From resection arthroplasty to partial knee replacements – a historical review

Background: Unicompartmental knee arthroplasty (UKA) originated from 18th-century surgical philosophies focused on motion preservation and minimal invasiveness. Historically, the procedure faced significant challenges regarding surgical risk, implant fixation, and clinical competition with realignment osteotomy or total knee arthroplasty.

Objective: This review delineates the chronological evolution of UKA, examining the transition from resection arthroplasty and soft tissue interposition to modern prosthetic designs and refined clinical indications.

Key Points: Early resection techniques by Park and Filkin preceded the scientific subperiosteal approach developed by Ollier. Subsequent developments in the 19th and early 20th centuries focused on realignment osteotomies and interpositional arthroplasty using fascia lata, adipose tissue, or Vitallium plates. The introduction of cemented polycentric implants by Gunston in the 1960s marked the transition to modern prosthetic UKA. Despite initial skepticism from Insall, who prioritized total knee arthroplasty, the development of specific selection criteria by Kozinn and Scott provided a standardized framework for patient selection. The resurgence of UKA was further driven by Marmor’s modular designs and Cartier’s technical refinements. A significant shift occurred with the introduction of the Oxford mobile-bearing prosthesis, which utilized a meniscal bearing to increase contact area and reduce polyethylene wear. Long-term data for mobile-bearing designs demonstrate implant survival rates of approximately 92% at 20 years.

Conclusion: The historical progression of UKA reflects a shift toward conservative, biomechanically informed surgical interventions. Current evidence supports UKA as a safe, reproducible, and effective treatment for isolated single-compartment gonarthrosis when strict selection criteria and precise surgical techniques are employed.