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MIS Unicondylar Arthroplasty: The Bone-Sparing Technique

  • John A. Repicci
  • Jodi F. Hartman
Chapter

Abstract

Minimally invasive (MIS) unicondylar knee arthroplasty (UKA) and total knee arthroplasty (TKA) each have specific indications and distinctive roles in the senior author’s algorithm for the treatment of knee osteoarthritis (OA). MIS UKA is not a substitute for TKA, which is the procedure of choice for treatment of advanced stages of OA. This philosophy is supported by Thornhill and Scott, who assert that UKA should be considered in the “continuum of surgical options for the treatment of the osteoarthritic patient.”1 In cases of earlier, nonadvanced OA, the two procedures may act in conjunction with one another, with MIS UKA serving as a supplement to future TKA. Together, these devices may be considered as a “knee prosthetic system.”2

With the limited survivorship of TKA and the aging of the active baby boomer population, there is a need for a procedure in addition to TKA to address the treatment of earlier, nonadvanced stages of OA and to extend the survivability of knee prosthetics. Because knee prosthetics have a finite life span, a single device cannot encompass the entire spectrum of survivability necessary for many patients. Under the senior author’s serial replacement concept, a procedure such as MIS UKA performed at an earlier age, before TKA use and as a supplement to TKA, will absorb approximately 10 years of functional capacity so that when and if future arthroplasty is required, the survivability of the entire knee prosthetic system is lengthened.2,3 By following this philosophy, the use of MIS UKA in conjunction with a future TKA may increase the functional capacity of the entire knee prosthetic system to 20–30 years. The fundamental goal of this serial prosthetic replacement is to decrease the likelihood of a complex revision procedure in the patient’s lifetime.

Keywords

Total Knee Arthroplasty Femoral Component Femoral Condyle Primary Total Knee Arthroplasty Unicondylar Knee Arthroplasty 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Thornhill TS, Scott RD. Unicompartmental total knee arthroplasty. Orthop Clin North Am 1989;20(2):245–256PubMedGoogle Scholar
  2. 2.
    Repicci JA, Hartman JF. Minimally invasive unicondylar knee arthroplasty for the treatment of unicompartmental osteoarthritis: an outpatient arthritic bypass procedure. Orthop Clin N Am 2004;35:201–216CrossRefGoogle Scholar
  3. 3.
    Repicci JA, Hartman JF. Unicondylar knee replacement: the American experience. In: Fu FH, Browner BD, editors. Management of osteoarthritis of the knee: an international consensus, 1st edition. Rosemont, IL: American Academy of Orthopaedic Surgeons, 2003. pp. 67–79Google Scholar
  4. 4.
    Repicci JA, Eberle RW. Minimally invasive surgical technique for unicondylar knee arthroplasty. J South Orthop Assoc 1999;8(1):20–27PubMedGoogle Scholar
  5. 5.
    Fithian DC, Kelly MA, Mow VC. Material properties and structure-function relationships in the menisci. Clin Orthop Relat Res 1990 Mar;(252):19–31Google Scholar
  6. 6.
    Grelsamer RP. Current concepts review. Unicompartmental osteoarthrosis of the knee. J Bone Joint Surg Am 1995;77(2):278–292PubMedGoogle Scholar
  7. 7.
    Ihn JC, Kim SJ, Park IH. In vitro study of contact area and pressure distribution in the human knee after partial and total meniscectomy. Int Orthop 1993;17(4):214–218CrossRefPubMedGoogle Scholar
  8. 8.
    Johnson RJ, Kettelkamp DB, Clark W, et al. Factors affecting late results after meniscectomy. J Bone Joint Surg Am 1974;56(4):719–729PubMedGoogle Scholar
  9. 9.
    Kurosawa H, Fukubayashi T, Nakajima H. Load-bearing mode of the knee joint: physical behavior of the knee joint with or without menisci. Clin Orthop Relat Res 1980 Jun;(149):283–290Google Scholar
  10. 10.
    Shrive NG, O’Connor JJ, Goodfellow JW. Load-bearing in the knee joint. Clin Orthop Relat Res 1978 Mar-Apr;(131):279–287Google Scholar
  11. 11.
    Walker PS, Erkman MJ. The role of the menisci in force transmission across the knee. Clin Orthop Relat Res 1975;(109):184–192Google Scholar
  12. 12.
    Marmor L. Results of single compartment arthroplasty with acrylic cement fixation. A minimum follow–up of two years. Clin Orthop Relat Res 1977 Jan–Feb;(122):181–188Google Scholar
  13. 13.
    Bohm I, Landsiedl F. Revision surgery after failed unicompartmental knee arthroplasty. A study of 35 cases. J Arthroplasty 2000;15(8):982–989CrossRefPubMedGoogle Scholar
  14. 14.
    Goodfellow JW, Kershaw CJ, Benson MK, et al. The Oxford knee for unicompartmental osteoarthritis. The first 103 cases. J Bone Joint Surg Br 1988;70(5):692–701PubMedGoogle Scholar
  15. 15.
    Goodfellow JW, Tibrewal SB, Sherman KP, et al. Unicompartmental Oxford meniscal knee arthroplasty. J Arthroplasty 1987;2(1):1–9CrossRefPubMedGoogle Scholar
  16. 16.
    Kennedy WR, White RP. Unicompartmental arthroplasty of the knee. Postoperative alignment and its influence on overall results. Clin Orthop Relat Res 1987 Aug;(221):278–285Google Scholar
  17. 17.
    Kozinn SC, Scott R. Unicondylar knee arthroplasty. J Bone Joint Surg Am 1989;71(1):145–150PubMedGoogle Scholar
  18. 18.
    Laskin RS. Unicompartmental tibiofemoral resurfacing arthroplasty. J Bone Joint Surg Am 1978;60(2):182–185PubMedGoogle Scholar
  19. 19.
    Marmor L. Marmor modular knee in unicompartmental disease. Minimum four year follow-up. J Bone Joint Surg Am 1979;61(3):347–353PubMedGoogle Scholar
  20. 20.
    Marmor L. Unicompartmental knee arthroplasty. Ten- to 13-year follow-up study. Clin Orthop Relat Res 1988 Jan;(226):14–20Google Scholar
  21. 21.
    Murray DW, Goodfellow JW, O’Connor JJ. The Oxford medial unicompartmental arthroplasty: a ten-year survival study. J Bone Joint Surg Br 1998;80(6):983–989CrossRefPubMedGoogle Scholar
  22. 22.
    Squire MW, Callaghan JJ, Goetz DD, et al. Unicompartmental knee replacement. A minimum 15 year follow-up study. Clin Orthop Relat Res 1999 Oct;(367):61–72Google Scholar
  23. 23.
    Stockelman RE, Pohl KP. The long-term efficacy of unicompartmental arthroplasty of the knee. Clin Orthop Relat Res 1991 Oct;(271):88–95Google Scholar
  24. 24.
    Swank M, Stulberg SD, Jiganti J, et al. The natural history of unicompartmental arthroplasty. An eight-year follow-up study with survival analysis. Clin Orthop Relat Res 1993 Jan;(286):130–142Google Scholar
  25. 25.
    Tabor OB, Jr, Tabor OB. Unicompartmental arthroplasty: a long-term follow-up study. J Arthroplasty 1998;13(4):373–379CrossRefPubMedGoogle Scholar
  26. 26.
    Brown A. The Oxford unicompartmental knee replacement for osteoarthritis. Issues Emerg Health Technol 2001;23:1–4PubMedGoogle Scholar
  27. 27.
    Deshmukh RV, Scott RD. Unicompartmental knee arthroplasty: long-term results. Clin Orthop Relat Res 2001 Nov;(392):272–278Google Scholar
  28. 28.
    Keys GW. Reduced invasive approach for Oxford II medial unicompartmental knee replacement-a preliminary study. Knee 1999;6(3):193–196CrossRefGoogle Scholar
  29. 29.
    Murray DW. Unicompartmental knee replacement: now or never? Orthopedics 2000;23(9):979–980PubMedGoogle Scholar
  30. 30.
    Price A, Webb J, Topf H, et al. Oxford unicompartmental knee replacement with a minimally invasive technique. J Bone Joint Surg Br 2000;82(Suppl 1):24Google Scholar
  31. 31.
    Romanowski MR, Repicci JA. Minimally invasive unicondylar arthroplasty. Eight-year follow-up. Am J Knee Surg 2002;15(1):17–22Google Scholar
  32. 32.
    Price AJ, Webb J, Topf H, Dodd CA, Goodfellow JW, Murray DW. Rapid recovery after Oxford unicompartmental arthroplasty through a short incision. J Arthroplasty 2001;16(8):970–976CrossRefPubMedGoogle Scholar
  33. 33.
    Barrett WP, Scott RD. Revision of failed unicondylar unicompartmental knee arthroplasty. J Bone Joint Surg Am 1987;69(9):1328–1335PubMedGoogle Scholar
  34. 34.
    Padgett DE, Stern SH, Insall JN. Revision total knee arthroplasty for failed unicompartmental replacement. J Bone Joint Surg Am 1991;73(2):186–190PubMedGoogle Scholar
  35. 35.
    Insall J, Dethmers DA. Revision of total knee arthroplasty. Clin Orthop Relat Res 1982 Oct;(170):123–130Google Scholar
  36. 36.
    Lai CH, Rand JA. Revision of failed unicompartmental total knee arthroplasty. Clin Orthop Relat Res 1993 Feb;(287):193–201Google Scholar
  37. 37.
    Rand JA, Bryan RS. Results of revision total knee arthroplasties using condylar prostheses. A review of fifty knees. J Bone Joint Surg Am 1988;70(5):738–745Google Scholar
  38. 38.
    Kozinn SC, Scott RD. Surgical treatment of unicompartmental degenerative arthritis of the knee. Rheum Dis Clin North Am 1988;14(3):545–564PubMedGoogle Scholar
  39. 39.
    Ahlback S. Osteoarthrosis of the knee. A radiographic investigation. Acta Radiol Diagn 1968;277(Suppl):7–72Google Scholar
  40. 40.
    Romanowski MR, Repicci JA. Unicondylar knee surgery: development of the minimally invasive surgical approach. In: Scuderi GR, Tria AJ, Jr, editors. MIS of the hip and the knee: a clinical prospective. New York: Springer, 2004. pp. 123–151CrossRefGoogle Scholar
  41. 41.
    Sisto DJ, Blazina ME, Heskiaoff D, et al. Unicompartmental arthroplasty for osteoarthrosis of the knee. Clin Orthop Relat Res 1993 May;(286):149–153Google Scholar
  42. 42.
    Carr A, Keyes G, Miller R, et al. Medial unicompartmental arthroplasty. A survival study of the Oxford meniscal knee. Clin Orthop Relat Res 1993 Oct;(295):205–213Google Scholar
  43. 43.
    Jackson RW. Surgical treatment. Osteotomy and unicompartmental arthroplasty. Am J Knee Surg 1998;11(1):55–57PubMedGoogle Scholar
  44. 44.
    Marmor L. Unicompartmental knee arthroplasty of the knee with a minimum ten-year follow-up period. Clin Orthop Relat Res 1988 Mar;(228):171–177Google Scholar
  45. 45.
    Cartier P, Sanouiller JL, Grelsamer RP. Unicompartmental knee arthroplasty surgery. 10-year minimum follow-up period. J Arthroplasty 1996;11(7):782–788CrossRefPubMedGoogle Scholar
  46. 46.
    Christensen NO. Unicompartmental prosthesis for gonarthrosis. A nine-year series of 575 knees from a Swedish hospital. Clin Orthop Relat Res 1991 Dec;(273):165–169Google Scholar
  47. 47.
    Voss F, Sheinkop MB, Galante JO, et al. Miller-Galante unicompartmental knee arthroplasty at 2- to 5-year follow-up evaluations. J Arthroplasty 1995;10(6):764–771CrossRefPubMedGoogle Scholar
  48. 48.
    Berger RA, Nedeff DD, Barden RM, et al. Unicompartmental knee arthroplasty. Clinical experience at 6- to 10-year follow-up. Clin Orthop Relat Res 1999 Oct;(367):50–60Google Scholar
  49. 49.
    Bert JM. 10-year survivorship of metal-backed, unicompartmental arthroplasty. J Arthroplasty 1998;13(8):901–905CrossRefPubMedGoogle Scholar
  50. 50.
    Capra SW, Jr., Fehring TK. Unicondylar arthroplasty. A survivorship analysis. J Arthroplasty 1992;7(3):247–251CrossRefPubMedGoogle Scholar
  51. 51.
    Hawker GA, Wright JG, Coyte PC, et al. Determining the need for hip and knee arthroplasty: the role of clinical severity and patients’ preferences. Med Care 2001;39:206–216CrossRefPubMedGoogle Scholar
  52. 52.
    Knutson K, Lewold S, Robertsson O, et al. The Swedish knee arthroplasty register. A nation-wide study of 30,003 knees 1976–1992. Acta Orthop Scand 1994;65:375–386CrossRefPubMedGoogle Scholar
  53. 53.
    Scott RD, Cobb AG, McQueary FG, et al. Unicompartmental knee arthroplasty. Eight- to 12-year follow-up evaluation with survivorship analysis. Clin Orthop Relat Res 1991 Oct;(271):96–100Google Scholar
  54. 54.
    Keblish PA. The case for unicompartmental knee arthroplasty. Orthopedics 1994;17:853–855PubMedGoogle Scholar
  55. 55.
    Repicci JA, Hartman JF. Minimally invasive surgery for unicondylar knee arthroplasty: the bone-sparing technique. In: Scuderi GR, Tria AJ, Jr, Berger RA, editors. MIS techniques in orthopedics. New York: Springer Science + Business Media, Inc., 2006. pp. 193–213CrossRefGoogle Scholar
  56. 56.
    Kapandji IA. The physiology of the joints, 5th edition, volume 2. New York: Churchill Livingstone, 1987Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Joint Reconstruction Orthopedic CenterBuffaloUSA

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