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CASE 3
GRADE III MEDIAL OA IN ACTIVE 55 YRS OLD MAN
TKA
Arlen D. Hanssen
Rochester, USA
Although UKR has enjoyed another resurgence, there are a number of realities that should give pause to
those who have embraced this trend.
1. Published results reveal that TKR has better survival, particularly beyond 10 years.
2. Traditionally, UKR has been used in the elderly and most published results are in the elderly.
3. Recent registry data show alarmingly high failure rates of UKR in patients less than 65 yrs age. This
makes UKR less cost-effective for overall global care of a specific patient group.
4. UKR is more technically difficult than TKR and in the presence of technical errors, UKR is less
forgiving than TKR.
5. One common cause of UKR failure is progression of arthritis in the contralateral compartment which
does not occur in TKR.
6. Revision of a failed UKR is not always routine and often requires revision TKR components.
7. The ideal candidate for UKR is distinctly uncommon.
8. Revision of enigmatic pain following UKR is universally unsuccessful.
Concerns
1. The concept that unicompartmental arthroplasty is a temporizing (prearthroplasty) procedure is not a
valid one in that the patient has to undergo another arthroplasty with all the risks of revision
arthroplasty surgery.
2. The treatment outcome of an infected UKR is similar to that of the infected TKR.
3. The change toward more liberal indications for UKR will not satisfy the expectations of many patients
requesting these procedures. Unfortunately, subsequent TKR will not be a good alternative or solution
for many of these patients. In one series, the most common causes of failure were: 1) a disputable
indication, or 2) suboptimal operative technique.
Conclusion
Based all available information, TKR is a more reliable, durable and more cost-effective option than UKR.
References
1. Hang JR, Stanford TE, Graves SE, Davidson DC, de Steiger RN, Miller LN. Outcome of revision of unicompartmental knee
replacement. Acta Orthop. 2010 Feb;81(1):95-8
2. 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 Aug;79(4):499-507
3. W-Dahl A, Robertsson O, Lidgren L, Miller L, Davidson D, Graves S. Unicompartmental knee arthroplasty in patients aged
less than 65. Acta Orthop. 2010 Feb;81(1):90-4.
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