Revision of minimal resection resurfacing unicondylar knee. Longterm clinical results of the oxford medial unicompartmental knee arthroplasty int orthop 2010. Unicompartmental knee replacement protocol the following protocol should be used as a guideline for rehabilitation progression, but may need to be altered pending the nature and extent of the surgical procedure, healing restraints or patient tolerance. Anatomical shape of tibial component for optimal bone coverage. Osteoarthritis oa is a degenerative disease of joints caused by a breakdown and eventual loss of articular cartilage. Unicondylar knee replacement simply means that only a part of the knee joint is replaced through a smaller incision than would normally be used for a total knee replacement. Complications and adverse events of unicompartmental. This study contains interesting findings, but it is the statistical methodology that sets it apart. A key factor in the longevity of the implant is the positioning. An editorial on outcome of unicondylar knee arthroplasty. In a unicondylar knee replacement, only one area or compartment of the joint is replaced. During the surgery, only the damaged compartment of the knee is removed and replaced with metal and plastic, leaving the remaining healthy cartilage and bone.
A total knee arthroplasty performed as a revision unicondylar knee arthroplasty is thought by some authors to have equivalent functional outcomes to a primary total knee replacement. This procedure is an alternative to total knee replacement for patients whose disease is limited to just one area of the knee. A prospective followup study of 1,819 patients from the finnish arthroplasty register. Uni or hemi replacement of the outside or lateral compartment of the knee is rarely recommended or. Revision of unicondylar to total knee arthroplasty. Comparing in vivo kinematics of unicondylar and bi. Unicondylar knee replacements have been performed since the early 1970s with mixed success. The current concepts of total knee arthroplasty have been devel oped gradually over the last 25 years.
Place the knee in extension and assess the extension gap with the tibial trial figure 18. Conceptually, the unicondylar knee replacement is to be used as a step before total knee replacement. Revision of unicondylar knee replacements to total knee replacement knee 1995. Outcome of unicondylar knee arthroplasty vs total knee. Complications and adverse events of unicompartmental versus. Hazard ratios less than 1 favour unicompartmental knee replacement.
Articular cartilage lines the bony joint surfaces and allows. Knee solutions unicompartmental knee arthroplasty system. In a total knee replacement all knee surfaces lose up to 12 of bone on each of the three compartments. Unicondylar knee replacement for primary osteoarthritis. Unicondylar knee replacement orthopaedic associates of st. In addition, current indicat ions for a unicondylar replacement necessitate the presence of. Nntnumber needed to treat ie, number of patients switching treatment to avoid one adverse event.
Oxford unicompartmental knee manual of the surgical technique. Unicompartmental knee replacement is an attractive concept that offers several potential advantages over bicompartmental or tricompartmental replacement, including preservation of bone stock, of. Unicondylar knee arthroplasty intramedullary technique intramedullary guide partial knee replacement femur first technique unicompartmental arthritis arthritis knee kinematics key points use of an intramedullary femoral alignment guide for unicompartmental arthroplasty is a reliable, reproducible technique. Unicompartmental arthroplasty uka of the knee in patients with isolated medial osteoarthritis yields adequate results. Soft tissue mobilization to the surrounding and posterior musculature, and to the patella to avoid flexion or patella contracture. Unicondylar knee arthroplasty clinics in sports medicine. Partial knee replacement femur first technique unicompartmental. Comparison of open wedge high tibial osteotomy versus. Unicompartmental knee replacement current perspectives. Partial knee system oxford partial knee zimmer biomet. This partial knee replacement is called the uni or hemi compartmental knee replacement. However, certain aspects of the procedure are still debated. These patients are often more athletic and expect better function than the typical patient with tricompartmental disease.
To do this, take the limb to the desired flexion angle and while supporting the thigh, apply a valgus stress to the knee joint while controlling and keeping the foot pointing straight ahead. Surgical technique sigma hp partial knee depuy synthes 3 surgical technique xray templating 3 approach and exposure 4 proximal tibial resection 5 tibial jig alignment 7 tibial sizing 10 balancing 11 distal femoral resection femoral sizing and rotation 15 trial reduction 18 tibial preparation 19 component implantation 22 cement technique 23. It has the advantages over tibial osteotomy of providing more certain relief of pain, quicker recovery, and better long term survival. In unicompartmental knee replacement also called partial knee replacement only a portion of the knee is resurfaced with metal and plastic components. Best unicondylar knee replacement surgeon in nyc ny bone. Vikram shah at shalby hospitals using zero technique. This guide should be used in conjunction with, not replacing. Download the following assets for more information. Unicompartmental knee replacement ukr is an effective treatment for endstage, symptomatic unicompartmental osteoarthritis of the knee. There is paucity of literature on unicondylar knee arthroplasty in postpatellectomy patients with isolated anteromedial knee arthritis. A followup study of 50,493 knee replacements from the finnish arthroplasty register acta orthopaedica 2008. The existing design inherits the clinical results of the phase i and ii implants, which have now demonstrated 20year survivorship 5 in the literature. In the lancet rheumatology, edward burn and colleagues1 present new data from the uk and usa, which logically,2,3 or controversially,4 compare the efficacy of unicompartmental knee replacement ukr and total knee replacement tkr.
Unicompartmental knee replacement is indicated for patients with osteoarthritis isolated to the medial or lateral tibiofemoral compartments. Oxford unicondylar knee replacement also known as unicompartmental knee replacement, unicondylar knee replacement is a less invasive alternative to a total knee replacement. The persona partial knee system is a unicondylar knee replacement system that is designed with an instrument. It should be noted that for a variety of reasons, uni compartmental knee replacement is limited to the medial compartment. Unicondylar knee arthroplasty in patellectomized patients.
Mckeever in the 1950s, followed up by both mckeever and macintosh introducing metallic tibial components that. However, patients should be made aware of the lower survival of the ukas compared with total knee arthroplasties. The mean knee society knee score improved 169% in the 1year group and 193% in the 2year group. Unicondylar knee arthroplasty uka has been performed for more than three decades. The navio surgical system is indicated for use with cemented implants only. Despite two decades of experience, the role of unicompartmental arthroplasty remains controversial and uncertain. Since the implants save more bone, future total knee replacement procedures can be performed if necessary. The unicondylar knee replacement uka centre had 22 patients over june 2012 to august 20 and used the oxford partial knee system in these operations. Pdf unicompartmental knee replacement current perspectives. This procedure is designed to replace only the portions of the knee most damaged by arthritis, leaving the healthier portions intact and letting patients benefit from less. Shalby hospitals multi specialty hospital 73,089 views. Conforming, spherical design minimizes contact stress throughout entire range of motion 4. Unicondylar knee replacement presents multimedia health education your practice on ine australia dr. This system restores the unique articular surface geometry of the compartment by using an intraoperative 3dimensional mapping system and contoured articular resurfacing implants.
Total knee arthroplasty total knee replacement has been proven to be a predictably successful procedure with reliable pain relief, increased knee function, and im provement in quality of life 19,27, 35. Results of unicompartmental versus total knee replacement. This is where the disease has not progressed to all 3 compartments of the knee, allowing the surgeon to replace fewer parts. These procedures include unicondylar knee replacement ukr, patellofemoral arthroplasty pfa, and total knee arthroplasty tka. Your practice on ine hips knees information on hip, knee.
This treatment is suitable for people who experience arthritis only in one compartment section of the knee joint, rather than throughout the joint. Theoretically, unicondylar knee replacement offers great potential in restoring knee kinematics. Adverse outcomes after total and unicompartmental knee. The zimmer biomet oxford partial knee is a medial partial knee replacement system consisting of a femoral component, a tibial component, and a freely mobile meniscal bearing, featuring. Zimmer biomets oxford partial knee is the most widely used partial knee in the world 4. Unicompartmental knee replacement page 5 about your knee the knee joint is one of the largest joints within the body, working mainly as a complex hinge.
An unicondylar replacement cannot change the original natural alignment or ligament balance of the knee. These areas of discussion include patient selection criteria, implant design and the discrepancy in survival rates between national registries and. The medical necessity criteria apply to different lines of business. An unicondylar replacement cannot change the original natural.
Pdf unicondylar knee replacement with a new tensioner device. Unicondylar knee arthroplasty rodriguez hip and knee. In the normal knee, movement between the tibia and the femur is controlled by. Optetrak unicondylar system total knee arthroplasty. Unicompartmental knee replacement, also called a partial knee replacement is surgery to treat arthritis which is limited to one of the knee knee compartments. In conclusion, this study shows that open wedge high tibial osteotomy and unicondylar knee replacements have no significant. Unicondylar knee arthroplasty intramedullary technique intramedullary guide. If youve caught the arthritic damage early, you may be eligible for a partial knee replacement. The postoperative functional outcome was good to excellent in all reports except one, which described revision surgery of all three patients. Navio surgical system surgical technique for unicondylar knee. Pdf the popularity of unicompartmental knee arthroplasty uka for the treatment of isolated compartment osteoarthritis of the knee has risen.
Oxford unicondylar knee replacement princeton new jersey. The revisionreoperation hazard ratios are split because of timevarying hazard see text. Also known as a partial knee replacement, a unicondylar knee replacement is an alternative to total knee replacement for patients suffering from osteoarthritis with damage confined to only one compartment of the knee joint. This is in part, because the cruciate ligaments and half of the knee joint are not touched in the surgery. Partial knee replacement also known as unicompartmental knee arthroplasty is a surgical treatment for knee arthritis. Increasing numbers of patients are presenting at a younger age for knee replacement with unicompartmental disease. Pdf ligament balancing is an established surgical technique in total knee arthroplasty with good clinical results.
Center and surgeon volume influence the revision rate following unicondylar knee replacement. It wasnt long ago that knee replacement surgery was reserved for the elderly. Springer, 2006 hallock and fell 2003 reported 1 and 2year data on 71 unispacer knee devices. Unicondylar knee replacement this is a general information packet for patients undergoing unicondylar knee replacement. In cases of osteoarthritis, unicompartmental knee replacement competes with upper tibial osteotomy at one end of the disease spectrum and with total condylar joint replacement at the other. Unicondylar spacer devices for treatment of pain or disability. Its biomedicallyinspired articular geometry and proprietary net compression molded polyethylene facilitate restoration for preprimary total knee replacement. Oxford unicompartmental knee manual of the surgical. Zuk is a clinically proven uni knee replacement introduced globally in 2004. However, there have been several studies suggesting that revision is not as simple as suggested, and that function is not as good as primary total knee arthroplasty. Reported advantages of unicompartmental knee arthro plasty uka over total knee arthroplasty tka include shorter operative time, reduced blood loss, quicker.
Also known as unicompartmental knee replacement, unicondylar knee replacement is a less invasive alternative to a total knee replacement. It should, in theory, also restore the normal kinematics of the knee. Since only one compartment is diseased, the overall geometry of the knee is better preserved. It has been suggested as the appropriate operation in 6% of patients with gonarthrosis. Unicondylar knee replacement orthopaedic associates of. Unicondylar knee replacement ukr or partial knee arthroplasty tka, is a type of knee replacement involving only the diseased half of the joint. A total of 5 implants were revised to total knee arthroplasty and 10 implants were revised to another unispacer knee device. Unicompartmental knee arthroplasty, bearing design, fixation technique.
Comparison of survival and costeffectiveness between unicondylar arthroplasty and total knee arthroplasty in patients with primary osteoarthritis. Unicondylar knee arthroplasty intramedullary technique intramedullary guide partial knee replacement femur first technique unicompartmental arthritis arthritis knee kinematics key points use of an intramedullary femoral alignment guide for unicompartmental arthroplasty is a. Biunicondylar arthroplasty has shown good outcomes 8 and there is renewed interest in this technique with the increasing popularity of unicondylar. Several studies have confirmed the excellent clinical outcome and survival of unicompartmental knee replacement fixed or mobile bearing implants, with a reported tenyear survival greater than 90%. In these cases the remaining opposite compartment articular cartilage is physically and biomechanically intact and capable of bearing normal loads.
Using the criteria given above, about one in four osteoarthritic knees requiring replacement are suitable for oxford medial unicompartmental. In addition, current indicat ions for a unicondylar replacement necessitate the presence of an intact anterior cruciate ligament. Navio surgical system surgical technique for unicondylar. This is a less invasive procedure that allows for a more natural feel after surgery. The extension gap can be filled 1, 2 or 3 mm distally with use of a femoral defect shim.
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