Tough choices in unicompartmental knee arthroplasty Indications, implants and new technologies

Unicompartmental knee arthroplasty (UKA) has found a renewed interest during the late 1990s and has currently been an established treatment option for isolated medial and lateral unicompartmental knee osteoarthritis (OA). Advances in technology have sparked debates on patient selection, implant choices, and robotic-assisted techniques, emphasizing the need for evidence-based decision-making. This thesis challenges the traditional view that patellofemoral OA is a contraindication for UKA. The findings support a more inclusive patient selection approach for both medial and lateral UKA, as mild to moderate patellofemoral OA and malalignment do not negatively affect clinical outcomes. The thesis also provides insights into implant selection, aiding surgeons in making informed decisions. Findings indicate that fixed-bearing implants have lower revision rates than mobile-bearing implants in lateral UKA, while cementless mobile-bearing implants outperform cemented ones in medial UKA, but only in high-volume centers. Additionally, metal-backed tibial onlay components demonstrate superior outcomes compared to all-polyethylene tibial inlay components. Lastly, the thesis highlights the potential of robotic-assisted UKA, showing high survival rates and patient satisfaction postoperatively. These findings underline that robotic-assisted UKA is a safe procedure. However, further research is needed to fully assess its cost-effectiveness and long-term benefits. Overall, this thesis contributes to optimizing UKA treatment strategies by refining patient selection, guiding implant choice, and evaluating new technologies.