Review Question - QID 1022

The radiograph seen in Figure A reveals varus alignment of the knee, with medial tibial deficiency; from this X-ray the patient appears to have unicompartmental arthritis. Treatment options for unicompartmental arthritis include high tibial osteotomy, interpositional arthroplasty, unicondylar knee replacement and total knee replacement. Interpositional arthroplasty became popular in the 1950’s when early outcomes analysis seemed to indicate good results; long term follow up in one study found 0/12 excellent results, with all patients requiring conversion to TKA. This procedure is no longer recommended due to the poor long term outcomes.

While an osteotomy is still used for young and active patients, unicompartmental or total knee arthroplasty have largely replaced this treatment in older patients. Advantages of UKA and TKA include more predictable relief of pain, quicker recovery, and better long-term results. Criteria for UKA include limited unicompartmental disease, no more than a fixed 10 degrees of varus or 5 degrees of valgus deformity from neutral and an intact anterior cruciate ligament with no signs of medial lateral subluxation of the femur on the tibia; this patient is therefore not a good candidate for this procedure.

Total knee arthroplasty can be used to provide predictable pain relief in a patient with unicompartmental and tricompartmental degenerative disease and varus malformation of the knee and for this patient is the best option.