Review Article

Current Concepts on Unicompartmental Knee Arthroplasty

Gary Ulrich, Hemant Pandit1
Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky College of Medicine, Lexington, KY, USA, 1Department of Orthopedic, Leeds Institute
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of Rheumatic and Musculoskeletal Medicine, Leeds Teaching Hospitals NHS Trust, Chapel Allerton Hospital, Leeds, UK

Abstract
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Unicompartmental knee arthroplasty (UKA) represents a treatment option to address knee pain deriving from either the medial or lateral
compartment of the knee. Compared to total knee arthroplasty, UKA offers the advantages of preserving native bone stock, offering less
surgical exposure and risks, and better restoring native knee kinematics. The UKA is a specialized procedure that has its best outcomes
in the hands of an experienced surgeon who performs UKA repeatedly and with proper patient selection. In this review, we discuss
current concepts for both medial UKA and lateral UKA with regard to indications, isolated knee compartment osteoarthritis clinical
and radiographic work‑up, surgical approaches, and patient outcomes, as well as analyzing the differences between fixed‑bearing and
mobile‑bearing implant designs.

Keywords: Fixed bearing, mobile bearing, osteoarthritis, partial knee arthroplasty, unicompartmental knee arthroplasty

Introduction Unicompartmental Knee Arthroplasty Indications

In 1968, Ahlback reported that 85% of knee osteoarthritis The indications for UKA have evolved over time since its
clinical cases had isolated medial compartment introduction in the 1970s. Traditionally, the primary indications
d e g e n e r a t i o n . [1] T h i s l a n d m a r k s t u d y l e d t o t h e were isolated compartment osteoarthritis and spontaneous
conceptualization of a unicompartmental knee arthroplasty osteonecrosis of the isolated knee compartment.[2] However,
(UKA), which became a reality in the 1970s with the initial high rates of complications narrowed the patient
introduction of the first UKA prostheses that resemble modern selection criteria as Kozinn and Scott in 1989 described
UKA implants. Compared to total knee arthroplasty (TKA), UKA indications to be a patient with an age >60 years
UKA offers the advantages of reduced surgical exposure, old, weight <180 pounds, no heavy labor occupation, least
conservation of native bone, not sacrificing the cruciate possible baseline pain, preoperative range of motion of 90°
ligaments, reduced perioperative morbidity, quicker or more, <5° flexion contracture, and a coronal angular
postoperative recovery, more native knee kinematics, deformity <15°. Contraindications included osteoarthritis
as well as improved cost benefit when performed in the in the other knee compartments, inflammatory arthropathy,
ideal candidate. These qualities make UKA an attractive chondrocalcinosis, and cruciate ligament deficiency.[3] These
treatment option in patients with isolated compartment knee traditional indications severely limited the selection criteria
osteoarthritis.[2] for UKA and were based on fixed‑bearing (FB) implants only
Since the 1970s, the UKA prosthesis design and its kinematics and were more instinctually based than evidence based.[4,5]
have undergone iterations and refinements with the goal of
improved clinical outcomes.[1,2] Despite these advancements, Address for correspondence: Dr. Gary Ulrich,
Department of Orthopaedic Surgery, Kentucky Clinic, 740 S. Limestone,
there still remains uncertainty around both medial UKA and Suite K401, Lexington, KY 40536‑0284, USA.
lateral UKA with regard to their indications, survivability, E‑mail: [email protected]
bearing design, and more. In this review, we aim to discuss
these topics to provide clarity on the current concepts regarding Submitted: 15‑Aug‑2023 Revised: 24-Aug-2023
UKA. Accepted: 27‑Aug‑2023 Published: 06-Dec-2023

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DOI:
10.4103/jajs.jajs_65_23 How to cite this article: Ulrich G, Pandit H. Current concepts on
unicompartmental knee arthroplasty. J Arthrosc Jt Surg 2024;11:1-6.

© 2023 Journal of Arthroscopy and Joint Surgery | Published by Wolters Kluwer - Medknow 1
 Ulrich and Pandit: Unicompartmental knee arthroplasty concepts

With the improvements in clinical knowledge, surgical patients <60 years old versus >60 years old.[8] Overall, recent
technique, and implant design over time, the current indications data tend to support UKA in patients <60 years old; however,
for UKA have expanded to consider UKA in patients with an these patients need to be consulted preoperatively regarding
increased body mass index (BMI), younger age, patellofemoral expectations and the potential risk of a higher revision
joint osteoarthritis, and anterior cruciate ligament (ACL) probability with substantial activity.[5]
deficiency.[2,5]
Patellofemoral arthritis (PFA) was initially a contraindication
A high BMI representing a strict contraindication to UKA due to the notion that a UKA should only be considered in
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was initially based on the fact that overweight patients patients with isolated unicompartmental arthritis. However,
subject an increased load on the UKA implant compared this contraindication has been challenged by recent evidence.
to normal weight patients, which predisposes to aseptic For instance, Berend et al. reported UKA survivorship
loosening.[2] Berend et al. found that a patient’s BMI >32 kg/ in patients with PFA (97.9%) versus patients without
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m 2 significantly predicted UKA failure and a need for PFA (93.8%) via a Kaplan–Meier analysis and found no
revision in their retrospective study assessing 79 FB UKAs.[6] significant difference at 70‑month follow‑up.[15] Moreover, van
Bonutti et al. reported that patients undergoing FB UKA der List et al. also found no significant difference in revision
with a BMI >35 kg/m 2 had significantly more revisions rate or functional outcome scores for UKA in patients with
than patients with a BMI <35 kg/m2, and the mean time PFA compared to patients without PFA.[9] Further work has
to revision was 33 months.[7] On the other hand, Hamilton delineated that there may be a difference regarding UKA
et al. assessed UKA in patients <180 lbs to patients >180 lbs outcome with PFA between FB and MB implants. Hamilton
and discovered no significant difference in survival of the et al. reported comparable functional outcome scores and
implant or functional outcome scores at 15‑year follow‑up.[8] revision rates at 10‑year follow‑up in patients with a UKA
Moreover, a meta‑analysis by van der List et al. of 31 studies MB implant and PFA versus patients with UKA MB implant
found no elevated risk for revision or substandard outcomes in without PFA.[8] However, Berger et al. demonstrated that
patients with a BMI >30 kg/m2.[9] With these results, a UKA advancing PFA in UKA FB implants was the main reason for
has become considered an option by some surgeons in patients failure at 15‑year follow‑up.[16] Thus, literature is developing
who do not strictly meet the traditional 180 lbs weight limit. the support of UKA in PFA patients, but this literature is more
However, these patients need to be consulted regarding the promising regarding UKA MB implants compared to UKA
preoperative risks and varying research on the survivorship FB implants.
of UKAs in patients with a high BMI.[5]
Finally, ACL deficiency also has traditionally been thought
Regarding patient age, the initial cutoff of <60 years old of as a UKA contraindication due to the initial high failure
derives from the concept that younger patients are more active, rates in these select patients.[17] However, recent work has
which predisposes them to implant wear and loosening.[2] called this contraindication into question. Boissonneault et al.
UKA in youthful patients often is challenging because this assessed UKA in ACL‑deficient patients versus ACL‑intact
patient population often have high expectations to return to patients and at 5‑year follow‑up actually demonstrated
activity with their UKA. Thus, a successful UKA by normal improved functional outcome scores in the ACL‑deficient
standards may lead to dissatisfaction due to the reality– group and only had one revision in this group due to arthritis
expectation mismatch and the potential need for revision.[5] development in the lateral compartment.[18] Moreover, van
There are data that both support and oppose the use of UKA der List et al.’s meta‑analysis found that ACL deficiency
in patients <60 years old. Parratte et al. assessed 35 FB medial did not result in increased UKA revision rates. [9] Some
UKAs in patients <50 years old and found a calculated 12‑year authors had advocated for concomitant ACL reconstruction
survival rate of 80.6% and concluded that polyethylene at the time of UKA in ACL‑deficient knees. Mancuso et al.
wear remains a major concern in this patient population.[10] assessed concomitant ACL reconstruction with medial
Registry joint data from Australia and Sweden also found UKA and reported that the ACL reconstruction group had
a similar 81% survival rate at 7‑year follow‑up in patients an increased rate of implant survival compared to isolated
who were <55 years old.[11,12] On the other hand, Walker et al. UKA in ACL‑deficient knees.[19] With these results, ACL
found that 93% of patients <60 years old were able to return deficiency does not necessarily eliminate the indication for
to full activity with only a mere revision rate of 2.5% with a UKA for some surgeons.
minimum follow‑up of 2 years.[13] Furthermore, Greco et al.
found a 96% survival rate at 6‑year follow‑up and an 86% Medial Unicompartmental Knee Arthroplasty and
survival rate at 10‑year follow‑up in patients <50 years old
who received a medial UKA mobile‑bearing (MB) implant.[14] Lateral Unicompartmental Knee Arthroplasty
A meta‑analysis found that an age <60 years old was associated Medial UKA and lateral UKA both represent treatment
with a higher revision rate, but these patients had improved options for medial and lateral compartment knee osteoarthritis,
functional outcome scores compared to patients >60 years respectively. While the decision to perform either a medial UKA
old.[9] Hamilton et al. found no significant difference in the or lateral UKA is made prior to surgery, the knee compartments
survival rate at 15‑year follow‑up for UKAs when comparing are assessed intraoperatively with direct visualization, and if

2 Journal of Arthroscopy and Joint Surgery ¦ Volume 11 ¦ Issue 1 ¦ January-March 2024

 Ulrich and Pandit: Unicompartmental knee arthroplasty concepts

there is extensive arthritic change involved, one may convert a 91% survival rate at 15‑year follow‑up in their series of 1000
to performing a TKA intraoperatively.[20] medial UKAs that were of a MB implant design.[22] Moreover,
Lisowski et al. demonstrated a 90.6% survivorship rate at
Medial unicompartmental knee arthroplasty 15‑year follow‑up, and Foran et al. found a 90% survivorship
An individual presenting with osteoarthritis isolated to the
rate at 20‑year follow‑up in medial UKAs of a FB implant
medial compartment often presents with anteromedial joint
design.[23,24] Further cohort studies have demonstrated similar
line knee pain. However, this finding is not necessary for
rates ranging from a 90.6% to 96% survivorship rate at 10‑year
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diagnosis, as pain can occur in any knee compartment or in

follow‑up.[25‑27]
the knee diffusely because of reactive synovitis. These patients
generally present with a varus deformity, which a surgeon There are a few potential complications of why a medial
should determine if it is correctable with valgus stress testing UKA may fail and need revision. In their systematic review,
with the knee flexed at 20°. In addition, knee range of motion, van der List et al. found the most common reasons for medial
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mechanical knee alignment, ligament testing, gait analysis, and UKA failure were aseptic loosening (36%), osteoarthritis
the presence of an effusion should all be assessed.[2] development (20%), pain that was unexplainable (11%),
instability (6%), infection (5%), and polyethylene wear (4%).
The standard knee radiographs, including anteroposterior,
The causes for early failure defined as <5 years were
lateral, merchant/sunrise, and Rosenberg views, should be
aseptic loosening (25%), osteoarthritis development (20%),
ordered. The lateral view provides insight into ACL deficiency
and dislocation of the bearing (17%). On the other hand,
with anterior tibial subluxation or evidence of posterior tibial
the causes for revisions at >5 years were osteoarthritis
wear. The merchant view can provide insight into the arthritic
development (40%), aseptic loosening (29%), and wear of the
change of the patellofemoral joint.[2] A special radiographic
polyethylene (10%).[28] Persistent pain that is unexplainable
view that can be ordered is the valgus stress view. This view
remains another cause for UKA failure and revision. It is
can determine if a varus deformity of a patient is correctable
estimated that persistent pain is a cause of UKA conversion
and also provide insight into if there is any lateral compartment
to TKA in 1.6%–11% of patients.[25,28]
arthritic change. To obtain a valgus stress view, a patient’s
knee is flexed to 20° and a valgus force is applied. If the Lateral unicompartmental knee arthroplasty
lateral joint compartment sustains a length of >5 mm and the Lateral UKA is less commonly performed compared to
mechanical varus alignment corrects to within 3° of neutral, medial UKA and accounts for <1% of the amount of all
then a surgeon can indicate an UKA.[21] Advanced imaging knee arthroplasties performed.[29] Moreover, medial UKAs
such as computed tomography (CT) and magnetic resonance are performed ten times more often than lateral UKAs.[20]
imaging (MRI) only have niche roles concerning UKA. A CT However, despite the infrequency of lateral UKA, the literature
is generally only ordered to aid in robotic UKA, and MRI is supports its use in the treatment of isolated lateral compartment
useful in the diagnosis of spontaneous osteonecrosis of the osteoarthritis.
knee in suspected patients, in which UKA can be a potential
Similar to the patient presentation of medial compartment
treatment option.[2]
osteoarthritis, a patient with lateral compartment osteoarthritis
For a medial UKA, the medial parapatellar approach is typically has lateral joint line knee pain. Bert described a
employed. The incision needs to be extensive enough to allow “one‑finger test” in which the patient uses one finger to
visualization of the medial compartment, but not too extensive, point to the lateral compartment of the knee to describe the
so the medial soft‑tissue release can be kept to a minimal. The location of his or her pain.[30] However, as discussed, the
axial tibial bone cut should be just beneath the arthritic joint in pain can be located diffusely throughout the knee because
parallel with the tibial slope to preserve as much native bone of reactive synovitis. In the setting of diffuse knee pain, the
as possible. Moreover, the sagittal tibial bone cut should be history, physical examination, and imaging work‑up should be
made near the medial tibial spine to increase the tibial implant vigilant to ensure that the symptoms derive from the lateral
surface area without compromising the ACL’s integrity. If there compartment.[20] Essentially the same physical examination and
is a varus deformity, one should not overcorrect it, as this will radiographic work‐up for the medial compartment discussed
cause increased stress on the medial soft tissues and excess earlier occurs pertaining to the lateral compartment. However,
joint contact forces in the lateral compartment. The femoral the only difference being that the special radiographic image for
component needs to be positioned in the middle or marginally the lateral compartment is now a varus stress view, as opposed
lateral on the medial femoral condyle to ensure proper to a valgus stress view.
articulation between the femoral and tibial UKA components.
A surgeon has a choice regarding the approach for a
Finally, care during impaction and bone cuts should be taken
lateral UKA, which can either be done through a medial
to reduce the risk of iatrogenic fracture.[2]
parapatellar approach or a lateral parapatellar approach. The
The survivorship of medial UKAs has demonstrated success medial parapatellar approach involves a medial parapatellar
with survivorship rates generally around 90% or above in arthrotomy as is utilized in the traditional approach to TKA
cohort studies with at least 10‑year follow‑up.[2] For example, and medial UKA. This approach for lateral UKA offers the
Pandit et al. found a 94% survival rate at 10‑year follow‑up and advantages of surgeon familiarity, extensibility if needed, and

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 Ulrich and Pandit: Unicompartmental knee arthroplasty concepts

the capability intraoperatively to convert to a TKA if needed. designs.[20,29] For instance, Gunther et al. demonstrated a 10%
Moreover, the medial parapatellar approach allows for easy complication rate for polyethylene‑bearing dislocation alone
positioning of the tibial component in a little bit of internal at 5‑year follow‑up, while Walker et al. further demonstrated
rotation, which aids in recreating lateral knee biomechanics. a polyethylene dislocation rate of 8.5% alone at 5‑year
Finally, if a revision is needed to convert a lateral UKA to a follow‑up.[33,34] Moreover, Burger et al. conducted a systematic
TKA in the future, the medial parapatellar approach is utilized. review and incorporated 28 studies (19 FB implant studies
Therefore, an initial medial parapatellar approach avoids and 9 MB implant studies) for a total of 2265 UKAs. They
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jeopardizing the blood supply to the patella, since the primary found that lateral UKA MB designs had a significantly higher
and revision approaches were both medial.[29] revision rate than FB designs, but the clinical scores were
similar between the two designs.[35]
Alternatively, the lateral parapatellar approach for lateral
UKA offers the advantages of direct access to the lateral
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compartment, a reduced surgical incision, and no need Fixed Bearing versus Mobile Bearing
for patellar eversion during the case. The challenges of As referenced throughout this review, the two main UKA
this approach involve less familiarity leading to increased implant designs include FB and MB. With FB implants, the
operative time, difficulty implanting the tibial component in metal tibial component and the polyethylene inlay are fixated
slight internal rotation, and a potential risk of compromising together, only allowing for micromotion throughout the knee
the blood supply to the patella if a TKA revision is needed range of motion. On the other hand, with MB implants, there
through a medial parapatellar approach.[29] Both approaches is mobility with the polyethylene insert as it is mobile on the
to lateral UKA can offer successful outcomes, as Edmiston metal tibial component, allowing for rotation of the tibial
et al. found comparable functional outcome scores in both polyethylene during knee range of motion to better mimic
approaches for lateral UKA. However, the authors did find natural knee kinematics.[36]
a slightly increased range of motion in the lateral approach
UKA was initially introduced as a FB implant, which was
group, which the others speculated was due to the increased
cemented with an all‑polyethylene tibial component. However,
postoperative scarring from the increased extensive incision
because of substantial polyethylene wear of this design, a
of the medial parapatellar approach group.[31]
metal‑backed polyethylene tibial design was implemented
The survivorship of lateral UKAs overall ranges from 72% to for modern FB implants.[5] The advantages of the FB design
100% according to Buzin et al.’s review, and it has improved include that it is technically less challenging to implant due to
since the surgery’s introduction in the 1970s.[20] Smith et al.’s its flat tibial surface and that there is a little risk of dislocation
review further categorized lateral UKA survivorship by of the bearing.[36‑39] The disadvantages include that a FB implant
separating the various studies into FB designs versus MB is less conforming in knee flexion, which can result in increased
designs. For lateral UKA MB designs, the survivorship ranged loading on specific locations of the polyethylene surface to
from 82.8% to 98% over a range of 1–9‑year follow‑up. For the cause delamination and deformation.[36,40,41]
lateral UKA FB designs, the survivorship ranged from 74.5%
The MB implant was inaugurated in 1986 by Goodfellow
to 100% over a range of 1–16‑year follow‑up.[29]
et al. to address the polyethylene wear complication associated
Regarding complications, Ernstbrunner et al. performed a with FB designs.[42] The MB implant was designed to replicate
systematic review, and the authors found that the most common inherent knee kinematics in addition to permitting an increased
cause of lateral UKA failure was osteoarthritis development amount of conformity among the articular surfaces. This
in 30% and aseptic loosening in 22%. Other causes of failure design offers the advantages of improved native knee motion,
ranged from instability, persistent pain, infection, wear of the minimized contact stress, and hence, minimized wear of the
polyethylene, and dislocation of the polyethylene bearing. polyethylene.[37,38,43,44] The disadvantages include that a MB
The most frequent cause of early failure was dislocation of implant is technically demanding to implant, and there is a
the bearing, whereas osteoarthritis development was the most requirement of precise implant alignment and ligamentous
frequent cause of failure later on. Moreover, the authors also balancing or else the complications of bearing dislocation
found that dislocation of the bearing was the most frequent and impingement causing polyethylene wear will ensue.[45,46]
cause of failure when a MB design was utilized.[32] Due to heightened stress placed on the ligaments, insufficient
ACLs and medial collateral ligaments can occur leading to an
Polyethylene‑bearing dislocation represents a unique
unstable knee. Thus, a functioning ACL stands as a prerequisite
complication of MB implants with a predilection for
to consider a UKA MB implant.[5]
specifically lateral UKA MB implants due to how the knee
kinematics of the lateral compartment work. In the lateral The debate of which UKA implant design has superior
compartment, there is a greater translation of the lateral condyle outcomes still remains unclear. Migliorini et al. performed a
on the lateral tibia plateau throughout the range of motion to meta‑analysis and included 25 studies and had a cumulative
account for femoral rollback and the screw‑home mechanism. UKA patient sample size of 4696 patients with a mean
With this increased translation, there is an increased risk follow‑up of 45.8 months (range, 3–180 months). In their
for polyethylene dislocation, especially in MB implant analysis, the authors found no significant difference in

4 Journal of Arthroscopy and Joint Surgery ¦ Volume 11 ¦ Issue 1 ¦ January-March 2024

 Ulrich and Pandit: Unicompartmental knee arthroplasty concepts

range of motion (P = 0.05), various functional outcome References

scores (P > 0.05), revision rate (P = 0.2), osteoarthritis 1. Ahlbäck S. Osteoarthrosis of the knee. A radiographic investigation.
progression (P = 0.2), aseptic loosening (P = 0.9), deep Acta Radiol Diagn (Stockh) 1968;277:7‐72.
infections (P = 0.99), or fractures (P = 0.6). The authors 2. Jennings JM, Kleeman‑Forsthuber LT, Bolognesi MP. Medial
unicompartmental arthroplasty of the knee. J Am Acad Orthop Surg
concluded that their meta‑analysis did not demonstrate one
2019;27:166‑76.
UKA implant design having better outcomes over the other.[36] 3. Kozinn SC, Scott R. Unicondylar knee arthroplasty. J Bone Joint Surg
Am 1989;71:145‑50.
Downloaded from http://journals.lww.com/jajs by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AW

Zhang et al. also performed a meta‑analysis and included 4. Stern SH, Becker MW, Insall JN. Unicondylar knee arthroplasty. An
17 studies with a cumulative 2612 patients with an average evaluation of selection criteria. Clin Orthop Relat Res 1993;286:143‐8.
follow‑up ranging from 7 months to 17.2 years. The authors 5. Mittal A, Meshram P, Kim WH, Kim TK. Unicompartmental knee
arthroplasty, an enigma, and the ten enigmas of medial UKA. J Orthop
found no significant difference in various functional outcome
Traumatol 2020;21:15.
nYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC1y0abggQZXdgGj2MwlZLeI= on 03/24/2024

scores, radiological outcomes, or revision rates between 6. Berend KR, Lombardi AV Jr., Mallory TH, Adams JB, Groseth KL.
the implant designs (P > 0.05). Moreover, there was no Early failure of minimally invasive unicompartmental knee arthroplasty
significant difference regarding osteoarthritis development is associated with obesity. Clin Orthop Relat Res 2005;440:60‑6.
7. Bonutti PM, Goddard MS, Zywiel MG, Khanuja HS, Johnson AJ,
in the contralateral compartment (P = 0.33), continuing Mont MA. Outcomes of unicompartmental knee arthroplasty stratified
pain (P = 0.84), or aseptic loosening (P = 0.45). However, there by body mass index. J Arthroplasty 2011;26:1149‑53.
was a significant difference in the occurrence of polyethylene 8. Hamilton TW, Pandit HG, Jenkins C, Mellon SJ, Dodd CA, Murray DW.
Evidence‑based indications for mobile‑bearing unicompartmental knee
wear and dislocation of the bearing, with polyethylene wear
arthroplasty in a consecutive cohort of thousand knees. J Arthroplasty
occurring more often in the FB implant at an average of 2017;32:1779‑85.
8.3 years (P = 0.02) and bearing dislocation occurring more 9. van der List JP, Chawla H, Zuiderbaan HA, Pearle AD. The role of
often in the MB implant at an average of 0.6 years (P = 0.03). preoperative patient characteristics on outcomes of unicompartmental
knee arthroplasty: A meta‑analysis critique. J Arthroplasty
The authors concluded that one UKA implant design did not 2016;31:2617‑27.
have superior outcomes compared to the other, but the two 10. Parratte S, Argenson JN, Pearce O, Pauly V, Auquier P, Aubaniac JM.
implants have dissimilarities in the mechanism of failure and Medial unicompartmental knee replacement in the under‑50s. J Bone
the timing of this failure.[47] Joint Surg Br 2009;91:351‑6.
11. Australian Orthopaedic Association National Joint Replacement
Peersman et al. also conducted a systematic review and Registry. Hip, Knee and Shoulder Arthroplasty. New York: Australian
Orthopaedic Association National Joint Replacement Registry; 2017.
meta‑analysis including 44 articles and an aggregate of 9463 12. W‑Dahl A, Robertsson O, Lidgren L. Surgery for knee osteoarthritis in
UKAs, with 4330 patients having undergone a FB implant and younger patients. Acta Orthop 2010;81:161‑4.
5133 patients having undergone a MB implant. The average 13. Walker T, Streit J, Gotterbarm T, Bruckner T, Merle C, Streit MR.
follow‑up was 8.7 years for the FB implant and 5.9 years for Sports, physical activity and patient‑reported outcomes after medial
unicompartmental knee arthroplasty in young patients. J Arthroplasty
the MB implant. The authors found that the revision rate was 2015;30:1911‑6.
0.90 (95% CI: 0.65–1.21) for the FB implants and 1.51 (95% 14. Greco NJ, Lombardi AV Jr., Price AJ, Berend ME, Berend KR.
CI: 1.11–1.93) for the MB implants per 100 component Medial mobile‑bearing unicompartmental knee arthroplasty in
young patients aged less than or equal to 50 Years. J Arthroplasty
years, which was not substantially different. Peersman et al. 2018;33:2435‑9.
concluded that there were no differences among the UKA 15. Berend KR, Lombardi AV Jr., Morris MJ, Hurst JM, Kavolus JJ. Does
designs with regard to revision rate, and surgeons can proceed preoperative patellofemoral joint state affect medial unicompartmental
with personal preference when selecting an UKA design.[48] arthroplasty survival? Orthopedics 2011;34:e494‑6.
16. Berger RA, Meneghini RM, Sheinkop MB, Della Valle CJ, Jacobs JJ,
Rosenberg AG, et al. The progression of patellofemoral arthrosis after
Conclusion medial unicompartmental replacement: results at 11 to 15 years. Clin
Orthop Relat Res 2004;428:92‐9.
The traditional indications for UKA have been challenged 17. Goodfellow JW, Kershaw CJ, Benson MK, O’Connor JJ. The Oxford
by recent literature, as there is evidence to consider UKA in Knee for unicompartmental osteoarthritis. The first 103 cases. J Bone
Joint Surg Br 1988;70:692‑701.
patients that previously would have been contraindicated for
18. Boissonneault A, Pandit H, Pegg E, Jenkins C, Gill HS, Dodd CA, et al.
the procedure. More specifically, there is evidence emerging No difference in survivorship after unicompartmental knee arthroplasty
to perform UKA in patients with an elevated BMI, a younger with or without an intact anterior cruciate ligament. Knee Surg Sports
age, presence of PFA, and ACL deficiency. With proper patient Traumatol Arthrosc 2013;21:2480‑6.
19. Mancuso F, Dodd CA, Murray DW, Pandit H. Medial unicompartmental
selection, both medial UKA and lateral UKA have successful knee arthroplasty in the ACL‑deficient knee. J Orthop Traumatol
survivorship and complication rates. FB and MB UKA implant 2016;17:267‑75.
designs both represent viable UKA options, each with their 20. Buzin SD, Geller JA, Yoon RS, Macaulay W. Lateral unicompartmental
knee arthroplasty: A review. World J Orthop 2021;12:197‑206.
own subset of advantages and disadvantages.
21. Waldstein W, Bou Monsef J, Buckup J, Boettner F. The value of valgus
stress radiographs in the workup for medial unicompartmental arthritis.
Financial support and sponsorship Clin Orthop Relat Res 2013;471:3998‑4003.
Nil. 22. Pandit H, Hamilton TW, Jenkins C, Mellon SJ, Dodd CA, Murray DW.
The clinical outcome of minimally invasive Phase 3 Oxford
Conflicts of interest unicompartmental knee arthroplasty: A 15‑year follow‑up of 1000
There are no conflicts of interest. UKAs. Bone Joint J 2015;97‑B:1493‑500.

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 Ulrich and Pandit: Unicompartmental knee arthroplasty concepts

23. Lisowski LA, Meijer LI, van den Bekerom MP, Pilot P, Lisowski AE. 36. Migliorini F, Maffulli N, Cuozzo F, Elsner K, Hildebrand F, Eschweiler J,
Ten‑ to 15‑year results of the Oxford Phase III mobile unicompartmental et al. Mobile bearing versus fixed bearing for unicompartmental
knee arthroplasty: A prospective study from a non‑designer group. Bone arthroplasty in monocompartmental osteoarthritis of the knee:
Joint J 2016;98 B:41‑7. A meta‑analysis. J Clin Med 2022;11:2837.
24. Foran JR, Brown NM, Della Valle CJ, Berger RA, Galante JO. 37. Emerson RH Jr, Hansborough T, Reitman RD, Rosenfeldt W, Higgins LL.
Long‑term survivorship and failure modes of unicompartmental knee Comparison of a mobile with a fixed‐bearing unicompartmental knee
arthroplasty. Clin Orthop Relat Res 2013;471:102‑8. implant. Clin Orthop Relat Res 2002;404:62‐70.
25. Faour‑Martín O, Valverde‑García JA, Martín‑Ferrero MA, 38. Jamari J, Ammarullah MI, Saad AP, Syahrom A, Uddin M,
Vega‑Castrillo A, de la Red Gallego MA, Suárez de Puga CC, et al. van der Heide E, et al. The effect of bottom profile dimples on the
Downloaded from http://journals.lww.com/jajs by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AW

Oxford phase 3 unicondylar knee arthroplasty through a minimally femoral head on wear in metal‑on‑metal total hip arthroplasty. J Funct
invasive approach: Long‑term results. Int Orthop 2013;37:833‑8. Biomater 2021;12:38.
26. Kim KT, Lee S, Kim JH, Hong SW, Jung WS, Shin WS. The survivorship 39. Brockett CL, Jennings LM, Fisher J. The wear of fixed and mobile
and clinical results of minimally invasive unicompartmental knee bearing unicompartmental knee replacements. Proc Inst Mech Eng H
arthroplasty at 10‑year follow‑up. Clin Orthop Surg 2015;7:199‑206. 2011;225:511‑9.
nYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC1y0abggQZXdgGj2MwlZLeI= on 03/24/2024

27. Emerson RH, Alnachoukati O, Barrington J, Ennin K. The results of 40. Argenson JN, Parratte S. The unicompartmental knee: Design and
Oxford unicompartmental knee arthroplasty in the United States: technical considerations in minimizing wear. Clin Orthop Relat Res
A mean ten‑year survival analysis. Bone Joint J 2016;98‑B:34‑40. 2006;452:137‑42.
28. van der List JP, Zuiderbaan HA, Pearle AD. why do medial 41. Manson TT, Kelly NH, Lipman JD, Wright TM, Westrich GH.
unicompartmental knee arthroplasties fail today? J Arthroplasty Unicondylar knee retrieval analysis. J Arthroplasty 2010;25:108‑11.
2016;31:1016‑21. 42. Goodfellow JW, Tibrewal SB, Sherman KP, O’Connor JJ.
29. Smith E, Lee D, Masonis J, Melvin JS. Lateral unicompartmental knee Unicompartmental oxford meniscal knee arthroplasty. J Arthroplasty
arthroplasty. JBJS Rev 2020;8:e0044. 1987;2:1‑9.
30. Bert JM. Unicompartmental knee replacement. Orthop Clin North Am 43. Smith TO, Hing CB, Davies L, Donell ST. Fixed versus mobile
2005;36:513‑22. bearing unicompartmental knee replacement: A meta‑analysis. Orthop
31. Edmiston TA, Manista GC, Courtney PM, Sporer SM, Traumatol Surg Res 2009;95:599‑605.
Della Valle CJ, Levine BR. Clinical outcomes and survivorship of 44. Ammarullah MI, Afif IY, Maula MI, Winarni TI, Tauviqirrahman M,
lateral unicompartmental knee arthroplasty: Does surgical approach Akbar I, et al. Tresca stress simulation of metal‑on‑metal total
matter? J Arthroplasty 2018;33:362‑5. hip arthroplasty during normal walking activity. Materials (Basel)
32. Ernstbrunner L, Imam MA, Andronic O, Perz T, Wieser K, Fucentese SF. 2021;14:7554.
Lateral unicompartmental knee replacement: A systematic review of 45. Gleeson RE, Evans R, Ackroyd CE, Webb J, Newman JH. Fixed or
reasons for failure. Int Orthop 2018;42:1827‑33. mobile bearing unicompartmental knee replacement? A comparative
33. Gunther TV, Murray DW, Miller R, Wallace DA, Carr AJ, O’Connor JJ, cohort study. Knee 2004;11:379‑84.
et al. Lateral unicompartmental arthroplasty with the Oxford meniscal 46. Ko YB, Gujarathi MR, Oh KJ. Outcome of unicompartmental knee
knee. Knee 1996;3:33‑9. arthroplasty: A systematic review of comparative studies between fixed
34. Walker T, Zahn N, Bruckner T, Streit MR, Mohr G, Aldinger PR, et al. and mobile bearings focusing on complications. Knee Surg Relat Res
Mid‑term results of lateral unicondylar mobile bearing knee arthroplasty: 2015;27:141‑8.
A multicentre study of 363 cases. Bone Joint J 2018;100‑B:42‑9. 47. Zhang W, Wang J, Li H, Wang W, George DM, Huang T. Fixed‑ versus
35. Burger JA, Kleeblad LJ, Sierevelt IN, Horstmann WG, Nolte PA. mobile‑bearing unicompartmental knee arthroplasty: A meta‑analysis.
Bearing design influences short‑ to mid‑term survivorship, but Sci Rep 2020;10:19075.
not functional outcomes following lateral unicompartmental knee 48. Peersman G, Stuyts B, Vandenlangenbergh T, Cartier P, Fennema P.
arthroplasty: A systematic review. Knee Surg Sports Traumatol Arthrosc Fixed‑ versus mobile‑bearing UKA: A systematic review and
2019;27:2276‑88. meta‑analysis. Knee Surg Sports Traumatol Arthrosc 2015;23:3296‑305.

6 Journal of Arthroscopy and Joint Surgery ¦ Volume 11 ¦ Issue 1 ¦ January-March 2024