Unicompartmental Knee Arthroplasty: Is it a Step in the Right Direction? – Surgical Options for Osteoarthritis of the Knee

Osteoarthritis of the knee is the commonest degenerative joint disease. The prevalence of symptomatic disease in adults over 65 years is 10%. The prevalence of radiological disease in the same age group is 33%(1). Because of the magnitude of the problem its management consumes a significant proportion of health care resources of the nation. In some countries a needs assessment has been performed so that the appropriate resources can be allocated for this growing problem. Prevention has not been entertained as a form of management as the aetiology has remained obscure. The main thrust of management has been medical and includes analgesics to relieve pain, exercises to maintain and promote function, braces and orthoses to help redistribute the load and contain the progression of osteoarthritis and, more recently, nutritional supplements such as glucosamine and chondroitin sulfate, professed to be chondroprotective agents, to help in cartilage “homeostasis”. Surgical management remains the last resort and is undertaken when pain is debilitating and function is compromised despite medical management. Until some five decades ago arthrodesis (fusion of the joint) was the only surgical option. Although it relieved pain, the resulting stiff knee remained a functional disability. The 1950s and 1960s witnessed major developments in the surgical management of osteoarthritis of the knee. Surgical debridement, realignment osteotomy and prosthetic arthroplasty were introduced. Realignment osteotomy although technically demanding, was the preferred surgical option in the 1960s and 1970s. With improved biomaterials and designs of prosthesis, prosthetic knee arthroplasty gained popularity. Both unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA) prostheses were developed and used. By the eighties TKA had become the gold standard for surgical management of osteoarthritis in the elderly, not responding to medical management, and remains so to this day