Should you choose a total or unicondylar knee replacement?

When deciding between total knee replacement (TKR) and unicondylar knee replacement (UKR), several factors need to be considered. Here are some key points:

Extent of Knee Joint Damage: Assess the extent of damage in the knee joint. TKR is typically recommended when the damage is widespread and affects multiple compartments of the knee, including the medial (inner) and lateral (outer) compartments. With specific stressed knee X-rays before surgery, and also with inspection during surgery, we make sure that only one compartment is affected. In conditions that might affect other compartment in the future, such as

rheumatoid arthritis, UKR is contraindicated. UKR, on the other hand, is suitable when the damage is limited to only one compartment of the knee, typically the medial compartment.

Patient Anatomy and Alignment: Evaluate the patient's anatomy, alignment, and joint stability. For patients with significant deformities, malalignment, or instability affecting multiple compartments, TKR may be the preferred option. UKR is more suitable for patients with good alignment, intact ligaments, and isolated compartmental damage.

Preoperative Range of Motion: Evaluate the patient's preoperative range of motion. UKR generally results in better postoperative range of motion compared to TKR, particularly for patients with good preoperative knee motion. If there are great range of motion deficits before surgery, these can be corrected easier during total knee arthroplasty.

Surgeon Experience and Expertise: Consider the surgeon's experience and expertise with both TKR and UKR procedures. Performing UKR requires specialized training and a surgeon with proficiency in the technique with a specific volume of UKR surgeries per year. It is crucial to ensure that the surgeon is skilled in both procedures to provide the best possible outcome for the patient.

Ultimately, we make the decision between TKR and UKR with our patients as it should be individualized and based on a thorough assessment of the patient's condition and preferences.