Abstract
Lateral UKA is rare due to the low incidence of genu valgum deformity and better long-term tolerance of lateral osteoarthritis. Alternatives include varus osteotomies and total knee replacement. Anatomical and kinematic characteristics of the external knee compartment make it more challenging to perform than medial UKA. The biomechanics and kinematics of lateral UKA differ between the medial and lateral tibiofemoral compartments, and the screw-home mechanism is key to knee stability in normal gait. Indications and preoperative assessment are based on anatomical and radiological criteria. Preoperative, clinical, and X-ray assessment should seek to determine the origin of the valgus deformity to differentiate six situations: lateral femoral condyle dysplasia, post-traumatic valgus, post-meniscectomy pain syndrome, avascular osteonecrosis, valgus secondary to coxofemoral disorder, and valgus secondary to congenital tibial deformity. Femoral condyle hypoplasia is the most common cause of OA, and post-traumatic or post-meniscectomy OA and osteonecrosis can be treated with lateral UKA. Surgical technique involves a lateral parapatellar approach and lateral facet and patellar osteophytes resected. It is important to release the peripheral capsule around the tibial plateau and osteophytes minimally to ensure good ligament tension. Osteophytes in the intercondylar notch and lateral femoral condyles should be conserved. Contact point between anterior part of femoral condyle and anterior part of tibial plateau should be noted. Sagittal tibial resection should be performed close to the tibial spine mass, followed by distal femoral resection to compensate for hypoplasia and wear. Posterior femoral resection should be minimal to compensate for posterior condylar offset. Rotation of the resection guide is essential to avoid excess internal rotation of the implant in flexion. Size of the resection guide is a compromise between an anatomical position and the long axis of impact perpendicular to the tibial plateau. Positioning the implants is a compromise between maximum tibial coverage and 15–20° internal rotation. The lateral UKA procedure is a resurfacing procedure to correct only intra-articular wear while leaving the extra-articular deformity intact. It involves cemented and placed tibial implants in complete flexion and internal rotation to increase exposure of the lateral compartment. UKA has good results with mean and long-term survival greater than 90%, but OA progression in the medial tibiofemoral compartment is the main cause of failure. Cemented implants with a “resection” technique have excellent long-term survival. Lateral unicompartmental knee arthroplasty is an effective procedure for isolated damage in the lateral compartment with good long-term results similar to those with medial UKA.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Parratte S, Ollivier M, Lunebourg A, Abdel MP, Argenson J-N. Long-term results of compartmental arthroplasties of the knee: long term results of partial knee arthroplasty. Bone Joint J. 2015;97-B(10 Suppl A):9–15. https://doi.org/10.1302/0301-620X.97B10.36426.
Scott RD. Lateral unicompartmental replacement: a road less traveled. Orthopedics. 2005;28(9):983–4.
Ranawat AS, Ranawat CS, Elkus M, Rasquinha VJ, Rossi R, Babhulkar S. Total knee arthroplasty for severe valgus deformity. J Bone Joint Surg Am. 2005;87(Suppl 1(Pt 2)):271–84. https://doi.org/10.2106/JBJS.E.00308.
Rossi R, Rosso F, Cottino U, Dettoni F, Bonasia DE, Bruzzone M. Total knee arthroplasty in the valgus knee. Int Orthop. 2014;38(2):273–83. https://doi.org/10.1007/s00264-013-2227-4.
Madelaine A, Lording T, Villa V, Lustig S, Servien E, Neyret P. The effect of lateral opening wedge distal femoral osteotomy on leg length. Knee Surg Sports Traumatol Arthrosc. 2016;24(3):847–54. https://doi.org/10.1007/s00167-014-3387-5.
de Andrade MAP, Gomes DCFF, Portugal AL, de A e. Silva GM. Distal femoral varusing for osteoarthritis of valgus knee: a long-term follow-up. Rev Bras Ortop. 2015;44(4):346–50. https://doi.org/10.1016/S2255-4971(15)30165-8.
Arirachakaran A, Choowit P, Putananon C, Muangsiri S, Kongtharvonskul J. Is unicompartmental knee arthroplasty (UKA) superior to total knee arthroplasty (TKA)? A systematic review and meta-analysis of randomized controlled trial. Eur J Orthop Surg Traumatol. 2015;25(5):799–806. https://doi.org/10.1007/s00590-015-1610-9.
Drager J, Hart A, Khalil JA, Zukor DJ, Bergeron SG, Antoniou J. Shorter hospital stay and lower 30-day readmission after unicondylar knee arthroplasty compared to total knee arthroplasty. J Arthroplast. 2016;31(2):356–61. https://doi.org/10.1016/j.arth.2015.09.014.
Zuiderbaan HA, van der List JP, Chawla H, Khamaisy S, Thein R, Pearle AD. Predictors of subjective outcome after medial unicompartmental knee arthroplasty. J Arthroplast. 2016;31(7):1453–8. https://doi.org/10.1016/j.arth.2015.12.038.
Miyatake N, Sugita T, Aizawa T, et al. Comparison of intraoperative anthropometric measurements of the proximal tibia and tibial component in total knee arthroplasty. J Orthop Sci. 2016;21(5):635–9. https://doi.org/10.1016/j.jos.2016.06.003.
Weinberg DS, Williamson DFK, Gebhart JJ, Knapik DM, Voos JE. Differences in medial and lateral posterior tibial slope: an osteological review of 1090 tibiae comparing age, sex, and race. Am J Sports Med. 2017;45(1):106–13. https://doi.org/10.1177/0363546516662449.
Longo UG, Ciuffreda M, Candela V, et al. Knee osteoarthritis after arthroscopic partial meniscectomy: prevalence and progression of radiographic changes after 5 to 12 years compared with contralateral knee. J Knee Surg. 2019;32(5):407–13. https://doi.org/10.1055/s-0038-1646926.
Demange MK, Von Keudell A, Probst C, Yoshioka H, Gomoll AH. Patient-specific implants for lateral unicompartmental knee arthroplasty. Int Orthop. 2015;39(8):1519–26. https://doi.org/10.1007/s00264-015-2678-x.
Greco NJ, Cook GJE, Lombardi AV, Adams JB, Berend KR. Lateral unicompartmental knee arthroplasty utilizing a modified surgical technique and specifically adapted fixed-bearing implant. Surg Technol Int. 2019;34:371–8.
Gulati A, Chau R, Beard DJ, Price AJ, Gill HS, Murray DW. Localization of the full- thickness cartilage lesions in medial and lateral unicompartmental knee osteoarthritis. J Orthop Res. 2009;27(10):1339–46. https://doi.org/10.1002/jor.20880.
Argenson J-NA, Komistek RD, Aubaniac J-M, et al. In vivo determination of knee kinematics for subjects implanted with a unicompartmental arthroplasty. J Arthroplasty. 2002;17(8):1049–54. https://doi.org/10.1054/arth.2002.34527.
Du PZ, Markolf KL, Boguszewski DV, McAllister DR. Femoral contact forces in the anterior cruciate ligament deficient knee: a robotic study. Arthroscopy. 2018;34(12):3226–33. https://doi.org/10.1016/j.arthro.2018.06.051.
Kim HY, Kim KJ, Yang DS, Jeung SW, Choi HG, Choy WS. Screw-home movement of the tibiofemoral joint during normal gait: three-dimensional analysis. Clin Orthop Surg. 2015;7(3):303–9. https://doi.org/10.4055/cios.2015.7.3.303.
Walker T, Aldinger PR, Streit MR, Gotterbarm T. Lateral unicompartmental knee arthroplasty – a challenge. Oper Orthop Traumatol. 2017;29(1):17–30. https://doi.org/10.1007/s00064-016-0476-2.
Fabre-Aubrespy M, Ollivier M, Pesenti S, Parratte S, Argenson J-N. Unicompartmental knee arthroplasty in patients older than 75 results in better clinical outcomes and similar survivorship compared to Total knee Arthroplasty. A matched controlled study. J Arthroplasty. 2016;31(12):2668–71. https://doi.org/10.1016/j.arth.2016.06.034.
Price AJ, Dodd C, Svard UGC, Murray DW. Oxford medial unicompartmental knee arthroplasty in patients younger and older than 60 years of age. J Bone Joint Surg Br. 2005;87(11):1488–92. https://doi.org/10.1302/0301-620X.87B11.16324.
Parratte S, Argenson J-NA, Pearce O, Pauly V, Auquier P, Aubaniac J-M. Medial unicompartmental knee replacement in the under-50s. J Bone Joint Surg Br. 2009;91(3):351–6. https://doi.org/10.1302/0301-620X.91B3.21588.
Lustig S, Parratte S, Magnussen RA, Argenson J-N, Neyret P. Lateral unicompartmental knee arthroplasty relieves pain and improves function in posttraumatic osteoarthritis. Clin Orthop Relat Res. 2012;470(1):69–76. https://doi.org/10.1007/s11999-011-1963-2.
Lustig S, Lording T, Frank F, Debette C, Servien E, Neyret P. Progression of medial osteoarthritis and long term results of lateral unicompartmental arthroplasty: 10 to 18 year follow-up of 54 consecutive implants. Knee. 2014;21(Suppl 1):S26–32. https://doi.org/10.1016/S0968-0160(14)50006-3.
Kozinn SC, Scott R. Unicondylar knee arthroplasty. J Bone Joint Surg Am. 1989;71(1):145–50.
Feldman DS, Goldstein RY, Kurland AM, Sheikh Taha AM. Intra-articular osteotomy for genu valgum in the knee with a lateral compartment deficiency. J Bone Joint Surg Am. 2016;98(2):100–7. https://doi.org/10.2106/JBJS.O.00308.
Pengas IP, Nash W, Khan W, Assiotis A, Banks J, McNicholas MJ. Coronal knee alignment 40 years after total meniscectomy in adolescents: a prospective cohort study. Open Orthop J. 2017;11:424–31. https://doi.org/10.2174/1874325001711010424.
Barrios JA, Heitkamp CA, Smith BP, Sturgeon MM, Suckow DW, Sutton CR. Three- dimensional hip and knee kinematics during walking, running, and single-limb drop landing in females with and without genu valgum. Clin Biomech (Bristol, Avon). 2016;31:7–11. https://doi.org/10.1016/j.clinbiomech.2015.10.008.
van Lieshout WAM, van Ginneken BJT, Kerkhoffs GMMJ, van Heerwaarden RJ. Medial closing wedge high tibial osteotomy for valgus tibial deformities: good clinical results and survival with a mean 4.5 years of follow-up in 113 patients. Knee Surg Sports Traumatol Arthrosc. 2019. https://doi.org/10.1007/s00167-019-05480-9.
Sah AP, Scott RD. Lateral unicompartmental knee arthroplasty through a medial approach. Surgical technique. J Bone Joint Surg Am. 2008;90(Suppl 2 Pt 2):195–205. https://doi.org/10.2106/JBJS.H.00257.
Ollivier M, Abdel MP, Parratte S, Argenson J-N. Lateral unicondylar knee arthroplasty (UKA): contemporary indications, surgical technique, and results. Int Orthop. 2014;38(2):449–55. https://doi.org/10.1007/s00264-013-2222-9.
Argenson J-NA, Parratte S, Bertani A, Flecher X, Aubaniac J-M. Long-term results with a lateral unicondylar replacement. Clin Orthop Relat Res. 2008;466(11):2686–93. https://doi.org/10.1007/s11999-008-0351-z.
Karimi E, Norouzian M, Birjandinejad A, Zandi R, Makhmalbaf H. Measurement of posterior tibial slope using magnetic resonance imaging. Arch Bone Jt Surg. 2017;5(6):435–9.
Moreland JR, Bassett LW, Hanker GJ. Radiographic analysis of the axial alignment of the lower extremity. J Bone Joint Surg Am. 1987;69(5):745–9.
Dejour H, Bonnin M. Tibial translation after anterior cruciate ligament rupture. Two radiological tests compared. J Bone Joint Surg Br. 1994;76(5):745–9.
Vasso M, Del Regno C, Perisano C, D’Amelio A, Corona K, Schiavone Panni A. Unicompartmental knee arthroplasty is effective: ten year results. Int Orthop. 2015. https://doi.org/10.1007/s00264-015-2809-4.
Pandit H, Jenkins C, Gill HS, Barker K, Dodd C, Murray DW. Minimally invasive Oxford phase 3 unicompartmental knee replacement: results of 1000 cases. J Bone Joint Surg Br. 2011;93(2):198–204. https://doi.org/10.1302/0301-620X.93B2.25767.
Lunebourg A, Parratte S, Ollivier M, Abdel MP, Argenson J-NA. Are revisions of unicompartmental knee arthroplasties more like a primary or revision TKA? J Arthroplasty. 2015;30(11):1985–9. https://doi.org/10.1016/j.arth.2015.05.042.
Ashraf T, Newman JH, Evans RL, Ackroyd CE. Lateral unicompartmental knee replacement survivorship and clinical experience over 21 years. J Bone Joint Surg Br. 2002;84(8):1126–30.
Deroche E, Batailler C, Lording T, Neyret P, Servien E, Lustig S. High survival rate and very low wear of lateral unicompartmental arthroplasty at long term: a case series of 54 cases at a mean follow-up of 17 years. J Arthroplasty. 2019;34(6):1097–104. https://doi.org/10.1016/j.arth.2019.01.053.
Fornell S, Prada E, Barrena P, García-Mendoza A, Borrego E, Domecq G. Mid-term outcomes of mobile-bearing lateral unicompartmental knee arthroplasty. Knee. 2018;25(6):1206–13. https://doi.org/10.1016/j.knee.2018.05.016.
Kim KT, Lee S, Kim J, Kim JW, Kang MS. Clinical results of lateral unicompartmental knee arthroplasty: minimum 2-year follow-up. Clin Orthop Surg. 2016;8(4):386–92. https://doi.org/10.4055/cios.2016.8.4.386.
Pandit H, Jenkins C, Beard DJ, et al. Mobile bearing dislocation in lateral unicompartmental knee replacement. Knee. 2010;17(6):392–7. https://doi.org/10.1016/j.knee.2009.10.007.
Perkins TR, Gunckle W. Unicompartmental knee arthroplasty: 3- to 10-year results in a community hospital setting. J Arthroplast. 2002;17(3):293–7.
Canetti R, Batailler C, Bankhead C, Neyret P, Servien E, Lustig S. Faster return to sport after robotic-assisted lateral unicompartmental knee arthroplasty: a comparative study. Arch Orthop Trauma Surg. 2018;138(12):1765–71. https://doi.org/10.1007/s00402-018-3042-6.
Witjes S, Van Geenen RCI, Koenraadt KLM. Expectations of younger patients concerning activities after knee arthroplasty: are we asking the right questions? Qual Life Res. 2017;26(2):403–17. https://doi.org/10.1007/s11136-016-1380-9.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2024 The Author(s), under exclusive license to Springer Nature Switzerland AG
About this chapter
Cite this chapter
Schmidt, A., Ollivier, M., Argenson, JN. (2024). Lateral Unicompartmental Knee Arthroplasty. In: Clavé, A., Dubrana, F. (eds) Unicompartmental Knee Arthroplasty. Springer, Cham. https://doi.org/10.1007/978-3-031-48332-5_8
Download citation
DOI: https://doi.org/10.1007/978-3-031-48332-5_8
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-031-48331-8
Online ISBN: 978-3-031-48332-5
eBook Packages: MedicineMedicine (R0)