Clinical outcome of bi-unicompartmental knee arthroplasty for both medial and lateral femorotibial arthritis: a systematic review—is there proof of concept?



Unicompartmental knee arthroplasty (UKA) is a well-accepted treatment for isolated unicompartmental osteoarthritis (OA) of the knee. In previous literature, it has been suggested that bi-unicompartmental knee arthroplasty (bi-UKA) which uses two UKA implants in both the medial and lateral compartments of the same knee is a feasible and viable option for the treatment of knee OA. Given the advantages of UKA treatment, it is warranted to review the literature of bi-UKA and discuss the evidence in terms of implant selection, indications, surgical techniques, and outcomes, respectively.

Materials and methods

Following the PRISMA guidelines, PubMed, Medline, Embase, CINAHL, Web of Science, and Cochrane Library were searched for studies presenting outcome of bi-UKA. Studies were included if they reported clinical outcomes using two unicompartmental prostheses for both medial and lateral femorotibial arthritis. Studies with the addition of patellofemoral arthroplasty or concomitant soft-tissue reconstruction and those not published in English were excluded.


In the early literature, the procedure of bi-UKA were performed for very severe OA and rheumatoid arthritis, but indications have evolved to reflect a more contemporary case-mix of knee OA patients. Both mobile and fixed bearing implants have been used, with the latter being the most frequent choice. A medial parapatellar approach for incision and arthrotomy has been the most frequently used technique. The present review found a promising clinical outcome of both simultaneous and staged bi-UKA although the number of long-term follow-up studies was limited.


Both simultaneous and staged bi-UKA has demonstrated good functional outcomes. However, the volume and level of evidence in general is low for studies captured in this review, and the data on long-term outcomes remain limited. The present review indicates that bi-UKA is a feasible and viable surgical option for bicompartmental femorotibial OA in carefully selected patients.

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Fig. 1
Fig. 2



Unicompartmental knee arthroplasty




Total knee arthroplasty


Patient-reported outcome measures


Bi-unicompartmental knee arthroplasty


Rheumatoid arthritis


Range of motion


Anterior cruciate ligament


Oxford Knee Score


International knee society score


Western Ontario and McMaster Universities Arthritis Index


Knee Injury and Osteoarthritis Outcome Scores


High tibial osteotomy


A dedicated UKR outcome score developed by the Italian Orthopaedic UKR’s Users Group


Hospital for Special Surgery score


Visual analog scale


American Knee Society Score


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Correspondence to Keizo Wada.

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Wada, K., Price, A., Gromov, K. et al. Clinical outcome of bi-unicompartmental knee arthroplasty for both medial and lateral femorotibial arthritis: a systematic review—is there proof of concept?. Arch Orthop Trauma Surg (2020).

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  • Knee
  • Osteoarthritis
  • Arthroplasty
  • Bi-unicompartmental knee arthroplasty
  • Unicompartmental knee arthroplasty