Our Summary

This research paper is about a particular type of knee surgery called unicondylar knee arthroplasty which is used to treat osteoarthritis (a type of joint disease that results from breakdown of joint cartilage and underlying bone) in the lateral (outer) part of the knee joint. This surgery is also used to treat a condition called avascular necrosis (death of bone tissue due to a lack of blood supply) of the lateral femoral condyle (the rounded end of the thigh bone).

However, this surgery isn’t recommended for everyone. It’s contraindicated (not advised) for people who have full thickness cartilage defect (complete loss of the protective cartilage layer) in the central part of the medial (inner) compartment of the knee or in the medial aspect of the patellofemoral joint (the joint between the kneecap and thigh bone). It’s also not recommended for people with unstable or contracted ligaments, certain deformities of the knee, rheumatoid arthritis (an autoimmune disease that causes joint inflammation), or those who have had a failed upper tibial osteotomy (a surgical procedure to correct knee alignment).

The surgical procedure is minimally invasive and involves making a small cut near the kneecap to expose the affected part of the knee, removing abnormal bone growths (osteophytes), cutting and preparing the bone for the implant, and then inserting and securing the implant components.

After surgery, patients are encouraged to start moving around using two crutches. The success rate of this surgery is quite high, with a low dislocation rate (0-6.6%) and a high rate of patients not needing any further surgeries (90-98%) within a follow-up period of 1.7 to 4 years.

FAQs

  1. What is unicondylar knee arthroplasty and when is it indicated?
  2. What are the contraindications for unicondylar knee arthroplasty?
  3. What is the postoperative management and success rate of unicondylar knee arthroplasty?

Doctor’s Tip

A helpful tip a doctor might tell a patient about knee replacement surgery is to follow the postoperative management plan carefully, including proper mobilization under full weight-bearing with the use of crutches as instructed. This will help promote healing and optimal recovery following the procedure. It is also important to attend all follow-up appointments and adhere to any prescribed physical therapy or rehabilitation exercises to ensure the best possible outcome.

Suitable For

Patients who are typically recommended for knee replacement surgery include those with lateral unicompartmental osteoarthritis of the knee joint and avascular necrosis of the lateral femoral condyle. Patients with contraindications such as full thickness cartilage defects in certain areas of the knee, ligament instability/contracture, severe deformities, or rheumatoid arthritis may not be suitable candidates for this procedure. The surgical technique involves a minimally invasive approach and careful preparation of the joint surfaces for the insertion of the prosthetic components. Postoperative management includes early mobilization and weight-bearing with the assistance of crutches. Overall, the procedure has shown good results with low rates of complications and high revision-free survival rates.

Timeline

Before knee replacement:

  1. Patient experiences chronic knee pain, stiffness, and swelling.
  2. Patient may have difficulty walking, climbing stairs, and performing daily activities.
  3. Patient undergoes consultation with an orthopedic surgeon and diagnostic tests such as X-rays and MRI scans to determine the extent of the knee damage.
  4. Patient may undergo physical therapy, medications, and other conservative treatments to manage symptoms.

After knee replacement:

  1. Patient undergoes preoperative preparation, including medical evaluation, education about the surgery, and possible optimization of health conditions.
  2. Patient undergoes knee replacement surgery, which involves removing damaged cartilage and bone and replacing it with artificial components.
  3. Patient is monitored in the hospital for a few days post-surgery for pain management, wound care, and rehabilitation.
  4. Patient begins physical therapy and rehabilitation to regain strength, range of motion, and function in the knee.
  5. Patient gradually increases activity level and returns to normal activities, with full weight-bearing allowed in a few weeks to months.
  6. Patient may experience improvement in knee pain, mobility, and quality of life after successful knee replacement surgery.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with knee replacement surgery?
  2. How long is the recovery process and what can I expect in terms of pain management and physical therapy?
  3. Will I need any additional procedures or treatments before or after the knee replacement surgery?
  4. What type of implant will be used and why is it the best option for my specific condition?
  5. What are the expected outcomes and success rates for this type of knee replacement surgery?
  6. How long can I expect the knee replacement to last and what factors can affect its longevity?
  7. Are there any restrictions or lifestyle changes I will need to make after the surgery?
  8. How can I best prepare for the surgery in terms of diet, exercise, and overall health?
  9. Are there any alternative treatments or therapies that I should consider before proceeding with knee replacement surgery?
  10. What is the experience and success rate of the surgeon performing the knee replacement surgery?

Reference

Authors: Walker T, Aldinger PR, Streit MR, Gotterbarm T. Journal: Oper Orthop Traumatol. 2017 Feb;29(1):17-30. doi: 10.1007/s00064-016-0476-2. Epub 2016 Dec 12. PMID: 27957592