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during the first 2 or 3 weeks according to
patient tolerance and motivation. Exercises are
focusing on immediate active recuperation of
flexion and extension.
Results
Following the report of our early experience of
a bicompartmental arthroplasty and results
from 5 to 23 years showing good clinical
outcomes, with a long-term survivorship lower
than for a TKA, we started a new series of
patient with a new patella-femoral arthroplasty.
Between 2008 and 2010, 22 patients have been
operated for a bicompartmental arthroplasty
using modern UKA and PFJ. The indications
for the procedure were the same than the
indications described early in this chapter. The
mean age of the patient was 61 years-old, and
12 patients were women and 10 were men. A
minimum follow-up of 2-years was required
for this study. Knee Society Function and Knee
scores respectively improved from 54 to 91 and
from 48 to 94 at a minimum follow-up of two
years. Mean pre-operative flexion was 125°
and 130° post-operatively. All patients resumed
their leisure or even sportive activities 3 to
6 months after surgery. All the items of the
KOOS significantly improved post-operatively.
According to the results of the QOL KOOS, 12
out of 22 patients considered their knee as a
forgotten knee. One hunter patient required a
revision for a septic complication following a
untreated bite boar of the leg below the operated
knee, one year and a half after the procedure.
No other complication required revision and at
two years follow-up, patient quality of life
scores were significantly higher than in TKA
patient. The restoration of the lower limb axis
was in all the cases in zone C or 2 according to
the Kennedy classification.
Discussion and
conclusion
Bicompartmentalarthroplastyhasbeenadvocated
as an alternative to TKA for limited arthritis of
the knee to preserve bone stock and restore more
normal kinematics. Due to these potential
advantages over TKA, there is a renewed interest
for combined compartmental implants including
association of medial UKA and femoro-patellar
arthroplasty. Our previously reported long-term
data demonstrated that bicompartmental
arthroplasty can provide reasonable function
restoration of the knee and adequate mechanical
axis restoration of the lower limb for moderate
deformities. Survivorship to revision at 17 years
was lower than those observed for TKAor UKA.
This higher failure rate was probably linked to
different factors: first the use of old generation of
implant without any reliable instrumentation,
second the use of old-generation of resurfacing
patello-femoral implants with very limited
instrumentation. Finally, a third of the patella-
femoral implants used in this series were un-
cemented implants and all of them have been
removed. In fact, catastrophic failure rate have
been observed with the use of cementless implant
for the patellofemoral joint. Based on these
results and our experience concerning the
indications, the implants characteristic, we started
in 2008 a new series with clearly defined
indications and using modern UKA and PFA
cemented implants through a standardized
subvastus approach. The short-term follow-up
outcomes at two years are encouraging. Function
score are comparable to those observed for UKA
with high restoration of function, high flexion
and high patient satisfaction. Of course longer
follow-up is required. Finally, to answer the
initial question: association of a medial UKAand
a patellofemoral arthroplasty: is it possible? The
answer is, yes using a combination of UKA and
PFA is possible with good indication, implant
and surgical technique, short-terms results are
encouraging.