Combined Partial Knee Arthroplasty

Abstract

Arthrosis commonly affects a single compartment of the knee, but may present with two or even three compartments affected. Wear to the medial tibiofemoral compartment is ten times more common than that in the lateral tibiofemoral compartment; primary patellofemoral joint (PFJ) arthrosis is least common [1, 2]. Bicompartmental disease is present in 59% of those with gonarthrosis [3]. In one study, 40% of patients over 50 years old with knee pain had radiographic evidence of combined medial compartment and PFJ wear, 24% had isolated PFJ arthrosis, whilst only 4% had isolated tibiofemoral arthrosis [4]. Degeneration of all three compartments simultaneously is rare [2]. Consequently, removal of healthy tissue in total knee arthroplasty (TKA) is common. The anterior cruciate ligament (ACL) is present in 78% of cases of patients undergoing primary knee replacement [5]. The fundamental role of the ACL in knee stability and functional gait is well described [6]; however, regardless of its functional integrity, it is resected in almost all TKAs.

Partial and Combined Partial Knee Arthroplasty: Greater Anterior-Posterior Stability Than Posterior Cruciate–Retaining Total Knee Arthroplasty

“…Combined partial knee arthroplasty (CPKA), the implantation of two PKAs within the same knee, offers a cruciate-sparing, higher functioning alternative to TKA, when at least one compartment is preserved [20][21][22][23][24][25][26][27]. Bicompartmental arthroplasty (BCA), the combination of a patellofemoral arthroplasty (PFA) with either a medial (BCA-M) or lateral (BCA-L) UKA, preserves the unaffected tibiofemoral compartment, meniscus and cruciate ligaments, whilst bi-unicondylar arthroplasty (Bi-UKA), the combination of UKA-M and UKA-L, spares the healthy patellofemoral joint and the cruciate ligaments [20,28]. However, little is known of knee anterior-posterior (A-P) stability following CPKA.…”

The compartmental approach to revision of partial knee arthroplasty results in nearer-normal gait and improved patient reported outcomes compared to total knee arthroplasty

“…The functional outcomes and patient reported outcome metrics (PROMs) associated with CPKA in the staged setting (Fig. 2 ) are not known [ 12 ]. This study aimed to compare the post-operative gait and patient reported outcomes of staged CPKA to those of healthy controls and primary TKA subjects.…”

Metabolic equivalent of task scores avoid the ceiling effect observed with conventional patient-reported outcome scores following knee arthroplasty

“…Overall, 99 patients underwent unicompartmental knee arthroplasty (UKA), seven total knee arthroplasty (TKA), seven bicompartmental arthroplasty (BCA), two bi-unicondylar arthroplasty (Bi-UKA), and one patellofemoral arthroplasty (PFA). 11,12 Data collection and statistical analysis. The distribution of OKS, EQ-5D, and MET scores were analyzed and assessed for skewness, kurtosis, and ceiling and floor effects.…”

“…Overall, 99 patients underwent unicompartmental knee arthroplasty (UKA), seven total knee arthroplasty (TKA), seven bicompartmental arthroplasty (BCA), two bi-unicondylar arthroplasty (Bi-UKA), and one patellofemoral arthroplasty (PFA). 11 , 12 …”