Interpretation of the expert consensus of the British Association for Surgery of the Knee (BASK) and the European Knee Society (EKS) on unicompartmental knee arthroplasty_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

MA Jun , SI Haibo , ZENG Yi , HUANG Qiang ,  SHEN Bin

Department of Orthopedic Surgery/Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China;

Corresponding author：

SHEN Bin, Email: shenbin71@hotmail.com

Keywords：

Unicompartmental knee arthroplasty; total knee arthroplasty; consensus statement

DOI：

10.7507/1002-1892.202405056

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Unicompartmental knee arthroplasty (UKA) has a long history and has many advantages in some aspects over total knee arthroplasty (TKA) for patients with suitable indications, but it has not been established as a treatment at the same level with TKA. Therefore, 80 members of the British Association for Surgery of the Knee (BASK) and the European Knee Society (EKS) were invited to attend a joint meeting with the aim of creating an evidence-based consensus statement on UKA, in London, UK (December 2019). A formal consensus process was undertaken at the meeting incorporating a multiple round Delphi exercise, with group discussion of areas of agreement and disagreement between rounds. Five consensus statements were issued: ① UKA should be offered as a successful alternative to TKA in patients undergoing arthroplasty who meet agreed indications. ② When consenting a patient for UKA, information including the benefits and risks that are specific to UKA, should be tailored to and discussed with the individual patient. ③ Evidence suggests that surgeons should avoid low-volume use of UKA to optimise outcomes for their patients. ④ Surgeons should use the contemporary evidence-based indications and contraindications for medial UKA. ⑤ Knee arthroplasty surgeons should have exposure to and training in UKA. On the basis of full study of the consensus, combined with the Expert Consensus on Perioperative Management of Unicompartmental Knee Arthroplasty in China in 2020, this paper elaborates the meaning of the final evidence-based consensus for clinicians’ reference.

Citation： MA Jun, SI Haibo, ZENG Yi, HUANG Qiang, SHEN Bin. Interpretation of the expert consensus of the British Association for Surgery of the Knee (BASK) and the European Knee Society (EKS) on unicompartmental knee arthroplasty. Chinese Journal of Reparative and Reconstructive Surgery, 2024, 38(9): 1029-1034. doi: 10.7507/1002-1892.202405056 Copy

1.	Goodfellow JW, Tibrewal SB, Sherman KP, et al. Unicompartmental Oxford Meniscal knee arthroplasty. J Arthroplasty, 1987, 2(1): 1-9.
2.	Murray DW, Goodfellow JW, O’Connor JJ. The Oxford medial unicompartmental arthroplasty: a ten-year survival study. J Bone Joint Surg (Br), 1998, 80(6): 983-989.
3.	Mittal A, Meshram P, Kim WH, et al. Unicompartmental knee arthroplasty, an enigma, and the ten enigmas of medial UKA. J Orthop Traumatol, 2020, 21(1): 15. doi: 10.1186/s10195-020-00551-x.
4.	中国研究型医院学会关节外科学专业委员会膝关节部分置换研究学组. 膝关节单髁置换术围手术期管理专家共识. 中华骨与关节外科杂志, 2020, 13(4): 265-271.
5.	Parvizi J, Gehrke T, Chen AF. Proceedings of the international consensus on periprosthetic joint infection. Bone Joint J, 2013, 95-B(11): 1450-1452.
6.	Abram SGF, Beard DJ, Price AJ, et al. Arthroscopic meniscal surgery: a national society treatment guideline and consensus statement. Bone Joint J, 2019, 101-B(6): 652-659.
7.	Beard DJ, Davies LJ, Cook JA, et al. The clinical and cost-effectiveness of total versus partial knee replacement in patients with medial compartment osteoarthritis (TOPKAT): 5-year outcomes of a randomised controlled trial. Lancet, 2019, 394(10200): 746-756.
8.	Wilson HA, Middleton R, Abram SGF, et al. Patient relevant outcomes of unicompartmental versus total knee replacement: systematic review and meta-analysis. BMJ, 2019, 364: l352. doi: 10.1136/bmj.l352.
9.	Evans JT, Walker RW, Evans JP, et al. How long does a knee replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up. Lancet, 2019, 393(10172): 655-663.
10.	Joint replacement (primary): hip, knee and shoulder. London: National Institute for Health and Care Excellence (NICE), 2020. https://www.nice.org.uk/ guidance/NG157.
11.	Niinimäki T, Eskelinen A, Mäkelä K, et al. Unicompartmental knee arthroplasty survivorship is lower than TKA survivorship: a 27-year Finnish registry study. Clin Orthop Relat Res, 2014, 472(5): 1496-1501.
12.	Ben-Shlomo Y, Blom A, Boulton C, et al. The National Joint Registry 16th Annual Report 2019 [Internet]. London: National Joint Registry, 2019. https://reports.njrcentre.org.uk.
13.	Kinsey TL, Anderson DN, Phillips VM, et al. Disease progression after lateral and medial unicondylar knee arthroplasty. J Arthroplasty, 2018, 33(11): 3441-3447.
14.	Misir A, Uzun E, Kizkapan TB, et al. Lateral and patellofemoral compartment osteoarthritis progression after medial unicompartmental knee arthroplasty: A five- to 10-year follow-up study. Knee, 2020, 27(4): 1135-1142.
15.	Alnachoukati OK, Barrington JW, Berend KR, et al. Eight hundred twenty-five medial mobile-bearing unicompartmental knee arthroplasties: The first 10-year us multi-center survival analysis. J Arthroplasty, 2018, 33(3): 677-683.
16.	Dyrhovden GS, Lygre SHL, Badawy M, et al. Have the causes of revision for total and unicompartmental knee arthroplasties changed during the past two decades? Clin Orthop Relat Res, 2017, 475(7): 1874-1886.
17.	Liddle AD, Judge A, Pandit H, et al. Adverse outcomes after total and unicompartmental knee replacement in 101, 330 matched patients: a study of data from the National Joint Registry for England and Wales. Lancet, 2014, 384(9952): 1437-1445.
18.	Hunt LP, Ben-Shlomo Y, Clark EM, et al. 45-day mortality after 467, 779 knee replacements for osteoarthritis from the National Joint Registry for England and Wales: an observational study. Lancet, 2014, 384(9952): 1429-1436.
19.	Liddle AD, Pandit H, Judge A, et al. Patient-reported outcomes after total and unicompartmental knee arthroplasty: a study of 14, 076 matched patients from the National Joint Registry for England and Wales. Bone Joint J, 2015, 97-B(6): 793-801.
20.	van Oost I, Koenraadt KLM, van Steenbergen LN, et al. Higher risk of revision for partial knee replacements in low absolute volume hospitals: data from 18, 134 partial knee replacements in the Dutch Arthroplasty Register. Acta Orthop, 2020, 91(4): 426-432.
21.	Badawy M, Espehaug B, Indrekvam K, et al. Higher revision risk for unicompartmental knee arthroplasty in low-volume hospitals. Acta Orthop, 2014, 85(4): 342-347.
22.	Robertsson O, Knutson K, Lewold S, et al. The routine of surgical management reduces failure after unicompartmental knee arthroplasty. J Bone Joint Surg (Br), 2001, 83(1): 45-49.
23.	Baker P, Jameson S, Critchley R, et al. Center and surgeon volume influence the revision rate following unicondylar knee replacement: an analysis of 23, 400 medial cemented unicondylar knee replacements. J Bone Joint Surg (Am), 2013, 95(8): 702-709.
24.	Liddle AD, Pandit H, Judge A, et al. Effect of surgical caseload on revision rate following total and unicompartmental knee replacement. J Bone Joint Surg (Am), 2016, 98(1): 1-8.
25.	Vasso M, Antoniadis A, Helmy N. Update on unicompartmental knee arthroplasty: Current indications and failure modes. EFORT Open Rev, 2018, 3(8): 442-448.
26.	White SH, Ludkowski PF, Goodfellow JW. Anteromedial osteoarthritis of the knee. J Bone Joint Surg (Br), 1991, 73(4): 582-586.
27.	Berend KR, Berend ME, Dalury DF, et al. Consensus statement on indications and contraindications for medial unicompartmental knee arthroplasty. J Surg Orthop Adv, 2015, 24(4): 252-256.
28.	Kozinn SC, Scott R. Current concepts review unicondylar knee arthroplasty. J Bone Joint Surg (Am), 1989, 71(1): 145-150.
29.	Pandit H, Jenkins C, Gill HS, et al. Unnecessary contraindications for mobile-bearing unicompartmental knee replacement. J Bone Joint Surg (Br), 2011, 93(5): 622-628.
30.	Beard DJ, Pandit H, Gill HS, et al. The influence of the presence and severity of pre-existing patellofemoral degenerative changes on the outcome of the Oxford medial unicompartmental knee replacement. J Bone Joint Surg (Br), 2007, 89(12): 1597-1601.
31.	Beard DJ, Pandit H, Ostlere S, et al. Pre-operative clinical and radiological assessment of the patellofemoral joint in unicompartmental knee replacement and its influence on outcome. J Bone Joint Surg (Br), 2007, 89(12): 1602-1607.
32.	Adams AJ, Kazarian GS, Lonner JH. Preoperative patellofemoral chondromalacia is not a contraindication for fixed-bearing medial unicompartmental knee arthroplasty. J Arthroplasty, 2017, 32(6): 1786-1791.
33.	Willis-Owen CA, Brust K, Alsop H, et al. Unicondylar knee arthroplasty in the UK National Health Service: an analysis of candidacy, outcome and cost efficacy. Knee, 2009, 16(6): 473-478.
34.	Alvand A, Gill HS, Price AJ, et al. Does a mixed training course on the Oxford unicompartmental knee arthroplasty improve non-technical skills of orthopaedic surgeons? J Orthop Surg (Hong Kong), 2012, 20(3): 356-360.

1. Goodfellow JW, Tibrewal SB, Sherman KP, et al. Unicompartmental Oxford Meniscal knee arthroplasty. J Arthroplasty, 1987, 2(1): 1-9.
2. Murray DW, Goodfellow JW, O’Connor JJ. The Oxford medial unicompartmental arthroplasty: a ten-year survival study. J Bone Joint Surg (Br), 1998, 80(6): 983-989.
3. Mittal A, Meshram P, Kim WH, et al. Unicompartmental knee arthroplasty, an enigma, and the ten enigmas of medial UKA. J Orthop Traumatol, 2020, 21(1): 15. doi: 10.1186/s10195-020-00551-x.
4. 中国研究型医院学会关节外科学专业委员会膝关节部分置换研究学组. 膝关节单髁置换术围手术期管理专家共识. 中华骨与关节外科杂志, 2020, 13(4): 265-271.
5. Parvizi J, Gehrke T, Chen AF. Proceedings of the international consensus on periprosthetic joint infection. Bone Joint J, 2013, 95-B(11): 1450-1452.
6. Abram SGF, Beard DJ, Price AJ, et al. Arthroscopic meniscal surgery: a national society treatment guideline and consensus statement. Bone Joint J, 2019, 101-B(6): 652-659.
7. Beard DJ, Davies LJ, Cook JA, et al. The clinical and cost-effectiveness of total versus partial knee replacement in patients with medial compartment osteoarthritis (TOPKAT): 5-year outcomes of a randomised controlled trial. Lancet, 2019, 394(10200): 746-756.
8. Wilson HA, Middleton R, Abram SGF, et al. Patient relevant outcomes of unicompartmental versus total knee replacement: systematic review and meta-analysis. BMJ, 2019, 364: l352. doi: 10.1136/bmj.l352.
9. Evans JT, Walker RW, Evans JP, et al. How long does a knee replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up. Lancet, 2019, 393(10172): 655-663.
10. Joint replacement (primary): hip, knee and shoulder. London: National Institute for Health and Care Excellence (NICE), 2020. https://www.nice.org.uk/ guidance/NG157.
11. Niinimäki T, Eskelinen A, Mäkelä K, et al. Unicompartmental knee arthroplasty survivorship is lower than TKA survivorship: a 27-year Finnish registry study. Clin Orthop Relat Res, 2014, 472(5): 1496-1501.
12. Ben-Shlomo Y, Blom A, Boulton C, et al. The National Joint Registry 16th Annual Report 2019 [Internet]. London: National Joint Registry, 2019. https://reports.njrcentre.org.uk.
13. Kinsey TL, Anderson DN, Phillips VM, et al. Disease progression after lateral and medial unicondylar knee arthroplasty. J Arthroplasty, 2018, 33(11): 3441-3447.
14. Misir A, Uzun E, Kizkapan TB, et al. Lateral and patellofemoral compartment osteoarthritis progression after medial unicompartmental knee arthroplasty: A five- to 10-year follow-up study. Knee, 2020, 27(4): 1135-1142.
15. Alnachoukati OK, Barrington JW, Berend KR, et al. Eight hundred twenty-five medial mobile-bearing unicompartmental knee arthroplasties: The first 10-year us multi-center survival analysis. J Arthroplasty, 2018, 33(3): 677-683.
16. Dyrhovden GS, Lygre SHL, Badawy M, et al. Have the causes of revision for total and unicompartmental knee arthroplasties changed during the past two decades? Clin Orthop Relat Res, 2017, 475(7): 1874-1886.
17. Liddle AD, Judge A, Pandit H, et al. Adverse outcomes after total and unicompartmental knee replacement in 101, 330 matched patients: a study of data from the National Joint Registry for England and Wales. Lancet, 2014, 384(9952): 1437-1445.
18. Hunt LP, Ben-Shlomo Y, Clark EM, et al. 45-day mortality after 467, 779 knee replacements for osteoarthritis from the National Joint Registry for England and Wales: an observational study. Lancet, 2014, 384(9952): 1429-1436.
19. Liddle AD, Pandit H, Judge A, et al. Patient-reported outcomes after total and unicompartmental knee arthroplasty: a study of 14, 076 matched patients from the National Joint Registry for England and Wales. Bone Joint J, 2015, 97-B(6): 793-801.
20. van Oost I, Koenraadt KLM, van Steenbergen LN, et al. Higher risk of revision for partial knee replacements in low absolute volume hospitals: data from 18, 134 partial knee replacements in the Dutch Arthroplasty Register. Acta Orthop, 2020, 91(4): 426-432.
21. Badawy M, Espehaug B, Indrekvam K, et al. Higher revision risk for unicompartmental knee arthroplasty in low-volume hospitals. Acta Orthop, 2014, 85(4): 342-347.
22. Robertsson O, Knutson K, Lewold S, et al. The routine of surgical management reduces failure after unicompartmental knee arthroplasty. J Bone Joint Surg (Br), 2001, 83(1): 45-49.
23. Baker P, Jameson S, Critchley R, et al. Center and surgeon volume influence the revision rate following unicondylar knee replacement: an analysis of 23, 400 medial cemented unicondylar knee replacements. J Bone Joint Surg (Am), 2013, 95(8): 702-709.
24. Liddle AD, Pandit H, Judge A, et al. Effect of surgical caseload on revision rate following total and unicompartmental knee replacement. J Bone Joint Surg (Am), 2016, 98(1): 1-8.
25. Vasso M, Antoniadis A, Helmy N. Update on unicompartmental knee arthroplasty: Current indications and failure modes. EFORT Open Rev, 2018, 3(8): 442-448.
26. White SH, Ludkowski PF, Goodfellow JW. Anteromedial osteoarthritis of the knee. J Bone Joint Surg (Br), 1991, 73(4): 582-586.
27. Berend KR, Berend ME, Dalury DF, et al. Consensus statement on indications and contraindications for medial unicompartmental knee arthroplasty. J Surg Orthop Adv, 2015, 24(4): 252-256.
28. Kozinn SC, Scott R. Current concepts review unicondylar knee arthroplasty. J Bone Joint Surg (Am), 1989, 71(1): 145-150.
29. Pandit H, Jenkins C, Gill HS, et al. Unnecessary contraindications for mobile-bearing unicompartmental knee replacement. J Bone Joint Surg (Br), 2011, 93(5): 622-628.
30. Beard DJ, Pandit H, Gill HS, et al. The influence of the presence and severity of pre-existing patellofemoral degenerative changes on the outcome of the Oxford medial unicompartmental knee replacement. J Bone Joint Surg (Br), 2007, 89(12): 1597-1601.
31. Beard DJ, Pandit H, Ostlere S, et al. Pre-operative clinical and radiological assessment of the patellofemoral joint in unicompartmental knee replacement and its influence on outcome. J Bone Joint Surg (Br), 2007, 89(12): 1602-1607.
32. Adams AJ, Kazarian GS, Lonner JH. Preoperative patellofemoral chondromalacia is not a contraindication for fixed-bearing medial unicompartmental knee arthroplasty. J Arthroplasty, 2017, 32(6): 1786-1791.
33. Willis-Owen CA, Brust K, Alsop H, et al. Unicondylar knee arthroplasty in the UK National Health Service: an analysis of candidacy, outcome and cost efficacy. Knee, 2009, 16(6): 473-478.
34. Alvand A, Gill HS, Price AJ, et al. Does a mixed training course on the Oxford unicompartmental knee arthroplasty improve non-technical skills of orthopaedic surgeons? J Orthop Surg (Hong Kong), 2012, 20(3): 356-360.

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Interpretation of the expert consensus of the British Association for Surgery of the Knee (BASK) and the European Knee Society (EKS) on unicompartmental knee arthroplasty

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