Summary

UKA is appropriate in 15% of patients, if more than radiologic criteria are applied.

Abstract

Aims:
Indications for unicompartmental knee arthroplasty (UKA) are controversial. Studies based solely on radiographic criteria suggest up to 49% of patients with knee osteoarthritis (OA) are suitable for UKA. In contrast, the ‘Appropriate use criteria’ (AUC), developed by the American Academy of Orthopedic Surgeons, applies both clinical and radiographic criteria to guide surgical treatment of knee OA. The aim of this study was to analyse patient suitability for TKA, UKA and osteotomy using both radiographic criteria and AUC in a cohort of 300 consecutive knee OA patients.

Patients and Methods:
Included were consecutive patients with clinical and radiographic signs of knee OA referred to a specialist clinic. We collected demographic data, radiographic wear patterns and clinical findings that were analyzed using the AUC. Patients with bilateral knee OA were analyzed separately for each knee. We compared the radiographic wear patterns with the treatment suggested by the AUC as well as the Surgeon Treatment Decision.

Results

There were 397 knees in 300 patients available for analysis. Median age was 68 [IQR 15], BMI 30 [6] with 55% females. We found excellent consistency for both the radiographic criteria and the AUC criteria. Based on radiological criteria, 41% of knees were suitable for UKA. However, when using the AUC criteria, UKA was the appropriate treatment in only 13.3% of knees. In 19.1% of knees, no surgical treatment was appropriate at the visit, based on the collected data.

Conclusion

Application of isolated radiologic criteria in patients with knee OA results in a UKA candidacy is misleadingly high. Appropriate Use Criteria that are based on both radiological and clinical criteria suggest UKA is appropriate in less than 15% of patients.