Unicompartmental Knee Arthroplasty: The Past, Current Controversies, and Future Perspectives

Sim Johal; Naoki Nakano; Mark Baxter; Ihab Hujazi; Hemant Pandit; Vikas Khanduja

doi:10.1055/s-0038-1625961

The Journal of Knee Surgery, Table of Contents

J Knee Surg 2018; 31(10): 992-998
DOI: 10.1055/s-0038-1625961

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Unicompartmental Knee Arthroplasty: The Past, Current Controversies, and Future Perspectives

Sim Johal

¹Department of Orthopaedic Surgery, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, United Kingdom

,

Naoki Nakano

²Department of Trauma and Orthopaedics, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, United Kingdom

,

Mark Baxter

³Clinical Research Unit, Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom

,

Ihab Hujazi

⁴North West Deanery, Manchester, United Kingdom

,

Hemant Pandit

⁵Department of Orthopaedic Surgery, University of Oxford, Oxford, Oxfordshire, United Kingdom

⁶Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom

,

Vikas Khanduja

²Department of Trauma and Orthopaedics, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, United Kingdom

› Author Affiliations

Abstract

Unicompartmental knee arthroplasty (UKA) is a bone conserving and ligament-sparing procedure that reliably restores normal knee kinematics and function for arthritis limited either to the medial or the lateral compartment of the knee. Although there is enough evidence to demonstrate that the UKA offers good medium to long-term success given the correct patient selection, prosthesis design, and implantation technique, there are several reports to suggest inferior survival rates in comparison with the total knee arthroplasty (TKA). Furthermore, it is a specialized procedure which works well in the hands of the experienced operator and therefore different authors' tend to draw different conclusions based on the same evidence, and as a result, there is great variability in the usage of the UKA. The aim of this current concept's review is to present to the readers the history of the UKA especially with reference to implant design, discuss current controversies, and outline the future perspectives of this novel procedure.

Keywords

unicompartmental knee arthroplasty - unicompartmental knee replacement - osteoarthritis - outcomes - implant design - UKA - UKR

Full Text

References

References
1 Ahlbäck S. Osteoarthrosis of the knee. A radiographic investigation. Acta Radiol Diagn (Stockh) 1968; 277: 7-72
2 Shetty A, Tindall A, Ting P, Heatley F. The evolution of total knee arthroscopy. Part II: the hinged knee replacement and the semi constrained knee replacement. Curr Orthop 2003; 17: 403-407
3 Australian Joint Registry Annual Report; 2016
4 NJR Online Annual Report 2016 ; 2016
5 Price AJ, Svard U. A second decade lifetable survival analysis of the Oxford unicompartmental knee arthroplasty. Clin Orthop Relat Res 2011; 469 (01) 174-179
6 Robertsson O, Knutson K, Lewold S, Lidgren L. The routine of surgical management reduces failure after unicompartmental knee arthroplasty. J Bone Joint Surg Br 2001; 83 (01) 45-49
7 MacIntosh DL, Hunter GA. The use of the hemiarthroplasty prosthesis for advanced osteoarthritis and rheumatoid arthritis of the knee. J Bone Joint Surg Br 1972; 54 (02) 244-255
8 McKeever DC. The classic: tibial plateau prosthesis.1960. Clin Orthop Relat Res 2005; 440 (440) 4-8
9 Springer BD, Scott RD, Sah AP, Carrington R. McKeever hemiarthroplasty of the knee in patients less than sixty years old. J Bone Joint Surg Am 2006; 88 (02) 366-371
10 Bailie AG, Lewis PL, Brumby SA, Roy S, Paterson RS, Campbell DG. The Unispacer knee implant: early clinical results. J Bone Joint Surg Br 2008; 90 (04) 446-450
11 Gunston FH. Polycentric knee arthroplasty. Prosthetic simulation of normal knee movement. J Bone Joint Surg Br 1971; 53 (02) 272-277
12 Mackinnon J, Young S, Baily RA. The St Georg sledge for unicompartmental replacement of the knee. A prospective study of 115 cases. J Bone Joint Surg Br 1988; 70 (02) 217-223
13 Engelbrecht E, Siegel A, Rottger J, Buchholz HW. Statistics of total knee replacement: partial and total knee replacement, design St. Georg: a review of a 4-year observation. Clin Orthop Relat Res 1976; (120) 54-64
14 Ackroyd CE, Whitehouse SL, Newman JH, Joslin CC. A comparative study of the medial St Georg sled and kinematic total knee arthroplasties. Ten-year survivorship. J Bone Joint Surg Br 2002; 84 (05) 667-672
15 Shaw NE, Chatterjee RK. Manchester knee arthroplasty. J Bone Joint Surg Br 1978; 60-B (03) 310-314
16 Marmor L. The modular knee. Clin Orthop Relat Res 1973; (94) 242-248
17 Insall J, Walker P. Unicondylar knee replacement. Clin Orthop Relat Res 1976; (120) 83-85
18 Laskin RS. Unicompartmental tibiofemoral resurfacing arthroplasty. J Bone Joint Surg Am 1978; 60 (02) 182-185
19 Cavendish ME, Wright JT. The Liverpool Mark II knee prosthesis. A preliminary report. J Bone Joint Surg Br 1978; 60-B (03) 315-318
20 Walker SJ, Sharma P, Parr N, Cavendish ME. The long-term results of the Liverpool Mark II knee prosthesis. J Bone Joint Surg Br 1986; 68 (01) 111-116
21 Shetty A, Tindall A, Ting P, Heatley F. The evolution of total knee arthroscopy. Part III: surface replacement. Curr Orthop 2003; 17: 478-481
22 Insall J, Aglietti P. A five to seven-year follow-up of unicondylar arthroplasty. J Bone Joint Surg Am 1980; 62 (08) 1329-1337
23 Insall JN, Ranawat CS, Aglietti P, Shine J. A comparison of four models of total knee-replacement prostheses. J Bone Joint Surg Am 1976; 58 (06) 754-765
24 Goodfellow J, O'Connor J. The mechanics of the knee and prosthesis design. J Bone Joint Surg Br 1978; 60-B (03) 358-369
25 Murray DW, Goodfellow JW, O'Connor JJ. The Oxford medial unicompartmental arthroplasty: a ten-year survival study. J Bone Joint Surg Br 1998; 80 (06) 983-989
26 Weale AE, Murray DW, Crawford R. , et al. Does arthritis progress in the retained compartments after ‘Oxford’ medial unicompartmental arthroplasty? A clinical and radiological study with a minimum ten-year follow-up. J Bone Joint Surg Br 1999; 81 (05) 783-789
27 Price AJ, Webb J, Topf H, Dodd CA, Goodfellow JW, Murray DW. ; Oxford Hip and Knee Group Rapid recovery after oxford unicompartmental arthroplasty through a short incision. J Arthroplasty 2001; 16 (08) 970-976
28 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 (04) 499-507
29 Ridgeway SR, McAuley JP, Ammeen DJ, Engh GA. The effect of alignment of the knee on the outcome of unicompartmental knee replacement. J Bone Joint Surg Br 2002; 84 (03) 351-355
30 Gillquist J, Messner K. Anterior cruciate ligament reconstruction and the long-term incidence of gonarthrosis. Sports Med 1999; 27 (03) 143-156
31 Goodfellow JW, Kershaw CJ, Benson MK, O'Connor JJ. The Oxford Knee for unicompartmental osteoarthritis. The first 103 cases. J Bone Joint Surg Br 1988; 70 (05) 692-701
32 Goodfellow J, O'Connor J. The anterior cruciate ligament in knee arthroplasty. A risk-factor with unconstrained meniscal prostheses. Clin Orthop Relat Res 1992; (276) 245-252
33 Engh GA, Ammeen D. Is an intact anterior cruciate ligament needed in order to have a well-functioning unicondylar knee replacement?. Clin Orthop Relat Res 2004; (428) 170-173
34 Tinius M, Hepp P, Becker R. Combined unicompartmental knee arthroplasty and anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2012; 20 (01) 81-87
35 Pandit H, Beard DJ, Jenkins C. , et al. Combined anterior cruciate reconstruction and Oxford unicompartmental knee arthroplasty. J Bone Joint Surg Br 2006; 88 (07) 887-892
36 Trompeter AJ, Gill K, Appleton MA, Palmer SH. Predicting anterior cruciate ligament integrity in patients with osteoarthritis. Knee Surg Sports Traumatol Arthrosc 2009; 17 (06) 595-599
37 Citak M, Bosscher MR, Citak M, Musahl V, Pearle AD, Suero EM. Anterior cruciate ligament reconstruction after unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2011; 19 (10) 1683-1688
38 Pandit H, Van Duren BH, Gallagher JA. , et al. Combined anterior cruciate reconstruction and Oxford unicompartmental knee arthroplasty: in vivo kinematics. Knee 2008; 15 (02) 101-106
39 Kozinn SC, Scott R. Unicondylar knee arthroplasty. J Bone Joint Surg Am 1989; 71 (01) 145-150
40 Pandit H, Jenkins C, Gill HS. , et al. Unnecessary contraindications for mobile-bearing unicompartmental knee replacement. J Bone Joint Surg Br 2011; 93 (05) 622-628
41 Berend KR, Lombardi Jr AV, Morris MJ, Hurst JM, Kavolus JJ. Does preoperative patellofemoral joint state affect medial unicompartmental arthroplasty survival?. Orthopedics 2011; 34 (09) e494-e496
42 Kang SN, Smith TO, Sprenger De Rover WB, Walton NP. Pre-operative patellofemoral degenerative changes do not affect the outcome after medial Oxford unicompartmental knee replacement: a report from an independent centre. J Bone Joint Surg Br 2011; 93 (04) 476-478
43 Heyse TJ, Khefacha A, Cartier P. UKA in combination with PFR at average 12-year follow-up. Arch Orthop Trauma Surg 2010; 130 (10) 1227-1230
44 Morrison TA, Nyce JD, Macaulay WB, Geller JA. Early adverse results with bicompartmental knee arthroplasty: a prospective cohort comparison to total knee arthroplasty. J Arthroplasty 2011; 26 (6, Suppl): 35-39
45 Epinette JA, Manley MT. Is hydroxyapatite a reliable fixation option in unicompartmental knee arthroplasty? A 5- to 13-year experience with the hydroxyapatite-coated unix prosthesis. J Knee Surg 2008; 21 (04) 299-306
46 Lindstrand A, Stenström A, Egund N. The PCA unicompartmental knee. A 1-4-year comparison of fixation with or without cement. Acta Orthop Scand 1988; 59 (06) 695-700
47 Campi S, Pandit HG, Dodd CA, Murray DW. Cementless fixation in medial unicompartmental knee arthroplasty: a systematic review. Knee Surg Sports Traumatol Arthrosc 2017; 25 (03) 736-745
48 Li MG, Yao F, Joss B, Ioppolo J, Nivbrant B, Wood D. Mobile vs. fixed bearing unicondylar knee arthroplasty: a randomized study on short term clinical outcomes and knee kinematics. Knee 2006; 13 (05) 365-370
49 Manson TT, Kelly NH, Lipman JD, Wright TM, Westrich GH. Unicondylar knee retrieval analysis. J Arthroplasty 2010; 25 (6, Suppl): 108-111
50 Kretzer JP, Jakubowitz E, Reinders J. , et al. Wear analysis of unicondylar mobile bearing and fixed bearing knee systems: a knee simulator study. Acta Biomater 2011; 7 (02) 710-715
51 Saccomanni B. Unicompartmental knee arthroplasty: a review of literature. Clin Rheumatol 2010; 29 (04) 339-346
52 Collier MB, Engh Jr CA, McAuley JP, Engh GA. Factors associated with the loss of thickness of polyethylene tibial bearings after knee arthroplasty. J Bone Joint Surg Am 2007; 89 (06) 1306-1314
53 Emerson Jr RH, Hansborough T, Reitman RD, Rosenfeldt W, Higgins LL. Comparison of a mobile with a fixed-bearing unicompartmental knee implant. Clin Orthop Relat Res 2002; (404) 62-70
54 Parratte S, Pauly V, Aubaniac JM, Argenson JN. No long-term difference between fixed and mobile medial unicompartmental arthroplasty. Clin Orthop Relat Res 2012; 470 (01) 61-68
55 Catani F, Benedetti MG, Bianchi L, Marchionni V, Giannini S, Leardini A. Muscle activity around the knee and gait performance in unicompartmental knee arthroplasty patients: a comparative study on fixed- and mobile-bearing designs. Knee Surg Sports Traumatol Arthrosc 2012; 20 (06) 1042-1048
56 Bhattacharya R, Scott CE, Morris HE, Wade F, Nutton RW. Survivorship and patient satisfaction of a fixed bearing unicompartmental knee arthroplasty incorporating an all-polyethylene tibial component. Knee 2012; 19 (04) 348-351
57 Heyse TJ, Tibesku CO. Lateral unicompartmental knee arthroplasty: a review. Arch Orthop Trauma Surg 2010; 130 (12) 1539-1548
58 Marmor L. Lateral compartment arthroplasty of the knee. Clin Orthop Relat Res 1984; (186) 115-121
59 Hill PF, Vedi V, Williams A, Iwaki H, Pinskerova V, Freeman MA. Tibiofemoral movement 2: the loaded and unloaded living knee studied by MRI. J Bone Joint Surg Br 2000; 82 (08) 1196-1198
60 Scott RD. Lateral unicompartmental replacement: a road less traveled. Orthopedics 2005; 28 (09) 983-984
61 Scott RD, Santore RF. Unicondylar unicompartmental replacement for osteoarthritis of the knee. J Bone Joint Surg Am 1981; 63 (04) 536-544
62 Gunther T, Murray D, Miller R. Lateral unicompartmental knee arthroplasty with Oxford meniscal knee. Knee 1996; 3: 33-39
63 Weston-Simons JS, Pandit H, Kendrick BJ. , et al. The mid-term outcomes of the Oxford Domed Lateral unicompartmental knee replacement. Bone Joint J 2014; 96-B (01) 59-64
64 Pandit H, Jenkins C, Gill HS, Barker K, Dodd CA, Murray DW. Minimally invasive Oxford phase 3 unicompartmental knee replacement: results of 1000 cases. J Bone Joint Surg Br 2011; 93 (02) 198-204
65 Wynn Jones H, Chan W, Harrison T, Smith TO, Masonda P, Walton NP. Revision of medial Oxford unicompartmental knee replacement to a total knee replacement: similar to a primary?. Knee 2012; 19 (04) 339-343
66 Chou DT, Swamy GN, Lewis JR, Badhe NP. Revision of failed unicompartmental knee replacement to total knee replacement. Knee 2012; 19 (04) 356-359
67 Pearse AJ, Hooper GJ, Rothwell A, Frampton C. Survival and functional outcome after revision of a unicompartmental to a total knee replacement: the New Zealand National Joint Registry. J Bone Joint Surg Br 2010; 92 (04) 508-512
68 Hang JR, Stanford TE, Graves SE, Davidson DC, de Steiger RN, Miller LN. Outcome of revision of unicompartmental knee replacement. Acta Orthop 2010; 81 (01) 95-98
69 Järvenpää J, Kettunen J, Miettinen H, Kröger H. The clinical outcome of revision knee replacement after unicompartmental knee arthroplasty versus primary total knee arthroplasty: 8-17 years follow-up study of 49 patients. Int Orthop 2010; 34 (05) 649-653
70 Goodfellow JW, O'Connor JJ, Murray DW. A critique of revision rate as an outcome measure: re-interpretation of knee joint registry data. J Bone Joint Surg Br 2010; 92 (12) 1628-1631
71 van den Heever DJ, Scheffer C, Erasmus P, Dillon E. Contact stresses in a patient-specific unicompartmental knee replacement. Clin Biomech (Bristol, Avon) 2011; 26 (02) 159-166
72 Steklov N, Slamin J, Srivastav S, D'Lima D. Unicompartmental knee resurfacing: enlarged tibio-femoral contact area and reduced contact stress using novel patient-derived geometries. Open Biomed Eng J 2010; 4: 85-92
73 Koeck FX, Beckmann J, Luring C, Rath B, Grifka J, Basad E. Evaluation of implant position and knee alignment after patient-specific unicompartmental knee arthroplasty. Knee 2011; 18 (05) 294-299
74 Konyves A, Willis-Owen CA, Spriggins AJ. The long-term benefit of computer-assisted surgical navigation in unicompartmental knee arthroplasty. J Orthop Surg 2010; 5: 94
75 Weber P, Utzschneider S, Sadoghi P. , et al. Navigation in minimally invasive unicompartmental knee arthroplasty has no advantage in comparison to a conventional minimally invasive implantation. Arch Orthop Trauma Surg 2012; 132 (02) 281-288
76 Roche M, O'Loughlin PF, Kendoff D, Musahl V, Pearle AD. Robotic arm-assisted unicompartmental knee arthroplasty: preoperative planning and surgical technique. Am J Orthop 2009; 38 (2, Suppl): 10-15
77 Pearle AD, O'Loughlin PF, Kendoff DO. Robot-assisted unicompartmental knee arthroplasty. J Arthroplasty 2010; 25 (02) 230-237
78 Plate JF, Mofidi A, Mannava S. , et al. Achieving accurate ligament balancing using robotic-assisted unicompartmental knee arthroplasty. Adv Orthop 2013; 2013: 837167
79 Cobb J, Henckel J, Gomes P. , et al. Hands-on robotic unicompartmental knee replacement: a prospective, randomised controlled study of the Acrobot system. J Bone Joint Surg Br 2006; 88 (02) 188-197
80 Lonner JH, John TK, Conditt MA. Robotic arm-assisted UKA improves tibial component alignment: a pilot study. Clin Orthop Relat Res 2010; 468 (01) 141-146