Incidence of Anteromedial Osteoarthritis in Patients Undergoing TKR in a high volume Centre in Indian Population : Time to be prepared for UKA!!

Presenting Author - Deepesh Daultani

Introduction: Unicompartmental knee arthroplasty (UKA) is increasing with advent of less invasive procedures. UKA’s rose by 33% between 1998-2005 compared to only 9% for TKR, but UKA still represented only 8% of all knee arthroplasty done in United States. Despite having clinical algorithms’, radiological criteria the final selection is by visualizing and confirming the findings intraoperatively. There are no studies with intraoperative findings on incidence of isolated anteromedial arthritis(AMOA) in patients undergoing TKA.The purpose was to establish the incidence of AMOA with Acl status at the time of arthroplasty among candidates for TKA.Materials and Methods:Its a prospective study including all primary TKA s performed at 2 centres –Sunshine Hospital , Secunderabad and Maxcure Hospital, Hyderabad between December 2016 and May 2017. Both the centres are high volume arthroplasty centres performing over 3000 TKA s in an year(Performing Second highest joint replacement surgeries in Asia-Pacific Region).Inflammatory arthritis, post traumatic arthritis, previous knee surgeries,HTO and valgus knees were excluded.The study comprised 1373 knees in 1089 patients(805-U/L,284- B/L).Evaluation was documented by 8 senior consultants who perform TKA s regularly on condition of ACL, PCL, MCL, LCL, involvement of tibial compartments, grading of chondromalacia and patellofemoral involvement. We classified the ACL as normal, Linear striations and Damaged/Absent. Medial component of tibia was divided by 2 arbitary lines in 3 equal compartments into Anteromedial, central or Posteromedial.Results: Of the 1089 patients (1373 knees) mean age was 61.68 yrs.51.49%(707) had an intact ACL, 7.72% linear striations, 40.78% had damaged Acl. We found 29.27% of population had isolated AMOA whereas 21.55% had central and 49.16% had PMOA. All patients with AMOA had Grade 3 or Grade 4 chondromalacia. We found as the BMI and AGE increases there is greater incidence of damaged ACL and less of AMOA which is statistically significant. All 29.2% of pts of isolated AMOA had intact ACL but vice versa was not true.Conclusion:Patient dissatisfaction with TKA has been reported at levels of 14 to 39%. More than 50% of patients preferred UKA above TKA. Given the rising number of patients expected to be candidates for knee arthroplasty and the increasing demand by this patient population for less invasive treatments, we believe a significant portion of the TKA patients could benefit from UKA. Approximately 29% of Asian population with OA of knee are ideal candidates for UKA and hence warrants an surgeon to be experienced in UKA with armorium ready for an UKA.