Archives of Orthopaedic and Trauma Surgery

, Volume 139, Issue 3, pp 393–403 | Cite as

Does unicompartmental knee arthroplasty have worse outcomes in spontaneous osteonecrosis of the knee than in medial compartment osteoarthritis? A systematic review and meta-analysis

  • Chan Yoon
  • Moon Jong Chang
  • Chong Bum Chang
  • Ji Hye Choi
  • Seung Ah Lee
  • Seung-Baik KangEmail author
Knee Arthroplasty



The role of unicompartmental knee arthroplasty (UKA) in spontaneous osteonecrosis of the knee (SONK) remains controversial, even though SONK involves only one compartment of the knee joint. We aimed to compare the survival rate and clinical outcomes of UKA in SONK and medial compartment osteoarthritis (MOA) via a meta-analysis of previous studies.

Materials and methods

MEDLINE, Embase, and Cochrane Library were searched up to January 2018 with keywords related to SONK and knee arthroplasty. Studies were selected with predetermined inclusion criteria: (1) medial UKA as the primary procedure, (2) reporting implant survival or clinical outcomes of osteonecrosis and osteoarthritis, and (3) follow-up period > 1 year. Quality assessment was performed using the risk of bias assessment tool for non-randomized studies. A random-effects model was used to estimate the pooled relative risk (RR) and standardized mean difference.


The incidence of UKA revision for any reason was significantly higher in SONK than in MOA group (pooled RR = 1.83, p = 0.009). However, the risk of revision due to aseptic loosening was not significantly different between the groups. Moreover, when stratified by the study quality, high-quality studies showed similar risk of overall revision in SONK and MOA (p = 0.71). Subgroup analysis revealed no significant difference in failure between SONK and MOA after cemented mobile and fixed bearing UKA. Results of uncemented UKA were reported only in one study, which showed higher failure of SONK compared to MOA. Clinical outcomes after UKA were similar between SONK and MOA (p = 0.66).


Cemented UKA has similar survival and clinical outcomes in SONK and MOA. Prospective studies designed specifically to compare the UKA outcomes in SONK and MOA are necessary.


Knee Osteoarthritis Arthroplasty Unicompartmental knee arthroplasty Unicondylar knee arthroplasty Spontaneous osteonecrosis of the knee 



This research was supported by the Bio & Medical Technology Development Program of the National Research Foundation (NRF) funded by the Korean government (MSIT) (2017M3A9D8063538).

Compliance with ethical standards

Conflict of interest

The author(s) declare that they have no competing interests.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Supplementary material

402_2019_3125_MOESM1_ESM.docx (21 kb)
Supplementary material 1 (DOCX 21 KB)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Orthopaedic SurgerySeoul Bumin HospitalSeoulSouth Korea
  2. 2.Department of Orthopaedic SurgerySeoul National University College of Medicine, SMG-SNU Boramae Medical CenterSeoulSouth Korea
  3. 3.Department of Physical Medicine and Rehabilitation, College of MedicineKyung Hee UniversitySeoulSouth Korea
  4. 4.Seoul National University College of MedicineSeoulSouth Korea

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