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Advances in Medial Unicompartmental Knee Arthroplasty

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Surgical Management of Knee Arthritis

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Abstract

Unicompartmental knee arthroplasty (UKA) is a safe and effective surgical treatment option for isolated end-stage unicompartmental knee osteoarthritis.

The advantages of medial unicompartmental knee arthroplasty over TKA in isolated medial OA include a faster recovery, lower cost and fewer major complications. The most significant disadvantage of medial UKA is the three times higher revision rates compared to TKA.

The primary indication for medial UKA is isolated bone-on-bone anteromedial osteoarthritis of the knee with a functionally intact anterior cruciate ligament and intact medial collateral ligament. There is no posterior wear on the tibia plateau and the intra-articular deformity is fully correctable. The cartilage in the weight-bearing area of the lateral compartment is biomechanically intact.

Numerous operative-related factors have been proven to affect clinical outcomes in UKA patients. There is clear evidence that UKA volume (caseload) and usage rates determine the survival and revision rates of UKA. A usage rate of 20% or greater yielded a significantly lower rate of failure.

The size and placement of the components are vital to the clinical outcomes and rate of failure, this is particularly evident of the tibial component. Oversizing and tibial overhang of >3 mm, excessive varus angulation of >5°, increased posterior tibial slope and changes in the joint line should be avoided. A post-operative varus angle of 1–4° should be achieved.

Aseptic loosening and progression of OA are the most common causes of failure in medial UKA.

The expansion of traditional indications, increasing surgeons’ usage, use of validated technology adjuncts such as robotic-assistance, and improvements in implant design all contribute to UKA’s good to excellent results, better outcomes compared to TKA, and to lowering UKA’s rate of failure. After being initially overlooked, UKA is seeing a resurgence and future research has an abundance of exciting directions to pursue.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA

    Julius K. Oni

  2. Orthopedic Clinic Paulinenhilfe, Diakonie Klinikum, Stuttgart, Germany

    Wenzel Waldstein

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  1. Department of Orthopedic Surgery, Hospital For Joint Diseases, New York, NY, USA

    Ajit J. Deshmukh

  2. University Clinical Center of Kosovo, Pristina, Kosovo

    Bujar H. Shabani

  3. Orthopedic Clinic Paulinenhilfe, Diakonie Klinikum, Stuttgart, Germany

    Wenzel Waldstein

  4. Department of Orthopedic Surgery, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA

    Julius K. Oni

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Oni, J.K., Waldstein, W. (2023). Advances in Medial Unicompartmental Knee Arthroplasty. In: Deshmukh, A.J., Shabani, B.H., Waldstein, W., Oni, J.K. (eds) Surgical Management of Knee Arthritis. Springer, Cham. https://doi.org/10.1007/978-3-031-47929-8_10

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