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JUEVES / THURSDAY
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Last but not least, the definitive cemented components are
implanted.
CONCLUSION
The Journey DEUCE should allow the patient with a Bi-
Compartmental Knee osteoarthritis to get treated with a new
knee device that would suit the best both his pathology and
expectations while resurfacing only the parts of the knee affected
and sparing as much as possible bone and soft tissues
in order to bring him back the closest to his forgotten knee.
UNICOMPARTMENTAL KNEE ARTHRITIS
UNICOMPARTMENTAL VS TOTAL KNEE
ARTHROPLASTY
Aaron G. Rosenberg, MD
Professor of Orthopaedic Surgery Rush Medical College
Chicago, Illinois (USA)
MANAGEMENT OF UNICOMPARTMENTAL ARTHRITIS
The management of uni-compartmental knee arthritis is complex
for several reasons. Because many viable treatment
options exist, there is legitimate disagreement about the
actual utility or relative value of the individual procedures, In
addition, it is not always easy to assess the degree to which
the knee is truly diseased in only one compartment and to
what extent additional compartments are the source of symptoms
or perhaps more importantly, likely to be subject to
symptomatic deterioration over time. The age, activity level
and expectations of the patient are additional factors which
render the decision making complex. As a consequence, the
clinician may be faced with a difficult decision making process
in terms of recommending a specific treatment for the patient.
In general, when conservative measures have failed, there
are 5 different options which may be available –some in
isolation and some in combination including; arthroscopy,
cartilage restoration procedures, and osteotomy. In general
these techniques are appropriate for younger patients and
patients with isolated cartilage defects or lesser degrees of
arthrosis. For more severe arthrosis and older patients the
choices are usually between uni-compartmental and total
knee arthroplasty. Choosing between them may be relatively
simple, or very complex, depending on the factors discussed
in more detail below.
DIAGNOSIS
Patient History
The history should include not only current complaints but
also an assessment of prior non-operative and operative
treatments and the response to those treatments. Patients
who have undergone multiple unsuccessful procedures are
generally better candidates for total rather than unicompartmental
arthroplasty. The location, character and quantity of
pain are important, as is the presence of pain at night or at
rest. In general, patients with pain at rest or at night are
poor candidates for unicompartmental arthroplasty. Likewise,
patients with diffuse pain or anterior pain are in general better
served by total arthroplasty. Patients are specifically questioned
to determine whether or not they are more symptomatic
when ascending or descending stairs as this indicates pain
from the patellofemoral joint. Symptoms of instability and
mechanical symptoms of knee locking or catching should
also be documented. It is also important to recognize those
patients with unrealistic expectations, such as those who
only experience pain and disability in the context of intense
physical exertion in whom activity modification or non-arthroplasty
surgical interventions would be most appropriate
IMAGING
Plain Radiographs
Radiographs obtained should including standing anteroposterior,
lateral and patellofemoral views. Standing radiographs
are imperative to detect subtle joint space narrowing
associated with loss of articular cartilage. A standing view
with the knee flexed 45 degrees is also useful in identifying
subtle joint space narrowing. Standing full-length mechanical
axis views are obtained pre-operatively for operative planning
and stress views may be obtained to determine whether or
not the sagital plane deformity is passively correctable.
Magnetic Resonance Imaging
Magnetic resonance imaging may occasionally be indicated
to further evaluate the integrity of the cartilaginous surfaces
when plain radiographic findings are unclear. Degenerative
meniscal tears often co-exist with arthritis. In addition, early
osteonecrosis may only be detectable by magnetic resonance
imaging.
Bone Scintigraphy
Bone scintigraphy can be useful in evaluation patients with
normal radiographic findings who have symptoms and signs
of osteoarthritis or may be useful when subtle degeneration
of the contralateral compartment or patellofemoral joint is
suspected.
ARTHROSCOPY
Arthroscopy allows for the direct visualization of the cartilaginous
surfaces and for the accurate detection of meniscal
pathology. There is no data to support its utility in determining
sutability for unicompartmental arthroplasty. It may however
be combined therapeutically with unicompartmental arthroplasty
when contra-compartmental pathology requires arthroscopic
treatment
General Pre-requisites
The general pre-requisites for surgical procedures directed
to uni-compartmental arthritis include severe damage to the
cartilage in an isolated compartment, an adequate range of