Optimal surgical management of the unicompartmental osteoarthritic knee has eluded the orthopedist for decades. McKeever is credited with recognizing that arthritis of the knee could be unicompartmental in nature. Treatment options for medial compartment arthritis have varied extensively, including valgus unloading braces; opening or closing wedge osteotomies of the proximal tibia, distal femur, or both; and unicompartmental or total knee arthroplasty (TKA).
Problem: The problem facing the orthopedist in unicompartmental arthritis is addressing single compartment articular cartilage wear and biomechanical overload while preserving the integrity of the remaining knee joint. Conservative measures including bracing, weight loss, physical therapy, and injection may provide temporary relief, often delaying the need for surgical intervention. Surgical options include arthroscopy, joint debridement, microfracture, osteotomy alone, or cartilage replacement in conjunction with osteotomy. Depending upon the severity of articular cartilage damage and joint deformity, one or more of these measures may ameliorate symptoms such that no further intervention is required. In cases of recurrent pain, a unicompartmental or conventional total joint arthroplasty may be undertaken.
Synonyms and related keywords: medial compartment osteoarthritis, knee arthritis, unicompartmental osteoarthritic knee, unicompartmental arthritis, arthritic knee, arthritis of the knee, degenerative arthritis of the knee
Scott E Marwin, MD & Kevin Trapp, MD 2005