A 67-year-old active male presents with chronic right knee pain that has been worsening over two years. He localises the pain specifically to the medial aspect of the knee. It is worse with walking and going up or down hills.
There is no pain at rest or at night, and no history of locking or instability. He still plays golf and cycles short distances but is unhappy with the ongoing unresolved pain despite maximal non-operative management.
On examination:
- BMI: 26
- Mild varus alignment
- Tenderness over the medial joint line
- Preserved range of motion (0–120°)
- No effusion
- Ligaments are stable
Weight-bearing X-ray shows bone-on-bone medial compartment osteoarthritis, with preserved lateral and patellofemoral compartments.
#1. Which of the following best describes the most appropriate management for this patient?
Results
Correct!
Answer: D – Unicompartmental knee replacement
This patient is an ideal candidate for unicompartmental knee replacement (UKR) because:
- Isolated medial compartment OA
- Bone-on-bone changes
- Intact cruciate ligaments
- Good range of motion
- Low BMI
- Active lifestyle
Total knee replacement (A) is more invasive and unnecessary for isolated disease.
Arthroscopy (B) has limited long-term benefit in established OA.
High tibial osteotomy (C) is generally reserved for younger, active patients with early OA.
Steroid injection (E) may provide temporary relief but does not alter disease progression or address structural deformity.
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