Objective: To report the survivorship rate and clinical outcome of a large series of lateral unicompartmental replacements. Method: 88 lateral St Georg Sled LTKRS were performed between 1978 and 1999. Clinical and radiological data was prospectively recorded at regular follow up and only 5 knees were lost during the 22 year period. Results: 15 knees were revised after an average of 8 years. (eight for progressive arthritis, six for loosening and four for femoral fracture) 29 patients (30 knees) died during the course of the study. At final follow up (average 9 years) 50 of the 63 remaining knees were rated as good or excellent, nine as fair and nine poor. The mean range of flexion was 110°. At 10 years the cumulative survival rate was 83% and at 15 years 78% (10 knees at risk). The “worst case scenario” where knees with pain or lost to follow up are added to revisions shows a 10 year survivorship of 74%. Conclusion: Although the results are not as good as medial UKR. These clinical outcomes suggest that the conservative surgical procedure of lateral UKR with the fixed bearing St George Sled prosthesis can give acceptable results in the uncommon situation of severely symptomatic isolated lateral tibio femoral arthritis

One hundred-one knees with medial compartmental osteoarthrosis were treated by unicompartmental arthroplasty with the Oxford Knee. The strict selection criteria were: (1) the presence of functioning anterior cruciate ligament, (2) correctable deformity and (3) full thickness of articular cartilage in the lateral compartment. The mean elapsed time from surgery was 28 months. One knee required revision for a loose tibial component; one had meniscal bearing dislplacement 1 month after the operation and was revised succesfully by replacing the meniscal implant with a thicker one. One implant was revised to a tricompartmental prosthesis. The femoral component has a spherical articular surface. The meniscal bearing is made of high-density polyethylene and is concave superiorly and flat inferiorly to fit exactly the metal femoral and tibial components. The meniscal bearing is not attached to either metal component but is held in place by its reciprocal shape and the tension in the ligaments. The bearing, which is avaliable in nine thicknesses, is inserted after the metal components have been fixed, allowing the ligaments to be restored to their physiologic tension. No femoral component was radiographically loose. Loosening was observed in two cases only in the tibial component. There were radiolucent lines more than 2 mm thick around two other tibial components, involving less than 15% of the component’s surface in each case. In none of these cases was the leg misaligned. There was no radiographic evidence of disease progression in the lateral compartment of any joint and the Ahlback grades remained unchanged. All the patients were evaluated 2 years after surgery according to the Oxford Knee Score. Our scores ranged from 40 to 48. In our opinion medial unicompartmental arthroplasty is the appropriate treatment in approximately one third of patients undergoing surgery for osteoarthrosis of the knee. Key point of this operation is: the surgical technique is less invasive and preserves all the structures of the knee so that a short patient recovery time is allowed. Furthermore, unicompartmental implants cost less than tricompartmental prostheses and revision surgery is relatively easy if performed early and before extensive bone erosion has occurred

Aim. To assess the survivorship of unicompartmental replacements (UKR) revised to UKR. Background: Partial revision of UKR, or revision to a further UKR is a rarely performed procedure with some data from the Australian registry suggesting that results are not good, with early revision being required. Method. All revision procedures from initial UKR are prospectively followed and scored as part of our department's knee database. We analysed the 37 cases in our database that showed revision of UKR to UKR. These included cases in the following categories: a) Mobile bearing revised to mobile bearing (n=8) b) Mobile bearing revised to fixed bearing (n=20) c) Fixed bearing revised to fixed bearing (n=9). Results. The survivorship of revisions of mobile UKR to mobile UKR was 87.5% at a mean of 5 yrs. The survivorship of revisions from mobile UKR to fixed bearing UKR was 95% at a mean of 8 yrs. The survivorship of revisions from fixed bearing UKR to fixed bearing UKR was 78% at 15 yr (1 revised at 9yrs, 1 at 12 yrs). Conclusion. Despite the perception that revision of a UKR to another UKR is likely to fail and require early revision, our results suggest that in specific circumstances acceptable survivorship and outcome are possible. MULTIPLE DISCLOSURES

This paper reports the authors’ experience of over 850 unicompartmental knee replacements beginning in 1985 with the MG2 uni and then the LCS uni in 1995, and more recently with the Allegretto, Oxford and PFC minimally invasive uni. Minimally invasive unicompartmental knee arthroplasty (MIU) offers the knee arthritis patient significant benefits compared with total knee arthroplasty. Some of these are especially important for Asian patients, in particular range of movement and ability to squat. The ideal indications for the MIU are not yet fully established but are becoming clearer. Contraindications are also clearer. These issues will be discussed in detail. The results in 100 cases of unicompartmental arthroplasty will be presented and discussed along with the complications in these patients. Special considerations and recommendations for the commencement of MIU will also be discussed. This recent and popular procedure also presents the knee surgeon with significant challenges. However, there are also disadvantages which will be outlined. The surgical technique of the MIU will be shown in detail. The paper closes on a brief discussion into recent developments by an 8 member international group of knee surgeons of a new MIU offering a choice of fixed or mobile bearing MIU, with precise instrumentation of both the femoral and tibial sides, and the early result of the first 18 procedures in 15 patients (3 bilateral)

Patellofemoral unicompartmental joint replacement is a controversial subject with a relatively small evidence base. Of the 50,000 total knee arthroplasties performed each year in the UK, approximately 10% are performed for predominantly patellofemoral arthritis. There are several patellofemoral unicompartmental prostheses on the market with the National Joint Registry recording 745 such prostheses used in 2007. Most evidence in favour of this procedure comes from experience with the Avon prosthesis (Stryker) predominantly from designer-surgeons. The FPV patellofemoral joint replacement (Wright Medical) has been in use in Europe for several years. The instruments have recently been redesigned and the device marketed in the UK. In 2007 the FPV had 5.9% market share (n=44). We present our early experience with the FPV patellofemoral joint replacement, which to our knowledge, is the first clinical outcome series for this prosthesis. 33 consecutive FPV joint replacements in 29 patients were performed between April 2007 and September 2009 for unicompartmental patellofemoral OA. All cases were performed or directly supervised by the senior author. Results are presented with a minimum follow-up of six months. Oxford and American Knee Society scores (AKSS) were obtained on all patients preoperatively and at subsequent outpatient visits. Mean preoperative AKSS knee score was 49.7 points and postoperative scores at 6 months and 1 year were 82.5 and 86.4 respectively. Mean Oxford score preoperatively was 30.4 (37%) and at 6 months and 1 year were 21.3 (56%) and 11.2 (77%) respectively. There were no complications related to the implant. One knee required a secondary open lateral release due to inadequate balancing at the index procedure. Further medium to long-term follow up data are required, but our initial experience with this device is encouraging

Patellofemoral unicompartmental joint replacement is a controversial subject with a relatively small evidence base. Of the 50,000 total knee arthroplasties performed each year in the UK, approximately 10% are performed for predominantly patellofemoral arthritis. There are several patellofemoral unicompartmental prostheses on the market with the National Joint Registry recording 745 such prostheses used in 2007. Most evidence in favour of this procedure comes from experience with the Avon prosthesis (Stryker) predominantly from designer-surgeons. The FPV patellofemoral joint replacement (Wright Medical) has been in use in Europe for several years. The instruments have recently been redesigned and the device marketed in the UK. In 2007 the FPV had 5.9% market share (n=44). We present our early experience with the FPV patellofemoral joint replacement, which to our knowledge, is the first clinical outcome series for this prosthesis. 33 consecutive FPV joint replacements in 29 patients were performed between April 2007 and September 2009 for unicompartmental patellofemoral OA. All cases were performed or directly supervised by the senior author. Results are presented with a minimum follow-up of six months. Oxford and American Knee Society scores (AKSS) were obtained on all patients preoperatively and at subsequent outpatient visits. Mean preoperative AKSS knee score was 49.7 points and postoperative scores at 6 months and 1 year were 82.5 and 86.4 respectively. Mean Oxford score preoperatively was 30.4 (37%) and at 6 months and 1 year were 21.3 (56%) and 11.2 (77%) respectively. There were no complications related to the implant. One knee required a secondary open lateral release due to inadequate balancing at the index procedure. Further medium to long-term follow up data are required, but our initial experience with this device is encouraging

Purpose: Varus deformity after total knee replacement (TKR) is associated with poor outcome. This aim of this study was to determine whether the same is true for medial unicompartmental arthroplasty (UKA). Methods: 158 patients implanted with the Oxford UKA, using a minimally invasive approach, were studied prospectively for five years. Leg alignment was measured with a long-arm goniometer referenced from Anterior Superior Iliac Spine, centre of patella and centre of ankle. Patients were grouped according to the American Knee Society Score (AKSS). Group A: > 0° varus (n=13, 8.2%); Group B: 0 to 4° valgus (n=39, 24.7%); Group C: 5–10° valgus (normal alignment, n=106, 67.12%). Comparisons were made between the three groups in terms of the absolute and the change in Oxford Knee Score (OKS) and AKSS over the five year period, and the presence of radiolucency. Results: There was no significant difference in any outcome measure except for Objective-AKSS (p< 0.001). The means and standard deviations of the ΔOKS for the groups were:. 24 ± 5,. 22 ± 10, and. 22 ± 9 and for Objective-AKSS were 84 ± 12, 82 ± 15 and 91 ± 11 respectively. The frequency of five year radiolucency for the groups A, B, and C were 42%, 35%, and 45% respectively. Conclusion: The aim of the Oxford UKA is to restore knee kinematics and thus knee alignment to the pre-disease state. Therefore, as demonstrated by this study, about 30% of patients have varus alignment. This study also demonstrates that post-operative varus alignment does not compromise the outcome. The only score which did show worse outcome was the Objective-AKSS. This is because 10 or 20 points are deducted for varus alignment, which is not appropriate following UKA. Therefore, AKSS in its present form is not a reliable tool for assessment of UKA

The purpose of this study was to determine the rate of polyethylene wear in a fixed bearing knee replacement in order to establish a norm against which mobile bearing implants can be judged. Method: Eighteen all polyethylene tibial components were retrieved when a St Georg Sled unicompartmental replacement was being revised. This prosthesis has a biconvex femoral component and a totally flat tibia; thus point loading occurs on at implantation. The implants had been in situ between 6 and 110 months, revision was predominantly for progression of the arthritic process. Linear wear was measured using an electronic micrometer and volumetric wear by creating a mould of the defect using dental wax, and subsequently weighing the wax. Results: All components developed dishing which varied in orientation but matched the alignment of the femoral component. A near congruous articulation was thus produced correctly aligned for that particular arthroplasty. The mean linear penetrative wear for the group was 0.33mm (0.09mm per year) and the volumetric wear 124mm³ (26mm³ per year). The rate of wear seemed greatest during the second year. Conclusion: The wear rate for this totally non congruous implant was much less than anticipated. The linear penetrative wear is comparable to that reported for Charnley hip replacement though more than for a fully congruent mobile UKR. The volumetric wear is much lower than that thought to cause osteolysis. The surprisingly low wear rate suggests that the need for mobile bearing UKRs, with their greater technical demands, should be questioned

Unicompartmental arthroplasty of the knee (UKA) is technically challenging because the prosthetic devices must function in concert with a mostly normal joint. Malalignment is common, leading to patient dissatisfaction and early failures. However, UKA remains attractive as a temporizing treatment in early disease. Until now, resurfacing UKAs were performed with free-hand techniques. This study is only the second report investigating the use of a tactile guidance system (TGS—essentially, a robotically assisted surgery) for the performance of UKA. Methods. The first 20 patients who underwent resurfacing using a Mako Surgical Inc. TGS system by a single surgeon were studied. Surgical goals were to place the components to replicate closely the patient’s native bony architecture. The surgical plan was completed on a workstation, and then executed with the TGS system through a mini-arthrotomy. Stelkast, Inc resurfacing components were implanted with methymethacrylate. Intraoperative measurements of component position were obtained. Pre- and postoperative radiographs were also measured for alignment correction, change in angulation of the joint line relative to the femoral and tibial anatomic axes, femoral component alignment relative to the femoral anatomic axis, and change in tibial slope. Results. All cases could be completed as planned. None were converted to a full arthrotomy. None required conversion to a different implant. There were no failures of the TGS, associated navigation, or the CAT-scan based preoperative plan. Intraoperative measurements showed an average femoral component position of 0.89+3.36 degrees of varus relative to the mechanical axis, with 62.5% being varus and 37.5% being valgus. The average femoral component flexion was 11.1+2.11 degrees, with no outliers (less than 5 degrees; greater than 15 degrees). The tibial component position was 4.60+1.76 degrees of varus, with all components in varus as desired. There was an average of 5.00+2.37 degrees of slope, with 25% outliers (less than 3 or greater than 7 degrees). Postoperative measurements showed an overall limb alignment correction of 4.29+2.60 degrees, femoral joint line change of only 0.43+0.49 degrees, and an overall component alignment relative to the anatomic axis of 4.54+3.77 degrees of valgus. On the tibial side, the joint line varus was corrected by 3.00+2.04 degrees and the slope was changed by 4.29+3.24 degrees, including 19% outliers (less than 3 degrees, more than 7 degrees). However, 33% of the outliers were outliers preoperatively as well. Interestingly, the bone level after resection on the tibial side averaged 5.36+3.00 degrees of varus, suggesting that component placement must be carefully watched. Discussion. TGS seems to be extremely accurate and precise in recreating individual patient anatomy. This also applies to cases in which the patient anatomy dictates placement of components in so-called “outlier” positions. It is unknown whether these “outlier” positions really translate into poorer outcomes. Impressively, there were no failures to execute the intended surgical plan and no failures of the TGS system. Future research will attempt to correlate component placement in native anatomical positions with functional outcomes and failures, as well as cost-effectiveness of the system

Medial unicompartmental replacement (UKR) has been shown to have superior functional results to total knee replacement (TKR) in appropriately selected patients, and this has been associated with a resurgence of interest in the procedure. This may relate to evidence showing that the kinematic profile of UKR is similar to the normal knee, in comparison to TKR, which has abnormal kinematics. Concerns remain over the survivorship of UKR and work has suggested the anterior cruciate ligament (ACL) may become dysfunctional over time. Cruciate mechanism dysfunction would produce poor kinematics and instability providing a potential mechanism of failure for the UKR. Aim: To test the hypothesis that the sagittal plane kinematics (and cruciate mechanism) of a fixed bearing medial UKR deteriorate over time (short to long term). A cross sectional study was designed in which 24 patients who had undergone successful UKR were recruited and divided into early (2–5 years) and late (> 9 years) groups according to time since surgery. Patients performed flexion/extension against gravity, and a step up. Video fluoroscopy of these activities was used to obtain the Patellar Tendon Angle (PTA), the angle between the long axis of the tibia and the patella tendon, as a function of knee flexion. This is a previously validated method of assessing sagittal plane kinematics of a knee joint. This work suggests the sagittal plane kinematics of a fixed bearing UKR is maintained in the long term. There is no evidence that the cruciate mechanism has failed at ten years. However, increased tibial bearing conformity from ‘dishing’, and adequate muscle control, cannot be ruled out as possible mechanisms for the satisfactory kinematics observed in the long term for this UKA

Background

Lateral Unicompartmental Knee Arthroplasty (UKA) is a recognised treatment option in the management of lateral Osteoarthritis (OA) of the knee. Whilst there is extensive evidence on the indications and contraindcations in Medial UKA there is limited evidence on this topic in Lateral UKA. The aim of this study was to assess our experience of mobile lateral UKR and to look specifically at the effect of Contraindications on the outcome.

The aim of this study was to assess the perioperative complications associated with bilateral simultaneous UKR and compare them with those of unilateral UKR and bilateral TKRs. Over a 2 year period, 40 patients underwent bilateral simultaneous Preservation unicompartmental knee replacement UKR. They were compared to 40 matched unilateral UKRs and 28 bilateral simultaneous total knee replacement patients who had their operations during the same time period by the senior author. There was no significant difference between the groups in terms of age, weight, ASA grade and throm-boprophylaxis received. There was no statistically significant difference in the complication rates of all 3 groups. When compared to 2 unilateral UKRs, bilateral simultaneous UKR results in a reduced operative time, blood loss and hospital stay but more blood transfusion. When compared to bilateral TKRs, bilateral simultaneous UKR results in reduced blood loss, reduced blood transfusion and hospital stay but an increased operative time. Bilateral UKR is a useful option in selected patients with bilateral unicompartmental osteoarthritis.

The aim of this study was to document the thickness of the patellofemoral joint before and after unicompart-mental joint replacement and to correlate these data with knee outcome scores.

Seventeen patients (22 knees) who underwent Patello-femoral replacement with FPV (Wright Medical) prosthesis between 2006 and 2008 were identified retrospectively and analyzed using chart and radiological review. Oxford and AKSS knee scores were gathered prospectively pre-operative and at follow-up.

Trochlear height was measured using lateral radiograph of the knee by measuring the distance between anterior distal femoral cortex and the highest point of trochlea. Trochlear height was compared pre and postoperatively. The range of movement and the Oxford and American knee society knee scores at six weeks postoperatively were noted. Association between increased trochlear height and improved range of motion was studied.

All but two patients regained full knee extension. Postoperative mean range of flexion of the knee joint was 114 degrees. The mean Oxford knee score at 6 weeks postoperatively was 21 points. The mean American Knee Society Knee Score was 85 points and function score 60 points.

We found the average trochlear height to be 6.2 mms pre and 9.7 mms post operatively with an average increase of 3.5 mms. We found no relationship between range of motion of the knee and knee function and trochlear height. This is important because there has been concern that ‘overstuffing’ of the patellofemoral joint can lead to stiffness and failure of resolution of pain post-operatively. Rather it appears that the FPV prosthesis restores the previous anatomical thickness of this compartment.

We conclude that FPV Patello-femoral replacement results in correct anatomical reconstruction of the trochlear height. This should in turn result in durable improvements in pain and function

The knee is one of the most commonly affected joints in osteoarthritis. Unicompartmental knee replacement (UKA) was developed to address patients with this disease in only one compartment. The conventional knee arthroplasty jigs, while usually being accurate, may result in the prosthesis being inserted in an undesired alignment which may lead to poor post-operative outcomes. Common modes of failure in UKA include edge loading due to incorrect sizing or positioning, development of disease in the other compartment due to over-stuffing or over-correction and early loosening or stress fractures due to inaccurate bone cuts.

Computer navigation and robotically assisted unicompartmental knee replacement were introduced in order to improve the surgical accuracy of both the femoral and tibial bone cuts. The aim of this study was to assess accuracy and reliability of robotic assisted, unicondylar knee surgery in producing reported bony alignment.

Two hundred and twenty consecutive patients with a mean age of 64 + 11 years who underwent successful medial robotic assisted unicondylar knee surgery performed by two senior total joint arthroplasty surgeons were identified retrospectively. The mean body mass index of the cohort was 33.5 + 8 kg/m² with a minimum follow-up of 6 months (range: 6–18 months). Femoral and tibial sagittal and coronal alignments as well as the posterior slope of the tibial component were measured in the post-operative radiographs. These measurements were compared with the equivalent measurements collected during intra-operative period by the navigation to study the reliability and accuracy of femoral and tibial cuts. Radiographic evaluation was independently conducted by two observers.

There was an average difference of 2.2 to 3.6 degrees between the intra-operatively planned and post-operative radiological equivalent measurements. For the femur, mean varus/valgus angulation was 2.8 + 2.5 degrees with 83% of those measured within 5% of planned. For the tibia mean varus/valgus angulation was 2.4 + 1.9 degrees with 93% within 5% of planned resection. There was minimal inter-observer variability between radiographic measurements. There were no infections in the evaluated group at the time of radiographic examination.

Alignment for unicondylar knee arthroplasty is important for implant survival and is a more difficult procedure to instrument as it is a minimally invasive surgery. Assuming appropriate planning, robotically assisted surgery in unicondylar knee replacement will result in reliably accurate positioning of component and reduce early component failures caused by malpositioning. A mismatch between pre-planning and post-operative radiography is often caused by poor cementing technique of the prosthesis rather than incorrect bony cuts. Addressing these factors can lead to greater success and improved outcomes for patients.

To our knowledge in medial unicompartmental knee arthroplasty (UKA) no study has specifically assessed the difference in outcome between matched gender groups. Previous unmatched gender studies have indicated more favourable results for women.

INTRODUCTION

Wear and polyethylene damage have been implicated in up to 22% of revision surgeries after unicompartmental knee replacement. Two major design rationales to reduce this rate involve either geometry and/or material strategies. Geometric options involve highly congruent mobile bearings with large contact areas; or moderately conforming fixed bearings to prevent bearing dislocation and reduce back-side wear, while material changes involve use of highly crosslinked polyethylene. This study was designed to determine if a highly crosslinked fixed-bearing design would increase wear resistance.

When the Oxford unicompartmental meniscal bearing arthroplasty (UCA) is used in the lateral compartment of the knee 10% of the bearings dislocate. An in-vitro cadaveric study was performed to investigate if the anatomy and joint geometry of the lateral compartment was a contributory factor in bearing dislocation. More specifically, the study investigated if the soft tissue tension of the lateral compartment, as determined by the length of the lateral collateral ligament (LCL), was related to bearing dislocation. A change in length of greater than 2 mm is sufficient to allow the bearing to dislocate.

The Vicon Motion Analysis System (Oxford Metrics, Oxford, UK) was used to assess length changes in the LCL of seven cadaveric knees. Measurements were made of the LCL length through knee flexion and of the change in LCL length when a varus force was applied at a fixed flexion angle. Measurements were made in the normal knee and with the knee implanted with the Oxford prosthesis.

In the intact knee the mean LCL change was 5.5mm (8%) over the flexion range. After implantation with the Oxford UCA the mean change in length was only 1 mm (1%). There was a significant difference in the LCL length at 90° (p=0.03) and 135° (p=0.01) of knee flexion compared to the intact knee. When a varus force was applied the LCL length change of the intact knee (5.4 mm) was significantly different (p=0.02) to that of the knee with the prosthesis implanted (2.7 mm)

This study used a new method to dynamically measure LCL length. It found that after implantation of the Oxford lateral UCA the LCL remains isometric over the flexion range and does not slacken in flexion as it in the normal knee. This would suggest that the soft tissue tension was adequate to contain the bearing within the joint.

However, when a varus force was applied the LCL did not sufficiently resist a displacing force producing an LCL length change greater than 2 mm.

The evidence provided by this study is contradictory. The “lack of change in LCL length through flexion” suggests that the ligament remains tight through range and is unlikely to allow dislocation. However, the amount of distraction possible when an adducting moment is applied is sufficient to allow bearing dislocation. The length tension properties of the lateral structures are therefore implicated in the mechanism of dislocation.

Introduction: This study assesses the outcome of medial unicompartmental knee arthroplasty (UKA) using the Oxford prosthesis for end-stage focal spontaneous osteonecrosis of the knee (SONK, Ahlback grades III & IV).

Methods: A total of 29 knees (27 patients) with SONK were assessed using the Oxford Knee Score. Twenty-six had osteonecrosis of the medial femoral condyle; 3 had osteonecrosis of the medial tibial plateau. This group was compared to a similar group who had undergone Oxford Medial UKA for primary osteoarthritis. Patients were matched for age, sex and time since operation.

Results: Mean length of follow-up was 5.2 years (range 1–13 years). There were no implant failures in either group, but there was one death 9 months post-arthroplasty from unrelated causes in the group with osteonecrosis. The mean Oxford Knee Score in the group with osteonecrosis was 37.8 (± 7.6) and 40.0 (± 6.6) in the group with osteoarthritis. There was no significant difference between the two groups using Student’s t-test (p=0.31).

Interpretation: Use of the Oxford Medial UKA for focal spontaneous osteonecrosis of the knee is reliable in the short to medium term, and gives similar results to when used for patients with primary osteoarthritis.

Introduction This study assesses the outcome of medial unicompartmental knee arthroplasty (UKA) using the Oxford prosthesis for end-stage focal spontaneous osteonecrosis of the knee (SONK, Ahlback grades III & IV).

Methods A total of 29 knees (27 patients) with SONK were assessed using the Oxford Knee Score. Twenty-six had osteonecrosis of the medial femoral condyle; 3 had osteonecrosis of the medial tibial plateau. This group was compared to a similar group who had undergone Oxford Medial UKA for primary osteoarthritis. Patients were matched for age, sex and time since operation.

Results Mean length of follow-up was 5.2 years (range 1–13 years). There were no implant failures in either group, but there was one death 9 months post-arthroplasty from unrelated causes in the group with osteonecrosis. The mean Oxford Knee Score (SD) in the group with osteonecrosis was 37.8 (7.6) and 40.0 (6.6) in the group with osteoarthritis. There was no significant difference between the two groups using Student’s t-test (p=0.29).

Interpretation Use of the Oxford Medial UKA for focal spontaneous osteonecrosis of the knee is reliable in the short to medium term, and gives similar results to when used for patients with primary osteoarthritis.

The aim of this study was to investigate the hypothesis that unicompartmental knee replacement (UKR) of a single arthritic tibio femoral compartment can slow the progression of arthritis to the other compartment.

Method: Since 1974, a prospective database has been established in Bristol to register and follow up the results of unicompartmental knee replacement. Forty two prostheses that had survived for more than 10 years were examined using the Ahlbach radiological scoring system and compared to a control group of patients from the Bristol “OA 500” series, in which patients being treated conservatively for gonarthritis were regularly reviewed by clinical scoring and radiological analysis. The groups were sex matched.

All AP and lateral standing knee radiographs at entry and 8 years were scored using the Ahlbach scoring system. The Ahlbach system has been shown to have good inter and intra observer correlation, and to relate closely to pathological findings at operation. An intra and inter observer error study of our results confirmed good correlation.

Results: The groups were well matched but the OA 500 group showed a lower average age, though not a significant difference (62 years compared to 67 years). The lateral compartment of all knees in both groups were Ahlbach grade 0 or 1 group before operation or entry to the OA 500 register.

In the UKR group, four out of 42 knees showed progression of a single Ahlbach grade (9.5%). 2 revisions for arthritic progression were added to this group making a total of six out of 42 (14.3%). In the control group 12 of the 42 knees progressed by one or two Ahlbach grades and a further case underwent surgery making a total of 13 (31%). This difference was significant (p< 0.01).

Conclusion: Recent studies have shown that with a better understanding of design, improved selection of patients and better surgical technique, a UKR can have at least as good, if not better, results than a TKR at 5 year follow up, and has benefits of preservation of anatomy, earlier rehabilitation, preservation of bone stock and easier revision. Our radiological findings in this study will need to be correlated with further randomised prospective clinical studies, but suggest that progression of Osteoarthritis is reduced by UKR, and that this should be an additional stated benefit of this surgical technique.