Disease Progression After Lateral and Medial Unicondylar Knee Arthroplasty

Medial unicompartmental knee arthroplasty (UKA) has been a successful option for treatment of arthritis in patients with a healthy lateral compartment. However, lateral UKA is less common and results are less consistent. The purpose of this study is to compare progression of radiographically evident osteoarthritis in unoperated compartments during 5 years after lateral and medial UKA.

We undertook serial radiographic evaluation of 20 lateral and 114 medial UKA performed by the senior author during calendar years 2007-2008. Anteroposterior, lateral, and skyline radiographs obtained preoperatively and 1 and 5+ (mean, 5.3; range, 5.1-6.4) years postoperatively were independently graded for osteoarthritis in the unoperated tibiofemoral (TF) and patellofemoral (PF) compartments using established scales of Kellgren (0-4 point global scale for osteoarthritis), Ahlbäck (0-5 point scale based on joint space narrowing), and Altman (0-12 point composite criteria score). Rates of disease progression were compared between lateral and medial UKA groups using bivariate methods and multilevel growth models that adjusted for baseline characteristics.

All mean disease grades for the TF and PF compartments increased (worsened) over time. The adjusted rate of Kellgren grade change was statistically (P < .05) faster for lateral UKA in the TF and PF compartments, as was Ahlbäck change in the TF compartment. Kellgren grade for the TF compartment of lateral and medial UKA groups increased 1.1 vs 0.6 points on average over 5 years adjusted for age, sex, and body mass index (P < .001).

Surgeons should consider the propensity for faster disease progression after UKA in evaluating patients with isolated lateral compartment disease.

Level III, therapeutic study.