Brief on OA knee, HTO, TKR and Unicondylar TKR.

1. Dr. Anshu Sharma

2.  Knee is a complex
synovial joint formed
between femoral
condyles, tibial condyles
& patella.
 Stabilized by variety of
ligaments.
 Active movement at the
knee are Flexion,
Extension, Medial
rotation & Lateral
rotation.

3.  The knee joint has no inherent
stability rather it is provided by
the surrounding ligaments and
muscles.
 The ligaments about the knee
include the collateral ligaments
and the cruciate ligaments.
 The medial and lateral collateral
ligaments prevent valgus and
varus stresses, respectively.
 The anterior and posterior cruciate
ligaments prevent anterior and
posterior tibial translation on the
femur and secondary restraint to
rotation.
 Fibro-cartilagenous medial and
lateral meniscus provides stability
and shock absorption , especially
with axial loading.

4.  Osteoarthritis is a
degenerative joint
disease characterized
by destruction of
Articular cartilage.
 More common than
Hip OA in Asian
population.

5.  Old age,
 Female sex,
 Obesity,
 Infection,
 Trauma,
Intra- articular fractures,
Ligament or meniscus
tears.
 Indian habits : cross-leg
sitting & squatting.

6.  In OA disease process usually
begins in Antero-medial
compartment of knee.
 Fibrillation of articular
cartilage due to loss of water.
 Destruction of articular
cartilage.
 Bone surfaces come in direct
contact during joint
movements leads to erosion.
 Sclerosis, subchondral
microfractures and cysts
formation.
 New bone & osteophyte
formation.

7. - Pain : Steady/intermittent.
- Stiffness : following periods of
inactivity, such as sleep or
sitting.
- Swelling of joint.
- Tenderness.
- Crepitus : Crunching feeling or
sound of bone rubbing on bone
- Locking.
- Limitation of movements.
- Deformity : Varus or Valgus.

8. - X-Ray Views:-
-Anteroposterior View (weight bearing)
-Lateral view,
-Notch patellar views (Sunrise view)
-Findings:-
-Joint space narrowing
 Medial tibiofemoral joint space narrowing
 Patellofemoral joint space narrowing
 Lateral joint space narrowing to lesser
extent.
-Osteophyte formation,
-New subchondral bone formation,
-Tibia lateral subluxation.

10.  The Mechanical Axis of the lower limb is a line
extending from the center of the hip joint to the
middle of the ankle joint.
 In a healthy, well aligned knee joint, the
mechanical axis passes through the middle of the
knee.
 Only when the mechanical axis passes through the
center of the knee joint, the stresses on the knee
joint surfaces are uniform in all areas of the joint
and well balanced.
 In many knee joint diseases, the mechanical axis is
disturbed and does not pass through the center of
the joint.
 This disturbance results in the overload of distinct
areas of the knee joint leading to their damage.

11. NORMAL VARUS
DEFORMITY

12.  Treatment directed at symptoms and slowing
progress of the condition.
 Goals: 4 R’s
 Relieve pain
 Restore function
 Reduce disability
 Rehabilitation

13.  EARLY Treatment
 PHYSIOTHERAPY
 LOAD REDUCTION
 ANALGESICS
 INTERMEDIATE Treatment
 JOINT DEBRIDEMENT
 AUTOLOGOUS CHONDROCYTE GRAFTING
 REALIGNMENT OSTEOTOMY
 LATE Treatment
 ARTHROPLASTY
 ARTHRODESIS.

14.  Non pharmacologic therapy
 Patient’s education
 Use of assistive devices
 Weight loss
 Physical therapy
 Occupational therapy
 Pharmacologic therapy
 NSAIDS
 Glucosamine sulphate
 Intra articular Corticoteroids
 Intra articular Hyaluronic acid.

15.  Arthroscopic joint debridement,
 Chondrocyte transplantation,
 Proximal tibial osteotomy,
 Distal femoral osteotomy,
 Total knee arthroplasty,
 Arthrodesis.

16.  PRINCIPLE:
In patients with unicompartmental O.A. of knee it
causes “unloading” of involved joint compartment
by correcting malalingnment & redistributing the
stresses on the joint.

17.  INDICATIONS:-
1. Pain & disability interfering high demand
employment,
2. Radiographic evidence of involvment of 1
compartment with valgus/varus deformity,
3. Good muscle strength,
4. Good preipheral vascular status,
5. Ability of the patient to use crutches after
operation and motivation to carry out a
rehabilitation programme.

18.  CONTRAINDICATIONS:-
 Narrowing of lateral compartment,
 Lateral tibial subluxation of more than 1cm,
 Medial compartment bone loss of> 2-3 cm,
 Flexion contracture of >15°,
 Knee flexion of < 90 ° ,
 More than 20 ° of correction needed,
 Inflammatory arthritis,
 Peripheral vascular disease.

19.  Lateral closing wedge osteotomy,
 Medial opening wedge with iliac crest bone graft
and rigid fixation,
 Dome or Barrel Vault osteotomy,
 Medial opening hemicallotasis described by Turi
et al., uses an external fixator to distract the
osteotomy site gradually.

20. Techniques for valgus-producing high tibial osteotomy.
A, Lateral closing wedge. B, Medial opening wedge. C, Dome osteotomy.

21. -Described by Coventry et al.,
-Advantages:
-It is made near the deformity
-It is made through cancellous bone, which heals
rapidly,
-It permits the fragments to be held firmly in
position by staples or by rigid fixation devices,
-It permits exploration of the knee through the
same incision.

22. -Disadvantages:
-Recurrence of deformity specially when alignment
was not overcorrected to at least 8* of valgus and
patient is overweight.
-Limb shortening
-Nerve injury
-LCL laxity
-Patella Baja
-Delayed union or non-union.
-More recently, calibrated cutting guides, rigid
internal fixation devices, and early mobilization
have produced improved results and low
complication rates after lateral closing wedge
osteotomy.

23. If tibia is 57 mm wide, length of wedge=degrees of correction
OR
Length = Diameter of tibia X 0.02 X Angle
Measure the amount
of correction needed
to achieve normal
angle then
additional 3 to 5
degree of
overcorrection is
added.

24. INCISION Positioning transverse
osteotomy guide

25. Placement of oblique
osteotomy guide &
performing osteotomy
Application of
compression clamp
& L- plate

26.  Completion of
osteotomy requires
disruption of
proximal tibia fibular
joint or removal of
infero medial portion
of fibular head.
 After osteotomy
fragment is fixed
with plate and
screws.

27.  Postoperative care:
 CPM is started immediately after surgery in
recovery room, usually from 0 to 30* of flexion,
progressing 10* each day.
 Ambulation is begun on 2nd post op day with
use of crutches and 50% weight bearing is
allowed for first 6 weeks.
 Muscle strengthening and ROM exercises also
are begun on 2nd post op day.
 Full weight bearing is allowed after 6 weeks.

28.  Described by Hernigou et al.,
 Require:
-Use of osteotomy jigs,
-Iliac crest bone graft ,
-Rigid plate fixation.
 Recommended if involved extremity shortening
is 2cm. or more.
 Indicated in patients with laxity of MCL or
combined ACL deficiency.

29.  A tourniquet is used.
 The skin incision was
placed vertically, on the
medial side of the tibia
curve to the proximal
and dorsal side.
 The periosteum was cut
and partially stripped .
 K-wire was drilled
under direct fluoroscopic
control in an oblique
manner and at an angle
to the tibial axis aiming
for the upper part of the
fibular head.

30.  When satisfactorily placed,
the osteotomy was
performed using an
oscillating saw for the first
part and finished using a
chisel under fluoroscopic
control.
 Great care was taken not to
damage the lateral cortex.
 The tibia was manually
wedged to the point of
desired correction, and the
osteotomy plate was
positioned and fixed.
 The osteotomy gap was
then filled with iliac crest
bone graft.

33.  With the principle of the
Locking Compression
Plate (LCP) system with
angular stable screws
locked within the new
TomoFix plate,
anatomically designed for
the medial high tibial
valgus correction, stable
fixation of the osteotomy
without bone grafts or
bone substitutes may be
achieved.
 The plate functions like a
bridging internal fixator .

37.  Difficult exposure,
 Fibular osteotomy
required,
 Higher union rate
 Fixation covered
with soft tissue,
 Short duration of
immobilization
postoperatively.
 Easy exposure,
 No fibular
osteotomy
required,
 Relatively unstable
so rigid fixation is
must,
 May increase MCL
tension,
 Less chances of
nerve injury.

38.  Schwartzman  After tibial osteotomy
Ilizarov fixator.
Advantages :
• More reliable healing,
• Less chances of patella baja,
• Less bone loss,
• Ability to translate distal fragment to correct
mechanical axis.
Disadvantages :
• Cumbersome, poor patient acceptance,
• Pin loosening,
• Pin site infection and close follow up is require.

39. Ilizarov method

41.  Turi et al  Dynamic uniplanar external
fixator after an opening wedge osteotomy.
 At 7th Post operative day, the fixator is
distracted 0.25mm four times a day until
desired correction is obtained.
 It is a slow distraction at the osteotomy site and
hence obviates the need of bone grafting.

42.  Position the fixator over
the leg to check the
position of the pin
clamps,osteotomy site
and hinge
 Osteotomy site is below
the tibial tuberosity
 Make longitudinal
incision just medial to
tibial tuberosity up to 3-
4 cm
 Position of the fixator
over the lateral tibial
cortex at the level of
osteotomy

43. Fixator secured with k-wires Proximal fixator pin inserted

44. Medial and lateral
proximal fixator pins
Distal fixator pin placed

45. Osteotomy guide attached Series of holes drilled at
osteotomy site

46. Holes connected with osteotomy Distraction of osteotomy

47.  Passive motion has been started immediately
after surgery.
 Ambulation is begun on 2nd day, allowing
weight bearing to tolerance with crutches.
 Seven day after surgery, instruct the patient to
distract the fixator 1 mm/day.
 After appropriate correction is achieved,
fixator is locked.
 The fixator is removed after solid union is
achieved.

48. Opening Wedge - Orthofix

51.  Described by MAQUET.
 Determine the angle of correction.
 Midline vertical incision.
 Curved line is marked on bone with its dome
just above tibial tuberosity.
 Multiple small drill holes made over this line.
 Two k-wires inserted parallel to each other on
either side of osteotomy.
 Complete the osteotomy using osteotomy

53.  Distal fragment is rotated until desired angle
subtend by wire.
 Fix the osteotomy using staples or plate. -Less
commonly used.
 To be a more technically demanding operation
because of the challenges of creating a curved
osteotomy and avoiding iatrogenic trauma to the
patellar tendon.
-Advantage of intraoperative flexibility, which allows
the surgeon to achieve the precise amount of
desired angular correction.
-Dome osteotomy permits concomitant anterior
translation of the tibial tubercle, which may
alleviate associated patellofemoral disease.

54. HTO: Problems of conversion
• Prior incisions,
• Hardware ,
• Joint line distortion,
• Malunion/ nonunion,
• Patella baja,
• Offset tibial shaft,
• Retropatellar tendon
adhesions,
• Peroneal palsy,
• Infection.

55. 1. HTO is a very useful option in young patients for
unilateral OA,
2. Good Relief of pain can last per ten years or longer,
3. Less expensive,
2. Short learning curve.

56.  COVENTARY TECHNIQUE.
 Indicated in active patients younger than 65
years with valgus angulation <15* or plane of
knee joint deviates from the horizontal by
more than 10*
 Indicated when distal femoral malunion
which leads to unicompartmental arthritic
changes.
 TKR following this will be difficult due to:
-Exposure difficulty from scarring,
-Difficulty in hardware removal.

57. -Determine the size of wedge to be removed,
-Establish the angle of plate insertion,
-Osteotomy done and plate is fixed by screw.

58. SUPRACONDYLAR V -OSTEOTOMY

59.  TKR is essentially a surface
replacement of the
articulating surfaces of
femur, tibia and patella.
 Soft tissue balancing is
absolutely critical for long
term success of the surgery.
 Bony resection is aimed at
achieving the normal
mechanical axis of the lower
limb.

60. 1. The restoration of mechanical alignment,
2. Preservation (or restoration) of the joint line,
3. Balanced Ligaments
4. Maintaining or restoring a normal Q angle.

61.  Fergussen (1860) resection arthroplasty
 Verneuil (1863-1921 ) performed first
interposition arthroplasty using joint capsule
followed by others and they used muscles, fat
& fascia and pig bladder.
 1940s- First artificial implants were tried when
molds were fitted in the femoral condyle.
 Walldius (1950)- Combined femoral and tibial
articular surface replacement appeared as
simple hinges.

62.  In 1971, Gunston importantly recognized that the knee
does not rotate on a single axis like a hinge, but rather
the femoral condyles roll and glide on the tibia with
multiple instant centers of rotation. His polycentric
knee replacement had early success with its improved
kinematics over hinged implants but was unsuccessful
because of inadequate fixation of the prosthesis to
bone.
 John Insall(1973), designed total condylar prosthesis at
the hospital for special surgery and this desighn is
basically the model used today.
 This was a prosthesis made of three components which
would resurface all three surfaces of the knee - the
femur, tibia and patella.

63.  Cobalt chrome alloy
femoral component,
 Cobalt chrome alloy
or Titanium tibial
tray,
 UHMWPE tibial
bearing component
 UHMWPE patella
component

64. (A) Unconstrained:-
Most common type, used
for uncomplicated knee
problems, artificial
components inserted into
the knee are not linked to
each other, have no stability
built into the system,
depends on the person’s
own ligaments and muscles.
 Cruciate retaining
 Cruciate substituting
 Mobile bearing knees

65. (B) Constrained (Hinged):
Rarely used as a first choice,
knee joint linked with a hinge,
used when knee is highly
unstable, useful in severely
damaged, it is not expected to
last as long as other types.
 Constraint
Ability of prosthesis to
provide varus – valgus and
flexion –extension stability in
presence of ligamentous
laxity/bone loss.

66.  Intact PCL
Varus def. < 10
Valgus def. < 15
 Advantage
1. Avoid post cam impingement/
dislocation,
2. More closely resembles knee
kinematics,
3. Bone preserving,
4. Improved proprioception.
 Disadvantage
1. Tight PCL – Increased poly wear,
2. Rupture PCL – flexion instability.

67.  ABSOLUTE INDICATION
-Previous patellectomy,
-Inflammatory arthritis,
-Deficient PCL
 Cam and post mechanism
 Insert more congruent / dished
Advantages
Easier to balance knee,
More range of motion.
Disadvantages
Cam jump,
Post wear,
Patellar clunk syndrome,
Additional cut from distal femur.

68.  INDICATION:
-Global ligamentous
deficiency,
-Hyperextension
instability
 Linked femoral and
tibial components,
 Tibial bearing rotates
around yoke.
 Disadvantages:
-Aseptic loosening,
-Large amount bone
resection

69.  Poly Rotates over
tibial base plate.
 Reduced poly wear.

70.  No advantage of mobile bearing over fixed
bearing.
 Increased wear in undersurface of mobile
bearing.

71.  Cultural/patient
expectation.
 Cut more posterior
condyle.
 No difference in
ROM – Mehin (JBJS
2010)
 No difference in
ROM Sumino (Int
Ortho 2010)

72.  Candidate for TKR
 Quality of life severely affected,
 Continuous pain,
 Restriction of ordinary daily activities,
 Severe Varus or Valgus deformity,
 Evidence of significant radiographic changes of
the knee

73.  Goal of TKR
 Pain relief,
 Correction of deformity,
 Restoration of normal limb alignment,
 Restoration of a functional range of motion.

74. TKR is an elective surgery not an
emergency so the patient’s condition
should be optimized before performing
surgery.
 A Complete Medical and Surgical History,
 Thorough Physical Examination,
 Laboratory Work-up,
 Anesthesia Assessment.
74

75. 1. Standing full-length anteroposterior radiograph
from hip to ankle,
2. Lateral knee x ray,
3. Merchant’s view.

76. • The Incision:
• An incision is made in the
midline and anterior
aspect of the knee with the
knee positioned in flexion,
starting about 2 inches
above upper pole of
patella and distally to just
medial to the tibial
tubercle.
• The most common
approach is the medial
parapatellar approach.

77.  The medial side of the
knee is then exposed by
removing the
anteromedial knee
capsule.
 It is important to note
that during exposure,
no dissection is done in
the subcutaneous tissue
as it can compromise
the vascularity of skin.
 Pes anserinus insertion
is not voilated.

78. • The leg is then extended and
the patella is everted.
• The knee is once again flexed
and the anterior horn of medial
and lateral menisci and anterior
cruciate ligament are removed.
• Posterior horns of menisci
excised after the femoral and
tibial cuts have been made.
• Subluxate and externally rotate
the tibia.
• Expose the tibial plateau by
partial excision of infra-patellar
fat pad.

79. -Proximal Tibial cut:-
-A resection guide is attached to
front of tibia.
-The medial/lateral adjustment
screw that is placed at the
ankle is used to align the
resection guide parallel with
the tibia.
-To check alignment to the ankle
an alignment rod is used.
-Direction of the saw cuts in 3D
 AP tilt
 LM tilt
-Upper end of tibia is resected.

80.  The amount of tibial resection depends on which side of
the joint is used for reference.
 If unaffected side is taken as a reference, usually 8 mm
cut is taken which is close to the size of the implant.
 If affected side is taken as a reference, the amount of
resection usually is 2mm or less.
 Proximal tibial cut is taken perpendicular to its
mechanical axis.
 It is important to not to use extra-long cutting saw blade
as it can go beyond the tibia to injure vital structures.
 Four spikes are used for protection- medially for MCL,
posteriorly for neurovascular bundle, two laterally for
patella and patella tendon.

81. -Distal Femoral cut:-
 Femoral entry point is marked on the line joining the top of
the notch and the bottom of the trochlear groove (Whiteside
line), 1cm anterior to the top insertion of the PCL.
 A drill bit is used to create an opening in the femoral canal.
 It is useful to lavage the medullary canal using long suction
tube to reduce the incidence of fat embolism.

82.  The valgus alignment guide is
then used and attached to the
IM reamer. It then rests and is
secured on the distal femoral
condyle.
 A resection guide is attached
to lower end of the femur 8-10
mm Osteo-cartilage surface is
removed at 5 to 7 degree of
valgus.
 Another resection guide is
anchored to end of femur and
pieces of femur are cut off the
front and back as directed by
the miter slots in guide.
 Then cuts are made to bevel
the end of femur to fit implant.

83. • Then extension gap is measured.
• The anterior and posterior femoral cuts
determine the rotation of the femoral
component and shape of the flexion gap.
• Make a cut in 3 degrees of external rotation.
• Then flexion gap is measured.
• Box cut is taken to accommodate post cam
mechanism of PCL substituting design.

84.  The flexion and extension gaps must be
roughly rectangular, equal and balanced.
 If the extension gap is smaller then remove
more bone from distal femoral cut surface.
 If the flexion gap is smaller then remove more
bone from posterior femoral condyles.
 If the flexion and extension gaps are equal, but
not enough space for prosthesis, remove more
bone from proximal tibia.

85.  Patellar Resurfacing:-
 First the patella is laterally
retracted with the articular
surface facing in the upward
position.
 Calipers are then used to
determine the size of the patella
along with the amount of bone
that will be removed.
 Patella must be at least 20mm
thick and around 8-9mm of
articular side of patella is
resected using patellar clamps
and saw.
 The patellar peg holding guide is
then placed on the resected
patella and the peg holes are then
drilled.
 The patella button is usually
cemented into place behind the
patella.

86. Trial tibial, femoral and patellar components
are inserted in place and trial poly
component is fitted
The knee is then put through a series of
motions to confirm normal movement,
alignment and mediolateral stability.
The trial components are then removed after
the correct fit is confirmed.
The joint is then irrigated with a pulse
lavage.
The cement is then applied on the cut bone
surfaces and the prostheses are then placed.

87.  The femoral impactor is used to insert the
femoral implant.
 The tibial base impactor is used to insert the
metal tibial base.
 The patellar implant is secured with bone
cement and held in place using the parallel
patellar recessing clamp.
 All excess cement is removed carefully.
 The tibial polyethylene insert is seated and
locked into place on the metal tibial base.
 The knee is maintained in full extension so
that the cement is pressuried.

89.  The wound is thoroughly irrigated.
 The tourniquet is then released and
hemostasis is achieved using electro-
cautery.
 The wound is then closed in layers with
or without suction drain and a
compressive dressing is placed on the
knee and knee brace applied.

91.  Balance in both
Coronal and saggital
plane.
 Concave side –
ligaments contracted –
release
 Convex side –
ligaments stretched –
Fill gap

92. HenriK Schroeder – Boesch – Ligament balancing in TKR

95. Posterior part
tight in
extension
Anterior part
tight in flexion

96.  Grade 2A + 2B

98.  With joint distracted
multiple punctures are
made in the length of the
MCL using 18 gauge
needle mounted on a
syringe.
 This can stretch the
medial side by 1-2mm.
 The number of punctures
needs to be graduated as
excessive punctures can
make the MCL
incompetent.
 Usual number of
punctures ranges from
10 to 15.

99.  Remove all osteophytes,
 Release posterolateral
capsule,
 Pie-crusting of iliotibial
band - Tight in
extension,
 Popliteus –Tight in
flexion,
 Release of LCL.

101.  The main issue here is larger
flexion gap and with tighter
extension gap.
 Balancing in such situations can be
done by:
-Remove all osteophytes,
-Release posterior soft tissue from
back of femur and tibia.
-Release PCL and use posterior
stabilized implant.
-Increase distal femoral cut by 4-
6mm.

102.  The principle here is to very conservative about
bone cuts.
 The ligaments need to be preserved and
routine release must not be done.
 Constrained type of knee prosthesis must be
kept ready.

103.  Mc Pherson’s rule
Symmetric gap – Address tibia.
Asymmetric gap – Address femur.

104. Tight in
Extension
Tight in flexion
Symmetric gap Cut more tibia
Loose in
Extension
Loose in
Flexion
Symmetric gap
•Thicker poly
•Tibial Metal
augmentation

105. Extension
good
Loose in
flexion
Asymmetric
gap
1. Increase size
femoral
component
2. Translate
femoral
component
posterior
3. Use thicker
poly and
readdress as
tight
extension
gap

106. Extension
Tight
Flexion Good
Asymmetric
Gap
1. Cut more
distal femur
2. Release
posterior
capsule

107. Extension
Good
Flexion Tight
Asymmetric
gap
1. Decrease
femoral
component
size
2. Recess PCL
3. Check slope
of tibia

108. Extension
Loose
Flexion Good
Asymmetric
gap
1. Distal
femoral
augmentatio
n
2. Decrease
femoral
component
size and
thicker poly

109.  Before closure it is mandatory for a surgeon to
assess the movements of the knee joint.
 The gliding of patella must be concentric on the
femur without lateral tilt or lateral shift.
 The patella gliding should be possible without the
surgeon supporting the patella.
 Patellar maltracking is most common
complication.
 To avoid this :
-Maintain Q angle,
-Proper rotation of components,
-Maintain normal patellofemoral tension

110.  Femur related factors:-
-Over sizing of femoral component,
-Not lateralizing the femoral component,
-Internally rotated femoral component,
-Excessive valgus position of femoral component.
 Tibia related factors:-
-Medializing tibial component,
-Internal rotation of component,
-Too thick tibial component,
-Excessive valgus of tibial component.

111.  Patella related factors:-
-Over stuffing of patella,
-Placing patella more
laterally on the bone,
-Placing the patella button
too low causing patella
baja,
-Oblique cut on patella.
 Soft tissue related factors:-
-Tight lateral patellofemoral
bands and too lax medial
retinacular structure,
-Infra-patellar contractures
due to previous surgery
(HTO, Fracture tibial
plateau).

112.  Resurfacing
 Component loosening,
 Clunk,
 Fracture,
 AVN.
 Non resurfacing
 Anterior knee pain,
 May require second
resurfacing.

113.  Metal backed patella higher complications.
 Patellar replacement does not guarantee
painless Patellofemoral joint.
 No significant benefit of patellar replacement.

114.  Immediate Complications:-
-Neuro-vascular injury.
 Early Complications:-
-Thromboembolism,
-Infection,
-Surgical wound related complications,
-Malalignment and instability,
-Patellofemoral complications,
-Stiffness.
 Late Complications:-
-Periprosthetic fractures,
-Implant loosening,
-Infection.

115. Different studies shows different results.
 Ranawat et al (Clin Orthop Relat Res )
-95% at 15 years,
-91% at 21 years.
 Gill and Joshi (Am J Knee Surg)
-96% at 15 years,
-82% at 23 years.
 Font-Rodriguez (Clin Orthop Relat Res)
-98% at 14 years.

116.  Precise surgical technique,
 Sound implant design,
 Appropriate material,
 Patient compliance with rehabilitation.

119.  Unlike total knee surgery UKA
is
 Less invasive procedure
 Replaces only damaged or
arthritic parts i.e. in either
compartments
 UKA aims to resurface the
diseased compartment without
altering the kinematics of knee
joint by load transfer or
sacrificing the cruciate
ligaments.

120.  Clinically:-
-Pain and tenderness localized to medial joint line,
-Flexion greater than 90*,
-FFD less than 10*.
 Radiologically:-
-Isolated medial compartment OA,
-Varus deformity less than 15*,
-Insignificant degenerative changes in opposite
compartment.
 Intra-operatively:-
-Correctable Varus deformity,
-Intact ACL,
-full thickness cartilage wear restricted to the
anteromedial half of resected tibial plateau.

121.  Absence of an intact ACL,
 Inflammatory arthritis,
 Crystal deposition induced arthritis,
 Full thickness patellar cartilage loss,
 Previous HTO,
 Previous patellectomy,
 BMI >30 kg/m2.

123.  Small incision size,
 Less bone removed,
 Less blood loss,
 Lower morbidity,
 Quicker recovery & Early
rehabilitation,
 Shorter hospitalization,
 Preservation of the ACL.

124.  Inferior survivorship,
 Error in proper placement of components,
 Loosening,
 Prosthetic wear,
 Secondary degeneration of opposite
compartment.

126. Erect
Postop xrays

127. Conversion of UKA to TKR

128.  Indicated for severe
disability esp. in young &
active patient whose
activity desire might
severly limit the
longevity of TKR,
Infected TKR and
Neuropathic joint.
 Techniques of
Arthrodesis:
- External Fixation,
- Intramedullary Nailing,
- Plate Fixation.