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Unicompartmental Knee Arthroplasty: Indications and Current Results. Natasha Holder MD, MSc PGY-1. Objectives. Classic indications Expanding indications UKR vs. TKR: current outcome studies. Unicompartmental Knee Arthroplasty. Preservation of normal kinematics

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Presentation Transcript
objectives
Objectives
  • Classic indications
  • Expanding indications
  • UKR vs. TKR: current outcome studies
unicompartmental knee arthroplasty
Unicompartmental Knee Arthroplasty
  • Preservation of normal kinematics
  • Lower perioperative morbidity
  • Accelerated patient rehabilitation
  • Preservation of bone stock
classic indications
Classic Indications
  • Diagnosis of unicompartmental arthritis
  • Age >60 with low demand for activity
  • Weight <82 kg
  • ROM arc >90° with <5° flexion contracture
  • Angular deformity of <15°

Kozinn et al. JBJS 1989:145-150

contraindications
Contraindications
  • Inflammatory arthritis
  • Patient age < 60
  • High patient activity level
  • Patellofemoral pain

Kozinn et al. JBJS 1989:145-150

uka and age
UKA and Age
  • Pennington et al. (JBJS, 2003)
    • Retrospective study, 46 UKA, age <60
    • Survivorship of 92% at 11 years
  • Price et al. (JBJS (Br), 2005)
    • Case Series, 564 UKA, compared 2 age groups
    • Age <60 – Survivorship of 91% at 10 years
    • Age >60 Survivorship of 96% at 10 years
  • Cartier et al. (Ortho, 2007)
    • Case Series, 161 UKA, age <60
    • Survivorship of 94% at 10 years, 88% at 12 years
uka and age1
UKA and Age
  • Kort et al. (Knee, 2007)
    • Case Series, 46 UKA, age <60, 2-6 yr F/U
    • Improved KSS and WOMAC scores
    • Obesity can affect outcome i.e. technical failure
  • Berend et al. (Orthopedics, 2007)
    • Case Series, 318 UKA, age 33-90, 6w-28 mo F/U
    • Early survivorship 98.1%, age <60 was not predictive of early failure
uka and obesity
UKA and Obesity
  • Berend et al. (Orthopedics, 2007)
    • Prospective study, 318 UKA, weight 51-158kg, 150 UKA BMI >32, 6w-28 mo F/U
    • Early surviorship 98.1%, weight >82 or BMI >35 was not predictive of early failure
uka and acl deficiency
UKA and ACL Deficiency
  • Pandit et al. (JBJS (Br), 2006)
    • Prospective Study, compared 15 UKA with ACL reconstruction to 15 UKA with intact ACL (age, gender, F/U matched)
    • Oxford Knee score, KSS, Tegner activity level score, radiological assessment
uka and acl deficiency1
UKA and ACL Deficiency
  • Pandit et al. (JBJS (Br), 2006)
    • ACLR had greater postoperative Oxford knee scores than ACLI
    • No pathological radiolucenciesor component subsidence in either group
uka vs tka
UKA vs TKA
  • Lombardi et al. (Clin Ortho Relat Res, 2009)
      • Retrospective cohort, 115 UKA and 115 TKA, matched for age, gender, BMI, bilaterality
      • UKA selection: anteromedial OA, intact ACL, flexion deformity <15°, varus deformity <15°
      • TKA selection: unicompartmental OA or more extensive OA
      • Outcomes: ROM, KSS, LOS
uka vs tka1
UKA vs TKA
  • Newman et al. (JBJS (Br), 2009
    • Prospective randomized control trial (1989-1992) with a 15 year follow up
    • 102 knees
    • Criteria: unicompartmental, intact cruciate ligaments, flexion deformity ≤ 15°, varus/valgus deformity ≤15°
    • Outcome: Bristol knee score
    • Failure: revision, Bristol score < 60
slide16

UKA 89.8% Survival rate

  • TKA 78.7% Survival rate
  • UKA results are comparable to TKA and have no greater tendency to fail at 15 years
summary
Summary
  • In appropriately selected patients UKA is a successful procedure
    • Indications are expanding with satisfactory results
    • Equal survivorship to TKA in first decade
    • Improved functional results
    • Fewer complications