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Preoperative Planning. What I do Before a UKA
193
gauged by single leg weight bearing lateral
x-rays showing no spontaneous tibial
translation. On the other hand, for very elderly
or frail patients for whom a TKR would be an
excessive risk, it might seem reasonable to
offer a UKA for the ACL deficient patient,
taking care not to leave an excessive tibial
slope, which would cause premature
polyethylene wear. Younger patients at least
have the option of either osteotomy with or
without ACL reconstruction.
For the most part, failure of osteotomy (the
most frequently performed of which is a valgus-
inducing tibial osteotomy) rules out the choice
of UKA on account of poor results and poor
functioning of the knee joint. However while
failure of HTO is related to incorrect deformity
correction (usually under-corrected), and when
all other criteria have been met, UKA can be
considered [32]. This remains a soft indication,
and a further osteotomy or indeed a TKR
should also be discussed.
Conclusion
While clinical and radiological screening must
be robust, and must allow appropriate
indications to be identified, it is important to
insist on contribution of the MRI imaging.
Apart from careful examination of the knee
itself, analysis of the patient allows fine-tuning
of the indication for UKA. In any event,
appropriately defined selection criteria should
allow a UKA to be considered not as a random
and temporary solution but one which is
selected as the best performing option and
more often than not, the definitive one.
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