UNICOMPARTMENTAL KNEE ARTHROPLASTY MINIMALLY INVASIVE TECHNIQUE Frank R. Ebert, MD Assistant Chief Department of Orthopædics The Union Memorial Hospital Baltimore, Maryland History Unicompartmental knee arthroplasties have been in use since the early 1970’s. UKA quickly gained popularity, but soon got a bad reputation, especially in the USA. UKA Failures Improper Poor indications surgical technique (no guides) Inferior prosthetic designs in some cases (e.g. PCA) UKA Failures cont’d. Improper Indication Inflammatory Arthritis Obesity Severe Deformity (> 10° Varus/>15° Valgus) Active Young Patient UKA Failures cont’d. Surgical Technique Overcorrection Undercorrection Patellar Impingement on Femur Component Malposition UKA Failures cont’d. Prosthetic Design 6-mm Polyethylene Cementless Fixation UKA results Some prostheses like the Marmor, St George Sledge, and the M.G. have proven good long term results UKA Results Swedish Registry 1975 to 1991 93% Survivorship over 16 years UKA Results Swedish Registry 1975-1991 90% Plus Survivorship – Surgeons doing 15 or more per year. 70% to 80% Survivorship – Surgeons doing less than 15 per year. Lesson: DO IT RIGHT! (Technique and Patient Selection) Advantages UKA Less invasive surgery Shorter hospital stay Better ROM than TKA More ”normal knee” Easier revision ”Miniarthrotomy” John A Repicci Buffalo USA Minimally invasive surgery ”Miniarthrotomy” Early mobilisation No Transfusion Short hospital stay Low Morbidity Quick rehabilitation Concerns Repicci II Demanding surgical technique No guides - ”free hand surgery” Thin tibial component (6 - 7 mm) Limited Sizes Long term results? Why Miller - Galante uni? Proven good / excellent long term clinical results Excellent results (Nilsson & Dahlen, Hyldahl al.) Adequate alignment and resection guides reproducible surgical technique – no ”free hand surgery” MG-UNI 98% 10 yr. Survival (loosening or revision endpoint.) 98% Good or Excellent Results -Berger, et al. CORR, 1999 Clinical Results – HSS Scores n=150 n=147 96 n=51 92 59 58 55 Preop Postop Berger RA, et al. Clin Orthop Rel Res. 1999;367:50-60. Argenson JN, et al. 2001 AAOS presentation. Swienckowski, J. 2001 Poster Osteopathic Specialists Meeting 95 Clinical Results – HSS Scores 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Excellent Good Fair Berger RA, et al. Clin Orthop Rel Res. 1999;367:50-60. Swienckowski, J. 2001 Poster Osteopathic Specialists Meeting Clinical Results – Survivorship 10-year 100% 90% 98% 80% 96% 95% Argenson Swienckowski 70% 60% 50% 40% 30% 20% 10% Berger n=62 n=160 n=187 Clinical Results – Range of Motion 160 150 140 130 120 128º 110 100 120º 90 Berger n=51 Argenson n=147 Randomised study comparing metal backed and all poly tibia Hyldahl, Regner, Carlsson, Kärrholm & Weidenhielm 1999 No difference in clinical results Metal backed or all poly tibia? Indications Medial OA grade I-III (Ahlbäck) no inflammatory joint disease Mild To Moderate Deformity Intact ACL (?) Minimal Patellofemoral Symptoms Age 55 yrs. (?) Perioperative Short 1 spinal with/without duramorph. gms.Ceflosporin I.V. prior to tourniquet inflation. Postoperative Compression dressing 24 h Full weight-bearing 4 - 6 h postop Free flexion / extension Oral pain killers DVT prophylaxis for 1 month SURGICAL TECHNIQUE Miniarthrotomy Flexed knee Leg stabilizer 0°-120° “Miniarthrotomy” Incision 8-10 cm, medial to patellar tendon Miniarthrotomy Arthrotomy 8-10 cm T-incision distal to vastus medialis Release 2 cm below joint line Femoral drilling i.m. IM guide femur Distal femoral cut Distal femoral cut finished Femur chamfer cuts Drilling peg holes Femur - posterior cut Tibial resection Tibial resection horizontal cut Tibial resection sagittal cut Resection posterior corner femur Tibial sizing Tibia - peg holes Trial reduction, flexion Trial reduction, extension Cementation Closure THANK YOU UNION MEMORIAL HOSPITAL BALTIMORE, MARYLAND Migration PFC, Sledge & MG uni (tibial component) Nilsson and Dahlen 1997 mm2,5 2 PFC Sledge MG uni 1,5 1 0,5 0 0 3 6 12 months