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Unicompartmental Knee Arthritis
Unicompartmental Knee Arthroplasty: The Modern Frontier
Foreword Unicompartmental Knee Arthritis
William J. Long, MD, FRCS
W. Norman Scott, MD, FACS
It is our honor and privilege to have this opportunity to address the validity, format, and substance of this symposium. While at first glance the topic of unicompartmental knee arthritis seems “new,” it’s not! The American Academy of Orthopedic Surgeons, via the Instructional Course Lectures, addressed this problem, and its application to the younger population in 1993, 20 years ago. The concern at that time was a developing comfort with total knee arthroplasty (TKA) and the application of TKA to both unicompartmental and tricompartmental arthritis, particularly in the younger population. The problem in the 1990s was that the indication for the technology was ill defined due to the sparsity of outcomes for all of the available treatment modalities. Nonoperative management, medicinal, mechanical, and rehabilitation similarly had limited results on which to indicate certainties of success. As illustrated in this symposium, there is some improvement in the understanding of nonoperative outcomes today and the authors are to be congratulated for illustrating these results. Biological surgical intervention is unquestionably a seductive approach, but with limited short-term results that must be examined critically; with further experience, we hope to see increased durability. Novel techniques, as mentioned in this symposium, will continue to develop and hopefully be monitored via rigid outcome analysis to allow us to develop appropriate indications. Currently, as one can surmise from the enclosed articles, the failures of both biological and nonoperative approaches led orthopedists to consider arthroplasty options for the treatment of unicompartmental arthritis, whether it be isolated to the patellofemoral or tibiofemoral compartments. Understanding and applying surgical techniques, such as intramedullary, extramedullary, image-guided, or rapid prototype technology, as discussed in this symposium in great detail, have enhanced the ability to more accurately position unicompartmental implants. Historically, these procedures did not enjoy the same level of reproducibility as total knee procedures, and there was a disparity Clin Sports Med 33 (2014) xiii–xiv http://dx.doi.org/10.1016/j.csm.2013.06.007 0278-5919/14/$ – see front matter Ó 2014 Published by Elsevier Inc.
sportsmed.theclinics.com
xiv
Foreword
between individual series and registry results with unicompartmental arthroplasty. Surgeons thus had to consider the reproducibility of the procedure when considering their indications and options. With newer techniques, improved implants and components, reasonable indications, and reproducible surgical techniques, as presented here, unicomparmtental replacement results should continue to improve. We would like to congratulate Drs Dunn and Plancher for assembling this panel of leaders in the field of unicompartmental arthritis. The topic is timely, well-organized, and critically assessed. The editors and authors should be proud of their accomplishments. William J. Long, MD, FRCS Insall Scott Kelly Institute New York, NY W. Norman Scott, MD, FACS Insall Scott Kelly Institute New York, NY E-mail addresses: [email protected] (W.J. Long) [email protected] (W.N. Scott)
Foreword Unicompartmental Knee Arthritis
William J. Long, MD, FRCS
W. Norman Scott, MD, FACS
It is our honor and privilege to have this opportunity to address the validity, format, and substance of this symposium. While at first glance the topic of unicompartmental knee arthritis seems “new,” it’s not! The American Academy of Orthopedic Surgeons, via the Instructional Course Lectures, addressed this problem, and its application to the younger population in 1993, 20 years ago. The concern at that time was a developing comfort with total knee arthroplasty (TKA) and the application of TKA to both unicompartmental and tricompartmental arthritis, particularly in the younger population. The problem in the 1990s was that the indication for the technology was ill defined due to the sparsity of outcomes for all of the available treatment modalities. Nonoperative management, medicinal, mechanical, and rehabilitation similarly had limited results on which to indicate certainties of success. As illustrated in this symposium, there is some improvement in the understanding of nonoperative outcomes today and the authors are to be congratulated for illustrating these results. Biological surgical intervention is unquestionably a seductive approach, but with limited short-term results that must be examined critically; with further experience, we hope to see increased durability. Novel techniques, as mentioned in this symposium, will continue to develop and hopefully be monitored via rigid outcome analysis to allow us to develop appropriate indications. Currently, as one can surmise from the enclosed articles, the failures of both biological and nonoperative approaches led orthopedists to consider arthroplasty options for the treatment of unicompartmental arthritis, whether it be isolated to the patellofemoral or tibiofemoral compartments. Understanding and applying surgical techniques, such as intramedullary, extramedullary, image-guided, or rapid prototype technology, as discussed in this symposium in great detail, have enhanced the ability to more accurately position unicompartmental implants. Historically, these procedures did not enjoy the same level of reproducibility as total knee procedures, and there was a disparity Clin Sports Med 33 (2014) xiii–xiv http://dx.doi.org/10.1016/j.csm.2013.06.007 0278-5919/14/$ – see front matter Ó 2014 Published by Elsevier Inc.
sportsmed.theclinics.com
xiv
Foreword
between individual series and registry results with unicompartmental arthroplasty. Surgeons thus had to consider the reproducibility of the procedure when considering their indications and options. With newer techniques, improved implants and components, reasonable indications, and reproducible surgical techniques, as presented here, unicomparmtental replacement results should continue to improve. We would like to congratulate Drs Dunn and Plancher for assembling this panel of leaders in the field of unicompartmental arthritis. The topic is timely, well-organized, and critically assessed. The editors and authors should be proud of their accomplishments. William J. Long, MD, FRCS Insall Scott Kelly Institute New York, NY W. Norman Scott, MD, FACS Insall Scott Kelly Institute New York, NY E-mail addresses: [email protected] (W.J. Long) [email protected] (W.N. Scott)