Unicompartmental knee arthroplasty: state of the art

摘要

The popularity of unicompartmental knee arthroplasty (UKA) for the treatment of isolated compartment osteoarthritis of the knee has risen over the past 2 decades. Currently, UKA covers 10% of all knee arthroplasties worldwide. Although indications have been extended, results have proven that patient selection plays a critical role in the success of UKA. From the current perspective, age, body mass index, patellofemoral osteoarthritis, anterior cruciate ligament deficiency and chondrocalcinosis are no longer absolute contraindications for UKA. Motivated by the desire to improve survivorship rates, patient-reported outcomes and reduce complications, there have been many technological advances in the field of UKA over the recent years. The aim of this review was to evaluate the current indications, surgical techniques, modes of failure and survivorship results of UKA, by assessing a thorough review of modern literature. Several studies show that innovations in implant design, fixation methods and surgical techniques have led to good-to-excellent long-term survivorship, functional outcomes and less complications. Until now, resurgence of interest of cementless designs is noted according to large national registries to address problems associated with cementation. The future perspective on the usage of UKA, in particular the cementless design, looks promising. Furthermore, there is a growing interest in robotic-assisted techniques in order to optimise result by controlled soft-tissue balancing and reproduce alignment in UKA. Future advances in robotics, most likely in the field of planning and setup, will be valuable in optimising patient-specific UKA. The popularity of unicompartmental knee arthroplasty (UKA) for the treatment of isolated compartment osteoarthritis of the knee has risen over the past 2 decades. Currently, UKA covers 10% of all knee arthroplasties worldwide. Although indications have been extended, results have proven that patient selection plays a critical role in the success of UKA. From the current perspective, age, body mass index, patellofemoral osteoarthritis, anterior cruciate ligament deficiency and chondrocalcinosis are no longer absolute contraindications for UKA. Motivated by the desire to improve survivorship rates, patient-reported outcomes and reduce complications, there have been many technological advances in the field of UKA over the recent years. The aim of this review was to evaluate the current indications, surgical techniques, modes of failure and survivorship results of UKA, by assessing a thorough review of modern literature. Several studies show that innovations in implant design, fixation methods and surgical techniques have led to good-to-excellent long-term survivorship, functional outcomes and less complications. Until now, resurgence of interest of cementless designs is noted according to large national registries to address problems associated with cementation. The future perspective on the usage of UKA, in particular the cementless design, looks promising. Furthermore, there is a growing interest in robotic-assisted techniques in order to optimise result by controlled soft-tissue balancing and reproduce alignment in UKA. Future advances in robotics, most likely in the field of planning and setup, will be valuable in optimising patient-specific UKA. Knee osteoarthritis (OA) is highly prevalent worldwide. It is the leading cause of musculoskeletal disability and associated with activity limitation, working disability, reduced quality of life and increased healthcare costs.1Bindawas SM Vennu V Auais M Health-related quality of life in older adults with bilateral knee pain and back pain: data from the Osteoarthritis Initiative.Rheumatol Int. 2015; 35: 2095-210110.1007/s00296-015-3309-yCrossref PubMed Scopus (15) Google Scholar 2Hooper G Lee AJ Rothwell A et al.Current trends and projections in the utilisation rates of hip and knee replacement in New Zealand from 2001 to 2026.N Z Med J. 20