Medial compartment osteoarthritis of the knee: a review of surgical options

Osteoarthritis of the medial compartment, where the lateral compartment and patella-femoral joint are relatively spared, is a common orthopaedic presentation. Most frequently, the treatment of choice would be a total knee replacement, which involves removing healthy joint surfaces in such patients. Arthroscopic debridement in the osteoarthritic knee has fallen out of favour due to poor clinical results. A trend has developed towards less invasive surgery with uni-compartmental knee replacement (UKR) and high tibial osteotomy (HTO) gaining increasing popularity. Surgeons differ in their relative indications and contraindications to performing these procedures. Total knee replacement (TKR) continues to have the lowest overall revision rate of the available options. Growing evidence demonstrates more favourable patient-reported outcome measures in UKR and HTO patients, compared to TKR. Knee joint distraction (KJD) has been demonstrated as an alternative method of treatment in such patients.