Key Takeaways & Executive Findings
- •• Unicompartmental knee arthroplasty (UKA) provides equivalent clinical outcomes to total knee arthroplasty (TKA) at 2 years postoperatively in patients with severe medial and moderate lateral compartment osteoarthritis. • UKA offers superior early functional recovery, with better American Knee Association Score and WOMAC scores at 3, 6, and 12 months postoperatively compared to TKA. • UKA demonstrates better joint perception (forgotten joint score) and gait parameters (speed and stride length) at 1 year postoperatively, indicating biomechanical advantages. • No significant progression of lateral compartment osteoarthritis was observed within 2 years, but long-term monitoring is required; patient selection and informed consent are crucial.
Abstract
BACKGROUND: In patients with severe medial compartment osteoarthritis of the knee combined with moderate lateral compartment osteoarthritis, it is controversial whether medial monondylar replacement alone can achieve satisfactory clinical benefit. OBJECTIVE: To compare and analyze the difference in clinical outcomes of unicompartmental knee arthroplasty and total knee arthroplasty in patients with heterogeneous degenerative changes of the knee (medial compartment Kellgren-Lawrence grade III-IV combined with lateral compartment Kellgren-Lawrence grade II). METHODS: Knee arthroplasty patients with severe medial ventricular osteoarthritis combined with mild and moderate lateral ventricular osteoarthritis shown by preoperative knee X-ray were selected and divided into unicompartmental knee arthroplasty group and total knee arthroplasty group according to different operation methods, and 50 patients were included in each group according to 1:1 pairing. Western Ontario and McMaster University Osteoarthritis Index (WOMAC), American Knee Association Score, joint amnesia score, postoperative gait parameters, and complications were collected at 3, 6 months, 1 and 2 years after surgery, and the relevant data were statistically analyzed to compare the differences in postoperative efficacy between the two groups. RESULTS AND CONCLUSION: (1) The American Knee Association Score and WOMAC scores of the unicompartmental knee arthroplasty group were better than those of the total knee arthroplasty group at 3, 6 months and 1 year after surgery (P < 0.05). Two years after surgery, American Knee Association Score and WOMAC score were not significantly different between two groups (P > 0.05). (2) There was no significant difference in joint amnesia score between the two groups at 3 months postoperatively (P > 0.05), but at 6 months, 1 year, and 2 years postoperatively, the unicompartmental knee arthroplasty group was higher than the total knee arthroplasty group (P < 0.05). (3) At 1 year postoperatively, the unicompartmental knee arthroplasty group had better gait speed and stride length than the total knee arthroplasty group (P < 0.05), while there was no significant difference in cadence between the two groups (P > 0.05). (4) No complications occurred in either group within 2 years postoperatively. (5) Follow-up confirmed that in patients with severe medial compartment osteoarthritis (Kellgren-Lawrence grade III-IV) combined with moderate lateral compartment degeneration (Kellgren-Lawrence grade II), unicompartmental knee arthroplasty had equivalent clinical efficacy to total knee arthroplasty at 2 years postoperatively, and the biomechanical advantages of unicompartmental knee arthroplasty were significant within 1 year postoperatively. During the follow-up period, no obvious progression of lateral compartment osteoarthritis (increase in Kellgren-Lawrence grade) was found, but long-term observation is needed. Before making a decision, clinicians should establish a multidimensional evaluation framework (including patient age, exercise load expectation, surgeon's unicompartmental knee arthroplasty volume, etc.), and fully inform patients of the risk of lateral compartment progression, and comprehensively evaluate whether to perform unicompartmental knee arthroplasty.
1. Introduction
Knee osteoarthritis is a common degenerative disease in the middle-aged and elderly population, with its incidence showing a continuous growth trend. For patients with end-stage knee osteoarthritis, knee arthroplasty remains the gold standard treatment, with the main surgical approaches including partial knee arthroplasty and total knee arthroplasty. In recent clinical practice, the proportion of partial knee arthroplasty, represented by unicompartmental knee arthroplasty (UKA), has increased significantly [1-2]. Evidence-based studies have shown that UKA has definite efficacy in patients with knee osteoarthritis confined to a single compartment [3], but when osteoarthritis involves the lateral compartment, total knee arthroplasty (TKA) is still considered the mainstream choice.
For the special group of patients with severe medial compartment osteoarthritis (Kellgren-Lawrence grade III-IV) combined with moderate lateral compartment osteoarthritis (Kellgren-Lawrence grade II), the clinical applicability of UKA remains controversial. Although biomechanical studies suggest that changes in lateral compartment contact stress after UKA may accelerate the progression of osteoarthritis, long-term follow-up data show that the actual incidence is less than 5% [4]. Notably, for patients with pre-existing moderate lateral compartment degeneration, there is still a lack of high-quality clinical evidence on the early postoperative efficacy and complication characteristics of UKA.
This study systematically evaluates the therapeutic value of UKA in this specific indication by comparing the clinical outcomes of UKA and TKA in patients with heterogeneous medial and lateral compartment lesions (severe medial/moderate lateral) knee osteoarthritis, providing evidence-based medical evidence for optimizing surgical strategy selection.
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Cui Pengfei, Wen Zhangkun, Chen Fengjiang, Wang Zhen, Wang Changyao (2026). Unicompartmental knee arthroplasty for severe medial compartment osteoarthritis with moderate lateral involvement: clinical outcomes. Chinese Journal of Tissue Engineering Research. https://doi.org/10.12307/2026.21397
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Frequently Asked Questions
What is the clinical benefit of unicompartmental knee arthroplasty (UKA) compared to total knee arthroplasty (TKA) in patients with severe medial and moderate lateral knee osteoarthritis?
UKA provides equivalent clinical outcomes to TKA at 2 years postoperatively, with superior early functional recovery (better American Knee Association Score and WOMAC scores at 3, 6, and 12 months) and better joint perception and gait parameters at 1 year, indicating biomechanical advantages.
Is unicompartmental knee arthroplasty safe for patients with moderate lateral compartment osteoarthritis?
In this study, no significant progression of lateral compartment osteoarthritis was observed within 2 years postoperatively, and no complications occurred in either group. However, long-term monitoring is needed, and patients should be informed of the potential risk of lateral compartment progression.
What are the key factors to consider when deciding between UKA and TKA for patients with heterogeneous knee osteoarthritis?
Clinicians should establish a multidimensional evaluation framework including patient age, exercise load expectation, surgeon's UKA volume, and fully inform patients of the risk of lateral compartment progression, to make a comprehensive decision.
How does the recovery trajectory differ between UKA and TKA in the first two years after surgery?
UKA shows faster improvement in knee function scores (AKS, WOMAC) within the first year, and better joint perception (forgotten joint score) from 6 months onward. Gait speed and stride length are also better at 1 year. By 2 years, differences in AKS and WOMAC become non-significant.
What is the significance of the Kellgren-Lawrence grading system in this study?
The Kellgren-Lawrence (K-L) grading system is used to classify the severity of knee osteoarthritis on X-rays. This study specifically included patients with medial compartment K-L grade III-IV (severe) and lateral compartment K-L grade II (moderate), to evaluate the outcomes of UKA in this specific population.
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