Surgical Technique and Long-Term Results of Bicompartmental Reconstruction with Small Implants

Abstract

Treatment of limited osteoarthritis of the knee remains a challenging problem [1–4]. While the therapeutic goals are to alleviate pain and restore knee function [1-4], non-operative modalities, including physiotherapy, activity modification (avoiding impact activities), anti-inflammatory medications, and bracing, often provide limited pain relief and functional improvement [1–4]. Surgical management of limited arthritis of the knee can include non-prosthetic treatments such as arthroscopic debridement, meniscus transplantation, cartilage repair, high tibial osteotomy (HTO), and tibial tubercle transposition [1–6]. Arthroplasty solutions consist of unicompartmental knee arthroplasty (UKA) and conventional total knee arthroplasty (TKA) [1–6], both of which are expected to be efficient, durable and safe but should preserve the bone stock when possible [3]. TKA may offer durable and satisfying clinical and radiological results when arthritis involves the three compartments of the knee; however, it does not preserve either the bone stock or the ligaments [7, 8]. UKA is a bone- and ligament-sparing technique that can reliably restore knee kinematics and function in patients with arthritis limited to one compartment of the knee [9–12]. The outcomes of UKA have improved since its introduction more than 30 years ago due to improvements in design, indications, materials, and surgical techniques [13, 14]. The results of UKA are reportedly better when the anterior cruciate ligament (ACL) is intact [15, 16]. Similarly, outcome and kinematic studies suggest that maintaining the ACL in bi- and tri-compartmental knee arthroplasty may be advantageous in terms of survivorship [17, 18], stair climbing ability [19], patient satisfaction, and joint kinematics [9, 17, 19–22].