Unicompartmental Knee Arthroplasty: Indications, Outcomes, and Complications.

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Abstract

[Indexed for MEDLINE] 16. Knee. 2024 Mar;47:186-195. doi: 10.1016/j.knee.2023.12.005. Epub 2024 Feb 23. Unicompartmental knee arthroplasty questionnaire (UniQ-study): Unknown is unloved. van Langeveld SJ(1), Koenraadt-van Oost I(2), Spruijt S(3), Breugem SJM(4), Kerkhoffs GMMJ(5), van Geenen RCI(2). Author information: (1)Department of Orthopaedic Surgery, FORCE (Foundation for Orthopaedic Research Care and Education), Amphia Hospital, Breda, The Netherlands. Electronic address: vanlangeveldstephan@gmail.com. (2)Department of Orthopaedic Surgery, FORCE (Foundation for Orthopaedic Research Care and Education), Amphia Hospital, Breda, The Netherlands. (3)Department of Orthopaedic Surgery, Reinier Haga Orthopaedic Center, Zoetermeer, The Netherlands. (4)Department of Orthopaedic Surgery, Bergman Clinics, Naarden, The Netherlands. (5)Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands. BACKGROUND: Almost 50% of the patients requiring knee replacement are suitable for medial unicompartmental knee arthroplasty (UKA). However, national registries have shown a use far below 50%. AIM: The aim of this study was to identify the factors that could influence the use of UKA. METHODS: A questionnaire was conducted among practicing knee surgeons of the Dutch Orthopedic Association. The questionnaire was classified into three domains: surgeon, patient selection, and professional opinion. Associations between the domains and UKA volume and contra-indications were tested using Pearson's chi-square tests. RESULTS: Of the 113 included respondents, 40% had no hands-on exposure during residency. Frequently reported contra-indications were obesity (68%), lateral osteophytes (21%), chondrocalcinosis (20%), and age (20%). Medial partial thickness lesions were considered a contra-indication by 49% and lateral joint space narrowing by 61% of the respondents. Respondents perceived UKA to outperform total knee arthroplasty regarding all outcomes, except survival (1.8% versus 42%). The reported barriers for UKA use were insufficient experience (20%), high revision rates (20%), and low hospital volume (16%), whereas 60% did not experience any at all. Hands-on UKA exposure during residency was associated with an increased use of correct indications. Furthermore, the use of correct indications was associated with an increased UKA volume. CONCLUSION: We showed a low UKA exposure during residency and considerable variations in contra-indications. These factors may contribute to an underuse of UKA. Improved UKA training could lead to increased experience and better patient selection among surgeons and consequently a higher use of medial UKA. Copyright © 2023 Elsevier B.V. All rights reserved. DOI: 10.1016/j.knee.2023.12.005