UKA: Who Gets One, Who Doesn't

Unicondylar knee arthroplasty (UKA) is the best operation for a select group of patients with knee osteoarthritis, according to Mark W. Pagnano, MD, from Mayo Clinic, Rochester, Minnesota.


Speaking at the 6th Annual ICJR Winter Hip & Knee course in Vail, Colorado, Dr. Pagnano said UKA is a reliable procedure that can be quite durable, as long as it is performed well. In his practice, patients have a faster recovery after UKA than after total knee arthroplasty (TKA), they achieve better range of motion, and they are happier.


Patient selection is critical. Dr. Pagnano noted that the ideal UKA candidate is the patient with:

  • Antero-medial osteoarthritis
  • Intact ACL
  • Correctable varus deformity
  • Intact lateral compartment
  • Intact patellofemoral joint
  • Good range of motion

In his practice, Dr. Pagnano sees UKA as an option for patients with isolated medial compartment disease and symptoms confined to the medial joint line.  


This is so important that during the preoperative visit, he wants the patient to specifically point to the medial joint line as the source of pain without prompting from him.


The Effects of Tranexamic Acid on Bleeding in TKA


Bleeding is one of primary reasons for impaired recovery after total knee arthroplasty (TKA) because it can cause:

  • Knee swelling
  • Increased pain
  • Restricted motion
  • Greater risk of wound complications

Tranexamic acid (TXA) is now being used in major joint reconstruction to control bleeding. Is it having the desired effect on bleeding and, by extension, on recovery after TKA?


At the recent ICJR Australia meeting in Sydney, Samuel J. MacDessi, MBBS (Hons), FRACS, FAOA, from Sydney Knee Specialists, sought to answer that question.


First, what is TXA? A synthetic amino acid, TXA is an antifibrinolytic agent that:

  • Saturates the lysine binding sites of plasminogen
  • Inhibits plasminogen from binding to fibrin

So TXA does not act in a "pro-thrombotic" way, but instead inhibits the breakdown of clots.



What's Hot on ICJR's App?

In the second quarter of 2014, thousands of videos from ICJR meetings were downloaded through our app, ICJR Mobile. Hot topics included: 
  • Why I Use a Posterior Approach and Why I Don't Use a Direct Anterior Approach
  • Mini-Posterior THA: Today's Gold Standard
  • Managing Instability in THA
  • Anterolateral Approach to the Hip and How to Make It Extensile
  • A Perfect X-ray but an Unhappy Patient: Expectations and Satisfaction after TKA
If you haven't downloaded ICJR's app for iOS and Android devices, what are you waiting for? It's free for ICJR members!


Treatment Options for Posterior Shoulder Instability      

By T. Bradley Edwards, MD; Benjamin W. Szerlip, DO; and Brent J. Morris, MD


The diagnosis of posterior instability is often delayed or even missed due to the relatively uncommon incidence and vague clinical presentation. Posterior instability incorporates a broad spectrum of pathology that may involve both soft tissue and bony architecture, making surgical management technically challenging.


It is critical for the surgeon to accurately identify the nature of instability, as well as have a clear understanding of the anatomy and biomechanics, to achieve a successful outcome.  


Surgical management for posterior instability, including new arthroscopic techniques, has evolved over the past several years with promising results.



Femoral Revision: What Are the Options?

At the recent ICJR Australia meeting in Sydney, Paul N. Smith, BM BS, FRACS, FAOrthA, reviewed his goals when performing a revision total hip:

  • Achieve an "anatomic" reconstruction
    • Restoration of the hip center of rotation, done largely on the acetabular side
    • Restoration of femoral offset, done on the femoral side
    • Restoration of limb length
  • Achieve a "mechanically sound" construct
    • Good fixation to host bone
  • Ensure a stable reconstruction that does not dislocate

Dr. Smith emphasized the importance of an anatomic reconstruction. Failure to restore "normal" anatomy in a hip arthroplasty has been associated with a higher rate of dislocation, muscle weakness, limping, leg length discrepancy, and impingement, as well as higher risk of early failure due to the increased load on the joint interphases.



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Pan Pacific Orthopaedic Congress

July 16-19, 2014
Hilton Waikoloa Village
Kona (Big Island), Hawaii
2nd Annual OrthoLIVE

September 4-6, 2014
Hotel Del Coronado
San Diego, California

3rd Annual Anterior Hip Course

September 18-20, 2014
Houston, Texas

3rd Annual Las Vegas Shoulder Course

September 18-20, 2014
The Cosmopolitan
Las Vegas, Nevada

ICJR Transatlantic Orthopaedic Congress

October 3-5, 2014
Sheraton New York Times Square Hotel
New York, New York

The David A. McQueen Memorial 22nd Annual Perspectives in Total Joint Arthroplasty: Updates in Knee Replacement

October 9-11, 2014
Flint Oak
Fall River, Kansas

ICJR Egypt

September 10-11, 2014
Mariott El Zamalek Hotel
Cairo, Egypt

ICJR Japan

January 16-17, 2015
Congr�s Convention Center
Osaka, Japan