Clinical Orthopaedics and Related Research®

, Volume 470, Issue 1, pp 84–90 | Cite as

Unicompartmental Versus Total Knee Arthroplasty Database Analysis: Is There a Winner?

  • Matthew C. Lyons
  • Steven J. MacDonaldEmail author
  • Lyndsay E. Somerville
  • Douglas D. Naudie
  • Richard W. McCalden
Symposium: Papers Presented at the Annual Meetings of The Knee Society



TKA and unicompartmental knee arthroplasty (UKA) are both utilized to treat unicompartmental knee arthrosis. While some surgeons assume UKA provides better function than TKA, this assumption is based on greater final outcome scores rather than on change in scores and many patients with UKA have higher preoperative scores.


We therefore asked whether TKA would demonstrate (1) better change in clinical outcome scores from preoperative to postoperative states and (2) better survivorship than UKA.


We evaluated 4087 patients with 5606 TKAs and 179 patients with 279 UKAs performed between 1978 and 2009. Patients with TKA were older and heavier than patients with UKA (mean age, 68 versus 66 years; mean BMI, 32 versus 29). We compared preoperative, latest postoperative, and change in Knee Society Clinical Rating System (KSCRS), SF-12, and WOMAC scores. Minimum followup was 2 years (UKA: mean, 7 years; range, 2.0–23 years; TKA: mean, 6.5 years; range, 2.0–33 years). Preoperative outcome measure scores (WOMAC, SF-12, KSCRS) were higher in the UKA group.


Patients with UKA had higher postoperative KSCRS and SF-12 mental scores. Changes in score for all WOMAC domains were similar between groups. Total KSCRS changes in score were similar between groups, although patients with TKA had higher knee scores (49 versus 43) but lower function scores than UKA (21 versus 26). Cumulative revision rate was higher for UKA than for TKA (13% versus 7%). Kaplan-Meier survivorship at 5 and 10 years was 95% and 90%, respectively, for UKA and 98% and 95%, respectively, for TKA.


While patients with UKA had higher pre- and postoperative scores than patients with TKA, the changes in scores were similar in both groups and survival appeared higher in patients with TKA.

Level of Evidence

Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.


Unicompartmental Knee Arthroplasty Knee Score Postoperative Score Medial Parapatellar Approach Clinical Outcome Score 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The authors thank Drs Robert Bourne and Jim McAuley for their guidance, leadership, and words of wisdom.


  1. 1.
    Abdeen AR, Collen SB, Vince KG. Fifteen-year to 19-year follow-up of the Insall-Burstein-1 total knee arthroplasty. J Arthroplasty. 2010;25:173–178.PubMedCrossRefGoogle Scholar
  2. 2.
    Ackroyd CE, Whitehouse SL, Newman JH, Joslin CC. A comparative study of the medial Sled and Kinematic total knee arthroplasties: ten-year survivorship. J Bone Joint Surg Br. 2002;84:667–672.PubMedCrossRefGoogle Scholar
  3. 3.
    Aglietti P, Buzzi R, De Felice R, Giron F. The Insall-Burstein total knee replacement in osteoarthritis: a 10-year minimum follow-up. J Arthroplasty. 1999;14:560–565.PubMedCrossRefGoogle Scholar
  4. 4.
    Akizuki S, Mueller JK, Horiuchi H, Matsunaga D, Shibakawa A, Komistek RD. In vivo determination of kinematics for subjects having a Zimmer Unicompartmental High Flex Knee System. J Arthroplasty. 2009;24:963–971.PubMedCrossRefGoogle Scholar
  5. 5.
    Amin AK, Patton JT, Cook RE, Gaston M, Brenkel IJ. Unicompartmental or total knee arthroplasty? Results from a matched study. Clin Orthop Relat Res. 2006;451:101–106.PubMedCrossRefGoogle Scholar
  6. 6.
    Argenson JN, Chevrol-Benkeddache Y, Aubaniac JM. Modern unicompartmental knee arthroplasty with cement: a three to ten-year follow-up study. J Bone Joint Surg Am. 2002;84:2235–2239.PubMedGoogle Scholar
  7. 7.
    Australian Orthopaedic Association National Joint Replacement Registry. Annual Report. Adelaide, Australia: AOA; 2010. Available at: Accessed March 11, 2011.
  8. 8.
    Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988;15:1833–1840.PubMedGoogle Scholar
  9. 9.
    Colizza WA, Insall JN, Scuderi GR. The posterior stabilized total knee prosthesis: assessment of polyethylene damage and osteolysis after a ten-year-minimum follow-up. J Bone Joint Surg Am. 1995;77:1713–1720.PubMedGoogle Scholar
  10. 10.
    Deshmukh RV, Scott RD. Unicompartmental knee arthroplasty: long-term results. Clin Orthop Relat Res. 2001;392:272–278.PubMedCrossRefGoogle Scholar
  11. 11.
    Diduch DR, Insall JN, Scott WN, Scuderi GR, Font-Rodriguez D. Total knee replacement in young, active patients: long-term follow-up and functional outcome. J Bone Joint Surg Am. 1997;79:575–582.PubMedGoogle Scholar
  12. 12.
    Dudley TE, Gioe TJ, Sinner P, Mehle, S. Registry outcomes of unicompartmental knee arthroplasty revisions. Clin Orthop Relat Res. 2008;466:1666–1670.PubMedCrossRefGoogle Scholar
  13. 13.
    Emerson RH Jr, Higgins LL. Unicompartmental knee arthroplasty with the Oxford prosthesis in patients with medial compartment arthritis. J Bone Joint Surg Am. 2008;90:118–122.PubMedCrossRefGoogle Scholar
  14. 14.
    Emmerson KP, Moran CG, Pinder IM. Survivorship analysis of the Kinematic Stabilizer total knee replacement: a 10- to 14-year follow-up. J Bone Joint Surg Br. 1996;78:441–445.PubMedGoogle Scholar
  15. 15.
    Epinette JA, Manley MT. Hydroxyapatite-coated total knee replacement: clinical experience at 10 to 15 years. J Bone Joint Surg Br. 2007;89:34–38.PubMedGoogle Scholar
  16. 16.
    Fetzer GB, Callaghan JJ, Templeton JE, Goetz DD, Sullivan PM, Kelley SS. Posterior cruciate-retaining modular total knee arthroplasty: a 9- to 12-year follow-up investigation. J Arthroplasty. 2002;17:961–966.PubMedCrossRefGoogle Scholar
  17. 17.
    Font-Rodriguez DE, Scuderi GR, Insall JN. Survivorship of cemented total knee arthroplasty. Clin Orthop Relat Res. 1997;345:79–86.PubMedCrossRefGoogle Scholar
  18. 18.
    Gill GS, Joshi AB. Long-term results of Kinematic Condylar knee replacement: an analysis of 404 knees. J Bone Joint Surg Br. 2001;88;355–358.CrossRefGoogle Scholar
  19. 19.
    Gioe TJ, Killeen KK, Hoeffel DP, Bert JM, Comfort TK, Scheltema K, Mehle S, Grimm K. Analysis of unicompartmental knee arthroplasty in a community-based implant registry. Clin Orthop Relat Res. 2003;416:111–119.PubMedCrossRefGoogle Scholar
  20. 20.
    Griffin T, Rowden N, Morgan D, Atkinson R, Woodruff P, Maddern G. Unicompartmental knee arthroplasty for the treatment of unicompartmental osteoarthritis: a systematic study. ANZ J Surg. 2007;77:214–221.PubMedCrossRefGoogle Scholar
  21. 21.
    Hollinghurst D, Stoney J, Ward T, Gill HS, Newman JH, Murray DW, Beard DJ. No deterioration of kinematics and cruciate function 10 years after medial unicompartmental arthroplasty. Knee. 2006;13:440–444.PubMedCrossRefGoogle Scholar
  22. 22.
    Hopper GP, Leach WJ. Participation in sporting activities following knee replacement: total versus unicompartmental. Knee Surg Sports Traumatol Arthrosc. 2008;16:973–979.PubMedCrossRefGoogle Scholar
  23. 23.
    Insall J, Aglietti P. A five to seven-year follow-up of unicondylar arthroplasty. J Bone Joint Surg Am. 1980;62:1329–1337.PubMedGoogle Scholar
  24. 24.
    Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the Knee Society Clinical Rating System. Clin Orthop Relat Res. 1989;248:13–14.PubMedGoogle Scholar
  25. 25.
    Isaac SM, Barker KL, Danial IN, Beard DJ, Dodd CA, Murray DW. Does arthroplasty type influence knee joint proprioception? A longitudinal prospective study comparing total and unicompartmental arthroplasty. Knee. 2007;14:212–217.PubMedCrossRefGoogle Scholar
  26. 26.
    Jahromi I, Walton NP, Dobson PJ, Lewis PL, Campbell DG. Patient-perceived outcome measures following unicompartmental knee arthroplasty with mini-incision. Int Orthop. 2004;28:286–289.PubMedCrossRefGoogle Scholar
  27. 27.
    Jeer PJ, Cossey AJ, Keene GC. Haemoglobin levels following unicompartmental knee arthroplasty: influence of transfusion practice and surgical approach. Knee. 2005;12:358–361.PubMedCrossRefGoogle Scholar
  28. 28.
    Keating EM, Meding JB, Faris PM, Ritter MA. Long-term followup of nonmodular total knee replacements. Clin Orthop Relat Res. 2002;404:34–39.PubMedCrossRefGoogle Scholar
  29. 29.
    Koskinen E, Eskelinen A, Paavolainen P, Pulkkinen P, Remes V. Comparison of survival and cost-effectiveness between unicondylar arthroplasty and total knee arthroplasty in patients with primary osteoarthritis: a follow-up study of 50,493 knee replacements from the Finnish Arthroplasty Register. Acta Orthop. 2008;79:499–507.PubMedCrossRefGoogle Scholar
  30. 30.
    Koskinen E, Paavolainen P, Eskelinen A, Pulkkinen P, Remes V. Unicondylar knee replacement for primary osteoarthritis: a prospective follow-up study of 1,819 patients from the Finnish Arthroplasty Register. Acta Orthop. 2007;78:128–135.PubMedCrossRefGoogle Scholar
  31. 31.
    Kostamo T, Bourne RB, Whittaker JP, McCalden RW, MacDonald SJ. No difference in gender-specific hip replacement outcomes. Clin Orthop Relat Res. 2009;467:135–140.PubMedCrossRefGoogle Scholar
  32. 32.
    Levine WN, Ozuna RM, Scott RD, Thornhill TS. Conversion of failed modern unicompartmental arthroplasty to total knee arthroplasty. J Arthroplasty. 1996;11:797–801.PubMedCrossRefGoogle Scholar
  33. 33.
    Lewold S, Robertsson O, Knutson K, Lidgren L. Revision of unicompartmental knee arthroplasty: outcome in 1,135 cases from the Swedish Knee Arthroplasty study. Acta Orthop Scand. 1998;69:469–474.PubMedCrossRefGoogle Scholar
  34. 34.
    Lindstrand A, Stenstrom A, Lewold S. Multicenter study of unicompartmental knee revision: PCA, Marmor, and St Georg compared in 3,777 cases of arthrosis. Acta Orthop Scand. 1992;63:256–259.PubMedCrossRefGoogle Scholar
  35. 35.
    MacDonald SJ, Charron KD, Bourne RB, Naudie DD, McCalden RW, Rorabeck CH. The John Insall Award. Gender-specific total knee replacement: prospectively collected clinical outcomes. Clin Orthop Relat Res. 2008;466:2612–2616.PubMedCrossRefGoogle Scholar
  36. 36.
    McAllister CM. The role of unicompartmental knee arthroplasty versus total knee arthroplasty in providing maximal performance and satisfaction. J Knee Surg. 2008;21:286–292.PubMedGoogle Scholar
  37. 37.
    McAuley JP, Engh GA, Ammeen DJ. Revision of failed unicompartmental knee arthroplasty. Clin Orthop Relat Res. 2001;392:279–282.PubMedCrossRefGoogle Scholar
  38. 38.
    McCalden RW, Charron KD, MacDonald SJ, Bourne RB, Naudie DD. Does morbid obesity affect the outcome of total hip replacement? An analysis of 3290 THRs. J Bone Joint Surg Br. 2011;93:321–325.PubMedGoogle Scholar
  39. 39.
    Murray DW, Goodfellow JW, O’Connor JJ. The Oxford medial unicompartmental knee arthroplasty: a ten-year survival study. J Bone Joint Surg Br. 1998;80:983–989.PubMedCrossRefGoogle Scholar
  40. 40.
    Naudie D, Guerin J, Parker DA, Bourne RB, Rorabeck CH. Medial unicompartmental knee arthroplasty with the Miller-Galante prosthesis. J Bone Joint Surg Am. 2004;86:1931–1935.PubMedGoogle Scholar
  41. 41.
    Newman J, Pydisetty RV, Ackroyd C. Unicompartmental or total knee replacement: the 15-year results of a prospective randomised controlled trial. J Bone Joint Surg Br. 2009;91:52–57.PubMedGoogle Scholar
  42. 42.
    Newman JH, Ackroyd CE, Shah NA. 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. 1998;80:862–865.PubMedCrossRefGoogle Scholar
  43. 43.
    O’Rourke MR, Gardner JJ, Callaghan JJ, Liu SS, Goetz DD, Vittetoe DA, Sullivan PM, Johnston RC. The John Insall Award. Unicompartmental knee replacement: a minimum twenty-one-year followup, end-result study. Clin Orthop Relat Res. 2005;440:27–37.PubMedCrossRefGoogle Scholar
  44. 44.
    Palmer SH, Morrison PJ, Ross AC. Early catastrophic tibial component wear after unicompartmental knee arthroplasty. Clin Orthop Relat Res. 1998;350:143–148.PubMedCrossRefGoogle Scholar
  45. 45.
    Parsch D, Krüger M, Moser MT, Geiger F. Follow-up of 11–16 years after modular fixed-bearing TKA. Int Orthop. 2009;33:431–435.PubMedCrossRefGoogle Scholar
  46. 46.
    Perkins TR, Gunckle W. Unicompartmental knee arthroplasty: 3 to 10 year results in a community hospital setting. J Arthroplasty. 2002;17:293–297.PubMedCrossRefGoogle Scholar
  47. 47.
    Petrou G, Petrou H, Tilkeridis C, Stavrakis T, Kapetsis T, Kremmidas N, Gavras M. Medium-term results with a primary cemented rotating-hinge total knee replacement: a 7- to 15-year follow-up. J Bone Joint Surg Br. 2004;86:813–817.PubMedCrossRefGoogle Scholar
  48. 48.
    Price AJ, Short A, Kellett C, Beard D, Gill H, Pandit H, Dodd CA, Murray DW. Ten-year in vivo wear measurement of a fully congruent mobile bearing unicompartmental knee arthroplasty. J Bone Joint Surg Br. 2005;87:1493–1497.PubMedCrossRefGoogle Scholar
  49. 49.
    Price AJ, Svard U. A second decade lifetable survival analysis of the Oxford unicompartmental knee arthroplasty. Clin Orthop Relat Res. 2011;469:174–179.PubMedCrossRefGoogle Scholar
  50. 50.
    Price AJ, Webb J, Topf H, Dodd CA, Goodfellow JW, Murray DW. Rapid recovery after Oxford unicompartmental arthroplasty through a short incision. J Arthroplasty. 2001;16:970–976.PubMedCrossRefGoogle Scholar
  51. 51.
    Rajgopal V, Bourne RB, Chesworth BM, MacDonald SJ, McCalden RW, Rorabeck CH. The impact of morbid obesity on patient outcomes after total knee arthroplasty. J Arthroplasty. 2008;23:795–800.PubMedCrossRefGoogle Scholar
  52. 52.
    Ranawat CS, Flynn WF Jr, Saddler S, Hansraj KK, Maynard MJ. Long-term results of the total condylar knee arthroplasty: a 15-year survivorship study. Clin Orthop Relat Res. 1993;286:94–102.PubMedGoogle Scholar
  53. 53.
    Ritter MA, Berend ME, Meding JB, Keating EM, Faris PM, Crites BM. Long-term followup of anatomic graduated components posterior cruciate-retaining total knee replacement. Clin Orthop Relat Res. 2001;388:51–57.PubMedCrossRefGoogle Scholar
  54. 54.
    Robertsson O, Borgquist L, Knutson K, Lewold S, Lidgren L. 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. 1999;70:170–175.PubMedCrossRefGoogle Scholar
  55. 55.
    Rougraff BT, Heck DA, Gibson AE. A comparison of tricompartmental and unicompartmental arthroplasty for the treatment of gonarthrosis. Clin Orthop Relat Res. 1991;273:157–164.PubMedGoogle Scholar
  56. 56.
    Saldanha KA, Keys GW, Svard UC, White SH, Rao C. Revision of Oxford medial unicompartmental knee arthroplasty to total knee arthroplasty—results of a multicentre study. Knee. 2007;14:275–279.PubMedCrossRefGoogle Scholar
  57. 57.
    Squire MW, Callaghan JJ, Goetz DD, Sullivan PM, Johnston RC. Unicompartmental knee replacement: a minimum 15 year followup study. Clin Orthop Relat Res. 1999;367:61–72.PubMedCrossRefGoogle Scholar
  58. 58.
    Steele RG, Hutabarat S, Evans RL, Ackroyd CE, Newman JH. Survivorship of the St Georg Sled medial unicompartmental knee replacement beyond ten years. J Bone Joint Surg Br. 2006;88:1164–1168.PubMedCrossRefGoogle Scholar
  59. 59.
    Svard UC, Price AJ. Oxford medial unicompartmental knee arthroplasty: a survival analysis of an independent series. J Bone Joint Surg Br. 2001;83:191–194.PubMedCrossRefGoogle Scholar
  60. 60.
    Tabor OB Jr, Tabor OB. Unicompartmental arthroplasty: a long-term follow-up study. J Arthroplasty. 1998;13:373–379.PubMedCrossRefGoogle Scholar
  61. 61.
    Vorlat P, Putzeys G, Cottenie D, Van Isacker T, Pouliart N, Handelberg F, Casteleyn PP, Gheysen F, Verdonk R. The Oxford unicompartmental knee prosthesis: an independent 10-year survival analysis. Knee Surg Sports Traumatol Arthrosc. 2006;14:40–45.PubMedCrossRefGoogle Scholar
  62. 62.
    Walton NP, Jahromi I, Lewis PL, Dobson PJ, Angel KR, Campbell DG. Patient-perceived outcomes and return to sport and work: TKA versus mini-incision unicompartmental knee arthroplasty. J Knee Surg. 2006;19:112–116.PubMedGoogle Scholar
  63. 63.
    Ware J Jr, Kosinski M, Keller SD. A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996;34:220–233.PubMedCrossRefGoogle Scholar
  64. 64.
    Whittaker JP, Naudie DD, McAuley JP, McCalden RW, MacDonald SJ, Bourne RB. Does bearing design influence midterm survivorship of unicompartmental arthroplasty? Clin Orthop Relat Res. 2010;468:73–81.PubMedCrossRefGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2011

Authors and Affiliations

  • Matthew C. Lyons
    • 1
  • Steven J. MacDonald
    • 1
    Email author
  • Lyndsay E. Somerville
    • 1
  • Douglas D. Naudie
    • 1
  • Richard W. McCalden
    • 1
  1. 1.Division of Orthopaedic SurgeryUniversity of Western Ontario & London Health Sciences Centre, University CampusLondonCanada

Personalised recommendations