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CAN WE JUSTIFY THE UNI AS A TEMPORISING PROCEDURE? – IN OPPOSITION



Abstract

The indications for unicompartmental replacement are quite specific. Overall there should be involvement of one tibiofemoral compartment, mild malalignment, and ligamentous stability. In a review of 250 osteoarthritic knees these pathologic findings were present in 9% of patients. If the average orthopaedic surgeon performs 25 total knee replacements per year only 2–3 patients will be ideally suited for this procedure. Technique, despite improvement in instrumentation, is still more demanding than tricompartmental knee replacement and therefore failure to achieve an optimal arthroplasty is higher. Overall results with unicompartmental replacement in the literature have been inferior to tricompartmental replacement (82% versus 97%). The concept that unicompartmental replacement is a temporising procedure is not a valid one in that the patient has to undergo another arthroplasty with all the risks of revision arthroplasty surgery. Tibial osteotomy remains the procedure of choice in the younger, active patient with unicompartmental replacement and tricompartmental replacement in the older, lower demand patient.

The abstracts were prepared by Mrs Dorothy L. Granchi, Course Coordinator. Correspondence should be addressed to her at PMB 295, 8000 Plaza Boulevard, Mentor, Ohio 44060, USA.