eMedicine Specialties > Orthopedic Surgery > Knee

Medial Compartment Arthritis: Follow-up

Author: Scott E Marwin, MD, Assistant Professor of Orthopedic Surgery, Albert Einstein College of Medicine; Associate Chair, Department of Orthopedic Surgery, Long Island Jewish Medical Center
Contributor Information and Disclosures

Updated: Sep 12, 2008

Outcome and Prognosis

Arthroscopy

Up to 74% of patients undergoing arthroscopy with lavage and debridement for treatment of arthritis can achieve good-to-excellent results at 14 months. As time passes, the results begin to deteriorate. If abrasion is added, up to 77% of patients may achieve good-to-excellent results at 2 years. With time, the fibrocartilage degenerates, and patient's knee symptoms return. The main disadvantage of arthroscopy is that the procedure is only temporizing and does not address the biomechanical malalignment that coexists. Patients should be counseled that joint resurfacing eventually will be required but that some relief can be achieved with arthroscopy.

Osteotomy

Clinical experience has confirmed the rationale of limb realignment by HTO, but results deteriorate over the long term. Many studies show that the results of HTO are satisfactory at 5-7 years. After this time, results significantly diminish. Many factors contribute to a good result. Surgical technique and patient selection appear to be the most crucial. Younger patients with primary osteoarthritis and intact ligaments and menisci have better results than do other patients. Also, postoperative alignment with the appropriate amount of correction has a major influence on the length of time in which good results are maintained.

Arthroplasty

The literature currently supports the use of UKA in a carefully selected patient population. The survivorship of the prosthesis has been reported in several different studies. One study reports a 93% survivorship at minimum 10-year follow-up. Other authors site that results of UKA are not as predictable as those of TKA. However, with careful patient selection, UKA is a viable option.

Zukor et al has reported a 76% success rate for 94 fresh osteochondral allografts with an average of 4.3 years follow-up. The complications experienced with meticulous surgical technique are few. The reasons given for failure are malposition of the graft or malalignment of the limb.

The results of TKA are excellent, which causes some surgeons to question whether UKA is ever indicated. Reports have documented that a TKA with good cement technique and well-positioned components has more than a 90% chance of surviving more than 15 years. The results of TKA are predictable and reproducible among orthopedists.

Future and Controversies

The future of the treatment of medial compartment osteoarthritis lies in genetic engineering. Work currently is being performed to generate articular cartilage in vitro with the ultimate goal of resurfacing a femoral condyle or tibial plateau. Viscosupplementation in association with the appropriate cytokine environment is being studied to determine if articular cartilage chondrocytes can be reactivated and programmed to regenerate in order to cover defects within the knee joint. Genetic tests are being identified to determine whether patients have the gene that predisposes them to osteoarthritis, with the ultimate goal being genetic engineering to eliminate arthritis with gene therapy.

Controversies abound among orthopedists regarding which osteotomy to perform and whether UKA is an acceptable alternative to TKA. Ultimately, patient selection and the surgeon's knowledge and skill level determine successful outcomes in the treatment of medial compartment osteoarthritis.

 
Acknowledgments

The authors and editors gratefully acknowledge Kevin Trapp, MD, for his contributions made to this article.



More on Medial Compartment Arthritis

Overview: Medial Compartment Arthritis
Workup: Medial Compartment Arthritis
Treatment: Medial Compartment Arthritis
Follow-up: Medial Compartment Arthritis
Multimedia: Medial Compartment Arthritis
References
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References

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Further Reading

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Keywords

medial compartment arthritis, medial compartment osteoarthritis, knee arthritis, unicompartmental osteoarthritic knee, unicompartmental arthritis, arthritic knee, arthritis of the knee, degenerative arthritis of the knee, arthroscopic surgery, osteotomy, arthroplasty

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Contributor Information and Disclosures

Author

Scott E Marwin, MD, Assistant Professor of Orthopedic Surgery, Albert Einstein College of Medicine; Associate Chair, Department of Orthopedic Surgery, Long Island Jewish Medical Center
Scott E Marwin, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons
Disclosure: Nothing to disclose.

Medical Editor

Albert W Pearsall IV, MD, Associate Professor, Department of Orthopedic Surgery, University of South Alabama; Director, Section of Sports Medicine and Shoulder Service, Department of Orthopedic Surgery, University of South Alabama Medical Center
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Thomas M DeBerardino, MD, Director, John A Feagin, Jr, Sports Medicine Fellowship at West Point, Associate Professor of Orthopedic Surgery, Uniformed Services University of the Health Sciences and Keller Army Community Hospital
Thomas M DeBerardino, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, and American Orthopaedic Society for Sports Medicine
Disclosure: Arthrex, Inc. Grant/research funds None; Arthrex, Inc. Honoraria Speaking and teaching; Genzyme Biosurgery. Inc. Grant/research funds Other; Musculoskeletal Transplant Foundation Grant/research funds Other; Histogenics Grant/research funds None

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Physicians of Indian Origin, American College of International Physicians, and American College of Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Carlos J Lavernia, MD, FAAOS, Adjunct Clinical Professor, Department of Orthopedic Surgery, University of Miami School of Medicine; Medical Director, Orthopedic Institute at Mercy Hospital
Carlos J Lavernia, MD, FAAOS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Hip and Knee Surgeons, Arthritis Foundation, Biomedical Engineering Society, Florida Orthopaedic Society, and Orthopaedic Research Society
Disclosure: Zimmer Stock Implant Designer

 
 
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