Perceptions of outcomes after unicompartmental and total knee replacements

An independent measurement of the quality of outcome of 31 consecutive Oxford medial unicompartmental knee replacements in 28 patients and 130 total knee replacements in 104 patients performed between 1993 and 1997 is reported. The indications for surgery were anteromedial osteoarthritis for unicompartmental replacement and more extensive osteoarthritis for total knee replacement. All patients were treated by one surgeon. As a validated outcome measure of knee function, the Oxford 12-item knee questionnaire showed identical outcome in both groups with a mean score of 36.5 (maximum possible, 48). Neither the pain nor the functional outcomes were significantly different, although patients receiving unicompartmental replacement were better able to descend stairs. Two patients needed revision surgery in the unicompartmental replacement group compared with only one patient in the total knee replacement group. The femoral component of two unicompartmental replacements showed radiologic signs of loosening. The tibial component of one total knee replacement appeared loose, but the patient had no symptoms. In comparison with total knee replacement, implantation of meniscal bearing unicompartmental replacement technically is demanding and unforgiving. However, revision of a failed Oxford unicompartmental replacement is easier than revision of a failed total knee replacement, and the authors recommend this device for younger patients in whom one could expect a total knee replacement to fail within their lifetime.