A943. MIMALLY-INVASIVE MANAGEMENT OF KNEE OSTEOARTHRITIS USING COMPARMENTAL ARTHROPLASTY COMBINATION AND ASSOCIATION WITH OSTEOTOMY

Abstract

Treatment of limited osteoarthritis of the knee remains a challenging problem. Total knee arthroplasty may provide a reliable long-lasting option but do not preserve the bone stock. In another hand, compartmental arthroplasty with or without osteotomy is a bone and ligament sparing solution to manage limited osteoarthritis of the knee. Considering the renewed interest for combined compartmental implants we aimed to evaluate the average 12-year clinical and radiological outcome of a consecutive series of patients treated with compartmental knee arthroplasty combined or not with osteotomy.

We retrospectively reviewed all 255 patients (274 knees) treated in our institution with a compartmental arthroplasty combined or not with an osteotomy for a diagnosis of either bi or tricompartmental osteoarthritis of the knee between April 1972 and December 2000. The series included: 100 cases of combined lateral and medial UKA, 77 combined medial UKA and patello-femoral arthroplasty (PFA), 19 cases of combined Bi-UKA and PFA, 14 cases of UKA and high tibial osteotomy (HTO), 7 cases of combined lateral-UKA and PFA and HTO, 16 cases of combined lateral-UKA and PFA and 13 cases of combined bi-UKA and HTO.

Patient’s selection and surgical indication was based on the physical exam and on the radiological analysis including full-length x-rays and stress x-rays. Clinical and radiological evaluations were performed at a minimum follow-up of 5 years (mean, 12 years; range, 5–23 years) by an independent observer.

The Knee Society knee and function scores improved respectively from 43 to 89 and from 47 to 90 at last-follow-up. The mean active knee flexion improved from 116° ± 6° (range, 100°–145°) pre-operatively to 129° ± 5° (range, 117°–149°) at final follow-up. The restoration of the mechanical axis of the knee was achieved in all the cases. Dramatic failures were observed for patient with uncemented PFA. Considering revision for any reason as the endpoint, the 17-years survivorship was 0.68 (95% confidence interval: 0.62 to 0.75).

Our results suggested that combined compartmental arthroplasty with or without osteotomy can restore function and alignment of the knee in compartmental arthritis. This combined surgery represents a bone and ligament sparing alternative to TKA which can be considerate as a true minimally invasive solution.