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Review
. 2024;12(8):546-557.
doi: 10.22038/ABJS.2024.61787.3030.

Painful Unicompartmental Knee Arthroplasty: Etiology, Diagnosis and Management

Justin M Walsh, Robert A Burnett, Joseph Serino, Tad L Gerlinger
Review

Painful Unicompartmental Knee Arthroplasty: Etiology, Diagnosis and Management

Justin M Walsh et al. Arch Bone Jt Surg. 2024.

Abstract

Unicompartmental knee arthroplasty (UKA) is an increasingly common procedure. Patients with persistent or new postoperative pain can present a challenge for surgeons to accurately diagnose and treat. The purpose of this study is to provide a comprehensive review of the presentation, diagnosis, and management of the various pathologies contributing to pain after UKA. The most common causes of a painful UKA include aseptic component loosening and progression of osteoarthritis. Both of these conditions may be treated with either revision UKA or conversion to total knee arthroplasty. While technically challenging, these procedures are often associated with favorable outcomes. Other causes of pain after UKA include infection, atraumatic tibial component subsidence, periprosthetic fracture and malalignment. Careful clinical, radiographic, and laboratory evaluation is therefore critical to accurately identify the source of pain and guide appropriate management.

Keywords: Complications after UKA; Knee arthroplasty; Painful UKA; UKA; Unicompartmental knee arthroplasty; Unicondylar knee arthroplasty.

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Conflict of interest statement

None

Figures

Figure 1
Figure 1
Standing anterior-posterior left knee radiographs of the patient described in Case 1. (A) Three weeks after primary medial UKA with well-fixed components. (B) Nine months postoperatively, the patient developed a radiolucent line beneath the tibial component suggestive of loosening. (C) Three weeks after revision of the tibial component with well-fixed components
Figure 2
Figure 2
Standing radiographs of the right knee. Anterior-posterior (A) and lateral (B) views 3 weeks after primary medial UKA. Anterior-posterior (C) and lateral (D) views 7 years postoperatively with medial clear space narrowing and anterior tibial subluxation concerning for polyethylene wear. Radiographs one month following revision UKA with polyethylene exchange (E and F) showing improved medial compartment alignment
Figure 3
Figure 3
Supine radiographs of the left knee. Anterior-posterior (A) and lateral (B) views 1 month after primary medial UKA. Images demonstrate components in proper position with a moderate knee effusion
Figure 4
Figure 4
Flowchart showing the management pathway for the most common causes of painful UKA
See this image and copyright information in PMC

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