title: Intra-operative findings in varus osteoarthritis of the knee. An analysis of pre-operative alignment in potential candidates for unicompartmental arthroplasty.
abstract: Interest in unicompartmental knee arthroplasty (UKA) for the treatment of medial compartment osteoarthritis has increased in recent years with apparent improvement in the long-term results. This is a result of improved surgical technique, patient selection, and implant design. In an effort further to improve patient selection we analysed the relationship between the pre-operative alignment of the knee and the anatomical findings at the time of surgery. We compared these findings with the indications for UKA. From 4021 total knee arthroplasties we compared intra-operative observations with the pre-operative clinical data in order to identify knees with isolated, medial, compartment changes, which would have been ideal candidates for UKA. We found that only 247 of the knees (6.1%) met anatomical qualifications for isolated, medial, unicompartmental osteoarthritis, and of these, only 168 (4.3%) met clinical standards ideal for UKA. Preoperative alignment showed a significant relationship with patterns of disease. Logistic regression revealed a relationship between pre-operative alignment and intraoperative findings resembling a Gaussian distribution. Patients with a pre-operative varus alignment of 7 degrees were slightly more likely to be selected for UKA. But the further the anatomical alignment in either direction varies from 7 degrees of varus, the more unlikely it is for the knee to exhibit a disease pattern of isolated, medial, unicompartmental osteoarthritis.
authors.affiliation: The Center for Hip and Knee Surgery, St. Francis Hospital, 1199 Hadley Road, Mooresville, Indiana 46158, USA.
authors.forename: M A
authors.initials: MA
authors.lastname: Ritter
authors.forename: P M
authors.initials: PM
authors.lastname: Faris
authors.forename: A E
authors.initials: AE
authors.lastname: Thong
authors.forename: K E
authors.initials: KE
authors.lastname: Davis
authors.forename: J B
authors.initials: JB
authors.lastname: Meding
authors.forename: M E
authors.initials: ME
authors.lastname: Berend
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D007720:Knee Prosthesis; D008297:Male; D008875:Middle Aged; D016011:Normal Distribution; D020370:Osteoarthritis, Knee / Q000473:pathology / Q000601:surgery*; D011300:Preoperative Care; D016059:Range of Motion, Articular; D012044:Regression Analysis; D012189:Retrospective Studies