The medial tibiofemoral compartment is the primary load-bearing compartment of the knee, accepting 60-70% of axial load in neutral alignment. Medial compartment OA is the most common form of knee osteoarthritis, producing the varus alignment of the bowlegged knee from medial joint space narrowing. High tibial osteotomy (HTO) unloads the medial compartment by correcting varus alignment; unicompartmental knee arthroplasty replaces only the medial compartment.
Unicompartmental knee arthroplasty (UKA) for isolated medial compartment OA preserves the ACL and normal knee kinematics, providing faster rehabilitation and greater activity than TKA. Patient selection criteria: medial compartment disease only, intact ACL, BMI < 35, correctable varus deformity.
Progressive medial joint space narrowing producing varus alignment managed with HTO for younger active patients and UKA or TKA for older patients.
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