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Review Question - QID 210935

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QID 210935 (Type "210935" in App Search)
A 72-year-old female undergoes an uncomplicated, medial unicompartmental arthroplasty. After 4 years, she develops progressive pain and limitations in function. Radiographs show progression of her arthritis into her lateral and patellofemoral compartments. She undergoes conversion to a total knee replacement with almost complete relief of her symptoms. Which is a plausible explanation for the failure of the UKA?

The unicompartmental arthroplasty was originally performed for spontaneous osteonecrosis of the knee

7%

124/1698

An ACL reconstruction with bone-tendon-bone patellar tendon autograft was performed 30 years ago

16%

272/1698

Initial surgeon did not ask or identify signs of gout in the operative knee

27%

457/1698

Patient was >65years old at time of UKA

42%

712/1698

The patient had a medial meniscectomy 10 years prior to her unicompartmental arthroplasty

5%

93/1698

Select Answer to see Preferred Response

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Because gouty arthritis affects the whole joint and not just one individual compartment, it is considered a contraindication to a partial knee replacement just as rheumatoid arthritis, psoriatic arthritis, or pseudogout.

Unicompartmental arthroplasty is generally considered an excellent procedure provided that appropriate surgical indications are used for patient selection. Classic indications for unicompartmental arthroplasty include unicompartmental disease in patients older than 60 with relatively low activity demands. Additionally, the patients should weigh less than 82 kg, have minimal pain at rest, have motion >90 degress, and have minimal flexion and angular deformities. While most of these classic indications are still used today, recent studies are showing excellent results in younger, heavier, and more active patients.

Heyse et al. retrospectively review the results of unicompartmental arthroplasty for spontaneous osteonecrosis of the knee (SONK). 75.7% of patients were "very satisfied" with the procedure and 21.6% were "satisfied." At 15 years, 90.6% of unicompartmental arthroplasties had not been revised. Overall, the authors feel it is an excellent procedure for SONK.

Illustration A is a T2-weighted MRI demonstrating SONK.

Incorrect Answers:
Answer 1: Unicompartmental arthroplasties have shown excellent results for patients with SONK.
Answer 2: A prior ACL reconstruction is not a contraindication to performing a unicompartmental arthroplasty.
Answer 4: Older age is not a contraindication for a UKA and was classically reserved for older individuals.
Answer 5: A prior medial meniscectomy is not a contraindication for a unicompartmental arthroplasty.

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