Pain, Disease Risk Help Determine Knee Arthroplasty Treatment

Surgeons must consider a patient’s knee pain and the risk of disease progression when choosing unicompartmental, bicompartmental or total knee arthroplasty as an appropriate treatment, according to physicians in the field.

David W. Murray, M.D., Ph.D., Sebastien Parratte, M.D., Ph.D., and Jan Victor, M.D., Ph.D., recently discussed the merits of the multiple compartment procedures compared to unicompartmental
arthroplasty. Murray is with the Nuffield Orthopaedic Centre at the University of Oxford in the United Kingdom; Parratte is with the Aix-Marseille University Center for Arthritis Surgery at Hospital Sainte-Marguerite in Marseille, France; and Victor is chairman of Orthopaedics at Ghent University Hospital in Belgium.

The three surgeons defended unicompartmental knee arthroplasty (UKA), bicompartmental knee arthroplasty and total knee arthroplasty (TKA), respectively, at the 15th EFORT Congress — a combined programme in partnership with the British Orthopaedic Association.

In general, they agreed there is a need for each of these procedures based on the indications.

“UKA deserves a place in the toolbox of treating degenerative arthritis of the knee but the main enigma is nailing your indications and that’s your job,” Victor said.

“TKA has a better survivorship than UKA. That is clear in our minds. I think UKA is a logical operation that deserves its place with patient selection, in my view, as the weakest part of the procedure,” he said.

Murray argued that TKA is difficult to revise and defended UKA with data from national joint replacement registers that support the use of the prosthesis.

“Anterior knee pain does not compromise the procedure,” said Murray, who also reviewed the merits of fixed vs. mobile bearing UKA procedures.

He defended the arguments that revision rates are high with UKA. A study conducted by Murray and colleagues demonstrated that most surgeons do five to 10 UKAs annually. “The optimum results occur if about 50 percent of the annual knee replacements are ‘unis,’” Murray said.

Furthermore, he said complications are fewer with UKA than TKA.

With bicompartmental knee arthroplasty surgeons can better manage rotation according to their preferences and the patient’s needs, according to Parratte.

“You can manage size easily and you can manage the femorotibial joint line without compromise,” he said.

Ultimately, the use of bicompartmental knee arthroplasty vs. UKA comes down to management of the patellofemoral joint.

“The patellofemoral joint may be painful for the patient…that is my concern,” Parratte said.