Unicompartmental Arthroplasty with the Oxford Knee. Buy the book here.
This chapter is available from Goodfellow Publishers as a PDF.
Introduction
While it is important to ensure that all the necessary indications are met (Pandit et al., 2011b), it is also important not to apply unnecessary contraindications. Some published lists of supposed contraindications have achieved wide acceptance without having much evidence to support them. We have recently argued with evidence that many of the suggested contraindications are unnecessary (Pandit et al., 2011c).
The suggested contraindications for UKA are based on Kozinn & Scott’s 1989 publication which stated that patients who weigh more than 82 kg, were younger than 60 years, undertook heavy labour, had exposed bone in the PFJ or chondrocalcinosis were not ideal candidates for UKA (Kozinn & Scott, 1989). We wanted to establish whether these potential contraindications should apply to candidates for OUKA. In order to do this, the outcome of patients with these potential contraindications was compared with that of patients without the contraindications in a prospective series of 1000 OUKAs (Kozinn & Scott, 1989). The outcome was assessed using the Oxford Knee Score, American Knee Society Score, Tegner activity score, revision rate and survival. The clinical outcome of patients with each of the potential contraindications was similar to, or better than, those without each contraindication. Overall, 678 UKA (68%) were performed in patients who had at least one potential contraindication and only 322 (32%) in patients deemed to be ideal for UKA. The 10-year survival was 97% (95% CI 93.4 to 100) for those with potential contraindications and 93.6% (95% CI 87.2 to 100) in the ‘ideal’ patients. This difference was maintained at 15 years as well. The 15-year survival was 94% (95% CI 88 to 100) for those with potential contraindications and 90% (95% CI 78 to 100) in the ‘ideal’ patients.
Each of these contraindications, and others, are discussed in detail in this chapter.
