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Online ISSN 1827-1707
Deshmuch R. V., Scott R. D.
Harvard Combined Orthopaedic Surgery Boston, MA, USA
Unicompartmental knee arthroplasty (UKA) has been controversial since its introduction in the early 1970’s. Some initial reports suggested that medial compartment replacement did not yield good enough early results to be a viable long-term option, while lateral compartment replacement appeared to be promising. By the early 1980’s, however, good initial results were being published for both medial and lateral replacement and enthusiasm for the procedure began to rise. Refinements were made in patient selection, surgical technique, and prosthetic design. Ten year follow-up studies were reported that showed survivorship was slightly less than that reported for total knee arthroplasty (TKA) but acceptable considering the theoretically conservative nature of unicompartmental surgery. We can now characterize UKA as a procedure with a reliable 8- to 10-year outcome in properly selected osteoarthritic patients with a skillfully implanted proper design. Unicondylar knee arthroplasty can be an attractive alternative to osteotomy or TKA especially in the selected middle-aged female. Almost all 10 year-plus follow-up studies appear to show that UKA will have inferior survivorship to TKA in the 2nd decade whether from loosening, prosthetic wear, or secondary degeneration of the opposite compartment. Recently published 10-year results from 3 centers (2 using a mobile-bearing design, the other using a fixed bearing) are comparable to that of TKA. This suggests that enhanced 2nd decade survivorship and therefore an expansion of the indications for UKA are possibilities.