Outcome of combined unicompartmental knee replacement and combined or sequential anterior cruciate ligament reconstruction

Abstract

The Oxford unicompartmental knee replacement (UKR) is an established treatment option in the management of symptomatic end-stage medial compartmental osteoarthritis (MCOA), which works well in the young and active patient. However, previous studies have shown that it is reliable only in the presence of a functionally intact anterior cruciate ligament (ACL). This review reports the outcomes, at a mean of five years and a maximum of ten years, of 52 consecutive patients with a mean age of 51 years (36 to 57) who underwent staged or simultaneous ACL reconstruction and Oxford UKR. At the last follow-up (with one patient lost to follow-up), the mean Oxford knee score was 41 (sd 6.3; 17 to 48). Two patients required conversion to TKR: one for progression of lateral compartment osteoarthritis and one for infection. Implant survival at five years was 93% (95% CI 83 to 100). All but one patient reported being satisfied with the procedure. The outcome was not significantly influenced by age, gender, femoral or tibial tunnel placement, or whether the procedure was undertaken at one- or two-stages. In summary, ACL reconstruction and Oxford UKR gives good results in patients with end-stage MCOA secondary to ACL deficiency.

Clinical outcome after UKA and HTO in ACL deficiency: a systematic review

“…Treatment with HTO ACL reconstruction had the lowest revision rate (0.62/100 observed component years) but the highest rate of complications (4.61/100 observed component years). Too little data were available to test for differences in In this latter group with ACL deficiency secondary to OA, a total knee arthroplasty (TKA) is considered the treatment of choice [34,37,44]; however, there is no consensus on the treatment of medial knee OA in ACL deficiency patients where ACL deficiency is the primary pathology.…”

“…Due to younger age and higher activity levels seen in patients with primary ACL deficiency who develop secondary OA, bone conserving options are preferred with TKA not being recommended as the primary treatment option in this cohort [37,44]. At the other end of the spectrum ACL reconstruction alone, with the exception of those patient who report instability as their primary complaint, is not a definitive treatment option but can be used as a reasonable, low co-morbidity treatment option to improve symptoms prior to subsequent HTO or UKA [47].…”

ACL-deficient knee and unicompartmental OA: state of the art

“…Pandit et al 52 and Weston-Simon et al 53 suggest taking a different surgical approach according to the predominant symptom. When pain is the main symptom, simultaneous ACL reconstruction and mobile UKA are indicated to ensure the best outcome; when joint instability is the main complaint, ACL reconstruction is the primary procedure.…”

(vi) Focal resurfacing implants in the knee and partial knee replacements

“…More latterly, medial UKRs have been performed in conjunction with an ACL reconstruction with good survivorship and outcome scores. 16 Mobile or fixed bearing device In an attempt to minimise wear, some fixed bearing components were introduced that had increased conformity, compared to the classic round-on-flat articulation. When failed non-conforming implants were studied, they found that the prosthetic articulation has a propensity to replicate that of the pre-operative arthritic wear pattern, which tends to be peripheral and anterior in the varus knee.…”

“…They found that the rate of revision of a TKA done following a UKR was four times that of a primary TKA; they also found a significantly worse Oxford knee score in the conversion group as compared to the primary group (30.02 vs 37. 16) This would indicate that a revision of a UKR to a TKA should be viewed more like a full revision procedure rather than a conversion to a conventional primary. 22 This does, however, contrast with the findings of the Oxford knee group who found the conversion of a UKR to a TKA gives equivalent outcomes to a primary TKA.…”