Unicompartmental knee arthroplasty

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Unicompartmental knee arthroplasty is a surgical procedure used to relieve arthritis in one of the knee compartments in which the damaged knees are replaced. UKA surgery can reduce post-operative pain and have a shorter recovery period than total knee replacement. In addition, UKA may have smaller incisions because the implants may be smaller.

In the United States, this procedure accounts for about 8% of knee arthroplasty.

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In the early 1950s, Duncan C. McKeever theorized that osteoarthritis can be isolated only into one knee joint compartment, and that the replacement of the entire knee may not be necessary if only one knee compartment is affected. The UKA concept is designed to cause less trauma or damage than traditional total knee replacement by removing less bone and trying to retain most of the patient's bones and anatomy. Also, the concept is designed to use smaller implants and thus keep most of the patient's bones; this can help the patient return to normal function faster.

Initially, UKAs did not always work, because the implants were poorly designed, the patients were not really filtered for conformity, and optimal surgical techniques were not developed. Recent advances have been made to improve the implant design. Also, choosing the most suitable patient is emphasized to ensure that the surgeon follows indications and contraindications for partial replacement. Selection of appropriate patients, following indications/contraindications, and performing surgery well is a key factor for UKA success.

Currently, UKA is often referred to as "partial knee replacement." In reality there is nothing "partial" about this replacement. This is the complete replacement of the "parts" of the arthritic knee. Patients who have arthritis are confined to only one part of the knee and have no reason not to undergo this surgery ("contraindication" is a medical term for reasons not having specific procedures) may consider this option.

Maps Unicompartmental knee arthroplasty

Indications and Contraindications

UKA may be suitable for patients with moderate joint disease caused by painful osteoarthritis or traumatic injury, history of unsuccessful surgical procedures or poor bone density that precludes other types of knee surgery. Patients who may not be eligible for the UKA include patients who have active or suspected infections on or about the knee joint, may have known sensitivity to device ingredients, have bone infections or diseases that result in an inability to support or fix a new one. implanted into the bone, has inflammatory arthritis, has a major defect that can affect the knee mechanical axis, has a neuromuscular disorder that may compromise motor control and/or stability, have mental neuromuscular disorders, skeletal skeletal patients, have obesity, have severe bone loss of the tibia or having severe tibial deformities, subjected to knee joint subluxation, untreated damage to the knee and thigh joints (patellofemoral joint), have untreated damage to the opposite compartment or the same knee side is not replaced by device, and/or have knee ligament instability so that postoperative stability of UKA will be a compromise d.

The anterior cruciate ligament (ACL) should be intact, although this is disputed by doctors for patients who require replacement medial compartments. For patients requiring lateral compartment replacement, ACLs should be intact and contraindicated for patients with ACL-deficient knees because the lateral component has more motion than the medial compartment.

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History and physical checks

Physical examination and history of the patient before surgery. A doctor may ask patients to identify their pain with one finger. A patient with pain in one area of ​​the knee may be a candidate for UKA. However, patients with pain in more than one knee area may not be a good candidate for UKA. The doctor may take some radiography (eg, x-rays) to check for the degeneration of other knee compartments and evaluate the knee. Physical examination may also include special tests designed to test knee ligaments and other anatomical structures. Most likely, the surgeon will decide to do UKA during an operation where he can immediately see the status of another compartment.

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Surgical information

The surgeon may choose the type of incision and implant used for the patient's knee. During surgery, the surgeon can align the instrument to determine the amount of bone to be removed. The surgeon lifts the bone from the shin (tibia) and femur (femur). The surgeon may decide to check whether they are removing the right amount of bone during surgery. To ensure that the correct implant size is used, the surgeon may choose to use a temporary trial. After ensuring the correct implant size is selected, the surgeon will place the implant on the end of the bone and secure it with the peg. Finally, the surgeon will cover the wound with stitches.

Uni-compartment replacement is a minimally invasive option for patients whose arthritis is isolated to the medial or lateral compartment. This procedure offers several benefits for patients with a fairly active lifestyle, who have arthritis in just one knee compartment, and who are within the normal weight range. The surgeon uses an incision only 3-4 inches; total knee replacement usually requires an incision of 8-12 inches. According to Dr. Howard J. Luks, Associate Professor of Orthopedic Surgery at New York Medical College, partial replacement does not disrupt the knee cover, which makes the rehabilitation period shorter. Partial replacement also causes minimal blood loss during the procedure, and results in much less postoperative pain. Hospitalization time compared to total knee replacement is also greatly reduced.

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Benefits

The potential benefits of UKA include smaller incisions because UKA implants are smaller than total knee replacement, and surgeons can make smaller incisions. This can cause a smaller scar. Another potential benefit is the reduction in postoperative pain because fewer bones are removed. Also, faster surgery and shorter recovery periods may be caused by reduced bone loss during surgery and soft tissue can maintain less trauma. Also, the rehabilitation process may be more progressive. UKA's more specific benefits are to increase the range of motion, reduce blood loss during surgery, reduce hospital time spent, and reduce costs.

Currently, the two most significant benefits of UKA or partial knee replacement are: 1. The knee replacement patient partially reports that the replaced knee feels more like an original knee that is not replaced compared to the total knee replacement 2, partial replacement of the partial knee. options open for further progress. By not replacing the rest of the knee with metal and plastic, if other options exist in the coming years for arthritis in these areas then partial knee replacement does not burn the bridge.

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Risk

Blood clotting (also known as deep vein thrombosis) is a common complication after surgery. However, your doctor may prescribe certain medications to help prevent blood clotting. Infection may occur after surgery. However, antibiotics may be prescribed by doctors to help prevent infection. Individual patient factors (eg, anatomy, weight, previous medical history, previous joint surgery) should be treated by the patient's physician. Causes of long-term UKAs failure include wear of polyethylene, loosening of implants, and adjacent knee compartment degeneration.

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Long-term results

Long-term studies report excellent results for UKA and the authors credited him for choosing the right patient, minimizing the amount of bone released, and using appropriate surgical techniques. One study found that at least 10 years of follow-up time after the initial surgery, the overall survival rate of the implant was 96%. Also, 92% of patients in this study had excellent or good results. Another study, reported that at 15 years of follow-up time after initial surgery, the overall level of implants was 93% and 91% of these patients reported good or excellent results.

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References

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External links

• Orthopedic and Sports Medicine University of Washington, School of Medicine
• About.com
• Knee Society [1]
• American Academy of Orthopedic Surgeon's Your Orthopedic Connection [2]
• Medline Plus [3]
• [4]
• About Partial Knee Replacement [5]
• Partial Knee Replacement: Orthopedic Stryker

Source of the article : Wikipedia