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Unicompartmental Arthroplasty
John GoodfellowNuffield Orthopaedic
Centre, Oxford
AnteromedialOsteoarthritis
(30% of OA knees)
Fixed Bearing UKR
• Wear inescapable Incongruous
• Thin polyethylene• Catastrophic failure
Meniscal function
Phase 1 1976
Polyethylene Wear
• Average penetration rate
0.03mm per year• Average time for 1mm
penetration 33 years
10 year retrieval
Indications
Criteria
• Antero-medial OA• Intact ACL• Full thickness lateral• Correctable varus• FFD less than 15°• 1 in 3 OA knees
Not Contraindications
• Patello-femoral joint• Chondrocalcinosis• Obesity• Age• Activity
0%
20%
40%
60%
80%
100%
0 5 10
Time post operation (years)
Su
rviv
al
UKR - Designer’s series
• 10 year survival 98%• Murray et al JBJS 1998
0
20
40
60
80
100
0 5 10 15 20Years
Sur
viva
l %Svard & Price (AAOS 2006)
20 yr survival 92% CI 15.1
10 yr 90% Good or Excellent HSS (n=187)
Minimally Invasive Surgery
MIS results – Early Recovery• Less Bleeding
• Lower Morbidity
• Shorter Hospital Stay
• Quicker Flexion
• Time to recovery:
3x faster than TKR (p<0.001)
2x faster than open UKR (p<0.001)
Functional recovery
0%
50%
100%
150%
TKR Open Minimal
Unilateral
Bilateral
National Registers
• Measured by revision, failure rate of UKR at 10yrs is approx x 2 TKR
• National failure rates of UKR are higher than reports from Specialist Centres
• Failure rates of UKR vary with the experience of the surgeon
Dependence on Surgical Experience(Roberttson et al)
Instructional Courses
• To diminish the ‘learning curve’
• To teach indications
• To improve surgical technique