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Introduction
Treatment of limited osteoarthritis of the knee
remains a challenging problem. The therapeutic
goals are to alleviate pain and restore knee
function. Arthroplasty solutions may include
unicompartmental knee arthroplasty (UKA) or
conventional total knee arthroplasty (TKA).
These therapeutic solutions have to be efficient,
durable and safe but should preserve the bone
stock when possible. TKA may offer durable
and satisfying clinical and radiological results
when arthritis is affecting the three compart
ments of the knee, however TKA does not
preserve the bone stock and the ligaments.
UKA is a bone and ligament sparing technique,
which is reliable to restore knee kinematics and
function for arthritis limited to one compartment
of the knee. The outcomes of UKA improved
since its introduction more than 30 years ago
due to improvement in designs, indications,
materials, and surgical techniques [23, 34].
Reported results of UKA are better when the
anterior cruciate ligament is intact. Similarly,
outcome and kinematic studies suggest that
maintaining the anterior cruciate ligament in
bi- and tri-compartmental knee arthroplasty
may be advantageous in terms of survivorship
[10, 21], stair climbing ability, patient satisfac
tion and joint kinematics. Bicomparmental
arthritis of the knee is not rare and bicompart
mental knee arthroplasties have been proposed
to bridge the gap between UKA and TKA.
There is a renewal interest for bicompartmental
knee arthroplasties including association of
medial UKA and femoropatellar arthroplasties.
A smaller implant size, a reduce operative
traumatism, the preservation of both cruciate
ligaments and bone stock, and a more
“physiologic” knee joint are considered advan
tageous over total knee replacement. Interesting
proprioceptive or kinematic studies, and long-
term clinical and radiological studies have been
reported. Considering the renewed interest for
combined compartmental implants (including
association of medial UKA and femoropatellar
arthroplasty we aimed to present in this chapter,
the surgical technique including tip and tricks
of combine UKA and patella-femoral arthro
plasties using two separate implants.
Surgical technique
The first step of a good surgical technique
remains a proper patient selection and a good
indication. The second step is related to the
implant choice and according to our experience
the only way to properly accommodate is to
use two separate implants. We recommend the
use of a fixed-bearing UKAand patella-femoral
implant with an anterior reference including an
anterior cut of the femur. Both implant are
cemented and this is important factor of
Association of a medial
UKAand a Patellofemoral
Arthroplasty: is it possible?
S. Parratte, M. Ollivier,
J.M.Aubaniac, J.N. Argenson