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Surgeon: UKA results in high patient satisfaction, low perioperative morbidity

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In carefully selected patients, unicompartmental knee arthroplasty is associated with high patent satisfaction, a lower risk of perioperative morbidity and long-term survivorship rivaling that found with total knee arthroplasty, according to one surgeon’s experience.

Craig J. Della Valle, MD, presented his findings at the Current Concepts in Joint Replacement 2011 Winter Meeting, in Orlando, Florida.

“The biggest difference between the fixed bearing and the mobile bearing is, I think, that the fixed bearing is a little bit more forgiving,” Della Valle said. “I think that mobile bearing is extremely attractive; I agree 100% that the studies show the wear rate is a little lower with the mobile bearing knee but, I think that in general, all of them show a certain rate of dislocation.”

He added, “If you make things too tight to compensate for that, you run into a higher risk of lateral compartment disease. At least for me, the fixed technique is a little more forgiving.”

Della Valle noted thatpatient selection is critical. According to his presentation, his department’s philosophy has been to perform unicompartmental knee arthroplasty (UKA) on patients with focal tibiofemoral arthritis of the medial or lateral compartment and an intact ACL.

“I have always reserved the right to convert to a total knee arthroplasty if I see something intraoperatively that I am uncomfortable with,” he said.

The most important facets of the UKA, Della Valle noted in his presentation, include a conservative tibial cut and avoidance of overcorrection. Further care must be taken to obtain congruence in the femoral-tibial articulation, so as to avoid edge loading that could lead to wear in the bearing surface.

“In conclusion, the fixed bearing technique for me is straightforward, similar and familiar with no risk of bearing dislocation,” Della Valle said. “We found decreased morbidity when compared to the total knee, and for me, it has resulted in some of my happiest patients.”

Reference:

• Della Valle CJ. The fixed uni: Forever & always! Paper #71. Presented at the Current Concepts in Joint Replacement 2011 Winter Meeting. Dec. 7-10. Orlando, Fla., 2011

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