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CHICAGO — The once-dismissed unicompartmental knee arthroplasty is regaining popularity due to its specific advantages in certain patients, compared with total knee arthroplasty, according to Dr. Bryan J. Nestor of the Hospital for Special Surgery in New York.
“It's an operation that's seen renewed interest over the last 10 years and I think for some good reasons,” Dr. Nestor said at a symposium sponsored by the American College of Rheumatology.
Indications for unicompartmental knee replacement (UKR), also called minimally invasive partial knee surgery, include:
▸ Isolated medial or lateral joint disease.
▸ Minimal and correctable deformity.
▸ Flexion contracture less than 5 degrees.
▸ Flexion greater than 115 degrees.
▸ Patient weight under 200 pounds.
“That leaves about 10% of the patients I see who have severe arthritis of the knee and are candidates for unicompartmental knee replacement,” said Dr. Nestor. He described the procedure as less invasive than total knee arthroplasty (TKA).
“If you're only bending to 110 degrees preoperatively, you're not going to gain that motion postoperatively and are better served with a TKA. However, if you're bending 130–135 degrees, which we sometimes see with isolated unicompartmental arthritis, doing a total knee [arthroplasty] may cause the patient to lose motion and I have to counsel him accordingly, as the average motion after total knee replacement is only about 115 degrees. With a unicompartmental knee I can feel pretty comfortable that I will preserve that 130-degree arc of motion,” he said.
In Dr. Nestor's experience, about half of UKR patients leave the hospital within 2–3 days, and many of these are bending beyond 90 degrees and can do outpatient rehabilitation. Further, many feel better by the 6th week, “whereas with total knee replacement we don't usually see that much self-reported improvement until 3 months,” he said. “More importantly, patients will tell you that the knee feels like a normal knee.”
“This technique is associated with a failure rate of 10%–15% at 10 years, compared with 2% or less for TKA. The unicompartmental procedure can now be revised. Today, a revision of a failed unicompartmental knee replacement approaches the results of a total knee arthroplasty, so we're not burning a bridge and that's why I think the renewed interest in UKR for selected patients is justified.”
CHICAGO — The once-dismissed unicompartmental knee arthroplasty is regaining popularity due to its specific advantages in certain patients, compared with total knee arthroplasty, according to Dr. Bryan J. Nestor of the Hospital for Special Surgery in New York.
“It's an operation that's seen renewed interest over the last 10 years and I think for some good reasons,” Dr. Nestor said at a symposium sponsored by the American College of Rheumatology.
Indications for unicompartmental knee replacement (UKR), also called minimally invasive partial knee surgery, include:
▸ Isolated medial or lateral joint disease.
▸ Minimal and correctable deformity.
▸ Flexion contracture less than 5 degrees.
▸ Flexion greater than 115 degrees.
▸ Patient weight under 200 pounds.
“That leaves about 10% of the patients I see who have severe arthritis of the knee and are candidates for unicompartmental knee replacement,” said Dr. Nestor. He described the procedure as less invasive than total knee arthroplasty (TKA).
“If you're only bending to 110 degrees preoperatively, you're not going to gain that motion postoperatively and are better served with a TKA. However, if you're bending 130–135 degrees, which we sometimes see with isolated unicompartmental arthritis, doing a total knee [arthroplasty] may cause the patient to lose motion and I have to counsel him accordingly, as the average motion after total knee replacement is only about 115 degrees. With a unicompartmental knee I can feel pretty comfortable that I will preserve that 130-degree arc of motion,” he said.
In Dr. Nestor's experience, about half of UKR patients leave the hospital within 2–3 days, and many of these are bending beyond 90 degrees and can do outpatient rehabilitation. Further, many feel better by the 6th week, “whereas with total knee replacement we don't usually see that much self-reported improvement until 3 months,” he said. “More importantly, patients will tell you that the knee feels like a normal knee.”
“This technique is associated with a failure rate of 10%–15% at 10 years, compared with 2% or less for TKA. The unicompartmental procedure can now be revised. Today, a revision of a failed unicompartmental knee replacement approaches the results of a total knee arthroplasty, so we're not burning a bridge and that's why I think the renewed interest in UKR for selected patients is justified.”
CHICAGO — The once-dismissed unicompartmental knee arthroplasty is regaining popularity due to its specific advantages in certain patients, compared with total knee arthroplasty, according to Dr. Bryan J. Nestor of the Hospital for Special Surgery in New York.
“It's an operation that's seen renewed interest over the last 10 years and I think for some good reasons,” Dr. Nestor said at a symposium sponsored by the American College of Rheumatology.
Indications for unicompartmental knee replacement (UKR), also called minimally invasive partial knee surgery, include:
▸ Isolated medial or lateral joint disease.
▸ Minimal and correctable deformity.
▸ Flexion contracture less than 5 degrees.
▸ Flexion greater than 115 degrees.
▸ Patient weight under 200 pounds.
“That leaves about 10% of the patients I see who have severe arthritis of the knee and are candidates for unicompartmental knee replacement,” said Dr. Nestor. He described the procedure as less invasive than total knee arthroplasty (TKA).
“If you're only bending to 110 degrees preoperatively, you're not going to gain that motion postoperatively and are better served with a TKA. However, if you're bending 130–135 degrees, which we sometimes see with isolated unicompartmental arthritis, doing a total knee [arthroplasty] may cause the patient to lose motion and I have to counsel him accordingly, as the average motion after total knee replacement is only about 115 degrees. With a unicompartmental knee I can feel pretty comfortable that I will preserve that 130-degree arc of motion,” he said.
In Dr. Nestor's experience, about half of UKR patients leave the hospital within 2–3 days, and many of these are bending beyond 90 degrees and can do outpatient rehabilitation. Further, many feel better by the 6th week, “whereas with total knee replacement we don't usually see that much self-reported improvement until 3 months,” he said. “More importantly, patients will tell you that the knee feels like a normal knee.”
“This technique is associated with a failure rate of 10%–15% at 10 years, compared with 2% or less for TKA. The unicompartmental procedure can now be revised. Today, a revision of a failed unicompartmental knee replacement approaches the results of a total knee arthroplasty, so we're not burning a bridge and that's why I think the renewed interest in UKR for selected patients is justified.”