ISAKOS: 2019 Congress in Cancun, Mexico
ISAKOS

2019 ISAKOS Biennial Congress ePoster #1311

 

Magnetic Resonance Imaging is Helpful in Surgical Decision Making Process of Medial Compartment Osteoarthritis of the Knee

Chulkyu Kim, MD, Seoul KOREA, REPUBLIC OF
Man-Soo Kim, MD, Seoul KOREA, REPUBLIC OF
Yong In, MD, PhD, Seoul KOREA, REPUBLIC OF

Seoul St. Mary’s Hospital, The Catholic University of Korea , Seoul, KOREA, REPUBLIC OF

FDA Status Cleared

Summary

The routine use of MRI was helpful in deciding surgical options in patients planning UKA, HTO, or TKA for the medial compartment OA of the knee.

Abstract

Background

Medial compartmental osteoarthritis (OA) of the knee is the commonly encountered condition in the middle-aged patients. Surgical options for the treatment of medial compartment OA with varus deformity include high tibial osteotomy (HTO), unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA). HTO and UKA are firstly considered for the middle-aged patients, as a role of buy time surgery until TKA is finally performed. Careful selection of patients for UKA and HTO is essential to draw the successful outcomes. Preoperative magnetic resonance imaging (MRI) can be used for the assessment of ligaments, cartilage, and meniscal structures of the lateral and patellofemoral compartments. The purpose of this study was to determine the usefulness of MRI in the decision making process of surgical plan for the patients with medial compartment OA of the knee.

Material And Method

Between September, 2011 and June, 2016, total 353 patients firstly planned for UKA or HTO were included in this study. First decision of UKA or HTO was based on the age, deformity, activity level and OA grade by history, physical examination and radiographs including stress views. The final surgical decision was made after having done an MRI for the evaluation of contraindications of UKA and HTO (Fig 1). The causes of the change in the surgical decision from UKA or HTO to TKA after MRI results were investigated. Preoperative and postoperative 2 years Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score were also compared between UKA group, HTO group and changing decision to TKA group.

Results

Of 353 cases, surgical decisions were changed from UKA or HTO to TKA in 29 knees (8.2%) after having done MRI. There were 15 knees of cartilage defect in the lateral compartment, 4 knees of cartilage defect in the patellofemoral joint, 6 knees of bone marrow lesions in the lateral compartment, 3 knees of anterior cruciate ligament deficiency, and one knee of osteonecrosis in the lateral femoral condyle. There were no differences in preoperative demographics except age between UKA, HTO, and changing decision to TKA groups (61.0 years, 55.8 years, and 60.2 years, respectively, p < 0.001). All three groups showed similar WOMAC scores at 2 years postoperatively (all p > 0.05) (Table 1).

Conclusion

and Discussion
The routine use of MRI was helpful in deciding surgical options in patients planning UKA, HTO, or TKA for the medial compartment OA of the knee.