Implantation Accuracy of a Lateral Unicompartmental Knee Arthroplasty: A Hoffa´s Fat Pad-Preserving Medial Approach Versus the Transpatellar Lateral Approach

Abstract

Background: A small proportion of patients suffer from isolated lateral osteoarthritis where the sole lateral unicompartmental knee arthroplasty (UKA) is a possible treatment option. There, both a medial and a lateral surgical approach can be considered. This study should answer the question whether the lateral approach is superior to a modified medial approach in terms of implantation accuracy and subjective outcome.

Methods: In this retrospective study, 175 patients with lateral UKA were included between 2015 and 2020. In 82 patients, the lateral approach was used, and in 93 patients, the medial approach was used. To assess implantation accuracy, different imaging criteria on postoperative radiographs were analyzed. Postoperative patient-related outcome measurements (PROMs) (OKS, LEFS, and EQ5D) were evaluated. Statistical significance was assumed for P < .05.

Results: The tibial implant relation to the tibial plateau diameter in the lateral approach was significantly larger than in the medial approach (23.6% vs 22.2%; P < .001). Significantly more deviations >15° regarding flexion position of the femoral implant (P = .002) and a higher number of deviations of the slope was found (P = .06) in the lateral approach. The lateral approach showed a significantly higher rate of lateral positioning of the femoral component (P = .007). Post-PROMs showed significant improvement in both approaches.

Conclusion: The lateral approach is not superior regarding different radiological accuracy criteria. The Hoffa´s fat pad-preserving medial approach showed good results in implantation accuracy and therefore is a good alternative to implant lateral UKA. In addition, significant improvement in PROMs could be demonstrated.

Keywords: PROM; implant positioning; implantation accuracy; lateral UKA; surgical approach.