Outcomes of Bicompartmental Knee Arthroplasty: A Review

Introduction: Total knee arthroplasty (TKA) offers high\ud survival and high functional scores when arthritis is affecting the\ud three compartments of the knee; however, TKA does not preserve\ud the bone stock and the ligaments and these points can represent\ud theoretical disadvantages, particularly for young patients with higher\ud demand and higher risk for potential revision. Bicompartmental knee\ud arthroplasty (BKA) is a type of resurfacing surgery where two of the\ud three compartments of the knee joint (medial tibiofemoral, lateral\ud tibiofemoral or patellofemoral) are replaced with preservation of the\ud third. Smaller implant sizes, less operative trauma, preservation of\ud both cruciate ligaments and bone stock, and a more ‘‘physiological’’\ud knee are reported advantages over TKA. BKA has been proposed to\ud bridge the gap between UKA and TKA.\ud Methods: A systematic literature search was conducted during\ud May and June 2014. The electronic databases searched were:\ud PUBMED/MEDLINE and Cochrane Library. No language or data\ud restrictions were used. The search keyword was bicompartmental\ud knee artroplasty, BKA, unicompartmental knee arthroplasty AND\ud patellofemoral arthroplasty, unicompartmental knee arthroplasty\ud AND patellofemoral joint, UKA AND PFJ, which appeared in the title, abstract or keyword fields. Initially, 129 articles were found:\ud based on abstract and after removal of duplicates, 102 articles\ud remained. The full text of each of these articles was read and another\ud 13 articles were considered non-relevant and removed. The final\ud number of articles included in this review was 89.\ud Results: Functional and radiological results, complication,\ud survivorship, kinematics and advantages of BKA versus TKA were\ud analyzed.\ud Discussion and Conclusion: Advantages of a bonesparing,\ud ligament-sparing, such as BKA, are clearly evident.\ud It seems intuitive that a knee reconstruction that maintains the\ud proprioceptive and kinematic benefits of retaining the cruciate\ud ligaments would be ideal for the treatment of advanced OA of the\ud medial and patellafemoral compartments. Choice of monolithic\ud or modular components remains in debate but the use of single\ud femoral components can lead to early revision.There is a need for\ud a prospective, randomized, long-term outcomes studies comparing\ud BKA with TKA before definitive treatment recommendations can be\ud made