equal in clinical outcome but with higher reoperation rate for patients with PTCL. Arch Orthop Trauma Surg 135(8):1169–1175

    Article  PubMed  Google Scholar 

  32. O’Rourke MR, Gardner JJ, Callaghan JJ, Liu SS, Goetz DD, Vittetoe DA, Sullivan PM, Johnston RC (2005) The John Insall Award: unicompartmental knee replacement: a minimum twenty-one-year followup, end-result study. Clin Orthop Relat Res 440:27–37

    Article  PubMed  Google Scholar 

  33. Bachmann M, Bolliger L, Ilchmann T, Clauss M (2014) Long-term survival and radiological results of the Duracon™ total knee arthroplasty. Int Orthop 38(4):747–752

    Article  PubMed  PubMed Central  Google Scholar 

  34. Feng B, Weng X, Lin J, Jin J, Wang W, Qiu G (2013) Long-term follow-up of cemented fixed-bearing total knee arthroplasty in a Chinese population: a survival analysis of more than 10 years. J Arthroplasty 28(10):1701–1706

    Article  PubMed  Google Scholar 

  35. Gøthesen O, Espehaug B, Havelin L, Petursson G, Lygre S, Ellison P, Hallan G, Furnes O (2013) Survival rates and causes of revision in cemented primary total knee replacement: a report from the Norwegian Arthroplasty Register 1994-2009. Bone Joint J 95(5):636–642

    Article  PubMed  Google Scholar 

  36. Deshmukh RV, Scott RD (2001) Unicompartmental knee arthroplasty: long-term results. Clin Orthop Relat Res 392:272–278

    Article  PubMed  Google Scholar 

  37. Squire MW, Callaghan JJ, Goetz DD, Sullivan PM, Johnston RC (1999) Unicompartmental knee replacement. A minimum 15 year followup study. Clin Orthop Relat Res 367:61–72

    PubMed  Google Scholar 

  38. W-Dahl A, Robertsson O, Lidgren L, Miller L, Davidson D, Graves S (2010) Unicompartmental knee arthroplasty in patients aged less than 65. Acta Orthop 81(1):90–94

    Article  PubMed  PubMed Central  Google Scholar 

  39. Bruni D, Akkawi I, Iacono F, Raspugli GF, Gagliardi M, Nitri M, Grassi A, Zaffagnini S, Bignozzi S, Marcacci M (2013) Minimum thickness of all-poly tibial component unicompartmental knee arthroplasty in patients younger than 60 years does not increase revision rate for aseptic loosening. Knee Surg Sports Traumatol Arthrosc 21(11):2462–2467

    Article  PubMed  Google Scholar 

  40. Heyse TJ, Tucker SM, Rajak Y, Kia M, Lipman JD, Imhauser CW, Westrich GH (2015) Frontal plane stability following UKA in a biomechanical study. Arch Orthop Trauma Surg 135(6):857–865

    Article  PubMed  Google Scholar 

  41. Ettinger M, Zoch JM, Becher C, Hurschler C, Stukenborg-Colsman C, Claassen L, Ostermeier S, Calliess T (2015) In vitro kinematics of fixed versus mobile bearing in unicondylar knee arthroplasty. Arch Orthop Trauma Surg 135(6):871–877

    Article  PubMed  Google Scholar 

  42. Cartier P, Cheaib S (1987) Unicondylar knee arthroplasty. 2-10 years of follow-up evaluation. J Arthroplasty 2(2):157–162

    Article  PubMed  CAS  Google Scholar 

  43. Argenson JN, Chevrol-Benkeddache Y, Aubaniac JM (2002) Modern unicompartmental knee arthroplasty with cement: a three to ten-year follow-up study. J Bone Joint Surg Am 84(12):2235–2239

    PubMed  Google Scholar 

  44. Mullaji AB, Sharma A, Marawar S (2007) Unicompartmental knee arthroplasty: functional recovery and radiographic results with a minimally invasive technique. J Arthroplasty 2(4 Suppl 1):7–11

    Article  Google Scholar 

  45. Hernigou P, Deschamps G (2004) Posterior slope of the tibial implant and the outcome of unicompartmental knee arthroplasty. J Bone Joint Surg Am 86(3):506–511

    PubMed  Google Scholar 

  46. Patil S, Colwell CW Jr, Ezzet KA, D’Lima DD (2005) Can normal knee kinematics be restored with unicompartmental knee replacement? J Bone Joint Surg Am 87(2):332–338

    Article  PubMed  Google Scholar 

  47. Cavaignac E, Lafontan V, Reina N, Pailhé R, Wargny M, Laffosse JM, Chiron P (2013) Obesity has no adverse effect on the outcome of unicompartmental knee replacement at a minimum follow-up of seven years. Bone Joint J. 95(8):1064–1068

    Article  PubMed  Google Scholar 

  48. Kuipers BM, Kollen BJ, Bots PC, Burger BJ, van Raay JJ, Tulp NJ, Verheyen CC (2010) Factors associated with reduced early survival in the Oxford phase III medial unicompartment knee replacement. Knee 17(1):48–52

    Article  PubMed  Google Scholar 

  49. Naal FD, Neuerburg C, Salzmann GM, Kriner M, von Knoch F, Preiss S, Drobny T, Munzinger U (2009) Association of body mass index and clinical outcome 2 years after unicompartmental knee arthroplasty. Arch Orthop Trauma Surg 129(4):463–468

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. 2 nd Orthopaedics and Traumatologic Clinic, Rizzoli Orthopaedic Institute, Via Pupilli 1, 40136, Bologna, Italy

    Francesco Iacono, Giovanni Francesco Raspugli, Ibrahim Akkawi, Danilo Bruni, Giuseppe Filardo, Mirco Lo Presti, Tommaso Bonanzinga & Maurilio Marcacci

  2. Orthopaedics and Traumatology Department, SANKO University-Private Sani Konukoglu Hospital, Gaziantep, Turkey

    Aydin Budeyri

  3. Dipartimento di Scienze Biomediche e Neuromotorie-DIBINEM, Univeristà di Bologna, Bologna, Italy

    Laura Bragonzoni

Authors
  1. Francesco Iacono
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Giovanni Francesco Raspugli
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ibrahim Akkawi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Danilo Bruni
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Giuseppe Filardo
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Aydin Budeyri
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Laura Bragonzoni
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Mirco Lo Presti
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Tommaso Bonanzinga
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Maurilio Marcacci
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ibrahim Akkawi.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Iacono, F., Raspugli, G.F., Akkawi, I. et al. Unicompartmental knee arthroplasty in patients over 75 years: a definitive solution?. Arch Orthop Trauma Surg 136, 117–123 (2016). https://doi.org/10.1007/s00402-015-2323-6

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-015-2323-6

Keywords

Search

Navigation