Minimally invasive unicompartmental knee replacement: rationale and correct indications.

In the early 1990s, unicompartmental knee replacements (UKRs) were almost forgotten as an option for the management of unicompartmental arthritis of the knee, and the two principal surgical options became proximal tibial osteotomy and total knee replacement. The recent introduction of minimally invasive techniques has renewed interest in uni-compartmental knee replacement. The proposed advantages of UKR over proximal tibial osteotomy include more predictable relief of pain, quicker recovery, and better long-term results. In appropriate cases, it has advantages over total arthroplasty in providing more physiologic function, better range of movement, easier salvage in case of failure, and quicker recovery because of minimally invasive techniques.

[1]  W. Norman Scott,et al.  Total Knee Replacement in Young, Active Patients , 1997 .

[2]  J. Witvoet,et al.  Total knee replacement after failed tibial osteotomy: results of a matched-pair study. , 1998, The Journal of arthroplasty.

[3]  D. Hungerford,et al.  Total knee arthroplasty after failed high tibial osteotomy. A comparison with a matched group. , 1994, Clinical orthopaedics and related research.

[4]  P. Sarangi,et al.  Revision total knee arthroplasty. Comparison of outcome following primary proximal tibial osteotomy or unicompartmental arthroplasty. , 1994, The Journal of arthroplasty.

[5]  L. Marmor Unicompartmental arthroplasty for osteonecrosis of the knee joint. , 1993, Clinical orthopaedics and related research.

[6]  O. B. Tabor Unicompartmental arthroplasty: a long-term follow-up study. , 1998, The Journal of arthroplasty.

[7]  A. Lindstrand,et al.  Cold flow reduced by metal backing. An in vivo roentgen stereophotogrammetric analysis of unicompartmental tibial components. , 1990, Acta orthopaedica Scandinavica.

[8]  In vitro measurement of patellofemoral force after three types of knee replacement. , 1998 .

[9]  J. Rand,et al.  Survivorship analysis of total knee arthroplasty. Cumulative rates of survival of 9200 total knee arthroplasties. , 1991, The Journal of bone and joint surgery. American volume.

[10]  L. Marmor Lateral compartment arthroplasty of the knee. , 1984, Clinical orthopaedics and related research.

[11]  J. Rand,et al.  Revision of failed unicompartmental total knee arthroplasty. , 1993, Clinical orthopaedics and related research.

[12]  P Cartier,et al.  Unicompartmental knee arthroplasty surgery. 10-year minimum follow-up period. , 1996, The Journal of arthroplasty.

[13]  D. Ammeen,et al.  The effect of alignment of the knee on the outcome of unicompartmental knee replacement. , 2002, The Journal of bone and joint surgery. British volume.

[14]  M A Ritter,et al.  Long-Term Followup of Anatomic Graduated Components Posterior Cruciate-Retaining Total Knee Replacement , 2001, Clinical orthopaedics and related research.

[15]  A. Lindstrand,et al.  Polyethylene wear of the PCA unicompartmental knee. Prospective 5 (4-8) year study of 120 arthrosis knees. , 1992, Acta orthopaedica Scandinavica.

[16]  J. Keenan,et al.  A study of polyethylene and modularity issues in >1000 posterior cruciate-retaining knees at 5 to 11 years. , 2002, The Journal of arthroplasty.

[17]  F. Landsiedl,et al.  Revision surgery after failed unicompartmental knee arthroplasty , 2000 .

[18]  P. Giannoudis,et al.  EFFECTS OF INTRAMEDULLARY FEMORAL FRACTURE FIXATION: WHAT IS THE IMPACT OF EXPERIMENTAL STUDIES IN REGARDS TO THE CLINICAL KNOWLEDGE? , 2002, Shock.

[19]  D. Heck,et al.  Unicompartmental knee arthroplasty. A multicenter investigation with long-term follow-up evaluation. , 1993, Clinical orthopaedics and related research.

[20]  R. Byrick,et al.  Pulmonary Effects of Fixation of a Fracture with a Plate Compared with Intramedullary Nailing. A Canine Model of Fat Embolism and Fracture Fixation* , 1997, The Journal of bone and joint surgery. American volume.

[21]  J. Knight,et al.  Early failure of the porous coated anatomic cemented unicompartmental knee arthroplasty. Aids to diagnosis and revision. , 1997, The Journal of arthroplasty.

[22]  R. Baily,et al.  Unicompartmental replacement and high tibial osteotomy for osteoarthritis of the knee. A comparative study after 5-10 years' follow-up. , 1986, The Journal of bone and joint surgery. British volume.

[23]  J. Tokunaga,et al.  Unicompartmental knee arthroplasty for lateral gonarthrosis , 2001 .

[24]  T. Perkins,et al.  Unicompartmental knee arthroplasty: 3- to 10-year results in a community hospital setting. , 2002, The Journal of arthroplasty.

[25]  D W Murray,et al.  Rapid recovery after oxford unicompartmental arthroplasty through a short incision. , 2001, The Journal of arthroplasty.

[26]  T. Thornhill,et al.  Unicompartmental knee arthroplasty. Eight- to 12-year follow-up evaluation with survivorship analysis. , 1991, Clinical orthopaedics and related research.

[27]  K Knutson,et al.  The routine of surgical management reduces failure after unicompartmental knee arthroplasty. , 2001, The Journal of bone and joint surgery. British volume.

[28]  K Knutson,et al.  Revision of unicompartmental knee arthroplasty: outcome in 1,135 cases from the Swedish Knee Arthroplasty study. , 1998, Acta orthopaedica Scandinavica.

[29]  J. Newman,et al.  Lateral unicompartmental knee replacement , 2002 .

[30]  H. Inoue,et al.  Clinico-radiological study of total knee arthroplasty after high tibial osteotomy , 2000, Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association.

[31]  J. Callaghan,et al.  Fat embolism precipitated by reaming of the femoral canal during revision of a total knee replacement. A case report. , 1994, The Journal of bone and joint surgery. American volume.

[32]  P. Tyrrell,et al.  Magnetic resonance imaging assessment for unicompartmental knee replacement: a limited role. , 2001, The Knee.

[33]  M. Adams,et al.  Mechanical properties of articular cartilage in knees with unicompartmental osteoarthritis. , 1994, The Journal of bone and joint surgery. British volume.

[34]  J. Insall,et al.  Technical considerations of total knee arthroplasty after proximal tibial osteotomy. , 1988, The Journal of bone and joint surgery. American volume.

[35]  C T Laurencin,et al.  Unicompartmental Versus Total Knee Arthroplasty in the Same Patient , 1991, Clinical orthopaedics and related research.

[36]  Gerard A Engh,et al.  Rapid Polyethylene Failure of Unicondylar Tibial Components Sterilized with Gamma Irradiation in Air and Implanted After a Long Shelf Life , 2002, The Journal of bone and joint surgery. American volume.

[37]  J W Goodfellow,et al.  Unicompartmental Oxford Meniscal knee arthroplasty. , 1987, The Journal of arthroplasty.

[38]  R. Scott,et al.  Revision of failed unicondylar unicompartmental knee arthroplasty. , 1987, The Journal of bone and joint surgery. American volume.

[39]  B. Nilsson,et al.  The Natural Course of Untreated Osteoarthritis of the Knee , 1977, Clinical orthopaedics and related research.

[40]  J. Newman,et al.  Lateral unicompartmental knee replacement survivorship and clinical experience over 21 years. , 2002, The Journal of bone and joint surgery. British volume.

[41]  J. Keller,et al.  Unicompartmental arthroplasty of the knee. Cadaver study of the importance of the anterior cruciate ligament. , 1985, Acta orthopaedica Scandinavica.

[42]  A. Lindstrand,et al.  The influence of metal backing in unicompartmental tibial component fixation , 1992, Archives of Orthopaedic and Trauma Surgery.

[43]  D. Heck,et al.  A Comparison of Tricompartmental and Unicompartmental Arthroplasty for the Treatment of Gonarthrosis , 1991, Clinical orthopaedics and related research.

[44]  G. Engh,et al.  Polyethylene wear of metal-backed tibial components in total and unicompartmental knee prostheses. , 1992, The Journal of bone and joint surgery. British volume.

[45]  R. Doherty Long term follow up , 1999, BMJ.

[46]  J. Callaghan,et al.  Unicompartmental knee replacement. A minimum 15 year followup study. , 1999, Clinical orthopaedics and related research.

[47]  D. Hungerford,et al.  Total knee arthroplasty after failed high tibial osteotomy. , 1994, The Orthopedic clinics of North America.

[48]  D. Ayers,et al.  Early failure of the femoral component in unicompartmental knee arthroplasty. , 1995, The Journal of arthroplasty.

[49]  A. Price,et al.  Oxford medial unicompartmental knee arthroplasty. A survival analysis of an independent series. , 2001, The Journal of bone and joint surgery. British volume.

[50]  D. Murray,et al.  Medial unicompartmental arthroplasty after failed high tibial osteotomy. , 2001, The Journal of bone and joint surgery. British volume.

[51]  D W Murray,et al.  Lateral unicompartmental arthroplasty with the Oxford meniscal knee , 1996 .

[52]  F. H. Gunston,et al.  Complications of polycentric knee arthroplasty. , 1976, Clinical orthopaedics and related research.

[53]  J. Goodfellow,et al.  Anteromedial osteoarthritis of the knee. , 1991, The Journal of bone and joint surgery. British volume.

[54]  N. Mahomed,et al.  Functional outcome of total knee arthroplasty after high tibial osteotomy. , 2002, Canadian journal of surgery. Journal canadien de chirurgie.

[55]  L. Weidenhielm,et al.  Does metal backing improve fixation of tibial component in unicondylar knee arthroplasty? A randomized radiostereometric analysis. , 2001, The Journal of arthroplasty.

[56]  N Egund,et al.  The PCA unicompartmental knee. A 1-4-year comparison of fixation with or without cement. , 1988, Acta orthopaedica Scandinavica.

[57]  M A Ritter,et al.  Direct Compression Molded Polyethylene for Total Hip and Knee Replacements , 2001, Clinical orthopaedics and related research.

[58]  J. Galante,et al.  Unicompartmental knee arthroplasty. Clinical experience at 6- to 10-year followup. , 1999, Clinical orthopaedics and related research.

[59]  J. Caillouette,et al.  Fat Embolism Syndrome Following the Intramedullary Alignment Guide in Total Knee Arthroplasty , 1990, Clinical orthopaedics and related research.

[60]  M A Freeman,et al.  Tibial high-density polyethylene wear in conforming tibiofemoral prostheses. , 1993, The Journal of bone and joint surgery. British volume.

[61]  David W. Murray,et al.  Wear of congruent meniscal bearings in unicompartmental knee arthroplasty: A RETRIEVAL STUDY OF 16 SPECIMENS , 1998 .

[62]  David W. Murray,et al.  The Oxford medial unicompartmental arthroplasty , 1998 .

[63]  A. Hofmann,et al.  High Tibial Osteotomy with a Calibrated Osteotomy Guide, Rigid Internal Fixation, and Early Motion. Long-Term Follow-up* , 2000, The Journal of bone and joint surgery. American volume.

[64]  L. Marmor The modular knee. , 1973, Clinical orthopaedics and related research.

[65]  D. Beard,et al.  Accelerated recovery for unicompartmental knee replacement--a feasibility study. , 2002, The Knee.

[66]  T. Thornhill,et al.  Unicompartmental knee arthroplasty in middle-aged patients: a 2- to 6-year follow-up evaluation. , 1998, The Journal of arthroplasty.

[67]  T. Thornhill,et al.  Conversion of failed modern unicompartmental arthroplasty to total knee arthroplasty. , 1996, The Journal of arthroplasty.

[68]  G. Bentley,et al.  Total knee arthroplasty after high tibial osteotomy: a medium-term review. , 2000, The Journal of arthroplasty.

[69]  D W Murray,et al.  Wear of congruent meniscal bearings in unicompartmental knee arthroplasty: a retrieval study of 16 specimens. , 1998, The Journal of bone and joint surgery. British volume.

[70]  J. Repicci,et al.  Minimally invasive unicondylar arthroplasty: eight-year follow-up. , 2002, The journal of knee surgery.

[71]  M. Ritter,et al.  Long-Term Followup of Nonmodular Total Knee Replacements , 2002, Clinical orthopaedics and related research.

[72]  J. Callaghan,et al.  Osteolysis Associated with a Cemented tModular Posterior-Cruciate-Substituting Total Knee Design: Five to Eight-Year Follow-up , 2002, The Journal of bone and joint surgery. American volume.

[73]  J. Newman,et al.  Unicompartmental arthroplasty and high tibial osteotomy for osteoarthrosis of the knee. A comparative study with a 12- to 17-year follow-up period. , 1994, Clinical orthopaedics and related research.

[74]  C. Ranawat,et al.  Total knee arthroplasty for patients younger than 55 years. , 1989, Clinical orthopaedics and related research.

[75]  M. Stuart,et al.  Total Knee Arthroplasty in Patients 55 Years Old or Younger: 10- to 17-Year Results , 1998, Clinical orthopaedics and related research.

[76]  R. Scott,et al.  Unicompartmental Knee Arthroplasty: Long-Term Results , 2001, Clinical orthopaedics and related research.

[77]  J. O'Connor,et al.  Polyethylene wear in meniscal knee replacement. A one to nine-year retrieval analysis of the Oxford knee. , 1992, The Journal of bone and joint surgery. British volume.

[78]  L Ryd,et al.  Wear in retrieved condylar knee arthroplasties. A comparison of wear in different designs of 280 retrieved condylar knee prostheses. , 1997, The Journal of arthroplasty.