Abstract
When considering treatment options for osteoarthritis of the knee, the pathology and progression of the disease must be considered. Past studies examining osteoarthritis of the knee have demonstrated that the disease is slow, progressive, and typically limited to the medial tibiofemoral compartment.1–4 Moreover, the erosion of cartilage in the medial compartment is almost always limited to the anterior half of the medial tibial plateau and the corresponding contact area on the distal portion of the medial femoral condylar.4 Anteromedial osteoarthritis was coined by White et al. to describe this distinct clinicopathological condition.4 The ensuing anatomic defect, namely, loss of articular cartilage in the extension gap with no corresponding loss of articular cartilage in the flexion gap, results in a 6-mm to 8-mm disparity between the extension and flexion gaps. For this reason, medial osteoarthritis also may be considered an extension gap disease (Figure 12.1). The joint surface asymmetry also accounts for the varus alignment and lateral tibial thrust commonly associated with medial unicompartmental osteoarthritis. At this stage in the disease process, the medial meniscus is either partially torn or completely compromised and tension is compromised in the anterior cruciate (ACL) and medial collateral (MCL) ligaments.5 To compensate for the varus deformity, a sclerotic layer of bone, or medial tibial buttress is formed.
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Keywords
- Anterior Cruciate Ligament
- Tibial Component
- Unicompartmental Knee Arthroplasty
- Invasive Surgical Technique
- 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
Ahlback S. Osteoarthrosis of the knee. A radiographic investigation. Acta Radiol Diagn. 1968;277(suppl):7–72.
Brocklehurst R, Bayliss MT, Maroudas A, et al. The composition of normal and osteoarthritic articular cartilage from human knee joints. With special reference to unicompartmental replacement and osteotomy of the knee. J Bone Joint Surg Am. 1984;66(1):95–106.
Hernborg JS, Nilsson BE. The natural course of untreated osteoarthritis of the knee. Clin Orthop. 1977;123:130–137.
White SH, Ludkowski PF, Goodfellow JW. Anteromedial osteoarthritis of the knee. J Bone Joint Surg Br. 1991;73(4):582–586.
Romanowski MR, Repicci JA. Unicondylar knee surgery: development of the minimally invasive surgical approach. In: Scuderi GR, Tria AJ Jr, eds. MIS of the hip and the knee: a clinical prospective. New York: Springer-Verlag; 2004:123–151.
Price A, Webb J, Topf H, Dodd C, Goodfellow J, Murray D. Oxford unicompartmental knee replacement with a minimally invasive technique. J Bone Joint Surg Br. 2000;82(suppl 1):24.
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):970–976.
Romanowski MR, Repicci JA. Minimally invasive unicondylar arthroplasty. Eight-year follow-up. Am J Knee Surg. 2002;15(1):17–22.
Kozinn SC, Scott RD. Surgical treatment of unicompartmental degenerative arthritis of the knee. Rheum Dis Clin North Am. 1988;14(3):545–564.
Kozinn SC, Scott R. Unicondylar knee arthroplasty. J Bone Joint Surg Am. 1989;71(1):145–150.
Bauer GC, Knutson K, Lindstrand A. Knee surgery for arthrosis. Scientific Exhibit, 54th Annual AAOS Meeting; 1987; San Francisco.
Carr A, Keyes G, Miller R, O’Connor J, Goodfellow J. Medial unicompartmental arthroplasty. A survival study of the Oxford meniscal knee. Clin Orthop. 1993;295:205–213.
Goodfellow JW, Tibrewal SB, Sherman KP, O’Connor JJ. Unicompartmental Oxford meniscal knee arthroplasty. J Arthroplasty. 1987;2(1):1–9.
Jackson RW. Surgical treatment. Osteotomy and unicompartmental arthroplasty. Am J Knee Surg. 1998;11(1):55–57.
Marmor L. Unicompartmental knee arthroplasty. Ten-to 13-year follow-up study. Clin Orthop. 1988;226:14–20.
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):983–989.
Marmor L. Unicompartmental knee arthroplasty of the knee with a minimum ten-year follow-up period. Clin Orthop. 1988;228:171–177.
Thornhill TS, Scott RD. Unicompartmental total knee arthroplasty. Orthop Clin North Am. 1989;20(2):245–256.
Repicci JA, Hartman JF. Unicondylar knee replacement: the American experience. In: Fu FH, Browner BD, eds. Management of osteoarthritis of the knee: an international consensus, 1st ed. Rosemont, Illinois: American Academy of Orthopaedic Surgeons; 2003:67–79.
Cartier P, Sanouiller JL, Grelsamer RP. Unicompartmental knee arthroplasty surgery. 10-year minimum follow-up period. J Arthroplasty. 1996; 11(7):782–788.
Christensen NO. Unicompartmental prosthesis for gonarthrosis. A nine-year series of 575 knees from a Swedish hospital. Clin Orthop. 1991;273: 165–169.
Stockelman RE, Pohl KP. The long-term efficacy of unicompartmental arthroplasty of the knee. Clin Orthop. 1991;271:88–95.
Voss F, Sheinkop MB, Galante JO, Barden RM, Rosenberg AG. Miller-Galante unicompartmental knee arthroplasty at 2-to 5-year follow-up evaluations. J Arthroplasty 1995;10(6):764–771.
Squire MW, Callaghan JJ, Goetz DD, Sullivan PM, Johnston RC. Unicompartmental knee replacement. A minimum 15 year follow-up study. Clin Orthop. 1999;367:61–72.
Tabor OB Jr, Tabor OB. Unicompartmental arthroplasty: a long-term follow-up study. J Arthroplasty 1998;13(4):373–379.
Sisto DJ, Blazina ME, Heskiaoff D, Hirsh LC. Unicompartmental arthroplasty for osteoarthrosis of the knee. Clin Orthop. 1993;286:149–153.
Berger RA, Nedeff DD, Barden RM, et al. Unicompartmental knee arthroplasty. Clinical experience at 6-to 10-year follow-up. Clin Orthop. 1999; 367:50–60.
Bert JM. 10-year survivorship of metal-backed, unicompartmental arthroplasty. J Arthroplasty 1998;13(8):901–905.
Capra SW Jr, Fehring TK. Unicondylar arthroplasty. A survivorship analysis. J Arthroplasty. 1992;7(3):247–251.
Laskin RS. Unicompartmental tibiofemoral resurfacing arthroplasty. J Bone Joint Surg Am. 1978;60(2):182–185.
Repicci JA, Eberle RW. Minimally invasive surgical technique for unicondylar knee arthroplasty. J Southern Orthop Assoc. 1999;8(1):20–27.
Kapandji IA. The physiology of the joints. 5th ed. Vol 2. New York: Churchill Livingstone; 1987.
Barrett WP, Scott RD. Revision of failed unicondylar unicompartmental knee arthroplasty. J Bone Joint Surg Am. 1987;69(9):1328–1335.
Padgett DE, Stern SH, Insall JN. Revision total knee arthroplasty for failed unicompartmental replacement. J Bone Joint Surg Am. 1991;73(2):186–190.
Bohm I, Landsiedl F. Revision surgery after failed unicompartmental knee arthroplasty. A study of 35 cases. J Arthroplasty. 2000;15(8):982–989.
Bourne RB. Reevaluating the unicondylar knee arthroplasty. Orthopedics. 2001;24(9):885–886.
Lewold S, Knutson K, Lidgren L. Reduced failure rate in knee prosthetic surgery with improved implantation technique. Clin Orthop. 1993;287: 94–97.
Lindstrand A, Stenstrom A, Lewold S. Multicenter study of unicompartmental knee revision. PCA, Marmor, and St. Georg compared in 3,777 cases of arthrosis. Acta Orthop Scand. 1992;63(3):256–259.
Weale AE, Halabi OA, Jones PW, White SH. Perceptions of outcomes after unicompartmental and total knee replacements. Clin Orthop. 2001;382: 143–153.
Robertsson O, Knutson K, Lewold S, Lidgren L. The routine of surgical management reduces failure after unicompartmental knee arthroplasty. J Bone Joint Surg Br. 2001;83(1):45–49.
Robertsson O, Borgquist L, Knutson K, Lewold S, Lidgren L. Use of unicompartmental instead of tricompartmental prostheses for unicompartmental arthrosis in the knee is a cost-effective alternative. 5,437 primary tricompartmental prostheses were compared with 10,624 primary medial or lateral unicompartmental prostheses. Acta Orthop Scand. 1999;70(2):170–175.
Fithian DC, Kelly MA, Mow VC. Material properties and structure-function relationships in the menisci. Clin Orthop. 1990;252:19–31.
Grelsamer RP. Current concepts review. Unicompartmental osteoarthrosis of the knee. J Bone Joint Surg Am. 1995;77(2):278–292.
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):214–218.
Johnson RJ, Kettelkamp DB, Clark W, Leaverton P. Factors affecting late results after meniscectomy. J Bone Joint Surg Am. 1974;56(4):719–729.
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. 1980;149:283–290.
Shrive NG, O’Connor JJ, Goodfellow JW. Load-bearing in the knee joint. Clin Orthop. 1978;131:279–287.
Walker PS, Erkman MJ. The role of the menisci in force transmission across the knee. Clin Orthop. 1975;109:184–192.
Fukubayashi T, Kurosawa H. The contact area and pressure distribution pattern of the knee. A study of normal and osteoarthritic knee joints. Acta Orthop Scand. 1980;51(6):871–879.
Kettelkamp DB, Jacobs AW. Tibiofemoral contact area—determination and implications. Bone Joint Surg Am. 1972;54(2):349–356.
Kuster MA, Wood GA, Stachowiak GW, Gachter A. Joint load considerations in total knee replacement. J Bone Joint Surg Br. 1997;79(1):109–113.
Marmor L. Results of single compartment arthroplasty with acrylic cement fixation. A minimum follow-up of two years. Clin Orthop. 1977;122:181–188.
Goodfellow JW, Kershaw CJ, Benson MK, O’Connor JJ. The Oxford knee for unicompartmental osteoarthritis. The first 103 cases. J Bone Joint Surg Br. 1988; 70(5):692–701.
Kennedy WR, White RP. Unicompartmental arthroplasty of the knee. Postoperative alignment and its influence on overall results. Clin Orthop. 1987; 221:278–285.
Marmor L. Marmor modular knee in unicompartmental disease. Minimum four year follow-up. J Bone Joint Surg Am. 1979;61(3):347–353.
Swank M, Stulberg SD, Jiganti J, Machairas S. The natural history of unicompartmental arthroplasty. An eight-year follow-up study with survival analysis. Clin Orthop, 1993;286:130–142.
Brown A. The Oxford unicompartmental knee replacement for osteoarthritis. Issues Emerg Health Technol. 2001;23:1–4.
Deshmukh RV, Scott RD. Unicompartmental knee arthroplasty: long-term results. Clin Orthop. 2001;392:272–278.
Keys GW. Reduced invasive approach for Oxford II medial unicompartmental knee replacement—a preliminary study. The Knee. 1999;6(3):193–196.
Murray DW. Unicompartmental knee replacement: now or never? Orthopedics. 2000;23(9):979–980.
Insall J, Dethmers DA. Revision of total knee arthroplasty. Clin Orthop. 1982;170:123–130.
Lai CH, Rand JA. Revision of failed unicompartmental total knee arthroplasty. Clin Orthop. 1993;287:193–201.
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):738–745.
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Repicci, J.A., Hartman, J.F. (2006). Minimally Invasive Surgery for Unicondylar Knee Arthroplasty: The Bone-Sparing Technique. In: MIS Techniques in Orthopedics. Springer, New York, NY. https://doi.org/10.1007/978-0-387-29300-4_12
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DOI: https://doi.org/10.1007/978-0-387-29300-4_12
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