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Unicompartmental Arthroplasty

Unicompartmental Arthroplasty. John Goodfellow Nuffield Orthopaedic Centre, Oxford. Anteromedial Osteoarthritis (30% of OA knees). Fixed Bearing UKR. Wear inescapable Incongruous Thin polyethylene Catastrophic failure. Meniscal function. Phase 1 1976. Polyethylene Wear.

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Unicompartmental Arthroplasty

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  1. Unicompartmental Arthroplasty John Goodfellow Nuffield Orthopaedic Centre, Oxford

  2. AnteromedialOsteoarthritis(30% of OA knees)

  3. Fixed Bearing UKR • Wear inescapable Incongruous • Thin polyethylene • Catastrophic failure

  4. Meniscal function

  5. Phase 1 1976

  6. Polyethylene Wear • Average penetration rate 0.03mm per year • Average time for 1mm penetration 33 years 10 year retrieval

  7. Criteria Antero-medial OA Intact ACL Full thickness lateral Correctable varus FFD less than 15° 1 in 3 OA knees Not Contraindications Patello-femoral joint Chondrocalcinosis Obesity Age Activity Indications

  8. UKR - Designer’s series • 10 year survival98% • Murray et al JBJS 1998

  9. Svard & Price (AAOS 2006) 20 yr survival92%CI 15.1 10 yr 90% Good or Excellent HSS (n=187)

  10. Minimally Invasive Surgery

  11. MIS results – EarlyRecovery • Less Bleeding • Lower Morbidity • Shorter Hospital Stay • Quicker Flexion • Time to recovery: 3x faster than TKR (p<0.001) 2x faster than open UKR (p<0.001)

  12. National Registers • Measured by revision, failure rate of UKR at 10yrs is approx x 2 TKR • National failure rates of UKR are higher than reports from Specialist Centres • Failure rates of UKR vary with the experience of the surgeon

  13. Dependence on Surgical Experience(Roberttson et al)

  14. Instructional Courses • To diminish the ‘learning curve’ • To teach indications • To improve surgical technique

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