Pre-existing patellofemoral disease does not affect 10-year survivorship in fixed bearing unicompartmental knee arthroplasty

  • Joel Wei-An LimEmail author
  • Jerry Yongqiang Chen
  • Hwei Chi Chong
  • Hee Nee Pang
  • Darren Keng Jin Tay
  • Shi-Lu Chia
  • Ngai Nung Lo
  • Seng Jin Yeo



The purpose of this study was to assess 10-year functional outcome and survivorship analysis of patients with significant radiographic evidence of patellofemoral joint arthritis treated with fixed bearing unicompartmental knee arthroplasty.


Two hundred and sixteen patients (263 knees) that underwent UKA from 2003 to 2005 for a mean of 10.5 ± 2.1 years were prospectively followed up. Preoperative radiological assessment of the patellofemoral joint state was assessed according to the Ahlback classification by an independent assessor and radiographically significant patellofemoral disease was defined as grade 2 or more. Patients with significant bone-on-bone contact in the patellofemoral joint were excluded.


Of the 263 knees, 222 (84.4%) had normal patellofemoral joint state and 41 (15.6%) radiologically significant patellofemoral disease. At 10 years’ follow-up, the normal and patellofemoral groups had similar OKS (20 ± 7 vs 20 ± 8, n.s.) and KSS scores (79 ± 20 vs 81 ± 20, n.s.), respectively. There were 12 revision surgeries in the normal group and the most common indication for revision was progression of contralateral compartment osteoarthritis (6 of 12 cases). There was only one revision in the patellofemoral group and it was due to progression of contralateral compartment osteoarthritis (n.s.). When all secondary surgeries to the operated knee were considered as failures, the 10-year survival rate was 95.1% (CI 95%: 92.2–97.7%).


The presence of significant preoperative radiological patellofemoral disease does not affect long-term implant survival and patients have excellent functional outcomes 10 years postoperatively. These patients should not be contraindicated from undergoing unicompartmental knee arthroplasty.

Level of evidence



UKA Patellofemoral Unicompartmental Arthroplasty Survivorship 


Author contributions

LW analysed the data and wrote the paper. CYJ contributed significantly to statistical design and data analysis. CHC collected and managed the data. PHN revised and approved the manuscript. TKJ revised and approved the manuscript. CSL revised and approved the manuscript. LNN revised and approved the manuscript. YSJ conceived the study, revised and approved the manuscript.


This study was approved by the Singhealth Centralised Institutional Review Board (CIRB) committee (CIRB:2016/2144).

Compliance with ethical standards

Conflict of interest

No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

Ethical approval

All authors and their immediate family did not receive any financial payments or other benefits from any commercial entity related to the subject of this article.


  1. 1.
    Adams AJ, Kazarian GS, Lonner JH (2017) Preoperative patellofemoral chondromalacia is not a contraindication for fixed-bearing medial unicompartmental knee arthroplasty. J Arthroplasty 32(6):1786–1791CrossRefGoogle Scholar
  2. 2.
    Andriacchi TP, Galante JO, Fermier RW (1982) The influence of total knee-replacement design on walking and stair-climbing. J Bone Jt Surg Am 64:1328–1335CrossRefGoogle Scholar
  3. 3.
    Ahlback S (1968) Osteoarthrosis of the knee. A radiographic investigation. Acta Radiol Diagn (Stockh) Suppl 277:7–72Google Scholar
  4. 4.
    Argenson JN, O’Connor JJ (1992) Polyethylene wear in meniscal knee replacement. A one to nine-year retrieval analysis of the Oxford knee. J Bone Jt Surg Br 74:228–232CrossRefGoogle Scholar
  5. 5.
    Argenson JN, Parratte S (2006) The unicompartmental knee: design and technical considerations in minimizing wear. Clin Orthop Relat Res 452:137–142CrossRefGoogle Scholar
  6. 6.
    Argenson J-NA, Blanc G, Aubaniac J-M, Parratte S (2013) Modern unicompartmental knee arthroplasty with cement:a concise follow-up, at a mean of twenty years, of a previous report. J Bone Jt Surg Am 95-A:905–909CrossRefGoogle Scholar
  7. 7.
    Beard DJ, Pandit H, Gill HS et al (2007) The influence of the presence and severity of preexisting patellofemoral degenerative changes on the outcome of the Oxford medial unicompartmental knee replacement. J Bone Joint Surg 89-B:1597–1601CrossRefGoogle Scholar
  8. 8.
    Beard DJ, Pandit H, Ostlere S et al (2007) Pre-operative clinical and radiological assessment of the patellofemoral joint in unicompartmental knee replacement and its influence on outcome. J Bone Jt Surg 89-B:1602–1607CrossRefGoogle Scholar
  9. 9.
    Berend KR, Lombardi AV Jr, Adams JB (2007) Obesity, young age, patellofemoral disease, and anterior knee pain: identifying the unicondylar arthroplasty patient in the United States. Orthopedics 30(Suppl):19–23PubMedGoogle Scholar
  10. 10.
    Berger RA, Meneghini RM, Jacobs JJ, Sheinkop MB, Della Valle CJ, Rosenberg AG, Galante JO (2005) Results of unicompartmental knee arthroplasty at a minimum of ten years of follow-up. J Bone Jt Surg Am 87-A:999–1006CrossRefGoogle Scholar
  11. 11.
    Bonutti PM, Dethmers DA (2008) Contemporary unicompartmental knee arthroplasty: fixed vs mobile bearing. J Arthroplasty 23:24–27CrossRefGoogle Scholar
  12. 12.
    Brown NM, Sheth NP, Davis K et al (2012) Total knee arthroplasty has higher postoperative morbidity than unicompartmental knee arthroplasty: a multicenter analysis. J Arthroplasty 27(8):86–90CrossRefGoogle Scholar
  13. 13.
    Callaghan JJ, Insall JN, Greenwald AS et al (2001) Mobile-bearing knee replacement: concepts and results. Instr Course Lect 50:431–449PubMedGoogle Scholar
  14. 14.
    Chassin EP, Mikosz RP, Andriacchi TP, Rosenberg AG (1996) Functional analysis of cemented medial unicompartmental knee arthroplasty. J Arthroplasty 11:553–559CrossRefGoogle Scholar
  15. 15.
    Davies AP, Vince AS, Shepstone L, Donell ST, Glasgow MM (2002) The radiologic prevalence of patellofemoral osteoarthritis. Clin Orthop Relat Res 402:206–212CrossRefGoogle Scholar
  16. 16.
    Dawson J, Fitzpatrick R, Murray D, Carr A (1998) Questionnaire on the perceptions of patients about total knee replacement. J Bone Jt Surg 80-B:63–69CrossRefGoogle Scholar
  17. 17.
    Goodfellow JW, O’Connor J (1986) Clinical results of the Oxford knee: surface arthroplasty of the tibiofemoral joint with a meniscal bearing prosthesis. Clin Orthop Relat Res 205:21–42Google Scholar
  18. 18.
    Goodfellow J, O’Connor J, Dodd CAF, Murray DW (2006) Unicompartmental arthroplasty with the Oxford Knee. Oxford University Press, New York, pp 117–128Google Scholar
  19. 19.
    Gleeson RE, Evans R, Ackroyd CE, Webb J, Newman JH (2004) Fixed or mobile bearing unicompartmental knee replacement? A comparative cohort study. Knee 11(5):379–384CrossRefGoogle Scholar
  20. 20.
    Hamilton TW, Pandit HG, Maurer DG, Ostlere SJ, Jenkins C, Mellon SJ, Dodd CAF, Murray DW (2017) Anterior knee pain and evidence of osteoarthritis of the patellofemoral joint should not be considered contraindications to mobile-bearing unicompartmental knee arthroplasty: a 15-year follow-up. Bone Jt J 99-B(5):632–639CrossRefGoogle Scholar
  21. 21.
    Hunt LP, Ben-Shlomo Y, Clark EM et al (2014) 45-day mortality after 467,779 knee replacements for osteoarthritis from the National Joint Registry for England and Wales: an observational study. Lancet 384:1429–1436CrossRefGoogle Scholar
  22. 22.
    Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 248:13–14Google Scholar
  23. 23.
    Kim KT, Lee S, Lee JS, Kang MS, Koo KH (2018) Long-term clinical results of unicompartmental knee arthroplasty in patients younger than 60 years of age: minimum 10-year follow-up. Knee Surg Relat Res 1;30(1):28–33CrossRefGoogle Scholar
  24. 24.
    Ko Y, Lo NN, Yeo SJ, Yang KY, Yeo W, Chong HC, Thumboo J (2013) Comparison of the responsiveness of the SF-36, the Oxford Knee Score, and the Knee Society Clinical Rating System in patients undergoing total knee replacement. Qual Life Res 22(9):2455–2459CrossRefGoogle Scholar
  25. 25.
    Kozinn SC, Scott R (1989) Unicondylar knee arthroplasty. J Bone Jt Surg Am 71:145–150CrossRefGoogle Scholar
  26. 26.
    Kim KT, Lee S, Tae Woo Kim (2012) The influence of postoperative tibiofemoral alignment on the clinical results of unicompartmental knee arthroplasty. Knee Surg Relat Res 24(2):;85–90CrossRefGoogle Scholar
  27. 27.
    Laurencin CT, Zelicof SB, Scott RD, Ewald FC (1991) Unicompartmental versus total knee arthroplasty in the same patient. A comparative study. Clin Orthop Relat Res 273:151–156Google Scholar
  28. 28.
    Li MG, Yao F, Joss B, Ioppolo J, Nivbrant B, Wood D (2006) Mobile vs. fixed bearing unicondylar knee arthroplasty: a randomized study on short term clinical outcomes and knee kinematics. Knee 13(5):365–370CrossRefGoogle Scholar
  29. 29.
    Liddle AD, Judge A, Pandit H et al (2014) Adverse outcomes after total and unicompartmental knee replacement in 101,330 matched patients: a study of data from the National Joint Registry for England and Wales. Lancet 384:1437–1445CrossRefGoogle Scholar
  30. 30.
    Lombardi AV Jr, Berend KR, Walter CA et al (2009) Is recovery faster for mobile-bearing unicompartmental than total knee arthroplasty? Clin Orthop Relat Res 467:1450–1457CrossRefGoogle Scholar
  31. 31.
    Pandit H, Jenkins C, Dodd CAF, Murray DW et al (2015) The clinical outcome of minimally invasive Phase 3 Oxford unicompartmental knee arthroplasty. Bone Jt J 97-B:1493–1500CrossRefGoogle Scholar
  32. 32.
    Parratte S, Abdel M, Argenson J-NA et al (2015) Long term results of compartmental arthroplasties of the knee. Bone Jt J 97-B(10 Suppl A):9–15CrossRefGoogle Scholar
  33. 33.
    Price AJ, Oppold PT, Murray DW, Zavatsky AB (2006) Simultaneous in vitro measurement of patellofemoral kinematics and forces following Oxford medial unicompartmental knee replacement. J Bone Jt Surg Br 88(12):1591–1595CrossRefGoogle Scholar
  34. 34.
    Robertsson O, Borgquist L, Knutson K, Lewold S, Lidgren L (1999) Use of unicompartmental instead of tricompartmental prostheses for unicompartmental arthrosis in the knee is a cost-effective alternative. 15,437 primary tricompartmental prostheses were compared with 10,624 primary medial or lateral unicompartmental prostheses. Acta Orthop Scand 70:170–175CrossRefGoogle Scholar
  35. 35.
    Rougraff BT, Heck DA, Gibson AE (1991) A comparison of tricompartmental and unicompartmental arthroplasty for the treatment of gonarthrosis. Clin Orthop Relat Res 273:157–164Google Scholar
  36. 36.
    Song EK, Park JK, Park CH, Kim MC, Agrawal PR, Seon JK (2016) No difference in anterior knee pain after medial unicompartmental knee arthroplasty in patients with or without patellofemoral osteoarthritis. Knee Surg Sports Traumatol Arthrosc 24(1):208–213CrossRefGoogle Scholar
  37. 37.
    Thein R, Zuiderbaan HA, Khamaisy S, Nawabi DH, Poultsides LA, Pearle AD (2015) Medial unicondylar knee arthroplasty improves patellofemoral congruence: a possible mechanistic explanation for poor association between patellofemoral degeneration and clinical outcome. J Arthroplasty 30(11):1917–1922CrossRefGoogle Scholar
  38. 38.
    Whittaker JP, Naudie DD, McAuley JP, McCalden RW, Mac-Donald SJ, Bourne RB (2010) Does bearing design influence midterm survivorship of unicompartmental arthroplasty? Clin Orthop Relat Res 468:73–81CrossRefGoogle Scholar

Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2018

Authors and Affiliations

  • Joel Wei-An Lim
    • 1
    Email author
  • Jerry Yongqiang Chen
    • 1
  • Hwei Chi Chong
    • 1
  • Hee Nee Pang
    • 1
  • Darren Keng Jin Tay
    • 1
  • Shi-Lu Chia
    • 1
  • Ngai Nung Lo
    • 1
  • Seng Jin Yeo
    • 1
  1. 1.Adult Reconstruction Service, Department of Orthopaedic SurgerySingapore General HospitalSingaporeSingapore

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